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Pharmacology Exam 3 > CV 2 > Flashcards

CV 2 Flashcards

1
Q

only drug that can be used for immediate relief of acute angina

A

Nitroglycerin

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2
Q

Actions of nitroglycerin

A

decrease oxygen demand

decrease preload by dilating veins

higher doses - dilates all major systemic arteries which decreases afterload

with variant angina - relaxes or prevent spasm in coronary arteries - increases oxygen supply, not decreasing oxygen demand

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3
Q

adverse effects of Nitrates

A

CNS - HA, syncope, flushed feeling, dizziness, weakness

CV - hypotension/orthostatic hypotension, reflex tachycardia

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4
Q

warnings with nitrates

A

contraindicated in patients with head trauma and cases of increased ICP or cerebral hemorrhage

avoid ETOH

careful when taking other meds that can decrease BP (beta blockers, CCB, diuretics)

contraindicated - PDE 5 inhibitors - life threatening hypotension

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5
Q

patient teaching with nitrates

A

take nitroglycerin at first sign of anginal attack

nitrates are not habit forming but tolerance can develop

lie/sit down when taking to prevent fall

dizziness from decreased preload may occur if 3 tabs taken at 5 min intervals

to prevent angina, take 1 dose 5-10 min before stressful physical activity

have a home BP cuff, rise slowly if orthostatic hypotension occurs

be compliant with medication even if you experience HA

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6
Q

Labs for bleeding and clotting times

A

PT
INR
aPTT

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7
Q

What are the 2 classes of antithrombotic drugs?

A

antiplatelet drugs

anticoagulant drugs

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8
Q

what do anti platelet drugs do?

A

prevent platelets from clumping and also prevent clots from forming and growing

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9
Q

what do anticoagulant drugs do?

A

slow down clotting time –> reducing fibrin formation and preventing clots from forming and growing

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10
Q

What drugs are anticoagulants?

A

Heparin
Lovenox (LMWH)
Warfarin (Coumadin)

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11
Q

Adverse effects of heparin

A

increased bleeding

spinal/epidural hematoma

heparin induced thrombocytopenia: 50% reduction in platelets from baseline within 5-10 days after exposure to heparin –> thrombosis - treatment involves discontinuation of all heparin products

hypersensitivity rxns - extracted from animal tissue

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12
Q

heparin warnings

A

use cautiously in patients at high risk of bleeding

contraindicated in patients with thrombocytopenia

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13
Q

What is the antidote to heparin?

A

protamine sulfate

give immediately and lasts for 2 hours, then more may need to be administered

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14
Q

nursing implications for heparin

A

assess for bleeding in urine, stool, venipuncture sites, nose, gums, wounds/incisions

monitor PTT - should be 1.5-2.5x the control for therapeutic effects

monitor MAR for drug interactions (ASA)

monitor CBC (platelets)

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15
Q

Low Weight Molecular Heparin drugs

A

Enoxaparin (Lovenox)

Dalteparin (Fragmin)

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16
Q

adverse affects of LMWH

A

bleeding

severe neurological injury if patient has spinal puncture or epidural

induced thrombocytopenia

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17
Q

Adverse effects of warfarin

A 
bleeding
hematuria
epistaxis
ecchymosis
tarry stool
bleeding gums
leukopenia
hypersensitivity
GI upset - diarrhea, N/V
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18
Q

Warfarin patient teaching

A

stop warfarin 5 daa\ys prior to surgery

stick to either generic or trade, do not switch

protect self from excessive bruising/cuts - use electric razor, soft toothbrush

consult HCP before taking OTC drugs (ASA, NSAIDS)

avoid ASA

report any bruising, pink urine, tarry stool

take bleeding precautions 9-10 days after last dose of drug

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19
Q

warfarin antidote

A

VITAMIN K

20
Q

Warfarin Labs ranges
PT:
INR:

A

PT: normal=11-13, therapeutic=15.5-35

INR: normal=0.8-1.1, therapeutic=2-3

if INR is below target –> need drug increase

if INR is above target –> need drug decrease

21
Q

warfarin - frequency of labs

A

1st 5 days: daily
next 1-2 weeks: 2x/week
next 1-2 months: 1x/week
after that: every 2-4 weeks

22
Q

what does a thrombolytic agent do?

A

dissolves clot by converting plasminogen to plasmin which lysis the thrombi and fibrinogen

23
Q

warnings with thrombolytic agents

A

increased tendency to bleed with any drug that alters coagulation or platelets

contraindicated in hemophilia, hemorrhagic strokes, uncontrolled HTN, GI ulcers

24
Q

Statins/HMG-CoA reductase inhibitors MOA

A

decrease rate of cholesterol production by inhibiting HMG-CoA reductase - live requires it to produce cholesterol

25
Q

adverse effects of statins

A

GI: dyspepsia, flatulence, constipation, abd cramps

Myopathy: soreness, weakness, increase CPK levels

hepatotoxicity

rhabdomyolysis –> acute renal failure

pregnancy category X

26
Q

Bile sequestering agents MOA

A

form insoluble complexes with the bile acids in the GI tract –> cholesterol replaces lost bile acids –> lowering cholesterol level

27
Q

bile sequestering drugs

A

Cholestyramine (Question)

Colestipol hydrochloride (Colestid)

Colesevelam

28
Q

bile sequestering agents adverse effects

A

GI: constipation, abd pain, nausea, diarrhea

vitamin deficiency - A, D, E, K

29
Q

bile sequestering agents patient teaching

A

mix powder in liquid or food to reduce esophageal irritation

remain upright for 30 min to reduce esophageal irritation

take other meds 1 hr before/4hrs after

30
Q

Fibric Acid Derivatives drugs

A

Genfibrozil (Lopid)

Fenofibrate (Lipidil)

31
Q

fabric acid derivatives MOA

A

activate lipoprotein lipase, an enzyme responsible for break down of cholesterol

suppresses the release of free fatty acids from adipose tissue

inhibit synthesis of triglycerides in the liver

increases secretion of cholesterol into bile

32
Q

adverse effects of fabric acid derivatives

A 
GI: N/V, diarrhea
Cholelithiasis
benign and malignant liver tumors
enhances effects of warfarin
enhances effects of statins-myopathy
33
Q

Niacin MOA

A

thought to work in the liver and adipose tissue to inhibit the synthesis of triglycerides –> decrease VLDL, can lower LDL

34
Q

niacin adverse effects

A 
flushing
itching
hepatotoxic
hyperglycemia
hyperuricemia
gouty arthritis
35
Q

niacin patient teaching

A

advise niacin along with diet and exercise

take with meal

minimize flush with ASA 325 mg 30 min prior to med - can cause increase in glucose and uric acid

36
Q

amiodarone MOA

A

blocks K+ channels which delay repolarization –> prolongs action potential duration

reduces automaticity in SA node

reduced contractility and conduction velocity in AV node, ventricles

37
Q

amiodarone uses

A

dysrhythmias that are difficult to treat

life threatening ventricular tachycardia or fibrillation, atrial fibrillation, or flutter that is resistant to other drugs

38
Q

amiodarone adverse effects

may not show up for weeks -months

A

CNS: malaise, fatigue, dizziness, tremors, ataxia, paresthesia, lack of coordination

CV: cardiac arrhythmias, cardiac arrest, hypotension

EENT: photophobia, dry eyes, halos, blurred vision, permanent blindness

endocrine: thyroid toxicity –> hypothyroidism or hyperthyroidism

GI: N/V, anorexia, constipation, abnormal LFT, hepatotoxicity

respiratory: pulmonary toxicity - pneumonitis, infiltrates

angioedema, photosensitivity

39
Q

digoxin MOA

A

increases myocardial contractility by promoting calcium accumulation within the myocytes

40
Q

digoxin uses

A

chronic atrial fibrillation

2nd line therapy for heart failure

41
Q

digoxin adverse effects

A

cardiac dysrhythmias (esp with hypokalemia)

anorexia
N/V
visual disturbances - blurred vision, yellow vision, halos

42
Q

relationship between K+ and digoxin

A

hypokalemia –> digoxin toxicity
digoxin toxicity –> hyperkalemia (esp in renal failure patients)

ACE inhibitors known to increase K+ –> decreased efficacy of digoxin

43
Q

digoxin antidote

A

digoxin immune fab (digibind)

44
Q

lidocaine adverse effects

A

drowsiness, dizziness, hypotension, bradycardia

45
Q

lidocaine toxicity

A 
CNS excitation
blurred/double vision
N/V
tinnitus
severe bradycardia
twitching
seizures
tremors
46
Q

therapeutic ranges of
lidocaine
digoxin

A

lidocaine: 1.5-5 mcg/ml
digoxin: 0.5-0.8 ng/ml

Pharmacology Exam 3 (4 decks)

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