CV 2 Flashcards by Christine Lee

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

Nitroglycerin

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Actions of nitroglycerin

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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adverse effects of Nitrates

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

CV - hypotension/orthostatic hypotension, reflex tachycardia

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warnings with nitrates

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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patient teaching with nitrates

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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Labs for bleeding and clotting times

PT
INR
aPTT

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What are the 2 classes of antithrombotic drugs?

antiplatelet drugs

anticoagulant drugs

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what do anti platelet drugs do?

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

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what do anticoagulant drugs do?

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

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What drugs are anticoagulants?

Heparin
Lovenox (LMWH)
Warfarin (Coumadin)

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Adverse effects of heparin

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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heparin warnings

use cautiously in patients at high risk of bleeding

contraindicated in patients with thrombocytopenia

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What is the antidote to heparin?

protamine sulfate

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

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nursing implications for heparin

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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Low Weight Molecular Heparin drugs

Enoxaparin (Lovenox)

Dalteparin (Fragmin)

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adverse affects of LMWH

bleeding

severe neurological injury if patient has spinal puncture or epidural

induced thrombocytopenia

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Adverse effects of warfarin

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

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Warfarin patient teaching

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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warfarin antidote

VITAMIN K

Warfarin Labs ranges
PT:
INR:

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

warfarin - frequency of labs

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

what does a thrombolytic agent do?

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

warnings with thrombolytic agents

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

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

Statins/HMG-CoA reductase inhibitors MOA

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

adverse effects of statins

GI: dyspepsia, flatulence, constipation, abd cramps Myopathy: soreness, weakness, increase CPK levels hepatotoxicity rhabdomyolysis --> acute renal failure pregnancy category X

Bile sequestering agents MOA

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

bile sequestering drugs

Cholestyramine (Question) Colestipol hydrochloride (Colestid) Colesevelam

bile sequestering agents adverse effects

GI: constipation, abd pain, nausea, diarrhea vitamin deficiency - A, D, E, K

bile sequestering agents patient teaching

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

Fibric Acid Derivatives drugs

Genfibrozil (Lopid) | Fenofibrate (Lipidil)

fabric acid derivatives MOA

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

adverse effects of fabric acid derivatives

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

Niacin MOA

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

niacin adverse effects

``` flushing itching hepatotoxic hyperglycemia hyperuricemia gouty arthritis ```

niacin patient teaching

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

amiodarone MOA

blocks K+ channels which delay repolarization --> prolongs action potential duration reduces automaticity in SA node reduced contractility and conduction velocity in AV node, ventricles

amiodarone uses

dysrhythmias that are difficult to treat life threatening ventricular tachycardia or fibrillation, atrial fibrillation, or flutter that is resistant to other drugs

amiodarone adverse effects | may not show up for weeks -months

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

digoxin MOA

increases myocardial contractility by promoting calcium accumulation within the myocytes

digoxin uses

chronic atrial fibrillation | 2nd line therapy for heart failure

digoxin adverse effects

cardiac dysrhythmias (esp with hypokalemia) anorexia N/V visual disturbances - blurred vision, yellow vision, halos

relationship between K+ and digoxin

hypokalemia --> digoxin toxicity digoxin toxicity --> hyperkalemia (esp in renal failure patients) ACE inhibitors known to increase K+ --> decreased efficacy of digoxin

digoxin antidote

digoxin immune fab (digibind)

lidocaine adverse effects

drowsiness, dizziness, hypotension, bradycardia

lidocaine toxicity

``` CNS excitation blurred/double vision N/V tinnitus severe bradycardia twitching seizures tremors ```

therapeutic ranges of lidocaine digoxin

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