CV 2 Flashcards
only drug that can be used for immediate relief of acute angina
Nitroglycerin
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
adverse effects of Nitrates
CNS - HA, syncope, flushed feeling, dizziness, weakness
CV - hypotension/orthostatic hypotension, reflex tachycardia
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
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
Labs for bleeding and clotting times
PT
INR
aPTT
What are the 2 classes of antithrombotic drugs?
antiplatelet drugs
anticoagulant drugs
what do anti platelet drugs do?
prevent platelets from clumping and also prevent clots from forming and growing
what do anticoagulant drugs do?
slow down clotting time –> reducing fibrin formation and preventing clots from forming and growing
What drugs are anticoagulants?
Heparin
Lovenox (LMWH)
Warfarin (Coumadin)
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
heparin warnings
use cautiously in patients at high risk of bleeding
contraindicated in patients with thrombocytopenia
What is the antidote to heparin?
protamine sulfate
give immediately and lasts for 2 hours, then more may need to be administered
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)
Low Weight Molecular Heparin drugs
Enoxaparin (Lovenox)
Dalteparin (Fragmin)
adverse affects of LMWH
bleeding
severe neurological injury if patient has spinal puncture or epidural
induced thrombocytopenia
Adverse effects of warfarin
bleeding hematuria epistaxis ecchymosis tarry stool bleeding gums leukopenia hypersensitivity GI upset - diarrhea, N/V
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
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
