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Pharm > CV drugs part 2 > Flashcards

CV drugs part 2 Flashcards

1
Q

What is angina pectoris?

A

Chest pain from lack of oxygenated blood supply to the heart- insufficient blood flow to heart

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2
Q

How do nitrates relieve angina?

They ____ the vessels to allow..

They _______ both ____ and _____

Results?

A

They dilate the vessels to allow for more blood flow/o2 flow.

Decrease preload and afterload -

Results:
increase o2, decrease o2 demand.

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3
Q

Nitroglycerin (nitrates): how to treat acute anginal attack?

A

Fast acting, SL or IV nitrates

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4
Q

Something important about Nitroglycerin/ NTGs/ Nitrates:

A

NTG is the first line treatment for acute/immediate angina

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5
Q

Use for sublingual NTGs

A

Used to trat acute anginal attacks

o Sublingual (SL), spray, intravenous (IV)

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6
Q

Proper administration for sublingual NTG:

A

Place one sublingual (SL) nitroglycerin under the tongue every 5 minutes for a maximum dose of three (3) tablets

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7
Q

Pt. teaching for sublingual NTG

A
  • Tell the patient, “If chest pain not improved after 1 dose, call 911”
  • Tell patient they will experience a tingling/burning feeling under their tongue
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8
Q

3 nursing considerations for sublingual NTGs

A

-Tablets are in an airtight, dark colored glass bottle – away from light, heat, moisture

-Sit or lie patient down and take medication to prevent orthostatic hypotension

-Keep a fresh bottle of SL nitroglycerin, because drug is only stable for 3 to 6 months

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9
Q

Review the use of nitroglycerin transdermal patch and ointments.

What area will you use?

A

Use a hairless area of the upper arms or body, rotate sites

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10
Q

When should you remove the nitroglycerin patch?

A
  • Tolerance develops with continuous use of transdermal patches/ointments. To decrease tolerance, remove at night to allow 8 hours without patch
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11
Q

For NTG patches, you want to apply it…

Wear the NTG patch for ___ hours

When do you remove the patch?

A
  • Apply once a day, wear for 12 hours; remove after wearing for 12-14 hours a day
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12
Q

How to apply NTG patch?

A

Squeeze the prescribed amount of ointment onto the paper & apply to the skin without rubbing. Tape the paper in place.

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13
Q

Why do we wear gloves when applying a NTG patch

A

Use gloves to avoid getting ointment on hands (vasodilation, ↓BP)

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14
Q

What is nitrates free period, how long, and why?

A

-Nitrate free period is a time frame where patients take a break from the medication. They need to take a break from the medication for 8-12 hours, so tolerance does not develop. Tolerance (a person’s diminished response to a drug) can develop with continuous use of transdermal patches/ointments.
- Generally, we apply the patch once a day in the morning.
Patients wear the patch for 12 hours and we remove the patch before they go to bed, so they take a break from the medication.

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15
Q

How to treat headaches from NTG?

How does NTG affect BP?

A

Headaches can be managed with acetaminophen.

NTG decreases BP (hypotension)

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16
Q

MOA of nitrates

A

Dilate (widens) veins and arteries causing smooth muscle relaxation. This decreases preload and afterload.

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17
Q

Adverse effects of nitrates

A
  • CNS – headaches (expected), syncope, flushed feeling, dizziness, weakness
  • CV – hypotension; reflex tachycardia
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18
Q

2 contraindications of nitrates

Why? (for first one)

A
  • Contraindicated: phosphodiesterase type 5 inhibitors (sildenafil [Viagra])
  • Why? It can cause life-threatening hypotension
  • Contraindicated in patients with head trauma and intracranial bleeding
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19
Q

Pt teaching for nitrates

A
  • Careful when taking other medications that can decrease BP
  • Avoid alcohol while using
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20
Q

Rapid acting forms of nitrates

A
  • Used to treat acute anginal attacks
  • Sublingual (SL), spray, intravenous (IV)
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21
Q

Long acting forms of nitrates

A

For chronic angina

o Used to prevent anginal attacks
o PO (extended-release), transdermal

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22
Q

Pt teaching with long-acting forms

A
  • Nitrates are not habit-forming, but tolerance may develop
  • Have a home monitor BP cuff; rise slowly
  • If patient has nitro patch and experiences sudden/acute chest pain, take SL nitro and monitor vital signs (esp. BP and heart rate)
  • Be compliant with medication even if experience headaches
  • Nursing: can give acetaminophen
  • If needs to discontinue, will need to do so slowly to prevent rebound angina
  • Remind patients that taking a long-acting NTG preparation should not keep them from using SL or spray nitroglycerin if chest pain develops.
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23
Q

How to evaluate the effectiveness of nitrates?

A

If the patient reports a relief of chest pain

We evaluate the effectiveness of nitrates by asking the patients about the chest pain and evaluating their vital signs. The pain level should be 0/10 and vital signs should be stable (BP not low/pulse not high).

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24
Q

Antiplatelet drugs

A

Aspirin
Clopidogrel (Plavix)
Prasugrel (Effient)

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25
Q

What do antiplatelets do

A

Decreases platelet aggregation & inhibits thrombus formation

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26
Q

Anticoagulant drugs

A
  • Heparin
  • Warfin
  • Enoxaparin

New anticoagulant drugs:
* Rivaroxaban (Xarelto) PO
* Apixaban (Eliquis) PO
* Fondaparinux (Arixtra) SQ
* Dabigatram (Pradaxa), PO

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27
Q

What do anticoagulants do

A

Inhibit certain clotting factors- NO direct effect on a blood clot that’s already formed

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28
Q

Thrombolytic drugs

A

Drugs (IV infusion):
* Alteplase (tPA)
* Streptokinase
* Tenecteplase
* Reteplase
* Urokinase
* Anistreplase

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29
Q

What type of drug is clopidogrel?

A

Antiplatelet

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30
Q

Contraindications of Clopidogrel

A

Contraindicated in bleeding disorders (peptic ulcer, hemorrhagic stroke)

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31
Q
  • Due to the increased risk of bleeding from decreased platelet aggregation, clopidogrel should be withheld…
A

5 days before elective surgery to decrease the risk of hemorrhage during surgery.

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32
Q

Indications for use of anticoagulants

A

Uses:
o Stroke, atrial fibrillation
o Myocardial infarction (MI)
o Deep vein thrombosis (DVT)
o Pulmonary embolism (PE)
o Mechanical heart valves

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33
Q

When is it appropriate to use _______ ______ as an antidote for heparin?

A

protamine sulfate-

If aPTT gets too long

(means they are taking too long to clot. we still want them to clot, but not hemorrhaging)

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34
Q

Adverse effects of heparin

A

o Monitor for hemorrhage (hematuria, epistaxis, ecchymosis, petechiae, melena, black/tarry stools, bleeding gums)
o Allergic reaction may occur heparin-induced thrombocytopenia (HIT) (an antibody-mediated reaction characterized by a profound decrease in platelets; potentially life-threatening and can cause thrombosis; monitor CBC esp. platelets levels)
o Platelet levels
should be monitored. Medication stopped for platelet levels <100,000/mm3

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35
Q

What is used to treat heparin-induced thrombocytopenia (HIT)

A

Argatroban

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36
Q

Monitor therapeutic effects for heparin:

A

o Requires frequent monitoring of activated partial thromboplastin time (aPTT) levels, measures how long it takes blood to clot

o Goal: aPTT between 1.5 – 2.5 times normal control level

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37
Q

How long should aPTT be on heparin?

If it’s too long, what is an antidote

A

APTT should be 60-80 seconds while on heparin

Antidote: effects reversed by IV protamine sulfate, if aPTT gets too long

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38
Q

Nursing implications for heparin:

A
  • Assess for bleeding (urine, stool, venipuncture sites, nose, gums, wounds/incisions)
  • Rotate sites for SQ & do not rub the injection site; use abdomen for SQ route; assess for IV site reactions (pain, bruising, redness)
  • Monitor aPTT, which should be 1.5 to 2.5 times the normal range for a therapeutic effect and monitor platelet levels
  • Use caution in patients with recent spinal surgery, epidural or spinal catheters
  • Use caution with other medications that promote bleeding
    (NSAIDs, aspirin, warfarin, ginkgo)
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39
Q

Enoxaparin is what type of drug

A

Anticoagulant

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40
Q

What is the use of Enoxaparin

A

Prevents DVT

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41
Q

Pt teaching for enoxaparin

A
  • Do not need to monitor aPTT, but need to monitor platelet count (CBC) due to risk of thrombocytopenia
  • Adverse effect: bleeding – can use protamine sulfate as antidote
  • Given subcutaneously (SQ) – rotate sites
  • Patient may be instructed for home administration
  • Bleeding precautions – use caution in patients with recent spinal surgery, epidural or spinal catheters
  • Use caution with other medications that promote bleeding (NSAIDs, aspirin, warfarin, ginkgo)
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42
Q

Adverse effects of warfarin

A

Bleeding, hemorrhage, melena

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43
Q

Lab monitoring values of warfarin

A
  • Requires frequent monitoring of PT/INR (international normalized ratio); PT should be 1.5 times the reference value. INR target is 2.0 to 3.0.
  • If PT is > 2.5 times the reference value, or INR > 4.0, the person will have bleeding tendencies. if its too high, at risk for bleeding. Too low - can form clots. Need to be in this range. WE ARE STOPPPING IF THE LEVELS ARENT OPTIMAL
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44
Q

What is the antidote of warfarin (if toxicity/hemorrhage occures)

A

Vitamin K

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45
Q

Nursing implications of warfarin

A
  • Given orally only – take exactly as prescribed at same time daily
  • Uses: in patients at risk for blood clots; takes 3-5 days for full effect; heparin is continued to prevent clots until PT/INR levels indicate therapeutic effect
  • Maintain consistent amount of vitamin K foods: leafy green vegetables – kale, spinach, collard green (do not increase or decrease)
  • Alcohol can affect how warfarin works and increase risk of bleeding
  • Monitor PT-INR regularly—keep follow-up appointments

Potential drug interactions—there are many! Warfarin interacts with many antibiotics and antifungal medications & increase the risk of bleeding.

  • Use caution with other medication that promote bleeding (aspirin, NSAIDs, ginkgo); contraindicated in bleeding disorders
  • Take exactly as prescribed
  • Avoid in pregnancy or breastfeeding (Pregnancy D)
46
Q

List interventions to protect patients from anticoagulant-induced bleeding

A
  • Avoid other medications/herbals that promote bleeding (aspirin/NSAIDs, ginkgo biloba, garlic)
  • Avoid IM injections and unnecessary venipuncture
  • Use soft toothbrush and electric razor because this can be less likely to cause cuts
  • Avoid going barefoot, especially outside
  • Place patients on fall precautions
  • Instruct patient to avoid straining
  • Wear medical alert bracelets
  • Eat a consistent amount of vitamin K foods if taking warfarin
  • Monitor labs regularly; keep follow-up appointments
47
Q

Use of thrombolytic (fibrinolytic) drugs

A

Uses: dissolving clots in stroke, MI, PE, DVT

48
Q

Adverse effects of thrombolytic (fibrinolytic) drugs

A

BLEEDING (if they are bleeding we hold the med)

  • Nausea, vomiting, hypotension
  • Cardiac dysrhythmias
49
Q

Contraindications of thrombolytic drugs

A
  • Internal bleeding
  • Severe uncontrolled hypertension
  • Recent trauma
  • Pregnancy
50
Q

Nursing implications of thrombolytic drugs

Monitor and observe for..

A
  • Monitor IV sites for bleeding, redness, pain
  • Monitor for bleeding from gums, mucous membranes, nose, injection sites
  • Observe for signs of internal bleeding (decreased BP, restlessness, weak peripheral pulses, confusion, abdominal/back pain)
51
Q

 Know the effects of ginkgo biloba with anticoagulants and NSAIDs

A

Listed above- Use caution with other medications that promote bleeding (NSAIDs, aspirin, warfarin, ginkgo) The effect is that it increases the risk of bleeding in patients taking NSAIDs, antiplatelets, and anticoagulants

52
Q

Drug names of HMG-CoA inhibitors

A

-statin

53
Q

Adverse effects/warnings/labs for patients on HMG-CoA reductase inhibitors (statins)

A
  • Myopathy: report muscle pain or tenderness, check creatine kinase/creatine phosphokinase (CPK) levels, may be 
  • Rhabdomyolysis (rare, but fatal) – breakdown of skeletal muscle fibers causing myoglobin to be release into the blood stream, can lead to kidney damage
  • Hepatotoxicity: check liver enzymes every 6 months; may be , jaundice
  • Report muscle pain, persistent GI upset – vomiting, constipation, abnormal bleeding.
  • Category X for pregnancy: not for pregnant women, alcoholic, or viral hepatitis
54
Q

Pt teaching for patients on HMG-CoA reductase inhibitors (statins)

A
  • Statins-most effective when taken at evening meal/bedtime
  • Eat high fiber diet; avoid foods high in fat or cholesterol
  • It takes 6 to 8 weeks to see a change in cholesterol levels
55
Q

Diet teaching for patients taking statins

A

Decrease fat in the diet and increase fiber

56
Q

Recognize names of bile acid sequestrants

A

Prefex is chole or cole

o cholestyramine (Questran)
o colesevelam (Welchol)
o colestipol (Colestid)

57
Q

Adverse effects for bile acid sequestrants

A

o Constipation (need to increase fiber intake)
o Heartburn, nausea, belching, bloating (disappear over time)

58
Q

Nursing implications for bile acid sequestrants

What to asses for?

A

o Assess for GI distress, bowel habits, vitamin K deficiency; may need vitamin supplementation

59
Q

Nursing implications for bile acid sequestrants:

May…

Powder forms must be taken with at least..

A

o May bind with other drugs (advise to take other meds 1 hour before or 6 hours after)
o Powder forms must be taken with at least 4 to 6 ounces of liquid or fruits (applesauce), mixed thoroughly, and never taken dry

60
Q

Recognize names of fibrates or fibric acid derivates

A

o Fenofibrate (Tricor)
o Gemfibrozil (Lopid)
o Fenofibric acid

61
Q

Use of fibrates or fibric acid derivatives

A

o Lower triglyceride levels; increase HDLs

62
Q

Adverse effects of fibrates or fibric acid derivatives

A
  • GI: nausea, diarrhea, abdominal discomfort
  • Increased risk of gallstones (right upper quadrant abdominal pain)
  • Increased risk of myopathy, rhabdomyolysis when combined with statins
  • Increased risk of bleeding when combined with warfarin
63
Q

Warnings of fibrates or fibric acid derivatives
contraindication

A
  • Contraindicated for patients with gallbladder disease and liver disease

Monitor: Liver function, assess for history of gallstones

64
Q

Nicotinic acid or Niacin therapy is :

A

Vitamin B3

65
Q

Side effect of vitamin B3 (Niacin therapy)

A

o Flushing of face and neck, lasting up to an hour (minimize flushing w/aspirin or NSAIDs 30 minutes prior) <- Patient teaching

o GI distress (take with meals to avoid GI irritation) <- Patient teaching

66
Q

Adverse effects of vitamin B3 (Niacin therapy)

A

o Hepatotoxicity (jaundice, clay-colored stools; dark urine), hyperglycemia, hyperuricemia, orthostatic hypotension

67
Q

Nursing implications for vitamin B3 (Niacin therapy)

A

Monitor for jaundice, clay-colored stools, & dark urine

68
Q

Recognize names and mechanism of action of HMG-CoA reductase inhibitors

A

Suffix: -statins

MOA: decrease the amount of cholesterol that is made by HMG CoA reductase in the liver.

(decrease the rate of cholesterol production by inhibiting HMG-CoA reductase. The liver requires HMG-CoA reductase to produce cholesterol)

69
Q

Adverse effects for patients on HMG-CoA reductase inhibitors (statins)

A

Myopathy/ and or rhabdomyolysis (break down of muscle)- LIFE THREATENING, hepatotoxicity

70
Q

Warnings with HMG-CoA reductase inhibitors (statins)

A

Category X for pregnancy: not for pregnant women, alcoholic, or viral hepatitis

71
Q

Pt teaching for HMG-CoA reductase inhibitors (statins)

A

Report muscle pain, persistent GI upset – vomiting, constipation, abnormal bleeding

Take at bedtime/evening meal (most effective then)

72
Q

With HMG-CoA reductase inhibitors (statins), it takes

A

6-8 weeks to see a change in cholesterol levels

73
Q

Diet teaching for patients take statins

A

Eat high fiber diet; avoid foods high in fat or cholesterol

74
Q

Labs to monitor w statins

A

Creatine, LFTs

75
Q

Recognize names of bile acid sequestrants

A

Prefix: chole-

cholestyramine, colesevelam, colestipol

76
Q

Adverse effects of bile acid sequestrants

A

Constipation, heartburn, nausea, belching, bloating

77
Q

Nursing implications of bile acid sequestrants (3)

Assess for..

May..

Powder forms must..

A

Nursing Implications:

  • Assess for GI distress, bowel habits, vitamin K deficiency; may need vitamin
    supplementation
  • May bind with other drugs (advise to take other meds 1 hour before or 6
    hours after)
  • Powder forms must be taken with at least 4 to 6 ounces of liquid or fruits
    (applesauce), mixed thoroughly, and never taken dry
78
Q

Recognize the names of fibrates or fibric acid derivates

A

Drugs:
* Fenofibrate (Tricor)
* Gemfibrozil (Lopid)
* Fenofibric acid

79
Q

Main use of fibrates or fibric acid derivates

A

Lower triglycerides and increase HDLs

80
Q

Adverse effects of fibrates or fibric acid derivates

A
  • GI: nausea, diarrhea, abdominal discomfort
  • Increased risk of gallstones (right upper quadrant abdominal pain)
  • Increased risk of myopathy, rhabdomyolysis when combined with statins
  • Increased risk of bleeding when combined with warfarin
81
Q

Fibrates are..

A

Contraindicated for patients with gallbladder disease and liver disease

82
Q

Pt teaching with Niacin (B3) therapy

A

Tell them they can minimize flushing w/aspirin or NSAIDs 30 minutes prior to taking it

Tell them they can take w meals to avoid GI irritation

83
Q

Antidysrhythmic drugs are broken into

A

4 classes

Class 1 is broken into 1a, 1b, 1c

84
Q

Antidysrhythmic drugs: Class 1A drugs

A

quinidine, procainamide

85
Q

Class 1 (1a,1b,1c) are..

A

Sodium channel blockers

86
Q

Quinidine adverse effects

A
  • Cinchonism (tinnitus, headache, nausea, vertigo), thrombocytopenia
  • Cardiotoxic – hypotension, high doses – QT prolongation, heart block
  • GI: Diarrhea (common)
87
Q

Class 1b drugs

A

Lidocaine and Phenytoin

88
Q

Side effects of lidocaine

A
  • CNS toxic effects: twitching, seizures (convulsions), confusion
  • Must continuously monitor BP and cardiac rhythm (ECG)
89
Q

Lidocaine may be used with a..

A

Patch (neuropathic pain) or throat spray and injections (local anesthesia)

-If used to anesthetize the throat- check for gag reflect: NPO until gag reflex returns

90
Q

Class IC drug

A

Flecainide

91
Q

Class IC: Flecainide side effects

A

Side effects: dizziness, visual disturbances, dyspnea (shortness of breath)

92
Q

Black box warning of flecainide

A

Proarrhythmic, increased mortality in patients with non life threatening ventricular dysrhythmias

93
Q

Class 2 drugs are

A

beta blockers

94
Q

Already covered beta blockers, but remind me of something to be cautious about

A
  • Caution: Diabetes – BBs slow down the heart rate and mask signs/symptoms of hypoglycemia
  • Abrupt withdrawal of a beta-blocking drug can cause rebound hypertension.
95
Q

Class 3 drugs are considered what type of channel blockers?

What drug does it classify?

A

Potassium Channel Blockers

Amiodarone

96
Q

Use of amiodarone

A

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

97
Q

Generally, what is the purpose of antidysrhythmic drugs

A

trying to restore the normal conductivity of the heart so it beats regularly.

98
Q

Amiodarone has MANY adverse effects- list them :(

A

Pulmonary toxicity (dyspnea – shortness of breath, cough, fibrosis), careful respiratory assessment, chest x-ray

  • Thyroid toxicity: hypothyroidism or hyperthyroidism (monitor thyroid function)
  • Hepatotoxicity (monitor LFTs, constipation, GI upset)
  • Corneal microdeposits(visual halos, photophobia, dry eyes); eye exams
  • Photosensitivity; alteration in skin color (bluish) if prolonged sun exposure
  • Dysrhythmias (monitor ECG, QT prolongation)
  • Hypotension, bradycardia (monitor BP & pulse closely)
  • Neurologic: abnormal gait, changes in mood, hallucinations; supervision
99
Q

Class IV is what type of blocker

A

Calcium channel blocker

100
Q

Remind me of the drugs and adverse effects of Class IV calcium channel blockers

A

verapamil (Calan), diltiazem (Cardizem)

  • Adverse effects: dizziness, hypotension, bradycardia, edema, heart block, constipation
101
Q

Pt teaching for amiodarone

A

wear sunglasses, visit your eye doctor and use sunscreen, report if BP is low, or if HR is low <60.

DO NOT TAKE WITH GRAPEFRUIT JUICE

102
Q

Nursing implications for amiodarone

A

Monitor LFT (baseline and periodic), xray, pulmonary function tests, thyroid function, eye exams. Anticipate CNS symptoms within a week after therapy. Will need help with ambulating

103
Q

All antidysrhythmic drugs can cause…

With antidysrhythmic drugs in general, monitor ____ and avoid ____

A

All antidysrhythmic drugs can cause dysrhythmias!

  • Monitor VS (pulse and BP); avoid caffeine
104
Q

Antidysrhythmic drugs in general:

  • Ensure patient knows to notify provider of any worsening of dysrhythmia or toxic effects:
A

Ensure the patient notifies the HCP for any allergic reactions, N/V, blurry vision, dizziness,

105
Q

Other antidysrhythmic drugs: Adenosine- what to know ab it?

A
  • Used to convert paroxysmal supraventricular tachycardia to sinus rhythm
    -May cause asystole for a few secs
    -Very short half life
106
Q

Other antidysrhythmic drugs:
Magnesium Sulfate

A

First line for TdP, which is Torsade de Pointes- variant of v tach that can result from prolonged QT interval

107
Q

Epinephrine- why is it the DOC for anaphylaxis

A

Vasoconstriction and bronchodilation = raise BP and open lungs

107
Q

AE of epinephrine

A

Hypertensive crisis, necrosis following extravasation

108
Q

NI of epinephrine

A

If giving IV, use central line

109
Q

Dopamine is used for

If giving..

A

shock, HF, and acute renal failure

-If giving IV use central line (never peripheral)

110
Q
A

Pharm (9 decks)

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