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Pharm Exam 2 > drugs for coronary artery disease > Flashcards

drugs for coronary artery disease Flashcards

1
Q

what are the actions of nitroglycerin?

A
  • venous dilation (most effective)
  • coronary artery dilation
  • arteriole dilation
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2
Q

what are the routes for nitroglycerin?

A
  • sublingual
  • topical ointment (nitropaste)
  • transdermal patch
  • intravenous drip
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3
Q

what are the directions and teaching points for sublingual nitroglycerin?

A
  • in a dark bottle due to light sensitivity
  • expires 3-6 months after opening
  • sit down while taking due to drop in BP
  • take every 5 minutes, call 911 after the 3rd time
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4
Q

what are the directions and teaching points for topical ointment nitroglycerin?

A

nitropaste

  • only used in the hospital
  • change every 6 hours
  • wear gloves as a nurse to avoid a headache
  • headache is a common side effect
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5
Q

what are the directions and teaching points for transdermal patch nitroglycerin?

A
  • apply in am and remove before bed to avoid tolerance
  • change location
  • pt. can use at home
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6
Q

what are the directions and teaching points for IV nitroglycerin?

A
  • in a glass bottle because it is flammable

- only given in the hospital

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7
Q

what are the side effects of nitroglycerin?

A
  • headache
  • hypotension
  • tachycardia to compensate with a decrease in BP
  • interacts with erectile dysfunction med
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8
Q

what kind of medication interacts with nitroglycerin?

A

erectile dysfunction

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9
Q

how can angina be prevented?

A

cold weather

  • raking leaves
  • shoveling snow
  • hunting
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10
Q

what is sublingual availability with nitroglycerin?

A

pt. should always have it with them even if they are on long-acting nitroglycerin

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11
Q

what are the two types of long-acting nitroglycerin?

A
  • isosorbide mononitrate (1x a day)

- isosorbide dinitrate (2x a day)

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12
Q

why would someone take isosorbide dinitrate instead of isosorbide mononitrate?

A

some people respond better to meds twice a day and some respond better to once a day

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13
Q

what are the 2 side effects of isosorbide dinitrate and isosorbide mononitrate?

A
  • headache (should diminish with time)

- decreased blood pressure

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14
Q

what is ranolazine (ranexa) used for?

A

angina

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15
Q

what is the action of ranolazine (ranexa)?

A

reduces Na and Ca accumulation in myocardial cells

- exact action is unknown

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16
Q

what group of people is ranolazine (ranexa) less effective in?

A

women

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17
Q

is ranolazine (ranexa) a 1st line treatment for angina?

A

yes but it is not common

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18
Q

what are the adverse effects of ranolazine (ranexa)?

A
  • prolonged QT interval - prolonged ventricular repolarization which can lead to v.tach and cardiac arrest
  • increased BP
  • numerous drug interaction
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19
Q

is nitroglycerin or ranolazine (ranexa) safer?

A

nitroglycerin

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20
Q

what do statins do?

A

lower LDL

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21
Q

what is an example of statin?

A

atorvastatin (Lipitor)

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22
Q

what is the action of statin?

A

decrease LDL levels by inhibiting the HMG-COA enzyme which controls a step in cholesterol synthesis

23
Q

what kind of drug is statin?

A

HMG-COA enzyme inhibitor

24
Q

what are the side effects of statin?

A
  • headache
  • GI disturbances
  • myopathy/myalgias (muscle pains and ache)
  • liver dysfunction/hepatotoxicity - monitor for elevated liver enzyme (AST & ATL)
25
Q

what teaching is needed with statin?

A
  • no grapefruit juice
  • poorly absorbed with the 1st dose
  • absorbs better with a meal
  • taking it at night could make it more effective
26
Q

what drug should not be taken with grapefruit juice?

A

statins

27
Q

what is the primary action of cholesterol absorption inhibitors?

A

decrease LDL and total cholesterol

28
Q

what drug is a cholesterol absorption inhibitor?

A

ezetimibe (Zetia)

29
Q

what is the action of ezetimibe (Zetia)?

A

decrease LDL and overall cholesterol levels but blocking the absorption of cholesterol

30
Q

can ezetimibe (Zetia) be used with statins?

A

yes it can be or it can be used alone

31
Q

what are the side effects of ezetimibe (Zetia)?

A
  • diarrhea

- increased risk of cholelithiasis

32
Q

what is cholelithiasis?

A

gallstones

33
Q

what is the primary action of fibrates (fibric acid derivates)

A

decrease triglycerdies

34
Q

what drug is a fibrate?

A

gemfibrozil (Lopid)

35
Q

what are the actions of fibrate - gemfibrozil (Lopid)?

A
  • decrease triglycerides by increased lipoprotein lipolysis
  • reduce cholesterol formation early in biosynthesis, mobilize cholesterol from tissue, decrease lipoprotein and triglyceride synthesis
36
Q

what are the side effects of fibrate - gemfibrozil (Lopid)?

A
  • GI upset
  • increased risk of cholelithiasis (gallstones)
  • myopathy (muscle weakness)
  • cardiac arrhythmias
  • flu-like symptoms
  • hypersensitivity
37
Q

a nurse should expect muscle pain if a pt is on what two medications?

A

statins and fribrates

38
Q

what other drug does fibrate - gemfibrozil (Lopid) effect?

A

coumadin - it would require a lower dose because if displaces anticoagulants on plasma proteins

39
Q

when would fibrates be used?

A

a pt with normal HDL and LDL, but high triglycerides

40
Q

what is the primary action of nicotinic acid - niacin?

A

increases HDL

41
Q

what is nicotinic acid - niacin also known as?

A

vitamin B3 - but a higher dose

42
Q

what are the actions of nicotinic acid - niacin?

A
  • increase HDL
  • also decreases triglycerides, total cholesterol, VLDL, and LDL
  • inhibit hepatic VLDL synthesis
43
Q

what are the side effects of nicotinic acid - niacin?

A
  • hyperglycemia
  • increased blood pressure
  • hyperuricemia/gout
  • vasodilation that can cause flushing, rash, tingling, and warmth (Asprin can help and it goes away in a few weeks)
44
Q

when should nicotinic acid - niacin not be used?

A
  • PUD (peptic ulcer disease)
  • hepatic disease
  • hypotension
  • ischemic heart disease
  • cerebrovascular disease
  • hemorrhage
45
Q

when would nicotinic acid - niacin be used?

A

in a pt with normal LDL levels but low HDL

46
Q

what is the primary action of bile acid sequestrant - cholestyramine (Questran)?

A

decrease LDL

47
Q

what drug is a bile acid sequestrant?

A

cholestyramine (Questran)

48
Q

what is the prefix for bile acid sequestrants?

A

cole or chole

49
Q

what are the actions of bile acid sequestrant - cholestyramine (Questran)?

A
  • decrease LDL

- blocks intestinal reabsorption of bile

50
Q

does bile acid sequestrant - cholestyramine (Questran) have to be used with other meds?

A

yes - with niacin or statins

51
Q

bile acid sequestrant - cholestyramine (Questran) slightly increases what?

A

triglycerides - so pt who is on this drug must have controlled triglycerides

52
Q

what teaching must be given with bile acid sequestrant - cholestyramine (Questran)?

A

it interacts with other drugs so other drugs must be taken 1 hour before or 4-6 hours after

53
Q

what are the side effects of bile acid sequestrant - cholestyramine (Questran)?

A
  • abdominal pain
  • gallstones
  • compliance issues
  • constipation
  • impaired absorption of fat-soluble vitamins
  • tastes awful
54
Q

what is most pt’s biggest complaint with bile acid sequestrant - cholestyramine (Questran)?

A

it tastes awful

Pharm Exam 2 (5 decks)

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