Exam 2 Flashcards
What class of drug is typically given for first line monotherapy to tx HTN?
diuretics
Why would diuretics be taken with other anti-hypertensive medications?
they will have enhanced effects
Diuretics work by decreasing what 2 things?
- blood volume
- arterial resistance
What type of beta blocker is best for diabetics? Why?
- B1 - cardioselective is preferred : s/s of hypoglycemia are masked but does not induce hypoglycemia
- non selective beta blockers can cause hypoglycemia in DM pts and the s/s are masked
Which type of CCB works on the heart?
What is the prototype?
- dipines : work on blood vessels only
- nifedipine
Why might a diabetic patient who does not have hypertension be prescribed an ACE inhibitor?
- it helps protect the kidney from diabetic nephropathy
- by dec angiotensin 2 the efferent arterioles are able to vasodilate –> lowering the pressure in the glomerulus –> slows the progression of kidney disease / problems
What is angioedema?
What do we give to treat it?
What causes it?
- a potentially life threatening hypersensitivity reaction
- give epi
- an increase in bradykinins from ACE inhibitors or ARBs can cause this –> it can happen at any point in drug therapy
What are the goals of anti angina drugs? (2)
- dec O2 demand of the heart : dec HR, contractility, preload or after load
- inc O2 delivery to heart : relax / dilate coronary arteries
When do the coronary arteries receive blood?
- during diastole / filling
Stable Angina
- triggered by :
- ___ is the underlying cause
- tx :
- triggered by : activity
- CAD (coronary artery disease)
- tx : dec O2 demand of the heart
Variant Angina
- What is it?
- triggers/timing?
- tx :
- coronary artery vasospasm
- occurs at anytime : rest or activity
- tx : inc O2 supply with relaxation and dilation of coronary arteries
Unstable Angina :
- emergency?
- tx ?
- yes : medical emergency
- tx as MI until proven otherwise
Why is PO short acting nitro not prescribed?
- completely metabolized by the liver and will have no effect on the heart : we do give long acting : isosorbide mononitrate or dinitrate
What edu should be given about storing SL nitro at home?
- dark container
- not in bathroom or humid area
- do not dump out into hand and pour back into bottle (dump into cap)
What edu should be given about nitro administration via patch?
- pt
- nurse / administrator who is not the pt
Pt
- remove patch at night to have drug free pd so tolerance does not develop
- rotate sites
Nurse
- wear gloves so your skin does to absorb the medication
- wipe off area before applying defib patches –> can cause burns
How is acute chest pain treated in the ED? (6)
- SL nitro x3 then IV
- IV BB (CCB is 2nd choice)
- supplemental O2
- IV morphine –> dec preload and after load
- ACE inhibitor : dec mortality in pts with Left vent dysfunction / HF
- anti platelet and anticoagulation therapy
What are underlying cxs of HF? (7)
- chronic HTN
- MI
- Valvular heart disease
- coronary artery disease
- congenital heart disease
- dysrhythmias
- aging
Right ventricular hypertrophy causes a back up of pressure into the ___ ___. Which causes __ (3 different things).
- back of up pressure into the peripheral veins
- cx : vein distention, edema in LE, ascites
Left ventricular hypertrophy causes a back up of pressure into the ___ ___. Which causes __ (3 different things).
- pressure backs up into the lungs
- cx : pulmonary HTN, pulmonary edema, wet lungs
The goal of HF tx is to inc force of ___ and dec ___ to reduce O2 consumption.
- need to increase the force of contraction
- need to dec HR
HF pts who take a diuretic may alter their daily doses using a ___ ___ that is based on ___ ___.
- sliding scale
- daily weight
When should diuretics be administered? (time of day)
- early so you aren’t peeing all night –> fall risk
Blocking angiotensin does what 3 things?
- cx vasodilation
- prevent Na and H2O retention
- prevents cardiac remodeling
Blocking aldosterone does what 2 things?
- inhibit Na and H2O retention
- prevent cardiac remodeling
What is the function of VLDL?
- deliver triglycerides from the liver to the adipose tissue and muscle
What is the function of LDL?
What does it contribute to?
- deliver cholesterol to non-hepatic (peripheral) tissue
- cx atherosclerosis
What is the function of HDL?
- deliver cholesterol from the peripheral tissue to the liver to be removed
- prevent atherosclerosis
Anticoagulants work in which bv group?
- veins : prevent clot formation
Antiplatelets work in which bv group?
arteries : prevent platelet aggregation
aPTT
- normal range
- therapeutic range
- norm : 40
- therapeutic : 1.5-2x baseline = 60-80
PT
- normal :
- therapeutic range :
- norm : 12
- therapeutic : 1-2 x baseline = 12-24
INR
- therapeutic range :
- mechanical heart valve:
- therapeutic range : 2-3
- mechanical heart valve : higher
What pt edu is specific to warfarin? (8)
- take at same time each day
- frequent lab monitoring
- soft tooth brush
- electric razor
- stop 1 week before procedure w/ approval from dr
- medical alert bracelet
- no NSAIDS / ASA
- garlic and ginger will inc bleeding
What 4 situations are a thrombolytic agent used?
- Acute MI
- Acute ischemic stroke
- Acute PE
- clearing a blocked central venous catheter
What is the best strategy for drug therapy for pts who have lipid disorders?
- decrease LDLs
What things are considered in the tx approach for a pt with a lipid disorder? (5)
- risk of atherosclerotic cv event : framingham risk reduction score
- therapeutic lifestyle changes : diet, exercise, weight control, stop smoking
- diabetes
- metabolic syndrome
- lifelong tx
Why might a diabetic pt who does not have a lipid disorder be prescribed a statin drug?
- reduce the risk of a cv event : dec inflammation, slower progression of coronary artery calcification. improve endothelial function in bv, improve bv dilation, reduce risk of afib, reduce risk of clots
How often are labs for aPTT drawn?
Why?
- Q6H
- the 1/2 life of heparin is 90 min –> it takes 4 1/2 lives to reach the therapeutic range –> 4 90 min 1/2 lives = 6 H
What is heparin induced thrombocytopenia?
- if platelets are reduced by 50% or are <100,000 –> stop heparin
- usually occurs after 4 days –> body makes AB against the heparin platelet protein complex –> cause the platelet to drop
- if this is suspected draw blood for a titer
How do you know if you pt is bleeding?
- look for blood coming out of every orpheus
- brusing
- discolored urine
- lumbar pain : peritoneal bleeding
Why is heparin and lovanox contraindicated in pts who are receiving an epidural?
- can cause a hematoma that leads to paralysis
Describe the transition from IV heparin to warfarin
- typically 2-3 days with simultaneous administration
- takes several days for warfarin to have effect
- warfarin does not effect the clotting factors that are already made
- monitor heparin and warfarin labs during this time
Describe the transition from IV harpoon to rivaroxaban
- stop heparin and immediately give PO dose
- may have double doses for a couple days then switch to maintenance dose
