Exam 2 Flashcards
1
Q
Sympathetic Nervous System (SNS)- fight or flight
A
- Responsible fight, flight, and fright functions
- Speeds everything up except the GI tract
- Epinephrine/Norepinephrine gets released by neurons of SNS and activates adrenergic receptors (alpha and beta receptors), Alpha 1&2, and Beta 1&2.
2
Q
Alpha Receptors
A
- Alpha 1- constricts smooth muscles, especially vessels.
- Alpha 2- inhibitory
3
Q
Beta Receptors
A
1 heart, 2 lungs
- Beta 1- on the heart, increased heart rate, increases contractility (squeeze of the heart), increases blood pressure.
- Beta 2- present throughout the airway–>relax smooth muscle–>bronchodilation.
4
Q
Non-selective adrenergic agonist: Epinephrine
MOA:
A
Activates Alpha 1, Beta 1&2
5
Q
Non-selective adrenergic agonist: Epinephrine
Uses:
A
o Asthmatic and allergic emergencies
o Cardiogenic shock
o Cardiac arrest
o Has a rapid onset, short duration of action.
6
Q
Non-selective adrenergic agonist: Epinephrine
SEs/ADRs:
A
o Nervousness
o Restlessness
o Tremors
o Headache
o Angia (chest pain)
o Arrhythmias
o Hypertension
o Tachycardia
o Hyperglycemia
o GI upset
7
Q
Non-selective adrenergic agonist: Epinephrine
Nursing Action:
A
o Monitor vital signs.
o CM (cardiac monitor)
o Monitor blood glucose closely.
8
Q
Epi-pen autoinjector
A
“Blue to sky, orange to thigh”
o Remove the blue cap.
o Inject the orange end into the lateral thigh.
o Hold at a 90-degree angle. Insert until you hear a click. HOLD for 10 secs, remove, then gently massage the area.
o Call 911. Effects are brief. The second dose may be given in 10 mins if the patient is not better before help arrives.
9
Q
Adrenergic Blockers: Beta-blockers
Action:
A
o Blocking Beta 1–> dec heart rate, dec blood pressure
o Blocking Beta 2–> bronchoconstriction ——-ADR
o Non-selective BBs (beta blockers) (N-Z) ex/propranolol. Block Beta 1&2
o Selective BB (A-M) ex/atenolol. Preferentially target Beta minimizes ADRs of non-selective.
10
Q
Adrenergic Blockers: Beta-blockers
Uses:
A
o Antihypertensive
o Cardioprotective benefits post MI (heart attack)
o Heart failure (not acute)
o Arrhythmias
11
Q
Adrenergic Blockers: Beta-blockers
SEs:
A
o Drowsy
o Dizzy
o Decreases sex drive.
o Orthostatic hypotension
12
Q
Adrenergic Blockers: Beta-blockers
ADRs:
A
o Bronchoconstriction
o Hypoglycemia
o Bradycardia
- Selective beta-blockers may be used with caution in patients with asthma/COPD.
13
Q
Adrenergic Blockers: Beta-blockers
Contraindications:
A
o Bradycardia
o Heart block (arrhythmia where heart rate is very slow)
o Cardiogenic shock
o Acute heart failure – pt must be stable before initiating beta blockers (no hypotension). Once stable, begin very low-dose BB (beta-blocker).
o Asthma
o COPD
o Sick sinus syndrome (pts heart rate is tachy then brady, tachy then brady, etc.)
14
Q
Adrenergic Blockers: Beta-blockers
Nursing Interventions:
A
o Check baseline vital signs- report heart rate less than 60.
o Check history- diabetic, asthma, or COPD.
o Counsel pt to change positions slowly.
15
Q
Parasympathetic Nervous System (PNS)- rest and digest
A
- Responsible for “rest and digest” functions
- Acetylcholine (ACH) is released by neurons of PNS and activates muscarinic/nicotinic receptors (cholinergic receptors).
16
Q
Muscarinic Receptors: M1
A
Found in exocrine- salivation and gastric acid secretions.
17
Q
Muscarinic Receptors: M2
A
Found in the heart- slow heart rate.
18
Q
Muscarinic Receptors: M3
A
Found in smooth muscle- bronchoconstriction, bladder contraction, GI contractility, produce vasodilation, pupil constriction, also found in pancreas–>insulin release.
19
Q
Effects of cholinergic stimulation (when they are activated)
A
- Hypotension, decreased heart rate
- Inc secretions (saliva, GI, sweat)
- Inc GI motility- diarrhea, nausea, abdominal pain
- Increased detrusor tone–> Micturition (peeing), incontinence
- Pupillary constriction
- Bronchospasm
20
Q
Effects of cholinergic blockade (anti)
A
- Inc heart rate
- Dec secretions (dry mouth, eyes)
- Dec GI motility (constipation)
- Dec detrusor muscle tone (urinary retention)
- Pupillary dilation/ciliary muscle–> Blurred vision.
- Bronchodilation
21
Q
Cholinergic agonists
A
“bind to and activate cholinergic receptors.”
22
Q
Cholinergic agonists: Bethanechol
Action:
A
o Stimulates receptors on the smooth muscle of the bladder and GI tract.
23
Q
Cholinergic agonists: Bethanechol
Uses:
A
o Urinary retention
o MUST rule out urinary/intestinal tract obstruction.
24
Q
Cholinergic agonists: Bethanechol
SEs/ADRs:
A
o Blurred vision
o Inc secretions
o Orthostatic hypotension
o Bronchoconstriction
o Hypotension
o Bradycardia
25
Cholinergic agonists: Bethanechol
Interactions:
o Other drugs that dec heart rate and blood pressure
o Atropine (reversal agent)- block PNS activity
26
Cholinergic agonists: Bethanechol
Contraindications:
o Bradycardia
o Hypotension
o COPD/asthma
o Peptic ulcer disease
o Parkinson’s disease
o Intestinal/urinary obstruction
27
Cholinergic agonists: Bethanechol
Nursing Actions:
o Check vital signs.
o Be familiar with the medications/medical history of the patient.
o Give 1 hour before, 2 hours after meals to avoid nausea and vomiting.
o Teach pt to change positions slowly.
o Monitor input and output.
28
Cholinergic agonists: Pilocarpine
Action:
o Directly stimulates cholinergic receptors in eye--> miosis (constrict pupil). This allows aqueous humor to exit.
29
Cholinergic agonists: Pilocarpine
Use, Administration:
1. Use:
o Eye drops to treat glaucoma.
2. Administration: pg 86
o Eye drops – punctal occlusion (a mechanical treatment that blocks the tear drainage system in order to aid in the preservation of natural tears on the ocular surface).
30
Cholinergic agonists: Pilocarpine
Nursing Actions:
o Teach proper administration of eye drops and punctual occusion technique.
o Causes difficulty in dark adaptation- advise pts to use caution while night driving or performing tasks in poor lighting.
31
Anticholinergic: Atropine
Action:
Opposes actions of PNS (Parasympathetic Nervous System)
32
Anticholinergic: Atropine
Uses:
o Eyes: mydriatic agent (dilates pupils)
o CV (cardiovascular): inc heart rate (used for symptomatic sinus bradycardia)
o Pulmonary: anti-secretory (used to dry up secretions, pre-op)
o GI: antispasmodic (dec GI motility, relieves cramps and diarrhea)
o Urinary tract: for incontinence (replaced by other drugs)
o Antidote: for cholinergic toxicity
33
Anticholinergic: Benztropine
Action:
o Inhibits cholinergic activity.
o Inhibits reuptake of dopamine
o Explanation: dopamine depletion-->inc ACH release-->activation of muscarinic receptors-->overstimulation of neurons by ACH-->tremors/rigidity
Overall effect: Benztropine blocks effects of ACH-->dec tremors, dec rigidity, dec drooling.
34
Anticholinergic: Benztropine
Uses:
o Dec tremors
o Dec rigidity
o Dec drooling
35
Urinary Anticholinergic: Tolterodine
Action:
Inhibits muscarinic receptors in bladder and urinary tract which helps retain bladder volume
36
Urinary Anticholinergic: Tolterodine
Use:
o Urge incontinence (dec frequency of urination/OAB (overactive bladder))
37
General Anticholinergics
Common SEs:
* Constipation
* Dry mouth/eyes
* Tachycardia
* Blurred vision
* Urinary retention
38
General Anticholinergics
ADRs:
* Confusion/hallucinations
* inc fall risk in the elderly.
39
General Anticholinergics
Contraindications:
* DO NOT GIVE to pts with a history of glaucoma.
* GI motility issues
* May worsen MG (myasthenia gravis)
* Tachycardia
* BPH (Benign prostatic hyperplasia-enlarged prostate that is not cancerous)
40
General Anticholinergics
Interactions:
* Other drugs with anticholinergic effects ex. TCAs, antihistamines, cyclobenzaprine (muscle relaxer), grapefruit juice
41
General Anticholinergics
Nursing Considerations:
* Asses for contraindications: glaucoma, Gi/bladder obstruction, MG (myasthenia gravis)
* Assess neurological status.
* Monitor vital signs.
* Assess abdomen, monitor bowel sounds.
* Monitor urine output.
* Oral care
* Safety – inc risk for falls in elderly.
* Inc FFF (fluid, fiber, fitness)
* Wear sunglasses in bright light due to pupil dilation
42
Parkinson’s Disease
Neurological disorder that results in progressive loss of coordination and movement.
43
Parkinson’s Disease
Etiology/Pathophysiology:
* Loss of dopaminergic neurons in the brain.
* Dec dopamine-->inc ACH (acetylcholine) levels-->abnormal signaling between neurons.
* Imbalance--> signs and symptoms such as impaired mobility, resting tremor, bradykinesia, rigidity, and postural instability.
44
Parkinson’s Disease
Drug treatment goals:
* Replace dopamine.
* Mimic dopamine’s action
* Antagonize excitatory effects of cholinergic neurons.
45
Anti-Parkinson’s Drug: Carbidopa/Levodopa
Dopamine replacement
46
Anti-Parkinson’s Drug: Carbidopa/Levodopa
Action:
Levodopa is a dopamine precursor. Dopamine itself cannot get across the blood-brain barrier. Levodopa can, with a little bit of help from carbidopa. Carbidopa prevents peripheral breakdown of levodopa so it can reach the brain.
47
Anti-Parkinson’s Drug: Carbidopa/Levodopa
Benefits of Carbidopa/Levodopa:
Less rigidity/hypokinesia
48
Anti-Parkinson’s Drug: Carbidopa/Levodopa
ADRs:
Due to inc dopamine activity in the brain
o Behavioral effects: confusion, sleep disturbances, vivid dreams, anxiety, schizophrenia-type symptoms
o Dyskinesia (involuntary movement)
o Peripheral effects: postural hypotension
o Mydriasis (dilation of the pupil)-->precipitate an attack of glaucoma.
o Alteration of smell and taste
o Altered labs: inc BUN and LFTs
o Brownish discoloration of body fluids
“Wearing-off effect”-as the disease advances, more neurons are lost, and the dose of the drug (carbidopa/levodopa) “wears off” before the next one is due.
49
Anti-Parkinson’s Drug: Carbidopa/Levodopa
Interactions, Contraindications:
1. Interactions: MAOIs
2. Contraindications:
o Psychosis
o Glaucoma
o Melanoma
50
Anti-Parkinson’s Drug: Carbidopa/Levodopa
Administration:
o With or without food
o inc protein, food may dec absorption
51
Anti-Parkinson’s Drug: Carbidopa/Levodopa
Nursing Actions:
o Monitor vital signs: may cause orthostatic hypotension.
o Drug is taken with food, take with low protein.
o Do not abruptly discontinue (may-->NMS (neuroleptic malignant syndrome)
52
Anti-Parkinson’s Drug:
Tolcapone
COMT- inhibitor, used in combination with carbidopa/levodopa.
53
Anti-Parkinson’s Drug:
Tolcapone
Action:
Inhibits COMT so that additional loss of levodopa is prevented and more enters the brain.
54
Anti-Parkinson’s Drug:
Tolcapone
Benefits:
o Prolongs the time dopamine is available to the brain.
o Lower doses of carbidopa/levodopa
o Dec wearing off effect.
55
Anti-Parkinson’s Drug:
Tolcapone
ADRs:
serious liver toxicity (entacapone preferred)
56
Alzheimer’s Dementia
Most common form, diagnosis of exclusion. Pt slowly loses orientation to time, place, then person.
57
Alzheimer’s Dementia
Etiology/Pathophysiology:
* Cortical atrophy- brain “shrinks.”
* Abnormal proteins in the brain called “plaques and tangles” accumulate in the brain and
destroy neurons-->dec ACH (acetylcholine)-->loss of memory and learning.
58
Alzheimer’s Dementia
Management:
o Palliative, aimed at reducing symptoms.
o Drugs improve symptoms but have no effect on the cause of disease.
o Approximate time between diagnosis of death is 8 yrs.
59
Alzheimer’s Dementia
Drug treatment:
Rivastigmine- acetylcholinesterase inhibitor
60
Alzheimer’s Dementia:
Rivastigmine
Action:
Inhibits enzymes from breaking down ACH (acetylcholine)-->inc levels/duration of action of ACH
61
Alzheimer’s Dementia:
Rivastigmine
SEs:
o Nausea and vomiting
o Diarrhea
o Insomnia
62
Alzheimer’s Dementia:
Rivastigmine
ADRs:
o Bradycardia
o Hypotension
o Syncope (a loss of consciousness for a short period of time)
o Lack of appetite
o Weight loss
63
Alzheimer’s Dementia:
Rivastigmine
Contraindications:
o Cardiac conduction abnormality
o Liver/renal disease
64
Alzheimer’s Dementia:
Rivastigmine
Administration:
o Transdermal patch or capsule BID
o Take with food.
65
Alzheimer’s Dementia:
Rivastigmine
Interactions:
o NSAIDs
o Other drugs that cause bradycardia/hypotension
o TCAs
66
Alzheimer’s Dementia:
Rivastigmine
Patient Teaching:
DON’T SMOKE – smoking inc clearance of drug-->dec amount of drug in the body.
67
Myasthenia Gravis
A disorder at the neuromuscular junction. It affects the nerve’s ability to communicate with muscles.
68
Myasthenia Gravis
Etiology/Patho:
Caused by antibodies that block ACH (acetylcholine) at receptors-->absence of muscle contraction-->weakness.
69
Myasthenia Gravis
Signs & Symptoms:
Systemic muscle weakness
o Primarily facial muscle weakness-->difficulty with eye-opening, talking, chewing.
o Also, proximal limb muscles
o Sever cases: may affect respiratory muscles- EMERGENCY!
70
Myasthenia Gravis
Drug treatment:
Pyridostigmine: acetylcholinesterase inhibitor
71
Myasthenia Gravis:
Pyridostigmine
Benefits:
* inc ACH (acetylcholine)levels in the synapse
* inc levels of ACH “outcompete” the antibodies.
* Improves muscle weakness (inc muscle strength).
72
Myasthenia Gravis:
Pyridostigmine
Caution:
o Hyperthyroidism
o Renal impairment
73
Myasthenia Gravis:
Pyridostigmine
Contraindications:
Intestinal/urinary obstruction
74
Myasthenia Gravis:
Pyridostigmine
SEs/ADRs:
Due to cholinergic overstimulation
o Glands: sweating, salivation, lacrimation (tearing)
o GI/GU: diarrhea, abdominal cramps, urination
o Effects on the heart: bradycardia
o Respiratory: bronchospasms (bronchoconstriction)
o M/S (Musculoskeletal): over-excitation
o Eye: miosis (pupil constriction)
75
Myasthenia Gravis:
Pyridostigmine
Interactions:
Atropine and other anticholinergics
76
Myasthenia Gravis:
Pyridostigmine
Nursing Interventions:
o Monitor vital signs.
o Monitor for SEs/ADRs and report.
o Administer before meals on an empty stomach.
77
Muscle Spasms:
Cyclobenzaprine
skeletal muscle relaxant. Pharmacologically and structurally similar to TCAs.
78
Muscle Spasms:
Cyclobenzaprine
Action:
Acts within CNS at the brainstem--> dec motor neuron activity-->dec muscle spasms
79
Muscle Spasms:
Cyclobenzaprine
Use:
Dec muscle spasms
80
Muscle Spasms:
Cyclobenzaprine
Administration:
o oral, usually dose is 5mg TID with food.
o MEANT TO BE TAKEN SHORT TERM, MAX LENGTH OF ADMINISTRATION IS 2-3 WEEKS
o SHOULD NOT BE STOPPED ABRUPTLY may--> rebound muscle spasms.
o Tapered down over a 1-week period.
81
Muscle Spasms:
Cyclobenzaprine
SEs:
o Dizziness
o Drowsiness
o Confusion
o Blurred vision
o Headache
o Dry mouth
o Constipation
o Nausea
o Altered taste.
82
Muscle Spasms:
Cyclobenzaprine
ADRs:
Can activate the cardiovascular system (CV)--> inc risk of arrhythmias, MI (heart attack), stroke.
83
Muscle Spasms:
Cyclobenzaprine
Contraindications:
o Patient’s recovering from MI (heart attack)
o Glaucoma
o AVOID in elderly (BEERS list)
o Hepatic impairment
84
Muscle Spasms:
Cyclobenzaprine
Interactions:
o Antidepressants (structurally similar to TCAs), inc serotonin levels-->serotonin syndrome
o Alcohol
o Other CNS depressants
85
Muscle Spasms:
Cyclobenzaprine
Nursing Actions:
o Monitor vital signs.
o Monitor for CNS effects.
o Safety- maintain a safe environment.
o Don’t stop abruptly.
o Avoid alcohol and other CNS depressants.
o Don’t drive.
o Inform the doctor if pregnant or nursing.
86
Heart failure
The heart is “too pooped to pump” insult or injury to heart causes heart muscle to weaken, no longer pumps effectively.
87
Cardiac Drug:
Digoxin
Cardiac glycoside
88
Cardiac Drug:
Digoxin
Action:
o Pos inotrope: inc contractility (inc heart rate)
o Neg chronotrope: dec heart rate
89
Cardiac Drug:
Digoxin
Uses:
o CHF (congestive heart failure)
o Arterial arrhythmias
90
Cardiac Drug:
Digoxin
SEs:
o Dizziness
o Weakness
o Headache
91
Cardiac Drug:
Digoxin
ADRs:
o Digoxin toxicity (rare) - may be triggered by hypokalemia, dec K-->inc digoxin.
o Severe symptoms: bradyarrhythmia
o Antidote: Digibind
o Signs & Symptoms:
* Hypersalivation
* Nausea and vomiting
* Diarrhea
* Fatigue
* Loss of appetite
* “yellow” visual disturbances (Blurred or yellow vision)
92
Cardiac Drug:
Digoxin
Monitoring:
o Digoxin levels: 0.5-2.0 ng (nanograms)/ml.
o Potassium levels
93
Cardiac Drug:
Digoxin
Interactions:
o Other drugs that dec heart rate
o Antacids (dec digoxin levels)
o PPI (proton pump inhibitor)- inc digoxin levels
94
Cardiac Drug:
Digoxin
Contraindications:
o Renal failure (dose adjustment)
o Hypokalemia
o Hypo/hyperthyroidism
o Bradycardia
95
Cardiac Drug:
Digoxin
Nursing Actions:
o Check apical pulse for a full minute.
o Hold and contact doctor if less than 60.
o Check potassium and digoxin levels before giving.
96
Angina
Chest pain due to decreased blood flow to the heart (ischemia).
97
Stable angina
Chest pain with exertion, relieved with rest.
98
Unstable angina
Chest pain with exertion, NOT relieved with rest.
99
Printzmetal’s angina (vasospastic)
Chest pain due to vasospasms, occurs in cycles. It may occur at rest.
100
Anti-anginal drugs: Nitroglycerin
Main medication therapy for angina.
101
Anti-anginal drugs: Nitroglycerin
Action:
Cause vasodilation-->inc blood flow to heart
102
Anti-anginal drugs: Nitroglycerin
Use:
Acute anginal attack
103
Anti-anginal drugs: Nitroglycerin
Forms:
o SL (sublingual)- most common
o Spray
o IV
o Topical
o TD (transdermal) patch
o Isosorbide (pill form)
104
Anti-anginal drugs: Nitroglycerin
SEs, ADRs:
Due to vasodilation
o Headache- oral acetaminophen may provide some relief.
o Flushing
o Orthostatic hypotension
o Syncope (fainting)
o Reflex tachycardia
105
Anti-anginal drugs: Nitroglycerin
Contraindications:
o Allergy
o Hypotension
o Anemia
o Inc intracranial pressure (ICP)
106
Anti-anginal drugs: Nitroglycerin
Interactions:
PDES inhibitors (sildenafil)-->dramatic hypotension
107
Anti-anginal drugs: Nitroglycerin
Patient instructions:
o Keep SL (sublingual) nitro in original glass container, store away from heat and light.
o Cap is screw-on, not child proof to facilitate emergency use.
o Sit or lie down when taking, may cause syncope (fainting) due to dilation.
o 3 doses five minutes apart can be taken.
-Nitro pill……...Nitro,5 min—if pain is not relived in 5 minutes call 911……. Nitro,5min
-DO NOT EXCEED 3 DOSES IN 15 MINS
108
Anti-anginal drugs: Beta-Blockers
Action:
Block Beta 1-->dec heart rate and blood pressure
Block Beta 2-->bronchospasm
o A-M: preferentially block Beta 1, but still antagonize Beta 2 a little. Use caution in patients with asthma/COPD.
o N-Z: non-selective-antagonize both Beta 1&2, contraindicated in patients with asthma/COPD.
109
Anti-anginal drugs: Beta-Blockers
Uses:
o Hypertension
o Congestive heart failure- not acute
o Stable angina (dec MO2 demand —> dec angina)
o Cardioprotective post MI (heart attack)
o Tachyarrhythmias
110
Anti-anginal drugs: Beta-Blockers
SEs:
o Dizziness
o Depression
o Fatigue
o Sexual dysfunction
111
Anti-anginal drugs: Beta-Blockers
ADRs:
o Bronchospasm
o Bradycardia
o Hypotension
112
Anti-anginal drugs: Beta-Blockers
Caution:
DO NOT abruptly discontinue.
-Can lead to anginal symptoms, rebound hypertension or tachycardia/palpations, anxiety.
113
Anti-anginal drugs: Calcium channel blocker (CCB): Diltiazem
Action:
Prevents calcium from entering into cells of blood vessels-->relaxation of vessel walls.
114
Anti-anginal drugs: Calcium channel blocker (CCB): Diltiazem
Uses:
o Hypertension
o Angina (vasospastic)
o Tachyarrhythmias
115
Anti-anginal drugs: Calcium channel blocker (CCB): Diltiazem
ADRs:
Syncope (fainting)
116
Anti-anginal drugs: Calcium channel blocker (CCB): Diltiazem
Contraindications:
Congestive heart failure
117
Antidysrhythmic drugs: Beta-Blockers: Acebutolol
* Prevent action of catecholamines (epinephrine & norepinephrine) on heart
* Dec sinus node activity-->dec heart rate
118
Antidysrhythmic drugs: Potassium(K+) channel blocker: Amiodarone
Also blocks sodium (Na+) channels, calcium channels, and some alpha and beta receptors.
119
Antidysrhythmic drugs: Potassium(K+) channel blocker: Amiodarone
Effect:
* Dec cardiac muscle cell excitability,
* Prevents abnormal heart rhythms.
120
Antidysrhythmic drugs: Potassium(K+) channel blocker: Amiodarone
Uses:
* Atrial and life-threatening ventricular dysrhythmias—
* Ventricular fibrillation,
* Unstable ventricular tachycardia
121
Antidysrhythmic drugs: Potassium(K+) channel blocker: Amiodarone
ADRs:
* Pulmonary toxicity
* Blue-gray skin discoloration
* Neuropathy
* Hepatotoxicity
* Thyroid disfunction
* Hypotension
* Bradycardia
122
Antidysrhythmic drugs: Calcium channel blockers (CCBs): Diltiazem
Slows conduction through SA & AV nodes-->dec heart rate.
123
Antidysrhythmic drugs: Calcium channel blockers (CCBs): Diltiazem
Use:
Most commonly used in arterial arrhythmias
124
Nursing Action for antidysrhythmic drugs: Acebutolol, Amiodarone, Diltiazem
o Monitor vital signs: hypotension, bradycardia.
o Monitor EKG: pt should be on cardiac monitor.
o Teach pt to take medication as ordered: DO NOT stop abruptly (BB)
o Teach pt to change positions slowly.
o Teach pt to avoid alcohol, tobacco, and caffeine.
125
Thrombus
Blood clot which may form in arteries/veins.
* Due to stasis, platelet aggregation or hypercoagulability
* Thrombus suppression: anti-platelets (ex/aspirin), anticoagulants (ex/heparin)
* Thrombolytics: “clot-busters”- dissolve blood clots
126
Anti-platelets: Aspirin
Action:
Inhibits platelet aggregation by inhibiting COX-1
127
Anti-platelets: Aspirin
Use:
Prevent MI (heart attack)/stroke.
128
Anti-platelets: Aspirin
Precautions:
Irreversibly inhibits platelets for 7 days. Stop 1 week before surgery/procedures.
129
Anti-platelets: Aspirin
Contraindications:
o GI bleed (peptic ulcer disease)
o Esophageal varices
o Intracranial bleed
130
Anti-platelets: Clopidogrel
Action:
Also inhibits platelet aggregation and clot formation
131
Anti-platelets: Clopidogrel
Uses:
Prevent repeat MI (heart attack)/stroke.
132
Anti-platelets: Clopidogrel
Interactions:
o Other drugs that cause bleeding
o Herbs/supplements: (4 Gs)
* Ginger
* Garlic
* Gingko
* Green tea
* Feverfew (inc bleeding)
133
Anticoagulants: Warfarin
Disrupts coagulation cascade.
134
Anticoagulants: Warfarin
Action:
Vit K antagonist, disrupts synthesis of clotting factors 2 (prothrombin),7,9, and 10.
135
Anticoagulants: Warfarin
Uses:
Prophylaxis and treatment of thromboembolic disorders (PE-pulmonary embolism, embolic stroke)
136
Anticoagulants: Warfarin
Monitor:
Monitor INR (International Normalization Ratio) at regular intervals, maintain at level of 2-3. To find number move the decimal place of the prothrombin level to the left ex 20 —>2, 25—>2.5
137
Anticoagulants: Warfarin
ADR:
Bleeding
138
Anticoagulants: Warfarin
Interactions:
o Other drugs that cause bleeding
Inc effects of warfarin
* Other drugs that cause bleeding
* Antibiotics
* Amiodarone
* Cranberry juice
* Vit E (is a blood thinner)
Dec effects of warfarin
* Ginseng
* Ginko
* Ginger
* Kava-Kava (used for anxiety)
* Green tea
* Foods high in Vit K (consistency)
139
Anticoagulants: Warfarin
Antidote:
o Vit K -slow reversal process
o FFP (fresh frozen plasma)- quicker reversal
140
Anticoagulants: Heparin
Action:
Inactivates thrombin, which converts fibrinogen-->fibrin
141
Anticoagulants: Heparin
Uses:
Prophylaxis and treatment of thromboembolic disorders:
* VTE (venous thromboembolism)-
* PE (pulmonary embolism) & DVT (deep vein thrombosis)
* afib (Atrial fibrillation)
* AMI (acute heart attack)
* Mechanical valves
142
Anticoagulants: Heparin
Monitor:
o PTT/APTT at regular intervals while on IV Heparin gtt (Keep 50-70)
o NOT needed for SQ Heparin
143
Anticoagulants: Heparin
ADRs:
o Bleeding
o Thrombocytopenia
144
Anticoagulants: Heparin
Interactions:
Other drugs that cause bleeding
145
Anticoagulants: Heparin
Contraindications:
Thrombocytopenia (platelet count less than 100,000 or if drops by more than 50% from baseline)
146
Anticoagulants: Heparin
Antidote:
Protamine sulfate
147
Anticoagulants: Enoxaparin
Made from heparin, lower risk of bleeding, more stable response at lower doses
148
Anticoagulants: Enoxaparin
Action:
Similar to heparin
-Inactivates thrombin, which converts fibrinogen-->fibrin
149
Anticoagulants: Enoxaparin
Advantages:
o Effects are more predictable.
o Fewer shots (1-2x daily)
150
Anticoagulants: Enoxaparin
Uses:
o Prevent VTE (venous thromboembolism)-: 40mg daily subcut. -in love handles
o Treatment (MI (heart attack), DVT (deep vein thrombosis), PE (pulmonary embolism)): 1 mg/kg SQ BID
151
Anticoagulants: Enoxaparin
Monitor:
none
152
Anticoagulants: Enoxaparin
ADRs:
o Bleeding
o Thrombocytopenia
153
Anticoagulants: Enoxaparin
Contraindications:
Thrombocytopenia reduced renal function.
154
Anticoagulants: Enoxaparin
Antidote:
Protamine
155
Anticoagulants: Thrombolytics: Alteplase
Action:
Activates protein called plasminogen which then converts to plasmin. Plasmin breaks up fibrin and dissolves clots.
156
Anticoagulants: Thrombolytics: Alteplase
Use:
o Ischemic stroke
o MI (heart attack)
o Massive PE (pulmonary embolism)
157
Anticoagulants: Thrombolytics: Alteplase
Administration:
Weight based IV infusion.
158
Anticoagulants: Thrombolytics: Alteplase
ADR:
Bleeding
159
Anticoagulants: Thrombolytics: Alteplase
Contraindications:
o Active internal bleeding
o Recent surgery
o Head trauma
o Severe uncontrolled hypertension -higher than 185/10
160
Anticoagulants: Thrombolytics: Alteplase
Monitor:
o Perform regular neurological assessments.
o Asses for bleeding
o Check for signs and symptoms of intracranial hemorrhage (ICH)
o Discontinue infusion if:
* Severe headache -might indicate
bleeding.
* Severe hypertension
* Nausea and vomiting
* Worsening neurological status
161
Anticoagulants: Thrombolytics: Alteplase
Interactions:
Anticoagulants --inc risk of bleeding
162
Anticoagulants: Thrombolytics: Alteplase
Reversal agent:
Cryoprecipitate or aminocaproic acid
163
Nursing Actions: Anticoagulants
o Baseline vital signs/labs: CBC, PT, PTT
o Medical history: any contraindications?
o For thrombolytics- inclusion/exclusion criteria
o Monitor for bleeding/bruising.
o Electric razors
o Soft bristle toothbrush
o Consistent intake of Vit K for Warfarin
164
Patient teaching: Anticoagulants
o Tell ALL health care providers you are taking this drug.
o Use care to prevent injury.
o Consistent intake of Vit K for Warfarin
o Wear a medical ID bracelet.
o Do not smoke- inc drug metabolism.
165
Hyperlipidemia
Abnormally high levels of fat particles in the blood, known as lipids.
* Why is this a problem? They can adhere to the walls of arteries and reduce blood flow.
o lead to risk of MI (heart attack), stroke, PAD (peripheral arterial disease)
* 85% is produced by the liver, the rest from food.
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Four major results of lipid panel:
* Total cholesterol: under 200
* LDL (bad cholesterol-deposits in arteries): depends on risk factors.
* HDL (want it to be high): greater than 45 in men and less than 55 in women. Picks up LDL, carries it away to the liver.
* Triglycerides: more than 150
167
HMG COA reductase inhibitor: Atorvastatin
They are associated with inc survival in pts with CAD (coronary artery disease).
168
HMG COA reductase inhibitor: Atorvastatin
Action:
dec biosynthesis of cholesterol.
o Liver cell (HMGCOA)----HMGCOA---->mevalonic acid (cholesterol precursor)
o By inhibiting this enzyme, statins dec concentration of cholesterol
169
HMG COA reductase inhibitor: Atorvastatin
Use:
o Dec LDL (bad cholesterol)
o Inc HDL
170
HMG COA reductase inhibitor: Atorvastatin
SEs:
o GI upset
o Dizziness
o Rash
o Pruritus (itching)
171
HMG COA reductase inhibitor: Atorvastatin
ADRs:
o Inc LFTs
o Inc risk of liver toxicity
o Muscle pain
o Rhabdomyolysis
- triad- muscle pain, weakness, dark urine
172
HMG COA reductase inhibitor: Atorvastatin
Contraindications:
o Liver disease
o Pregnancy
173
HMG COA reductase inhibitor: Atorvastatin
Nursing actions/teaching:
o Take at night.
o Monitor LFTs
o Avoid alcohol.
o Avoid grapefruit juice (can inc statin levels)
o Annual eye exams
o REPORT:
- Muscle pain
- Weakness
- Tenderness
- Dark urine
- Dec appetite
- Stomach pain
- Yellowing of skin/eyes
174
PAD (peripheral arterial disease)
Most common form of PVD (peripheral vascular disease)
Atherosclerosis of lower extremities- arteries become hardened due to plaque buildup.
175
PAD (peripheral arterial disease)
Signs and Symptoms:
* Ischemia/pain in lower extremities
* Numbness
* Non-healing ulcers
* Dec/absent peripheral pulses
* Cool/pale legs/feet
* Less hair growth on the affected limb
* Dependent rubor
176
PAD (peripheral arterial disease)
Hallmark Stage:
Stage 2 PAD (peripheral arterial disease)- intermittent claudication- “exercise-induced reversible ischemia.” Pain occurs with exercise and is relieved with rest, due to not enough oxygen in the lower extremities. Most commonly felt in the calf.
177
Drug treatment: PAD-
Cilostazol
* Anti-platelet
* Vasodilator
178
Drug treatment: PAD-
Cilostazol
Use:
Treatment of intermittent claudication due to PVD (PAD)
179
Drug treatment: PAD-
Cilostazol
SEs:
o Headache
o Diarrhea
o Palpitations
180
Drug treatment: PAD-
Cilostazol
ADRs:
o Arrhythmias
o Inc heart rate
o Hypotension
o Thrombocytopenia
o Leukopenia
181
Drug treatment: PAD-
Cilostazol
Contraindications:
o Heart failure
o Arrhythmias
o Bleeding disorders
182
Drug treatment: PAD-
Cilostazol
Interactions:
o Grapefruit juice
o Other drugs that cause bleeding
183
Drug treatment: PAD-
Cilostazol
Nursing actions/teaching:
o Perform peripheral vascular assessment.
o Monitor vital signs.
o Desired response may take up to 3 months.
o Do not smoke.
o Change positions slowly
o Take with food but not grapefruit.
