exam 3 cardiac pharm Flashcards by Garrett Anderson

Anti-anginals
treat

stable angina

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which 2 drugs would we be concerned about with a HR < 60 BPM

what about low BP (2)?

LOW HR is concern with
beta blockers ______lol
digitalis

LOW BP is concern with
beta blockers ______lol
nitrates

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goal of Anti-anginals
1. Relieve _______ _______
2. Reduce _________
3. Improve morbidity and mortality

Relieve chest pain
Reduce hyperlipidemia
Improve morbidity and mortality

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Class of drugs and MOA
goal = to relieve pain for stable angina

_________ – dilates veins and decreases preload
_________ – decrease HR and contractility
___________ – dilate arteries, decreases afterload, decreases HR and contractility
_________ helps myocardium generate energy more efficiently

Nitrates, Ranolazine, Beta blockers, Calcium channel blockers

Nitrates – dilates veins and decreases preload
Beta blockers – decrease HR and contractility
Calcium channel blockers – dilate arteries, decreases afterload, decreases HR and contractility
Ranolazine – helps myocardium generate energy more efficiently

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Anti-anginals
treat stable angina

goal
1. ___________
- Nitrates
- Beta blockers
- Calcium channel blockers
- Ranolazine
- Statins
- Aspirin
2. ____________
- Lipid lowering drug like statins
- Aspirin or clopidogrel
3. _____________
- ACE inhibitor or ARB

Reduce hyperlipidemia
Improve morbidity and mortality
Relieve chest pain

Anti-anginals
treat stable angina

goal
1. Relieve chest pain
- Nitrates
- Beta blockers
- Calcium channel blockers
- Ranolazine
- Statins
- Aspirin
2. Reduce hyperlipidemia
- Lipid lowering drug like statins
- Aspirin or clopidogrel
3. Improve morbidity and mortality
- ACE inhibitor or ARB

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MOA
- Dilates veins
- Decreases preload

Nitroglycerin
Class – Nitrates

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Nitroglycerin
Class – Nitrates

MOA
- Dilates veins
- Decreases preload

s/e
1.
2.

s/e
- Vasodilation = h/a, hypotension, reflex tachycardia
- Tolerance

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which drug?

Interactions
- Severe hypotension when taken with
o Sindenafil/Viagra
o Antihypertensives
o Alcohol

Nitroglycerin
Class – Nitrates

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nitrate Types
- _________ – rapid acting
o Most common
o For active angina
o Sublingual
o Put under tongue
o Repeat q5 min x3 as needed
- ___________ – short acting
o Skin patch
o Apply to chest or thigh daily
- __________– short acting
o Ointment
o Apply 1-2 inches to chest or thigh area
- ________ – long acting
o Sublingual or oral
o For prevention of anginal attacks
o Tolerance builds up over time

Nitrostat, Isosorbide, Nitro-bid , Transderm-nitro

Types
- Nitrostat – rapid acting
o Most common
o For active angina
o Sublingual
o Put under tongue
o Repeat q5 min x3 as needed
- Transderm-nitro – short acting
o Skin patch
o Apply to chest or thigh daily
- Nitro-bid – short acting
o Ointment
o Apply 1-2 inches to chest or thigh area
- Isosorbide – long acting
o Sublingual or oral
o For prevention of anginal attacks
o Tolerance builds up over time

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nitrate
Nursing implications
- Monitor for ____ – should go away in about 20 mins, can take a mild analgesic
- Apply patch in ______ and remove in evening – hairless site, rotate sites
- Educate on how to treat acute chest pain
o Take only as many SL tablets as you need – b/c _______ is s/e
o With SL form – do not swallow
o Fall precautions – s/e hypotension and dizziness
o If no relief in chest pain in 5 mins after taking 1st SL = ______ , can take 2nd in 5 mins, can take 3rd dose in another 5 mins
o Do not exceed ___ doses
- IV form – glass bottle with special tubing
o Monitor for severe h/a and _______cardia
- Long acting forms (isosorbide) – ______ when d/c to prevent increased chest pain from vasospasm

Nursing implications
- Monitor for h/a – should go away in about 20 mins, can take a mild analgesic
- Apply patch in morning and remove in evening – hairless site, rotate sites
- Educate on how to treat acute chest pain
o Take only as many SL tablets as you need – b/c tolerance is s/e
o With SL form – do not swallow
o Fall precautions – s/e hypotension and dizziness
o If no relief in chest pain in 5 mins after taking 1st SL = call 911, can take 2nd in 5 mins, can take 3rd dose in another 5 mins
o Do not exceed 3 doses
- IV form – glass bottle with special tubing
o Monitor for severe h/a and tachycardia
- Long acting forms (isosorbide) – taper when d/c to prevent increased chest pain from vasospasm

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nitrates
!!! when to call 911?

!!! if chest pain has not improved OR it has worsened 5 mins after taking the 1st nitro dose = call 911

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Ranolazine and nitrates both treat

stable angina

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indications
- stable angina

MOA
- Unknown

Warnings
- Prolong QT interval
- Acute renal failure with existing renal disease
- Liver cirrhosis
- CYP inhibtor – avoid grapejuice and other CYP inhibitor meds

route
- PO

s/e
- h/a
- dizzy
- nausea
- constipation

Ranolazine

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ACE inhibitor, ARBS, ARNI
Beta blockers
Mineralcorticoid receptor antagonist (MRAs)
SLGT2 inhibitors
Diuretics
Digitalis
Nitrates

treatment for

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ACE inhibitor
________opril

treat

HF and stable angina

learned with BP meds

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angiotensin receptor blocker (ARB)
losartan
valsartan

treats

stable angina and HF

learned with BP meds

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Check HR every time before giving ____________ – hold and contact HCP if HR < 60 or systolic BP < 100

beta blockers

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Sacubitril/valsartan

treats

combination medication used to treat heart failure.
- Sacubitril: neprilysin inhibitor
- Valsartan: angiotensin receptor blocker (ARB)

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Class - Angiotensin Receptor Neprilysin Inhibitor (ARNI)
combination medication used to treat heart failure.

Sacubitril/valsartan
- Sacubitril: neprilysin inhibitor
- Valsartan: angiotensin receptor blocker (ARB)

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MOA
- Decrease preload and afterload
- Suppress aldosterone
- Stops cardiac remodeling

Sacubitril/valsartan

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Take highest or lowest dose possible?

s/e
- Hypotension
- Hyperkalemia
- Cough - ACEI

Sacubitril/valsartan

HIGHEST dose

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Carvedilol
Beta blockers
Blocks both alpha and beta

MOA
- Protects against SNS activation and dysrhythmias
- Reverses cardiac remodeling

s/e
- Fluid retention = worsening HF
- Fatigue
- Hypotension
- Bradycardia

treats -

angina, HF, and RR control

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MOA
- Protects against SNS activation and dysrhythmias
- Reverses cardiac remodeling

Carvedilol
Beta blockers
Blocks both alpha and beta

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the suppression of sodium/water retention helps with offloading the left ventricle

spironolactone
Mineralocorticoid receptor antagonist (MRAs)

We’ve learned this as a potassium sparing diuretic

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spironolactone Mineralocorticoid receptor antagonist (MRAs) Watch for - ________kalemia - Worsening _____ failure

Watch for - Hyperkalemia - Worsening renal failure

SLG2 inhibitors treats HF helps with depleting excess volume

Dapagliflozin We’ve learned this as a DM medication

Treats – volume overload seen in HF patients

Furosemide Loop diuretic

Furosemide Loop diuretic Treats – volume overload seen in HF patients s/e - ____kalemia - ____tension - _______ toxicity

s/e - Hypokalemia - Hypotension - Digoxin toxicity

Class - Inotropic agent: cardiac glycoside (work by directly affecting the heart muscle)

Digitalis (digoxin)

Positive inotropic = if we can increase the contractility of the heart muscles, then we can increase the force of contraction, which causes increased ____

Positive inotropic = if we can increase the contractility of the heart muscles, then we can increase the force of contraction, which causes increased CO

MOA - Inhibits sodium potassium ATP pump causing calcium to collect within the cells of the heart helping to increase myocardial contractility - Increases blood flow to the kidney helping with excretion of sodium and water - Decreases sympathetic action and increases parasympathetic action = decreased HR

Digitalis (digoxin)

Digitalis (digoxin) s/e - Cardiac __________ (considered 2nd line drug for this reason) - __________

s/e - Cardiac dysrhythmias (considered 2nd line drug for this reason) - Toxicity

Digitalis (digoxin) Nursing implications - Monitor serum _________ levels (avoid _____kalemia) - Digitalis + _____kalemia + -Toxicity - Cardiac dysfunction - Serious dysrhythmias - Take apical pulse for one FULL min prior to giving digitalis - HOLD if pulse <____ BPM - Monitor for cardiac rhythm - Education – take own pulse

Digitalis (digoxin) Nursing implications - Monitor serum potassium levels (avoid hypokalemia) o Digitalis + hypokalemia +  Toxicity  Cardiac dysfunction  Serious dysrhythmias - Take apical pulse for one FULL min prior to giving digitalis - HOLD if pulse <60 BPM - Monitor for cardiac rhythm - Education – take own pulse

Digitalis toxicity - Risk factors - Women or men - OA or young - Combination drugs – like digitalis and _________

Digitalis toxicity - Risk factors - Women - OA - Combination drugs – like digitalis and diuretics

Digitalis toxicity - Prevention - Reduced dose - Serum digitalis levels – periodic monitoring of levels - Supplemental ________ – if kidneys work

Prevention - Reduced dose - Serum digitalis levels – periodic monitoring of levels - Supplemental potassium – if kidneys work

expected or unexpected s/s when taking digitalis? - Bradycardia - h/a - dizzy - confusion - nausea - visual disturbances – blurry/yellow vision

expected - Cardiac dysrhythmias (considered 2nd line drug for this reason) - Toxicity unexpected = toxicity - Bradycardia - h/a - dizzy - confusion - nausea - visual disturbances – blurry/yellow vision

digitalis toxicity antidote

antidote - digoxin immune fab (digibind) - route – IV

- Beta blockers - Calcium channel blockers - Amiodarone - Adenosine - Atropine - Dofetilide treat?

rate and rhythm control

stable angina, HF, or rate/rhythm control? nitrates

angina HF

stable angina, HF, or rate/rhythm control? beta blockers

stable angina, HF, and rate/rhythm control

stable angina, HF, or rate/rhythm control? calcium channel blockers

angina and RR control

stable angina, HF, or rate/rhythm control? ranolazine

angina

stable angina, HF, or rate/rhythm control? statins

angina

stable angina, HF, or rate/rhythm control? clopidogrel and aspirin - antiplatelets

angina

stable angina, HF, or rate/rhythm control? ACE inhibitor or ARB - RAAS system control

angina, HF

stable angina, HF, or rate/rhythm control? ARNI - Sacubitril/valsartan

stable angina, HF, or rate/rhythm control? Mineralocorticoid receptor antagonist (MRAs) - spironolactone

stable angina, HF, or rate/rhythm control? SLG2 inhibitors - Dapagliflozin

HF helps with depleting excess volume

stable angina, HF, or rate/rhythm control? amiodarone

RR control

stable angina, HF, or rate/rhythm control? digitalis

stable angina, HF, or rate/rhythm control? Furosemide Loop diuretic

stable angina, HF, or rate/rhythm control? adenosine

RR control

stable angina, HF, or rate/rhythm control? atropine

RR control

stable angina, HF, or rate/rhythm control? dofetilide

RR control

MOA - Prolongs the action potential duration and the effective refractory period in all cardiac tissues - Blocks alpha and beta adrenergic receptors in the SNS

amiodarone

Indications - PSVT - Ventricular dysrhythmias - Afib with RVR amiodarone or ranolazine?

amiodarone - RR control ranolazine - angina

s/e - LOTS - Thyroid alterations – contains iodine - Corneal microdeposits – deposits in eye causes visual issues - Fat loving – concentrates in adipose tissue BLACK BOX WARNING - Pulmonary toxicity – accumulates in lung tissue - Hepatotoxicity – live damage - Pro-arhythmic effect – starts new arrhythmias Interactions - Digoxin - Warfarin Very long half life Contraindicated for people with - Severe bradycardia - Heart blocks (rhythm)

amiodarone - RR control

which 2 RR control drugs have a black box warning amiodarone adenosine atropine dofetilide

amiodarone BLACK BOX WARNING - Pulmonary toxicity – accumulates in lung tissue - Hepatotoxicity – live damage - Pro-arhythmic effect – starts new arrhythmias dofetilide BLACK BOX WARNING - Torsades – deadly rhythm

MOA - Slows the conduction time through the AV node Indications - PSVT Very short half life, multiple doses s/e - Very few - Commonly causes a short burst of asystole/flat lining until sinus rhythm returns

adenosine

Anticholinergic/antimuscarinic MOA - Poisins the vagus nerve - Inhibits postganglionic acetylcholine receptors and direct vagolytic action

atropine

Indications - Symptomatic Sinus bradycardia Route - IV s/e - Anticholinergic s/e - Xerostomia- dry mouth - Blurry vision - Photophobia - Tachycardia - Flushing - Hot skin Nursing implications - Must be on cardiac monitor - If it doesn’t work quickly give a 2nd dose

atropine

class - Antidysrhythmic MOA - Selectively blocking the rapid cardiac ion channel carrying potassium currents

dofetillide

Indications - PSVT - Ventricular dysrhythmias - Afib with RVR Indications - PSVT Indications - Symptomatic Sinus bradycardia Indications - Conversion from afib/aflutter to NSR 1. pharm for angina, HF, or RR control? 2. amiodarone, adenosine, dofetiliide, atropine?

RR control amiodarone: Indications - PSVT - Ventricular dysrhythmias - Afib with RVR adenosine: Indications - PSVT atropine: Indications - Symptomatic Sinus bradycardia dofetillide: Indications - Conversion from afib/aflutter to NSR

Indications - Conversion from afib/aflutter to NSR s/e - Torsades – deadly rhythm - SVT - abnormal rhythm - h/a - dizzy - chest pain nursing implications - start in hospital with ECG monitoring - don’t give to patients with long QT intervals or with other drugs that may prolong QT interval BLACK BOX WARNING - Torsades – deadly rhythm

dofetillide

directly blocks SNS negative effects on HF and reduces cardiac remodeling

carvedilol

- blocks action of aldosterone - decreases intravascular volume by sodium excretion - retains potassium

spironalactone

primary effect = decreases intravascular fluid volume which decreases preload

furosemide

decreases afterload by reducing levels of angiotension II and aldosterone also helps with cardiac remodeling

ACEI - enalapril

HF patient with HR of 52 BPM why can't they take digitalis

HR > 60 BPM

A fib patient taking metoprolol why?

metropolol can treat stable angina, HF, and RR control. In this patient metropolol controls heart rate in patients with rate/rhythm control issues

MOA dilates veins which increases preload

nitrates

MOA helps heart muscle generate energy more efficiently

ranolazine

decrease HR, contractility, and afterload treats chronic, stable angina

CCB damn ______ dipine block that calcium one more time get low HR, get low contractility, get low afterload

HF patient which drug decreases preload in HF: digoxin? carvedilol? furosemide? captopril? aspirin? atorvastatin?

furosemide (diuretic) = decreases fluid volume dcreases preload captopril (ACEI) = stops the RAAS system, decreases fluid volume, decreases preload

desmopressin 1. for _____genic DI 2. can be given via ______ spray 3. large or small dose?

1. for neurogenic DI 2. nasal spray 3. small

levothyroxine is for

hypothyroid