exam 3 cardiac pharm Flashcards
Anti-anginals
treat
stable angina
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
goal of Anti-anginals
1. Relieve _______ _______
2. Reduce _________
3. Improve morbidity and mortality
- Relieve chest pain
- Reduce hyperlipidemia
- Improve morbidity and mortality
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
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
MOA
- Dilates veins
- Decreases preload
Nitroglycerin
Class – Nitrates
Nitroglycerin
Class – Nitrates
MOA
- Dilates veins
- Decreases preload
s/e
1.
2.
s/e
- Vasodilation = h/a, hypotension, reflex tachycardia
- Tolerance
which drug?
Interactions
- Severe hypotension when taken with
o Sindenafil/Viagra
o Antihypertensives
o Alcohol
Nitroglycerin
Class – Nitrates
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
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
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
Ranolazine and nitrates both treat
stable angina
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
- ACE inhibitor, ARBS, ARNI
- Beta blockers
- Mineralcorticoid receptor antagonist (MRAs)
- SLGT2 inhibitors
- Diuretics
- Digitalis
- Nitrates
treatment for
HF
- ACE inhibitor
________opril
treat
HF and stable angina
learned with BP meds
angiotensin receptor blocker (ARB)
losartan
valsartan
treats
stable angina and HF
learned with BP meds
- Check HR every time before giving ____________ – hold and contact HCP if HR < 60 or systolic BP < 100
beta blockers
Sacubitril/valsartan
treats
combination medication used to treat heart failure.
- Sacubitril: neprilysin inhibitor
- Valsartan: angiotensin receptor blocker (ARB)
Class - Angiotensin Receptor Neprilysin Inhibitor (ARNI)
combination medication used to treat heart failure.
Sacubitril/valsartan
- Sacubitril: neprilysin inhibitor
- Valsartan: angiotensin receptor blocker (ARB)
MOA
- Decrease preload and afterload
- Suppress aldosterone
- Stops cardiac remodeling
Sacubitril/valsartan
Take highest or lowest dose possible?
s/e
- Hypotension
- Hyperkalemia
- Cough - ACEI
Sacubitril/valsartan
HIGHEST dose
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
MOA
- Protects against SNS activation and dysrhythmias
- Reverses cardiac remodeling
Carvedilol
Beta blockers
Blocks both alpha and beta
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
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
HF
stable angina, HF, or rate/rhythm control?
Mineralocorticoid receptor antagonist (MRAs) - spironolactone
HF
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
HF
stable angina, HF, or rate/rhythm control?
Furosemide
Loop diuretic
HF
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
- pharm for angina, HF, or RR control?
- 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?
- for neurogenic DI
- nasal spray
- small
levothyroxine is for
hypothyroid
