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sav NUR 326 > exam 3 cardiac pharm > Flashcards

exam 3 cardiac pharm Flashcards

1
Q

Anti-anginals
treat

A

stable angina

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2
Q

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

what about low BP (2)?

A

LOW HR is concern with
beta blockers ______lol
digitalis

LOW BP is concern with
beta blockers ______lol
nitrates

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3
Q

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

A
  1. Relieve chest pain
  2. Reduce hyperlipidemia
  3. Improve morbidity and mortality
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4
Q

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

A
  • 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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5
Q

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

A

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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6
Q

MOA
- Dilates veins
- Decreases preload

A

Nitroglycerin
Class – Nitrates

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7
Q

Nitroglycerin
Class – Nitrates

MOA
- Dilates veins
- Decreases preload

s/e
1.
2.

A

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

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8
Q

which drug?

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

A

Nitroglycerin
Class – Nitrates

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9
Q

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

A

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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10
Q

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

A

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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11
Q

nitrates
!!! when to call 911?

A

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

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12
Q

Ranolazine and nitrates both treat

A

stable angina

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13
Q

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

A

Ranolazine

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14
Q
  • ACE inhibitor, ARBS, ARNI
  • Beta blockers
  • Mineralcorticoid receptor antagonist (MRAs)
  • SLGT2 inhibitors
  • Diuretics
  • Digitalis
  • Nitrates

treatment for

A

HF

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15
Q
  • ACE inhibitor
    ________opril

treat

A

HF and stable angina

learned with BP meds

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16
Q

angiotensin receptor blocker (ARB)
losartan
valsartan

treats

A

stable angina and HF

learned with BP meds

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17
Q
  • Check HR every time before giving ____________ – hold and contact HCP if HR < 60 or systolic BP < 100
A

beta blockers

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18
Q

Sacubitril/valsartan

treats

A

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

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19
Q

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

A

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

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20
Q

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

A

Sacubitril/valsartan

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21
Q

Take highest or lowest dose possible?

s/e
- Hypotension
- Hyperkalemia
- Cough - ACEI

A

Sacubitril/valsartan

HIGHEST dose

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22
Q

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 -

A

angina, HF, and RR control

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23
Q

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

A

Carvedilol
Beta blockers
Blocks both alpha and beta

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24
Q

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

A

spironolactone
Mineralocorticoid receptor antagonist (MRAs)

We’ve learned this as a potassium sparing diuretic

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25
Q

spironolactone
Mineralocorticoid receptor antagonist (MRAs)

Watch for
- ________kalemia
- Worsening _____ failure

A

Watch for
- Hyperkalemia
- Worsening renal failure

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26
Q

SLG2 inhibitors

treats HF
helps with depleting excess volume

A

Dapagliflozin

We’ve learned this as a DM medication

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27
Q

Treats – volume overload seen in HF patients

A

Furosemide
Loop diuretic

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28
Q

Furosemide
Loop diuretic

Treats – volume overload seen in HF patients

s/e
- ____kalemia
- ____tension
- _______ toxicity

A

s/e
- Hypokalemia
- Hypotension
- Digoxin toxicity

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29
Q

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

A

Digitalis (digoxin)

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30
Q

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

A

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

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31
Q

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

A

Digitalis (digoxin)

32
Q

Digitalis (digoxin)

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

A

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

33
Q

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
A

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

34
Q

Digitalis toxicity -

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

A

Digitalis toxicity -

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

35
Q

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

A

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

36
Q

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

A

expected
- Cardiac dysrhythmias (considered 2nd line drug for this reason)
- Toxicity

unexpected = toxicity
- Bradycardia
- h/a
- dizzy
- confusion
- nausea
- visual disturbances – blurry/yellow vision

37
Q

digitalis toxicity antidote

A

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

38
Q
  • Beta blockers
  • Calcium channel blockers
  • Amiodarone
  • Adenosine
  • Atropine
  • Dofetilide

treat?

A

rate and rhythm control

39
Q

stable angina, HF, or rate/rhythm control?

nitrates

A

angina
HF

40
Q

stable angina, HF, or rate/rhythm control?

beta blockers

A

stable angina, HF, and rate/rhythm control

41
Q

stable angina, HF, or rate/rhythm control?

calcium channel blockers

A

angina and RR control

42
Q

stable angina, HF, or rate/rhythm control?

ranolazine

A

angina

43
Q

stable angina, HF, or rate/rhythm control?

statins

A

angina

44
Q

stable angina, HF, or rate/rhythm control?

clopidogrel and aspirin - antiplatelets

A

angina

45
Q

stable angina, HF, or rate/rhythm control?

ACE inhibitor or ARB - RAAS system control

A

angina, HF

46
Q

stable angina, HF, or rate/rhythm control?

ARNI - Sacubitril/valsartan

A

HF

47
Q

stable angina, HF, or rate/rhythm control?

Mineralocorticoid receptor antagonist (MRAs) - spironolactone

A

HF

48
Q

stable angina, HF, or rate/rhythm control?

SLG2 inhibitors - Dapagliflozin

A

HF

helps with depleting excess volume

49
Q

stable angina, HF, or rate/rhythm control?

amiodarone

A

RR control

50
Q

stable angina, HF, or rate/rhythm control?

digitalis

A

HF

51
Q

stable angina, HF, or rate/rhythm control?

Furosemide
Loop diuretic

A

HF

52
Q

stable angina, HF, or rate/rhythm control?

adenosine

A

RR control

53
Q

stable angina, HF, or rate/rhythm control?

atropine

A

RR control

54
Q

stable angina, HF, or rate/rhythm control?

dofetilide

A

RR control

55
Q

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

A

amiodarone

56
Q

Indications
- PSVT
- Ventricular dysrhythmias
- Afib with RVR

amiodarone or ranolazine?

A

amiodarone - RR control

ranolazine - angina

57
Q

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)

A

amiodarone - RR control

58
Q

which 2 RR control drugs have a black box warning

amiodarone
adenosine
atropine
dofetilide

A

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

59
Q

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

A

adenosine

60
Q

Anticholinergic/antimuscarinic

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

A

atropine

61
Q

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

A

atropine

62
Q

class - Antidysrhythmic

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

A

dofetillide

63
Q

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?
A

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

64
Q

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

A

dofetillide

65
Q

directly blocks SNS negative effects on HF
and reduces cardiac remodeling

A

carvedilol

66
Q
  • blocks action of aldosterone
  • decreases intravascular volume by sodium excretion
  • retains potassium
A

spironalactone

67
Q

primary effect = decreases intravascular fluid volume
which decreases preload

A

furosemide

68
Q

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

A

ACEI - enalapril

69
Q

HF patient
with HR of 52 BPM

why can’t they take digitalis

A

HR > 60 BPM

70
Q

A fib patient
taking metoprolol
why?

A

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

71
Q

MOA
dilates veins which increases preload

A

nitrates

72
Q

MOA
helps heart muscle generate energy more efficiently

A

ranolazine

73
Q

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

A

CCB

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

74
Q

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

A

furosemide (diuretic) = decreases fluid volume dcreases preload

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

75
Q

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

A
  1. for neurogenic DI
  2. nasal spray
  3. small
76
Q

levothyroxine is for

A

hypothyroid

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