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
