Heart disease medications Flashcards
What is Digoxin?
Cardiac Glycoside
What does digoxin treat?
- Supraventricular tachyarrythmias
- Heart Failure (due to LV systolic dysfunction)
Therapeutic range
0.5-2.0ng/mL
Digoxin overdose S/S
N/V, anorexia, abdominal pain, arrhythmia, confusion, visual changes
Lab tests for dig toxicity?
Dig level, electrolytes (mag, ca, k), creatinine, EKG
Treatment for dig toxicity?
Digoxin specific antibodies (IgG)
-Ex: digibind, digifab
How long do anticoagulant effects persist after warfarin is discontinued?
2-5 days
Warfarin Sodium (Coumadin)
Category X
Vitamin K antagonist
Used for: prophylaxis and tx of thromboembolic events associated with Atrial Fib or heart valve replacement
A-fib target INR is:
2.0-3.0
Initial starting dose coumadin:
2 to 5 mg orally x1 per day, may start lower if elderly/ liver disease.
Labs for coumadin:
Pt, PTT, creatinine, LFT’s, INR
Antidote for Warfarin
Vitamin K (phytonadione)
Antidote for Dabigatran (pradaxa)
Praxibind
Antidote for Rivaroxabon (xarelto)
Recombinant or Andexxa
Heparin (lovenox) antidote
protamine sulfate
Antidote Clopidogrel (plavix)
NO REVERSAL
INR monitoring
Consistently Stable = 2 to 4 weeks, up to every 12 weeks
Single out of range= retest 1 to 2 weeks
INR less than 5 w/ no significant bleeding= omit 1 dose or reduce maintenance dose then recheck INR
Elevated INR S/S
Prolonged bleeding, nose bleeds, bloody stool, hematuria, petechiae, excessive bruising, excessive menstrual bleeding, sudden decrease in hemoglobin, new onset severe HA
Foods rich in vitamin K
kale, spinach, collards, mustard, beet greens, broccoli raab
ADR’s to Warfarin
Purple toes, skin necrosis in sub-Q fat
Thiazide Diuretic Uses
HTN, HF, edema, diabetes
HTN w/ osteoporosis (BENEFIT)
Contra: sulfa allergy
Thiazide ADR’s
Elevates plasma glucose/ hyperglycemia, cholesterol and LDL, uric acid, hypokalemia
Loop Diuretic Uses
Edema from HF, cirrhosis, renal disease, HTN
Contra: sulfa allergy
BB warning Loop’s
excessive amounts of furosemide may lead to profound diuresis; medical supervision required, individualized dose schedule
Loop ADR’s
- Electrolytes (hypokalemia, hyponatremia, hypomagnesemia, low chlorine levels)
- Hypovolemia/ hypotension
- Pancreatitis, jaundice, rash, ototoxity
Mineralcorticoid receptor antagonists
Ex: Spironolactone/ Eplerenone
Uses: htn, hf, hirsutism
Contra: severe renal disease
Mineralcorticoids do not give:
Potassium supplementation
Mineralcorticoids and ACE/ARB
Be careful, increases risk for hyperkalemia
Spironolactone ADR:
Gynecomastia and hyperkalemia (increased risk of both benign and malignant tumors.
Potassium Sparing Diuretics
Uses: htn, alternativ diuretic for patients with severe SULFA allergy!
EX: triamterene/ amiloride
Potassium sparing BB warning
Hyperkalemia
Always monitor serum potassium (baseline, during, dose changes, illness)
