Heart disease medications

Question 1

What is Digoxin?

Answer 1

Cardiac Glycoside

Question 2

What does digoxin treat?

Answer 2

• Supraventricular tachyarrythmias

- Heart Failure (due to LV systolic dysfunction)

Question 3

Therapeutic range

Answer 3

0.5-2.0ng/mL

Question 4

Digoxin overdose S/S

Answer 4

N/V, anorexia, abdominal pain, arrhythmia, confusion, visual changes

Question 5

Lab tests for dig toxicity?

Answer 5

Dig level, electrolytes (mag, ca, k), creatinine, EKG

Question 6

Treatment for dig toxicity?

Answer 6

Digoxin specific antibodies (IgG)

-Ex: digibind, digifab

Question 7

How long do anticoagulant effects persist after warfarin is discontinued?

Answer 7

2-5 days

Question 8

Warfarin Sodium (Coumadin)

Answer 8

Category X
Vitamin K antagonist
Used for: prophylaxis and tx of thromboembolic events associated with Atrial Fib or heart valve replacement

Question 9

A-fib target INR is:

Answer 9

2.0-3.0

Question 10

Initial starting dose coumadin:

Answer 10

2 to 5 mg orally x1 per day, may start lower if elderly/ liver disease.

Question 11

Labs for coumadin:

Answer 11

Pt, PTT, creatinine, LFT’s, INR

Question 12

Antidote for Warfarin

Answer 12

Vitamin K (phytonadione)

Question 13

Antidote for Dabigatran (pradaxa)

Answer 13

Praxibind

Question 14

Antidote for Rivaroxabon (xarelto)

Answer 14

Recombinant or Andexxa

Question 15

Heparin (lovenox) antidote

Answer 15

protamine sulfate

Question 16

Antidote Clopidogrel (plavix)

Answer 16

NO REVERSAL

Question 17

INR monitoring

Answer 17

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

Question 18

Elevated INR S/S

Answer 18

Prolonged bleeding, nose bleeds, bloody stool, hematuria, petechiae, excessive bruising, excessive menstrual bleeding, sudden decrease in hemoglobin, new onset severe HA

Question 19

Foods rich in vitamin K

Answer 19

kale, spinach, collards, mustard, beet greens, broccoli raab

Question 20

ADR’s to Warfarin

Answer 20

Purple toes, skin necrosis in sub-Q fat

Question 21

Thiazide Diuretic Uses

Answer 21

HTN, HF, edema, diabetes
HTN w/ osteoporosis (BENEFIT)
Contra: sulfa allergy

Question 22

Thiazide ADR’s

Answer 22

Elevates plasma glucose/ hyperglycemia, cholesterol and LDL, uric acid, hypokalemia

Question 23

Loop Diuretic Uses

Answer 23

Edema from HF, cirrhosis, renal disease, HTN

Contra: sulfa allergy

Question 24

BB warning Loop’s

Answer 24

excessive amounts of furosemide may lead to profound diuresis; medical supervision required, individualized dose schedule

Question 25

Loop ADR’s

Answer 25

• Electrolytes (hypokalemia, hyponatremia, hypomagnesemia, low chlorine levels)
• Hypovolemia/ hypotension
• Pancreatitis, jaundice, rash, ototoxity

Question 26

Mineralcorticoid receptor antagonists

Answer 26

Ex: Spironolactone/ Eplerenone

Uses: htn, hf, hirsutism

Contra: severe renal disease

Question 27

Mineralcorticoids do not give:

Answer 27

Potassium supplementation

Question 28

Mineralcorticoids and ACE/ARB

Answer 28

Be careful, increases risk for hyperkalemia

Question 29

Spironolactone ADR:

Answer 29

Gynecomastia and hyperkalemia (increased risk of both benign and malignant tumors.

Question 30

Potassium Sparing Diuretics

Answer 30

Uses: htn, alternativ diuretic for patients with severe SULFA allergy!

EX: triamterene/ amiloride

Question 31

Potassium sparing BB warning

Answer 31

Hyperkalemia

Always monitor serum potassium (baseline, during, dose changes, illness)