Lewis 37 - CAD and ACS

Question 1

MOA/Class

atorvastatin, simvastatin, rosuvastatin

Answer 1

Decreased cholesterol production by the liver

HMG-Co-Enzyme A (HMG-CoA) Reductase Inhibitor (Statin)

Tucker 47

Question 2

Side Effects

atorvastatin, simvastatin, rosuvastatin

Answer 2

Hepatotoxicity, myopathy/rhabdomyolysis, GI upset

Tucker 47

Question 3

Nursing Considerations

atorvastatin, simvastatin, rosuvastatin

Answer 3

Avoid grapefruit juice
Monitor LFTs
May be most effective when taken at bedtime

Tucker 47

Question 4

Indications

atorvastatin, simvastatin, rosuvastatin

Answer 4

Hypercholesterolemia
(may be part of stroke or MI prophyaxis regimen)

Tucker 47

Question 5

MOA/Class

Niacin

Answer 5

Unknown

B Vitamin (B3)

Tucker 47

Question 6

Side Effects

Niacin

Answer 6

Flushing, pruritis, GI upset
Orthostatic hypotension

Tucker 47

Question 7

Nursing Considerations

Niacin

Answer 7

Pretreat with ASA or NSAID 30 minutes before niacin to decrease side effects

Tucker 47

Question 8

Indications

Niacin

Answer 8

Hypercholesterolemia

Tucker 47

Question 9

MOA/Class

fenofibrate, gemfibrozil

Answer 9

Inhibits synthesis of triglycerides in the liver. Activates enzymes responsible for breaking down cholesterol.

Fibrate/Fibric acid derivative

Tucker 47

Question 10

Side Effects

fenofibrate, gemfibrozil

Answer 10

GI upset, rash, increased PT, hepatotoxicity, myalgia/rhabdomyolysis

Tucker 47

Question 11

Nursing Considerations

fenofibrate, gemfibrozil

Answer 11

May increase bleeding risk when used with anticoagulants

Tucker 47

Question 12

Indications

fenofibrate, gemfibrozil

Answer 12

Hypercholesterolemia

Tucker 47

Question 13

MOA/Class

cholestyramine, colesevelam, colestipol

Answer 13

Binds with bile acids (which are high in cholesterol) to be excreted in stool.
*Bile salts are conjugated bile acids which can deposit under the skin when developed in excess causing itching. Decreasing bile acids will decrease formation of bile salts, thus decreasing itching with biliary dysfunction.

Bile acid sequestrant

Tucker 47

Question 14

Side Effects

cholestyramine, colesevelam, colestipol

Answer 14

Headache, fatigue, increased bleeding time, rash, constipation, flatulence, nausea

Tucker 47

Question 15

Nursing Considerations

cholestyramine, colesevelam, colestipol

Answer 15

Other PO drugs MUST be taken 1 hour before or 4 hours after a bile acid sequesterant for proper absorption.
May need to supplement fat soluble vitamins

Tucker 47

Question 16

Indications

cholestyramine, colesevelam, colestipol

Answer 16

Hypercholesterolemia, pruritis due to biliary dysfunction

Tucker 47

Question 17

MOA/Class

ezetimibe

Answer 17

Inhibits cholesterol absorption from the GI tract

Cholesterol absorption inhibitor

Tucker 47

Question 18

Side Effects

ezetimibe

Answer 18

GI upset, myalgia, hepatotoxicity

Tucker 47

Question 19

Nursing Considerations

ezetimibe

Answer 19

Multiple medication interactions. Monitor liver function.

Tucker 47

Question 20

Indications

ezetimibe

Answer 20

Hypercholesterolemia

Tucker 47

Question 21

MOA/Class

Aspirin (ASA)

Answer 21

Inhibits the synthesis of prostaglandin (pain)
Inhibits platelet aggregation by inhibiting the synthesis of thromboxane A2 and prostacyclin.

Salicylate

Tucker 16

Question 22

Side Effects

Aspirin (ASA)

Answer 22

GI upset, bleeding, salicylism

Tucker 16

Question 23

Nursing Considerations

Aspirin (ASA)

Answer 23

Risk for Reye’s syndrome when given to children or with concurrent chicken pox or influenza.
Salicylism manifestations - tinnitus, sweating, headache, dizziness, acidosis. Give activated charcoal and/or bicarbonate.
Dose of 81 mg is typically for antiplatelet activity. May give larger dose for antiplatelet effect in acute situations (i.e., active MI).
Risk for hypersensitivity in patients with asthma and/or nasal polyps.

Tucker 16

Question 24

Indications

Aspirin (ASA)

Answer 24

Mild-moderate pain/fever
Inflammatory conditions (IBD, RA, etc.)
MI/TIA prevention

Tucker 16

Question 25

# MOA/Class nitroglycerin (SL tablet/spray, paste, IV) isosorbide dinitrate, isosorbide mononitrate

Answer 25

Increases coronary blood flow through healthy arteries and decreases cardiac workload through decreased SVR/afterload (through vasodilation) | Nitrate ## Footnote Tucker 46

Question 26

# Side Effects nitroglycerin (SL tablet/spray, paste, IV) isosorbide dinitrate, isosorbide mononitrate

Answer 26

Hypotension, orthostatic hypotension, reflex tachycardia, headache. ## Footnote Tucker 46

Question 27

# Nursing Considerations nitroglycerin (SL tablet/spray, paste, IV) isosorbide dinitrate, isosorbide mononitrate

Answer 27

SL doses may be given every 5 minutes up to 3 doses. Sit/lie down before administration. Should tingle when placed under the tongue. Store away from heat and moisture in dark area/container. Rotate sites for transdermal application. Use nitrate-free period with topical and long-acting nitrations (overnight) to decrease tolerance. Do not give within 24 hours of ED drugs (sildenafil, tadalafil, etc.) as serious hypotension may occur. ## Footnote Tucker 46

Question 28

# Indications nitroglycerin (SL tablet/spray, paste, IV) isosorbide dinitrate, isosorbide mononitrate

Answer 28

Treatment and prevention of angina. Decrease afterload for patients with heart failure or significant hypertension (IV or topical applications) ## Footnote Tucker 46

Question 29

# MOA/Class lisinopril, enalapril, captopril, etc.

Answer 29

Prevents conversion of angiotensin 1 to angiotensin 2 (causing vasodilation) | Angiotensin-Converting Enzyme (ACE) Inhibitor ## Footnote Tucker 43

Question 30

# Side Effects lisinopril, enalapril, captopril, etc.

Answer 30

Dry cough Hyperkalemia First-dose hypotension, orthostatic hypotension Angioedema ## Footnote Tucker 43

Question 31

# Nursing Considerations lisinopril, enalapril, captopril, etc.

Answer 31

* NSAIDs may decrease therapeutic effect and contribute to kidney injury * Monitor other medications that strongly depend on fluid/electrolyte balance (digoxin, lithium, etc.) * Avoid potassium supplements * Note: While ACE inhibitors have some effect on all portions of the cardiac system (“pump, pipes, and volume”), they are most effective on the “pipes” portion. ## Footnote Tucker 43

Question 32

# Indications lisinopril, enalapril, captopril, etc.

Answer 32

Hypertension; Decrease cardiac workload; Prevent/limit ventricular remodeling ## Footnote Tucker 43

Question 33

# MOA/Class losartan, valsartan, etc.

Answer 33

Blocks the binding of A2 to receptors | Angiotensin II Receptor Blocker (ARB) ## Footnote Tucker 43

Question 34

# Side Effects losartan, valsartan, etc.

Answer 34

Hypotension Hyperkalemia (less common than ACEIs, but still need to monitor) Less dry cough than ACEIs ## Footnote Tucker 43

Question 35

# Nursing Considerations losartan, valsartan, etc.

Answer 35

Avoid potassium supplements Like ACEIs, most important to monitor BP ## Footnote Tucker 43

Question 36

# Indications losartan, valsartan, etc.

Answer 36

Hypertension; Decrease cardiac workload; Prevent/limit ventricular remodeling ## Footnote Tucker 43

Question 37

# MOA/Class atenolol, esmolol, metoprolol

Answer 37

Blocks beta receptors in the heart decreasing HR, contractility, and excitability. Also blocks beta receptors in the juxtaglomerular cells this decreasing activation of the RAAS. | Beta-1 adrenergic blocker ## Footnote Tucker 31

Question 38

# Side Effects atenolol, esmolol, metoprolol

Answer 38

fatigue, dizziness, bradycardia, impotence ## Footnote Tucker 31

Question 39

# Nursing Considerations atenolol, esmolol, metoprolol

Answer 39

Monitor BP and heart rate. B1 selectivity decreases with higher doses. Teach safety interventions for postural hypotension. Decreased effect when given with NSAIDs ## Footnote Tucker 31

Question 40

# Indications atenolol, esmolol, metoprolol

Answer 40

MI/chronic angina (decreased workload/increased supply), HTN, tachycardia (SVT, A-fib, A-flutter), heart failure (decreased workload) ## Footnote Tucker 31

Question 41

# MOA/Class amlodipine, nicardipine, nifedipine diltiazem, verapamil

Answer 41

Inhibits the movement of calcium ions across the membrane of myocardial and arterial muscle cells - blocking muscle cell contraction Depresses myocardial contractility, slows cardiac impulse formation, and relaxes and dilates arteries | Calcium channel blocker (CCB) ## Footnote Tucker 43

Question 42

# Side Effects amlodipine, nicardipine, nifedipine diltiazem, verapamil

Answer 42

Dizziness, headache, peripheral edema, bradycardia/heart block, flushing, nausea, hypotension | Calcium channel blocker (CCB) ## Footnote Tucker 43

Question 43

# Nursing Considerations amlodipine, nicardipine, nifedipine diltiazem, verapamil

Answer 43

Nifedipine is safe to use during pregancy to treat high BP. Diltiazem can increase toxicity of cyclosporine. | Calcium channel blocker (CCB) ## Footnote Tucker 43

Question 44

# Indications amlodipine, nicardipine, nifedipine diltiazem, verapamil

Answer 44

HTN, tachycardia (Note: Generally, the "-dipine" CCBs work better for blood pressure. Diltiazem and verapamil work better for vasospasms or heart rate control). | Calcium channel blocker (CCB) ## Footnote Tucker 43

Question 45

# MOA/Class ranolazine

Answer 45

Decreases myocardial workload | Sodium current inhibitor ## Footnote Tucker 46

Question 46

# Side Effects ranolazine

Answer 46

dizziness, headache, GI upset ## Footnote Tucker 46

Question 47

# Nursing Considerations ranolazine

Answer 47

Does not affect BP or HR. Monitor QT interval. May increase risk for dignoxin toxicity. ## Footnote Tucker 46

Question 48

# Indications ranolazine

Answer 48

Chronic angina that is unresponsive to other therapies ## Footnote Tucker 46

Question 49

# MOA/Class morphine

Answer 49

Binds to opioid receptors producing analgesia and sedation. Dilates pulmonary and systemic blood vessels. Decreases anxiety. ## Footnote Tucker 26

Question 50

# Side Effects morphine

Answer 50

respiratory depression, itching (from histamine release), orthostatic hypotension, CNS depression, constipation (with long-term use) ## Footnote Tucker 26

Question 51

# Nursing Considerations morphine

Answer 51

Antidote - naloxone Monitor respiratory status, BP, neuro status, and oxygenation. ## Footnote Tucker 26

Question 52

# Indications morphine

Answer 52

pain (adjunct management of anxiety, angina/HF, and air hunger) ## Footnote Tucker 26

Question 53

# MOA/Class spironolactone

Answer 53

Blocks the action of aldosterone in the renal tubule; creates loss of sodium (and water) while retaining potassium | Aldosterone antagonist/ K+ sparing diuretic ## Footnote Tucker 51

Question 54

# Side effects spironolactone

Answer 54

Hyperkalemia, hirsutism, gynecomastia, voice deepening, irregular menses ## Footnote Tucker 51

Question 55

# Nursing Considerations spironolactone

Answer 55

May be used in combination with loop diuretics to help offset potassium loss ## Footnote Tucker 51

Question 56

# Indications spironolactone

Answer 56

Ascites, HTN, nephrotic syndrome, HF, hyperaldosteronism ## Footnote Tucker 51

Question 57

# MOA/Class * Bisocodyl, senna * Psyllium * Magnesium formulations, lactulose, polyethylene glycol * Docusate

Answer 57

* Bisocodyl, senna - stimulant laxative * Psyllium - bulk-forming laxative * Magnesium formulations, lactulose, polyethylene glycol- osmotic laxative * Docusate - lubricant laxative ## Footnote Tucker 58

Question 58

# Side Effects * Bisocodyl, senna * Psyllium * Magnesium formulations, lactulose, polyethylene glycol * Docusate

Answer 58

Diarrhea, cramping, bloating ## Footnote Tucker 58

Question 59

# Nursing Considerations * Bisocodyl, senna * Psyllium * Magnesium formulations, lactulose, polyethylene glycol * Docusate

Answer 59

Contraindicated with acute abdominal disorders (risk for bowel rupture). Overuse can lead to dependence. ## Footnote Tucker 58

Question 60

# Indications * Bisocodyl, senna * Psyllium * Magnesium formulations, lactulose, polyethylene glycol * Docusate

Answer 60

Constipation (lactulose - elevated serum ammonia) ## Footnote Tucker 58

Question 61

# MOA/Class alteplase

Answer 61

Activates tissue plasminogen to break down fibrin threads in formed clots | Thrombolytic / Tissue plasminogen activator ## Footnote Tucker 48

Question 62

# Side Effects alteplase

Answer 62

Bleeding! ## Footnote Tucker 48

Question 63

# Nursing Considerations alteplase

Answer 63

Contraindications may include: recent surgery, active internal bleeding, CVC within 3 months (unless symptoms started in the last few hours), aneurysm, OB delivery, organ biopsy, recent serious GI bleed, rupture of noncompressible blood vessel, recent major trauma (including CPR), blood clotting disorder, cerbrovascular disease, uncontrolled hypertension, liver disease. Monitor for signs of bleeding including alterations in mental status. Avoid IM injections, invasive procedures, etc. ## Footnote Tucker 48

Question 64

# indications alteplase

Answer 64

Treatment of active MI, PE, ischemic stroke (under specific circumstances) Restoration of function in occluded central venous catheters (CVCs) ## Footnote Tucker 48