Lewis 37 - CAD and ACS Flashcards
MOA/Class
atorvastatin, simvastatin, rosuvastatin
Decreased cholesterol production by the liver
HMG-Co-Enzyme A (HMG-CoA) Reductase Inhibitor (Statin)
Tucker 47
Side Effects
atorvastatin, simvastatin, rosuvastatin
Hepatotoxicity, myopathy/rhabdomyolysis, GI upset
Tucker 47
Nursing Considerations
atorvastatin, simvastatin, rosuvastatin
Avoid grapefruit juice
Monitor LFTs
May be most effective when taken at bedtime
Tucker 47
Indications
atorvastatin, simvastatin, rosuvastatin
Hypercholesterolemia
(may be part of stroke or MI prophyaxis regimen)
Tucker 47
MOA/Class
Niacin
Unknown
B Vitamin (B3)
Tucker 47
Side Effects
Niacin
Flushing, pruritis, GI upset
Orthostatic hypotension
Tucker 47
Nursing Considerations
Niacin
Pretreat with ASA or NSAID 30 minutes before niacin to decrease side effects
Tucker 47
Indications
Niacin
Hypercholesterolemia
Tucker 47
MOA/Class
fenofibrate, gemfibrozil
Inhibits synthesis of triglycerides in the liver. Activates enzymes responsible for breaking down cholesterol.
Fibrate/Fibric acid derivative
Tucker 47
Side Effects
fenofibrate, gemfibrozil
GI upset, rash, increased PT, hepatotoxicity, myalgia/rhabdomyolysis
Tucker 47
Nursing Considerations
fenofibrate, gemfibrozil
May increase bleeding risk when used with anticoagulants
Tucker 47
Indications
fenofibrate, gemfibrozil
Hypercholesterolemia
Tucker 47
MOA/Class
cholestyramine, colesevelam, colestipol
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
Side Effects
cholestyramine, colesevelam, colestipol
Headache, fatigue, increased bleeding time, rash, constipation, flatulence, nausea
Tucker 47
Nursing Considerations
cholestyramine, colesevelam, colestipol
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
Indications
cholestyramine, colesevelam, colestipol
Hypercholesterolemia, pruritis due to biliary dysfunction
Tucker 47
MOA/Class
ezetimibe
Inhibits cholesterol absorption from the GI tract
Cholesterol absorption inhibitor
Tucker 47
Side Effects
ezetimibe
GI upset, myalgia, hepatotoxicity
Tucker 47
Nursing Considerations
ezetimibe
Multiple medication interactions. Monitor liver function.
Tucker 47
Indications
ezetimibe
Hypercholesterolemia
Tucker 47
MOA/Class
Aspirin (ASA)
Inhibits the synthesis of prostaglandin (pain)
Inhibits platelet aggregation by inhibiting the synthesis of thromboxane A2 and prostacyclin.
Salicylate
Tucker 16
Side Effects
Aspirin (ASA)
GI upset, bleeding, salicylism
Tucker 16
Nursing Considerations
Aspirin (ASA)
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
Indications
Aspirin (ASA)
Mild-moderate pain/fever
Inflammatory conditions (IBD, RA, etc.)
MI/TIA prevention
Tucker 16
MOA/Class
nitroglycerin (SL tablet/spray, paste, IV)
isosorbide dinitrate, isosorbide mononitrate
Increases coronary blood flow through healthy arteries and decreases cardiac workload through decreased SVR/afterload (through vasodilation)
Nitrate
Tucker 46
Side Effects
nitroglycerin (SL tablet/spray, paste, IV)
isosorbide dinitrate, isosorbide mononitrate
Hypotension, orthostatic hypotension, reflex tachycardia, headache.
Tucker 46
Nursing Considerations
nitroglycerin (SL tablet/spray, paste, IV)
isosorbide dinitrate, isosorbide mononitrate
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.
Tucker 46
Indications
nitroglycerin (SL tablet/spray, paste, IV)
isosorbide dinitrate, isosorbide mononitrate
Treatment and prevention of angina.
Decrease afterload for patients with heart failure or significant hypertension (IV or topical applications)
Tucker 46
MOA/Class
lisinopril, enalapril, captopril, etc.
Prevents conversion of angiotensin 1 to angiotensin 2 (causing vasodilation)
Angiotensin-Converting Enzyme (ACE) Inhibitor
Tucker 43
Side Effects
lisinopril, enalapril, captopril, etc.
Dry cough
Hyperkalemia
First-dose hypotension, orthostatic hypotension
Angioedema
Tucker 43
Nursing Considerations
lisinopril, enalapril, captopril, etc.
- 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.
Tucker 43
Indications
lisinopril, enalapril, captopril, etc.
Hypertension; Decrease cardiac workload; Prevent/limit ventricular remodeling
Tucker 43
MOA/Class
losartan, valsartan, etc.
Blocks the binding of A2 to receptors
Angiotensin II Receptor Blocker (ARB)
Tucker 43
Side Effects
losartan, valsartan, etc.
Hypotension
Hyperkalemia (less common than ACEIs, but still need to monitor)
Less dry cough than ACEIs
Tucker 43
Nursing Considerations
losartan, valsartan, etc.
Avoid potassium supplements
Like ACEIs, most important to monitor BP
Tucker 43
Indications
losartan, valsartan, etc.
Hypertension; Decrease cardiac workload; Prevent/limit ventricular remodeling
Tucker 43
MOA/Class
atenolol, esmolol, metoprolol
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
Tucker 31
Side Effects
atenolol, esmolol, metoprolol
fatigue, dizziness, bradycardia, impotence
Tucker 31
Nursing Considerations
atenolol, esmolol, metoprolol
Monitor BP and heart rate.
B1 selectivity decreases with higher doses.
Teach safety interventions for postural hypotension.
Decreased effect when given with NSAIDs
Tucker 31
Indications
atenolol, esmolol, metoprolol
MI/chronic angina (decreased workload/increased supply), HTN, tachycardia (SVT, A-fib, A-flutter), heart failure (decreased workload)
Tucker 31
MOA/Class
amlodipine, nicardipine, nifedipine
diltiazem, verapamil
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)
Tucker 43
Side Effects
amlodipine, nicardipine, nifedipine
diltiazem, verapamil
Dizziness, headache, peripheral edema, bradycardia/heart block, flushing, nausea, hypotension
Calcium channel blocker (CCB)
Tucker 43
Nursing Considerations
amlodipine, nicardipine, nifedipine
diltiazem, verapamil
Nifedipine is safe to use during pregancy to treat high BP.
Diltiazem can increase toxicity of cyclosporine.
Calcium channel blocker (CCB)
Tucker 43
Indications
amlodipine, nicardipine, nifedipine
diltiazem, verapamil
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)
Tucker 43
MOA/Class
ranolazine
Decreases myocardial workload
Sodium current inhibitor
Tucker 46
Side Effects
ranolazine
dizziness, headache, GI upset
Tucker 46
Nursing Considerations
ranolazine
Does not affect BP or HR.
Monitor QT interval.
May increase risk for dignoxin toxicity.
Tucker 46
Indications
ranolazine
Chronic angina that is unresponsive to other therapies
Tucker 46
MOA/Class
morphine
Binds to opioid receptors producing analgesia and sedation. Dilates pulmonary and systemic blood vessels. Decreases anxiety.
Tucker 26
Side Effects
morphine
respiratory depression, itching (from histamine release), orthostatic hypotension, CNS depression, constipation (with long-term use)
Tucker 26
Nursing Considerations
morphine
Antidote - naloxone
Monitor respiratory status, BP, neuro status, and oxygenation.
Tucker 26
Indications
morphine
pain
(adjunct management of anxiety, angina/HF, and air hunger)
Tucker 26
MOA/Class
spironolactone
Blocks the action of aldosterone in the renal tubule; creates loss of sodium (and water) while retaining potassium
Aldosterone antagonist/ K+ sparing diuretic
Tucker 51
Side effects
spironolactone
Hyperkalemia, hirsutism, gynecomastia, voice deepening, irregular menses
Tucker 51
Nursing Considerations
spironolactone
May be used in combination with loop diuretics to help offset potassium loss
Tucker 51
Indications
spironolactone
Ascites, HTN, nephrotic syndrome, HF, hyperaldosteronism
Tucker 51
MOA/Class
- Bisocodyl, senna
- Psyllium
- Magnesium formulations, lactulose, polyethylene glycol
- Docusate
- Bisocodyl, senna - stimulant laxative
- Psyllium - bulk-forming laxative
- Magnesium formulations, lactulose, polyethylene glycol- osmotic laxative
- Docusate - lubricant laxative
Tucker 58
Side Effects
- Bisocodyl, senna
- Psyllium
- Magnesium formulations, lactulose, polyethylene glycol
- Docusate
Diarrhea, cramping, bloating
Tucker 58
Nursing Considerations
- Bisocodyl, senna
- Psyllium
- Magnesium formulations, lactulose, polyethylene glycol
- Docusate
Contraindicated with acute abdominal disorders (risk for bowel rupture).
Overuse can lead to dependence.
Tucker 58
Indications
- Bisocodyl, senna
- Psyllium
- Magnesium formulations, lactulose, polyethylene glycol
- Docusate
Constipation
(lactulose - elevated serum ammonia)
Tucker 58
MOA/Class
alteplase
Activates tissue plasminogen to break down fibrin threads in formed clots
Thrombolytic / Tissue plasminogen activator
Tucker 48
Side Effects
alteplase
Bleeding!
Tucker 48
Nursing Considerations
alteplase
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.
Tucker 48
indications
alteplase
Treatment of active MI, PE, ischemic stroke (under specific circumstances)
Restoration of function in occluded central venous catheters (CVCs)
Tucker 48
