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MSII Medication Review > Lewis 37 - CAD and ACS > Flashcards

Lewis 37 - CAD and ACS Flashcards

1
Q

MOA/Class

atorvastatin, simvastatin, rosuvastatin

A

Decreased cholesterol production by the liver

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

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2
Q

Side Effects

atorvastatin, simvastatin, rosuvastatin

A

Hepatotoxicity, myopathy/rhabdomyolysis, GI upset

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3
Q

Nursing Considerations

atorvastatin, simvastatin, rosuvastatin

A

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

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4
Q

Indications

atorvastatin, simvastatin, rosuvastatin

A

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

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5
Q

MOA/Class

Niacin

A

Unknown

B Vitamin (B3)

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6
Q

Side Effects

Niacin

A

Flushing, pruritis, GI upset
Orthostatic hypotension

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7
Q

Nursing Considerations

Niacin

A

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

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8
Q

Indications

Niacin

A

Hypercholesterolemia

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9
Q

MOA/Class

fenofibrate, gemfibrozil

A

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

Fibrate/Fibric acid derivative

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10
Q

Side Effects

fenofibrate, gemfibrozil

A

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

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11
Q

Nursing Considerations

fenofibrate, gemfibrozil

A

May increase bleeding risk when used with anticoagulants

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12
Q

Indications

fenofibrate, gemfibrozil

A

Hypercholesterolemia

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13
Q

MOA/Class

cholestyramine, colesevelam, colestipol

A

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

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14
Q

Side Effects

cholestyramine, colesevelam, colestipol

A

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

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15
Q

Nursing Considerations

cholestyramine, colesevelam, colestipol

A

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

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16
Q

Indications

cholestyramine, colesevelam, colestipol

A

Hypercholesterolemia, pruritis due to biliary dysfunction

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17
Q

MOA/Class

ezetimibe

A

Inhibits cholesterol absorption from the GI tract

Cholesterol absorption inhibitor

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18
Q

Side Effects

ezetimibe

A

GI upset, myalgia, hepatotoxicity

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19
Q

Nursing Considerations

ezetimibe

A

Multiple medication interactions. Monitor liver function.

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20
Q

Indications

ezetimibe

A

Hypercholesterolemia

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21
Q

MOA/Class

Aspirin (ASA)

A

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

Salicylate

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22
Q

Side Effects

Aspirin (ASA)

A

GI upset, bleeding, salicylism

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23
Q

Nursing Considerations

Aspirin (ASA)

A

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.

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24
Q

Indications

Aspirin (ASA)

A

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

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25
Q

MOA/Class

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

A

Increases coronary blood flow through healthy arteries and decreases cardiac workload through decreased SVR/afterload (through vasodilation)

Nitrate

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26
Q

Side Effects

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

A

Hypotension, orthostatic hypotension, reflex tachycardia, headache.

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27
Q

Nursing Considerations

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

A

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.

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28
Q

Indications

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

A

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

Tucker 46

29
Q

MOA/Class

lisinopril, enalapril, captopril, etc.

A

Prevents conversion of angiotensin 1 to angiotensin 2 (causing vasodilation)

Angiotensin-Converting Enzyme (ACE) Inhibitor

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30
Q

Side Effects

lisinopril, enalapril, captopril, etc.

A

Dry cough
Hyperkalemia
First-dose hypotension, orthostatic hypotension
Angioedema

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31
Q

Nursing Considerations

lisinopril, enalapril, captopril, etc.

A
  • 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.

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32
Q

Indications

lisinopril, enalapril, captopril, etc.

A

Hypertension; Decrease cardiac workload; Prevent/limit ventricular remodeling

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33
Q

MOA/Class

losartan, valsartan, etc.

A

Blocks the binding of A2 to receptors

Angiotensin II Receptor Blocker (ARB)

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34
Q

Side Effects

losartan, valsartan, etc.

A

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

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35
Q

Nursing Considerations

losartan, valsartan, etc.

A

Avoid potassium supplements
Like ACEIs, most important to monitor BP

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36
Q

Indications

losartan, valsartan, etc.

A

Hypertension; Decrease cardiac workload; Prevent/limit ventricular remodeling

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37
Q

MOA/Class

atenolol, esmolol, metoprolol

A

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

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38
Q

Side Effects

atenolol, esmolol, metoprolol

A

fatigue, dizziness, bradycardia, impotence

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39
Q

Nursing Considerations

atenolol, esmolol, metoprolol

A

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

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40
Q

Indications

atenolol, esmolol, metoprolol

A

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

Tucker 31

41
Q

MOA/Class

amlodipine, nicardipine, nifedipine
diltiazem, verapamil

A

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)

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42
Q

Side Effects

amlodipine, nicardipine, nifedipine
diltiazem, verapamil

A

Dizziness, headache, peripheral edema, bradycardia/heart block, flushing, nausea, hypotension

Calcium channel blocker (CCB)

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43
Q

Nursing Considerations

amlodipine, nicardipine, nifedipine
diltiazem, verapamil

A

Nifedipine is safe to use during pregancy to treat high BP.
Diltiazem can increase toxicity of cyclosporine.

Calcium channel blocker (CCB)

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44
Q

Indications

amlodipine, nicardipine, nifedipine
diltiazem, verapamil

A

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)

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45
Q

MOA/Class

ranolazine

A

Decreases myocardial workload

Sodium current inhibitor

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46
Q

Side Effects

ranolazine

A

dizziness, headache, GI upset

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47
Q

Nursing Considerations

ranolazine

A

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

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48
Q

Indications

ranolazine

A

Chronic angina that is unresponsive to other therapies

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49
Q

MOA/Class

morphine

A

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

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50
Q

Side Effects

morphine

A

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

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51
Q

Nursing Considerations

morphine

A

Antidote - naloxone
Monitor respiratory status, BP, neuro status, and oxygenation.

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52
Q

Indications

morphine

A

pain
(adjunct management of anxiety, angina/HF, and air hunger)

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53
Q

MOA/Class

spironolactone

A

Blocks the action of aldosterone in the renal tubule; creates loss of sodium (and water) while retaining potassium

Aldosterone antagonist/ K+ sparing diuretic

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54
Q

Side effects

spironolactone

A

Hyperkalemia, hirsutism, gynecomastia, voice deepening, irregular menses

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55
Q

Nursing Considerations

spironolactone

A

May be used in combination with loop diuretics to help offset potassium loss

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56
Q

Indications

spironolactone

A

Ascites, HTN, nephrotic syndrome, HF, hyperaldosteronism

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57
Q

MOA/Class

  • Bisocodyl, senna
  • Psyllium
  • Magnesium formulations, lactulose, polyethylene glycol
  • Docusate
A
  • Bisocodyl, senna - stimulant laxative
  • Psyllium - bulk-forming laxative
  • Magnesium formulations, lactulose, polyethylene glycol- osmotic laxative
  • Docusate - lubricant laxative

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58
Q

Side Effects

  • Bisocodyl, senna
  • Psyllium
  • Magnesium formulations, lactulose, polyethylene glycol
  • Docusate
A

Diarrhea, cramping, bloating

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59
Q

Nursing Considerations

  • Bisocodyl, senna
  • Psyllium
  • Magnesium formulations, lactulose, polyethylene glycol
  • Docusate
A

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

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60
Q

Indications

  • Bisocodyl, senna
  • Psyllium
  • Magnesium formulations, lactulose, polyethylene glycol
  • Docusate
A

Constipation
(lactulose - elevated serum ammonia)

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61
Q

MOA/Class

alteplase

A

Activates tissue plasminogen to break down fibrin threads in formed clots

Thrombolytic / Tissue plasminogen activator

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62
Q

Side Effects

alteplase

A

Bleeding!

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63
Q

Nursing Considerations

alteplase

A

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.

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64
Q

indications

alteplase

A

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

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MSII Medication Review (13 decks)

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