Medications: Cardiovascular Flashcards
What are the drug classes of Acetylsalicyclic Acid (ASA) aka Aspirin
Anti-Platelet Aggregator
Salicylate
NSAID
Of its many drug classes, which is the reason ASA (Aspirin) is given for cardiovascular health?
Anti-Platelet Aggregator
How does ASA (Aspirin) work in the body as an Anti-Platelet Aggregator?
Inhibits platelet aggregation in the arteries
How does ASA (Aspirin) work in the body as a Salicylate and a NSAID
Inhibits prostaglandin synthesis to reduce pain and fever
What route is ASA (Aspirin) administered? When is it administered?
Given PO
Given daily for anti-platelet aggregator effects
Given daily or PRN for salicylate and NSAID effects
What lab should be monitored when the patient is taking daily ASA (Aspirin)
Platelets
What complications are ideally being prevented by administering a daily ASA (Aspirin)
Transischemic Attack (TIA)
Stroke
Myocardial Infarction (MI)
Coronary Artery Disease (CAD)
When a patient takes ASA (Aspirin) or Plavix (Clopidogrel) daily, what are they at increased risk for? What education needs to be provided?
Increased risk for bleeding
Educate the patient on increased bruising and bleeding more easily
Educate the patient on s/s of bleeding (blood in urine or stool)
If a patient presents with s/s of bleeding, what labs must the nurse assess?
Hemoglobin
Hematocrit
RBCs
Platelets
What is the drug class of Plavix (Clopidogrel)?
Anti-Platelet Aggregator
How does Plavix (Clopidogrel) work in the body?
Inhibits platelet aggregation in the arteries
What complications are ideally being prevented by administering a daily Plavix (Clopidogrel)?
Transischemic Attack (TIA) Stroke Myocardial Infarction (MI) Coronary Artery Disease (CAD) Stenosis of coronary stents
What are medications that fall under the drug class of a statin?
Simvastatin (Zocor)
Atorvastatin (Lipitor)
Pravastatin (Pravachol)
What drug class are the following medications:
Simvastatin (Zocor)
Atorvastatin (Lipitor)
Pravastatin (Pravachol)
Statin
How does a statin work?
Reduces LDL and total cholesterol by reducing cholesterol synthesis in the liver
Statins can increase HDL levels
Statins can decrease triglyceride level
How is a statin administered? When is it administered? Why?
Administered PO
Administered daily, at night; because this is when cholesterol synthesis is the highest
What labs need to be monitored when a patient is taking a statin?
HDL, LDL, Triglycerides, Total Cholesterol: These labs will tell us how well the statin is working
AST, ALT, ALP: These labs will tell us if liver function is impaired (statins are hepatotoxic)
How long must a patient remain on a statin?
Lifelong, unless other measures (like diet and exercise) are taken to reduce cholesterol.
If high cholesterol is genetic, modifiable risk factors will not change cholesterol levels
What medications fall under the drug class of a loop diuretic?
Bumetanide (Bumex)
Furosemide (Lasix)
Tosemide (Demadex)
The medications Bumetanide (Bumex), Furosemide (Lasix), and Tosemide (Demadex) are in what drug class?
Loop Diuretic
How does a loop diuretic work?
It is a potent diuretic
It increases renal secretion of sodium, chloride, potassium, and water
It increases urine output - thus removing fluid from the body
When fluid is removed, it will decrease intravascular fluid volume, thus lowering blood pressure and decreasing cardiac workload
About how long does it take for diuresis to begin after administration of a PO loop diuretic? How long will it work in the body?
Diuresis begins in about 60 minutes
Lasts about 8 hours
What are some reasons diuretic (all types) are given?
To manage: Hypertension Chronic Heart Failure Pulmonary Edema Edema
When can diuretics be given during the day?
They can be given daily or multiple times a day
If only given once a day it should be scheduled in the morning to prevent nocturia
What vital sign should be assessed before and after administering any type of diuretic?
Blood pressure
What should be monitored when a patient is taking any type of diuretic?
Blood pressure; monitor for hypotension Intake and output Signs and symptoms of dehydration Weight daily Electrolyte levels S/s of electrolyte imbalances
What medications fall under the drug class of a Thiazide diuretic?
Hydrochlorothiazide - aka HCTZ - (Microzide or Hydrouril)
Chlorothiazide (Diuril)
Metolazone
The medications Hydrochlorothiazide - aka HCTZ - (Microzide or Hydrouril), Chlorothiazide (Diuril) and Metolazone are in what drug class?
Thiazide Diuretic
How does a Thiazide diuretic work?
It increases renal secretion of sodium, chloride, potassium, and water
It increases urine output - thus removing fluid from the body
When fluid is removed, it will decrease intravascular fluid volume, thus lowering blood pressure and decreasing cardiac workload
What is the difference between a Thiazide diuretic and a Loop diuretic?
A loop diuretic is much more potent than a Thiazide diuretic, it does not produce as much diuresis
Thiazide diuretics aren’t effective in decreased kidney function
About how long does it take for diuresis to begin after administration of a PO Thiazide diuretic? How long will it work in the body?
Diuresis begins about 2 hours after administration
Works up to 12 hours
What medication falls under the drug class of a Potassium Sparing diuretic?
Spironolactone (Aldactone)
The medication Spironolactone (Aldactone) is in what drug class?
Potassium Sparing Diuretics
How does a Potassium Sparing Diuretic work?
Blocks actions of aldosterone
Increased excretion of sodium and fluid
Retains potassium
What foods should be avoided when the patient is taking a potassium sparing diuretic?
Foods rich in potassium
What medications fall under the drug class of an Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor)?
Lisinopril (Prinivil)
Enalapril (Vasotec)
Captopril (Capoten)
Quinapril (Accupril)
The medications Lisinopril (Prinivil), Enalapril (Vasotec), Captopril (Capoten), and Quinapril (Accupril) are in what drug class?
Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor)
How does an Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor) work?
It blocks synthesis of Angiotensin II
This prevents vasocontriction (promotes vasodilation of arteries –> decreased blood pressure)
Prevents release of aldosterone (increased excretion of sodium and fluid, decreased fluid volume –> decreased blood pressure)
These actions ultimately reduce peripheral vascular resistance which decreases blood pressure
Cardiac workload decreases
Why is an Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor) given?
Treatment of:
Hypertension
Chronic Heart Failure
What symptoms does the nurse need to educate on and monitor for when the patient is taking an Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor)
New-onset dry, irritating, persistent, nonproductive cough
Angioedema (swollen tongue and lips, narrowed airway –> emergency!)
What vital signs should be assessed before and after administration of an Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor)
Blood pressure
Monitor for hypotension
What electrolyte does an Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor) retain? What imbalance should be monitored for?
Potassium
Monitor for s/s of hyperkalemia
What medications fall under the drug class of an Angiotensin II Receptor Blocker (ARB)?
Candesartan (Atacand)
Losartan (Cozaar)
Olmesartan (Benicar)
The medications Candesartan (Atacand), Losartan (Cozaar), and Olmesartan (Benicar) are in what drug class?
Angiotensin II Receptor Blocker (ARB)
How does an Angiotensin II Receptor Blocker (ARB) work?
Blocks Angiotensin II Receptors
Prevents Angiotensin II from binding to receptors
Promotes vasodilation (reduces blood pressure)
Decreased release of aldosterone (increases excretion of sodium and fluid –> reduces fluid volume –> decreases blood pressure)
These actions ultimately reduce peripheral vascular resistance which decreases blood pressure
Cardiac workload decreases
Why is an Angiotensin II Receptor Blocker (ARB) given?
Treatment of:
Hypertension
Chronic Heart Failure
What symptoms does the nurse need to educate on and monitor for when the patient is taking an Angiotensin II Receptor Blocker (ARB)?
New-onset dry, irritating, persistent, nonproductive cough
Angioedema (swollen tongue and lips, narrowed airway –> emergency!)
What electrolyte does an Angiotensin II Receptor Blocker (ARB) retain? What imbalance should be monitored for?
Potassium
Monitor for s/s of hyperkalemia
What vital signs should be assessed before and after administration of an Angiotensin II Receptor Blocker (ARB)
Blood pressure
Monitor for hypotension
Would a patient be prescribed both an Angiotensin II Receptor Blocker (ARB) and an Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor)?
No, they have the same actions on the body.
What medications fall under the drug class of a Calcium Channel Blocker (CCB)?
Amlodipine (Norvasc)
Nicardipine (Cardene)
Nifedipine (Procardia)
Diltiazem (Cardizem)
The medications Amlodipine (Norvasc), Nicardipine (Cardene), Nifedipine (Procardia), and Diltiazem (Cardizem) are in what drug class?
Calcium Channel Blocker (CCB)
How does a Calcium Channel Blocker (CCB) work?
Prevents movement of extracelluar calcium from entering the cell (cardiac cells, smooth muscle cells)
Promotes vasodilation (decreases blood pressure) Decreases afterload (decreases cardiac workload and blood pressure) Slows cardiac conduction system (decreases contractility of the myocardium, decreases cardiac workload, decreased myocardial oxygen demand)
Why is a Calcium Channel Blocker (CCB) given?
To treat:
Hypertension
Cardiac dysrhythmias (atrial fibrillation)
What symptoms does the nurse need to educate on and monitor for when the patient is taking a Calcium Channel Blocker (CCB)?
Monitor and educate on cardiac dysrhythmias and bradycardia
What vital signs should be assessed before and after administration of a Calcium Channel Blocker (CCB)
Blood pressure and heart rate
Monitor for hypotension and bradycardia
When should a Calcium Channel Blocker (CCB) not be given?
If the heart rate is less than 60 bpm
What medications fall under the drug class of a Beta Blocker? (differentiate between cardio selective and non selective)
Cardio Selective:
Metoprolol Tartrate (Lopressor)
Metoprolol Succinate Extended Release (Toprol XL)
Atenolol (Tenormin)
Non Selective:
Propranolol
The medications Metoprolol Tartrate (Lopressor)
Metoprolol Succinate Extended Release (Toprol XL)
Atenolol (Tenormin), and Propranolol are in what drug class?
Beta Blocker
How does a Beta Blocker work?
Blocks beta receptors from binding to epinephrine, which causes: Decreased heart rate Decreased cardiac output Decreased cardiac workload Decreased myocardial oxygen demand Prevents release of renin
Indirectly decreases blood pressure
Why is a Beta Blocker given?
To treat:
Hypertension
Tachycardia
What symptoms does the nurse need to educate on and monitor for when the patient is taking a Beta Blocker?
Monitor and educate on hypotension and bradycardia
Hypoglycemic Unawareness in Diabetics
What vital signs should be assessed before and after administration of a Beta Blocker
Heart rate and blood pressure
When should a Beta Blocker not be given?
If heart rate is less than 60 bpm
If blood pressure is less than 100 mmHg systolic
Do not administer a nonselective beta blocker (propranolol) to a patient with asthma or COPD
What medications fall under the drug class of a combo drug (Alpha and Beta Blocker)?
Carvedilol
Labetalol
The medications Carvedilol and Labetalol are in what drug class?
Combo drug (Alpha and Beta Blocker)
How does a combo drug (Alpha and Beta Blocker) work?
Blocks alpha and beta receptors from binding to epinephrine, which causes the follow effects
Beta Antagonist Actions: Decreased heart rate Decreased cardiac output Decreased cardiac workload Decreased myocardial oxygen demand Prevents release of renin
Indirectly decreases blood pressure
Alpha Antagonist Actions:
Promotes vasodilation of arteries (decreased blood pressure)
Why is a combo drug (Alpha and Beta Blocker) given?
To treat:
Hypertension
Tachycardia
What symptoms does the nurse need to educate on and monitor for when the patient is taking a combo drug (Alpha and Beta Blocker)?
Monitor and educate on hypotension and bradycardia
Hypoglycemic Unawareness in Diabetics
What vital signs should be assessed before and after administration of a combo drug (Alpha and Beta Blocker)
Heart rate and blood pressure
When should a combo drug (Alpha and Beta Blocker) not be given?
If heart rate is less than 60 bpm
If blood pressure is less than 100 mmHg systolic
Do not administer a nonselective beta blocker (propranolol) to a patient with asthma or COPD
Are combo drugs (Alpha and Beta Blocker) cardio selective or non selective?
Non selective
How does a direct vasodilator work?
Relaxes smooth muscle (arteries)
Vasodilates arteries, decreases blood pressure
What medication falls under the drug class of an Antidysrhythmic Agent?
Amiodarone (Cordarone or Pacerone)
The medications Amiodarone (Cordarone or Pacerone) are in what drug class?
Antidysrhythmic Agent
How does an Antidysrhythmic Agent work?
Decreases cardiac contractility
Promotes dilation of coronary arteries and peripheral blood vessels
Controls rhythm and rate during atrial fibrillation
Why is an Antidysrhythmic Agent given?
To control heart rate and rhythm
What vital signs should be assessed before and after administration of an Antidysrhythmic Agent
Blood pressure and heart rate
Also need to assess heart rhythm
What medication falls under the drug class of a Cardiac Glycoside/Inotrope?
Digoxin (Lanoxin)
The medication Digoxin (Lanoxin) is in what drug class?
Cardiac Glycoside/Inotrope
Why is a Cardiac Glycoside/Inotrope given?
To control heart failure
What symptoms does the nurse need to educate on and monitor for when the patient is taking a Cardiac Glycoside/Inotrope
Digitalis Toxicity
Bradycardia
S/S of hypokalemia
How does a Cardiac Glycoside/Inotrope work?
Increases the force of contraction within the ventricles
Increases stroke volume
This increases cardiac output so that heart rate can decrease and heart doesn’t have to work as hard
Heart works smarter not harder.. each beat/pump of the ventricles is efficient, so its rate doesn’t have to increase to maintain cardiac output.
What education needs to be given to the patient when they are taking a Cardiac Glycoside/Inotrope?
Take the medication at the same time each day
Educate on the signs and symptoms of Digitalis Toxicity
If Digitalis Toxicity s/s are present, report ASAP
Monitor heart rate before taking the medication, do not take if <60 bpm
What serum levels should be monitored when the patient is taking Digoxin? What is the appropriate range?
Digoxin Levels
Should be between 0.8-2.0 ng/mL
If serum Digoxin levels are < 0.8 ng/mL, what does this mean?
There is not enough medication in the body, the medication is not working to its full potential
If serum Digoxin levels are > 2.0 ng/mL, what does this mean?
The patient is at risk for or may have developed Digitalis Toxicity. This needs to be treated immediately
What vital signs should be assessed before and after administration of a Cardiac Glycoside/Inotrope
Heart rate
Do not administer if heart rate is <60 bpm
Monitor for bradycardia
What can cause Digitalis Toxicity?
High serum levels of Digoxin
List the signs and symptoms of Digitalis Toxicity. If these symptoms occur, what does the nurse do?
Bradycardia
Anorexia (Loss of appetite)
Nausea, Vomiting, Diarrhea
Abdominal Discomfort
Blurred vision, yellow/green halos visualized
Fatigue
Confusion
Decreased LOC
If these s/s are noted or reported the nurse must inform the provider
What is the drug class of the medication Nitroglycerin
Direct Vasodilator
How does Nitroglycerin work?
Promotes vasodilation of veins and arteries to reduce preload and afterload
Reduces oxygen consumption of myocardial tissue
Improves oxygen delivery to tissues
Why is Nitroglycerin given?
To prevent or treat angina
What must you assess before and after Nitroglycerin administration?
BP, HR, pain level
