module two meds Flashcards
what meds do you use for heart failure?
diuretics, angiotensin system blockers, beta-adrenergic blockers, & cardiac glucoside (second line treatment)
diuretic: loop diuretic
med: furosemide
indication: HF, HTN (reducing vol= goal)
action: reduce bv
-increase Na + H2O excretion
-decrease venous pressure, arterial pressure (after load), pul edema, per edema, cardiac dilation)
adverse effects: hypokalemia, hypotension, digoxin toxicity
considerations:
-oral or IV
-assess serum K level before/after admin (hold if <3.5 mEg/L)
-may need to give K sup
-promote rapid diuresis
diuretic: thiazide diuretic
med: hydrochlorothiazide
indication: HTN
action: reduce bv & arterial res
-low GFR -> not effective
adverse effects: hypokalemia, dehydration, hyperglycemia, hyperuricemia
consideration: assess K+ level before (hold if <3.5 mEg/L)
diuretic: aldosterone antagonist
med: spironolactone
indication: HTN, HF
action:
-aldosterone receptor blocker
-promote Na+ Cl excretion (K sparing)
-promote renal retention of K+
adverse effects: hyperkalemia
consideration: assess K+ level before (hold if >5.5 mEg/L)
angiotensin system blockers: ACE I
med: enalapril, lisinopril, captopril
indication: HTN, HF, MI
-nephropathy (slows progression)
-prevention of MI, stroke, death w/ high CV risk
-diabetic retinopathy (slows progression)
action:
-prevent form of AT II-mediated vasoconstriction
-block aldosterone-mediated vol expansion
-increase levels of bradykinin
adverse effects: cough, angioedema (rare; mouth, tongue, lips), renal failure w/ renal art stenosis, fetal injury
considerations:
-assess BP before/after admin
-watch for “first dose” hypotension
-take on empty stomach
-assess K+ levels before (hold if >5.5 mEg/L)
-KD -> reduce dose
angiotensin system blockers: angiotensin receptor blocker
med: losartan, valsatan
indicator: HTP, HF, MI
-nephropathy (slows progression)
-prevention of MI, stroke, death w/ high CV risk
-diabetic retinopathy (slows progression)
action: block action of AT II @ receptor site
adverse effects: angioedema (rare; mouth, tongue, lips), renal failure w/ renal art stenosis, fetal injury
consideration: assess BP before/after
angiotensin system blockers: AT receptor blocker (cont.)
med: sacubitril/valsartan
-valsartan + sacubitril= neprilvsin inhibitor
indication: chronic, advance HF, EF <40%
action:
-neprilysin inhibitor (increased levels of NPs)
-blocks harmful effects of RAAS (valsartan)
-permit ben effects of NPs (sacubitril)
adverse effects: hypotension, hyperkalemia, cough, renal impairment
considerations: may need to reduce dose in renal & hepatic dysfunc
-don’t take if pregnant
beta-adrenergic blockers: cardioselective beta blocker
med: metoprolol
-cardiac selective= atenolol, metoprolol, bisoprolol, esmolol
indication:
-excessive symp activity -> dysrhythmias
-prevent vent arrhythmias
-reduce mortality in MI & HF pt
-hypertension
A: reduce automaticity in SA node, slow conduction velocity in AV node, reduce contractility in atria & ven
-blocks beta-adrenergic receptors
-overall reducing SNS influence
-decrease cardiac workload & O2 consumption
adverse effects:
-airway= laryngospasm
-CNS= fatigue, dizziness
-CV= bradycardia, HF, dysrhythmias SA/AV node blocks, hypotension
-asthma= blocking B2 receptors in lungs -> bronchospasm
considerations:
-assess BP, HR, rhythm before/after (notify HCP if <60 bpm)
-prolong PR, bradycardia
-propranolol= contraindicated for pt w/ asthma, sinus bradycardia, high-degree heart block, HF
2nd line treatment: cardiac glycoside
med: digoxin
indication: supraven dysrhythmias (a-fib), HF
action:
-vagotonic effect (decreased O2 demand -> VG nerve stem (PNS) -> decreased HR -> a-fib)
-positive inotropic effect (increased contraction force -> inhibit Na+K+ pump 0> increased intracell Na -> decreased act of Na+ Ca2+ exchange -> increased intracell Ca2+ -> increased act of contractile elements)
indication:
-cardiac= cardiotoxicity (dysrhythmias- v.flutter or v.fib= most dangerous; risk increased by hypokalemia; bradycardia common)
-CNS= fatigue
-GI: anorexia, nausea, vomiting, abdominal discomfort
-vision: visual disturbances (yellowish hue)
consideration:
-assess apical pulse for full min before (hold & notify HCP if <60 bpm)
-assess K levels (normal range= 3.5-5 mEg/L)
-digoxin level= 0.5-1.1 ng/mL
-prolongs PR int, QT may be shortened, ST seg dep/inverted
-assess drug-drug interaction (potentiate bradycardia & hypokalemic effects of other meds)
-digoxin immune FAB for toxic levels (>2.0 ng/mL), D/C drug until toxicity resolves
-contraindicated: 2nd & 3rd degree heart block, sick sinus syndrome
what meds do you use for CHD?
organic nitrates, anti-platelet therapy
organic nitrates: nitrates
meds: nitroglycerine, isosorbide dinitrate
indication: stable & variant angina, unstable angina/MI
action: extracell nitrate binds w/ intracell nitrate-> nitric acid -> VSM relax -> venous vasodilation -> reduce preload -> decrease cardiac O2 demand
adverse effects: headache, orthostat hypotension, reflex tachycardia secondary to lower BP
-alcohol: sev hypotension, CV collapse
-many drug-drug interactions= sev
-PDE 5 inhibitors (ED drugs): sildenafil -> profound vasodilation, hypotension
-beta-blockers & CCB: block reflex tachycardia, may promote hypotension
-heparin: decrease anticoag
-lithium: possible lith toxicity
-fentanyl: SEV hypotension, increased fluid req
considerations:
-assess HR, BP before admin
-SL acute angina: tabs btw cheek/lip & gum (don’t swallow, 1 tab q5min x3, call 911 if CP cont.)
-creams & patches (12 hrs on/off)
-no alcohol
-slow position changes, orthostat hypotension
-headaches (no -> NTC may not be working)
-pt edu!
anti-platelet therapy: thromboxane A2 inhibitors
med: aspirin
indication: thrombosis prevention in
-ischemic stroke, TIA’s, chronic stable angina, unstable angina, coronary stenting, MI
action: inhibit synthesis of prostaglandins
-suppress COX & platelet aggregation (synthesize thromboxane A2 -> platelet aggregation)
-irreversible (life of platelet= 7-10 days)
adverse effects: GI bleeding, hem stroke
considerations:
-dose 325 mg PO initially in acute event -> 81 mg/day (maintenance dosing)
-enteric coating may not prevent GI bleeding
anti-platelet therapy: adenosine diphosphate receptor antagonists
med: clopidogrel
indication: prophylaxis
-reduce MI, stroke, & blood clots in pt w/ hx atherosclerosis & blood clots or placement of stents
action: irreversibly blocks ADP receptor on platelet surface
-inhibit platelet aggregation
adverse effects: bleeding or hem, GI distress
considerations:
-can use in combo w/ 81mg aspirin therapy for prophylaxis
-must be discount before & some dental procedures -> avoid excessive bleeding
-edu pt on bleeding precautions: use soft toothbrush, electric razor; wear med alert bracelet; bruise when falling or running into; notify Dr or go to hospital if in accident or head trauma
