Monica - Final Exam: Anti-anginal, Anti-arrhythmic Flashcards
angina
coronary atherosclerosis leads to angina (chest pain):
- plaque impairs elasticity and dilation leading to myocardial ischemia, which deprives cells of needed O2 and nutrients
Angina is precipitated by ______ or _______.
exertion or stress
Angina can be relieved with _____ and ______.
rest (decreased cardiac demand) and nitrates
- pain relief with decreased cardiac workload and increased O2 supply
sxs of angina in men
pressure, squeezing, “crushing” pain, radiating pain felt on left side
dyspnea, diaphoresis, tachycardia
sxs of angina in women
sxs are not as clear with women:
flu-like symptoms, nausea, fatigue, back pain, jaw pain
Goal of tx of angina:
- inc. blood flow
- dec. myocardial O2 demand
- dec. duration + intensity of anginal pain
- minimize freq of attacks
- prevent MI
forms of rapid-acting nitroglycerin:
sublingual, spray
rapid-acting nitroglycerin forms are indicated for:
acute/emergency anginal episodes b/c SL and sprays bypass first pass.
forms of nitroglycerin for long-term management of angina:
PO, transdermal patch, isosorbide
nitroglycerin: action
- vasodilation
- dec. amount of blood returning to heart decreases workload and O2 demand
- inc. blood flow to coronary arteries
- inc. O2 supply
nitroglycerin: AEs
dizziness, *HA, tachycardia, hypotension
If a patient has a headache after taking nitroglycerin that means:
it’s working!
nitroglycerin: D-D interactions
concurrent use w/ sildenafil (Viagra), tadalafil (Cialis) increases risk of life-threatening hypotension
Nitrates should not be taken within ___ hours before or after using _____
24 hours of sildenafil or tadalafil
If an ER nurse needs to administer nitro to a patient, he should first ask:
if the patient has taken any medication for erectile dysfunction.
nitroglycerin: outcome
- decreased frequency and severity of anginal attacks
- increased activity tolerance
How should SL nitro tabs be stored?
in a dark container
When should SL nitro tabs be taken?
first sign of chest pain
SL nitro tabs may be repeated q__min for __ doses.
q5min x 3 doses
If anginal pain is not relieved by SL nitro tabs:
call 911
Nitroglycerin ointment is administered using
dosing paper. Based on the order, an amount in inches is spread onto the paper and applied to the chest wall.
When applying nitroglycerin ointment the RN should:
- wear gloves to prevent contact
- rotate sites
- removal all residual dose
- write dose, date, and initial
A transdermal nitro patch should be left on for __-__ hours and then:
left on for 12-14 hours and removed for 10-12 hours at night.
*NOC RN may need to look at original order to know what time to remove patch
alpha-1 receptors: location - action
vascular smooth muscle - vasocontriction
beta-1 receptors: location - action
heart - inc. conractility, HR, and conduction
kidney - inc. renin secretion
beta-2 receptors: location - action
vascular/non-vascular smooth muscle - bronchodilation
Why are non-selective beta blockers contraindicated for patient s with COPD?
block beta-2 receptors causing bronchoconstriciton
Adrenergic receptors include ____, _____, and _____ and are activated by _______.
alpha-1, beta-1, and beta-2 are activated by catecholamines (epinephrine, norepinephrine)
Beta-adrenergic antagonists are called “___ _______”
beta-blockers
Which beta blockers are cardioselective/cardioprotective? Why?
selective beta-1 blockers b/c they protect the heart from catecholemines (epi/NE) by blocking beta-1 adrenergic receptors:
- decreasing HR
- reducing the force of contraction (dec. CO and O2 demand)
- prevents renin release (dec. BP)
Selective beta-1 blockers may slow conduction of the heart.
True - decreased electrical impulses may lead to cardiac dysrhythmias
beta blocker drug names end in:
-lol
beta-1 blocker: atenolol
indications
- HTN
- angina
- prevention of MI
beta-1 blocker: metoprolol
indications
- HTN
- angina
- prevention of MI
- dec. mortality if recent MI
- manage stable HF
beta-1 blockers (atenolol, metoprolol): AEs
dizziness, bradycardia, hypotension, erectile dysfunction, hypo/hyperglycemia, bronchospasm, wheezing
beta-1 blockers (atenolol, metoprolol): D-D interactions
anti-HTN, nitrates - hypotension
digoxin, CCB - bradycardia
hypoglycemics - fluctuations in glucose levels
beta-1 blockers (atenolol, metoprolol): implementation
- assess apical pulse (1 min)
- hold if < 50 bpm or arrhythmia
- abrupt d/c can cause rebound HTN, angina, life-threatening arrhythmia
beta-1 blockers (atenolol, metoprolol): outcome
- dec BP and HR
- dec frequency of angina
- prevention of MI
- *only metoprolol - maintain stable HF
Beta-blockers are classified as _______ and _______.
antianginals, antihypertensives
non-selective beta-blocker: prototypical drug
carvedilol (Coreg)
non-selective beta-blockers block ______, ______, and ______ receptors.
beta-1
beta-2
alpha-1
carvedilol: indications
- HTN
- management of HF (when unstable)
- left ventricular function after MI (low EF, heart is not able to pump enough blood to meet the needs of the body)
Which drug would be more appropriate for a patient with unstable HF, metoprolol or carvedilol?
carvedilol
Non-selctive beta-blockers have the same side effects as selective beta-blockers, in addition to _____ ______.
orthostatic hypotension
Why do non-selective beta-blockers (carvedilol) cause orthostatic hypotension?
They block alpha-1 receptors leading to vasodilation.
Non-selective beta-blockers (carvedilol) have the same drug-drug interactions as selective.
True - anti-HTN/nitrates increased hypotension; digoxin/CCB leads to bradycardia; hypoglycemics leads alterations in glucose levels
carvedilol: contraindications
asthma and other bronchospastic disorders
- b/c carvedilol blocks beta-2 receptors causing bronchoconstriction
carvedilol: outcome
- decreased HR and BP
- improved CO
- slowing severity of HF
calcium channel blocker (CCB): prototypical drug
diltiazem (Cardizem)
prototypical selective beta-1 blockers
atenolol, metoprolol
prototypical nonselective beta-blocker
carvedilol
diltiazem: indications
- HTN
- angina
- supraventricular tachyarrhythmia (SVT)
- rapid ventricular rates (RVR) in Afib
- SVT w/ RVR means heart is erratic and ineffective
diltiazem: action
- inhibits transport of Ca+ into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and contractions
- slows cardiac conduction
- vessel vasodilation
- coronary artery vasodilation: inc O2 supply and dec O2 demand
diltiazem: outcomes
- dec BP
- dec frequency and severity of anginal attacks
- prevention of tacharrythmia
diltiazem: AEs
dizziness, arrhythmias, peripheral edema, sexual dysfunction
diltiazem: D-D interactions
- ant-HTN, nitrates - inc. hypotension
- beta-blockers, digoxin - risk of bradycardia
diltiazem: implementations
- assess BP and HR
HOLD if: - SBP < 90
- HR < 50 bpm
prototypical cardiac (digitalis) glycoside
digoxin
digoxin: indication
- HF
- atrial fibrillation
digoxin: action and outcome
- increased force of myocardial contraction
- increased CO, increased EF
- slows contraction
digoxin: outcome
- increase CO
- decrease severity of HF
- decrease ventricular response
digoxin: AEs
fatigue, bradycardia, anorexia, n/v
digoxin: D-D interactions
concurrent use w/ beta-blockers and other anti-arrhythmics - bradycardia and inc. digoxin levels
What labs need to be monitored with digoxin?
electrolytes: hypoK+ and hypoMg+ can increase the risk of digoxin toxicity
digoxin: implementation
- assess apical pulse
- HOLD if <60 bpm
- drug monitoring
digoxin: therapeutic levels
very narrow! 0.5 - 2 ng/ml
sxs of digoxin toxicity
abd pain, anorexia, n/v, bradycardia, visual disturbances (ex. yellow/green halos)
How is digoxin toxicity treated?
It depends of the severity of sxs.
May only require d/c-ing the drug OR, if life-threatening, may require the antidote.
What is the antidote for digoxin?
digoxin immune Fab
digoxin: drug-food interaction
high-fiber meal may decrease absorption
Digoxin immune Fab
Digibind, DigiFab
IV - complex formed with digoxin that prevents the drug from reaching tissues
- excreted by kidneys
* serum dig levels not valid 5-7 days after administration - assess for dig toxicity
Digoxin immune Fab: AE
hypokalemia
