Pharm: Cardiac

Question 1

what is the name of a cardiac glycoside?

Answer 1

digoxin (digitalis preparations)

Question 2

digoxin has positive inotropic effects. What is that?

Answer 2

increases myocardial contractility

Question 3

digoxin has negative chronotropic effects. What is that?

Answer 3

decreases (slows) heart rate

Question 4

take what before digoxin admin?

Answer 4

apical pulse for 60 sec (baseline pulse)

Question 5

do not give digoxin when pulse is what?

Answer 5

<60 or >100

Question 6

digoxin is contraindicated when pt has what kind of HF?

Answer 6

diastolic HF

Question 7

most worrisome side effect of digoxin?

Answer 7

bradycardia (no perfusion)

Question 8

digoxin has a ____ therapeutic window

Answer 8

short

Question 9

___ lvls drawn prior to digoxin admin

Answer 9

dig

Question 10

true or false: digoxin has a long 1/2 life, increasing the risk for toxicity

Answer 10

true.

Question 11

other than dig lvl, what other serum lvl should we look at before admin of digoxin?

Answer 11

potassium (hypokalemia can precipitate dig toxicity)
<3.5

Question 12

chest pain that occurs with exertion and is predictable

Answer 12

stable angina

Question 13

chest pain that occurs frequently w/ progressive severity unrelated to activity (unpredictable)

Answer 13

unstable angina

Question 14

chest pain due to abnormal coronary artery spasm (vasospastic), occurs during rest

Answer 14

prinzmetal (variant)

Question 15

antianginal drugs that promote vasodilation, decrease workload on heart, and decrease pressure in vessels

Answer 15

nitrates

Question 16

routes of admin of nitrates

Answer 16

-SL, TL (top surface of tongue), topical, aerosol spray (inhalation), IV
-buccal and oral extended release

Question 17

process of taking nitro before calling EMS?

Answer 17

1) 1 dose SL of nitro
2) wait 5 min
do steps 1 and 2 (x3), and if chest pain continues, call EMS

Question 18

true or false: do not obtain baseline vitals before nitrate admin

Answer 18

false. Take vitals before admin, especially BP because of the risk of hypotension from the vasodilation

Question 19

what position should the pt be in when taking a nitrate?

Answer 19

sitting or lying down (bc of hypotensive effect)

Question 20

what serum lab has to be monitored while on nitrates?

Answer 20

potassium (normal = 3.5-5)
effects contractility and rhythm of heart

Question 21

digoxin antidote

Answer 21

immune FAB (DSFab)

Question 22

serum digs lvls should be what for dysrhythmias and for HF

Answer 22

dysrhythmias= 0.8-2 ng/mL
HF= 0.5-1 ng/mL

Question 23

meds that reduce hypertension and decrease edema

Answer 23

diuretics

Question 24

type of diuretic that act on the ascending loop of Henle (in kidneys)

Answer 24

loop diuretics

Question 25

when water goes, what follows?

Answer 25

electrolytes (potassium, calcium, magnesium)

Question 26

since loop diuretics can cause loss of potassium, what might a pt also be put on

Answer 26

potassium supplement (could cause hypokalemia)

Question 27

two worrisome side effects from loop diuretics

Answer 27

electrolyte imbalances and orthostatic hypotension (monitor BP before admin)

Question 28

monitor _____ lvls when a pt is on a loop diuretic, especially when concurrently taking digoxin

Answer 28

potassium

Question 29

what two things to monitor DAILY when pt on loop diuretic?

Answer 29

urinary output and weight (determine body fluid gain/loss)

Question 30

1L of fluid is = to ___ Ibs

Answer 30

2.2 Ibs

Question 31

name a loop diuretic

Answer 31

furosemide (Lasix)

Question 32

PREVENT the formation of clots that inhibit circulation

Answer 32

anticoagulants

Question 33

prevent platelet aggregation (platelets less sticky, can't clump)

Answer 33

antiplatelets

Question 34

dissolve clots that have already formed

Answer 34

thrombolytics

Question 35

are anticoagulants used prophylactically?

Answer 35

yes

Question 36

do anticoagulants dissolve clots that are already formed?

Answer 36

no

Question 37

how can anticoags be administered

Answer 37

PO, subQ, IV

Question 38

name 2 anticoags

Answer 38

heparin and low molecular weight heparin

Question 39

how to administer heparin

Answer 39

subQ, IV (continuous drip, requires frequent labs)

Question 40

can heparin be given PO?

Answer 40

no, it is poorly absorbed in GI tract

Question 41

what is the lab value used to eval heparin therapy

Answer 41

PTT (1.5-2x control value) *control = 60-70sec*

Question 42

will everyone with elevated lvls need heparin antidote?

Answer 42

no, heparin has a short 1/2 life (4hrs)

Question 43

side effect of heparin

Answer 43

bleeding

Question 44

heparin antidote

Answer 44

protamine sulfate

Question 45

how are LMWH (low molecular weight heparin) administered?

Answer 45

subQ injection

Question 46

when are LMWH given?

Answer 46

prevent DVT/PE after ortho or abdominal surgery

Question 47

name two LMWH

Answer 47

enoxaparin (Lovenox) dalteparin (Fragmin)

Question 48

can self admin be taught for at home use of LMWH?

Answer 48

yes

Question 49

true or false: frequent lab monitoring IS required for LMWH

Answer 49

false. it is NOT

Question 50

should aspirin be taken with LMWH

Answer 50

no

Question 51

what is the most commonly prescribed PO anticoag

Answer 51

warfarin

Question 52

warfarin inhibits the synthesis of vitamin __

Answer 52

K

Question 53

which clotting factors does warfarin effect

Answer 53

II, VII, IX, and X *2, 7, 9, and 10*

Question 54

monitor which lab values on warfarin

Answer 54

PT and INR

Question 55

major side effect of warfarin?

Answer 55

bleeding

Question 56

how long does it take for warfarin to be effective?

Answer 56

24-48hrs

Question 57

how can vitamin K (antidote for warfarin) be administered

Answer 57

PO, IM, subQ, (maybe IV in ICU)

Question 58

name 2 factor Xa inhibitors (a kind of oral anticoagulant)

Answer 58

apixaban (Eliquis) rivaroxaban (Xarelto)

Question 59

advantage of taking factor Xa inhibitors over warfarin

Answer 59

do not require routine coag monitoring (they are more expensive than warfarin)

Question 60

can a patient of warfarin eat green leafy veggies?

Answer 60

yes, they can have foods with vit K just keep a consistent intake (fish, liver, coffee, tea) <--- other foods with vit K

Question 61

suppress platelet aggregation

Answer 61

antiplatelets

Question 62

antiplatelets are used to prevent __ and ____ for pts w/ familial history

Answer 62

MI and stroke

Question 63

name of 2 antiplatelet meds

Answer 63

aspirin and clopidogrel (Plavix)

Question 64

antihyperlipidemic that reduce LDL lvls by binding with bile acids in the intestine

Answer 64

bile-acid sequestrants (cholestyramine *Questran*)

Question 65

__ side effects occur with bile-acid sequestrants

Answer 65

GI

Question 66

antihyperlipidemic that reduces triglycerides from plasma and VLDL

Answer 66

fibrates

Question 67

fibrates are contraindicated with _____

Answer 67

anitcoags they compete for protein sites and has an increase for bleeding

Question 68

an OTC antihyperlipidemic that reduces VLDL and LDL

Answer 68

niacin (nicotinic acid)

Question 69

what side effect makes many people stop taking niacin

Answer 69

flushing/hot flashes

Question 70

antihyperlipidemic that acts in the cells in the small intestine to inhibit dietary cholesterol absorption

Answer 70

cholesterol absorption inhibitor

Question 71

a cholesterol absorption inhibitor must be combined with a ____ for optimum effect

Answer 71

statin

Question 72

antihyperlipidemic that inhibits the enzyme HMG CoA reductase in cholesterol biosynthesis (blocks metabolism of cholesterol)

Answer 72

Statins

Question 73

major side effect of statins

Answer 73

rhabdomyolysis

Question 74

true or false: a statin is a lifetime commitment

Answer 74

true. Abrupt discontinuation may cause rebound effect

Question 75

a name of a statin

Answer 75

atorvaSTATIN (will end in statin)

Question 76

what lab value to monitor on statins

Answer 76

LFTs because med is metabolized in the liver