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Pharm > PPT of HF drugs, etc. > Flashcards

PPT of HF drugs, etc. Flashcards

1
Q

Which class of drugs are considered inotropic (alters muscle contraction rate)?

A

Cardiac Glycosides

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2
Q

Therapeutic action of cardiac gycosides?

A

-increase contractility/strength of myocardial contraction (positive inotropic effect).
-increased output and renal perfusion (increasing urine output and decreasing blood volume)

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3
Q

Which medication is the only cardiac glycoside suited for long-term therapy?

A

Digoxin

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4
Q

What should I do before giving cardiac glycoside?

A

take an apical pulse for one full minute

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5
Q

Contraindications of cardiac glycoside?

A

concurrent use of diuretics, beta-blockers, or other inotropes

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6
Q

What condition can lead to accumulation of digoxin in the body?

A

renal impairment

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7
Q

Action of digoxin?

A

binds to potassium

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8
Q

Danger of having low serum potassium levels when taking digoxin?

A

Increases risk of digoxin toxicity

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9
Q

Side effects of cardiac glycoside (inotropic drugs) like digoxin?

A

Headache, drowsiness, vision changes (yellow halo around objects), GI upset and anorexia

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10
Q

Which class of medications directly relaxes vascular smooth muscle by blocking the enzyme phosphodiesterase?

A

Phosphodiesterase inhibitors (

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11
Q

Besides directly relaxing vascular smooth muscles, what is the therapeutic value of phosphodiesterase inhibitors?

A

increases myocardial cell function = stronger contraction and prolonged response to sympathetic stimulation

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12
Q

Prototype drug of phosphodiesterase inhibitors?

A

Milrinone (only drug available in this class)

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13
Q

What condition is milrinone used for?

A

short-term management of heart failure

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14
Q

Which group of drugs is news (approved 2015) and reduces the heart rate with no effect on muscle contraction?

A

Hyperpolarization-Activated Cyclic Nucleotide-Gated Channel Blockers

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15
Q

Action of HCN GCB?

A

blocks hyperpolarization-activated cyclic nucleotide (HCN) to slow heart’s pacemaker (reduces heart rate with no effect on muscle contraction)

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16
Q

Prototype drug of HCN GCBs?

A

Ivabradine

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17
Q

pharmacokinetics of ivabradine?

A

Oral
rapid onset (one hour)
last 6 hours
metabolized in liver and excreted in feces and urine
half life = 2 hours

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18
Q

Adverse effects of HCN GCBs? (Ivabradine)

A

bradycardia, atrial fibrillation, hypertension, luminous phenomena (visual changes)

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19
Q

Which class of drugs is also newer (approved 2015) and is a combination drug?

A

Angiotensin receptor neprilysin inhibitors

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20
Q

What is the prototype drug for ARNIs?

A

Ernesto

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21
Q

Ernest is made up of what two drugs?

A
  1. valsartan (ARB)
  2. sacubitril (neprilysin inhibitor)
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22
Q

pharmacokinetics of Ernesto?

A

steady level is reaching in 3 days with 2 x a day dosing

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23
Q

How should Ernesto be taken?

A

with or without food

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24
Q

What 4 drug classes are used to treat HF?

A

-cardiac glycoside (inotropic drugs) [digoxin]
-phosphodiesterase inhibitors [milrinone]
-hyperpolarization-activated cyclic nucleotide-gated channel blockers [ivabraden]
-angiotensin receptor neprilysin inhibitors [Ernesto (valsartan & neprilysin inhibitor)]

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25
Q

Which class of medications are complex with multiple mechanisms of action and are classified by their effects on the electrical conduction system of the heart?

A

Antiarrhythmic agents

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26
Q

What are the classes of antiarrhythmic agents?

A

-1A
-1B
-1C
-II (beta blockers)
-III
-IV (calcium channel blockers)

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27
Q

Prototype drug for Class II (beta blockers) of the antiarrhythmic agents.

A

Lidocaine

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28
Q

Lidocaine’s therapeutic actions:

A

-decreases depolarization
-decreases automaticity of the ventricular cells
-increases ventricular fibrillation threshold

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29
Q

Prototype drugs (2) for Class II (beta blockers) of antiarrhythmic agents

A

-propranolol
-adenosine

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30
Q

Arrhythmic condition treated with propranolol

A

SVTs (supraventricular tachycardia)

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31
Q

What other conditions are treated with propranolol outside of arrhythmia?

A

-hypertension
-angina
-migraines
-anxiety

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32
Q

Action of propranolol (Class II- beta blocker)

A

blocks beta-adrenergic receptors in the heart and kidney
= membrane stabilizing effect
=decreases effect of sympathetic nervous system

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33
Q

Side effects of propranolol?

A

bradycardia, cerebrovascular accident (stroke), N/V, impotence

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34
Q

What is adenosine (Class II beta-blocker) used for?

A

Converts SVT (supraventricular tachycardia) to sinus rhythm (normal healthy rhythm of the heart)

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35
Q

Side effects of adenosine (antiarrhythmic class II beta-blocker)

A

flushing, nausea, bronchospasm, and potential prolonged asystole (heart stops beating)

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36
Q

How is adenosine (antiarrhythmic class II beta blocker) administered?

A

Rapid IV push (in 1-2 seconds) followed by immediate flush of 10 mL normal saline.

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37
Q

What side effects are expected with a rapid IV admin of adenosine?

A

flushing, headache, SOB (side effects are short term due to drug’s short half life)

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38
Q

Prototype drug for class III antiarrhythmic agents?

A

Amiodarone

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39
Q

What conditions is amiodarone (antiarrhythmic class III) used to treat?

A

ventricular fibrillation and unstable ventricular tachycardia

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40
Q

Side effects of amiodarone (antiarrhythmic class II)

A

-bradycardia, cardiogenic shock (heart can’t pump enough blood to meet body’s needs), and pulmonary disorders.

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41
Q

Which drug is incompatible with amiodarone (class III antiarrhythmic)

A

Heparin (flush line very well before administration of either)

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42
Q

Which class of drugs are also known as anti-anginals and nitrates?

A

Vasodilators

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43
Q

Which drug is a form of a vasodilator?

A

Nitroglycerin tablets

44
Q

Action of vasodilators

A

relaxes blood vessels and increases supply of blood and oxygen to heart
-reduces workload

45
Q

Forms of vasodilators:

A

pills, dissolvable tablets, topical application (cream), sublingual spray, and IV infusion

46
Q

Things to be aware of with topical vasodilators

A

-may cause skin irritation
-do not massage or rub area
-rotate site
-can apply to chest, flank, or upper arm on a hairless area

47
Q

5 commonly prescribed vasodilators?

A
  1. isosorbide dinitrate (Isordil)
  2. nesiritide (Natrecor)
  3. hydralazine (Apresoline)
  4. nitrates
  5. minoxidil
48
Q

What condition do vasodilators treat when it comes to the heart?

A

eases chest pain (angina)

49
Q

Patient teaching for nitroglycerin (nitrates) sublingual application

A
  1. Take 1 pill at onset of chest pain and sit or lie down
  2. repeat dose in 5 minutes.
  3. If no relief, take another does in 5 minutes
50
Q

Nitrate (nitroglycerin) medication care:

A

dark container (preferably original)
-replace every 6 months (may lose strength)

51
Q

ABSOLUTE contraindicated medications when taking nitrates:

A

erectile dysfunction medication (sildenafil, tadalafil)
-profound hypotension and death may occur

52
Q

Action of antihyperlipidemic agents:

A

lowers lipid levels in the blood

53
Q

Which class of antihyperlipidemic drugs are used to decrease plasma cholesterol levels?

A

Bile Acid Sequestrants

54
Q

Action of bile acid sequestrants?

A
  • prevents reabsorption of bile salts, which are high in cholesterol. Liver will be forced to pull cholesterol from the blood to make bile acids = lowers plasma serum cholesterol levels
55
Q

Prototype drug for antihyperlipidemic bile acid sequestrants:

A

Cholestyramine

56
Q

Action of cholestyramine?

A

binds with bile acids in the intestines: excretes in feces instead of being reabsorbed.
= cholesterol is oxidized in the liver = serum levels of cholesterol fall

57
Q

Adverse effects of bile acid sequestrants (cholestyramine)

A

rash, headache, anxiety, vitamin A & D deficiencies

58
Q

Example of drugs that are HMG-CoA Reductase inhibitors (also antihyperlipidemics)

A

Statins

59
Q

HMG-CoA reductase inhibitors (statins) do what?

A

-block the enzyme HMG-CoA reductase
= lower serum cholesterol levels
= breakdown of LDLs
=slight increase in HDLs
-also works to lower triglycerides

60
Q

When is the peak effect of HMG-CoA Reductase Inhibitors (Statins)?

A

2-4 weeks

61
Q

Contraindication for HMG-CoA reductase inhibitors (statins)

A

-pregnancy and lactation

62
Q

5 HMG-CoA reductase inhibitors (statins) examples:

A

atorvastatin, fluvastatin, lovastatin, simvastatin, rosuvastatin

63
Q

Which class of drugs is usually the first drug choice to lower LDS?

A

HMG-CoA reductase Inhibitors (statins)

64
Q

Which drug is a cholesterol absorption inhibitor that was approved in 2003?

A

Ezetimibe

65
Q

What is ezetimibe (cholesterol absorption inhibitor) used in conjunction with?

A

-diet and exercise (lowers serum cholesterol levels)
-statins (lower total and LDS cholesterol)
-fenofibrate (familial hyperlipidemia) = assists with lowering both serum cholesterol and triglyceride levels
*can be used as monotherapy

66
Q

Contraindications for cholesterol absorption inhibitor ezetimibe?

A

-pregnancy
-lactation
-severe liver disease

67
Q

Which class of drugs is used to treat cholesterol levels that have been unresponsive to lifestyle and statin treatments and/or familial hypercholesterolemia

A

Proprotein Convertase Subtilisin/ Kexin Type 9 Inhibitors (PCSK9 Inhibitors)

68
Q

2 examples of PCSK9 Inhibitors)

A

-alirocumab
-evolocumab

69
Q

Action of PCSK9 Inhibitors

A

blocks a protein called PCSK9 to make it easier for the body to remove LDL.

70
Q

How are PCSK9 inhibitors delivered?

A

injection every 2 weeks

71
Q

What non-pharmacologic agent also is used to lower LDL cholesterol and raise HDL cholesterol?

A

-vitamin b3 (niacin)

72
Q

What is used to boost HDL while lowering triglyceride production?

A

Fibrates (fenofibrate and gemfibrozil)

73
Q

Which class of drugs keeps blood blots from forming by preventing blood platelets from sticking together?

A

Antiplatelet agents

74
Q

4 commonly prescribed antiplatelet drugs

A
  1. Aspirin
  2. ticlopidine
  3. clopidogrel (Plavix)
  4. dipyridamole
75
Q

Conditions treated with antiplatelet agents (aspiring, ticlopidine, clopidogrel (Plavix), dipyridamole)?

A

Helps prevent clotting in pt. who
-has had a heart attack
-unstable angina
-ischemic strokes
TIA (transient ischemic attacks or “little strokes”)
-other cardiovascular diseases

76
Q

When are antiplatelet meds usually prescribed?

A

As a preventative when plaque buildup is evident but is not yet a large obstruction in the artery

77
Q

Pt ed for antiplatelets (aspirin, ticlopidine, clopidogrel (Plavix), dipyridamole

A
  • report tarry stools
    -“” ecchymosis (bruising or bleeding underneath the skin)
    -signs of bleeding
78
Q

Which class of drugs decreases the clotting (coagulating) ability of blood?

A

Anticoagulants

79
Q

What are two misconceptions about anticoagulants?

A
  1. They do not thin blood
  2. They do not dissolve existing blood clots
80
Q

What conditions are anticoagulants used to treat?

A

conditions of the blood vessels, heart, and lungs

81
Q

4 commonly prescribed anticoagulants:

A

-rivaroxaban (Xarelto)
-dabigatran (Pradaxa)
-heparin
-warfarin (Coumadin)

82
Q

What conditions do dabigatran (Pradaxa) & rivaroxaban (Xarelto) treat?

A

a-fib and artificial heart valves

83
Q

What is usually the first-line drug of choice when it comes to anticoagulants?

A

Heparin (often weaned from heparin and onto warfarin)

84
Q

3 things to consider with warfarin (Coumadin)

A
  1. administered orally
  2. cannot be taken during pregnancy
  3. will be transitioned into heparin by the body
85
Q

What is the purposes of anticoagulant drugs/ what do they prevent?

A

-help prevent clots from forming in the blood vessels
-may prevent clots from becoming larger
-may prevent first or recurrent stroke

86
Q

What conditions may indicate need for anticoagulants (6)?

A
  1. cardiac catheterization
  2. myocardial infarction
  3. DIC
  4. evolving stroke
  5. pulmonary embolism
  6. deep vein thrombosis
87
Q

Potential side-effects of anticoagulants?

A

-hemorrhage
-heparin-induced thrombocytopenia
-toxicity/overdose

88
Q

nursing considerations for anticoagulants?

A
  1. monitor for signs of bleeding
  2. initiate safety precautions to prevent bleeding
89
Q

Antidote for heparin toxicity?

A

protamine sulfate

90
Q

antidote for warfarin tox?

A

Vitamin K

91
Q

What should the pt. avoid when taking anticoagulant meds?

A

-garlic
-ginger
-ginkgo
-ginseng
=increases risk of bleeding

92
Q

Thrombolytics therapeutic action:

A

dissolves clots that have already formed

93
Q

Thrombolytics mechanism of action:

A

Converts plasminogen to plasmin = destroys fibrinogen and other clotting factors

94
Q

Commonly prescribed thrombolytics (3)

A

alteplase (Activase, tPA)
-tenecteplase (TNKase)
-reteplase (Retavase)

95
Q

Conditions treated by thrombolytics?

A
  1. myocardial infarction (MI)
  2. deep vein thrombosis (DVT)
  3. massive pulmonary emboli
  4. ischemic stroke
96
Q

What conditions are contraindicated for the use of thrombolytics?

A
  1. intracranial hemorrhage
  2. active bleeding
  3. severe hypertension
  4. Caution with pt. with severe HT
97
Q

Concurrent use of thrombolytics with which two classes of meds increases the risk of bleeding?

A

anticoagulants with antiplatelet meds.

98
Q

Side effects/ adverse effects of thrombolytics

A

bleeding

99
Q

Example of antihemophilic agents:

A

antihemophilic factor

100
Q

What is antihemophilic factor used to treat?

A

Classic hemophilia

101
Q

How do antihemophilic factors work?

A

Temporarily replaces clotting factors that otherwise don’t exist = correct or prevents bleeding episodes or allows for necessary surgery

102
Q

Example of a hemostatic agent

A

aminocaproic acid (systemic)

103
Q

What are hemostatic agents (aminocaproic acid) used to treat?

A

-excessive bleeding caused by hyperfibrinolysis
-prevent reoccurrence of subarachnoid hemorrhage

104
Q

Side effects of hemostatic agents?

A

tinnitus, hypotensive, nausea, cramps, headache, weakness

105
Q
A

Pharm (5 decks)

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