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Pharm 1 > Cardiac > Flashcards

Cardiac Flashcards

1
Q

What are the 3 goals of pharmacology with stable angina

A

Relieve Chest pain

Reduce hyperlipidemia

Improve morbidity & mortality

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2
Q

4 classes to relieve chest pain in stable angina

A

Nitrates
Beta Blockers
Calcium Channel blockers
Ranolazine

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3
Q

3 classes to reduce hyperlipidemia in stable angina

A

-statins
aspirin
clopidogrel

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4
Q

2 classes to imporve morbidity & mortality in stable angina

A

ACE inhibitor

ARB

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5
Q

Nitrates mechanism of relief in stable angina

A

Dilates veins, which decreases preload

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6
Q

beta blockers mech of relief in stable angina

A

decrease heart rate and contractility

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7
Q

calcium channel blockers mech of relief in stable angina

A

Dilate arterioles, which decreases afterload

decrease HR and contractility

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8
Q

Ranolazine mech of relief in stable angina

A

helps the myocardium generate energy more efficiency

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9
Q

MOA of Nitroglycerin

A

Dilates veins

Decreases preload

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10
Q

A/E of Nitroglycerin (4)

A 
R/T vasodilation:
H/A
hypotension
reflex tachycardia
Tolerance
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11
Q

4 types of Nitroglycerin drugs

A

Rapid - nitrostat - SL
SA- transderm- skin patch
SA -Nitro-Bid - ointment
LA - Isosorbide - SL/Oral (Prevention)

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12
Q

Nursing Implications with Nitrates

A
  1. Monitor for headache
    Mild analgesic
    Most h/a subside in 20 min
  2. Apply nitro patches in the morning and remove in the evening
    Apply to hairless site and rotate sites
3.Pt Ed: Treatment of acute chest pain
Take only as many SL tablets as needed - TOLERANCE
Use SL form – do not swallow
Fall Precautions –dizziness/hypotension
No relief in 5 min – call 911

Ok to take a second SL tab in 5 min and a third in 5 more min – do not exceed 3 doses

  1. IV form
    Glass bottle with special tubing
    Monitor for severe h/a, h/a, and tachycardia
  2. Long acting forms - taper when d/c to prevent increased chest pain from vasospasm
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13
Q

Nitrate interactions

A

Severe hypotension when taken with:

sindenafil/Viagra, antihypertensives, and ETOH

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14
Q

MOA of ranolazine

A

unknown

Possibly helps the myocardium use energy more efficiently

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15
Q

Warnings with ranolazine

A

Prolong the QT interval
Acute renal failure (existing renal disease)
Liver cirrhosis

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16
Q

A/E ranolazine

A

Headache,
dizziness
Nausea
constipation

CYP340 inhibitor– avoid grapefruit juice and other medications that are CYP inhibitors

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17
Q

7 classes used in treatment of Heart Failure

A 
ACE inhibitors or ARBs, ARNI
Beta blockers
Mineralocorticoid Receptor Antagonist (MRAs) 
SLGT2 Inhibitors 
Diuretics
Digitalis
Nitrates
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18
Q

RAAS inhibitors in HF (3)

A

ACE 1
ARB
ARNI

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19
Q

Angiotensin receptor neprilysin inhibitor DRUG

A

sacubitril/valsartan

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20
Q

MOA of ARNI

A

Decreases preload & afterload, suppresses aldosterone, favorably impact cardiac remodeling

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21
Q

A/E of ARNI

A

hypotension
hyperkalemia
cough (ACE1)

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22
Q

Beta blocker used in HF

A

carvedilol

blocks beta and alpha

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23
Q

MOA of carvedilol

A

Protects against SNS activation and dysrhythmias, reverses cardiac remodeling

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24
Q

A/E of carvedilol

A

Fluid retention or worsening HF

Fatigue

Hypotension

Bradycardia

25
Q

Mineralocorticoid receptor antagonist

A

spironolactone

26
Q

MOA of spironolactone in HF

A

suppression of sodium/water retention to help with offloading the LV

27
Q

what to watch for in spironolactone

A

Must watch carefully for hyperkalemia and worsening renal failure

28
Q

SLG2 inhibitor in HF

A

dapaglifozin

29
Q

dapaglifozin action in HF

A

Thought to help with ventricular unloading through natriuresis/osmotic diuresis without actually depleting volume like traditional diuretics

May affect cardiac metabolism/bioenergetics

30
Q

first line diruetic in HF

A

furosemide (Lasix)

31
Q

A/E of furosemide

A

Hypokalemia
Hypotension
Digoxin toxicity

32
Q

inotropic drug and class

A

digitalis

cardiac glycoside

33
Q

MOA of digitalis

A

s sodium-potassium ATP pump causing calcium to collect within the cells of the heart helping to increase myocardial contractility.

Increases blood flow to the kidney helping with excretion of sodium and water

Decreases sympathetic action and increases parasympathetic action= Decreased HR

34
Q

A/E of digitalis

A

Cardiac dysrhythmias

Digitalis toxicity

35
Q

Who is at risk of digitalis

A

older age
women
combo drugs with diuretics

36
Q

prevent digitalis toxicity

A

reduce dose
monitor levels
potassium supplemental

37
Q

S/S of digitals toxicity (7)

A 
Bradycardia 
Headache
Dizziness
Confusion 
Nausea
Visual disturbances- blurry/yellow vision
38
Q

caution with digitals

A

Take apical pulse for a FULL minute prior to administering digoxin
Hold if pulse below 60 bpm
Monitor cardiac rhythm

39
Q

ANTIDOTE for digitalis toxicity

A

Digoxin immune Fab (Digibind) given IV

40
Q

MOA of amiodarone

A

prolongs the action potential duration and the effective refractory period in all cardiac tissues; blocks alpha- and beta-adrenergic receptors in the SNS

41
Q

A/E of amiodarone

A

LOTS of adverse effects (75% have adverse effects); thyroid alterations, corneal microdeposits
Pulmonary toxicity= fatal in 10% of patients

42
Q

black box warning for amiodarone

A

Black box warning: pulmonary toxicity, hepatotoxicity, and pro-arhythmic effects

43
Q

2 sig drug interactions with amiodarone

A

digoxin and warfarin

Increase digoxin levels by 50%
And increase INR by 50-100%

44
Q

Warnings with amiodarone

A

EXTREMELY long half-life– last in system many days

If someone has adverse effects, may take 2-3 months for them to fully go away

Contraindicated in people with severe bradycardia, or heart blocks (type of rhythm)

45
Q

Class of Atropine for sinus brady

A

Anticholinergic/Antimuscarinic

46
Q

MOA of Atropine

A

Poisons the vagus nerve; inhibits postganglionic acetylcholine receptors and direct vagolytic action

47
Q

A/E of atropine

A

xerostomia, blurry vision, photophobia, tachycardia, flushing, hot skin

48
Q

nursing implications of atropine

A

Need to be on cardiac monitoring, if doesn’t work quickly, give a second dose

Given IV push ONLY for bradycardia; 1mg every 3-5 minutes, 3mg MAX

49
Q

adenosine MOA

A

slows the conduction time through the AV node

50
Q

what is adenosine used for

A

PSVT - Paroxysmal supraventricular tachycardia

51
Q

S/E of adenosine

A

Commonly causes a short burst of asystole until sinus rhythm returns

52
Q

route of adenosine

A

Only given IV

53
Q

Nursing implications with Adenosine

A

VERY SHORT HALF LIFE

Always follow with rapid normal saline flush or 2 saline flushes

54
Q

class of Dofetilide

A

antidysrhythmic

55
Q

indications of dofetilide

A

conversion from afib/aflutter to NSR

56
Q

MOA of dofetilide

A

selectively blocking the rapid cardiac ion channel carrying potassium currents

57
Q

S/E of Dofetilide

A 
TORSADES,
 SVT, 
headache, 
dizziness, 
chest pain
58
Q

Nursing Implications of Dofetilide

A

started in-hospital with ECG monitoring due to risk of Torsades (black box warning);

don’t give to patients with long QT intervals or other drugs that may prolong QT interval

59
Q

6 classes that control heart rate and rhythm

A 
Beta blockers
Calcium Channel Blockers
Amiodarone 
Adenosine
Atropine
Dofetilide

Pharm 1 (28 decks)

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