Cardiac Drugs Flashcards
(38 cards)
1
Q
Drugs used for stable angina relief
A
Nitrates, beta blockers, Ca channel blockers, Ranolazine
2
Q
Drugs for stable angina reduction
A
Lipid lowering, aspirin or clopidrogrel
3
Q
Drugs for improving stable angina
A
ACEs or ARBs
4
Q
Nitroglycerin class, indications, MOA
A
- nitrates
- angina
- Dilate veins, which dec preload and takes pressure off heart (dilates all vessels, big and small, esp veins)
5
Q
Nitrates NC
A
- tolerance can occur quickly - only use with actual angina or know you will have it (prophylactic for exercise)
- if take once and doesn’t help, don’t take another
- can take Tylenol for HA but often doesn’t last long
- risk for hypo/dizzy
- no relief in 5 min - 911 (but also take another, don’t exceed 3)
- IV form - glass bottle and special tubing (severe HA and tachy)
- severe hypotension with sildenafil, antiHTN, alc
6
Q
Nitrostat
A
- nitrates
- ACTIVE ANGINA
- sublingual; use every 5 min x3
7
Q
Nitrates SE
A
- R/t vasodilation - HA, hypotension/dizzy, reflex tachy (compensate)
8
Q
Transderm-Nitro
A
- short-acting nitro
- chest or thigh
- rotate site
- hairless site
- on in morning, off at night
9
Q
Nitro-bid (2%)
A
- short acting nitro
- 1-2 inches to chest or thigh area
- cover with piece of paper
10
Q
Isosorbide
A
- long acting nitrate
- PREVENTION
- only long acting
- taper to prevent inc pain from coronary artery vasospasm
- not for current pain and can take
- SPECIAL SE: VASOSPASM
11
Q
Ranolazine class, MOA
A
Antianginal agent
- Helps myocardium generate energy more efficiently; unknown
12
Q
Ranolazine SE and NC
A
- HA, dizzy, nausea, constipation
- only PO
- can PROLONG QT INTERVAL (risk for other lethal dysrhythmia)
- careful with liver/kidney fail
- CYP 340 inhibitor (avoid grapefruit and other inhibitors)
13
Q
sacubitril/valsartan class, MOA
A
- Angiotensin receptor-Neprilysin inhibitor (ARNI)
- Dec preload and afterload, suppress aldosterone, which helps with cardiac remodeling
14
Q
Ppl with HF are often on…
A
- ACE, ARB, or ARNI
- beta blocker
- mineralcorticoid rec antagonist
- SLGT2 inhibitor
15
Q
sacubitril/valsartan SE and NC
A
- Hypotension, hyperkalemia, cough (ACE)
- highest dose possible
- ARNI best bc have Nepriysin inhibit but pricy
- ARBs might be tolerated better
16
Q
Which drug is a mineral corticoid receptor antagonist and how does it work?
A
Spironolactone - suppresses Na/H2O retention and offloads the LV
17
Q
Carvedilol class, MOA
A
- Beta and alpha blockade
- Protects against SNS activation (neurohormonal) and dysrhythmia, reverse cardiac remodeling
18
Q
Carvedilol SE and NC
A
- Lethargy, fatigue, dec BP, bradycardia, can exacerbate lung issues, fluid retention, worsening HF
- wean when discontinuing the med to avoid CVD event, - watch asthma patients,
- no give with HR <60 or SBP<100
19
Q
Dapagliflozin class, MOA
A
- SLPG2 inhibitor
- Not well known; helps with vent unloading thru natriuresis/osmotic diuresis w/o actually depleting volume like most diuretics; may affect cardiac metab and bioenergetics (NOT TOO IMPORTANT TO KNOW)
20
Q
Dapaglifozan NC
A
- no ESRD or severe kidney
- oral
- dec readmission, mort and morb
21
Q
Diuretics w/ HF
A
- LOOP is first line
- vol overload
- oral or IV
- SE - hypokalemia, hypotension, digoxin tox
- no survival benefit, just helps sx
22
Q
Digitalis class and MOA
A
- Cardiac glycosides - inotropic drug
- Inhibit Na/K ATP pump in cardiac cell which causes Ca to collect in heart which inc contractility; inc BF to kidneys and dec sympathetic action to dec HR
- Second line bc inc risk dysrhythmias
23
Q
Digitalis SE and NC
A
- Cardiac dysrthymias (A fib, A flutter), digitalis tox,
- high risk tox - age, women, combo drugs like diuretics
- monitor levels (weekly INR)
- dec dose
- supplemental K bc inc risk tox with low K (higher risk with diuretics)
- take apical pulse full minute before and hold<60
- antidote for tox is Digibind (only if severe)
24
Q
What is the other inotropic drug that we see?
A
Sympathomimetics like dopamine and dobutamine
25
Amiodarone class, indications, MOA
- Antidysrthmic
- Help bring out a fib and vent dysrhtmia
- Prolong AP duration and effective refractors period in all cardiac tissues; blocks alpha and beta adrenergic rec in SNS
26
Digitalis tox sx
- brady, HA, dizzy, confusion, Nausea, visual disturbances (blurry, yellow vision)
27
Amio SE and NC
- Many adverse (75% have)- thyroid alterations corneal microdeposits - light sensitivity, dry eye, visual halo; can cause pulm tox (fatal sometimes)
- - IV or PO
- very lipidphyllic - gets conc in adipose tissue
- may not see for pt with iodine allergies
- BLACK BOX - pulm tox, hepatotox, pro-arythmic fx (new rhythm)
- intx with Digoxin (tox) and warfarin (can GREATLY inc INR)
- v long half life - can take 2-3M for SE to leave
- CI with severe brady or heart blocks
28
Atropine class, indications, and MOA
- Antichol and antimuscarinic
- sinus brady
- Poisons the vagus nerve, inhib postganglionic ACh rec and direct vagolytic action
29
Atropine SE and NC
- ACh - Xerostomia, blurry vision, photophobia, tachy, flushing, hot skin
- only for symptomatic (don’t use if they talking) and VAGALLY INDUCED brady
- does not work on sick hearts
- IVP (1mg q3-5, 3mg MAX)
- only work ¼ ppl
- NEED ON TELE
30
Adenosine MOA and indications
- SVT, PSVT, sinus tach
- Slows the conduction of time thru AV node
31
Adenosine SE and NC
- v short half life (may need multiple doses)
- cause short burst asystole (flat line)
- only IV (6mg IVP, can give another 12mg if not converted, can give 3rd 12 mg if needed)
- always follow with flush (rapid or 2 normal)
- given with stopcoc
- needs AED pads on
32
Dofetilide (Tikosyn) class, indications, and MOA
- Antidysrhythmic
- A fib, a flutter to stay in sinus rhythm (maintenance)
- Selectively blocking rapid cardiac ion channel carrying K currents
33
Dofetilide (Tikosyn) SE and NC
- High risk of Torasades (polymorphic V tach - deadly - CPR) and SVT, HA, dizzy, chest pain
- always start in hospital on tele (ECG)
- don’t give for long QT or other drugs that may prolong QT
34
Why is warfarin given for cardiac probs
Given in conjunction with rhythm problems like a-fib or a-flutter to dec risk of stroke
35
Cilostazol (pletal) MOA and indication
- IC
- Platelet inhibitor and vasodilation
36
Cilostazol SE and NC
- HA, dizzy, diarrhea, abnormal stools, palpitations, peripheral edema
- metab by Cyp 450
37
Pentoxifylline class, MOA, and indications
- Vasoactive agent
- Txs intermittent claudication caused by PVD
- Relieve leg pain by inc BF and oxygen thru BVs, helps to inc walking distance and duration
38
Pentoxifyllines SE and NC
- N/V, dizzy
- PO TID
