Cardiac II - Cardiac Drugs

Question 1

ACE Inhibitors

Answer 1

ex: ramipril (Altase), renal protector, inhibits bradykinin for HTN, HF, MI. adverse: 1% angioedema, 10-20% dry cough… hold when developed, 1st dose effect, supresses aldosterone (h2o/na secretion)

Question 2

difference btwn ACE/ARBs?

Answer 2

ARBs are better but lack of evidence

Question 3

ex of ARBs

Answer 3

like ACE but lack of evidence, “-sartan”

Question 4

ex of CCB

Answer 4

vasodilation, ex: amlodipone (Norvasc), verapamil (Calan), diltiazem (Cardizem), for Artrial Dysrhythmia, hemodynamically unstable

Question 5

what core measure must pts w L ventricle HF have?

Answer 5

ACE/ARBs

Question 6

3 first line tx for HF?

Answer 6

diuretics, ACE/ARBs, beta blockers

Question 7

ex of beta 1 blockers?

Answer 7

carvedilol (Coreg has a1 blocking qualities), metropolol (Lopressor). dec contractility

Question 8

ex of phosphodiesterade inhibitors

Answer 8

milrinone (Primacor), for short term use or ICU for HF, adverse: 12% ventricular dysrhythmias, IV pump only

Question 9

ex of human b-type natriuretic peptide (BNP)

Answer 9

nesiritide (Natrecor), for ICU, adverse: HoTN, IV line admin, hold if SBP is <90

Question 10

therapeutic range of dig?

Answer 10

.8-2.0 ng/ml, narrow

Question 11

ex of inotropes/cardiac glycosides

Answer 11

dig (Lanoxin), not 1st line, excreted in renal so dec dose for renal insufficiency, doesnt improve survival of HF, can give to kids

Question 12

contra of dig

Answer 12

hypokalemia, hypomagnesemia, hypercalcemia, if toxicity: halo

Question 13

admin of dig

Answer 13

PO, IV only. slow IV for loading dose. must be on tele. dose depends on age, muscle, renal function.

Question 14

what is digitalization?

Answer 14

reaching steady state of digoxin quicker

Question 15

tx of dig toxicity?

Answer 15

stopping may metabolize drug. activated charcoal is universal antidote. or IV Digibind. always get same brand.

Question 16

nursing implications of dig?

Answer 16

check apical… hold if <60 adults, <70 adolescent, <100 infant, admin same time w food, daily wt

Question 17

classifications of antidysrythmias

Answer 17

I. Sodium Channel Blockers, II. Beta Adrenergic Blockers, III. Potassium Channel Blockers, IV. CCB

Question 18

Sodium Channel Blockers

Answer 18

IA. quinidine for a and v dysr, IB. lidocaine for v dysr (most common, narrow range, toxicity), IC. propafenone (Rhythmol) for a and v dysr

Question 19

B adrenergic Blockers

Answer 19

“-olol” dec conduction in SV node

Question 20

K Channel Blockers

Answer 20

ex: amiodarone (cordarone), BBW: pulmonary toxicity, adverse: hepatotoxicity, eye deposits, hypo/hyperthyroid d/t iodine… REVERSIBLE when stopped

Question 21

adenosine (Adenocard)

Answer 21

terminate a dysr, 10 sec half life, RAPID IV PUSH close to heart to stop the heart

Question 22

Magnesium Sulfate

Answer 22

hypomagnesemia = life threatening dysrhthmia, adverse: worsening, heart block, HoTN

Question 23

Antianginal medications?

Answer 23

CCB, Organic Nitrates, Metabolic Modulator, Beta Blockers

Question 24

prototype of organic nitrates

Answer 24

NTG (Nitrobid) = .4mg (1/50 grain)

Question 25

pharmacokinetics of organic nitrates

Answer 25

highly soluble, extensive 1st dose effect, 1-4 min 1/2 life, readily crosses membranes

Question 26

routes of organic nitrates

Answer 26

1. sublingual: 1-3 mins, termination 2. transdermal: 20-60 mins, prevention 3. oral (ex: Isordil, Imdur): 4-8 hrs, prevention for long term but not true ntg bc destroyed by enzymes 4. Continuous IV pump: 1-3 min, ICU

Question 27

contraindications of Organic Nitrates

Answer 27

hypersensitivity, HoTN, hypovolemia, 1) sublingual: 1 tab q 5 min 3 doses, keep in dark, replace q 6mo, 2) trans: alternate site d/t irritation 3) IV pump: ICU only

Question 28

QSEN for O Nitrates

Answer 28

tolerance so give in nitrate free intervals (10-12hrs), contraindicated w phosphodiesterase enzymes (erectile dysfunction, ex: Viagra)

Question 29

Nursing Implications of O Nitrates

Answer 29

always take BP prior to admin for HoTN, avoid otc decongestants

Question 30

B adrenergic blockers

Answer 30

drug choice for CAD but avoid w coronary vasospasm, avoid abrupt withdrawal

Question 31

CCB for angina

Answer 31

"-dipines", use for coronary vasospasm

Question 32

metabolic modulator

Answer 32

ex: ranexa (ranolazine), extended release, no effect on HR or BP but must have good O2 supply/deman, combo use w nitrate, b blocker, CCB

Question 33

contraindications of Ranexa

Answer 33

cant even get started if have QT prolongation