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BNPH700 > Cardiac Medications > Flashcards

Cardiac Medications Flashcards

1
Q

How many drug categories are there within the cardiac medications? Give at least one example of a medication for each category

A
  • Cardiac Glycosides - Digoxin
  • Nitrates - GTN
  • ACE inhibitors - Enalapril
  • Diuretics - Furosemide
  • Beta Blockers – Metoprolol, Propranolol
  • HMG-CoA reductase inhibitors – Simvastatin
  • Anti-platelet – Aspirin
  • Anticoagulants – Warfarin, Heparin
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2
Q

What is the indication of use for Cardiac Glycosides (Digoxin)?

A

Heart failure and cardiac arrhythmia most common is atrial fibrillation

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3
Q

What is the MOA for Cardiac Glycosides (Digoxin)?

A

Inhibits active transport (pumping) of sodium and potassium across cell membrane. This increase intracellular sodium and produces a secondary increase in intracellular calcium which increases cardiac contraction. It slows the heart rate by decreasing conduction through the SA and AV nodes (anti-arrhythmic effect).

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4
Q

What are some adverse drug reactions associated with the use of Cardiac Glycosides (Digoxin)?

A

Anorexia, GI disturbances (Nausea & Vomiting, diarrhoea), confusion, fatigue, visual disturbances

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5
Q

What are some signs and symptoms of digoxin toxicity?

A

Decreased appetite, N & V, abdo pain, diarrhoea, tiredness, bradycardia, visual disturbance, drowsiness, confusion

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6
Q

What is the antidote for digoxin toxicity?

A

Digibind - binds to digoxin and prevents the digoxin from binding to the site of action

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7
Q

What can increase the chance of digoxin toxicity and why?

A

Hypokalaemia and hypercalcemia can increase the risk of digoxin toxicity (visual changes) due to more receptors sites being available for digoxin to bind to = enhanced effect of digoxin

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8
Q

What are some monitoring requirements of cardiac glycosides?

A

Take apical pulse for a full minute (note irregular heartbeats), Monitor potassium levels in patients taking diuretics or corticosteroids. (Digoxin and potassium compete for the same receptor site).

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9
Q

What patient education would you provide for cardiac glycosides?

A
  • Take with water
  • caution using in conjunction with antacids and calcium preparations (should be taken 2 hours apart)
  • Teach patient to take pulse and to contact Dr before taking medication if pulse rate is <60 or >100. Hold medication if HR is below 60bpm
  • Review signs and symptoms of digoxin toxicity with patient and family.
  • Instruct patient to notify health care professional of all prescription or Over the counter medications.
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10
Q

What is an example of a Nitrate medication?

A

Glyceryl trinitrate (GTN)

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11
Q

What is the indication of use for nitrates?

A

Nitrates are a direct-acting vasodilator and are commonly indicated for use in preventing and treating angina

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12
Q

What is the MOA for Nitrates (GTN)?

A

Bind to nitrate receptors in vascular smooth muscle causing vasodilation in peripheral veins leading to decreased venous return to the heart. This results in decreased O2 demand by myocardium. Also, vasodilation in arteries which lower BP. End result is increased coronary perfusion and increased O2 delivery to the myocardium. More blood flowing through which = more oxygen to the myocardium

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13
Q

What are some adverse drug reactions associated with Nitrates?

A
  • Postural hypotension
  • Dizziness
  • Fainting
  • Headache
  • Nausea / vomiting
  • Agitation
  • Dry Mouth
  • Blurred vision
  • Facial flushing
  • Reflex tachycardia
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14
Q

What patient education would you provide to the patient regarding nitrates?

A
  • Be aware of nitrate tolerance – to prevent this, ensure a nitrate free period each day as body can create resistance.
  • Have an angina action plan
  • Sensitive to light, heat. Store in dark place.
  • Discard after 3 months to ensure medication maintains maximum potency
  • Sit down on first administration as may cause dizziness
  • 1 spray under tongue, no more than 3 doses for sublingual
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15
Q

What are some key points from the angina action plan?

A
  • Advise patient to carry meds at all time (away from body heat)
  • Sit down and use med at first sign of attack.
  • Spray under the tongue (do not inhale), mouth should be closed immediately; do not eat, drink or smoke after delivery of drug.
  • Dose can be repeated if pain is not relieved in 5 mins. Call 111 if 3 doses taken 5 mins apart don’t relieve angina pain (not taken more than 3 doses)
  • Inform Patient transient headache & flushing may occur. Caution patient to change positions slowly to ↓ postural hypotension.
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16
Q

What is the suffix for ACE Inhibitors?

A

“Pril”

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17
Q

What are some examples of ACE Inhibitors?

A

Captopril, Enalapril, Cilazapril, Quinapril, Benazepril

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18
Q

What is the indication of use for an ACE Inhibitor like Enalapril?

A

HTN, Heart Failure, post MI, diabetic nephropathy, left ventricular dysfunction

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19
Q

What is the MOA for an ACE inhibitor?

A

inhibits the conversion of angiotensin I to angiotensin II. Leads to decreased BP. Inhibits the release of aldosterone from adrenal cortex. Decreased Na+ and water retention.

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20
Q

What are some adverse drug reactions associated with ACE Inhibitors?

A
  • Hypotension
  • Headaches
  • Dizziness
  • Fatigue
  • Nausea
  • Hyperkalaemia
  • Renal impairment
  • Cough: Common to experience dry persistent cough
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21
Q

What drugs can ACE Inhibitors interact with?

A

Avoid concurrent use with combination loop diuretics as may result in renal dysfunction. NSAID increases the risk of increased potassium levels and can reduce the effects of the ACE inhibitor.

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22
Q

What are some contraindications associated with ACE Inhibitors?

A

In patients with renal impairment, pregnant woman and patients with known hypersensitivity.

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23
Q

What are some monitoring requirements associated with ACE Inhibitors?

A

Baseline vitals, monitoring of electrolytes and renal function

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24
Q

What patient education would you provide to someone on ACE Inhibitors?

A
  • Take meds as prescribed; do not stop ACE inhibitor without consultation with Dr.
  • Take medication with food
  • notify health care professional of all prescription or Over The Counter medications.
  • Avoid salt substitutes containing potassium or foods containing high levels of potassium or sodium (Salt raises BP and can lead to faster risk of renal failure and HF)
  • Inform patients ADRs. E.g. dizziness, hypotension.
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25
Q

What is the suffix for beta blockers?

A

“olol”

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26
Q

What category does Metoprolol and Propranolol come under for beta blockers?

A

o Beta-1 selective blocker—Metoprolol
o Non-selective beta blocker—Propranolol

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27
Q

What is the indicator of use for beta blockers?

A
  • Angina
  • Arrhythmias
  • Hypertension
  • Heart failure
  • Post MI
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28
Q

Where do Metoprolol (selective blocker) target within the body?

A

Beta 1 receptors in the heart (cardio selective)

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29
Q

Where do Propranolol (Non-selective blocker) target within the body?

A

Beta 1 (heart) and beta 2 receptors (lungs)

30
Q

What is the MOA of beta blockers?

A

Binds to Beta receptors in the autonomic nervous system and prevents the catecholamines (adrenaline / noradrenaline) from stimulating the receptors and resultant sympathetic response. This results in decreased HR, decreased myocardial contractility, decreased blood pressure and decreased speed of impulse through AV node.

31
Q

What is the pharmacokinetics of Beta Blockers?

A

metabolised in the liver and excreted as unchanged drugs by the kidneys

32
Q

What are some adverse drug reactions associated with beta blockers?

A
  • Bradycardia
  • Dizziness
  • Hypotension
  • Arrhythmia
  • Bronchoconstriction
  • Fatigue
  • Insomnia
  • Depression
  • Nightmares
33
Q

What are some contraindications associated with beta blockers?

A
  • Not used in heart block
  • Cautions with respiratory conditions as can cause bronchoconstriction
  • Causes with diabetes as can mask a hypoglycaemic event and inhibit the sympathetic response to a hypo event
  • Caution with abrupt cessation as can cause rebound tachycardia and hypertension due to excessive stimulation of Beta receptors
34
Q

What patient education would you provide for someone who are on Beta Blockers?

A
  • Explain why the person is taking it
  • Falls prevention / postural hypotension
  • May need to “start low and go slow” (low dose at first)
  • Monitor BP and pulse
  • Monitor for respiratory symptoms
  • Report any symptoms to prescriber
  • Patients that have been on long-term treatment should have their medication discontinued gradually over 1-3 weeks to avoid rebound effect which occurs due to upregulation of beta receptors causing tachycardia and dysrhythmia.
35
Q

What is an example of a Diuretic?

A

Frusemide

36
Q

What is the indication of use for a Diuretic?

A
  • Heart Failure
  • Hypertension (to reduce fluid and therefore reduce cardiac workload)
37
Q

What is the MOA for diuretics?

A

Diuretics modify renal function and induce diuresis (increased urine) and natriuresis (enhanced excretion of sodium chloride). The increase in urine volume is achieved primarily by inhibiting reabsorption of sodium and chloride in the nephron. The increased excretion of salt leads to an increase in the excretion of water. By eliminating excess water, blood volume and blood pressure, as well as preload, are decreased.

38
Q

What are some adverse drug reactions associated with diuretics?

A
  • Dehydration and electrolyte imbalance
  • Dizziness
  • Postural Hypotension
39
Q

What patient education would you provide for the patient on diuretics?

A
  • This medication will make you urinate a lot, so take in the morning
  • Notify healthcare provider if you have noticed a significant change in weight
  • Monitor BGL’s as some agents may cause hyperglycaemia
  • Avoid alcohol = hypotension and the medication not working due to alcohol and the med cancelling each other out
40
Q

What are some monitoring requirement associated with diuretics?

A
  • Weight
  • Input/urine output
  • Serum electrolyte levels
  • Potassium levels
  • Vital signs
41
Q

What is an example of a HMG-CoA reductase inhibitors?

A

Simvastatin

42
Q

What is the suffix for HMG-CoA Reductase Inhibitors?

A

“Statin”

43
Q

What is the indication of use for HMG-CoA reductase inhibitors (Simvastatin)?

A
  • Risk of cardiovascular disease (assessed using the recommended tools)
  • Prevention of atherosclerosis with hyperlipidaemia / dyslipidaemia
44
Q

What is the MOA for HMG-CoA reductase inhibitors (Simvastatin)?

A

Inhibit the synthesis of cholesterol in the liver by inhibiting the HMG-CoA reductase enzyme. Reduction in cholesterol synthesis results in lower LDL (low-density lipoprotein) levels – less required to transport cholesterol as there is less cholesterol

45
Q

What are some adverse drug reactions as well as patient education associated with HMG-CoA reductase inhibitors (Simvastatin)?

A
  • Must report any muscle pain or weakness due to rare but serious risk of myopathy / rhabdomyolysis
  • GI upset including stomach cramps
  • Headache and sleep disturbances
  • Low fat diet, exercise.
  • Explain to the patient the risk of CVD & the benefits of taking statins—improve compliance
  • Medication should be used in conjunction with diet restrictions (low saturated fat, cholesterol, carbohydrates, alcohol), exercise & cessation of smoking.
  • Take in evening to maximise efficacy (as hepatic cholesterol synthesis is maximal during midnight to 2am)
  • Inform patients ADRs. Instruct patients to Notify Dr. if unexplained muscle pain, tenderness, or weakness occurs, esp. if accompanied by fever or malaise.
46
Q

What are some cautions/contraindications of HMG-CoA reductase inhibitors (Simvastatin)?

A
  • Avoid grapefruit as grapefruit compete for the same receptor as the Statins do
  • St John’s Wort
  • Any other drug that may inhibit the metabolism of the statin = increased risk of myopathy / rhabdomyolysis
  • Avoid alcohol. Take at bedtime as liver works at a higher capacity overnight.
  • Not to be taken in pregnancy.
47
Q

What is an example of an Antiplatelet?

A

Asprin

48
Q

What is the indication of use for an antiplatelet?

A

Used for the prevention of arterial thrombosis

49
Q

What is the MOA for antiplatelet medications?

A

Aspirin inhibits the cyclooxyrgenase enzyme (COX 1) causing a decrease in synthesis of thromboxane A2 which then inhibits platelet aggregation and vasoconstriction. Aspirin binds to the platelet for the life of the platelet. Stops the platelets from sticking together

50
Q

What are some adverse drug reactions associated with antiplatelet medications?

A
  • Bleeding
  • Bruising
  • GI bleeding/upset
  • Dyspepsia (pain or discomfort in the upper abdomen which is usually described as a burning sensation, heaviness or an ache)
  • Rash
  • Allergy
  • Bronchospasm
51
Q

What are some Contraindications/cautions associated with antiplatelet medications?

A
  • Should not be used for children, due to risk of Reye’s disease
  • Caution in older persons due to decreased hepatic and renal function
  • Avoid in persons with hemorrhagic conditions, respiratory conditions, coagulation disorders, recent surgery or trauma
52
Q

What are some monitoring requirements associated with antiplatelet medications

A

Blood test, monitor for bleeding and bruising.

53
Q

What patient education would you provide for someone who is on antiplatelet medications?

A
  • Avoid taking additional over the counter NSAID’s without advice
  • Caution with surgery and dental treatment
  • Monitor for signs of GI bleeds, dyspnoea / bronchoconstriction
  • If you cut yourself, apply pressure as you won’t clot without pressure
54
Q

What are two examples of anticoagulants?

A

Heparin and Warfarin

55
Q

What is the indication of use for Heparin?

A

Used for prevention of and treatment of venous thromboembolism, formation of clots in IV catheters, dialysis. Has a shorter half life so used in acute situations

56
Q

What is the MOA for Heparin?

A

Combines with antithrombin and increases its effect. Therefore, blocks the conversion of prothrombin to thrombin and fibrinogen to fibrin. Faster acting as works on 2 factors but requires monitoring.

  • Highly protein bound
57
Q

What is the pharmacokinetics for Heparin?

A

Onset of action immediate, route of administration parenteral, duration of action short

58
Q

What are some adverse drug reactions associated with Heparin?

A
  • Bleeding
  • Bruising
  • Lipohypertrophy
  • Low platelet count
59
Q

What are some contraindications/cautions associated with Heparin?

A

Avoid use in patient with risk of bleeding. Not recommended in pregnancy. Caution in Renal failure/impairment, asthma, history of allergies.

60
Q

What are some monitoring requirements associated with Heparin?

A

blood test – platelet count, monitor for signs of bleeding + bruising, baseline vitals. Activated Partial Thromboplastin Clotting Time regular monitoring

61
Q

What patient education would you provide to someone who is on Heparin?

A
  • Alternate sites of injection to prevent bruising and lipohypertrophy
  • Avoid over the counter aspirin and NSAIDs
  • Monitor for signs of GI bleeding
  • Care with dental treatment (use a soft toothbrush to minimise gum bleeding)
  • Encourage the patient to refrain from contact sports or activities.
  • Advise the use of an electric razor to minimise bleeding.
62
Q

What is the antidote for Heparin?

A

Protamine

63
Q

What is the indication of use for Warfarin?

A

For prevention of existing clots and for prevention of DVT, PE, thrombi associated with prosthetic heart valves, chronic Atrial Fibrillation

64
Q

What is the MOA for Warfarin?

A

Interacts with hepatic synthesis of Vitamin K dependent clotting factors

65
Q

What is the antidote for Warfarin?

A

Vitamin K

66
Q

What is the pharmacokinetics for Warfarin?

A

Can cross placenta causing foetal abnormalities; not enter breast milk. The dose is closely monitored via PT &INR. Therapeutic range: 2.0-4.0

PT = (prothrombin time) - how long it takes for a clot to form within a blood sample and INR (international normalised ratio) is a type of calculation based on the PT results

67
Q

What are some concerns regarding pharmacokinetics within Warfarin?

A

Highly protein bound so need to consider albumin levels, hepatic function, renal function

68
Q

What are some adverse drug reactions associated with Warfarin?

A
  • Bleeding
  • Chest Pain
  • Dyspnoea
  • Headache
  • Dizziness
  • Visual disturbance
  • GI upset
69
Q

What monitoring requirements would you monitor for Warfarin?

A

Patients INR (international normalised ratio) levels (2-3), takes 3 to 5 days to act to therapeutic level. Monitor for signs of bleeding.

Relatively long half-life and Narrow therapeutic range

70
Q

What are some contraindications/cautions with Warfarin?

A

History of hemorrhagic conditions, alcoholism, elderly (especially with prosthetic heart valves), pregnancy

71
Q

What patient education would you provide to someone on Warfarin?

A
  • Risk of bleeding, look for signs of GI bleeding
  • Regular monitoring
  • Need to take at same time each day, do not stop taking without consultation, don’t double dose if miss a dose
  • Avoid vitamin K rich foods
  • Avoid large consumption of alcohol (increases risk of bleeding)
  • Care with dental treatment (Use a soft toothbrush to minimise gum bleeding)
  • Stop taking warfarin few days before surgery

BNPH700 (8 decks)

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