Cardiovascular Medications

Question 1

What is anticoagulants?

Answer 1

Prevent extension and formation of clots by inhibiting factors in clotting cascade and decreasing blood coagulability.

Question 2

When are anticoagulants used?

Answer 2

Evidence of or likelihood of clot formation:
MI
Unstable angina
Afib
DVTs (deep vein thrombosis)
PE (pulmonary embolism)
Presence of mechanical heart valves

Question 3

Contraindications of anticoagulants?

Answer 3

Active bleeding (except disseminated intravascular coagulation DIC)
Bleeding disorders
Blood dycrasias
Ulcers
Liver and kidney disease
Hemorrhagic brain injuries

Question 4

Common side effects and adverse effects of anticoagulants?

Answer 4

Hemorrhage
Hematuria (blood in urine)
Epistaxis (nose bleed)
Ecchymosis (bruising; bleeding under skin)
Bleeding gums
Thrombocytopenia (platelet count in blood too low)
Hypotension

Question 5

Oral route

Answer 5

Apixaban
Dabigatran etexilate
Edoxaban
Rivaroxaban
Warfarin sodium

Question 6

Parenteral route

Answer 6

Argatroban
Bivalirudin
Dalteparin
Desirudin
Enoxoparin
Fondaparinux
Heparin sodium

Question 7

Heparin sodium (parenteral)

Answer 7

Prevents thrombin from converting fibrinogen to fibrin.
Normal aPTT is 30-40 seconds
THERAPEUTIC LEVEL receiving continuous infusion is aPTT 1.5-2.5 times normal value (depending on agency protocol).
MEASURE aPTT every 4-6 hours during initial infusion and then daily per agency policy.
MONITOR aPTT and platelet count.
OBSERVE for bleeding gums, bruises, epistaxis, hematuria, hematemesis, occult blood in stool, and petechiae.
ANTIDOTE is protamine sulfate.
INFUSION is always done with infusion pump and preprogrammed to ensure safe delivery rate.

Question 8

Enoxaparin (parenteral)

Answer 8

Prevents thrombin from converting fibrinogen to fibrin.
Same action of heparin but longer half-life.
DO NOT expel air bubble from prefilled syringe.
Admin in abdomen subcu.
MONITOR aPTT and for bleeding.
TEACH pt to prevent bleeding.
ANTIDOTE is protamine sulfate.

Question 9

Warfarin Sodium (Oral)

Answer 9

Suppresses coagulation by acting as an antagonist of vitamin K (inhibiting clotting factors X, IX, VII, & II).
MONITOR prothrombin time (PT) and international normalized ratio (INR).
Long term use.
PT 11-12.5 seconds
Therapeutic Range is 1.5 to 2 times control value.
INR 0.81-1.2 conventional and standard units
TEACH pt to prevent bleeding.
ANTIDOTE is phytonadione.
Routine monitoring is required.

Question 10

Dabigatran etexilate

Answer 10

Works through direct inhibition of thrombin, preventing conversion of fibrinogen into fibrin and activation of factor XIII.
Clot prevention w/ nonvalvular a fib.
No testing is required.
OBSERVE for bleeding and TEACH client regarding ways measures to prevent bleeding.
ANTIDOTE for warfarin is phytonadione.

Question 11

Substances to avoid with anticoagulants?

Answer 11

Allopurinol
Cimetidine
Corticosteroid
Fluoroquinolones
Green, leafy vegetables and other foods high in vitamin K
Gingko and ginseng (herbs)
Macrolide antibiotics
Oral hypoglycemic agents
Phenytoin
Salicylates
Sulfonamides

Question 12

Thrombolytic medications

Answer 12

Alteplase
Reteplase
Tenecteplase

Question 13

What are thrombolytic medications?

Answer 13

Activate plasminogen which generates plasmin (the enzyme that dissolves clots).

Question 14

What are thrombolytic medications used for?

Answer 14

Used in early course of MI (within 4-6 hours of onset) to restore blood flow, limit damage, preserve left ventricular function, and prevent death.

Question 15

What are contraindications of thrombolytic medications?

Answer 15

Active internal bleeding
Hx of stroke
Intracranial problems including trauma
Intracranial or intraspinal surgery within last 2 months.
Hx of thoracic, pelvic, or abdominal surgery.
Hx of hepatic or renal disease.
Uncontrolled HTN
Recent, prolonged cardiopulmonary resuscitation.
known allergy to product or its preservatives.

Question 16

What are side effects of thrombolytic agents?

Answer 16

Bleeding
Dysrhythmias
Allergic Reactions

Question 17

What are interventions to use during the use of thrombolytic medications?

Answer 17

Determine aPTT, PT, fibrinogen level, hematocrit, and platelet count.
Monitor vitals
Check pulses
Monitor for bleeding
Monitor neurologic changes
Monitor for hypotension and tachycardia
Avoid injections and unnecessary venipunctures.
Apply pressure over a puncture site for 20-30 minutes.
When moving pt handle as little as possible.
Teach pt to use electric razor and brush teeth with soft tooth brush gently.
Hold medication if bleeding is present and contact HCP.
ANTIDOTE is amniocaproic acid

Question 18

What does an antiplatelet medication do?

Answer 18

Inhibits the aggregation of platelets in clotting process thereby prolonging bleeding time.
Used with anticoagulants.

Question 19

What are contraindications of antiplatelet medications?

Answer 19

Patients with bleeding disorders and known sensitivity.

Question 20

What are antiplatelet medications used for?

Answer 20

Prophylaxis of long-term complications after MI, coronary revascularization, stents, and stroke.

Question 21

What are common adverse effects of antiplatelet medications?

Answer 21

GI Bleeding
Bruising
Hematuria
Tarry Stools

Question 22

What are interventions to use for antiplatelet medication use?

Answer 22

Blood test for sensitivity.
Monitor vital signs.
Teach to take with food if GI upset occurs.
Monitor bleeding time
Reinforce instructions to client to monitor for side effects related to bleeding and measures to prevent bleeding.

Question 23

What do cardiac glycosides do?

Answer 23

Inhibits the sodium-potassium pup, thus increasing intracellular calcium which causes the heart muscle fibers to contract more efficiently.
Increases the force of myocardial contractions and slows the heart rate.

Question 24

What medications are cardiac glycosides?

Answer 24

Digoxin

Question 25

What is digoxin (cardiac glycoside) used for?

Answer 25

Increases cardiac, peripheral, and kidney function by increasing cardiac output, decreasing preload, improving blood flow to periphery and kidneys, decreasing edema, and increasing fluid excretion.
Reduces fluid retention in lungs and extremities.

Question 26

What medications are cardiac glycosides?

Answer 26

Second line for HF and cardiogenic shock, atrial tachycardia, atrial fibrillation, and atrial flutter.

Question 27

Contraindications of digoxin?

Answer 27

Ventricular dysrhythmias and second- or third- degree heart block.
Use with caution in patients with renal disease, hypothyroidism and hypokalemia.

Question 28

What are side and adverse effects of digoxin?

Answer 28

Anorexia, nausea, vomiting, diarrhea
Headache
Visual disturbances including diplopia, blurred vision, yellow-green halos, photophobia
Drowsiness
Bradycardia
Fatigue, weakness

Question 29

What are early signs of digoxin toxicity?

Answer 29

GI manifestations (anorexia, nausea, vomiting, diarrhea) then heart rate abnormalities and visual disturbances appear.

Question 30

What are interventions to consider with digoxin?

Answer 30

Monitor for toxicity: anorexia
vomiting, visual disturbances, confusion, bradycardia, heart block, premature ventricular contractions, and tachydysrhythmia.

Question 31

What is the therapeutic range for digoxin?

Answer 31

0.5-2.0 ng/mL
Low end of normal preferred to avoid toxicity

Question 32

What electrolytes

Answer 32

potassium level (3.5-5 mEq/L); if hypokalemia occurs notify the HCP

Question 33

What to teach patients on digoxin?

Answer 33

Avoid taking OTC meds
Advise the client to eat foods high in potassium such as fresh and dried fruits, fruit juices, vegetables and potatoes.
Teach pt how to monitor pulse and to notify the HCP if less than beats/min.
Teach S/S of dig toxicity.

Question 34

What is the antidote for digoxin?

Answer 34

Digoxin immune Fab is used in extreme toxicity.