Cardiovascular Medications

Question 1

Refers to the stopping of blood flow. It is an essential mechanism that protects the body from both external and internal injury.

Is also achieved once a blood clot is formed and the body is protected from excessive hemorrhage.

Answer 1

Hemostasis

Question 2

Also known as Clotting, this refers to the process by which blood changes from a liquid to a gel, forming a blood clot.

Answer 2

Coagulation

Question 3

Refers to the series of steps in response to bleeding caused by tissue injury, where each step activates the next and ultimately produces a blood clot.

Answer 3

Coagulation Cascade

Question 4

What substance does the liver require to make four of the clotting factors?

Answer 4

Vitamin K

Question 5

Refers to the coagulation pathway that is activated in response to injury.

Answer 5

Intrinsic Pathway

Question 6

Refers to the coagulation pathway that is activated when blood leaks out of a vessel and enters tissue spaces.

Answer 6

Extrinsic Pathway

Question 7

Also known as clotting factor I, forms fibrin that binds together platelets and some plasma proteins in a hemostatic plug.

Answer 7

Fibrinogen

Question 8

Also known as clotting factor II, activates thrombin.

Answer 8

Prothrombin

Question 9

Is a chemical responsible for converting the clotting factor prothrombin into an enzyme called thrombin

Answer 9

Prothrombin Activator / Prothrombinase

Question 10

Refers to an enzyme that converts fibrinogen, a plasma protein, to fibrin

Answer 10

Thrombin

Question 11

What is the approximate time in which normal blood clotting occurs?

Answer 11

6 Minutes

Question 12

Refers to drugs that are used to prolong bleeding time and thereby prevent blood thrombi from forming or growing larger.

These drugs impart a negative charge to the surface of the platelets, which inhibits the clumping action or aggregation of these cells.

Answer 12

Anticoagulants

Question 13

Is the traditional drug of choice for parenteral anticoagulation. It is administered intravenously or subcutaneously to achieve a rapid onset of action.

This drug acts by enhancing the actions of antithrombin III. A protein in plasma that inactivates thrombin, and several other procoagulant enzymes, and inhibits coagulation.

Answer 13

Heparin Sodium

Question 14

Refers to shortened and modified heparin molecules. Are a newer class of drugs related to heparin.

Answer 14

Low-Molecular-Weight-Heparins (LMWHs)

Question 15

Another name for heparin. Is used to distinguish it from LMWHs

Answer 15

Unfractionated Heparin

Question 16

What is the action of Heparin? And what is its onset of action?

Answer 16

Heparin binds to Antithrombin III, resulting in the inactivation of several clotting factors and inhibits thrombin activity.

The onset of action for IV Heparin is immediate, whereas subcutaneous heparin may take up to 1 hour to achieve a therapeutic effect

Question 17

What are some Nursing Interventions for Heparin Sodium?

Answer 17

• Monitor aPPT (Activated partial thromboplastin time)
• Monitor platelet count
• When administering heparins via SC, inject into abdomen with a 25-28 G needle at a 90 degree angle. Do not aspirate once the needle has entered the skin and never massage the site after injection
• Observe for signs of bleeding: gums, bruises, nosebleeds, hematuria, hematemesis, occult blood in stool and petechia
• If aPPT is longer than 80 seconds, lower the dosage, if less than 60 seconds, increase the dosage

Question 18

Name a contraindication for Heparin Sodium

Answer 18

IM administration is contraindicated due to bleeding risk

Question 19

What is the antidote for Heparin Sodium?

Answer 19

Protamine Sulfate

Question 20

What is the normal aPPT? (Activated partial thromboplastin time)

Answer 20

20 - 40 seconds. may vary in different sources, but essentially are within this range

Question 21

What type of drug is Enoxaparin Sodium?

Answer 21

LMWHs (Low-Molecular-Weight-Heparins)

Question 22

This drug’s mechanism of action and use are similar to that of heparin, but is not interchangeable. It’s inhibition is more specific to active Factor X and has a longer half-life than heparin.

Answer 22

Enoxaparin Sodium

Question 23

Refers to the most commonly prescribed oral anticoagulant

Answer 23

Warfarin Sodium

Question 24

Why do both heparin and warfarin therapy sometimes overlap?

Answer 24

Because unlike heparin that can act either immediately or within an hour, the anticoagulant activity of warfarin can take several days to reach its maximum effect.

Question 25

What is the action of Warfarin? And what is its onset of action?

Answer 25

Warfarin **inhibits the action of vitamin K**. Without adequate vitamin K, the **synthesis of clotting factors II, VII, IX, and X is diminished**. Because these clotting factors are **normally circulating in the blood**, it takes **several days for their plasma levels to fall** and for the anticoagulant effect of warfarin to appear.

Question 26

What are some Nursing Interventions for Warfarin Sodium?

Answer 26

- **Observe for signs of bleeding**: bleeding gums, bruises, nosebleeds, hematuria, hematemesis, occult blood in stool, and petechia. - Instruct patient regarding diet and measures to prevent bleeding. - If life-threatening bleeding occurs during therapy, the anticoagulant effects of warfarin can be reduced by **intramuscular (IM) or subcutaneous administration** of its **antagonist, Vitamin K1**.

Question 27

What is the **antidote** for Warfarin Sodium?

Answer 27

Vitamin K

Question 28

What is the normal INR **(International Normalized Ratio)** of the average person?

Answer 28

**1.3 - 2.0 seconds** However, the treatment goal of warfarin sodium is to raise the INR to an appropriate value—**2 to 3 seconds**. Which is appropriate for most patients

Question 29

List the anticoagulant drugs that were mentioned in this deck.

Answer 29

- **Heparin** Sodium - **Enoxaparin** Sodium - **Warfarin** Sodium

Question 30

Refers to drugs that **promotes the process of fibrinolysis, or clot destruction**, by converting plasminogen into **plasmin, an enzyme that digests fibrin** and **breaks it down into small soluble fragments**

Answer 30

Thrombolytics

Question 31

What enzyme **digests fibrin**, and breaks it down into small soluble fragments?

Answer 31

Plasmin

Question 32

When are thrombolytics used in the course of MI?

Answer 32

Within **4 to 6 hours** of the onset of the infarction.

Question 33

Refers to a **thombolytic drug used for dissolving clots**. Is also the **preferred drug** for the treatment of **stroke, arterial thrombosis, deep vein thrombosis, occluded shunts or catheters and pulmonary emboli**.

Answer 33

Alteplase

Question 34

What are the **Nursing Interventions** for Alteplase?

Answer 34

- **Observe for signs of bleeding**: bleeding gums, bruises, nosebleeds, hematuria? hematemesis, occult blood in stool, and petechia - Instruct patient regarding diet and measures to prevent bleeding. - Monitor for neurological changes such as slurred speech, lethargy, confusion, and hemiparesis - Monitor vital signs **closely** and assess pulses - Must give drug **within 12 hours of onset** of symptoms of MI and **within 3 hours of thrombotic stroke** for maximum effectiveness - Apply direct pressure over a puncture site for **20-30 minutes**.

Question 35

What is the **antidote** for Alteplase?

Answer 35

Aminocaprioc Acid (Amicar). **Is used only in acute life threatening conditions**.

Question 36

What are some of the **contraindications** of Alteplase?

Answer 36

- Active internal bleeding - History of hemorrhage brain attack (stroke) - Uncontrolled hypertension - Intracranial problems, including trauma - History of hepatic or renal disease - Recently acquired, prolonged CPR - Intracranial or Intraspinal surgey within the previous 2 months - History of thoracic, pelvic, or abdominal surgery in the previous 10 days

Question 37

Refers to a type of drug that **produces an anticoagulant effect by interfering with platelet aggregation**. Are used to **prevent clot formation in the arteries**, and **may be used with anticoagulants**.

Answer 37

Antiplatelet Drugs

Question 38

What is the **difference between the locations** in which **Antiplatelet and Anticoagulant drugs** act upon?

Answer 38

- Anticoagulants **prevent thrombosis in veins**. - Antiplatelet drugs **prevent clot formation in arteries**.

Question 39

Refers to an **Antiplatelet Drug** that **acts by binding irreversibly to the enzyme **cyclooxygenase** in platelets**. Resulting in the formation of **Thromboxane A**, a powerful inducer of platelet aggregation.

Answer 39

Aspirin

Question 40

Refers to an **Antiplatelet Drug** that **prolongs bleeding time** by **inhibiting platelet aggregation**, directly inhibiting ADP binding to its receptor. Said binding is irreversible, and the platelet will be affected for the remainder of its life span.

Answer 40

Clopidogrel

Question 41

Refers to a drug that is usually prescribed for patients who are **unable to tolerate aspirin,** which has similar anticoagulant activity. **It is given PO OD.**

Answer 41

Clopidogrel

Question 42

List some **indications** for the drug **Aspirin**.

Answer 42

- Is a drug prototype for pain relief - Used for prevention of strokes - Used for prevention of MI - Used for reducing inflammation

Question 43

Refers to a small group of drugs that **irreversibly alter the plasma membrane of platelets**. An alteration that **changes the binding of ADP to its receptor on platelets. Making them unable to receive the chemical signals required for them to aggregate**.

Answer 43

ADP Receptor Blockers

Question 44

What is the **primary concern** for a client taking an anticoagulant, thrombolytic. or antiplatelet medication?

Answer 44

Bleeding

Question 45

Refers to a **change in contractility of the heart**.

Answer 45

Inotropic Effect

Question 46

Refers to drugs that **increases the contractility of the heart**.

Answer 46

Positive Inotropic Agents

Question 47

Give an example of **Positive Inotropic Agents**.

Answer 47

- Epinephrine - Norepinephrine - Dopamine - Thyroid Hormone

Question 48

Refers to drugs that are used for **short term management of heart failure**. Which increases myocardial contractility, improves cardiac, peripheral, and kidney function by increasing cardiac output, decreasing preload, improving blood flow to the periphery and kidneys, decreasing edema, and increasing fluid retention. Resulting in fluid retention to be decreased in the lungs and extremities.

Answer 48

Positive Inotropic Agents

Question 49

Refers to a drug that is used as a **short term rescue measure** for clients with severe, acute heart failure. This drug **increases myocardial contractility**, thereby improving cardiac performance.

Answer 49

Dopamine

Question 50

**In what route** do positive inotropic and cardiotonic medications administered in?

Answer 50

Intravenous Administration

Question 51

Is a positive inotropic agent. A drug that **inhibits the sodium-potassium pump**, increasing intracellular calcium, causing the heart muscles to contract more efficiently (Increases the force of myocardial contractions).

Answer 51

Digoxin

Question 52

Why is Digoxin sometimes used to treat dysrhythmias?

Answer 52

- Because of its ability to **suppress** the SA node - Because it **slows electrical conduction** through the AV node

Question 53

What is the **antidote** for **Digoxin toxicity?**

Answer 53

Digoxin Immune Fab

Question 54

What are the classifications of Diuretics?

Answer 54

- Loop Diuretics - Osmotic Diuretics - Potassium-retaining Diuretics - Thiazide Diuretics

Question 55

Refers to **Diuretics** that **increase sodium and water excretion** by **inhibiting sodium reabsorption** in the **distal tubule of the kidney**.

Answer 55

Thiazide Diuretics

Question 56

Why should Thiazide Diuretics be **used with caution** in patients taking **lithium?**

Answer 56

Because **Lithium Toxicity** can occur.

Question 57

Refers to diuretics **more potent** than thiazide diuretics. They increase **sodium and chloride reabsorption** from the **loop of Henle and the distal tubule**

Answer 57

Loop Diuretics

Question 58

Are diuretics that act on the **distal tubule** to **promote sodium and water excretion, and potassium retention**. They are used for edema and hypertension to **increase urine output, and to treat fluid retention and overload**.

Answer 58

Potassium-retaining Diuretics

Question 59

What are the **contraindications** for Potassium-retaining Diuretics?

Answer 59

- Severe Kidney or Hepatic Disease - Severe Hyperkalemia

Question 60

Refers to drugs that decrease sympathetic vasoconstriction by reducing the effects of norepinephrine at **peripheral nerve endings**, resulting in vasodilation and decreased BP.

Answer 60

Peripherally Acting Alpha Adrenergic Blockers

Question 61

Refers to drugs that stimulate alpha receptors in the **central nervous system** to inhibit vasoconstriction, thus reducing peripheral resistance.

Answer 61

Centrally Acting Sympatholytic (Adrenergic Blockers)

Question 62

Why are patients using Centrally Acting Sympatholytic (Adrenergic Blockers) instructed not to discontinue medication?

Answer 62

Because **abrupt withdrawal** can cause **severe rebound hypertension**.

Question 63

Are drugs that prevents peripheral vasoconstriction by **blocking conversion of angiotensin I to angiotensin II**.

Answer 63

Angiotensin - Converting Enzyme Inhibitors

Question 64

Refers to drugs that **prevent peripheral vasoconstriction and secretion of aldosterone**. Also blocks the **binding of AT1 receptors**.

Answer 64

Angiotensin II Receptor Blockers

Question 65

Is a type of **Antianginal Medication** that produces vasodilation, **decreases preload and afterload**, and reduces myocardial oxygen consumption.

Answer 65

Nitrates (Nitroglycerin)

Question 66

Why do we instruct patients to **check the expiration date** of nitroglycerin tablets?

Answer 66

Because expiration may occur **within 6 months** of obtaining the medication. The tablets by that point **will not relieve chest pain, if expired**.

Question 67

Are drugs that **inhibit the response to beta adrenergic stimulation**, decreasing cardiac output. These drugs **block the release** of catecholamines, epinephrine, and norepinephrine, thus decreasing the heart rate and BP. They also **decrease the workload of the heart and decrease oxygen demands**.

Answer 67

Beta Adrenergic Blockers

Question 68

Is a type of Antianginal Medication that induces a negative inotropic effect by **relaxing smooth muscle**, thus **decreasing cardiac contractility** and the workload of the heart. Reducing the need for oxygen.

Answer 68

Calcium Channel Blockers

Question 69

Refers to drugs that **decrease peripheral resistance** by exerting a direct action on the arteries or on the arteries and the vein. These drugs also **increase blood flow to the extremities** and are used in peripheral vascular disorders of venous and arterial vessels.

Answer 69

Peripheral Vasodilators

Question 70

Are drugs that relax the smooth muscles of the blood vessels, **mainly the arteries**, causing vasodilation. With vasodilation, BP drops, and sodium and water are retained, resulting in peripheral edema. (Diuretics may be given to reduce the edema) These drugs **promote an increase in blood flow to the brain and kidneys**.

Answer 70

Direct - Acting Arteriolar Vasodilators

Question 71

When it comes to vasodilators, why do we have to **instruct the patient about safety measures when taking Direct - Acting Arteriolar vasodilators?**

Answer 71

Because **vasodilators cause orthostatic hypotension**. As such, patients should be instructed when they are rising from lying to a sitting or standing position to slowly do so.

Question 72

Refers to drugs that suppress dysrhythmias by **inhibiting abnormal pathways** of electrical conduction through the heart.

Answer 72

Antidysrhythmic Medications

Question 73

What are the **classes** of Antidysrhythmic Medications?

Answer 73

- Class I : **Sodium Channel Blockers** - Class II : **Beta Blockers** - Class III : **Potassium Channel Blockers** *(Medications that delay repolarization)* - Class IV : **Calcium Channel Blockers**

Question 74

Why are antidysrhythmics **not administered with food?**

Answer 74

Because food **may affect absorption**

Question 75

Refers to drugs that **reduce serum levels of cholesterol, triglycerides, or low-density lipoprotein**.

Answer 75

Antilipemic Medications

Question 76

Refers to an Antilipemic Medication that **binds with acids in the intestines, which prevents reabsorption of cholesterol**.

Answer 76

Bile Sequestrants

Question 77

Refers to an Antilipemic Medication that **blocks an enzyme called HMG-CoA reductase**. Which is responsible for synthesizing cholesterol in the liver.

Answer 77

HMG-CoA Reductase Inhibitors

Question 78

Why are patients using HMG-CoA Reductase Inhibitors instructed to have an **annual eye examination**?

Answer 78

Because these medications can **cause cataract formation**.

Question 79

Give examples of Antilipemic Medications

Answer 79

- Gemfibrozil - Lovastatin *(HMG-CoA Reducatse Inhibitor)* - Cholestyramine *(Bile Sequestrant)* - Nicotinic Acid

Question 80

Why should Gemfibrozil **not be taken with anticoagulants?**

Answer 80

Because they **compete for protein sites**.

Question 81

Why should Gemfibrozil **not be administered with HMG-CoA Reductase Inhibitors?**

Answer 81

Doing so increases the risk for **myositis, myalgias, and rhabdomyolysis**