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NUR326 Cardiac > cardiovascular pharmacology > Flashcards

cardiovascular pharmacology Flashcards

(65 cards)

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1
Q

what are anti-anginals used for?

A

to treat stable angina

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2
Q

Goal of pharmacotherapy of stable angina

A

Goal: relieve (nitrates, beta blockers, clacium channel blockers, ranolazine)
Goal: Reduce (lipid lowering drug, ASA or clopidogrel (plavix) )
Goal: Improve morbidity and mortality
(ace inhibitor or arb)

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3
Q

anti-anginals

What do nitrates do

A

dilates veins, which decreases preload

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4
Q

anti-anginals

What do beta blockers do

A

decrease heart rate and contractility

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5
Q

anti-anginals

What do calcium channel blockers do?

A

dilate arterioles, which decreases afterload

decrease heart rate and contractility

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6
Q

What do anti-anginals and

ranolazine do?

A

helps the myocardium generate energy more efficiently

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7
Q

meds to treat stable angina

A

nitrates and ranolazoine

** beta blockers, calcium channel blockers, statins, asa covered in fundamentals**

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8
Q

nitroglycerin

A

organic nitrates
first anginal agent
dilates veins and decreases preload

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9
Q

side effects of nitro

A

r/t vasodilation, Headache, hypotension, reflex tachycardia, tolerance

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10
Q

rapid acting nitro

A

sublingual
translingual
iv

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11
Q

nitrostat

A

rapid
sublingual
put under tongue
repeat every 5 min x3 PRN

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12
Q

types of short acting nitro

A

skin patch

ointment

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13
Q

transderm-nitro

A

skin patch
short acting
apply to chest or thigh area daily

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14
Q

nitro-bid

A

short acting
ointment
apply 1-2 inches to chest or thigh area

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15
Q

long acting nitro

A

isosorbide
sub lingual or oral
for prevention of anginal attacks
tolerance builds up over time

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16
Q

nursing implications for nitrates

A

headache- most subside after 20 min
apply nitro patch in AM and remove in PM (apply to hairless site and rotate)
IV form- glass bottle with special tubing, monitor for severe ha, tachycardia
long acting- taper when d/c to prevent increased CP from vasopressin

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17
Q

pt education for nitrates

A 
treatment of acute chest pain
take only as many SL tabs as needed
do not swallow SL
fall precautions- can make you dizzy/ hypotension
no relief in 5 min call 911
DO NOT exceed 3 doses
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18
Q

Severe drug interactions of nitrates

A

severe hypotension when taken with sildenafil/viagra, antihypertensive and etoh

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19
Q

what is the most recent guideline for nitro

A

if chest pain is not relieved or worsened 5 min after taking the first nitro, call 911 and take another

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20
Q

ranolazine (ranexa)

A

anti-anginal

MOA unknown, possibly helps myocardium use energy more efficiently

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21
Q

warnings using ranolazine

A

prolonged QT intervals
acute renal failure with existing renal disease
liver cirrhosis

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22
Q

what do you need to avoid on ranolazine?

A

grapefruit juice and CYP inhibitors

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23
Q

side effects of ranolazine

A

ha, dizziness, nausea, constipation

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24
Q

pharmacology tx of HF

A 
ace
arb
arni
beta blockers
mineralocorticoid receptor agonist
SLGT2 inhibitors
diuretics 
digitalis
nitrates
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25
ARNI's
sacubitril/valsartan *thought to be the best but are newer and more expensive RAAS inhibitor
26
MOA of ARNI's
decreases preload and afterload suppresses aldosterone Stops cardiac remodeling use highest dose possible
27
side effects of ARNI's
hypotension hyperkalemia cough (ACEI)
28
carvedilol
beta blocker | protects against SNS activation and dysrhythmias, reverses cardiac remodeling
29
side effects of carvedilol
fluid retention, worsening HF fatigue hypotension bradycardia
30
spironolactone
mineralocorticoid receptor | used for the suppression of sodium/water retention to help with offloading the LV
31
what condition must watch for with spironolactone and what can it cause?
hyperkalemia and worsening renal failure
32
dapaglifozin
SLG2 inhibitor MOA for HF not well understood helps with ventricular unloading through osmotic diuresis without depleting volume decreases readmissions, mortality and morbidity
33
first-line therapy of diuretics in HF
loop diuretics furosemide used for volume overload No survival benefit!!
34
side effects of furosemide
hypokalemia hypotension digoxin toxicity
35
digitalis/ digoxin
inotropic drug cardiac glycosides second line drug therapy due to increased risk for dysrhythmia's
36
what does positive inotropic effect mean?
if we increase contractility of heart muscle then we increase force of contraction increasing CO
37
what plant is digitalis made from?
foxglove
38
MOA of digitalis/digoxin
cardiac glycoside inhibits sodium-potassium ATP pump causing calcium to collect within cells of heart helping to increase myocardial contractility decreased HR
39
side effects of digitalis/digoxin
cardiac dysrhythmias | digitalis toxicity
40
who is at highest risk of digitalis toxicity
Increased age women combination drugs (digoxin and diuretic therapy)
41
how do you prevent digitalis toxicity
reduced dose serum digitalis levels (periodic monitoring) supplemental potassium
42
nursing implications when giving digoxin
``` monitor serum potassium levels take apical pulse 1 full minute prior to administering digoxin hold if pulse below 60 monitor cardiac rhythm TEACH pt to take own pulse before taking ```
43
what is the antidote for digitalis toxicity
digoxin immune fab (digibind) given IV
44
signs and symptoms of digitalis toxicity
``` bradycardia headache dizziness confusion nausea visual disturbances - blurry/yellow vision ```
45
meds to control rate and rhythm control
``` beta blockers calcium channel blockers amiodarone adenosine atropine dofetilide ```
46
what is the HR goal for beta blockers?
HR <100 and normal rhythm
47
amiodarone MOA
prolongs action potential duration and the effective refractory period in ALL cardiac tissues blocks alpha and beta adrenergic receptors in the SNS one of the most effective antidysrhythmic for PSVT and ventricular dysrhythmias used for afib with RVR
48
black box warning of amiodarone
pulmonary toxicity hepatotoxicity pro-arhythmic effects
49
2 significant drug interactions with amiodarone
digoxin and warfarin causing increased digoxin levels and increased INR extremely long half life-lasts in system for 2-3 months
50
who is amiodarone contraindicated in?
people with severe bradycardia, or heart blocks
51
signs and symptoms of amiodarone toxicity
``` tremors ataxia blue-gray skin bradycardia hepatotoxicity ocular neuritis corneal microdeposits ```
52
atropine
for sinus brady (symptomatic only) for rate and rhythm control anticholenergic/antimuscarinic given IV only for bradycardia 1mg every 3-5 min 3mg max
53
MOA of atropine
poisons the vagus nerve, inhibits postganglionic acetylcholine receptors and direct vagolytic action
54
side effects of atropine
xerostomia, blurry vision, photophobia, tachycardia, flushing, hot skin
55
nursing implications for atropine
cardiac monitoring, if med doesn't work quickly give second dose
56
adenosine for PSVT
slows the conduction time through AV node very short half life- may need multiple doses only given IV 6mg IVP, if no conversion give 12mg IVP, can give 3rd time 12 mg IVP ALWAYS follow with rapid normal saline flush or 2 saline flushes
57
what does adenosine cause?
short burst of ASYSTOLE until sinus rhythm returns
58
side effects of adenosine?
very few, can cause short bursts asystole | Have shock pads on pt incase rhythm doesn’t rerun
59
dofetilide (tikosyn)
antidysrhythmic conversion from afib/aflutter to NSR And to stay in NSR Maintenance med
60
moa of dofetilide
selectively blocking the rapid cardiac ion channel carrying potassium currents
61
side effects of dofetilide
torsades, svt, headache, dizziness, chest pain
62
nursing implications of dofetilide
started in hospital with ECG monitoring r/t risk of Torsades | DONT give to patients with long QT intervals or other drugs that may prolong QT intervals
63
Amidodarone Side effects
``` Fat loving causing: Thyroid alterations Corneal micro deposits Pulmonary toxicity Hepatotoxicity ```
64
Torsades
``` Caused by dofetilide Form of Vtach Deadly CPR Very fast ```
65
A fib patients also need to take
Warfarin

NUR326 Cardiac (6 decks)

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