Cardiovascular Pharmacology Study Guide Flashcards
Heparin Drug Class uniqueness and actions
Drug Therapy for Thromboembolic Disorders
Drug class: Anticoagulant
Example: Heparin
Actions/Uses/Therapeutic outcomes:
-Used to treat DVT, PE, peripheral arterial embolism, MI and PCIs.
-Therapeutic range: 1.5 – 2.5
-Used to treat thromboembolism
-Promote neutralization of activated clotting factors
-Does not dissolve clots
-Antidote: Protamine sulfate
Med combination therapy beneficial for angina pectoris treatment
-Combination therapy is beneficial for many patients.
-Beta blockers, calcium channel blockers, long acting nitrates and ranolazine can reduce the frequency of angina episodes
Nitroglycerin SL tablets -dosing regimen, N/I, refill, storage, patient education
Drug therapy for Angina Pectoris
Drug class: Nitrates
Example: Nitroglycerin
Nitroglycerin Sublingual administration:
-Onset: 1-2 minutes
-Duration: 30 minutes
-Instruct pt to lie down or sit at the first sign of angina attack
-Place tablet under the tongue, allow to dissolve and not to swallow immediately
-Call 911 if chest pain not relieved 5 minutes after admin
-One or two tablets may be taken a few minutes before engaging in activities that may trigger angina attack
-Chart pt’s ability to place med under tongue correctly
Patient education:
-Taken on an empty stomach every 8 to 12 hours. If gastritis develops, it may be taken with food.
-Make sure pt knows how to read the expiration date and have prescription filled (must be refilled every 6 months and old tablets must be safely discarded)
Medication Storage:
-Store Nitroglycerin in its original dark-colored glass container with a tight lid
Nitroglycerin spray -dosing regimen, N/I, refill, storage, patient education
Drug therapy for Angina Pectoris
Drug class: Nitrates
Nitroglycerin Translingual Spray admin:
-Onset: 2 minutes
-Duration: 30-60 minutes
-One or two sprays onto under tongue for acute attack; repeat if needed in 3-5 minutes;
-Patient should be in a sitting position upon admin
-Canister should be held vertically with the valve head uppermost and the spray orifice as close to the mouth as possible.
-Do not shake container
-Pt’s mouth should be closed immediately after each dose
-Spray is highly flammable; take precautions
Heparin, Enoxaparin therapy - admin regimen, N/I, patient education, do’s & don’ts
Drug Therapy for Thromboembolic Disorders
Drug class: Anticoagulant
Example: Heparin
Actions/Uses/Therapeutic outcomes:
-Used to treat DVT, PE, peripheral arterial embolism, MI and PCIs.
-Therapeutic range: 1.5 – 2.5
-Used to treat thromboembolism
-Promote neutralization of activated clotting factors
-Does not dissolve clots
-Antidote: Protamine sulfate
Administration regimen:
-2 nurses must confirm dosage calculations
-Blood samples for labs are drawn 4 to 6 hours after IV infusion
-Effects of Heparin only lasts for 4 hours, so continuous infusion is needed
Dos and Don’ts and patient education:
-Subcutaneous injection: tissue over abdomen
-Do not inject within 2 inches of umbilicus
-Site should NOT be massaged before or after injection
-Sites should be rotated
-90 degree angle for injection
-Do not aspirate and do not inject into a hematoma or infected site
-After injection, apply gentle pressure for 1- 2 minutes to control local bleeding
-Ice packs may be used
-Intramuscular is not recommended
Example: Enoxaparin
Actions:
-Prevents completion of the coagulation cascade
-Used to prevent DVT after hip or knee surgery or abdominal surgery
Admin regimen and Do’s and Don’ts
-Subcutaneous: do NOT expel air bubble from prefilled syringe before admin (to prevent loss of drug)
-Inject anterolateral or posterolateral into abdominal wall every 12 to 24 hours
-Entire length of needle should be introduced into a skinfold held between the thumb and forefinger
-Inject drug slowly and leave for 10 seconds after
-Do not rub injection site
-Rotate site every 12 hours
-Periodic cbc and stool occult blood tests are recommended
-DO NOT inject Intramuscularly
-Dosage adjustment required in patients with creatinine lower than 30 mL/min
-Men less than 125 lb and women less than 99 lb must be observed carefully for s/s of bleeding
Nursing Interventions, - pre assessment, patient education in treatment with ACE inhibitor DRUG THERAPY FOR HIGH BP
Use: Reduces blood pressure, preserves cardiac output, and increases renal blood flow.
Drug class: Angiotensin-Converting Enzyme Inhibitors aka ACE Inhibitors
Examples: Lisonipril, Enalapril, Ramipril
Premedication assessment:
-Obtain baseline BP in supine and standing position (hold med if systolic bp is less than 100 mm Hg or if the heart rate is less than 50 bpm
-Obtain history of bowel elimination patterns
-Initiate lab studies to serve as baseline
-Ask if pt is pregnant
-Ask if pt has persistent cough
Nursing Intervention/Patient Education:
-Teach pt to rise slowly from a supine to sitting and then standing position
-Initial dose may cause hypotension with dizziness, tachycardia and fainting (commonly with pts taking diuretics)
-Discontinue diuretics 1 week before starting ACE inhibitor
-Lie down immediately if symptoms develop
Adverse affects:
-Nausea, Diarrhea, Fatigue, headache, Orthostatic hypotension (dizziness, weakness, faintness), chronic cough, birth defects for those who are prego, difficulty breathing, swollen lips, swollen eyes, swollen face, swollen tongue.
***ACE Inhibitors are not as effective in lowering bp in African Americans unless used with a diuretic
Coumadin therapy- N/I, dietary management, patient education, adverse effects
Drug Therapy for Thromboembolic
Drug class: Vitamin K Inhibitor
Example: Warfarin (Coumadin)
Uses:
-Prevents and treat venous thrombosis and embolism
-Prevention and treatment of thromboembolism associated with atrial fibrillation
-Reduces risk of death, recurrent MI, and thromboembolic events, such as stroke and MI.
-Prevents and treats of thromboemboli associated with cardiac valve replacement.
Nursing intervention
-Obtain baseline vital signs
-Be aware of most recent PT or INR results to determine range of therapy for Warfarin.
-Inspect skin and mucous membranes for petechial, ecchymosis or hematoma
-Ensure pt is not pregnant
Patient education and Dietary management
-Not to eat foods high in Vitamin K (leafy vegetables)
Adverse effect:
-Bleeding (petechiae, ecchymoses or hematomas and bleeding gums
Therapeutic Outcome with- ACEI, Heparin, Nitrates, Vasodilator, Beta adrenergic blockers
ACEI for angina pectoris
-Reduction in frequency of recurrent myocardial infarction
Nitrates for angina pectoris
-Relief of angina pain during attack
-Reduced frequency and severity of angina attacks
-Increased tolerance of activities
Beta Adrenergic blockers for angina pectoris
-Reduced frequency and severity of angina attacks
-Increased tolerance of activities
-Reduced use of nitroglycerin for acute angina attack
Heparin for Thromboembolic
-Prevents DVT
-Used to treat thromboembolism and promote neutralization of activated clotting factors
Comparison of the Beta-adrenergic blocking agents to other Anti-HTN agents
Clinical advantages of beta blockers in treating HTN including:
-minimal postural or exercise hypotension
-minimal effect on sexual function
-BP reduction in supine position
-little to no effect in the central nervous system
***Beta blockers are not as effective in African American patients and should be avoided in patients with asthma, Type 1 diabetes, heart failure caused by systolic dysfunction, and peripheral vascular disease.
Patient care plan and nursing interventions with an angiotensin-converting inhibitor (ACE
Drug Therapy for HTN and Angina Pectoris
Drug class: Angiotensin-Converting Enzyme Inhibitors aka ACE Inhibitors
Premedication assessment:
-Obtain baseline BP in supine and standing position (hold med if systolic bp is less than 100 mm Hg or if the heart rate is less than 50 bpm
-Obtain history of bowel elimination patterns
-Initiate lab studies to serve as baseline
-Ask it pt is pregnant
-Ask if pt has persistent cough
Nursing Intervention/Patient Education:
-Teach pt to rise slowly from a supine to sitting and then standing position
-Initial dose may cause hypotension with dizziness, tachycardia and fainting (commonly with pts taking diuretics)
-Discontinue diuretics 1 week before starting ACE inhibitors
-Lie down immediately if symptoms develop
Instructions following Calcium Channel Blockers in management of Heart Failure
-Verapamil and diltiazem must be avoided in patients with heart failure.
-Caution the patient that hypotension and syncope may occur during the first week of therapy.
-These adverse effects decline once the dosage is stabilized.
-Take blood pressure readings every shift in the hospitalized patient and stress the need for the patient to monitor blood pressure after discharge.
-Prevent hypotensive episodes by instructing the patient to rise slowly from a supine or sitting position and perform exercises to prevent blood pooling when standing or sitting in one position for a prolonged period.
-If faintness occurs, instruct the patient to sit or lie down.
Dietary instructions for patients on Coumadin therapy
Dietary instructions for patients on
Coumadin/warfarin therapy
- LIMIT foods high in Vitamin K.
Rationale: Coumadin/warfarin is a Vitamin K inhibitor (drug class) for thromboembolic disease.
To ensure that warfarin is effectively thinning your blood, it’s important to eat about the same amount of vitamin K every day. Vitamin K normally helps your blood clot so wounds don’t bleed too much. Warfarin works against vitamin K, making your blood clot more slowly.
Digoxin toxicity-explain, causes, prevention, management and nursing intervention
Causes:
-Older adults commonly experience digoxin toxicity as a result of digoxin’s long half-life.
-In children, digoxin toxicity is often first detected by the development of atrial dysrhythmias.
-Hypokalemia potentiates the effects of digoxin and can lead to toxicity.
Prevention:
-Early symptoms of toxicity are anorexia and mild nausea, but they are often overlooked or are not associated with drug toxicity.
-Any change in pulse rhythm and rate or central nervous system signs (e.g., mental status, orientation, hallucinations, behavioral changes) should be investigated and reported.
Management:
-Blood should be drawn before the daily dose of medication is given or at least 6 hours after administration.
-It is important to be consistent with regard to the time of drawing blood and administering the dose.
-Always check the potassium level of the patient before administration and replace the potassium if low before giving the dose of digoxin.
Nursing Interventions:
-Always have the mathematical computations checked by another professional nurse.
-Use the correct type of syringe to facilitate the accuracy of the dosage measurement.
-Always question any order that is unusual before administration.
-Read the medication label carefully for proper drug and strength.
Treatment of digoxin toxicity
-The basic treatment of digoxin-induced dysrhythmias consists of stopping the digoxin and any potassium-depleting diuretics, checking the potassium level (i.e., administering potassium as indicated), and administering antidysrhythmic drugs (e.g., phenytoin).
Antidote for severe digoxin intoxication
-Digoxin immune fab (ovine) (Digibind).
LMWHs, Enoxaparin -uses, admin and Nursing Care
Drug Therapy for Thromboembolic Disorders
Brand name: LOVENOX
Drug class: Anticoagulant
Example: Enoxaparin (example of a Low Molecular Weight Heparin)
Notes:
- LMWHs have less potential for hemorrhage and longer duration of action than other anticoagulants
-Enoxaparin prevents completion of the coagulation cascade
- No antiplatelet activity and does not affect the PTT or aPTT
Uses:
-Enoxaparin is used to prevent DVT (deep vein thrombosis=blood clot) after hip replacement surgery, knee replacement surgery, or abdominal surgery
-Approved for use in combination with Warfarin (blood thinner) to treat acute DVT (deep vein thrombosis=blood clot), with or without PE (pulmonary embolism, when blood clot travels to lungs)
-Also used to treat ST segment elevation MI (myocardial infarction=heart attack)
Actions:
-Prevents completion of the coagulation cascade
-Used to prevent DVT after hip or knee surgery or abdominal surgery
Admin regimen and Do’s and Don’t’s
-Should not be used in patients with allergy to pork by-products, Enoxaparin is manufactured from heparin derived from pigs
-Do not inject intramuscularly! ( medication safety alert in book)
-Subcutaneous: do NOT expel air bubble from prefilled syringe before admin (to prevent loss of drug)
-Inject anterolateral or posterolateral into abdominal wall every 12 to 24 hours
-Entire length of needle should be introduced into a skinfold held between the thumb and forefinger
-Inject drug slowly and leave for 10 seconds after
-Do not rub injection site
-Rotate site every 12 hours
-Periodic cbc and stool occult blood tests are recommended
-DO NOT inject Intramuscularly
-Dosage adjustment required in patients with creatinine lower than 30 mL/min
-Men less than 125 lb and women less than 99 lb must be observed carefully for s/s of bleeding
Dosage range:
-Prophylaxis: 30 mg twice daily or 40 mg once daily depending on medical/surgical condition
-Therapeutic: 1mg/kg ever 12 hours or 1.5/kg every 24 hours administered at the same daily.
-Dosage adjustment for patients older than 75 years of age
Adverse effects Common:
-Hematoma (bruising) and bleeding at injection site * can be avoided by using proper technique
Serious Adverse effects:
-Bleeding- check for abnormal bleeding, blood in urine, stool, or vomit, also check dressings for excessive bloody drainage
-Thrombocytopenia ( low platelet count) Can be caused by use of Enoxaparin* monitor platelet counts
-Rare but serious, Thrombotic thrombocytopenic pupura is possible 3 months after the start of treatment* signs are neurologic abnormalities, fever, followed by renal impairment (kidney failure)
Drug Interactions:
-No drug interactions exist, BUT should be used with caution in patients in patients receiving antiplatelet or warfarin therapy
Patient education for Coumadin therapy in preventing venous thrombosis
Brand name: Coumadin, Jantoven
Generic name: Warfarin
Drug Class: Vitamin K inhibitor
Actions:
-Potent anticoagulant that acts by inhibiting the activity of Vitamin K, ( Vitamin K promotes clotting, it counteracts that)
-Inhbits the activation of clotting factors II, VII, IX, and X, as well as proteins C S in the blood
-Blockade of the activation of these factors prevents clot formation.
* This drug inhibits Vitamin K ability to activate the clotting factors mentioned above, therefore preventing clot formation
Patient Education
-Monitor closely for evidence of hemorrhage when therapy is initiated
-Diet should consist of foods rich in Vit K, including green leafy vegetables
-PT and INR blood tests should be performed regularly to ensure dosage administered is therapeutic and toxic
-Compliance with lab testing very important to determine correct maintenance dose
-Not intended for patients 6-12 weeks pregnant, and at term pregnancy. exclusion is for pregnant patient with prosthetic heart valve (risk vs. benefit weighed)
-If one dose is missed, patient should take the next dose
-If two doses missed, patient should contact health provider
Dosing:
-initial: 2-5 mg/day adjusting dose every few days until INR is in target range
*loading dose not recommended as it does not anticoagulate any faster than maintenance dose
-maintenance: 2-10 mg daily as determined by INR blood test
Antidote: Vitamin K
Adverse effects:
-Bleeding, excessive. ( petechiae, ecchymoses, hematomas) bleeding gums, blood in urine or stool, for patient of child bearing age monitor menstrual bleeding
-S&S of internal bleeding: decreased BP, increased pulse rate, cold and clammy skin, feelings of faintness, disoriented sensorium.
Drug interactions that enhance therapeutic effect but can cause toxicity: can increase risk of internal bleeding, hemorrhaging, toxicity
-many, but good to know day to day OTC drugs like Nsaids and Tylenol, aspirin, and omeprazole that can increase risks of internal bleeding
