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NURS 2514 > Coronary artery disease drugs > Flashcards

Coronary artery disease drugs Flashcards

(48 cards)

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1
Q

Goal for lipid lowering agents

A

Lower LDL: prevent plaque

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2
Q

Drug examples of lipid lowering agents

A

HMG-CoA reductase inhibitors (Atorvastatin)

Bile-Acid Sequestrates (Colesvelam)

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3
Q

Goal for nitrates: sublingual nitroglycerin

A

Control pain associated with ischemia

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4
Q

Drugs that prevent/ dissolve blood clots

A

Antiplatelet Therapy: ASA
Adenosine Diphosphate Receptor Antagonist: Clopidogrel (Plavix)

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5
Q

Drugs that reduce cardiac workload

A

Beta Adrenergic Blockers: Metoprolol
Ca Channel Blockers: Nifedipine
ACE Inhibitors: Captopril

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6
Q

Statins brand

A

Atorvastatin-Lipitor

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7
Q

Statins description

A

HMG-CoA reductase inhibitors
Drugs that lower lipoprotein production
Lowers LDL and total cholesterol
Increases HDL
Lower risk of heart failure, MI, and sudden death
Significant reduction in 2 weeks but effect goes away if drug is stopped

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8
Q

Statins MOA

A

Inhibits synthesis of cholesterol by blocking HMG CoA enzyme, increases LDL receptors in hepatocytes allowing for increased removal of LDL

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9
Q

Adverse effects of Atorvastatin (Lipitor)

A

Generally well tolerated
Headache, rash, memory loss, GI disturbance (usually transient)
Myopathy/ rhabdomyolysis (mild 5-10%)
Hepatotoxicity (0.5-2%)

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10
Q

Nursing considerations of Atorvastatin (Lipitor)

A

Dose should be given in the evening because of cholesterol synthesis
GI assessment
Monitor Liver and Renal Function
Observe for muscle pain (often legs)

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11
Q

Colesevelam (Welchol) effect

A

Decrease in LDL ~20% after one month

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12
Q

Colesevelam (Welchol) MOA

A

A non-absorbable resin that binds bile acid preventing reabsorption

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13
Q

Bile is made from _____

A

cholesterol

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14
Q

Colesevelam can be _________

A

Colesevelam can be used together with statins

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15
Q

Metoprolol (Lopressor) MOA

A

Blocks cardiac Beta 1 adrenergic receptors
Reduces heart rate, force of contraction, decreased renin secretion

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16
Q

Indications for metoprolol

A

Lowers blood pressure in the large veins by slowing heart rate and widening vessels

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17
Q

Adverse effects of metoprolol

A

Bradycardia, AV heart block, heart failure, arrhythmias

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18
Q

Nursing considerations for metoprolol

A

Assess HR prior to admin
Monitor HR, chest pain, BP, and palpitations
Monitor for early signs of heart failure
Withdraw medication slowly, do not abruptly discontinue

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19
Q

Early warning signs of heart failure

A

Shortness of breath after mild exertion or lying flat, edema, weight gain, coughing at night

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20
Q

Precautions of beta-adrenergic antagonists and epinephrine

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A

Epinephrine activates beta 1 receptors in heart, and beta 2 receptors in lungs, if the receptors are blocked, epinephrine may not work

21
Q

Precautions of beta-adrenergic antagonists and diabetes

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A

Blocks beta 1 receptors which give early warning signs of hypoglycemia (tachycardia, tremors, perspiration)

22
Q

Calcium channel blockers drug example

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A

Verapamil (Isoptin)

23
Q

Verapamil (Isoptin) MOA

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A

Inhibits ca ion influx across cell membrane. Heart: lowers SA/AV conduction, lowers HR, lowers force of contraction.
Arteries/ arterioles: Block ca channels on vascular smooth muscle causing vasodilation (coronary and peripheral arteries/ arterioles)

24
Q

Indications for verapamil (Isoptin)

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A

Angina, hypertension, and cardiac dysrhythmias

25
Therapeutic effect of verapamil (Isoptin)
Vasodilation, slows ventricular rate (good for atrial arrhythmia)
26
Adverse effects of verapamil (Isoptin)
Constipation, dizziness, facial flushing, headache, edema to legs and feet
27
Captopril MOA
Block production of angiotensin II and prevent breakdown of bradykinin which results in vasodilation, lowered blood volume, lowered cardiac remodelling, can lead to K retention
28
Therapeutic effects of ACE inhibitors
Vasodilation, lowered blood volume, lowered cardiac remodeling
29
Adverse effects of ACE inhibitors
Hypotension, cough, hyperkalemia, renal failure, angioedema
30
Nursing considerations for ACE inhibitors
Assess BP, pulse Assess for signs of heart failure Monitor hydration status Monitor blood work (K, Urea, Creatine)
31
Precautions for ACE inhibitors
Caution with impaired renal function, hypovolemia, drugs that increase K (K-sparing diuretics)
32
Nitroglycerin spray (organic nitrate) MOA
Dilates veins in body to decrease venous return and preload which decrease workload (stable angina) Dilates coronary arteries and increases collateral blood flow to ischemia regions Relaxes vasospasm in coronary arteries (vasospastic angina)
33
Adverse effects of nitroglycerin spray (organic nitrate)
Headache, hypotension, tachycardia (secondary to vasodilation)
34
Difference between nitroglycerin spray (organic nitrate) and isosorbide dinitrate (long-acting nitrate)
isosorbide dinitrate (long-acting nitrate) can be in pill form to last all day. Available in immediate release and sustained release options
35
ASA MOA
Suppresses platelet aggregation by causing irreversible inhibition of cyclooxygenase (an enzyme) Reduces risk of arterial thrombosis
36
Adverse effects of ASA
Risk of GI bleed (2.7%) - PPI used if bleeding occurs, abdominal pain, dyspepsia, diarrhea, rash
37
Indications for ASA
Chronic stable angina, unstable angina, acute MI, primary and secondary prevention of MI
38
Clopidogrel (Plavix) MOA
Irreversibly blocks P2Y12ADP receptors on platelets, preventing platelet aggregation through this pathway
39
Clopidogrel (Plavix) indications
Prevention of stenosis of coronary stents. Secondary prevention of MI
40
Dalteparin (Fragmin) MOA
Enhance activity of antithrombin As effective as UFH but can be given in fixed dose More expensive than UFH Can be used by out-patients (no bloodwork required)
41
Indications for dalteparin
USA, NSTEMI, DVT and PE prevention
42
Adverse effects of dalteparin (Fragmin)
Bleeding (4%), bruises, black stool, hematuria, headaches, lumbar pain, HIT
43
Unfractionated heparin MOA
Enhance activity of antithrombin Cheaper to use than LMWH Require more monitoring (including regular aPPT) Only used in hospital setting
44
Indication for UFH
Acute MI, DVT, PE
45
Adverse effects of UFH
Bleeding (10%), bruises, black stool, hematuria, headaches, lumbar pain, HIT
46
Alteplase (tPA) MOA
Binds to plasminogen -> plasmin (enzyme that digest fibrin) Most effective when given within 4-6 hours of symptom onset (max 24hrs)
47
Indication for alteplase (tPA)
STEMI
48
Absolute contraindications for alteplase (tPA)
Prior intracranial hemorrhage Recent stroke (last 3 months) Active internal bleeding

NURS 2514 (14 decks)

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