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Flashcards in CV 2 Deck (46):
1

only drug that can be used for immediate relief of acute angina

Nitroglycerin

2

Actions of nitroglycerin

decrease oxygen demand

decrease preload by dilating veins

higher doses - dilates all major systemic arteries which decreases afterload

with variant angina - relaxes or prevent spasm in coronary arteries - increases oxygen supply, not decreasing oxygen demand

3

adverse effects of Nitrates

CNS - HA, syncope, flushed feeling, dizziness, weakness

CV - hypotension/orthostatic hypotension, reflex tachycardia

4

warnings with nitrates

contraindicated in patients with head trauma and cases of increased ICP or cerebral hemorrhage

avoid ETOH

careful when taking other meds that can decrease BP (beta blockers, CCB, diuretics)

contraindicated - PDE 5 inhibitors - life threatening hypotension

5

patient teaching with nitrates

take nitroglycerin at first sign of anginal attack

nitrates are not habit forming but tolerance can develop

lie/sit down when taking to prevent fall

dizziness from decreased preload may occur if 3 tabs taken at 5 min intervals

to prevent angina, take 1 dose 5-10 min before stressful physical activity

have a home BP cuff, rise slowly if orthostatic hypotension occurs

be compliant with medication even if you experience HA

6

Labs for bleeding and clotting times

PT
INR
aPTT

7

What are the 2 classes of antithrombotic drugs?

antiplatelet drugs
anticoagulant drugs

8

what do anti platelet drugs do?

prevent platelets from clumping and also prevent clots from forming and growing

9

what do anticoagulant drugs do?

slow down clotting time --> reducing fibrin formation and preventing clots from forming and growing

10

What drugs are anticoagulants?

Heparin
Lovenox (LMWH)
Warfarin (Coumadin)

11

Adverse effects of heparin

increased bleeding

spinal/epidural hematoma

heparin induced thrombocytopenia: 50% reduction in platelets from baseline within 5-10 days after exposure to heparin --> thrombosis - treatment involves discontinuation of all heparin products

hypersensitivity rxns - extracted from animal tissue

12

heparin warnings

use cautiously in patients at high risk of bleeding

contraindicated in patients with thrombocytopenia

13

What is the antidote to heparin?

protamine sulfate

give immediately and lasts for 2 hours, then more may need to be administered

14

nursing implications for heparin

assess for bleeding in urine, stool, venipuncture sites, nose, gums, wounds/incisions

monitor PTT - should be 1.5-2.5x the control for therapeutic effects

monitor MAR for drug interactions (ASA)

monitor CBC (platelets)

15

Low Weight Molecular Heparin drugs

Enoxaparin (Lovenox)
Dalteparin (Fragmin)

16

adverse affects of LMWH

bleeding

severe neurological injury if patient has spinal puncture or epidural

induced thrombocytopenia

17

Adverse effects of warfarin

bleeding
hematuria
epistaxis
ecchymosis
tarry stool
bleeding gums
leukopenia
hypersensitivity
GI upset - diarrhea, N/V

18

Warfarin patient teaching

stop warfarin 5 daa\ys prior to surgery

stick to either generic or trade, do not switch

protect self from excessive bruising/cuts - use electric razor, soft toothbrush

consult HCP before taking OTC drugs (ASA, NSAIDS)

avoid ASA

report any bruising, pink urine, tarry stool

take bleeding precautions 9-10 days after last dose of drug

19

warfarin antidote

VITAMIN K

20

Warfarin Labs ranges
PT:
INR:

PT: normal=11-13, therapeutic=15.5-35

INR: normal=0.8-1.1, therapeutic=2-3

if INR is below target --> need drug increase

if INR is above target --> need drug decrease

21

warfarin - frequency of labs

1st 5 days: daily
next 1-2 weeks: 2x/week
next 1-2 months: 1x/week
after that: every 2-4 weeks

22

what does a thrombolytic agent do?

dissolves clot by converting plasminogen to plasmin which lysis the thrombi and fibrinogen

23

warnings with thrombolytic agents

increased tendency to bleed with any drug that alters coagulation or platelets

contraindicated in hemophilia, hemorrhagic strokes, uncontrolled HTN, GI ulcers

24

Statins/HMG-CoA reductase inhibitors MOA

decrease rate of cholesterol production by inhibiting HMG-CoA reductase - live requires it to produce cholesterol

25

adverse effects of statins

GI: dyspepsia, flatulence, constipation, abd cramps

Myopathy: soreness, weakness, increase CPK levels

hepatotoxicity

rhabdomyolysis --> acute renal failure

pregnancy category X

26

Bile sequestering agents MOA

form insoluble complexes with the bile acids in the GI tract --> cholesterol replaces lost bile acids --> lowering cholesterol level

27

bile sequestering drugs

Cholestyramine (Question)

Colestipol hydrochloride (Colestid)

Colesevelam

28

bile sequestering agents adverse effects

GI: constipation, abd pain, nausea, diarrhea

vitamin deficiency - A, D, E, K

29

bile sequestering agents patient teaching

mix powder in liquid or food to reduce esophageal irritation

remain upright for 30 min to reduce esophageal irritation

take other meds 1 hr before/4hrs after

30

Fibric Acid Derivatives drugs

Genfibrozil (Lopid)
Fenofibrate (Lipidil)

31

fabric acid derivatives MOA

activate lipoprotein lipase, an enzyme responsible for break down of cholesterol

suppresses the release of free fatty acids from adipose tissue

inhibit synthesis of triglycerides in the liver

increases secretion of cholesterol into bile

32

adverse effects of fabric acid derivatives

GI: N/V, diarrhea
Cholelithiasis
benign and malignant liver tumors
enhances effects of warfarin
enhances effects of statins-myopathy

33

Niacin MOA

thought to work in the liver and adipose tissue to inhibit the synthesis of triglycerides --> decrease VLDL, can lower LDL

34

niacin adverse effects

flushing
itching
hepatotoxic
hyperglycemia
hyperuricemia
gouty arthritis

35

niacin patient teaching

advise niacin along with diet and exercise

take with meal

minimize flush with ASA 325 mg 30 min prior to med - can cause increase in glucose and uric acid

36

amiodarone MOA

blocks K+ channels which delay repolarization --> prolongs action potential duration

reduces automaticity in SA node

reduced contractility and conduction velocity in AV node, ventricles

37

amiodarone uses

dysrhythmias that are difficult to treat

life threatening ventricular tachycardia or fibrillation, atrial fibrillation, or flutter that is resistant to other drugs

38

amiodarone adverse effects
(may not show up for weeks -months)

CNS: malaise, fatigue, dizziness, tremors, ataxia, paresthesia, lack of coordination

CV: cardiac arrhythmias, cardiac arrest, hypotension

EENT: photophobia, dry eyes, halos, blurred vision, permanent blindness

endocrine: thyroid toxicity --> hypothyroidism or hyperthyroidism

GI: N/V, anorexia, constipation, abnormal LFT, hepatotoxicity

respiratory: pulmonary toxicity - pneumonitis, infiltrates

angioedema, photosensitivity

39

digoxin MOA

increases myocardial contractility by promoting calcium accumulation within the myocytes

40

digoxin uses

chronic atrial fibrillation
2nd line therapy for heart failure

41

digoxin adverse effects

cardiac dysrhythmias (esp with hypokalemia)

anorexia
N/V
visual disturbances - blurred vision, yellow vision, halos

42

relationship between K+ and digoxin

hypokalemia --> digoxin toxicity
digoxin toxicity --> hyperkalemia (esp in renal failure patients)

ACE inhibitors known to increase K+ --> decreased efficacy of digoxin

43

digoxin antidote

digoxin immune fab (digibind)

44

lidocaine adverse effects

drowsiness, dizziness, hypotension, bradycardia

45

lidocaine toxicity

CNS excitation
blurred/double vision
N/V
tinnitus
severe bradycardia
twitching
seizures
tremors

46

therapeutic ranges of
lidocaine
digoxin

lidocaine: 1.5-5 mcg/ml
digoxin: 0.5-0.8 ng/ml