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PPT of HF drugs, etc. Flashcards

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1
Q

Which class of drugs are considered inotropic (alters muscle contraction rate)?

A

Cardiac Glycosides

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2
Q

Therapeutic action of cardiac gycosides?

A

-increase contractility/strength of myocardial contraction (positive inotropic effect).
-increased output and renal perfusion (increasing urine output and decreasing blood volume)

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3
Q

Which medication is the only cardiac glycoside suited for long-term therapy?

A

Digoxin

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4
Q

What should I do before giving cardiac glycoside?

A

take an apical pulse for one full minute

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5
Q

Contraindications of cardiac glycoside?

A

concurrent use of diuretics, beta-blockers, or other inotropes

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6
Q

What condition can lead to accumulation of digoxin in the body?

A

renal impairment

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7
Q

Action of digoxin?

A

binds to potassium

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8
Q

Danger of having low serum potassium levels when taking digoxin?

A

Increases risk of digoxin toxicity

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9
Q

Side effects of cardiac glycoside (inotropic drugs) like digoxin?

A

Headache, drowsiness, vision changes (yellow halo around objects), GI upset and anorexia

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10
Q

Which class of medications directly relaxes vascular smooth muscle by blocking the enzyme phosphodiesterase?

A

Phosphodiesterase inhibitors (

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11
Q

Besides directly relaxing vascular smooth muscles, what is the therapeutic value of phosphodiesterase inhibitors?

A

increases myocardial cell function = stronger contraction and prolonged response to sympathetic stimulation

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12
Q

Prototype drug of phosphodiesterase inhibitors?

A

Milrinone (only drug available in this class)

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13
Q

What condition is milrinone used for?

A

short-term management of heart failure

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14
Q

Which group of drugs is news (approved 2015) and reduces the heart rate with no effect on muscle contraction?

A

Hyperpolarization-Activated Cyclic Nucleotide-Gated Channel Blockers

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15
Q

Action of HCN GCB?

A

blocks hyperpolarization-activated cyclic nucleotide (HCN) to slow heart’s pacemaker (reduces heart rate with no effect on muscle contraction)

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16
Q

Prototype drug of HCN GCBs?

A

Ivabradine

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17
Q

pharmacokinetics of ivabradine?

A

Oral
rapid onset (one hour)
last 6 hours
metabolized in liver and excreted in feces and urine
half life = 2 hours

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18
Q

Adverse effects of HCN GCBs? (Ivabradine)

A

bradycardia, atrial fibrillation, hypertension, luminous phenomena (visual changes)

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19
Q

Which class of drugs is also newer (approved 2015) and is a combination drug?

A

Angiotensin receptor neprilysin inhibitors

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20
Q

What is the prototype drug for ARNIs?

A

Ernesto

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21
Q

Ernest is made up of what two drugs?

A
  1. valsartan (ARB)
  2. sacubitril (neprilysin inhibitor)
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22
Q

pharmacokinetics of Ernesto?

A

steady level is reaching in 3 days with 2 x a day dosing

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23
Q

How should Ernesto be taken?

A

with or without food

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24
Q

What 4 drug classes are used to treat HF?

A

-cardiac glycoside (inotropic drugs) [digoxin]
-phosphodiesterase inhibitors [milrinone]
-hyperpolarization-activated cyclic nucleotide-gated channel blockers [ivabraden]
-angiotensin receptor neprilysin inhibitors [Ernesto (valsartan & neprilysin inhibitor)]

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25
Which class of medications are complex with multiple mechanisms of action and are classified by their effects on the electrical conduction system of the heart?
Antiarrhythmic agents
26
What are the classes of antiarrhythmic agents?
-1A -1B -1C -II (beta blockers) -III -IV (calcium channel blockers)
27
Prototype drug for Class II (beta blockers) of the antiarrhythmic agents.
Lidocaine
28
Lidocaine's therapeutic actions:
-decreases depolarization -decreases automaticity of the ventricular cells -increases ventricular fibrillation threshold
29
Prototype drugs (2) for Class II (beta blockers) of antiarrhythmic agents
-propranolol -adenosine
30
Arrhythmic condition treated with propranolol
SVTs (supraventricular tachycardia)
31
What other conditions are treated with propranolol outside of arrhythmia?
-hypertension -angina -migraines -anxiety
32
Action of propranolol (Class II- beta blocker)
blocks beta-adrenergic receptors in the heart and kidney = membrane stabilizing effect =decreases effect of sympathetic nervous system
33
Side effects of propranolol?
bradycardia, cerebrovascular accident (stroke), N/V, impotence
34
What is adenosine (Class II beta-blocker) used for?
Converts SVT (supraventricular tachycardia) to sinus rhythm (normal healthy rhythm of the heart)
35
Side effects of adenosine (antiarrhythmic class II beta-blocker)
flushing, nausea, bronchospasm, and potential prolonged asystole (heart stops beating)
36
How is adenosine (antiarrhythmic class II beta blocker) administered?
Rapid IV push (in 1-2 seconds) followed by immediate flush of 10 mL normal saline.
37
What side effects are expected with a rapid IV admin of adenosine?
flushing, headache, SOB (side effects are short term due to drug's short half life)
38
Prototype drug for class III antiarrhythmic agents?
Amiodarone
39
What conditions is amiodarone (antiarrhythmic class III) used to treat?
ventricular fibrillation and unstable ventricular tachycardia
40
Side effects of amiodarone (antiarrhythmic class II)
-bradycardia, cardiogenic shock (heart can't pump enough blood to meet body's needs), and pulmonary disorders.
41
Which drug is incompatible with amiodarone (class III antiarrhythmic)
Heparin (flush line very well before administration of either)
42
Which class of drugs are also known as anti-anginals and nitrates?
Vasodilators
43
Which drug is a form of a vasodilator?
Nitroglycerin tablets
44
Action of vasodilators
relaxes blood vessels and increases supply of blood and oxygen to heart -reduces workload
45
Forms of vasodilators:
pills, dissolvable tablets, topical application (cream), sublingual spray, and IV infusion
46
Things to be aware of with topical vasodilators
-may cause skin irritation -do not massage or rub area -rotate site -can apply to chest, flank, or upper arm on a hairless area
47
5 commonly prescribed vasodilators?
1. isosorbide dinitrate (Isordil) 2. nesiritide (Natrecor) 3. hydralazine (Apresoline) 4. nitrates 5. minoxidil
48
What condition do vasodilators treat when it comes to the heart?
eases chest pain (angina)
49
Patient teaching for nitroglycerin (nitrates) sublingual application
1. Take 1 pill at onset of chest pain and sit or lie down 2. repeat dose in 5 minutes. 3. If no relief, take another does in 5 minutes
50
Nitrate (nitroglycerin) medication care:
dark container (preferably original) -replace every 6 months (may lose strength)
51
ABSOLUTE contraindicated medications when taking nitrates:
erectile dysfunction medication (sildenafil, tadalafil) -profound hypotension and death may occur
52
Action of antihyperlipidemic agents:
lowers lipid levels in the blood
53
Which class of antihyperlipidemic drugs are used to decrease plasma cholesterol levels?
Bile Acid Sequestrants
54
Action of bile acid sequestrants?
- prevents reabsorption of bile salts, which are high in cholesterol. Liver will be forced to pull cholesterol from the blood to make bile acids = lowers plasma serum cholesterol levels
55
Prototype drug for antihyperlipidemic bile acid sequestrants:
Cholestyramine
56
Action of cholestyramine?
binds with bile acids in the intestines: excretes in feces instead of being reabsorbed. = cholesterol is oxidized in the liver = serum levels of cholesterol fall
57
Adverse effects of bile acid sequestrants (cholestyramine)
rash, headache, anxiety, vitamin A & D deficiencies
58
Example of drugs that are HMG-CoA Reductase inhibitors (also antihyperlipidemics)
Statins
59
HMG-CoA reductase inhibitors (statins) do what?
-block the enzyme HMG-CoA reductase = lower serum cholesterol levels = breakdown of LDLs =slight increase in HDLs -also works to lower triglycerides
60
When is the peak effect of HMG-CoA Reductase Inhibitors (Statins)?
2-4 weeks
61
Contraindication for HMG-CoA reductase inhibitors (statins)
-pregnancy and lactation
62
5 HMG-CoA reductase inhibitors (statins) examples:
atorvastatin, fluvastatin, lovastatin, simvastatin, rosuvastatin
63
Which class of drugs is usually the first drug choice to lower LDS?
HMG-CoA reductase Inhibitors (statins)
64
Which drug is a cholesterol absorption inhibitor that was approved in 2003?
Ezetimibe
65
What is ezetimibe (cholesterol absorption inhibitor) used in conjunction with?
-diet and exercise (lowers serum cholesterol levels) -statins (lower total and LDS cholesterol) -fenofibrate (familial hyperlipidemia) = assists with lowering both serum cholesterol and triglyceride levels *can be used as monotherapy
66
Contraindications for cholesterol absorption inhibitor ezetimibe?
-pregnancy -lactation -severe liver disease
67
Which class of drugs is used to treat cholesterol levels that have been unresponsive to lifestyle and statin treatments and/or familial hypercholesterolemia
Proprotein Convertase Subtilisin/ Kexin Type 9 Inhibitors (PCSK9 Inhibitors)
68
2 examples of PCSK9 Inhibitors)
-alirocumab -evolocumab
69
Action of PCSK9 Inhibitors
blocks a protein called PCSK9 to make it easier for the body to remove LDL.
70
How are PCSK9 inhibitors delivered?
injection every 2 weeks
71
What non-pharmacologic agent also is used to lower LDL cholesterol and raise HDL cholesterol?
-vitamin b3 (niacin)
72
What is used to boost HDL while lowering triglyceride production?
Fibrates (fenofibrate and gemfibrozil)
73
Which class of drugs keeps blood blots from forming by preventing blood platelets from sticking together?
Antiplatelet agents
74
4 commonly prescribed antiplatelet drugs
1. Aspirin 2. ticlopidine 3. clopidogrel (Plavix) 4. dipyridamole
75
Conditions treated with antiplatelet agents (aspiring, ticlopidine, clopidogrel (Plavix), dipyridamole)?
Helps prevent clotting in pt. who -has had a heart attack -unstable angina -ischemic strokes TIA (transient ischemic attacks or "little strokes") -other cardiovascular diseases
76
When are antiplatelet meds usually prescribed?
As a preventative when plaque buildup is evident but is not yet a large obstruction in the artery
77
Pt ed for antiplatelets (aspirin, ticlopidine, clopidogrel (Plavix), dipyridamole
- report tarry stools -"" ecchymosis (bruising or bleeding underneath the skin) -signs of bleeding
78
Which class of drugs decreases the clotting (coagulating) ability of blood?
Anticoagulants
79
What are two misconceptions about anticoagulants?
1. They do not thin blood 2. They do not dissolve existing blood clots
80
What conditions are anticoagulants used to treat?
conditions of the blood vessels, heart, and lungs
81
4 commonly prescribed anticoagulants:
-rivaroxaban (Xarelto) -dabigatran (Pradaxa) -heparin -warfarin (Coumadin)
82
What conditions do dabigatran (Pradaxa) & rivaroxaban (Xarelto) treat?
a-fib and artificial heart valves
83
What is usually the first-line drug of choice when it comes to anticoagulants?
Heparin (often weaned from heparin and onto warfarin)
84
3 things to consider with warfarin (Coumadin)
1. administered orally 2. cannot be taken during pregnancy 3. will be transitioned into heparin by the body
85
What is the purposes of anticoagulant drugs/ what do they prevent?
-help prevent clots from forming in the blood vessels -may prevent clots from becoming larger -may prevent first or recurrent stroke
86
What conditions may indicate need for anticoagulants (6)?
1. cardiac catheterization 2. myocardial infarction 3. DIC 4. evolving stroke 5. pulmonary embolism 6. deep vein thrombosis
87
Potential side-effects of anticoagulants?
-hemorrhage -heparin-induced thrombocytopenia -toxicity/overdose
88
nursing considerations for anticoagulants?
1. monitor for signs of bleeding 2. initiate safety precautions to prevent bleeding
89
Antidote for heparin toxicity?
protamine sulfate
90
antidote for warfarin tox?
Vitamin K
91
What should the pt. avoid when taking anticoagulant meds?
-garlic -ginger -ginkgo -ginseng =increases risk of bleeding
92
Thrombolytics therapeutic action:
dissolves clots that have already formed
93
Thrombolytics mechanism of action:
Converts plasminogen to plasmin = destroys fibrinogen and other clotting factors
94
Commonly prescribed thrombolytics (3)
alteplase (Activase, tPA) -tenecteplase (TNKase) -reteplase (Retavase)
95
Conditions treated by thrombolytics?
1. myocardial infarction (MI) 2. deep vein thrombosis (DVT) 3. massive pulmonary emboli 4. ischemic stroke
96
What conditions are contraindicated for the use of thrombolytics?
1. intracranial hemorrhage 2. active bleeding 3. severe hypertension 4. Caution with pt. with severe HT
97
Concurrent use of thrombolytics with which two classes of meds increases the risk of bleeding?
anticoagulants with antiplatelet meds.
98
Side effects/ adverse effects of thrombolytics
bleeding
99
Example of antihemophilic agents:
antihemophilic factor
100
What is antihemophilic factor used to treat?
Classic hemophilia
101
How do antihemophilic factors work?
Temporarily replaces clotting factors that otherwise don't exist = correct or prevents bleeding episodes or allows for necessary surgery
102
Example of a hemostatic agent
aminocaproic acid (systemic)
103
What are hemostatic agents (aminocaproic acid) used to treat?
-excessive bleeding caused by hyperfibrinolysis -prevent reoccurrence of subarachnoid hemorrhage
104
Side effects of hemostatic agents?
tinnitus, hypotensive, nausea, cramps, headache, weakness
105

Pharm (5 decks)

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