Week 6: Cardiovascular Pharmacology

Question 1

Which classes of drugs are to relieve stable angina?

Answer 1

nitrates, beta blockers, calcium channel blockers, and ranolazine

Question 2

What class of drugs is to reduce stable angina?

Answer 2

lipid lowering drug, Aspirin, or clopidogrel

Question 3

What class of drugs is used to improve morbidity and mortality with stable angina?

Answer 3

ACE and ARBs

Question 4

What are the first line meds for stable angina?

Answer 4

beta blocker OR CCB
AND
Nitrates

Question 5

MOA of nitroglycerin

Answer 5

dilates veins and decreases preload

Question 6

S/E of nitroglycerin

Answer 6

vasodilation, headache, hypotension, reflex tachycardia

Question 7

What routes are offered with nitroglycerin?

Answer 7

sublingual, translingual, intravenous, patch, ointment, and oral

Question 8

What routes are considered rapid acting nitro?

Answer 8

sublingual, translingual and IV

Question 9

what routes are considered short acting nitro?

Answer 9

skin patch and ointment

Question 10

What routes are considered long acting nitro?

Answer 10

sublingual or oral isosorbide

Question 11

What is important pt education when taking nitroglyceirn?

Answer 11

If pain is not relieved in 5 minutes call 911

and dont take more than 3 doses

Question 12

What drugs interact with nitoglycerin?

Answer 12

sindenafil/Viagra, antihypertensive, and ETOH

Question 13

MOA of ranolazine

Answer 13

unknown? possibly helps the cardiac muscles use energy more efficiently

Question 14

S/E of ranolazine

Answer 14

prolonged QT interval acute renal failure, and liver cirrhosis

headache, dizziness, nausea and constipation

Question 15

Is ranolazine a CYP340 inhibitor or inducer?

Answer 15

inhibitor

Question 16

what should be avoided when taking ranolazine?

Answer 16

grapefruit juice and other CYP340 inhibitor

Question 17

MOA for RASS inhibitors : ACE ARB and ARNI (in regards to heart failure)

Answer 17

decrease preload and afterload, suppresses aldosterone and favorably impact cardiac remodeling

Question 18

Which RAAS inhibitor is seen as the best?

Answer 18

ARNI, Sacubitril/valsartan

Question 19

S/E of RAAS inhibitors

Answer 19

hypotension, hyperkalemia, and cough

Question 20

What beta blocker is used for heart failure?

Answer 20

carvedilol

Question 21

MOA for carvedilol

Answer 21

protect against SNS activation and dysrhythmias, reverses cardiac remodeling

Question 22

S/E of carvedilol

Answer 22

fluid retention, fatigue, hypotension, bradycardia

Question 23

Why do we use spironolactone in heart failure?

Answer 23

the suppression of sodium and water retention to help with offloading the left ventricle

Question 24

What SLG2 inhibitor is used in heart failure?

Answer 24

dapagliflozin

Question 25

MOA for dapagliflozin

Answer 25

not well understood in HF thought to help with ventricular unloading through osmotic diuresis without depleting volume

Question 26

What diuretic is used with heart failure?

Answer 26

loop, furosemide

Question 27

S/E of furosemide

Answer 27

hypokalemia, hypotension, and digoxin toxicity

Question 28

What class is digitalis (digoxin)?

Answer 28

cardiac glycosides

Question 29

What does positive inotropic effect mean?

Answer 29

if we can increase the contractility of the heart muscle then we can increase the force of contraction, and thus increasing the cardiac output

Question 30

MOA of digitalis

Answer 30

inhibits sodium-potassium ATP pump channel causing calcium to collect within the cells of the heart helping to increase myocardial contractility

Question 31

What does increasing myocardial contractility do?

Answer 31

increase blood flow to the kidneys decrease sympathetic action increase parasympathetic action decreases heart rate

Question 32

S/E of digitalis

Answer 32

cardiac dysrhythmias and digitalis toxicity

Question 33

who is at highest risk for digitalis toxicity?

Answer 33

age, women and combination drugs (diuretic therapy)

Question 34

How to prevent digitalis toxicity?

Answer 34

reduced dose, periodic monitoring of levels, and supplemental potassium

Question 35

S/S of digitalis toxicity

Answer 35

bradycardia, headache, dizziness, confusion, nausea and blurry/yellow vision

Question 36

What does the nurse need to do before giving digoxin?

Answer 36

take apical pulse for one minute don't give if pulse is less than 60 and monitor cardiac rhythm

Question 37

What is the antidote for digitalis toxicity?

Answer 37

digoxin immune dab (given IV)

Question 38

MOA of amiodarone

Answer 38

prolongs the action potential duration and the effective refractory period in all cardiac tissue blocks alpha and beta adrenergic receptors in the SNS

Question 39

What is amiodarone usually used for?

Answer 39

PSVT, ventricular dysrhythmias, afib with RVR

Question 40

S/E of amiodarone

Answer 40

pulmonary toxicity, thyroid alterations, corneal microdeposits, black box warning: pulmonary toxicity, hepatoxicity, and pro-arrhythmic effects

Question 41

What 2 drugs interact with amiodarone?

Answer 41

digoxin and warfarin

Question 42

Does amiodarone have short or long half life?

Answer 42

EXTREMELY long (many days)

Question 43

When is amiodarone contraindicated?

Answer 43

severe bradycardia or heart blocks

Question 44

What class is atropine?

Answer 44

anticholinergic/antimuscarinic

Question 45

MOA for atropine

Answer 45

poisons the vagus nerve, inhibits postganglionic acetylcholine receptors and diret vagolytic action

Question 46

Indications for atropine

Answer 46

bradycardia (IV push only)

Question 47

S/E of atropine

Answer 47

xerostomia, blurry vision, photophobia, tachycardia, flushing, hot skin

Question 48

What is adenosine used for?

Answer 48

PSVT

Question 49

MOA for adenosine

Answer 49

slows the conduction time through the AV node

Question 50

Does adenosine have a short or long half life?

Answer 50

VERY short

Question 51

S/E of adenosine

Answer 51

causes a short burst of asystole until sinus rhythm returns

Question 52

Dosing of adenosine

Answer 52

6mg IVPB, if that doesnt work give 12mg IVPB, and can give a third 12mg IVPB

Question 53

What should always follow administering adenosine?

Answer 53

rapid normal saline flush (or 2)

Question 54

Indication for dofetilide

Answer 54

conversion from afib/aflutter to normal sinus

Question 55

MOA for adenosine

Answer 55

selectively blocking the rapid cardiac ion channel carrying potassium currents

Question 56

S/E of adenosine

Answer 56

torsade, SVT, headache, dizziness, chest pain

Question 57

Nursing implications when giving dofetilide

Answer 57

start on EKG monitoring do NOT give to pts with long QY intervals OR with other drugs that may prolong QT intervals