Week 9- Cardiac Glycosides, Antianginal Agents, Anticoagulants Flashcards
(113 cards)
1
Q
What is congestive heart failure (HF)?
A
a condition in which the body fails to effectively pump the blood throughout the body
2
Q
What is the primary treatment for HF?
A
- involves helping the heart muscles to contract more efficiently to bring the system back into balance
- Vasodilators (ACEI and Nitrates)
- Diuretics
- Beta-Adrenergic agonists
3
Q
What are some examples of underlying problems in HF?
A
- atherosclerosis or cadiomyopath (damage to muscles)
- hypertension or valvular diseases (heart has to work too hard)
- congenital cardiacdefects (abnormal structure)
4
Q
What are some causes of HF?
A
- Coronary Artery Disease (CAD)
- Cardiomyopathy
- Hypertension
- Valvular Heart Disease
5
Q
How do vasodilators (ACEI and Nitrates) work to treat HF?
A
- decrease workload of overworked cardiac muscles
6
Q
How do diuretics work to treat HF?
A
- decrease blood volume, which decreases venous return and BP
7
Q
How do Beta-Adrenergic Agonists work to treat HF?
A
- stimulate the beta-receptors in the SNS, increasing calcium flow into the myocardial cells, and causing increased contraction
8
Q
What are the effects of cardiac glycosides?
A
- Increased force of myocardial contraction
- Increased cardiac output and renal perfusion
- Increased urine output and decreased blood volume
- Slowed heart rate
- Decreased conduction velocity through the AV node
9
Q
What are the actions of cardiac glycosides?
A
- Increases intracellular calcium, allows more Ca to enter the myocardial cells during depolarization
- positive notrpic efefct, increases renal perfusion with a diuretic effect and decreases in renin release, and slowed conduction through the AV node
10
Q
What are cardiac glycosides indicated for?
A
- HF
- atrial fibrillation
11
Q
What are the pharmacokinetics of cardiac glycosides?
A
- Rapidly absorbed and widely distributed throughout the body
- Primarily excreted unchanged in the urine
12
Q
What are the adverse effects of cardiac glycosides?
A
- Headache, weakness, drowsiness, and vision changes
- GI upset and anorexia
- Arrhythmia development
13
Q
What is the most common complaint of cardiac glycosides?
A
headaches
14
Q
What are the contraindications and cautions of cardiac glycosides?
A
Contraindications
- Allergy
- Ventricular tachycardia or fibrillation
- Idiopathic hypertrophic subaortic stenosis
- Acute MI, renal insufficiency, and electrolyte abnormalities
Caution
- Pregnancy and lactation
- Pediatric and geriatric patients
15
Q
What are cardiac glycosides drug to drug interactions?
A
- Verapamil, amiodarone, quindine, quinine, erythromycin
- potassium losing diuretics
- cholestyramine, charcoal, colestipol, bleomycin, cyclopisphamide
16
Q
What is the prototype of cardiac glycosides?
A
digoxin (Lanoxin)
increase intracellular calcium causing increased force of contraction, better renal perfusion and slower HR
17
Q
What is digoxin the prototype of?
A
cardiac glycocides (increase intracellular calcium causing increased force of contraction, better renal perfusion and slower HR)
18
Q
What is the main concern of digoxin (Lanolin)?
A
slowing HR too much
19
Q
Does digoxin have a narrow therapeutic window?
A
yes
20
Q
What needs to be monitored when patients are on digoxin?
A
- drug levels
- electrolytes (potassium especially)
- BP, apical pulse, heart sounds, breath sounds; weight, intake and output (to monitor for edema)
- electrocardiogram
- serum lab: potassium (decreased potassium increases its toxicity), sodium, magnesium, calcium, renal and liver function
- monitor therapeutic and adverse effects
21
Q
What are normal potassium levels?
A
3.5-5 mmol/L
22
Q
What is the most important to remember with digoxin?
A
Before giving digoxin take apical pulse for 1 min; only give if it is in-between 60-120 bpm, otherwise hold dose and notify prescriber
23
Q
Why are signs and symptoms of digoxin toxicity?
A
- anorexia, nausiea, vomiting, diarrhea or visual disterbances (blurred vision seeing green or yellow halos)
24
Q
What should be avoided on digoxin?
A
- high fibre (fibre binds to digitalis)
25
What patient teaching is needed for those taking digoxin?
- avoid fibre
- report weight gain of 1 kg or more in one day
- signs and symptoms of toxicity
26
What therapeutic effects of digoxin are you monitoring for?
- increased urinary output
- decreased edema, SOB, dyspnea, crackles, fatigue
- resolving or paroxysmal nocturnal dyspnea
- improved peripheral pulse, skin colour, temp
27
Define atheroma.
fatty tumour in the intima of the heart vessels
28
Define atherosclerosis.
narrowing of the heart vessels
29
Define angina pectoris.
suffocation of the chest wall
30
Define myocardial infarction.
cells in the myocardium become necrotic and die
31
What are 4 types of CAD?
- atheromas
- atherosclerosis
- angina pectoris
- myocardial infarction
32
What are 3 types of angina?
- stable angina (effort angina or classic angina)
- unstable angina (pre-infarction)
- Prinzmetal's angina (vasospastic)
33
What is stable angina?
- no damage to the heart muscle
| - basic reflexes surrounding the pain restores blood flow
34
What is unstable angina?
episodes of ishemia occur
35
What is Prinzmetal's angina?
- caused by spasm of the blood vessels, not just by vessels narrowing
36
What is the action of anginas?
- improve blood delivery to the heart muscle by dilating blood vessels; improves delivery
37
What are some types of anti- anginal medications
- Nitrates
- Beta-adrenergic blockers
- Calcium channel blockers
38
What is the action of nitrates?
acts directly on smooth muscle to cause relaxation and depress muscle tone
39
What are nitrates indicated for?
angina pectoris
40
What is the pharmacokinetics of nitrates?
- rapid absorption
- metabolized in the liver
- excreted in the urine
41
What is an example of nitrates?
- nitroglyseride
42
What are the contraindications and caution of nitrates?
```
CONTRAINDICATIONS
- allergy
- severe anemia
- head trauma or cerebral hemorrhage
- pregnancy and lactation
CAUTIONS
- hepatic or renal disease
- hypotension, hypovolemia, and conditions that limit CO
```
43
When you cause vasodilation you have increased risk of...
hypotension
44
What are the adverse effects of nitrates?
- related to vasodilation and decrease in blood flow
- CNS- headach, dizziness, and weakness
- GI- N&V
- CV- hypotension
- misc.- flushing, pallor increased perspiration
45
What drug does nitrate react with?
heparin
46
What is important to inform patients taking nitroglycerin?
- HEADACHES are a common side effect, but they decrease as you continue to use the meds
- teach PROPER USE of SL route (do not chew or swallow, lie down do to risk of hypotension)
- proper topical use (rotate site, removal of old meds)
- FIZZLE or burn sensation is felt with SL form and it indicates it is still potent
- DO NOT EXPOSE to light, heat, moisture
- keep in ORIGINAL PACKAGING
- keep FRESH SUPPLY(open bottle only good for 3m)
- TOLERANCE
47
What is the prototype of nitrates?
nitroglycerine
48
What category of drug is nitroglycerin?
nitrates
49
What routes can nitroglycerin be given in?
- IV
- Sublingual
- Translingual spray
- Transmucosal tablet
- Oral SR
- Topical ointment
- Transdermal
50
What routs are recommended for anginal attacks of nitroglycerin?
spray, sublingual, IV
51
What are some important nursing implications?
- lots of patient teaching
| - monitor VS frequently if using IV nitroglycerine
52
When anginal pain occurs the patient should...
- stop activity sit or lie down
- take SL tab and wait 5 min
- if no relief in 5 min, take a second SL tab
- after 3 tabs or 15min with no relief call 911
- do not drive yourself to the hospital
53
What is the action of beta blockers?
- block beta-adrenergic receptor blockers in the heart and kidneys, decreasing the influence of SNS of these tissues; decreases CO and the release of renin
54
What are beta blockers indicated for?
treat stable angina pectoris and hypertension, prevents reinfarction in MI patients; treats stable CHF
55
Are doses of beta blockers the same for those taking it for hypertension as for those taking them for angina?
dose is significantly higher for hypertension for angina
56
What are the pharmacokinetics of beta blockers?
absorbed by GI tract, undergoes hepatic metabolism, excreted in the urine
57
What are the contraindications and cautions of beta blockers (atenolol)?
```
CONTRAINDICATIONS
- bradycardia
- cardiogenic shock
- asthma or COPD
- pregnancy and lactation
CAUTIONS
- DM
- PVD
- thyrotoxicosis
```
58
What are the adverse effects of atenolol?
Related to the block of SNS
59
What drugs interact with atenolol?
clonidine
60
What is an off label use for beta blockers?
stage fright
61
What routes are used for atenolol?
oral and IV
62
What is atenolol?
a beta blocker
63
What are the nursing implications of patients taking beta blockers?
- monitor pulse rate daily (after taking med)
- dizziness or fainting should be reported (hypotension)
- constipation prevention
- never stop med abruptly (rebound hypertension)
- inform patients of long term effects (not meant for immediate relief of angina pain)
- combining with NSAIDs can lead to a decreased antihypertensive effect
64
What patient teaching is required about rebound hypertensive crisis?
Inform patients that these medications are for long-term prevention of angina, not for immediate relief
65
What do calcium channel blockers do?
Inhibit the movement of calcium ions across the membranes of myocardial and arterial muscle cells, altering the action potential and blocking muscle cell contraction
66
What are calcium channel blockers indicated for?
- hypertension
| - angina
67
What are the pharmacokinetics of calcium channel blockers?
Well absorbed
Metabolized in the liver
Excreted in the urine
68
What are the contraindications of calcium channel blockers/
- allergy
- renal or hepatic dysfunction
- pregnancy or lactation
69
What are the adverse effects of CCB?
```
Hypotension
Cardiac arrhythmias
GI upset
Skin reactions
Headache
```
70
What reaches with calcium channel blockers?
vary with each drug
71
What is the prototype of calcium channel blockers?
diltiazem
72
What is diltiazem?
calcium channel blocker
73
What is thromboembolic disorder?
Conditions that predispose a person to the formation of clots and emboli
74
What is hemorrhagic disorder?
disorder which excess bleeding occurs
75
What are 2 blood disorders?
thromboembolic disorder
| hemorrhagic disorder
76
What is the action of anticoagulants?
interfere with the clotting cascade and thrombin formation
77
What is the action of anti platelet drugs?
alter the formation of platelet plug
78
What do thrombolytic drugs do?
break down the thrombus that has been formed
79
If you have an embolism what drug would you use to break up the clot?
- thrombolytic drugs
80
Which drug inhibits the platelet adhesion and aggregation by blocking receptor sites on the platelet membrane?
antiplatelet
81
What are anti platelet drugs indicated for?
- reduction of risk of recurrent TIAs or strokes
- reduce death or nonfatal MI
- MI prophylaxis
- anti-inflammatory, analgesic and antipyretic
82
What are the pharmacokinetics of anti platelet drugs?
- Well absorbed and bound to plasma proteins
| - Metabolized in the liver and excreted in the urine
83
What are the contraindications and cautions of anti platelet drugs?
CONTRAINDICATIONS
- allergy, pregnancy and lactation
CAUTIONS
- bleeding disorders, recent surgery, closed-head injury
84
What are the adverse effects of anti platelet meds (aspirin)?
- bleeding
- headache, dizziness, and weakness
- GI distress
85
What re the drug interactions to watch for?
another drug that affects blood clotting
86
What kind of drug is aspirin?
antiplatelet
87
What are anticoagulants used for?
prophylactically to prevent...
- clot formation (thrombus)
- an embolism
88
In preventing clot formation what do anticoagulants also prevent?
- stroke
- MI
- deep vein thrombosis (DVT)
- pulmonary embolism
89
What are some signs of deep vein thrombosis (DVT)?
inflamed, hot and red (usually in the calf)
90
What are anticoagulants indicated for?
prevention of clot formation in settings where clots are likely to form
- atrial fibrillation
- indwelling devices (mechanical heart valves)
- major orthopaedic surgery
91
Why would heparin be given to someone with mechanical heart valves?
- slots tend to form around implanted devices
92
What kind of drugs are heparin (generic) and warfarin (Coumadin)?
anticoagulants
93
What is warfarin's indication?
maintain state of anticoagulation when a patient is susceptible to potentially dangerous side effects
94
What is heparin's action
inhibits the conversion of prothrombin to thrombin
95
What route is warfarin given?
PO
96
What route is heparin given?
IV or SC
97
What is the action of anticoagulants?
interfere with the normal cascade of events involved in the clotting cascade
98
Are the pharmacokinetics the same for all anticoagulants?
no they differ
99
What are contraindications for anticoagulants?
CONTRAINDICATIONS
- allergy
- conditions that could be compromised by increased bleeding tendencies
- pregnancy
- renal and hepatic disorders
CAUTIONS
- CHF, throtoxicosis, senility or psychosis
100
What is the antidote for warfarin?
vitamin K
101
What is thrombocytopenia?
low platelet levels
102
Warfarin is strongly contraindicated for what?
pregnancy
103
What are the adverse effects of anticoagulants?
- thrombocytopenia (low platelet levels)
- GI: N&V, abdominal cramps
- hepatic dysfunction
- alopecia, dermatitis, bone marrow suppression, prolonged and painful erection
104
What are the drug to drug interactions of anticoagulants like heparin and warfarin?
- Heparin and oral anticoagulants, salicylates, penicillins, or cephalosporins
- Heparin and nitroglycerine
- Warfarin – Number of documented interactions
105
What are the nursing interventions of heparin?
- DOUBLE CHECK DOSE by another nurse
- ensure that SC doses are given SC not IM
- SITE should be ROTATED and in an area of deep fat (abdomen)
- DO NOT give heparin within 5 cm of umbilicus, abdominal incisions, open wounds, scars or drainage tubes, stomas
- DO NOT aspirate or massage site (may cause hematoma formation)
- IV (bolus or infusion)
- Anticoagulant EFFECTS IMMEDIATELY
- lab values done daily (aPPT)
- antidote close
106
What does aPPT stand for?
activated partial thromboblastin time (lab test of heparin)
107
What is the antidote for heparin?
Protamine sulfate
108
How fast are the effects of heparin seen?
IV- immediately
| SC- 20-60 min
109
How long does it take for warfarin to reach therapeutic levels?
3 days
110
What are the nursing implication of warfarin sodium?
- warfarin may be started while patient is on heparin until PT/INR levels indicate adequate anticoagulation
- monitor PT/INR reg (follow up appointments)
- antidote vitamin k
- dietary restriction
- leafy greens and fruits and veg (things high in vitamin k)
111
What are low molecular weight heparins?
- Inhibit thrombus and clot formation by blocking factors Xa and Iia
- fewer systemic adverse effects
- block angiogenesis
- indicated for specific uses in the prevention of clot formation after certain surgeries or bed rest
- do not need frequent blood monitoring
- SQ
- Prevention or management of thromboembolic disorders associated with surgery or ischemic complications of unstable angina and MI
- as effective as IV heparin
112
What are some examples of LMWH?
enoxaparin (Lovenox)
| dalteparin (Fragmin)
113
What is the antidote for LMWH
protamine sulfate (same as heparin)
