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Pharmacotherapeutics > Week 9- Cardiac Glycosides, Antianginal Agents, Anticoagulants > Flashcards

Week 9- Cardiac Glycosides, Antianginal Agents, Anticoagulants Flashcards

1
Q

What is congestive heart failure (HF)?

A

a condition in which the body fails to effectively pump the blood throughout the body

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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
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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)
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4
Q

What are some causes of HF?

A
  • Coronary Artery Disease (CAD)
  • Cardiomyopathy
  • Hypertension
  • Valvular Heart Disease
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5
Q

How do vasodilators (ACEI and Nitrates) work to treat HF?

A
  • decrease workload of overworked cardiac muscles
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6
Q

How do diuretics work to treat HF?

A
  • decrease blood volume, which decreases venous return and BP
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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
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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
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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
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10
Q

What are cardiac glycosides indicated for?

A
  • HF

- atrial fibrillation

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11
Q

What are the pharmacokinetics of cardiac glycosides?

A
  • Rapidly absorbed and widely distributed throughout the body
  • Primarily excreted unchanged in the urine
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12
Q

What are the adverse effects of cardiac glycosides?

A
  • Headache, weakness, drowsiness, and vision changes
  • GI upset and anorexia
  • Arrhythmia development
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13
Q

What is the most common complaint of cardiac glycosides?

A

headaches

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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
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15
Q

What are cardiac glycosides drug to drug interactions?

A
  • Verapamil, amiodarone, quindine, quinine, erythromycin
  • potassium losing diuretics
  • cholestyramine, charcoal, colestipol, bleomycin, cyclopisphamide
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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

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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)
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18
Q

What is the main concern of digoxin (Lanolin)?

A

slowing HR too much

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19
Q

Does digoxin have a narrow therapeutic window?

A

yes

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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
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21
Q

What are normal potassium levels?

A

3.5-5 mmol/L

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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

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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)
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24
Q

What should be avoided on digoxin?

A
  • high fibre (fibre binds to digitalis)
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25
Q

What patient teaching is needed for those taking digoxin?

A
  • avoid fibre
  • report weight gain of 1 kg or more in one day
  • signs and symptoms of toxicity
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26
Q

What therapeutic effects of digoxin are you monitoring for?

A
  • increased urinary output
  • decreased edema, SOB, dyspnea, crackles, fatigue
  • resolving or paroxysmal nocturnal dyspnea
  • improved peripheral pulse, skin colour, temp
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27
Q

Define atheroma.

A

fatty tumour in the intima of the heart vessels

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28
Q

Define atherosclerosis.

A

narrowing of the heart vessels

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29
Q

Define angina pectoris.

A

suffocation of the chest wall

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30
Q

Define myocardial infarction.

A

cells in the myocardium become necrotic and die

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31
Q

What are 4 types of CAD?

A
  • atheromas
  • atherosclerosis
  • angina pectoris
  • myocardial infarction
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32
Q

What are 3 types of angina?

A
  • stable angina (effort angina or classic angina)
  • unstable angina (pre-infarction)
  • Prinzmetal’s angina (vasospastic)
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33
Q

What is stable angina?

A
  • no damage to the heart muscle

- basic reflexes surrounding the pain restores blood flow

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34
Q

What is unstable angina?

A

episodes of ishemia occur

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35
Q

What is Prinzmetal’s angina?

A
  • caused by spasm of the blood vessels, not just by vessels narrowing
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36
Q

What is the action of anginas?

A
  • improve blood delivery to the heart muscle by dilating blood vessels; improves delivery
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37
Q

What are some types of anti- anginal medications

A
  • Nitrates
  • Beta-adrenergic blockers
  • Calcium channel blockers
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38
Q

What is the action of nitrates?

A

acts directly on smooth muscle to cause relaxation and depress muscle tone

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39
Q

What are nitrates indicated for?

A

angina pectoris

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40
Q

What is the pharmacokinetics of nitrates?

A
  • rapid absorption
  • metabolized in the liver
  • excreted in the urine
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41
Q

What is an example of nitrates?

A
  • nitroglyseride
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42
Q

What are the contraindications and caution of nitrates?

A 
CONTRAINDICATIONS
- allergy
- severe anemia
- head trauma or cerebral hemorrhage
- pregnancy and lactation
CAUTIONS
- hepatic or renal disease
- hypotension, hypovolemia, and conditions that limit CO
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43
Q

When you cause vasodilation you have increased risk of…

A

hypotension

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44
Q

What are the adverse effects of nitrates?

A
  • related to vasodilation and decrease in blood flow
  • CNS- headach, dizziness, and weakness
  • GI- N&V
  • CV- hypotension
  • misc.- flushing, pallor increased perspiration
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45
Q

What drug does nitrate react with?

A

heparin

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46
Q

What is important to inform patients taking nitroglycerin?

A
  • 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
Q

What is the prototype of nitrates?

A

nitroglycerine

48
Q

What category of drug is nitroglycerin?

A

nitrates

49
Q

What routes can nitroglycerin be given in?

A
  • IV
  • Sublingual
  • Translingual spray
  • Transmucosal tablet
  • Oral SR
  • Topical ointment
  • Transdermal
50
Q

What routs are recommended for anginal attacks of nitroglycerin?

A

spray, sublingual, IV

51
Q

What are some important nursing implications?

A
  • lots of patient teaching

- monitor VS frequently if using IV nitroglycerine

52
Q

When anginal pain occurs the patient should…

A
  • 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
Q

What is the action of beta blockers?

A
  • 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
Q

What are beta blockers indicated for?

A

treat stable angina pectoris and hypertension, prevents reinfarction in MI patients; treats stable CHF

55
Q

Are doses of beta blockers the same for those taking it for hypertension as for those taking them for angina?

A

dose is significantly higher for hypertension for angina

56
Q

What are the pharmacokinetics of beta blockers?

A

absorbed by GI tract, undergoes hepatic metabolism, excreted in the urine

57
Q

What are the contraindications and cautions of beta blockers (atenolol)?

A 
CONTRAINDICATIONS
- bradycardia
- cardiogenic shock
- asthma or COPD
- pregnancy and lactation
CAUTIONS
- DM
- PVD
- thyrotoxicosis
58
Q

What are the adverse effects of atenolol?

A

Related to the block of SNS

59
Q

What drugs interact with atenolol?

A

clonidine

60
Q

What is an off label use for beta blockers?

A

stage fright

61
Q

What routes are used for atenolol?

A

oral and IV

62
Q

What is atenolol?

A

a beta blocker

63
Q

What are the nursing implications of patients taking beta blockers?

A
  • 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
Q

What patient teaching is required about rebound hypertensive crisis?

A

Inform patients that these medications are for long-term prevention of angina, not for immediate relief

65
Q

What do calcium channel blockers do?

A

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
Q

What are calcium channel blockers indicated for?

A
  • hypertension

- angina

67
Q

What are the pharmacokinetics of calcium channel blockers?

A

Well absorbed
Metabolized in the liver
Excreted in the urine

68
Q

What are the contraindications of calcium channel blockers/

A
  • allergy
  • renal or hepatic dysfunction
  • pregnancy or lactation
69
Q

What are the adverse effects of CCB?

A 
Hypotension
Cardiac arrhythmias
GI upset
Skin reactions
Headache
70
Q

What reaches with calcium channel blockers?

A

vary with each drug

71
Q

What is the prototype of calcium channel blockers?

A

diltiazem

72
Q

What is diltiazem?

A

calcium channel blocker

73
Q

What is thromboembolic disorder?

A

Conditions that predispose a person to the formation of clots and emboli

74
Q

What is hemorrhagic disorder?

A

disorder which excess bleeding occurs

75
Q

What are 2 blood disorders?

A

thromboembolic disorder

hemorrhagic disorder

76
Q

What is the action of anticoagulants?

A

interfere with the clotting cascade and thrombin formation

77
Q

What is the action of anti platelet drugs?

A

alter the formation of platelet plug

78
Q

What do thrombolytic drugs do?

A

break down the thrombus that has been formed

79
Q

If you have an embolism what drug would you use to break up the clot?

A
  • thrombolytic drugs
80
Q

Which drug inhibits the platelet adhesion and aggregation by blocking receptor sites on the platelet membrane?

A

antiplatelet

81
Q

What are anti platelet drugs indicated for?

A
  • reduction of risk of recurrent TIAs or strokes
  • reduce death or nonfatal MI
  • MI prophylaxis
  • anti-inflammatory, analgesic and antipyretic
82
Q

What are the pharmacokinetics of anti platelet drugs?

A
  • Well absorbed and bound to plasma proteins

- Metabolized in the liver and excreted in the urine

83
Q

What are the contraindications and cautions of anti platelet drugs?

A

CONTRAINDICATIONS
- allergy, pregnancy and lactation
CAUTIONS
- bleeding disorders, recent surgery, closed-head injury

84
Q

What are the adverse effects of anti platelet meds (aspirin)?

A
  • bleeding
  • headache, dizziness, and weakness
  • GI distress
85
Q

What re the drug interactions to watch for?

A

another drug that affects blood clotting

86
Q

What kind of drug is aspirin?

A

antiplatelet

87
Q

What are anticoagulants used for?

A

prophylactically to prevent…

  • clot formation (thrombus)
  • an embolism
88
Q

In preventing clot formation what do anticoagulants also prevent?

A
  • stroke
  • MI
  • deep vein thrombosis (DVT)
  • pulmonary embolism
89
Q

What are some signs of deep vein thrombosis (DVT)?

A

inflamed, hot and red (usually in the calf)

90
Q

What are anticoagulants indicated for?

A

prevention of clot formation in settings where clots are likely to form

  • atrial fibrillation
  • indwelling devices (mechanical heart valves)
  • major orthopaedic surgery
91
Q

Why would heparin be given to someone with mechanical heart valves?

A
  • slots tend to form around implanted devices
92
Q

What kind of drugs are heparin (generic) and warfarin (Coumadin)?

A

anticoagulants

93
Q

What is warfarin’s indication?

A

maintain state of anticoagulation when a patient is susceptible to potentially dangerous side effects

94
Q

What is heparin’s action

A

inhibits the conversion of prothrombin to thrombin

95
Q

What route is warfarin given?

A

PO

96
Q

What route is heparin given?

A

IV or SC

97
Q

What is the action of anticoagulants?

A

interfere with the normal cascade of events involved in the clotting cascade

98
Q

Are the pharmacokinetics the same for all anticoagulants?

A

no they differ

99
Q

What are contraindications for anticoagulants?

A

CONTRAINDICATIONS
- allergy
- conditions that could be compromised by increased bleeding tendencies
- pregnancy
- renal and hepatic disorders
CAUTIONS
- CHF, throtoxicosis, senility or psychosis

100
Q

What is the antidote for warfarin?

A

vitamin K

101
Q

What is thrombocytopenia?

A

low platelet levels

102
Q

Warfarin is strongly contraindicated for what?

A

pregnancy

103
Q

What are the adverse effects of anticoagulants?

A
  • thrombocytopenia (low platelet levels)
  • GI: N&V, abdominal cramps
  • hepatic dysfunction
  • alopecia, dermatitis, bone marrow suppression, prolonged and painful erection
104
Q

What are the drug to drug interactions of anticoagulants like heparin and warfarin?

A
  • Heparin and oral anticoagulants, salicylates, penicillins, or cephalosporins
  • Heparin and nitroglycerine
  • Warfarin – Number of documented interactions
105
Q

What are the nursing interventions of heparin?

A
  • 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
Q

What does aPPT stand for?

A

activated partial thromboblastin time (lab test of heparin)

107
Q

What is the antidote for heparin?

A

Protamine sulfate

108
Q

How fast are the effects of heparin seen?

A

IV- immediately

SC- 20-60 min

109
Q

How long does it take for warfarin to reach therapeutic levels?

A

3 days

110
Q

What are the nursing implication of warfarin sodium?

A
  • 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
Q

What are low molecular weight heparins?

A
  • 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
Q

What are some examples of LMWH?

A

enoxaparin (Lovenox)

dalteparin (Fragmin)

113
Q

What is the antidote for LMWH

A

protamine sulfate (same as heparin)

Pharmacotherapeutics (7 decks)

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