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32 Cards in this Set

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4 classes of cholesterol lowering drugs

Statins, bile acid sequestrants, nicotinic acid, and fibrates.

Statins

Lovastatin, pravastatin, and simvastatin.


Can cause myopathy. Patients should report muscle pain and/or weakness and brown urine. Liver function tests must be performed regularly.

Bile Acid Sequestrants

Cholestyramine, colestipol, colesevelam.


Administer powder with 4-6 Oz of water or juice with meals. Drink lots of fluids, constipation and bloating are major side effects. Report constipation, severe gastric distress with N/V, unexplained weight loss, black tarry stools, and/or sudden back pain.

Cholesterol Absorption Inhibitors

Ezetimibe


Can initially increase liver enzymes when used with statins. Resolves with continued use. Can be taken without regard to meals.

Nicotinic Acid

Niacin (Nicobid, Nicolar, Niaspan, etc..)


Give with meals and a cold beverage to minimize GI effects. Administer with caution to patients with active liver disease, peptic ulcer disease, gout, or type 2 diabetes. Monitor blood glucose, uric acid levels, and liver function tests during treatment.


Can cause flushing of face, neck, and ears within 2 hours following dose. Alcohol increases this effect. Can cause ortho static hypotension, contact doctor if this occurs.

Fibrin Acid Derivitives

Gemfibrozil, Fenofibrate, Clofibrate.


Monitor serum LDL and VLDL levels, electrolytes, glucose, liver enzymes, renal function tests, and CBC during therapy. Report abnormal values. Most need 2 months of treatment for results to show and rebound effect is possible in the 2nd-3rd month. Take with meals if GI upset occurs. Report flu like symptoms immediatly. Do not use while pregnant.

Nitrates

Nitroglycerin, Isosorbide dinitrate, Isosorbide mononitrate, amyloid nitrite.


Coronary artery vasodialator. Increases blood flow and oxygen to the myocardium. Reduces preload, and afterload as well as cardiac work.



Use glass and non PVC tubing to infuse nitro IV, wear gloves to administer paste or transdermal patch, remove at night to prevent tolerance. Keep nitro out of sunlight. Use only sublingual or buccal for a cut angina. May cause headache and tingling under the tongue.

Beta Blockers

Atenolol, carvedilol, metaprolol, nadolol, and propanolol.



Beta blockers decrease cardiac workload by blocking beta receptors on the heart muscle, decreasing heart rate, contractility, myocardial oxygen consumption, and blood pressure. Anti-anginal and anti-hypertensive.


Document HR and BP before administering. Withhold if HR <50 or BP is super low. Call physician. Assess and report any possible contraindications to the therapy, such as heart failure, bradycardia, AV block, asthma, or COPD. BB and CCB used together can increase risk of CHF. Do not discontinue abruptly. Take pulse daily. Not for acute angina.

Calcium Channel Blockers

Amlodipine, bepridil, dilitiazem, felodipine, isradipine, nicardipine, nifedipine, nimodipine, verapamil.



Used to control angina, hypertension, and dysrhythmias. Block calcium from myocardial cells, reducing contractility, slow the heart rate and conduction, and cause vasodilation. Increase myocardial oxygen supply by vasodilation. Often prescribes for transient angina (Prinzmetal's).


Do not mix verapamil in any solution containing sodium bicarbonate. Push over 2-3 minutes. Document HR and BP before administering. Withhold if HR <50 and notify the physician. Nifedipine capsule can be punctured and administered by extracting the liquid with a syringe and squirting meds under the tounge (discard needle first). Not for acute angina.

Oral antiplatelet Drugs

Aspirin, clopidogrel, dipyridamole, and ticlopidine.



Inquire about history of intracranial hemorrhage, upper GI bleeding, peptic ulcer disorde, or known bleeding tendencies. Observe for and report increasing bruising, petechiae, purpura, and apparent or occult bleeding. Only dipyridamole can be used concurrently with warfarin.


Take aspirin with food or milk. Do not use any NSAIDs, OTC meds, or herbal remedies without consulting your physician. Report unusual bleeding or excessive bleeding. Inform all care providers (dentists) of use of these drugs.

Intravenous Antiplatelet Drugs

Abciximab, eptifibatide, and tirofibin.



These block the final common pathway of platelet activation, and are more effective. Risk for bleeding is increased.



Determine history of bleeding disorders, intracranial hemorrhage, recent trauma or surgery. Inquire about recent antiplatelet or anticoagulant drug use. Monitor CBC'S including hemoglobin, hematocrit, and platelet count. Clotting studies: PT, INR, PTT, vital signs, and ECG during administration. Maintain seperate IV line for blood draws and administration of other drugs during infusion. Closely observe for anaphylaxis or bleeding uncontrolled by pressure. Keep rescucitation handy. Maintain bed rest during infusion.

Dopamine

A vasopressor. Low doses: improves blood flow to the kidneys. Increased doses: improves myocardial contractility and causes vasoconstriction, improving blood pressure and cardiac output.

Antidysrhythmic Drugs:



Class I Drugs:

Sodium Channel Blockers



Class IA: quinidine, procainamide, disopyramide, moricizine.



Decrease the flow of sodium into the cell and prolong the action potential. Decreases automacity, slows the rate of impulse conduction, and prolongs refractiveness. Used for supraventricular and ventricular tachycardia.



Class IB: lidocaine, mexiletine, tocainide, and Phenytion.



Lidocaine-like; decrease the refractory period but little effect on automacity. Primarily used to treat ventricular dysrhythmias like PVC's and V-tach.



Class IC: Flecainide and Propafenone.



Slow impulse conduction velocity but has little effect on refractoriness. Used to reduce or eliminate tachydysrhythmias associated with reentry. Can be used to treat supraventricular tachycardia.

Antidysrhythmic Drugs



Class II Drugs:

Beta-Blockers:


Atenolol, carvedilol, esmolol, metaprolol, naldolol, propranolol.



Decrease automacity and conduction through the AV node. Reduces heart rate and myocardial contractility. Used to treat supraventricular tachycardia and to slow the ventricular response rate to atrial fibrillation. These drugs may cause bronchospasms and are contraindicated for patients with asthma, COPD, or other restrictive or obstructive lung disorders.

Antidysrhythmic Drugs


Class III drugs:

Potassium Channel Blocker:


Amioderone, bretylium, dofetilide, ibutilide, sotalol.



Prolong repolarization and the refractory period. Used primarily to treat ventricular tachycardia and ventricular fibrillation. Amioderone may also be used for supraventricular tachycardia.

Antidysrhythmic Drugs


Class IV drugs:

Calcium Channel Blockers


Amlodipine, Verapamil, Dilitiazem



Decrease automacity and AV node conduction. They are used to manage supraventricular tachycardias. Like beta-blockers, CCB's reduce myocardial contractility.

Other Antidysrhythmic Drugs

Adenosine and digoxin.



Decrease conduction through the AV node and are used to treat supraventricular tachycardia.

Nursing responsibilities with antidysrhythmic drugs:

Obtain baseline data including vital signs, cardiac rhythm, and physical assessment.


Assess medication regimen to identify drugs that may interfere with antidysrhythmic therapy.


Monitor ECG to evaluate the effectiveness of therapy and to immediately report manifestations of drug toxicity.


Use an infusion pump to administer IV infusions. Monitor dose and assess it's effectiveness.


Take HR before administering.

Atenolol

At therapuetic dosages, atenolol selectively blocks only the beta1 receptors in the heart, not the beta2 receptors located in the lungs.

Propranolol

An effective not selectively beta - adrenergic antagonist. It is non-selective and blocks both beta1 and beta2 receptors at therapuetic doses.

Phentolamine

A potent alpha-blocking drug specifically effective for treatment of hypertension associated with pheochromocytoma.

Priority nursing diagnosis for a patient taking metoprolol:

Risk for decreased cardiac tissue perfusion related to effects of medication. Using the ABC'S of prioritization.

Digoxin's therapuetic effect

Digoxin increases cardiac contractility (positive inotropic effect), decreases heart rate (negative chronotropic effect), and decreases conductivity (negative domotropic effect).

Phosphodiesterase inhibitors

For treating heart failure. They cause a positive inotropic effect and vasodialate. Also called inodialators.

Milrinone

A phosphodiesterase inhibitor, contraindicated in severe aortic or pulmonary valvular disease and in diastolic heart failure.

Digoxin

Large amounts of bran taken with digoxin will decrease and negatively impact the drug's absorption.

Quinidine

Grapefruit juice can inhibit the metabolism of quinidine, which increases the risk of cinchonism (toxicity).

Adenosine

For the treatment of PSVT. Must be given as a rapid IV push.

Ibutilide

Class III antiarrhythmic drug.


Conversion of recent-onset atrial fibrillation and flutter.

Calcium Channel Blockers

Coronary vasodilation

Amioderone

Patients taking amioderone must have baseline and serial pulmonary function tests in order to monitor for potential pulmonary toxicity.



Potential side effects include photosensitivity, bluish skin discoloration, hyperthyroidism, hypothyroidism, and decreased libido.

Isosorbide Mononitrate

Mononitrate is a vasodilator and thus can cause hypotension. Blood pressure is a priority assessment before administering this drug.