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62 Cards in this Set

  • Front
  • Back

Angina/Coronary heart disease

Episode of chest pain caused by demand for oxygenated blood for body is greater than supply

Caused by: atherosclerotic plaque in coronary arteries, high levels of catecholamines

Results in: MI or heart attack

Types of Angina (3)

1. Stable

2. Variant

3. Unstable

Stable Angina

chest pain, squeezing, suffocating, may go down arm or up into jaw

Nurse: women also see fatigue and SOB

Variant Angina

spasms of coronary artery during rest

Nurse: pain relieved by nitroglycerin

Unstable Angina

common/intense chest pain, spasms, squeezing, suffocating due to advanced coronary artery disease


Action: relax smooth muscle in blood vessels, vasodialator, decrease pre+afterload

Use: used for/prophylactically for angina and MI

Adverse: HA, hypotension, dizziness, N/V, flushing, tachycardia

Nurse: wear gloves, hold ptn at 30 pts less than normal systolic, no beta blockers of ED meds, telemetry these patients

Teach: for short term attacks take 3 pills, 5 mins apart. call EMS if condition doesn't improve. no smoke/ETOH. sit/lie down when taking

3 types of Nitrates

1. NTG

2. Isordil - long term prophylactic

3. Imdur - sustained release taken once/day


Type: Nitrate (most common)

Use: angina, MI (for and prophylactic)

Given: pill under tongue, cream, patch, IV, spray

Nurse: Patch 12 hrs on/off, rotate site. Pills must be stored in original dark container. should fizzle under tongue. if they don't then they are expired.

Beta 1 blockers

Action: decrease energy demands of heart

Use: chronic stable angina, MI, HTN, dysrhythmia

Adverse: hypoglycemia

Nurse: monitor VS's, change positions slowly, taper dose, avoid hot tubs/hot showers, saunas, no ETOH, want HR > 60.

Types: Tenormin (improves MI survival rate) and Lopressor

Normal cholesterol levels (4)

Total: <200/dL

LDL: <100

HDL: >60 (problem if under 40)

Tiglycerides: <150

High cholesterol is linked to:

arteriosclerosis, HTN, CAD, PVD, MI

-agents to lower lipids attempt to lower lipid/triglyceride levels in serum

Lipitor and Zocor

Type: lipid lowering agent

Class: HMG-COA reductase inhibitor (aka statin)

Action: block cholesterol synthesis in liver

Use: lower LDL by 30-40%, maintain HDL

Adverse: constipation, abd distention, burping

Contra: don't give to ptns with liver failure

Nurse: first line cholesterol drugs, give at night, don't get pregnant, restrict ETOH, starts in 1-2 weeks, max effect in 4-6 weeks


Type: lipid lowering agent

Class: bile and acid sequestrants

Action: inhibit or increase excretion of bile in GI

Adverse: constipation, bloating, farting

Contra: no ptns with bile obstruction disease

Nurse: take powder in mixed with food/drink before meal, increase fiber


Type: lipid lowering agent

Class: fabric acid derivatives

Action: reduce plasma triglycerides by increasing enzyme lipoprotein lipase

Use: short term for hyperlipidemia patients who fail diet

Adverse: abd pain, diarrhea,

Nurse: signs of gall stones, need fiber and fluid


Type: lipid lowering agent

Class: cholesterol absorption inhibitor

Action: acts in small intestine

Nurse: used in adjunct with statins for those who are intolerant to other therapies

What is heart failure and what are the symptoms?

Heart not being able to meet the demands of the body

Symptoms: dyspnea, fatigue, ankle edema, jugular vein distention, pulmonary edema

What are the 6 classes of drugs that treat heart failure?

1. Ace inhibitors

2. angiotensin II blockers (ARBS)

3. Phospodiesterase inhibitors

4. Cardiac glycocides

5. Diuretics

6. beta blockers

Lisinopril and Captopril

Type: drug for heart failure

Class: ACE inhibitor

Action: inhibits Angiotensin I to II

Use: heart failure, HTN

Adverse: hypotension, renal tubular damage, cough, angioedema

Contra: no renal disorder or pregnant patients

Nurse: monitor weight, I&O, rebound hypertension w/ abrupt stop, monitor K, no NSAIDS

What is the function of Angiotensin II?

potent vasoconstrictor

2 cool things about ACE inhibitors

1. they are heart protective following an MI - stop progression of ventricular hypertrophy

2. protect kidney in diabetics when there is no existing kidney failure

Losartan and Valsartan

Type: drugs for heart failure

Class: ARBS

Action: compete w/ Angiotensin II for binding site

Adverse: hypotension, less cough

Conatra: no liver failure or pregnant patients

Nurse: monitor weight, I&O, rebound hypertension w/ abrupt stop, monitor K, no NSAIDS


Type: drug for heart failure

Class: B-type natriuretic peptide

Action: increase CO, SV and contraction without altering HR/BP

Use: given IV in ICU for Acute heart failure

Adverse: hypotension, dysrhythmias

Nurse: Monitor BNP

Primacor and Inocor

Type: drug for heart failure

Class: Phospodiesterase inhibitor

Action: vasodilation to decrease pre+afterload, inhibit action phosphodiesterase enzyme

Use: given in ICU for acute heart failure only after other treatment failure

Adverse: hypotension, hysrhythmias

Inocor can cause thrombocytopenia


Type: oldest heart failure drug

Class: Cardiac glycocides

Action: slow HR and increase force of contrations

Use: heart failure, tachyarrhythmias

Adverse: bradycardia, heart block

Nurse: no new patients RX'd this drug b/c not shown to decrease mortality, start with loading dose, hold HR <60

Cardiac Glycocides Toxicity symptoms

-anorexia, hypokalemia, yellow/green eyes

-Elderly more likely to experience toxicity

-Normal blood level of drug should be .5-2 ng/mL


-Combination of Apresline/isosorbide (vasodilators)

-shown to treat heart failure and HTN in African american population

What is a Dysrhythmia, what are the 5 types and which are life threatening?

Disturbance in the hearts electrical conduction

1. Sinus

2. Atrial

3. Nodal

4. Ventricular (LT)

5. Heart block (LT)

Quinidex, Pronestyl an Norpace

Type: dysrhythmia drug

Class: I-A

Action: block Na+ channel, membrane stabilizing

Use: supraventricular/ventricular arrhythmias

Adverse: Pronestyl - can cause blood disorder/lupus like syndrome, Quinidex - can cause tinnitus

Caution: those with liver/kidney disorders

Nurse: many drug interactions, take on time schedule


Type: dysrhythmia drug

Class: I-B (not used as much now)

Action: decrease automaticity in ventricles

Use: local anesthetic, serious dysrhythmias

Adverse: bradycardia, heart block, confusion

Caution: pregnant, elderly, acute MI

Nurse: IV in ICU only - monitor ptn very closely

Rythmol and Tambocor

Type: dysrhythmia drug

Class: I-C

Action: decrease conduction of ventricles

Use: given PO for ventricular arrhythmias

Adverse: sudden death, dizziness, fatigue

Caution: heart failure, liver dz, K+ imbalance

Nurse: monitor K+, given to ptn in hospital to see for adverse effects, black box warnings on both

Propranolol, esmolol and sotalol

Type: dysrhythmia drug

Class: II

Use: supraventricular tachycardia

Adverse: decreases cardiac output too much after a while

Nurse: must monitor ptn closely

Describe supraventricular tachycardia and which drugs are given for this?

Happens above the ventricle

-"narrow rhythm"

Class II drugs


Type: dysrhythmia drug

Class: III

Action: prolong action potential and refractory period in atria and ventricles, slow repolarization

Use: ventricular/problamatic dysrhthmias that can't be tx with other drugs

Caution: liver/pulmonary dz

Class III dysrhythmia drugs adverse effects and nurse implications

Adverse: pulmonary toxicity, vision probs, can deposit in fat, hypo/hyperthyroidism

-75% of ptns will experience adverse effect

Nurse: super long 1/2 life (2-3 months), monitor VS, thyroid function, drug interaction with Coumadin

-Black box warning due to lung/liver damage

Calan and Cardiazem

Type: dysrhythmia drug

Class: IV

Action: Ca+ channel blocker and slow inward flow of Ca+

Use: prevent/control supraventricular arrhythmias, HTN

Adverse: leg cramps, bradycardia, heart block

Caution: pregnant, heart block, hypotension, elderly

Nurse: monitor VS, give with food


Type: dysrhythmia drug

Action: slows conduction time through the AV node

Use: conversion of PSVT to sinus rhythm, after failure with other tx's

Nurse: given fast IV push in CC unit, asystole for a few seconds, then heart starts back up in reg rhythm

HTN diagnosis and what is first line treatment?

Diagnose: SBP>140 and/or DBP>80

Prehypertensive: SBP 120-139 or DBP 80-89

Treatment: Thiazide Diuretics <- especially for women

The 7 types of Antihyperstensives

1. ACE inhibitors


3. Antiadrenergics

4. Beta adrenergic blockers

5. Ca+ channel blockers

6. Vasodilators

7. Diuretics


Type: Anti-HTN Loop Diuretic - VERY POTENT

Class: diuretic

Action: increase water excretion by blocking reabsorption of Na+ and CL in loop of Henle

Use: pulmonary edema, edema, HTN, for rapid diuresis

Adverse: hypokalemia, dehydration, hypotension, ototoxic with high dose

Nurse: keep accurate I&O and weight, hold drug and contact MD if K+ level <3.5 in morn

General guidelines for diuretics

-Give in morning

-started singularly then other meds will likely be added


Type: Anti-HTN

Class: Diuretic (K+ sparing - pretty weak)

Action: causes Na+ loss in urine, inhibits aldosterone

Use: heart failure, HTN, edema, ascites

Adverse: hyperkalemia

Nurse: monitor K+, I&O, weight


Type: Anti-HTN

Class: Diuretic (Thiazide)

Action: decrease reabsorption of Na+, water, CL and HCO3 in distal convoluted tubules

Use: given PO for HTN, heart failure

Adverse: electrolyte probs, dehydration

Contra: not for those with renal failure

Nurse: monitor VS's, photosensitive

Nifedipine, Norvasc and Cardizem

Type: Anti-HTN

Class: Ca+ channel blockers

Action: inhibit influx of Ca+ entering channels, produces vasodilation thus lowering BP

Use: Angina, HTN, Raynaud's

Adverse: hypotension, fusing, lower limb edema

Nurse: can't eat grapefruit due to synergitic effect, don't crush pill

What is Raynaud's and what medication should be used?

- Vascular disease usually seen in hands making them intolerant to cold

-Ca+ channel blockers


Type: Anti-HTN

Class: Vasodilator

Action: direct vasodilation

Use: HTN emergencies - not first line tx

Adverse: tachycardia

Given: IV in ICU to produce controlled hypotension

Nurse: check HR/BP every 3-5 mins, cyanide poisoning possible with long term use


Type: Anti-HTN

Class: Vasodilator

Given: PO or IV

Nurse: less commonly used

The 3 class's of blood coagulation drugs

1. Anticoagulants

2. Antiplatlets

3. Thrombolytics

-Most dangerous drugs used today

Plavix and ASA

Type: blood coagulation durgs

Class: Antiplatelet

Action: decrease platelet aggregation

Use: prevent MI, CVA, Plavix used to improve graft potency (stent),

Adverse: bleeding

Nurse: monitor LOC

Anticoagulants (Action, Use, Adverse, Caution)

Action: interfere with coagulation cascade - can't break apart already formed clots but can help that they don't get larger

Use: thrombotic disorders, Angina, those with mechanical heart valves, atrial fibrillation, keep central lines from clotting, non-mobile patients usually going into surg

Adverse: HIT

Caution: those with bleeding disorders, gastric ulcers, pregnant

What is HIT and what drug can possibly cause it?

Heparin induced thrombocytopenia

-when someone has a catheter inserted into vein and clot forms.

-Heparin - not being used as much though b/c of this


Type: blood coagulation drug

Class: Anticoagulant

Use: central line flushes

Given: IV infusion after DVT, IV push, SubQ

Nurse: given to patients who were previously on coumadin prior to surgery, give loading dose, very short half life

Protamine sulfate

Given in the case of an heparin OD


Type: blood coagulation durg

Class: anticoagulant

Use: prophylactic to prevent clots

Given: SubQ ONLY, can be given at home, dosed by weight

Nurse: no lab work needed but VERY EXPENSIVE


Type: blood coagulation drug

Class: Anticoagulant

Use: prophylactic for DVT after hip fracture sugery, knee replacement, abd surgery

Given: SubQ


Type: blood coagulation drug

Class: anticoagulant

Action: interferes with Vit K dependent clotting

Given: PO, dosage adjusted daily

Nurse: 3-5 days for effect, many drug interactions, watch K intake (green leafy veggies), PT/INR should be between 2-3, Vit K antidote


Type: blood coagulation drug

Class: Thrombolytics (clot busters)

Action: dissolve clots, restore blood flow, prevent/limit tissue damage

Use: Acute MI, stroke, PE (not used as much in MI due to advances in PTCA's)

Adverse: bleeding Caution: pregnancy, delivery w/in 10 days

Nurse: give right after symptoms, check for bleeding every 15 mins/1st hour, 30 mins/next 4 hours, oral temp only, bed rest

What system do Adrenergic drugs mimic, what are the 3 receptors, and what are the 4 drugs?

Mimic: SNS "fight or flight"

1. Alpha - vasoconstrictor

2. Beta 1 - increase HR

3. Beta 2 - open up airway

- Epinephrine, Levophed, Dopamine, Neo-Synephrine

Adrenergic Agents (Action, use, adverse, nurse)

Action: mimic SNS - widespread action

Use: emergency CA, hypotension, bronchospasm, anaphylaxis, HF, bleeding

Adverse: arrhhthmias, HTN, palpatations, angina, nervousness

Nurse: can't be used with TCA and MAO anti-depressents, extreme care with calculations, monitor VS's, tolerance can develope


Type: Adrenergic agent prototype


Type: Adrenergic agent

Action: stimulates alpha receptors

Adverse: may see hands/feet turn purple


Type: Adrenergic agent

Action: stimulates alpha/beta

Nurse: dose determines effect

Low: increase urine

Med: increase cardiac output

High: increase BP


Type: Adrenergic agent

Action: stimulates alpha

Use: nasal decongestant