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BC3cardiac lec. 1/23
BC3 lecture cardiac drug classes 1/23/08
| Question | Answer |
|---|---|
| Fibrinolytics | the “-plases”; the alteplase, tenecteplase, and the reteplase. it literally lyses the clot; use this for acute ST elevation; clot is occluding that artery right now; very expensive;converting fibrinogen to plasma which lyses the clot and opens up vessel |
| Anticoagulants | use after the fibrinolytics/ avoid recurent clots;limits fibrin formation;low mole weight. Heparin,as the lovenox ; block factor X and thrombin;for unstable angina & non -Q-wave MI’s; combines/w antithrombin III/and inhibits thrombin formation |
| platelet inhibitors | Aspirin, Glycoprotein IIb/IIIa inhibitors; prevent a thrombus from forming by inhibiting thromboxane. |
| One of the biggest complications of fibrinolytics | systemic bleeding;don’t want to stick needles in this patient because they bleed ;doesn’t go to the clot and lyse it – it works everywhere. |
| patient who has a history of a GI bleed are you going to use a fibrinolytic? | No. |
| has had a stroke in the last 3 months, a bleed stroke, not just a thrombus? use a fibrinolytic? | no |
| patient has anemia, severe anemia, would you use a fibrinolytic? | no |
| how aspirin works | inhibits the thromboxane |
| Plavix and Ticlid work by | irreversible inhibition |
| irreversible inhibition of platelets | once off drugs, goes back to normal in about 3-7 days |
| maximum platelet inhibition is | about 8-10 days |
| take Plavix for 8-10 days before they reach their | maximum inhibition |
| inotropes. | drugs that increase the force of contraction; thereby increasing cardiac output and increasing workload of the heart.sympathomemetic;fight or flight;Dopamine.; |
| Dopamine. | stimulates the alpha and beta receptors;Dose related ;renal dose(very low) to increase renal perfusion; higher doses;3-10mcg to increase cardiac output |
| Dopamine low dose, usually 3mcg | for renal |
| Dopamine.3-10 mcg | for increase cardiac output |
| Inotropic sympathomemetic is Dobutamine | acts on the beta1 cells (located in the heart) stimulate the beta1 cells,increasing myocardial contractivity |
| Epinephrine Inotropic | stimulates all of them, alpha, beta1, beta2.low dose it stimulates the beta 1 receptors in high dose it stimulates the alpha receptors;high dose epinephrine? for cardiac arrest, shock;want to increase his blood pressure |
| if patient is in V-fib | coarsen this so that the defibrillator will hit on the R wave. You give epi, Coarsen – make it bigger |
| Norepiinephrine | stimulates the alpha receptors ;increases blood pressure and systemic venous resistance;for cardiogenic shock;left ventricle is not pumping enough |
| phosphodiesterase inhibitor | Amrione Milrinone;minimally affect the heart rate; decrease arterial pressure;treatment of CHF |
| Vasodilators | used to decrease preload; nitrates ;work 3 places: decrease preload, decrease afterload, increase perfusion to the coronary artery; IV, Sublingual, by a patch; |
| Viagra, you cannot give them | nitroglycerin; will have irreversible hypotension; no reversible agent for nitroglycerin |
| . Alright, if you hang nitro IV | light will break it down; brown plastic bag hanging over an IV bag |
| The problem with long term nitro | cyanide toxicity; patient is on nitro, make sure it is bitter under the tongue.only lasts about 6 months, |
| one nitro if not relieved in 5 minutes | call the ambulance |
| Antidysrhythmics, | according to class I, II, III, IV |
| Class I antidysrhythmic | inhibits the fast sodium channels, likely to cause dysrhythmias, but it prolongs and depresses the action potention.largely ineffective ; old drugs – Quinidine, tocainide, lidocaine |
| do use Lidocaine for | PVC’s hang a Lidocain drip |
| best drugs are Class II and Class III | beta blockers;both for heart failure and an acute MI. standard of care for a patient who has had an MI, needs to be discharged with a beta blocker. end in "ol" |
| what case would make you think twice about sending a patient home on a beta blocker? | Asthma. |
| Propranolol, stalol, atenolol, metoprolol, | are all beta blockers |
| Class III drugs are | amiodarone; primarily for ventricular dysfunction and a-fib. Ibutilide is used for both a-fib and a-flutter. |
| Class IV drugs are "pine." | calcium channel blockers;slow the conduction down in the heart. |
| when calcium is released from the cell | increase muscle contraction…. |
| give a calcium channel blocker to a heart cell, | Decrease rate, decrease contractility. Examples of those would be the “-pines”, Amlodopine? – pine. |
| drug used for Torsades is what? | Magnesium Sulfate |
| bradycardic. and symptomatic give? | atropine |
| Antihyperlipidemics 4 classifications | #1 are your –statins ;everybody knows ;Lipitor;They reduce the enzyme that is used to make cholesterol. So it breaks that pathway and does not allow the cholesterol to be formed. |
| Nicotinic Acid is another classification ; Antihyperlipidemics | it decreases the LDL, the total cholesterol and the triglycerides.;I get so hot and so red and my face flushes – tell them to take it with an aspirin.a lot of non-compliance |
| Bile acid sequestrants; Antihyperlipidemics | bind the bile acids that are used to form cholesterol and LDL and this occurs in the liver. |
| Fibrates; Antihyperlipidemics | decrease the liver extraction of free fatty acids and decrease triglyceride formation. |
| 4 classifications Antihyperlipidemics;same side effects | Liver failure ;check labs Liver functions, again in 6 weeks, again in 6 months, must monitor;GI upset, such as constipation ;abdominal pain ; diarrhea |
| problem with having liver failure and being on a statin? | rhabdo; generalized weakness, fatigue, aches and pain, they cannot be on this drug. problem with rhabdo – it causes renal failure. So, they should never, ever be on statins again. |
| CPK is normally | 25 so high means a lot of cellular damage |
| PTCA – percutaneous transcoronartery angioplasty, or PCI Percutaneous coronary intervention | shoot the dye; find the plaque; advance the catheter to the area of the plaque, inflate the balloon, presses the plaque into the intima of the vessel |
| number one cause of re-steonsis after PTCA? | smoking |
| PTCA is used to treat a patient with an MI – basic time frame – 90 minutes door to balloon. | from the time they hit the door in the ED to the time they hit the door in the cath lab needs to be 90 minutes or less;get the labs done, get the EKG, get them triaged, |
| we do PTCA if there is greater than | 70% occlusion of a coronary artery |
| re-stenosis is a real problem | are stented – to prevent re-stenosis a stent it holds the stenotic lesion in place |
| drug eluding stents – | Drug eluding stents release heparin or another drugs some times (?) to prevent clot formation, because a stent is metal – what happens when you put metal in the body – you have platelet reaction – clots., |
| after a stent, you need to monitor the platelet and give and anti-platelet such as Aspirin and Plavix. | They are on that for about 4-6 weeks. After the stent, they need to have a repeat treadmill or a thalium study;assess the PCI’s efficiency and the ability of that stent to hold that vessel open |
| Nursing care after a stent | Check for bleeding at the sheath site;to prevent hematoma at site, sandbags(pressure) ; HOB elevated at less than 45 degrees;Check coagulation studies;enzymes;any chest pain ;one of the complications of PTCA is an MI –need an EKG |
| vaso-spastic | blood vessels get a little irritated; clamp down Clamping down, he is not having blood flow, blood carries oxygen….he is going to have shortness of breath, he is going to have chest pain – so give oxygen right? |
| A dumbbell or apple core lesion is very (?) to stenting. | (blank) |
| IABP. Intraaortic Balloon Pump | it decreases the workload of the left ventricle by decreasing afterload,It increases perfusion to the coronary artery. threaded up through the femoral artery up to the aorta.balloon is 8-12 inches long;aorta is a high pressure system;inflates on diastol |
| IABP. Intraaortic Balloon Pump how it works | it inflates on diastole ;when the coronary arteries become perfused;increases perfusion to the coronary arteries;you decrease what? Angina, chest pain;deflates on systole;connected to an EKG monitor ; deflate during the QRS complex |
| IABP. Intraaortic Balloon Pump | it inflates and deflates according to what the heart is doing and it is an a rhythmic fashion. It will inflate and deflate on each one initially and that is a 1:1 ratio and then as the patient gets better it goes 1:2, 1:3 then the balloon pump is out. |
| the two reasons for a balloon pump:iabp | Increase coronary artery perfusion;inflates on diastole; deflates on systole; deflation of that balloon decreases the afterload; decreases the workload of that left ventricle, so it decreases the workload of the left vent use this in pt. with weak L vent |
Created by:
goryan
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