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Cardio Drugs 5

Advanced Pharm for Nursing Practice 5

What is BiDil? Why is it significant? A study was done specifically on Afr. Amer /c BiDil (a drug combo of hydralazine & isosorbride PO); we know it’s useful in treating Afr. Ameri.
What are dysrhythmias? dysrhythmias generally appear as an ectopic pacemaker, instead of SA node being pacemaker, signal is coming from elsewhere; you get heart block (where ventri cell is pacemaker), or reentry circuit (this is where Ca++ channel blockers often used)
How do antidysrhythmias work? antidysrhythmics work by altering Na+, K+, or Ca++ mvmt (the cations that mainly control action potential); these drugs depress automaticity to try and slow the SA & AV nodes; they try & incr refractoriness so that premature impulses won’t set them off
*What drug group is used to treat Reentrant Activation? Ca++ channel blockers
What antidysrhythmic drug is used for sustained supraventricular dysrhythmia (SVT)? Verapamil
What antidysrhythmic drug is used for acute supraventricular dysrhythmia? Adenosine
Which drugs slow down atrial flutter or fibrillation conduction through the AV or SA node? Beta-blockers, CCB, Digoxin
Which drug is used for sustained ventricular tachyarrythmia? Lidocaine*, procainamide*, or Amiodarone* (last resort)
Describe the antiarrhythmic Class 1A drug QUINIDINE* Quinidine decr Na+ conduction, slowing conduction time, & decr ability of membrane to respond; USES: atrial, nodal, or ventricular dysrhythmias; SE/ADR: much diarrhea, N/V, abdominal pain, widens Q-T interval
What does QUINIDINE** toxicity cause? cinchonism-ringing in the ears and nausea
What are QUINIDINE** interactions? Quinidine metabolized by 3A4, so affected by enzyme inducers (i.e. rifampine) & enzyme inhibitors (i.e. erythromycin); Quinidine inhibits 2D6, so causes toxicity for pts on tricyclic antidepressants; it raises p-glycoprotein levels --> digoxin toxicity
Quinidine is weak base, if you alkalinize pt (i.e. Na+Bicarb), causes QUINIDINE TOXICTY bc it’ll go to its non-ionized lipid-soluble form in alkaline media; changes in pH can alter effectiveness of drug Quinidine is weak base, if you alkalinize pt (i.e. Na+Bicarb), causes QUINIDINE TOXICTY bc it’ll go to its non-ionized lipid-soluble form in alkaline media; pH changes can alter effectiveness of drug
Describe the antiarrhythmic Class IA drug PROCAINAMIDE** Procainamide sometimes in place of Quinidine; procainamide has bttr effect on ventricular dysrhythmias than on atrial dysrhythmias; it causes less GI upset than quinidine; may produce Lupus-like condition (&bone marrow suppression)
Describe the antiarrhythmic Class IB drug LIDOCAINE** used in emergencies of ventricular dysrhythmias; similar to quinidine but doesn’t slow AV conduction; short onset, fast acting; metabolized in liver
Describe the antiarrhythmic Class IC drug FLECAINIDE** option when others have failed treating atrial or ventricular dysrhythmias
Describe the antiarrhythmic Class II drug BETAB-BLOCKERS* What’s t/ med for this group? Esmolol*is a beta-blocker /c fast onset and short action (all the other Beta-blockers take time to wrk); propranolol (non-selective beta-blocker) used PO for sustained ventricular tachyarrhythmias assoc /c sympathetic activity
What are the actions of Class II antiarrhythmics? actions of Class II antiarrhythmics: depress automaticity, slow conduction, decr heart rate
Describe the antiarrhythmic Class III drug AMIODARONE* (Cordarone) amiodarone only used when other antiarrhythmics fail; effective against ventr & supraventr arrhythmias; ACLS DRUG OF CHOICE FOR PULSELESS V-FIB; given IV & fast acting /c short ½-life (PO, slow onset /c 1-2 mos ½-life); liver metabolism
What are the side effects of t/ Class III antiarrhythmic drug AMIODARONE* (Cordarone)? IV: hypotension & bradycardia; may cause hypothyroidism or hyperthyroidism; proarrhythmia effect (what it’s last resort drug); muscle weakness, fatigue, sinus arrest, corneal microdeposits, N/V, constipation, liver damage, photosensitivity
What are interactions with AMIODARONE? it’s an enzyme inhibitor that enhances digoxin toxicity bc it inhibits p-glycoprotein; it increase action of many antiarrhythmics; it incre action of phenytoin & cyclosporine
When dealing with antiarrhythmic drugs, why do we only focus on VERAPAMIL & DILTIAZEM as the Class IV bc Verapamil and Diltiazem (t/ non-dihyropyradine drugs) are the only Ca++ channel blockers that have an effect on the heart
VERAPAMIL** is the drug of choice for reentry dysrhythmias (sometimes Diltiazem) & sustained ventricular dysrhythmias; verapamil can be given over sustained period (unlike Adenosine) VERAPAMIL** is the drug of choice for reentry dysrhythmias (sometimes Diltiazem) and sustained ventricular dysrhythmias; verapamil can be given over sustained period (unlike Adenosine)
Diltiazem indicated IV for supraventricular dysrhythmias (not ventricular ones bc might make those worse); they block SA node conduction to ventricles Diltiazem indicated IV for supraventricular dysrhythmias (not ventricular ones bc might make those worse); they block SA node conduction to ventricles
Describe the final antiarrhythmic drug ADENOSINE** (Adenocard) used: supraventricular dysrhythmias **PRIMARIILY PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIAS (PSVT) TERMINATION; action: inhibits SA & VA nodes; it STOPS HEART CONDUCTION for few seconds to try and reset sinus rhythm
What is the consideration for ADENOSINE** administration? med given in small dose into vein as close to heart as possible; ½-life <10 sec.; give 6mg, if no effect, give 12mg; SE/ADR: facial flushing, dyspnea
What is the prototype for Iron? FERROUS SULFATE**
What type of anemia is caused by iron deficiency? hypochromic (low color) microcytic (small cell) anemia
How do children’s vs adult’s body’s tolerate iron? for children, iron can by very toxic (beware of children overdosing on coated ferrous tablets that look like candy—it can be fatal); adults’ bodies doesn’t absorb iron unless it needs it
Where is iron stored? iron is stored in cells in intestinal tract, pancreas and RBC’s
What are the SE/ADR of Ferrous Sulfate? GI irritation (N/V, diarrhea or constipation); iron best tolerated with food, but best absorbed on empty stomach b/c it’ll naturally bind to Ca++ in food (decr its absorption); black stool (iron + stomach acid)[prob b/c ulcer bleeding causes black stool too, esp if the bleeding is from peptic ulcer from iron irritation]; acute toxicity rare except for those who develop hemochromatosis from XS blood transfusions)
What are interactions /c iron? antacids interfere /c absorption; tetracyclines and fluroroquinolones bind to iron; high zinc decr bioavailability of ferrous sulfate; GIVE IRON SEPARATE FROM OTHER DRUGS
What is caused by a lack of Vit. B12? PERNICIOUS ANEMIA (it’s a megaloblastic anemia /c too few RBCs that are very large; pernicious anemia also goes /c spinal cord degeneration
Where is Vit B12 found? meats, fish, dairy, NOT PLANTS
How does Vit B12 work in the body? Vit B12 absorption requires intrinsic factor made by gastric cells; active absorption happens in distal ileum (prob for Cancer pts that destroy GI mucosa); pts /c pernicious anemia can get Vit B12 shots /c no bad SEs
What should one determine if pt has megaloblastic anemia? need to determine if the anemia is a folic acid deficiency or a Vit B12 deficiency b/c if you give folic acid, you’ll change hematologic picture w/o reversing the spinal cord degeneration
If there’s a folic acid anemia, why does the FDA regulate OTC dose of the drug? bc too much folic acid can mask signs of pernicious anemia
Where is folic acid found? folic acid is found in green, leafy, veggies, though most multivitamins have folic acid
What can happen to a pregnant woman deficient of folic acid? her baby can develop spina bifida (from the spinal cord degeneration-neuro tube damage)
What folic acid antagonist is given to cancer pts to block the turnover of DNA and RNA cancerous (and healthy) cells? methotrexate; but if you give Leucovorin (a derivative of folic acid w/in 24hrs of the methotrexate, cancer can’t recognize the drug, but the normal cells do!
What’s the prototype of ERYTHROPOIETIN*? Epoetin Alfa
What does Epoetin do to the body? it’s a protein produced in the kidney. It goes to bone marrow and stimulates RBC production; EPOETIN IS USED FOR POOR RENAL FUNCTION AND CANCER CHEMO PTS
What are the SE/ADR of Epoetin? BLACK BOX WARNING: Hgb levels of >12gm/dL incr risk of mortality so BE SURE TO DO HGB/HCT LEVELS AND KEEP THEM <12GM/dL
When is FILGRASTIM* used? for pts on cancer chemo and have decr granulocyte, filgrastim stimulates myeloid growth factor and replaces granulocytes
Which factors are inhibited by Warfarin? factors II, VII, IX, X
Factor Xa is affected by which drug? heparin
Thrombin is inhibited by what drug? heparin
What is HEPARIN**? Heparin is a large water-soluble ionized compound that DOES NOT CROSS PLASMA MEMBRANES; used in bldstream to treat/prevent venous thrombosis and pulm embolism; heparin is a weak acid primarily used to treat/prevent in large doses
What are the kinetics of HEPARIN? heparin given IV has almost immediate onset; it’s metabolized in the liver /c ½-life of 90min (larger doses-larger ½-life); doesn’t cross plasma membranes
What is the antidote to Heparin? Protamine Sulfate (a weak base)
How does Heparin prevent clots? Heparin binds to thrombin and/or factor Xa and prevents thrombin from forming clots
What do you monitor /c pt on Heparin? APTT (activated plasmin thromboplastin time) or ANTI-Xa
What’s the SE/ADR of Heparin? XS bleeding, allergies for those allergic to cows (animal Heparin is made from); since it’s binding to thrombin, it can cause thrombocytopenia
What is the antidote to Heparin? Protamine Sulfate (a weak base)
When is protamine sulfate used in pts? for hemodialysis pts, or pts on heart-lung pumps /p their txs
What is the prototype for Low molecular weight heparin? ENOXAPARIN SODIUM (LOVENOX)**
How does Lovenox work? Lovenox is a low molecular weight heparin with “extras” cut off and it only binds to factor Xa; it’s given sub-q to treat/prevent deep vein thrombosis; Lovenox is drug of choice prophylactically /p orthopedic surgeries
Created by: Fukanwa