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Cardio Drugs 5
Advanced Pharm for Nursing Practice 5
| Question | Answer |
|---|---|
| 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
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