pharm 2 CV drugs, lipids, angina
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What OTC drug may be used to increase HDL levels?
Elevated liver enzymes may occur with ____ and all other _____ drugs.
Which lipid drug decreases LDL but has no effect on HDL?
Lowering serum lipid levels decreases risk for _____ ______.
Limiting dietary ____ intake is imp part of reducing serum lipid levels.
What is the first step in treating high lipids?
What is the next step if this doesn't work?
should start meds but cont. with diet modification
lipid-lowering drugs - all have same characteristics
3 most important considerations with NTG admin?
- 1. check BP & pulse before admin
- 2. monitor for hypotension & ortho hypotension
- 3. monitor for reflex tachycardia
Prototype statin drug?
Drug of choice for Prinzmetal's angina?
Ca channel blocker
spasms of the artery respond well to Ca channel blockers
Actions of lovastatin/Mevocor/statins?
- 1. decreases synth of chol in the liver
- 2. decreases all lipids except HDL - increases HDL
Lovastatin/mevacor (statin) is contraindicated with ______ _____ and ______.
liver damage and alcohol use
If a person drinks alcohol and is going to take a statin what must be done?
may need a liver enzyme test before starting and will have to stop drinking
2 reasons quinidine increases risk for arrhythmias?
- 1. increases QT time
- 2. is affected by K levels
What lab work must be done during follow up visits with a lovastatin/Mevacor or other statin user?
must check liver enzymes
If the liver enzymes are elevated in a pt that is taking a statin like lovastatin/Mevacor what should be done?
must stop the med
Drug/food interactions with lovastatin/Mevacor or other statins?
any drugs or substances that inhibit the pathway of the enzyme that metabolizes the drug will increase serum drug concentration
grape fruit juice is one of them
Nursing actions for a pt on quinidine who has a prolonged QT time?
stop the med and call the MD
3 AE of lovastatin/Mevacor, a statin?
- 1. myalgia
- 2. myositis
- 3. rhabdomyolysis - muscle b/d
S/S of rhabdomyolysis that may be caused by lovastatin/Mevacor?
pee out muscle - can be seen in urine
What serious condition can develop due to rhabdomyolysis that may be caused by lovastatin/Mevacor?
can cause renal damage due to excess muscle/protein in the urine
Quinidine is an _______ drug.
S/S of myalgia and myositis caused by lovastatin/Mevacor?
What actions need to be taken?
muscle aches esp in legs
need to have CK levels drawn to check for mus damage that indicates rhabdomyolysis
AE of fibric acid derivatives that decrease lipids?
may increase liver enzymes
Actions of nicotinic acid? (lipid drug)
- 1. reduces triglycerides and LDL chol.
- 2. increases HDL chol.
2 ways to increase HDL's without RX?
nicotinic acid and exercise
AE of nicotinic acid?
How can this be avoided?
take ASA 30 min before taking to decrease inflammatory process
What pt may have hard time dealing with nicotinic acid facial flushing?
Second or third line therapy drugs for lipid reducing?
bile acid sequestrants
Action of bile acid sequestrants?
bind with bile acids in int to make them nonreabsorbable then excrete them
lowered bile acid level prompts chol to be used to make more bile acid
When should bile acid sequestrants be admin?
before a meal
How to prime IV tubing for admin of NTG?
run 50-100 ml thru tubing and waste so pt is getting drug r/t NTG binding to plastic
AE of bile acid sequestrants?
- 1. may impair fat soluble vitamins
- 2. causes bad GI probs: diarrhea and/or constipation that can lead to obstruction
2 bile acid sequestrant drugs?
- 1. cholestyramine/Questran
- 2. cholestipol/Colestid
What type of drug is ezetimibe/Zetia?
selective chol. absorption inhibitor
Action of ezetimibe/Zetia?
inhibits absorption of chol from food in the sm int
decreases LDL but no effect on HDL
3 types of antianginal drugs?
Which are used for maintenance and which are used in emergency?
- 1. beta blockers - maintenance
- 2. Ca channel blockers - maintenance
- 3. nitrates - emergency
Actions of beta blockers?
prevent stim of the beta receptors of the heart
slow HR, depress conduction, decrease CO & BP = decreased O2 demand
What is the primary use for Ca channel blockers?
BV spasms like Raynauds
Action of Ca channel blockers/
inhibit Ca from moving across cell membranes
slows HR, depress impulse formation & conduction = decreased O2 demand of heart
What drug Tx arrhythmias and causes constipation?
Ca channel blockers
When will Ca channel blocker be used for angina?
used in chronic stable angina when pt cannot tolerate beta blockers or nitrates or if s/s are not adequately controlled with these
2 things that must be checked before giving NTG?
BP & HR
NTG affect on BP?
can drop it drastically
2 actions of NTG?
- 1. relaxes vascular sm mus
- 2. dilates both arterial and venous vessels
What does venous dilation created by NTG result in?
decreases peripheral resistance = decreased BP
Why must a person see an eye doctor while taking amiodarone?
can cause optic neuropathy
What does arterial dilation caused by NTG result in?
reduces systemic vascular resitance and arterial pressure = decreased afterload
Major effect of NTG?
decreases myocardial O2 consumption and workload of the heart
How does NTG improve circulation to ischemic areas?
redistributes BF in the heart
3 routes of NTG to Tx acute angina?
- 1. SL
- 2. transmucosal
- 3. translingual spray
Why is a person taking NTG at risk for falls?
can cause orthostatic hypotension
Pt teaching about storage of NTG?
NTG needs to be kept in brown bottle or other bottle that keeps out light
does not stay active long- need to know exp date
Pt teaching about taking SL NTG?
should burn when placed under the tongue
4 routes of admin for NTG used for chronic recurrent angina?
- 1. topical
- 2. transdermal
- 3. transligual spray
- 4. transmucosal or oral sustained-release
Applying topical NTG?
Put paste on a patch - must wear gloves
Put new paste/patch in a different area from the one removed that has not been agitated/shaved.
Most important consideration for applying a new topical/patch NTG?
TAKE THE OLD ONE OFF and wipe off any paste left
How is NTG usually given for hypertension?
IV - usually says titrate up for chest pain
Important consideration if titrating IV NTG up for chest pain?
monitor BP - if it gets low do not increase dose
What may occur with long-term use of NTG?
may dev tolerance to vascular and antianginal effects
2 ways to minimize dev tolerance to NTG?
- 1. start with as small a dose as poss
- 2. remove NTG paste/patch from pt for 10-12 h per day while they are sleeping
What teaching should be done if a pt takes a daily dose of NTG and also has SL tabs for acute angina?
need to teach them why they have 2 and when to take each
NTG loses potency with exposure to ____, ____, _____, _______.
- 1. light
- 2. humidity
- 3. heat
- 4. plastic (in IV bag/tubing)
How to take SL NTG for acute angina?
- Place under tongue and lie down.
- In 5 minutes take another if still have angina.
- In 5 minutes take another if still have.
- After taking 3 NTG tabs assume MI if no relief
Why does pt need to lie down when taking SL NTG tab for angina?
NTG can cause orthostatic hypotension and pt may be having an MI
3 nursing responsibilities r/t NTG admin?
- 1. assess BP & pulse before admin
- 2. Have pt sit or lie down before taking NTG for acute angina
- 3. Monitor for hypotension and reflex tachycardia
NTG is contraindicated with ____ & _____ because all 3 cause vasodilation & can cause too much decrease in BP.
alcohol and viagra
NTG is contraindicated in what health condition?
increased ICP/head injuries
4 drugs that may be used as adjunct to NTG?
- 1. ASA
- 2. anticoagulants
- 3. lipid lowering agents
- 4. morphine
Advantage of using morphine as an adjunct to NTG?
helps with anxiety
Common AE of NTG caused by vasodilation?
What is the purpose of using adjunct drugs with NTG?
do not decrease O2 demands on heart but slow down progression of CAD or prevent/treat complications that may arise with angina
What electrolye is required for the creation of the action potential that causes heart contraction?
What causes cardiac arrhythmias?
changes in ionic currents thru ion channels of the myocardial cell membrane: Na, K, & Ca
Important consideration with ANY drug used to treat arrhythmias?
any anti-arrhythmic drug can also cause arrhythmias
3 ways that ionic chages cause arrhythmias?
- 1. disorder with impulse formation
- 2. disorder of impulse conduction
- 3. combination of both
What type of arrhythmias is quinidine used to treat?
AE of quinidine?
- 1. GI disturbances: NV
- 2. serious cardiac changes r/t increased QT length
- 3. hepatic toxicity
- 4. can cause torsades de pointes - lethal rhythm with no pulse
Why is increased QT a problem?
QT represents when heart is resting after contraction (repolarization)
during this time heart is more vulnerable to arrhthmias
4 things that need to be monitored with quinidine?
- 1. EKG
- 2. serum drug levels
- 3. CBC & liver & renal function
- 4. electrolytes esp K
Effect of increased/decreased K on effects of quinidine?
increased K = enhanced effects & AE of quinidine
low K = decreased effects & AE of qunidine
Normal admin of lidocaine/Xylocaine?
IV 1-4 mg/min usually given bolus
What is lidocaine usually used for?
given during a code or lethal arrhythmia that still has a pulse
What type of arrhythmias is lidocaine given for?
3 common AE of lidocaine?
- 1. arrhythmias and hypotension
- 2. dizzy, fatigue, drowsiness
- 3. lidocaine crazies - confusion & seizures
If confusion & seizures/lidocaine crazies occur what should be done?
stop the med and check serum levels
2 things that must be monitored continuously with lidocaine?
Why does pt taking quinidine need to be on constant monitoring with EKG?
because of potential to prolong QT
fecainide/Tambocor used for?
usually limited to life threatening ventricular arrhythmias b/c of increased risk for mortality
2 things to monitor with admin of fecainide/Tambocor?
BP & EKG
Action of beta blockers in arrhythmia Tx?
depress cardiac action potential
slows HR & decreases CO
Can a pt get an allergy shot while taking beta blocker?
No, b/c if they have allergic reaction to the shot EPI will not help due to beta blocking
Important consideration about the half life of amiodarone/Cordarone/Pacerone?
has half life of 53 days- if it has AE will last a LONG time
Amiodarone/Cordarone/Pacerone has a high affinity for ______ tissue.
What types of arrhythmias are amiodarone/Cordarone/Pacerone used for?
ventricular and atrial
When will amiodarone be used for life threatening ventricular arrhythmias?
when they have not responded to other meds
Teaching about amiodarone and children?
looks like candy - keep away from children
2 most important things to monitor with admin of amiodarone?
- 1. EKG b/c can prolong QT interval
- 2. s/s of CHF & breath sounds b/c can cause pulmonary toxicity
- 3. exacerbation of arrhythmias
Amiodarone binds with _____.
3 things to assess before giving amiodarone?
BP, heart rhythm, and HR
What is the most common AE of amiodarone?
4 uses for Ca channel blockers?
- 1. spasms of any artery
- 2. BP
- 3. arrhythmias: atrial flutter/fibrillation, ventricular tachycardia arrhythmias
- 4. angina
AE of Ca channel blockers?
Sodium polystyrene sulfonate/Kayexalate use?
K-removing resin - lowers K to prevent arrhythmias by pulling K from the int and excreting in excrement
What drug is mixed with kayexalate?
sorbitol - it is a laxative that will speed up the excretion of K removed by kayexalate
Is kayexalate given for lethal K levels?
no b/c it takes several hours for it to lower levels
What 2 drugs may be given to lower lethal levels of K?
insulin and bicarb
How does insulin lower K levels?
What must be given with insulin?
puts K into the cells
must give with D50 to prevent hypoglycemia
How does bicarb lower K?
K prefers acidic env. If bicarb is given = alkaline blood -> K will go into more acidic cells
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