pharm 2 CV drugs, lipids, angina

  1. What OTC drug may be used to increase HDL levels?
    nicotinic acid
  2. Elevated liver enzymes may occur with ____ and all other _____ drugs.

  3. Which lipid drug decreases LDL but has no effect on HDL?
  4. Lowering serum lipid levels decreases risk for _____ ______.
    CV disease
  5. Limiting dietary ____ intake is imp part of reducing serum lipid levels.
  6. What is the first step in treating high lipids?

    What is the next step if this doesn't work?
    diet modification

    should start meds but cont. with diet modification
  7. Statins?
    lipid-lowering drugs - all have same characteristics
  8. 3 most important considerations with NTG admin?
    • 1. check BP & pulse before admin
    • 2. monitor for hypotension & ortho hypotension
    • 3. monitor for reflex tachycardia
  9. Prototype statin drug?


    highly effective
  10. Drug of choice for Prinzmetal's angina?

    Ca channel blocker

    spasms of the artery respond well to Ca channel blockers
  11. Actions of lovastatin/Mevocor/statins?
    • 1. decreases synth of chol in the liver
    • 2. decreases all lipids except HDL - increases HDL
  12. Lovastatin/mevacor (statin) is contraindicated with ______ _____ and ______.
    liver damage and alcohol use
  13. 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
  14. 2 reasons quinidine increases risk for arrhythmias?
    • 1. increases QT time
    • 2. is affected by K levels
  15. What lab work must be done during follow up visits with a lovastatin/Mevacor or other statin user?
    must check liver enzymes
  16. 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
  17. 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
  18. Nursing actions for a pt on quinidine who has a prolonged QT time?
    stop the med and call the MD
  19. 3 AE of lovastatin/Mevacor, a statin?

    Most serious?
    • 1. myalgia
    • 2. myositis
    • 3. rhabdomyolysis - muscle b/d

  20. S/S of rhabdomyolysis that may be caused by lovastatin/Mevacor?
    pee out muscle - can be seen in urine
  21. 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
  22. Quinidine is an _______ drug.
  23. 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
  24. AE of fibric acid derivatives that decrease lipids?
    may increase liver enzymes
  25. Actions of nicotinic acid? (lipid drug)
    • 1. reduces triglycerides and LDL chol.
    • 2. increases HDL chol.
  26. 2 ways to increase HDL's without RX?
    nicotinic acid and exercise
  27. AE of nicotinic acid?

    How can this be avoided?
    facial flushing

    take ASA 30 min before taking to decrease inflammatory process
  28. What pt may have hard time dealing with nicotinic acid facial flushing?
    menopausal woman
  29. Second or third line therapy drugs for lipid reducing?
    bile acid sequestrants
  30. 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
  31. When should bile acid sequestrants be admin?
    before a meal
  32. 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
  33. 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
  34. 2 bile acid sequestrant drugs?
    • 1. cholestyramine/Questran
    • 2. cholestipol/Colestid
  35. What type of drug is ezetimibe/Zetia?
    selective chol. absorption inhibitor
  36. Action of ezetimibe/Zetia?
    inhibits absorption of chol from food in the sm int

    decreases LDL but no effect on HDL
  37. 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
  38. Actions of beta blockers?
    prevent stim of the beta receptors of the heart

    slow HR, depress conduction, decrease CO & BP = decreased O2 demand
  39. What is the primary use for Ca channel blockers?
    BV spasms like Raynauds
  40. Action of Ca channel blockers/
    inhibit Ca from moving across cell membranes

    slows HR, depress impulse formation & conduction = decreased O2 demand of heart
  41. What drug Tx arrhythmias and causes constipation?
    Ca channel blockers
  42. 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
  43. 2 things that must be checked before giving NTG?
    BP & HR
  44. NTG affect on BP?
    can drop it drastically
  45. 2 actions of NTG?
    • 1. relaxes vascular sm mus
    • 2. dilates both arterial and venous vessels
  46. What does venous dilation created by NTG result in?
    decreases peripheral resistance = decreased BP
  47. Why must a person see an eye doctor while taking amiodarone?
    can cause optic neuropathy
  48. What does arterial dilation caused by NTG result in?
    reduces systemic vascular resitance and arterial pressure = decreased afterload
  49. Major effect of NTG?
    decreases myocardial O2 consumption and workload of the heart
  50. How does NTG improve circulation to ischemic areas?
    redistributes BF in the heart
  51. 3 routes of NTG to Tx acute angina?
    • 1. SL
    • 2. transmucosal
    • 3. translingual spray
  52. Why is a person taking NTG at risk for falls?
    can cause orthostatic hypotension
  53. 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
  54. Pt teaching about taking SL NTG?
    should burn when placed under the tongue
  55. 4 routes of admin for NTG used for chronic recurrent angina?
    • 1. topical
    • 2. transdermal
    • 3. transligual spray
    • 4. transmucosal or oral sustained-release
  56. 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.
  57. Most important consideration for applying a new topical/patch NTG?
    TAKE THE OLD ONE OFF and wipe off any paste left
  58. How is NTG usually given for hypertension?
    IV - usually says titrate up for chest pain
  59. Important consideration if titrating IV NTG up for chest pain?
    monitor BP - if it gets low do not increase dose
  60. What may occur with long-term use of NTG?
    may dev tolerance to vascular and antianginal effects
  61. 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
  62. 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
  63. NTG loses potency with exposure to ____, ____, _____, _______.
    • 1. light
    • 2. humidity
    • 3. heat
    • 4. plastic (in IV bag/tubing)
  64. 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
  65. 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
  66. 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
  67. NTG is contraindicated with ____ & _____ because all 3 cause vasodilation & can cause too much decrease in BP.
    alcohol and viagra
  68. NTG is contraindicated in what health condition?

    increased ICP/head injuries
  69. 4 drugs that may be used as adjunct to NTG?
    • 1. ASA
    • 2. anticoagulants
    • 3. lipid lowering agents
    • 4. morphine
  70. Advantage of using morphine as an adjunct to NTG?
    helps with anxiety
  71. Common AE of NTG caused by vasodilation?
  72. 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
  73. What electrolye is required for the creation of the action potential that causes heart contraction?
  74. What causes cardiac arrhythmias?
    changes in ionic currents thru ion channels of the myocardial cell membrane:  Na, K, & Ca
  75. Important consideration with ANY drug used to treat arrhythmias?
    any anti-arrhythmic drug can also cause arrhythmias
  76. 3 ways that ionic chages cause arrhythmias?
    • 1. disorder with impulse formation
    • 2. disorder of impulse conduction
    • 3. combination of both
  77. What type of arrhythmias is quinidine used to treat?
    atrial arrhythmias
  78. 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
  79. Why is increased QT a problem?
    QT represents when heart is resting after contraction (repolarization)

    during this time heart is more vulnerable to arrhthmias
  80. 4 things that need to be monitored with quinidine?
    • 1. EKG
    • 2. serum drug levels
    • 3. CBC & liver & renal function
    • 4. electrolytes esp K
  81. Effect of increased/decreased K on effects of quinidine?
    increased K = enhanced effects & AE of quinidine

    low K = decreased effects & AE of qunidine
  82. Normal admin of lidocaine/Xylocaine?
    IV 1-4 mg/min usually given bolus
  83. What is lidocaine usually used for?
    given during a code or lethal arrhythmia that still has a pulse
  84. What type of arrhythmias is lidocaine given for?
    ventricular arrhythmias
  85. 3 common AE of lidocaine?
    • 1. arrhythmias and hypotension
    • 2. dizzy, fatigue, drowsiness
    • 3. lidocaine crazies - confusion & seizures
  86. If confusion & seizures/lidocaine crazies occur what should be done?
    stop the med and check serum levels
  87. 2 things that must be monitored continuously with lidocaine?
    • 1. EKG
    • 2. BP
  88. Why does pt taking quinidine need to be on constant monitoring with EKG?
    because of potential to prolong QT
  89. fecainide/Tambocor used for?
    usually limited to life threatening ventricular arrhythmias b/c of increased risk for mortality
  90. 2 things to monitor with admin of fecainide/Tambocor?
    BP & EKG
  91. Beta blocker suffix?
  92. Action of beta blockers in arrhythmia Tx?
    depress cardiac action potential

    slows HR & decreases CO
  93. 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
  94. 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
  95. Amiodarone/Cordarone/Pacerone has a high affinity for ______ tissue.
  96. What types of arrhythmias are amiodarone/Cordarone/Pacerone used for?
    ventricular and atrial
  97. When will amiodarone be used for life threatening ventricular arrhythmias?
    when they have not responded to other meds
  98. Teaching about amiodarone and children?
    looks like candy - keep away from children
  99. 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
  100. Amiodarone binds with _____.
  101. 3 things to assess before giving amiodarone?
    BP, heart rhythm, and HR
  102. What is the most common AE of amiodarone?
    pulmonary toxicity
  103. 4 uses for Ca channel blockers?
    • 1. spasms of any artery
    • 2. BP
    • 3. arrhythmias:  atrial flutter/fibrillation, ventricular tachycardia arrhythmias
    • 4. angina
  104. AE of Ca channel blockers?
  105. Sodium polystyrene sulfonate/Kayexalate use?
    K-removing resin - lowers K to prevent arrhythmias by pulling K from the int and excreting in excrement
  106. What drug is mixed with kayexalate?

    sorbitol - it is a laxative that will speed up the excretion of K removed by kayexalate
  107. Is kayexalate given for lethal K levels?
    no b/c it takes several hours for it to lower levels
  108. What 2 drugs may be given to lower lethal levels of K?
    insulin and bicarb
  109. How does insulin lower K levels?

    What must be given with insulin?
    puts K into the cells

    must give with D50 to prevent hypoglycemia
  110. How does bicarb lower K?
    K prefers acidic env.  If bicarb is given = alkaline blood -> K will go into more acidic cells
Card Set
pharm 2 CV drugs, lipids, angina
CV drugs: Vickers