Podcast
Questions and Answers
Which medication can be administered rapidly to slow conduction through the AV node?
Which medication can be administered rapidly to slow conduction through the AV node?
What is a common side effect of nitroglycerin?
What is a common side effect of nitroglycerin?
Which of the following is a requirement for accurately assessing an apical pulse?
Which of the following is a requirement for accurately assessing an apical pulse?
What is true regarding the management of hypertension when the systolic BP is greater than 180?
What is true regarding the management of hypertension when the systolic BP is greater than 180?
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Which characteristic distinguishes factor Xa inhibitors from warfarin?
Which characteristic distinguishes factor Xa inhibitors from warfarin?
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What should be assessed as the first indication of bleeding in a patient taking Clopidogrel?
What should be assessed as the first indication of bleeding in a patient taking Clopidogrel?
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What is the therapeutic INR range for a patient on Warfarin?
What is the therapeutic INR range for a patient on Warfarin?
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Which of the following patients should use caution when taking medications associated with anticoagulants?
Which of the following patients should use caution when taking medications associated with anticoagulants?
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What is the reversal agent for Dabigatran?
What is the reversal agent for Dabigatran?
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What is the main adverse effect of Amiodarone related to vision?
What is the main adverse effect of Amiodarone related to vision?
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Which of the following should be avoided when taking Verapamil?
Which of the following should be avoided when taking Verapamil?
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In managing a patient receiving Heparin, what lab test is primarily monitored?
In managing a patient receiving Heparin, what lab test is primarily monitored?
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What type of medication is Alteplase classified as?
What type of medication is Alteplase classified as?
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What is a common adverse effect associated with HMG-CoA reductase inhibitors?
What is a common adverse effect associated with HMG-CoA reductase inhibitors?
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Which medication should be taken with food to avoid heartburn?
Which medication should be taken with food to avoid heartburn?
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Which of the following is NOT a side effect of Ezetimibe?
Which of the following is NOT a side effect of Ezetimibe?
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What is the primary action of Milrinone in heart failure patients?
What is the primary action of Milrinone in heart failure patients?
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Before administering Digoxin, which of the following should be assessed?
Before administering Digoxin, which of the following should be assessed?
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What is the consequence of doubling a missed dose of an ACE inhibitor?
What is the consequence of doubling a missed dose of an ACE inhibitor?
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Which of the following medications are contraindicated in pregnancy?
Which of the following medications are contraindicated in pregnancy?
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Which of the following medications ends with 'statin'?
Which of the following medications ends with 'statin'?
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Study Notes
Statins
- Statins are HMG-CoA reductase inhibitors, ending with "statin," used to treat cholesterol and prevent cardiovascular disease in high risk individuals.
- Risk factors for cardiovascular disease include hypertension, diabetes, and smoking.
- Major adverse effect is rhabdomyolysis, characterized by severe muscle pain, weakness and dark urine.
- Before starting statins, assess lipid AST and ALT levels to determine medication effectiveness.
- Statins are contraindicated in pregnancy.
- Assess the client's ability to learn prior to educating them about statins.
Fibrates
- Fibrates are cholesterol medications, like gemfibrozil.
- Gemfibrozil should be taken with food to prevent heartburn.
- A complication of gemfibrozil is gallstones, which can cause right upper quadrant pain, requiring medical attention.
PCSK9 Inhibitors
- PCSK9 inhibitors decrease the number of LDL receptors in the liver by inhibiting the PCSK9 protein, leading to increased LDL excretion and reduced cholesterol levels.
Selective Cholesterol Absorption Inhibitors
- Ezetimibe is a selective cholesterol absorption inhibitor.
- Common adverse effects include nasopharyngitis, upper respiratory infections, and diarrhea.
- Before administering ezetimibe, ensure the client's LDL, HDL, total cholesterol, and triglyceride levels are within normal limits.
ACE Inhibitors
- ACE inhibitors end with "pril" and are contraindicated in pregnancy.
- Do not double the dose if a dose is missed.
Phosphodiesterase Enzyme Inhibitors
- Milrinone is a phosphodiesterase enzyme inhibitor, used intravenously for heart failure patients, typically in the ICU.
- It is an inotropic agent that increases contractility and cardiac output.
- Common adverse effects include hypotension, requiring continuous ECG monitoring.
- It is a chronotropic agent (affects heart rate) and a dromotropic agent (affects electrical conduction).
Cardiac Glycosides
- Digoxin is a cardiac glycoside, used to treat heart failure and arrhythmias.
- It lowers heart rate, so withhold the medication if the heart rate is less than 60 beats per minute and notify the physician.
- Always measure the apical pulse for a full minute before administering digoxin.
- Digoxin can cause toxicity, which may manifest as visual disturbances, anorexia, vomiting, and fatigue.
- The antidote for digoxin toxicity is digibind.
- When starting a new medication, assess the client's heart rate, dysrhythmias, loss of appetite, and potassium levels prior to administration.
Beta Blockers
- Beta blockers end with "lol," such as propranolol and metoprolol.
- They are used to treat arrhythmias, thyroid storms, PTSD, angina, and heart failure.
- Beta blockers slow heart rate and decrease blood pressure, so assess these parameters before administering.
- Common adverse effects include fatigue, weakness, dizziness, and drowsiness.
- Avoid abrupt discontinuation of beta blockers.
- Use cautiously in clients with COPD.
Antiplatelets
- Clopidogrel is an antiplatelet medication.
- Assess for bleeding, with bruising being the first indication.
- It is available orally only.
- Discontinue clopidogrel before surgery.
- It is indicated in patients with myocardial infarction, post-stent placement, and prevention of stroke.
- Adverse effects include bleeding gums, black tarry stools, flu-like symptoms, and petechiae.
Anticoagulants
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Warfarin is an anticoagulant, monitored through the PT/INR test.
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The therapeutic INR range for patients on warfarin is 2 to 3.
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Vitamin K acts as a reversal agent for warfarin.
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Educate patients on avoiding changes in vitamin K intake, found in green leafy vegetables and bananas.
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Numerous drug-drug interactions exist with warfarin, including antibiotics.
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Educate clients on taking warfarin at the same time each day, avoiding changes in vitamin K intake, adhering to regular blood tests to monitor dosage, and reporting signs of bleeding to their doctor.
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Heparin is another anticoagulant, monitored through the APTT lab.
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Dose is titrated to achieve the prescribed APTT.
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Monitor platelets for HIT (Heparin-induced thrombocytopenia).
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Protamine sulfate acts as the reversal agent for heparin.
Direct Thrombin Inhibitors (DTIs)
- Dabigatran is a DTI, with idarucizumab serving as its reversal agent.
Factor Xa Inhibitors
- Factor Xa inhibitors are oral anticoagulants, such as apixaban (Eliquis) and rivaroxaban (Xarelto).
- Educate clients about potential drug interactions that may inhibit or potentiate the medication, such as aspirin.
- Andexanet alfa is used to treat life-threatening uncontrolled bleeding caused by Factor Xa inhibitors.
Thrombolytics
- Thrombolytics are clot-busters, like alteplase.
Class III Antiarrhythmics (Potassium Channel Blockers)
- Amiodarone is a Class III antiarrhythmic, with a half-life of up to 50 days.
- Used to treat atrial arrhythmias and is contraindicated in pregnancy, requiring reliable birth control.
- Amiodarone decreases heart rate.
- Adverse effects include blurred vision, photosensitivity, and anorexia.
- Check potassium levels before administering amiodarone.
Calcium Channel Blockers
- Verapamil is a calcium channel blocker.
- Avoid grapefruit juice while taking verapamil.
- It is used to treat hypertension, angina, and dysrhythmias.
Class I B Antiarrhythmic Agents (Sodium Channel Blockers)
- Lidocaine is a Class I B antiarrhythmic agent, with a black box warning about potential for CNS toxicity, leading to confusion and psychosis.
Class V Antiarrhythmics
- Adenosine is a Class V antiarrhythmic, administered rapidly as it has a 10-second half-life.
- It slows conduction through the AV node and decreases SA node automaticity.
Crystalloids
- Crystalloids can rapidly expand circulating blood volume.
- Monitor clients for signs of heart failure following crystalloid administration.
Diuretics
- Diuretics cause polyuria.
- Loop diuretics, like furosemide and bumetanide, require potassium monitoring (normal range is 3.5 to 5 mEq/L).
Vasodilators
- Nitroglycerin is a vasodilator, commonly associated with headaches as a side effect.
- Useful in exacerbations of heart failure as it dilates veins and coronary arteries.
Hypertensive Emergency
- Hypertensive emergency is defined as systolic blood pressure greater than 180 mmHg or diastolic blood pressure greater than 120 mmHg.
Improving Cardiac Output in Heart Failure
- Decreasing afterload can improve cardiac output in heart failure patients.
Medications to Treat Heart Failure
- ARBs (angiotensin II receptor blockers) ending in "sartan"
- Beta blockers ending in "lol"
- Vasodilator: isosorbide dinitrate
Accurate Apical Pulse Assessment Steps
- Gather necessary supplies.
- Position the stethoscope directly on the skin.
- Listen for a full minute to the apical pulse.
- Record the results.
Self-Administering Subcutaneous Heparin Steps
- Clean the injection site with alcohol.
- Inject the needle.
- Do not pull back on the plunger.
- Avoid massaging the injection site.
Education for Newly Diagnosed Hyperlipidemia
- Statins are the most common medications for hyperlipidemia.
- Long-term medication may be required.
- Lifestyle changes can potentially reduce or eliminate the need for medications.
Advantages of Factor Xa Inhibitors Over Warfarin
- Factor Xa inhibitors do not require INR monitoring.
- They have fewer drug-drug interactions.
- Their effects dissipate within 1 to 2 days of discontinuation.
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