Pharmacology Quiz on Nitroglycerin and Digoxin

Vasodilator, antianginal drug decreasing cardiac oxygen demand
Routes of administration include sublingual tablets (most common), sustained-release oral capsules, transdermal delivery systems, translingual spray, IV infusion, paste, spray, and tablets
Sublingual: Place under tongue, wait until pain relieved, max 3 x 5 minutes dosages
Patch: place on chest (and move to lower body if headache develops)
Therapeutic response: prevents angina attacks
Use with caution, can cause hypotension, check BP and Male PT meds
Adverse effects: Headache, orthostatic hypotension, reflex tachycardia
Education: May burn when placed under the tongue, place sublingual tabs under tongue until dissolved, do not swallow, use original container, do not discard without use

Used in heart failure and atrial fibrillation
Therapeutic action: increases myocardial contractility, decreases HR, increases cardiac output
Therapeutic level: .5-2 ng/mL
Side effects of toxicity include nausea, vomiting, blurred vision, arrhythmias.

Therapeutic use: for life-threatening ventricular arrhythmias, recurrent ventricular fibrillation, recurrent atrial fibrillation, recurrent hemodynamically unstable ventricular tachycardia
Effects on heart and EKG: reduces automaticity in the SA node, reduces contractility, reduces conduction velocity, widens the QRS, prolongs PR and QT intervals
Adverse Effects: pulmonary toxicity, cardiotoxicity, toxicity in pregnancy/breastfeeding, corneal microdeposits, optic neuropathy
Caution: Protracted half-life

Voltage-gated sodium channel blocker
Used for life-threatening ventricular arrhythmias and heart attacks
Therapeutic use: Ventricular arrhythmias (stable VT: 1-1.5 mg/kg IV/IO + 0.5-0.75 mg/kg Q5-10min; 1-4 mg/min infusion after rhythm corrected), Pulseless VT/VF:1-1.5mg/kgIV/10+0.5-0.75mg/kg, Q5-10min; 1-4 mg/min infusion after return of perfusion, Status Epilepticus
Adverse effects: Cardiovascular depression, respiratory depression, audiovisual disturbance, dizziness/seizures, malignant hyperthermia, methemoglobinemia, lethargy, and nausea
Pregnancy Category B

Used for supraventricular and ventricular dysrhythmias, also atrial fibrillation and flutter
Effects on the heart: Blocks sodium channels, slows impulse conduction, delays repolarization, blocks vagal input to heart
Effects on EKG: Widens the QRS complex, prolongs the QT interval
Adverse effects: Diarrhea, cinchonism (vertigo, nausea, vomiting, headache, abdominal pain), cardiotoxicity, hepatotoxicity, arterial embolism, alpha-adrenergic blockade (hypotension), hypersensitivity reactions
Drug interactions: Digoxin
Nursing considerations: baseline ECG, liver function tests, and blood pressure (can cause hypotension)

Use: Asystole, abnormally slow heart rhythms (bradydysrhythmias)
Responses: increased heart rate and cardiac output, decreased symptoms like dizziness and lightheadedness
Side effects: tachycardia, drowsiness, blurred vision, dry mouth, and urinary hesitancy or retention and constipation
Nursing considerations: check vital signs first, patients with glaucoma should avoid atropine, and assess bowel sounds

Use: Shock
Increases cardiac output and tissue perfusion, dilates renal blood vessels (improves renal perfusion
Increased myocardial contractility resulting in increased cardiac output
Adverse effects: dysrhythmias and anginal pain

Dabigatran (Pradaxa), Rivaroxaban (Xarelto), Apixaban (Eliquis), Edoxaban (Savaysa)
Direct thrombin inhibitors
Does not require lab monitoring or diet changes

Short-term use
Route: IV or subQ
Blood test: APTT (activated partial thromboplastin time)
Baseline tests: HCT, PLT CT, HGB, VS
Overdose: Give Protamine sulfate
Side effects: Hematuria, hemorrhage, thrombocytopenia, anemia, anaphylaxis
Patient education: Avoid alcohol, ASA, NSAIDs, OTC herbs, IM injections, use of an electric razor, soft toothbrush, monitor for signs and symptoms of bleeding, and notify doctor of black stools
Nursing considerations: avoid IM injections

Long-term prophylaxis of thrombosis
Prevention of venous thrombosis and associated pulmonary embolism, thromboembolism (in patients with prosthetic heart valves), thrombosis during atrial fibrillation
Lab: Monitor INR level (via PT test)
Route: Oral medication only
Vitamin K is the antidote
Patient education: Avoid alcohol, use electric razor, brush teeth gently, follow-up with HCP and obtain lab work regularly

Therapeutic uses: Ischemic stroke, TIA, chronic stable angina, unstable angina, coronary stenting, primary prevention of MI, acute MI, previous MI
Adverse effects: bleeding, GI bleeding, hemorrhagic stroke, enteric-coated tablets may not reduce the risk
Aspirin is administered during acute ST elevation MI and indefinitely after

Mechanism of action: activates conversion of plasminogen to plasmin
Therapeutic uses: myocardial infarction, ischemic stroke, massive pulmonary emboli
Adverse effects: bleeding and fever.
Advantages: does not cause allergic reactions or induce hypotension

Microcytic-hypochromic anemia: iron-deficiency anemia (treat with ferrous sulfate)
Macrocytic-normocytic anemia (megaloblastic): correct abnormality, administer folic acid