Drugs for Angina
Name the 3 drug classes used to treat angina.
1. Nitrates or nitrites
2. Beta blockers
3. Calcium channel blockers
Name the one drug that is a phosphodiesterase inhibitor that is used to treat heart failure (HF).
Milrinone
Heparin and Enoxaparin (Lovenox) are both anticoagulants. How do these drugs differ?
HEPARIN: requires frequent lab monitoring for bleeding times using tests such as aPTT; heparin is NOT fractionated
ENOXAPARIN: does NOT required frequent laboratory monitoring of bleeding times; has undergone fractionation, so its pharmacodynamics are more predictable
What are the 4 classes of antilipemic drugs?
1. HMG-CoA Reductase Inhibitors
2. Bile acid sequestrants
3. Fibric acid derivatives
4. B vitamin niacin
What is the MOA of the antilipemic drug niacin?
- Increases activity of lipase, which breaks down lipids.
- Reduces the metabolism/catabolism of cholesterol and triglycerides.
Name 2 drugs that are nitrates/nitrites.
- Nitroglycerin
- Isosorbide dinitrate
What is the route by which Milrinone is administered?
It is available only in intravenous form.
How is enoxaparin administered?
Via SQ injection (remember, it comes in pre-filled syringes, and the nurse should not expel the air bubble)
What is the suffix of HMG-CoA Reductase Inhibitor drugs?
"-statin" (i.e., Simvastatin, Atorvastatin)
What is another name for niacin?
Vitamin B3
What is the MOA of nitrates/nitrites?
They cause vasodilation through relaxation of smooth muscles.
What are some adverse effects that may occur when taking Milrinone?
- Cardiac dysrhythmias
- Elevated liver enzymes
- Hypokalemia
What is the reversal agent for heparin as well as enoxaparin?
Intravenous (IV) protamine sulfate
What is the MOA of HMG-CoA Reductase Inhibitors?
Lower LDL, triglyceride, and total cholesterol levels; raise HDL levels.
(Inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol.)
What adverse effect is associated with taking niacin, and how can this effect be prevented?
Flushing
Take niacin with meals, avoid alcohol or hot beverages which can worsen flushing, and take small dose aspirin or NSAIDS 30 minutes before taking niacin.
Name some contraindications to the use of nitrates.
- hypotention
- use of erectile dysfunction drugs (i.e., tadalafil)
Name a cardiac glycoside drug used to treat HF and atrial fibrillation.
Digoxin
Another anticoagulant drug is warfarin (Coumadin). What is the MOA of warfarin?
Inhibits vitamin K synthesis by bacteria in the GI tract.
Inhibits production of vitamin K-dependent clotting factors in the liver.
Name some adverse effects associated with the use of HMG-CoA Reductase Inhibitors.
Myopathy (muscle pain), possibly leading to the serious condition rhabdomyolysis
Elevated liver enzymes or liver diseaseName 2 antilipemic drugs in the fibric acid derivatives class.
- Fenofibrate
- Gemfibrozil
What is the most common adverse effect associated with nitrates?
Headaches
What is the MOA of cardiac glycosides?
They increase myocardial contractility.
**POSITIVE INOTROPIC drugs
What are the nursing implications with warfarin?
- Careful monitoring of patient's PT/INR blood level.
- Normal INR with warfarin ranges from 2 to 3.5.
- Patient should be aware that vitamin K intake from foods needs to be consistent from day-to-day, because vitamin K can make warfarin less effective.
- Foods high in vitamin K include leafy green vegetables.
If a patient is experiencing symptoms of rhabdomyolysis (muscle soreness, changes in urine color), what should the nurse do?
Discontinue the statin drug.
How should nitroglycerin be stored?
In an airtight dark glass bottle with a metal cap.
What concerns are associated with digoxin?
Remember, digoxin has a very narrow therapeutic window, so drug levels must be monitored. Normal levels are 0.5 to 2 ng/mL.
** LOW POTASSIUM levels increase its toxicity.
**LOW MAGNESIUM levels can also increase digoxin toxicity.
What is the reversal agent for warfarin?
Vitamin K
What patient teaching should be done for a patient taking Simvastatin.
- Simvastatin should be taken once daily in the evening.
- Notify health care professional promptly if pregnancy is planned or suspected.
- Risk of myopathy and rhabdomyolysis are increased with concurrent use of grapefruit juice.
- It takes 6-8 weeks for simvastatin to take full effect.
How long should a nitroglycerin patch be left on the skin?
Nitroglycerin patches should be removed after 12-16 hours. By removing the patch at bedtime and applying a new dose/patch in the morning, it helps reduce tolerance by allowing for a nitrate-free period.
Name an important symptom associated with digoxin toxicity.
Seeing green or yellow halos around objects, blurred vision.
What are the anticoagulant drugs rivaroxaban and dabigatran used for?
They are used for the prevention of strokes in patients with atrial fibrillation.
NOTE: Rivaroxaban is also used for post-op thromboprophylaxis with ortho surgeries.
Name a drug which is a bile acid sequestrant.
cholestyramine
What are some contraindications to taking anticoagulants?
- Pt has an indwelling epidural catheter.
- Pregnancy (warfarin is strongly contraindicated in pregnancy).
- Bleeding risk
What is the MOA of bile acid sequestrants?
They prevent resorption of bile acids from the small intestine (bile acids are necessary for the absorption of cholesterol).
What is the MOA of antiplatelet drugs?
They work to prevent platelet adhesion at the site of blood vessel injury.
A patient is prescribed a bile acid sequestrant. What patient education should the nurse provide?
All drugs must be taken at least 1 hour before or 4 to 6 hours after the administration of bile acid sequestrants.
Name 2 antiplatelet drugs.
- Aspirin
- Clopidogrel
What conditions are treated with antiplatelet drugs?
Antiplatelet drugs are often used after a heart attack, especially if a stent was fitted.
They are also used to treat and prevent stroke, angina, and peripheral arterial occlusive disease.
What adverse effects are associated with clopidogrel?
Flu-like symptoms:
- body aches, headaches, fever, chills, fatigue
1. What do thrombolytic drugs do?
2. Name 1 drug in this class.
1. These drugs break down, or lyse, preformed clots.
2. Alteplase
What are indications for the use of thrombolytic drugs?
- acute MI
- DVT
- pulmonary embolus
- acute ischemic stroke