Exam 4 drugs
What is a D-D interaction of ivabradine (corlanor)?
do not take with other negative chronotropic drugs because it will cause severe bradycardia
What are adverse effects of captopril (capoten)?
dry cough, some related to vasodilation like tachycardia, chest pain, heart failure, arrhythmias
when are class 1 anti-arrhythmic drugs used?
during ACLS
What are drug to drug interaction with nitroglycerin (nitro-bid or nitrostat)?
erectile dysfunction medication (viagra) which can cause hypotension and CV collapse, alcohol, antihypertensive medications like ACE (captopril, losartan), CCB (diltiazem), and BB (propanolol)
What is the prototype drug for cholesterol absorption inhibitor?
ezetimibe (zetia)
What are D-D interactions with cholestyramine?
fat soluble vitamins like A,D,E,K
What are AE of amiodarone (cardarone)?
fatal liver toxicity, ocular abnormalities, lung fibrosis, cardiac dysrhymias
What are digoxin (lanoxin) derived from?
foxglove or digitalis plane
What do you need to do to ensure safe drug-drug interactions with digoxin (lanoxin)?
get medication list checked by pharmacy
What are drug to food interactions with diltiazem (cardizem)?
grapefruit juice
What are AE of Losartan (cozaar)?
headache, dizziness, syncope, weakness, hypotension
What are adverse effects of digoxin (lanoxin)?
headache, weakness, visual disturbances (yellow halo around objects), arrhythmias, GI upset, digoxin toxicity
What are AE of diltiazem (cardizem)?
heart block, peripheral edema, bradycardia, hypotension, fatigue, headache, dizzy, light headedness
When is digoxin (lanoxin) given ?
heart failure, atrial fibrillation
What are contraindications of nitroglycerin (nitro-bid or nitrostat)?
severe anemia, head trauma and cerebral hemorrhage, hypotension, hypovolemia
What are contraindications of milrinone?
severe vascular disease, acute MI, fluid volume deficit, ventricular dysrhymias
What is a contraindications of lidocaine?
shock
When is milrinone given?
short term treatment of heart failure in patients who have not responded to digitalis, diuretics, or vasodilators
What is the MOA of lidocaine? It decreases the _________________ which decreases the ______________ of the ventricular cells
stabilizes the cell membrane by blocking sodium channels, depressing phase 0 of the action potential and changing the duration of it, depolarization, automaticity
What is important administration information for Losartan (cozaar)?
take drug in the morning, monitor BP daily
What is the therapeutic serum level for digoxin (lanoxin)?
0.5-2
What are drug-drug interactions for Losartan (cozaar)?
ACE 1 or ARB
What labs would you monitor for atorvastatin (lipitor)?
ALT and AST
What is the MOA for ivabradine (corlanor)?
Blocks HCN during repolarization phase to slow the hearts pacemaker which lowers the heart rate with no effect on muscle contraction and increases CO and increase ventricular filling time
What is the MOA of propanolol?
Blocks beta receptors during phase 4 action potential in the heart and kidneys which decreases the sympathetic NS (slows conduction through AV node, decreases renin, decrease BP and hearts workload)
What is the MOA of diltiazem (cardizem) with anti arrhymics?
Blocks movement of calcium ions across cardiac and arterial muscle cells leading to decreased impulses, conduction, contractility, dilated arteries, lowered BP, decreased myocardial o2 consumption. depressing action potentials and delayed phase 1 and 2 of repolarization
What is the MOA of amiodarone (cardarone)?
Blocks potassium channels and slows the outward movement of potassium during phase 3 action potential, acts directly on the heart and peripheral smooth muscle cells to prolong repolarization and refractory period
What is the MOA of milrinone?
Blocks the enzyme phosphodiesterase which increased CAMP which increases calcium in the cell which leads to stronger cardiac contraction and prolonged response to sympathetic stimulation which directly relaxes vascular smooth muscle
When is atorvastatin (lipitor) given?
CAD, hypercholesterolemia
What are AE of propanolol?
CNS, CV (alteration in peripheral tissue perfusion), respiratory, loss of libido, altered blood glucose levels
What are AE of lidocaine?
Cardiac arrest, respiratory arrest, CNS (convulsions)
What are D-D interactions of amiodarone (cardarone)?
Digoxin, quinidine
What is the MOA of atorvastatin (lipitor)?
HMG-CoA reductase is blocked causing a decrease in cholesterol and LDL but an increase in HDL
What is the deal with sublingual tablets for chest pain in nitroglycerin (nitro-bid or nitrostat)?
If one tablet does not work and get help and can take 2 more 5 minutes apart while going to the hospital
What is the prototype drug for angiotensin 2 receptor blockers?
Losartan (cozaar)
What are special considerations when administering diltiazem (cardizem)?
Monitor VS and cardiac rhythm when administering IV and have crash cart nearby
What are contraindications of amiodarone (cardarone)
None when all other drugs have been used
What is the MOA of nitroglycerin (nitro-bid or nitrostat)?
Relaxes and vasodilates veins arteries and capillaries which increases blood flow, lowers BP, decreases venous return, decreases arterial pressure, decreases left ventricular workload, decreases O2 consumption
When is diltiazem (cardizem) with anti arrhymics given?
SVT, a fib, a flutter
What is the given for ivabradine (corlanor)?
Stable heart failure patients who are at maximum beta blocker doses
What are adverse effects of milrinone?
V fib, abd pain, thrombocytopenia, ascites, pericarditis, pleuritis, vasculitis, chest pain, hypotension, N/V
What happens in digoxin toxicity?
anorexia, N/V, depression, irregular heart rhythms (heart block, v tach, atrial arrhythmias)
What is nitroglycerin (nitro-bid or nitrostat) given for?
acute angina, IV for angina unresponsive to beta blockers, IV for HTN crisis
What are contraindications of diltiazem (cardizem)?
allergy, heart block, sick sinus syndrome, renal or hepatic dysfunction, pregnancy
What are contraindications for Losartan (cozaar)?
allergy, renal or hepatic dysfunction, pregnancy (women of childbearing age should use barrier contraceptives)
What are drug to drug interactions of captopril (capoten)?
allopurinol increases hypersensitivity, NSAIDS decrease effectiveness
What are some key points for administering captopril (capoten)?
always check BP before giving, give 1 hour before eating or 2 hours after eating
What is the prototype drug for class 3 anti-arrhythmic drugs?
amiodarone (cardarone)
When is propanolol contraindicated?
asthma, respiratory depression
What is the prototype drug for HMG-CoA reductase inhibitors?
atorvastatin (lipitor)
What is the MOA of cholestyramine?
binds to bile acids in the intestine that get excreted in the feces which causes cholesterol to decrease
What is the MOA of captopril (capoten)?
blocks ACE from converting angio 1 to angio 2 in the lungs resulting in a decreased in BP, decrease in aldosterone, increase in potassium, and sodium and fluid loss
What is the MOA of Losartan (cozaar)?
blocks binding of angio 2 in smooth vascular muscle and adrenal cortex which blocks vasoconstriction and blocks release of aldosterone
What is the prototype drugs for ACE inhibitors?
captopril (capoten)
What is the prototype drug for bile acid sequestrants?
cholestyramine
Which class is the safest anti-arrythmic drug?
class 4, diltiazem
What are contraindications of cholestyramine?
complete biliary obstruction, abnormal GI function
What are adverse effects of cholestyramine?
constipation which leads to GI obstruction and increased bleeding from malabsorption of vitamin K and clotting factors
What is important after administration of lidocaine?
crash cart, cardiac monitoring
What are drug to drug interactions with diltiazem (cardizem)?
cyclosporine
When should you use caution with propanolol?
diabetes, thyroid dysfunction
What is the prototype drug for cardiac glycosides?
digoxin (lanoxin)
What are drug-drug interactions of lidocaine?
digoxin and beta blockers can increase risk for dysrhythmias, anticoagulants can increase bleeding
What is the antidote for digoxin toxicity and when is it used?
digoxin immune fab (digifab), >10
What is the prototype drug for calcium channel blockers?
diltiazem (cardizem)
What is the prototype for class 4 anti-arrhythmic drugs?
diltiazem (cardizem)
What are AE of atorvastatin (lipitor)?
hepatotoxicity, myopathies, GI effects, cataract development, rhabdomyolysis
What is diltiazem (cardizem) given for?
hypertension, angina, anti-arrhythmic drug
What is Losartan (cozaar) given for?
hypertension, heart failure, diabetic neuropathy (renal disease in DM)
What is captopril (capoten) given for?
hypertension, heart failure, diabetic neuropathy, left ventricular dysfunction post MI
What are AE of nitroglycerin (nitro-bid or nitrostat)?
hypotension, HEADACHE, hot flushing, compensation tachycardia
What are contraindications of ivabradine (corlanor)?
hypotension, bradycardia, patients who are dependent on a pacemaker like 3rd degree heart block
What are adverse effects of ivabradine (corlanor)?
hyypertension, bradycardia, a-fib, luminous phenomena of retina (sudden changes in brightness in parts of the visual field like colored bright lights, imagine decompensation, and multiple images)
When should you hold nitroglycerin (nitro-bid or nitrostat)?
if BP <90/30 and HR>100
What are contraindications of captopril (capoten)?
impaired renal function, allergy to any ace inhibitor, pregnancy
What is the MOA of digoxin (lanoxin)?
increases intracellular calcium and allows calcium to enter during depolarization leading to inotropic effect (increased contraction), diuretic effect, decreased renin, negative chronotropic effect (slower HR), slow conduction through AV node, increased cardiac output, increased filling time
What is the MOA of diltiazem (cardizem)?
inhibits movement of calcium ions across cardiac and arterial muscle cells which leads to depressed cardiac impulses, slowed cardiac conduction, decreased cardiac contractility, dilates arteries, lowers BP, decreases myocardial oxygen consumption
What are D-D interaction with propanolol?
insulin (increase risk of hypoglycemia)
What are 5 important things about administering cholestyramine?
it is a powder that you mix with liquid and drink immediately, take it 6 times a day, drink lots of fluids, do not take with food, take 2 hours before or 4 hours after taking other medication
What 2 things are important about the administration of atorvastatin (lipitor)?
it takes 2-4 weeks to work, most effective at night because liver is processing the most lipids
What is the prototype drug for HCN gated channel blockers?
ivabradine (corlanor)
What is the prototype drugs for class 1 anti-arrhythmic drugs?
lidocaine
When is lidocaine given?
life threatening V tach during cardiac surgery or MI
When is amiodarone (cardarone) given?
life threatening V-fib, pulseless v tach, ACLS
How does the RAAS system work?
low BP releases renin which goes to the liver to convert angiotensinogen to angio 1, angio 1 then goes to the lungs and converts to angio 2 using ACE, angio 2 causes vasoconstriction that increases BP and sitmulates aldosterone release
What is the prototype drug for phosphodiesterase inhibitors?
milrinone
What do you do before administering digoxin (lanoxin)? When would you hold the medication?
monitor apical pulse for 1 minute before giving medication, if pulse <60
What is important to note when administering propanolol?
must taper off the drug to avoid cardiac ischemia
What is the prototype drug for Nitrates?
nitroglycerin
What are important administration notes for milrinone?
not compatible with lasix in IV because will precipitate, protect the drug from light, monitor platelets before and during admin, have crash cart nearby, monitor I & O
What are drug-drug interactions with digoxin (lanoxin)?
potassium wasting diuretics like lasix
When is cholestyramine given?
primary hypercholesterolmia, pruritus associated with partial biliary obstruction
What are all class 3 anti-arrythmic drugs? When are they used?
proarrhythmic which means they have the potential to induce dysrhythmias, ACLS
What is the prototype drug for class 2 anti-arrhyrthmic drugs?
propanolol
Where do ACE inhibitors work and what do they do?
the lungs, prevent angio 1 from converting to angio 2
When is propanolol given?
v-tach, premature ventricular contractions (PVCs)
Which nerve does the parasympathetic NS control and what can it do?
vagus nerve, slow the HR
What are contraindications of digoxin (lanoxin)?
ventricular tachycardia, v fib, heart block, sick sinus syndrome, acute MI, HYPOKALEMIA, renal impairment
What should you always do before administering nitroglycerin (nitro-bid or nitrostat) in a paste form?
wear gloves
What is the MOA of ezetimibe (zetia)?
works in the brush border of the small intestines to inhibit the absorption of HDL and LDLs