pharm test 2

range for PT with an INR

2-3 *mechanical valve 2.5-3.5

Drugs for HTN

CCBs (Ca channel blockers), ACEI (ACE inhibitors), ARBs (angiotensin II receptor blockers), Cardiac glycoside

Cardiac Glycosides

Digoxin (Lanoxin)

ACEIs

Enalapril (Vasotec) Captapril (Capoten)

how is warfarin therapy monitored?

PT (prothrombin time)

Which of the following would a nurse expect to administer for a heparin overdose?

Protamine sulfate is the antidote for heparin. Thrombin is a topical hemostatic agent. Pentoxifylline is a hemorrheologic agent (one that can induce hemorrhage). Urokinase is a thrombolytic agent.

MONA

morphine O2 Nitrates Aspirin

The client is admitted to the hospital after a suicide attempt. The nurse discovers that the client overdosed on aspirin. What does the nurse expect the physician to do?

Prescribe transfusion of platelets; No antidote exists for the effects of aspirin or the adenosine diphosphate receptor antagonists, because both produce irreversible platelet effects; platelet transfusion may be required.

how is heparin therapy monitored?

aPTT (activated partial thromboplastin time)

A patient is receiving low-molecular-weight heparin to prevent thromboembolic complications. The nursing student asks her instructor the reason why this treatment is given instead of heparin. What is the instructor's best explanation of the rationale for LMWH over heparin?

"LMWH is associated with less thrombocytopenia than standard heparin."; Low-molecular-weight heparins are associated with less thrombocytopenia than standard heparin. Low-molecular-weight heparin is not stronger than standard heparin. Low-molecular-weight heparin is administered cautiously in patients with blood dyscrasia and hypertension

A patient is being administered heparin IV and has been started on warfarin (Coumadin). The patient asks the nurse why she is taking both medications. What is the nurse's most accurate response?

"Warfarin takes 3-5 days to develop anticoagulant effects, and you still need heparin."

The physician orders thrombolytic agents when treating a client diagnosed with acute myocardial infarction. Which drug should the nurse keep readily available when blood flow is reestablished?

Antidysrhythmic; When the thrombolytic agents are used in acute myocardial infarction, cardiac dysrhythmias may occur when blood flow is reestablished; antidysrhythmic drugs should be readily available

Blood coagulation results from the activation of one of two pathways: one pathway occurs in tissue, and the other occurs in the vascular system. What are the names of these pathways?

Extrinsic and intrinsic pathways; The coagulation process results from the activation of the intrinsic or the extrinsic pathways. The intrinsic pathway is activated by an injury to a blood vessel; the extrinsic pathway is activated by an injury to tissue.

What are the hearts 2 types of action potential?

Fast and Slow... Fast initiates and controls contraction Slow impacts rate of impulse conduction

A patient is to receive abciximab. The nurse would expect to administer the drug by which route?

IV

Unstable angina

MEDICAL EMERGENCY pain r/t plaque, vasospasm, platelet aggregation MONA Ca Channel Blockers Antiplatelets in addition to ASA - clopridogel (Plavix) and Abciximab (ReoPro) if PCI is planned

antidote for direct thrombin inhibitors (Pradaxa)

None

Reversal agent for Clavix

None, but we can give them new platelets because they have minded to receptor sites of plasma and will no longer be attached after the platelet dies (10 days)

After reviewing the drugs that may interfere with warfarin, the students indicate that they need additional study when they identify which of the following as requiring a dosage increase in the warfarin?

Phenytoin; When combined with phenytoin, warfarin leads to a decrease in anticoagulant effect, which would necessitate an increase in the dosage of the warfarin. Clofibrate, quinidine, and cefoxitin increase the risk of bleeding with warfarin; thus, a decreased dose of warfarin would be indicated

All antidysrhymic drugs are considered..

Proarrhythmic and prodsyrhthmic because their actions may control arrhythmias

A client exhibits signs and symptoms of heparin overdose. The nurse would anticipate administering which of the following?

Protamine sulfate; Protamine sulfate is the antidote for heparin overdose. Vitamin K is the antidote for warfarin overdose. Urokinase is a thrombolytic. Drotrecogin alfa is a C reactive protein that has anticoagulant effects.

pacemaker of the heart

SA Node

Where do slow action potentials occur?

SA and AV nodes The electrical areas responsible for impulse origination and heart rate

Which of the following would the nurse identify as the end of the intrinsic pathway?

Thrombin formation occurs at the end of the intrinsic pathway. The first reaction to a blood vessel injury is local vasoconstriction. In addition, injury then exposes blood to the collagen and other substances under the endothelial lining of the vessel causing platelet aggregation. Release of factor XI occurs in response to activation of the Hageman factor.

Which of the following would be considered a topical hemostatic agent?

Thrombin; Thrombin is a topical hemostatic agent. Protamine sulfate is the antidote for heparin. Pentoxifylline is a hemorrheologic agent (one that can induce hemorrhage). Urokinase is a thrombolytic agent

The squad just delivered to your ED a 73-year-old man with crushing chest pain. He has a history of cardiovascular disease. Onset of symptoms is within the last 60 minutes. What medication would you expect the physician to order for his thromboembolic disorder?

Thrombolytic drugs; The main use of thrombolytic agents is for management of acute, severe thromboembolic disease, such as myocardial infarction or pulmonary embolism.

Adenosine (Adenocard)

Used to concert supraventricular tachycardiac to sinus rhythm when vagal maneuvers have been ineffective Used to treat arrhythmias

ARBs

Valsartan (Diovan) Losartan (Cozaar) Olmesartan (Benicar)

Reversal agent for coumadin/warfarin

Vitamin K (Phytonodione) IN ACTIVE FORM INR > 7 we want to do this INR of 0.1 we will increase dose INR of 3.5 we will decrease dose

3 phases of platelet activity

adhesion activation aggregation

pharmacotherapy for hyperlipidemia and HTN should be employed only..

after lifestyle changes alone have proven unsuccessful

Arterial thrombi are best prevented with..

anti-platelet drugs

venous thrombi are best prevented with...

anticoagulants (heparin, warfarin)

Plavix is an...

antiplatelet agent

Class IV Antiarrhythmics

block Ca channels which impairs the SLOW action potential or delays impulses from SA and AV node Tx atrial and supraventricular rhythms Diltizem (Cardizem) Verapamil (Calan/Isoptin)

Class II Antiarrhythmics

block cardiac Beta 1 receptors which decreases SA and AV conduction and myocardial contraction Tx mostly atrial dysrhythmias Carvedilol (Coreg) Metoprolol (Lopressor) Propranolol (Inderol)

Class III Antiarrhythmics

block potassium channels which delay the FAST phase of depolarization (ventricular dysrhythmias) Tx ventricular and irregular rapid atrial rhythms Amiodarone (Cordarone)

Class I Antiarrhythmics

block the Na channels which slow impulse conductions by impairing the FAST action potential Often tx ventricular dysrhythmias Lidocaine/Procainimide

3 phases of fast polarization

depolarization (phase 1 and 2) and repolarization (phase 3) Rapid influx of Na Ca enters cardiac cells rapidly -> contraction forceful movement of K across the cell membrane

Chronic/Classic/Stable Angina

exertional pain r/t plaque which limits blood flow (CAD) and most often treated with Nitroglycerin

helpful in reversal of all bleeding d/o

fresh frozen plasma

3 determinants of cardiac O2 demand are:

heart rate contractility intra-cardiac wall tension (AKA preload and after load)

Heparin suppresses coagulation by..

helping inactivate thrombin and factor Xa

Protamine is used to treat overdose of...

heparin and low-molecular weight heparins (LMWHs).

What is the most common CV disease?

hypertension - over time is creastes vascular noncompliance, insufficiency, failure, and collapse

Antidysrhthmic drugs work by...

impeding, enhancing, or blocking impulse origination/conduction

Where do fast action potentials occur?

in the HIs - Purkenje systems, the atrial muscle, and ventricles The mechanical areas responsible for contraction

Variant/Prinzemetal/Vasospastic angina

pain r/t arterial spasm Treated with NTG but primary effect is vasodilitory creating increased blood flow and delivery of O2

reversal agent for heparinoids

protamine sulfate no effect on fondaparinux

chronotropic effect

refers to a change in HEART RATE positive - an increase in HR negative - a decrease in HR

Inotropic effect

refers to a change in myocardiac CONTRACTILITY positive - increase in myocardial contractility negative - decrease in myocardial contractility

dromotropic effect

refers to a change in the speed of CONDUCTION through the AV junction positive - increase in AV conduction velocity negative - decrease in AV conduction velocity

what is the best way to determine whats going on inside of the cell?

serum electrolyte levels; if we have a high K level, its outside of the cell in our circulation this means that inside of the cell, K is low. The free space inside the cell due to the low level of K allows for extra Na to come in carrying extra impulses = dysrhthmia

Digoxin

slow Ca from leaving the cell, prolonging the action potential and slowing conduction and HR Used to treat arrhythmias

Goals of therapy

to preserve the myocardium optimize or enhance the cardiac function and health prevent increased O2 demand and limit ischemia

A patient is prescribed eptifibatide (Integrilin), which inhibits platelet aggregation by preventing activation of GP IIb/IIIa receptors on the platelet surface and the subsequent binding of fibrinogen and von Willebrand factor to platelets. Which of the following syndromes are treated with eptifibatide?

unstable angina