LDL, HDL, Triglycerides, Total cholesterol
Total Chol - Less than 200
LDL - Less than 100
HDL - Less than 35
Tri - Less than 149
ST segment elevation means what?
Sign of a MI
Atorvastatin (Lipitor)
Moa: inhibits HMG-CoA reductase.
First line of drugs to reduce serum-lipid levels.
What are some AE? and what must the nurse asses for?
(Atorvastatin)
AE: Headache, fatigue, muscle or joint pain, Heartburn
Assess for complaints of muscle pain, tenderness, and weakness. Can cause Rhabdomyolysis.
Bile-acid Resins
Cholestyramine (Questran)
Moa: Bind with bile acids, increasing cholesterol excretion in stool.
Primary use: lower serum-lipid levels.
What are the AE for Cholestyramine?
GI tract, such as bloating and constipation.
It can bind to other drugs increasing potential for drug interactions.
Nicotinic Acid
(Niacin) - B-complex Vitamin B3
It decreases VLDL and LDL levels.
Reduces the triglycerides; increase HDL levels
What are the AE for Niacin ?
Flushing, hot flashes, nausea, excess gas, diarrhea.
Serious AE: hepatotoxicity and gout possible (monitor Uric acid)
(Pt can take aspirin 30min prior to taking niacin to decrease hot flash side effect)
Fibric-Acid Agents
(Gemfibrozil)
Tx severe hypertriglyceridemia.
AE for Gemfibrozil (Lopid)
GI distress, watch for bleeding w/ pts on anticoagulants
Beta-Adrenergic Blockers
Metoprolol, Atenolol, Labetalol, Propranolol, Sotalol, Carvedilol
Moa: Block cardiac action of sympathetic nervous system to slow heart rate and BP, reducing workload of heart.
Primary use: reduce symptoms of HF and slow progression of disease.
AE of Metoprolol
Fluid retention, worsening of HF, Fatigue, hypotension, bradycardia, heart block.
Do not stop abruptly. Hold Med if pulse less than 60 and BP below 90/60.
Acebutalol
can give to pts with asthma or COPD.
Maintains satisfactory HR
Calcium Channel Blockers
Dihydropyridines
Nifedipine (Adalat, Procardia), Amlodipine (Norvasc),
They are the most potent vasodilators.
Clevidipine (IV only)
Non-Dihydropyridines/Peripheral and Heart
Verapamil, Diltiazem
Both can be given PO or IV.
lowers the HR so hold if less than 60
The AE for CCBs
Dihydropyridines:
Dizziness, Headache, flushing, reflex tachycardia
Peripheral edema, gingival hyperplasia,
AE for non-Dihydropyridines
Peripheral edema, headache, gingival hyperplasia,
Constipation in 10% of pts taking verapamil.
ACE inhibitors
Lisinopril, Captopril, enalopril
Moa: Inhibit ACE enzyme and decrease aldosterone secretion
Primary use: to decrease BP and reduce blood volume; dilate veins.
What are the AE for Ace inhibitors?
First dose Hypotension, cough, hyperkalemia, renal failure.
Edema of tongue, Glottis and Pharynx
What is a Black box warning for ACE drugs?
Can cause injury and death to developing fetus.
ARBs - Angiotensin II Receptor Blockers
It relaxes the smooth muscle to promote vasodilation
ARBs
Losartan, Olmesartan, Valsartan
PO only.
Higher cost, reserved for pts who develop cough with ACE inhibitors.
Indications: Hypertension, MI, HF, Prevention of stroke in pt with high risk of CVD.
Alpha 1 blockers
Prazosin, Terazosin, Doxazosin, Tamsulosin
Promotes dilation of arterioles and veins
Reduces prostatic symptoms in men.
The A2 Agonists
Methyldopa, Clonidine
Meth.- PO
Clon- PO, Transdermal patch.
MOA: Vasodilation, reduces HR and CO
Pregnant women CAN have methyldopa
Arteriolar Vasodilators
Hydralazine, Minoxidil
Hydra - Po, IV
Minox- PO
IV Hydralazine is reserved for pts with Hypertension emergencies.
Minoxidil - can be used for alopecia
What are some AE for Arteriolar Vasodilators?
AE: Reflex tachycardia, Vascular headache, Lupus-like syndrome (Hydralazine)
Minoxidil: Pericardial effusion - reserved for pts who do not respond to first line agents; Hirsutism.
What do you need to check before giving Digoxin?
Apical Pulse for 1min. If less than 60bpm hold the dose and notify Dr
Cardiac Glycosides
Digoxin (Lanoxin)
Moa: to cause more forceful heartbeat, slower heart rate
Primary use: increases contractility to strength of MI contraction making the heart a more effective pump while decreasing the PR.
Milrinone
Increase cardiac output by increasing the force of myocardial contraction
What are the AE for Digoxin ?
Neutropenia, dysrhythmias, digitals toxicity
Digoxin Toxicity: N/V, fatigue, anorexia and visual disturbances like seeing yellow haze and halos or blurring.
Antidote: Digibind
Nitrates
Relax both arterial and venous smooth muscle.
Short acting - Terminate acute angina episode
Long Acting - Decrease severity and frequency of episode
Nitrates (Nitroglycerin)
What is a common side effect and what can help?
Headache is common expected Side effect, pt can take Tylenol PRN.
It can lead to reflex tachy due to vasodilation and Orthostatic Hypotension.
Do not use Viagra and Nitrates Concurrently,
What is the first line drug for angina pain?
Beta-adrenergic blockers,
Atenolol,
can cause: Fatigue, insomnia, drowsiness, impotence, bradycardia, confusion
Troponin I and Troponin T
To determine MI.
Thombolytics
Reteplase (Retavase)
Dissolves clots obstructing coronary arteries.
PT,INR, Platelet, aPTT
PT - 11-12.5 sec
INR - 2-3
aptt - 25-35
Platelet - 150,000 - 350,000
Oral Antiplatlet Agents
Aspirin
75mg-325mg
Clinical use: Primary and secondary use prevention of MI
ADP Antagonists
Clopidogrel, Prasugrel
slightly more effective than ASA for MI but more expensive.
AE: Bleeding
IV Antiplatelet Agents
Eptifibatide, Tirofiban, Abciximab
Final common pathway for platelet aggregation
Short term used to prevent ischemia in pts with acute coronary syndromes
AE: Increase risk for major bleeding, possible risk for fatal hemorrhage
Anticoagulants
Heparin (Parenteral), Warfarin (oral)
Moa: prevent formation or enlargement or clots
Primary use: prevent formation of clots in veins, to treat thromboembolic disorders.
what is the antidote for warfarin and heparin?
Protamine Sulfate - Heparin
Vit K - Warfarin
What labs do you check when taking warfarin (coumadin)?
PT and INR
Fibrinolysis
Clot removal
ONAM
Oxygen, Nitroglycerin, Aspirin, Morphine
Antidote for Morphine?
Naloxone
Adenosine
First line drug of choice to tx PSVT
AE: Short period of asystole
Flushing, dyspnea, chest pain, hypotension,
Diltiazem
2nd line agent after adenosine to tx PSVT
Monitor BP, HR and Rhythm
AE: Dysrhythmias, bradycardia, Heart block, hypotension
Amiodarone
IV Form is first line agent in ACLS for tx of life-threatening ventricular dysrhythmias and cardiac arrest.
AE: Hypotension, Bradycardia
Lidocaine
Tx significant ventricular dysrythmias
Lidocaine Toxicity: Confusion, drowsiness, hearing impairments, muscle twitching, seizures, Myocardial depression
Magnesium Sulfate
Tx refractory ventricular tachy and Ventricular fibrillation
Magnesium toxicity: Hypotension, bradycardia, flushing, sweating, diarrhea, Resp. Dep.,
Epinephrine
tx profound bradycardia and hypotension, asystole,
1:1,000
1:10,000