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