Comprehensive Cardiac and Lipid Management: Digoxin, Statins, ACE Inhibitors, and Hypertension Drugs

What class of medication is Digoxin?

Cardiac glycosides

What is the primary use of Digoxin?

To increase cardiac output by increasing the force of contraction and decreasing heart rate.

What are the early signs of Digoxin toxicity?

Nausea, vomiting, fatigue, anorexia.

What are the later signs of Digoxin toxicity?

Visual disturbances such as seeing halos, a yellow-green tinge, or blurring.

What is the normal therapeutic range for Digoxin?

0.8-1.8 ng/mL

What should be monitored before administering Digoxin?

Apical heart rate for one full minute; hold if less than 60 BPM.

What is the antidote for Digoxin toxicity?

Digibind

What is the drug of choice for heart failure?

ACE inhibitors

What risk is increased when using ACE inhibitors with Digoxin?

Risk of hyperkalemia

What are the side effects of Atorvastatin?

Myositis, rhabdomyolysis, hepatotoxicity.

What should be avoided when taking Atorvastatin?

Grapefruit juice, as it stops drug metabolism.

What is the primary use of Atorvastatin?

To treat hyperlipidemia and high cholesterol.

What are the nursing considerations for Cholestyramine?

Mix with liquid and administer 2 hours before or 4 hours after other medications.

What are the side effects of Cholestyramine?

GI distress, constipation, deficiencies of fat-soluble vitamins.

What is the class of Ezetimibe?

Cholesterol Absorption Inhibitors

What is a significant side effect of Niacin?

Niacin flush, characterized by redness and heat.

How can Niacin flush be prevented?

By taking aspirin 325 mg prophylactically 30 minutes before.

What is the role of potassium in Digoxin administration?

Potassium levels must be monitored; hypokalemia increases the risk of Digoxin toxicity.

What lab tests should be monitored for Atorvastatin?

Liver Function Tests (LFTs) and Creatine Kinase levels.

What is the effect of Loop diuretics on Digoxin?

They can decrease potassium levels, increasing the risk of Digoxin toxicity.

What is the effect of Beta Blockers when used with Digoxin?

They can cause severe bradycardia.

What should be done if muscle aches appear while taking Atorvastatin?

Hold the medication and contact the provider.

What is the primary indication for using Ezetimibe?

To lower LDL cholesterol, especially when used with a statin.

What is a common side effect of Ezetimibe?

Uncommon side effects include URI, myalgia, arthralgia, diarrhea.

What is the risk associated with Rhabdomyolysis?

It can lead to renal failure due to rapid muscle breakdown.

What dietary consideration should be made when taking Cholestyramine?

Increase fiber intake to relieve constipation.

What are the major side effects of statins?

Myositis, rhabdomyolysis (rhabdo), and hepatotoxicity.

Who should not take statins?

Individuals with liver disease and pregnant women.

What are the main functions of cholesterol?

Maintaining cell membranes, synthesizing hormones (steroid-based), synthesizing bile salts, and aiding in vitamin D production.

What class of medication is Lisinopril?

ACE Inhibitor.

What are the uses of Lisinopril?

Treatment for hypertension (HTN) and heart failure (HF).

What is a significant black box warning for ACE inhibitors like Lisinopril?

Fetal injury and death may occur when taken during pregnancy.

What is a primary side effect of Lisinopril?

Orthostatic hypotension.

What adverse effect can occur due to Lisinopril's action on bradykinin?

Persistent dry cough.

What should be monitored before starting Lisinopril?

Potassium levels due to the risk of hyperkalemia.

What class of medication is Losartan?

ARB Inhibitor.

What are the common adverse effects of Losartan?

Orthostatic hypotension, hyperkalemia, and angioedema.

What is a nursing consideration for patients taking Losartan?

Evaluate potassium levels and instruct patients to avoid pregnancy.

What class of medication is Verapamil?

Non-selective Calcium Channel Blocker.

What are the uses of Verapamil?

Used for cardiac issues and hypertension.

What is a common adverse effect of Verapamil?

Constipation.

What nursing considerations should be taken with Verapamil?

Monitor heart rate for bradycardia and assess for peripheral edema.

What class of medication is Nifedipine?

Selective Calcium Channel Blocker.

What are the indications for Nifedipine?

Angina and hypertension.

What adverse effects are associated with Nifedipine?

Reflex tachycardia, hypotension, peripheral edema, nausea, flushing, dizziness, and lightheadedness.

What are nonpharmacological treatments for hypertension?

Diet recommendations (salt restriction, weight reduction), exercise, alcohol reduction, stress reduction, smoking cessation, and caffeine reduction.

What safety measures should be taken to prevent falls in patients with hypertension?

Change positions slowly, avoid hot environments, and monitor for dizziness.

What symptoms should patients report that may indicate heart failure?

Unusual shortness of breath, difficulty breathing, swelling in extremities or face, weight changes, chest pain, palpitations, or excessive fatigue.

What medications should patients avoid while on antihypertensive therapy?

Over-the-counter medications without physician approval, including pseudoephedrine, NSAIDs, and prostaglandin blockers.

What is the mechanism of action for nitroglycerin?

Arterial and venous dilation to relieve coronary artery vasospasm.

What are the side effects of sublingual nitroglycerin?

Slight tingling and headaches due to vasodilation.

What adverse effects can occur with nitroglycerin use?

Tachycardia and postural hypotension.

What should be monitored when administering nitroglycerin?

Monitor for hypotension and ensure the patient is not taking erectile dysfunction medications.

What is the onset time for sublingual nitroglycerin tablets?

2-3 minutes

How long do sublingual nitroglycerin tablets last?

30-60 minutes

What should a patient do if they experience chest pain and no relief after taking nitroglycerin?

Take another tablet after 5 minutes, up to a maximum of 3 tablets in 15 minutes.

What should be monitored before administering transdermal nitroglycerin?

Blood pressure and pulse

What is a critical blood pressure threshold for holding transdermal nitroglycerin?

Systolic blood pressure below 90 mmHg

What is the purpose of a 'nitroglycerin free period'?

To prevent tolerance, the patch should be removed for 12 hours daily.

What are the nursing considerations for IV nitrates?

Assess for chest pain first and titrate upward until pain is relieved; maximum dosage is 200 mcg/min.

What can happen if IV nitrates are stopped abruptly?

It can lead to rebound angina and coronary artery spasm.

What are common side effects of nitroglycerin?

Dizziness and syncope

What should male patients be educated about regarding ED medications when taking nitroglycerin?

They should not share ED medications due to potential interactions.

What is the class of Metoprolol?

Selective Beta Blocker

What are the primary uses of Metoprolol?

Hypertension, angina, post-MI, dysrhythmias, tremors, anxiety, hyperthyroid, and pheochromocytoma.

What are the adverse effects of Metoprolol?

Bradycardia, hypotension, and hypoglycemia unawareness.

What should be assessed before administering Metoprolol?

Contraindications such as decreased heart rate, asthma, and COPD.

What is the class of Propranolol?

Non-Selective Beta Blocker

What are the additional indications for Propranolol?

Similar to Metoprolol, including angina, dysrhythmias, and anxiety.

What are the adverse effects of Propranolol?

Bradycardia, AV block, hypotension, wheezing, hyperglycemia, and hypoglycemia unawareness.

What should be monitored when administering non-selective beta blockers like Propranolol?

Heart rate, blood pressure, and signs of bronchoconstriction.

Why should caution be taken when combining beta blockers and calcium channel blockers?

There is a risk of excessive slowing of heart rate, dangerously low blood pressure, and worsening heart failure.

What is a common side effect of nitroglycerin that can be treated with Tylenol?

Headaches

What are non-selective calcium channel blockers used for?

They are used for cardiac issues and hypertension.

What is a potential side effect of non-selective calcium channel blockers?

They can cause bradycardia.

How do selective calcium channel blockers function?

They selectively block calcium movement only in arterioles.

What reflex can be activated by selective calcium channel blockers?

The baroreceptor reflex, leading to increased sympathetic activity.

What is a potential side effect of selective calcium channel blockers?

They can cause tachycardia.

What are the primary uses of Heparin?

Prevention of acute MI, prophylaxis of DVT, treatment of DVT or pulmonary emboli, and acute CVA.

What are common adverse effects of Heparin?

Bleeding, immune-mediated thrombocytopenia, and risk of epidural or spinal hematoma.

What should be assessed before administering subcutaneous Heparin?

Assess for contraindications and check platelet count.

What is the goal aPTT range for Heparin therapy?

60-90 seconds.

What is the antidote for Heparin?

Protamine sulfate.

What are the primary uses of Warfarin?

DVT/PE, atrial fibrillation, myocardial infarction, and mechanical heart valves.

What are common adverse effects of Warfarin?

Bleeding at IV sites, excessive bruising, and signs of internal bleeding.

What is the goal PT/INR range for patients with DVT/PE or A Fib on Warfarin?

2.0-3.0.

What is the antidote for Warfarin?

Vitamin K (given IV).

What is a key difference between Heparin and Warfarin?

Heparin has a rapid onset and is given IV or SC, while Warfarin takes several days to reach full effect and is given PO.

What are the signs and symptoms of internal bleeding?

Dizziness, pale skin, high heart rate, low blood pressure, and abdominal pain.

What is the purpose of anticoagulants?

To make the blood thinner and prevent clots from forming or getting larger.

What are common drug-drug interactions with Warfarin?

Garlic, Gingko, Ginseng, and Feverfew can increase bleeding risk.

What is the purpose of antiplatelet medications like Aspirin?

To prevent ischemic strokes, TIAs, and myocardial infarctions.

What are common adverse effects of Aspirin?

GI bleeding and salicylate poisoning.

What should be monitored when administering Aspirin?

Signs of gastrointestinal bleeding and CBC for anemia.

What is the mechanism of action for Clopidogrel?

It inhibits platelet aggregation by directly inhibiting ADP binding to its receptor.

What is the administration route for Rivaroxaban?

Only given orally.

What is the antidote for Rivaroxaban?

Andexanet alfa (Andexxa).

What lab monitoring is required for Heparin therapy?

aPTT every 8 hours or daily.

What lab monitoring is required for Warfarin therapy?

PT-INR daily while hospitalized.

What should patients on Warfarin be advised regarding diet?

Maintain a steady intake of green leafy vegetables.