Cardiovascular Medications Study Guide week 5

Flashcards for Cardiovascular Medications, Hypertension, and Fluid Volume Excess

Anticoagulant

Drug that prevents formation of new clots & extension of present clots, but does NOT dissolve formed clots.

Antiplatelets

Drugs that prevent one or more steps on the prothrombotic activity of platelets.

Embolus

Object that migrates through the circulation until it lodges in a vessel, causing occlusion. Examples: Thrombus, fat, air, amniotic fluid, tissue, or bacterial debris.

Heparin-induced thrombocytopenia (HIT)

Immune-mediated adverse effect of Heparin that leads to thrombosis – evidenced by a decrease in platelet count in patients with detectable HIT antibodies.

Thrombolytics

Drugs that dissolve blood clots.

Thrombus

Blood clot.

Heparin

Inactivates clotting factors, prevents thrombus formation. Used prophylactically for major illnesses, history of DVT/PE, major surgeries, mobility restrictions.

LMWH (Low Molecular Weight Heparin)

Smaller molecular structures that inactivate factor Xa. As effective as IV heparin and do not cross the placenta. Examples: enoxaparin (Lovenox), dalteparin (Fragmin).

Warfarin (Coumadin)

Prevents synthesis of Vitamin K, taking 3 to 5 days to take effect. Used for long-term management. Adverse effects include hemorrhage, n/v, abd pain, alopecia, dizziness, urticaria, and joint or muscle pain.

Dabigatran etexilate (Pradaxa)

Peaks in 1 hour, has no known antagonists (antidote). Uses: Prevent stroke, embolization (a-fib), DVT/PE. Adverse effects: bleeding, dyspepsia (indigestion), abd pain, gastritis, and anemia.

Rivaroxaban

Rapidly absorbed and highly protein bound. Peak 2 to 4 hours, half-life 5 to 9 hours. Inhibits platelet activation. Uses: 2nd DVT & stroke in pt’s with a-fib. Adverse effect: bleeding.

Clopidogrel (Plavix)

Prevents platelet aggregation. Uses: MI, post coronary stents, unable to take warfarin. Common adverse effect: pruritus (severe itching), rash, purpura, diarrhea. Severe adverse effect: Thrombotic thrombocytopenic purpura (TTP), hemorrhage, and severe neutropenia.

Alteplace (rtPA)

Clot buster – dissolves formed clots. Used as 1st line treatment of acute ischemic stroke (if criteria are met).

Protamine sulfate

Reversal agent for Heparin & LMWH. Administered as a slow IV infusion over at least 10 minutes.

Vitamin K

Reversal agent for Vit K antagonists (warfarin)

Idarucizumab (Praxbind)

Reversal agent for Direct Thrombin Inhibitors – Used for uncontrolled or life-threatening bleeding or emergency surgery. IV in 2 doses no more then 15 minutes apart.

Aminocaproic acid (Amicar)

Reversal agent for Thrombolytics - IV infusion

Tranexamic acid (Cyklokapron)

Reversal agent for Thrombolytics - oral or IV

Anasarca

Generalized massive edema.

Anuria

No urine output.

Ascites

Accumulation of fluid in the abdominal cavity.

Edema

Excessive accumulation of fluid in body tissue.

Dependent edema

Localized edema in feet and ankles

ACE Inhibitors (captopril)

Blocks the conversion of angiotensin I to angiotensin II. Uses: Heart Failure & Hypertension. Adverse Effects: Angioedema, persistent cough, acute hypotension.

Angiotensin II Receptor Blockers (losartan)

Block access to angiotensin II receptors in blood vessels, adrenals, and other tissues. Adverse Effect: Angioedema.

Calcium Channel Blockers (amlodipine)

Block influx of Ca+, causing relaxation and vasodilation. Uses: HTN, Angina pectoris, Cardiac dysrhythmias. Adverse effects: peripheral edema (HF pt), HA, drowsiness, fatigue, dizziness, nausea

Direct renin inhibitors (DRI) Aliskiren (Tekturna)

Treatment of HTN. Used as monotherapy or in combination. Adverse Effects: diarrhea; hyperkalemia if taken with other drugs that ↑K.

Nonselective beta blockers: propranolol

Blocks beta1 AND beta2 receptors. Uses: HTN, Angina, Cardiac dysrhythmias, MI, Migraine headache.

Selective beta blockers: metoprolol (Lopressor)

Cardioselective: Blocks Beta1 receptors. Preferred for pts with asthma or diabetes. USE: HTN, angina pectoris, HF, MI.

Signs and Symptoms of hypokalemia

Alkalosis, Shallow Respirations, Irritability, Confusion and drowsiness, Weakness and fatigue, Arrhythmias, Lethargy, Thready Pulse, Intestinal motility decrease.

Loop Diuretics: Furosemide (Lasix)

Inhibit Na+ & Cl- reabsorption in ascending Henle’s loop. 10x sodium-losing effect than thiazides. Uses: HTN, Acute Pulm Edema, HF, Hepatic & Renal disease. Adverse Effect: F&E imbalance, ototoxicity.

Thiazides: hydrochlorothiazide (HCTZ)

Acts to decrease reabsorption of sodium, water, chloride, and bicarbonate in the distal convoluted tubule. Uses: HTN, Edema – HF and Nephrotic syndrome.

Spironolactone: aldosterone antagonist

Blocks the action of aldosterone in the distal nephron. Uses: HTN, HF, ascites, hypokalemia, hyperalosteronism. Adverse Effects: Dizziness, HA, abd cramping, diarrhea, Deepening of voice, gynecomastia, menstrual irregularities, testicular atrophy, Hyperkalemia, Risk of GI bleeding.

Triamterene (K+- sparing)

Directly inhibits the exchange of K+ and Na+ in the distal nephron. Uses: HTN, Edema, Counteract K+ loss. Adverse effects: hyperkalemia, n/v, leg cramps, dizziness.

Osmotic diuretics: mannitol (Osmitrol)

Creates osmotic force within the lumen of the nephron - Inhibits passive reabsorption of water. Uses: Prophylaxis of renal failure, ICP, IOP. Adverse Effects: Edema, May precipitate CHF and Pulm Edema in pts with heart disease, Coma, hypotension.