Pharm Exam 2 MEDS ONLY

HF Medication Classifications

• Cardiotonic Agents

• Phosphodiesterase Inhibitor

• Hyperpolarization-Activated Cyclic Nucleo..etc

• Angiotensin Receptor Neprolysin Inhibitor

Cardiotonic Agents Medication

Digoxin (Lanoxin)

Digoxin actions

• INCREASE contractility, cardiac output, renal blood flow, urine production = decreases HR

Digoxin can help treat

• Symptoms of HF

• A-Flutter

• A-Fib

• Paroxysmal tachycardia

Digoxin Adverse Effects

• DIG Toxicity (N/V, yellow halos around light)

• HR less than 60

• Headache, weakness, drowsiness

Digoxin Contraindications/Cautions

• Renal insufficiency (increases DIG toxicity)

• Ventricular tachycardia or fibrillation (potential fatal arrhythmias)

• Idiopathic hypertrophic subaortic stenosis (obstructs outflow)

• Acute MI

Digoxin Interactions

• Increases DIG: LOTS of black licorice (causes loss of K), Ginseng, Hawthorn

• Herbals: psyllium, st johns wort (decrease effect)

• “Quin” meds

Phosphodiesterase Inhibitor Medications

Milrinone

Milrinone actions..

• INCREASE calcium level

• cause stronger contraction

• Prolong effects of sympathetic stimulations

Milrinone treats

HF

Milrinone only

Short term/severe situations

Milrinone is used if you have..

Poor response to digoxin, diuretics, and vasodilators

Milrinone is only available through

IV

Contraindications/Caution with milrinone

• Severe aortic/pulmonic valvular disease

• Acute MI

• Fluid Volume Deficit (heart empty & meds causing it to pump harder = heart damage)

• Ventricular Arrhythmias

• Older adults (prone to adverse effects)

Adverse Effects of Milrinone

• Ventricular Arrhythmia (can progress to V-Fib = life threatening)

• Hypotension, Chest Pain

• N/V, Anorexia/Abd Pain

• Thrombocytopenia

• Vasculitis

Interactions with Milrinone

Furosemide (cant combine same IV bag)

Hyperpolarization-Activated Cyclic Nucleotide-Gated Channel Blocker MEDICATIONS

Ivabradine (Corlanor)

Ivabradine Actions

• Reduces HR by affecting SA Node (doesnt affect muscle contraction)

• Allows more time for ventricular filling

• Not sympathetic blocker

• Affects channels in retinal (alters bright light)

Ivabradine Treats..

• Reduce risk of hospitalization in HF pts

• stables symptoms, EF 35% or less (systolic), sinus & HR of 70+

Patients put on Ivabradine are dosed..

At MAX medication or NONE at all

Contraindications/Cautions with Ivabradine

• Allergies to sulfates

• Decompensated HF

• Sick Sinus Syndrome

• Resting HR under 60

• Complete dependency on Pacemaker

Ivabradine Adverse Effects

• Bradycardia, HYN, A-Fib

• Luminous Phenomena (sudden change in darkening of vision)

Ivabradine Interactions

• Altered concentrations w/ CYP3A4 causes SEVERE BRADYCARDIA

Angiotensin Receptor Neprilysin Inhibitor MEDICATION

Entresto

Entresto is a combination of

• Valsartan (ARB)

• Sacubitril (neprilysin inhibitor)

Entresto Actions

• Reduces hospitalization and risk for CV death

• Improved HF symptoms

• Indicated for peds pts w/ symptomatic HF

Entresto usually takes..

3 days to kick in

Entresto Contraindications/Cautions

• Concurrent use w/ ACE (increase risk of angioedema)

• Aliskiren (increase risk of renal impairment)

Adverse effects of Entresto

• Cough

• Hypotension, Hyperkalemia, Vertigo, Renal impairment, Angioedema

Entresto Interactions

• ACE: disc this med 36hrs+ prior

• GFR less than 60

• Potassium sparing diuretics

• Lithium & nephrotoxic drugs

Antianginal Classifications

• Nitrates

• Beta-Adrenergic Blockers

• CCB

• Piperazine Acetamides

Nitrates Medications

• Isosorbide dinitrate

• Nitroglycerin

Nitrates Actions

• Dilates arteries, veins, and capillaries

• Increase blood flow through vessels

• Lowers BP

Nitrates act on..

Smooth muscle (no influence on nerves)

Nitrates help treat

MI & prevent them

Nitroglycerin Routes

• IV, Patch, Topical ointment/paste, sublingual, spray

Topical Nitroglycerin is used for

Anal fissures

When applying Nitroglycerin make sure..

• WEAR GLOVES (can absorb in skin)

• FULLY remove it before reapplying

When to dial 911 with Isosorbide

• after 2nd tablet

• Leave door open & be in visual view for EMS

Nitrates Contraindications/Cautions

• Severe anemia

• Head trauma

• Cerebral hemorrhage

• Hepatic/Renal disease

• Hypotension or hypovolemia

Adverse Effects w/ Nitrates

• CNS - H/A, Vertigo, Weakness

• GI - N/V

• CV - Hypotension, reflex tachycardia, angina

• Skin - flushing, pallor, contact dermatitis

• TOLERANCE CAN DEVELOP w/ continual use

Nitrate Interactions

• Heparin

• PDES: Viagra (sildenafil, tadalafil, vardenafil) can cause severe hypotension = coding

Beta-Adrenergic Blockers (BAB) Medications

“olol”

BAB Medication Actions:

• Block sympathetic nervous system (fight or flight)

• Lowers BP, HR, & cardiac output

BAB medications treats

• Long term management of angina thats caused by atherosclerosis

BAB medications are NOT for

• prinzmetal Angina (worsens vasospams)

Propranolol & metoprolol can help

Prevent refraction (repeat) MI in stable pts 1-4 weeks AFTER MI

Contraindications/Cautions with BAB meds

• Asthma & COPD

• Anything that slows down HR (bradycardia, heart block, DM, cardiogenic shock, Throtoxicosis)

Why should we be cautious with diabetic patients taking BAB medications?

It can mask hypoglycemia

BAB Medication Adverse Effects:

• CNS - vertigo, fatigue

• GI - N/V, pain, colitis, diarrhea

• CV - HF, reduced cardiac output, arrhythmias

• Resp - bronchospasm, dyspnea, cough

BAB Medication interactions

• NSAIDs : result in antihypertensive agents

• Epinephrine, Ergot Alkaloids

CCB medications

• “Pine’s”

• Diltiazem & verapamil

Nondihydropyridines are..

• diltiazem & verapamil

• More dangerous to HF pts (due to decreasing muscle function)

• More direct negative inotropic (less heart pumping) & chronotropic (lower HR)

Dihydropyridines are

“Pine’s” meds

CCB medications Actions

• inhibit movement of calcium, decrease cardiac workload & o2 consumption

• Vasodilation, decrease peripheral resistance, loss of smooth muscle tone, preload/afterload is decreased

CCB Meds Treat

• Pinzmetal/Chronic/Effort Associated Angina

• HYN

• Slows progression of atherosclerosis

• Verapamil/Diltiazem = slow conduction & treat arrhythmias

Contraindication/Caution with CCB Meds

• Heart block

• Sick sinus syndrome

• Renal/Hepatic dysfunction

• HF

Adverse Effects of CCB

• CNS: vertigo, H/A, fatigue, light headedness

• GI: Nausea, hepatic injury

• CV: hypotension, bradycardia, peripheral edema, heart block

• Skin: flushing and rash

CCB medication Interactions

• Cyclosporine, Digoxin, general anesthesia

Piperazine Acetamides Medications

Ranolazine (Ranexa)

Ranolazine is considered

• primary/secondary medication

• Can combine w/ nitrates, BAB, amlodipine

Ranolazine actions

• may inhibit sodium influx

• Doesn’t decrease BP/HR

• Decreases myocardial workload

Ranolazine Treats

• Angina & Blood glucose in DM pts

Ranolazine Routes

Tablet (DO NOT CRUSH/CHEW/CUT)

Ranolazine Contraindications/Cautions

• prolonged QT Intervals

• Renal/Hepatic impairment

• Digoxin

• TCA’s & antipsychotics

• Concurrent use with CYP3A (prolonged QT intervals)

Adverse Effects of Ranolazine

• vertigo

• H/A

• Nausea

• Constipation

Ranolazine Food-Drug Interactions

Grapefruit Juice

Antiplatelet Medications

• Aspirin

• Clopidogrel

• Ticagrelor

• Tirofiban

Antiplatelet Agents Actions

Inhibit platelet adhesion/aggregation

Antiplatelet meds treat

• Peripheral artery disease (blood isnt reaching feet)

• Maintenance for venous or arterial grafts

• Increased risk of of narrowing/occlusions

• Prevents MI & cerebrovascular occlusion (stroke)

• CV disease

Antiplatelet Meds Contraindications/Cautions:

• allergies

• Bleeding disorder/active bleeding

• Recent Surgery/Women who just gave birth

• Closed head injury

Antiplatelet Adverse Effects:

• Bleeding

• GI distress

• Headache, dizziness, weakness, skin rash

Antiplatelet Medication Interactions

• Any herbal supplement that starts with a G

• Drugs that affect blood clotting

Anticoagulants Meds

• Enoxaprin, Heparin, Warfarin, Rivaroxaban, Apixaban

Anticoagulants Action

Interfere with cascade of clotting

Antidote of warfarin

Vitamin K

Anticoagulants Contraindication/Cautions

• allergies

• Conditions compromised by increased bleeding tendencies

• Renal/Hepatic disease

What anticoagulant Medication is safer for pregnancy women?

• Heparin

Anticoagulant Adverse Effects

• bleeding

• Thrombocytopenia (heparin): blood sells not functioning properly

Anticoagulant Medication Interactions

• other drugs/substances that increase bleeding risk

• Warfarin: LOTS OF DRUGS

Warfarin takes..

Several days to work

Thrombolytic Medications

• Alteplase, Retaplase, Tenecteplase “plase”

Thrombolytic agents actions:

Breaks up blood clots

Thrombolytic agents treats

Blood clots formed during acute, MI, PE, ischemic strokes

Thrombolytic Agents should never be given to

Someone who is bleeding

Thrombolytic agents contraindications/cautions

• allergies

• Pregnancy/lactation

• Conditions that could be worsened by dissolution of clots

Thrombolytic Adverse Effects

• Bleeding / GI bleeding

• Cardiac arrhythmia

• Hypotension

• Mental status change

Thrombolytic Agent Interactions

Any anticoagulants or antiplatelet drugs