Medication Review - Cardiology, Anticoagulation, and HF/Angina Medications

Flashcards covering medications, indications, monitoring, interactions, and contraindications from the provided notes.

What class is Propranolol?

Beta blocker.

When should Propranolol be held?

If heart rate is under 60 bpm or systolic blood pressure is under 90 mmHg.

What is Digoxin?

A cardiac glycoside.

How is Digoxin monitoring performed?

Use apical pulse to check heart rate; hold if HR < 60 bpm.

What electrolyte abnormality increases the risk of Digoxin toxicity?

Hyperkalemia.

What is the antidote for Digoxin toxicity?

Digibind (digoxin immune fab).

Quinidine/Procainamide: what class are they?

Sodium channel blockers.

What is Quinidine/Procainamide primarily used for?

To control rhythm.

What should you avoid giving with Digoxin or Grapefruit?

Quinidine/procainamide.

What class is Flecainide?

Sodium channel blocker.

What are Flecainide’s main uses?

Control rhythm; life-threatening arrhythmias.

How is Flecainide used in A-fib when other meds fail?

Used for lifelong A-fib if no other medications work.

What class is Dabigatran?

Anticoagulant.

What does Dabigatran prevent?

DVT, PE, and clots; used to prevent stroke in A-fib.

What is the antidote for Dabigatran?

Idarucizumab.

What is Atorvastatin used for?

Treatment for hyperlipidemia.

What serious adverse effect is associated with Atorvastatin?

Rhabdomyolysis.

Which fruit juice increases Atorvastatin toxicity?

Grapefruit juice.

How does Warfarin interact with Atorvastatin?

Warfarin increases the risk of bleeding when used with atorvastatin.

What is the therapeutic effect of Atorvastatin?

Reduction of LDL and triglycerides.

What metabolic effect can Atorvastatin have on some patients?

May increase glucose in patients at risk for type 2 diabetes.

What is Ezetimibe used for?

Treatment for hyperlipidemia.

Which drug should be avoided with Ezetimibe?

Warfarin.

How can Ezetimibe be used?

Adjunct with a statin or by itself; lowers LDL.

What dosing note is associated with Ezetimibe/related therapy?

Given at bedtime has the greatest effect.

What class is Colesevelam?

Bile acid sequestrant.

What is Colesevelam’s effect on LDL?

Lowers LDL.

What dosing consideration does Colesevelam require?

Need a 4-hour break between taking this med and other meds.

What vitamin deficiency risk is linked to Colesevelam?

Vitamin deficiency causing bleeding.

What is Gemfibrozil used for?

Treatment for hypertriglyceridemia.

What are Gemfibrozil’s adverse effects?

Gallstones and pancreatitis.

What should be avoided with Gemfibrozil?

Warfarin.

What is Bempedoic acid used for?

Treatment for hyperlipidemia.

What are the adverse effects of Bempedoic acid?

Back pain, gout, and tendon rupture.

What is Alirocumab used for?

Used for familial hyperlipidemia.

How is Alirocumab administered?

SubQ injection every 2-4 weeks; patient self-administers; educate to alternate injection sites.

What is Inclisiran used for?

Used for familial hyperlipidemia.

How is Inclisiran administered and by whom?

SubQ injection; only nurses or providers can administer; every 3-6 months.

What does Ferrous sulfate treat?

Iron deficiency anemia.

What should you do for liquid ferrous sulfate to prevent teeth staining?

Use a straw and rinse mouth after administration.

What are the common GI effects of Ferrous sulfate?

Dark green stool and constipation.

Who is at risk of iron toxicity with Ferrous sulfate?

Children.

What vitamin increases iron absorption?

Vitamin C.

Which foods should be avoided with oral iron due to decreased absorption?

Coffee, dairy, and eggs.

What is Folic acid used for?

For megaloblastic anemia.

What must be monitored with Folic acid therapy?

Monitor for B12 deficiency.

What is Cyanocobalamin used for?

For megaloblastic anemia.

What should be monitored with Cyanocobalamin therapy?

Monitor for folic acid deficiency.

Lack of intrinsic factor requires what injection?

Vitamin B12 injection.

What is Clopidogrel?

Antiplatelet.

What should be monitored with Clopidogrel?

Platelet count; risk of bleeding, chest pain, and headache.

When should Clopidogrel be stopped before surgery?

7 days before elective surgery.

What are Heparin and Enoxaparin?

Anticoagulants.

What should be monitored with Heparin/Enoxaparin?

APTT and bleeding.

What is the antidote for Heparin/Enoxaparin?

Protamine sulfate.

What is Warfarin?

Anticoagulant.

What dietary instruction is important for Warfarin?

Consistent intake of vitamin K.

How long does Warfarin take to show effect?

Takes 3-5 days for effect.

What should be monitored with Warfarin?

INR and PT.

What is the antidote for Warfarin?

Vitamin K.

Is Warfarin teratogenic?

Yes.

What is Alteplase?

The only clot buster – thrombolytic.

What baseline information is needed before giving Alteplase?

Last known normal.

What is the time window for Alteplase administration?

Within 4.5 hours of last known normal.

What are Alteplase contraindications?

Uncontrolled hypertension (185/110), prior stroke or aneurysm, active bleeding, or age <18.

What is Nitroglycerin?

A vasodilator used to treat acute and chronic angina.

What are common adverse effects of Nitroglycerin?

Hypotension and headaches.

How should Nitroglycerin be stored?

In the original dark container; sensitive to heat and light.

What is the dosing limit for Sublingual Nitroglycerin?

No more than 3 doses, 5 minutes apart.

What should you do if Nitroglycerin does not relieve pain after the first dose?

Call 911.

What is Ranolazine used for?

Treatment for chronic stable angina.

What administration notes apply to Ranolazine?

Do not chew, crush, or cut; take twice daily; avoid grapefruit juice and alcohol; monitor magnesium and potassium.

What are Epinephrine’s effects?

Increases contractions and contractility; used for cardiac arrest; increases BP, HR, bronchodilation, vasoconstriction; increases coronary perfusion.

What is Empagliflozin used for?

Treatment for type 2 diabetes; decreases cardiovascular risk and worsening kidney disease; decreases hospitalization.

What is Hydralazine?

Antihypertensive; causes vasodilation and decreases blood pressure; may increase heart rate when added with beta blockers.

What is Ivabradine used for?

Used for chronic heart failure and angina in patients with sinus rhythm and adequate heart rate (usually above 70).

What is Dobutamine used for?

Treatment for cardiac shock; improves pumping; short-term use; administered via IV pump; beta blockers may oppose its effects.

What is Milrinone used for?

Last-line medication for heart failure; short-term use; requires dedicated IV line; avoid combining with furosemide; increases contractility and can cause ventricular dysrhythmias and severe hypotension.