NURS 3082 - Wk 8 Study Guide

Statins

• MOA: Decrease hepatic cholesterol synthesis and lower LDL.

• Class: HMG-CoA reductase inhibitors

• Use: For hyperlipidemia and cardiovascular-risk reduction.

• Adverse effects: Include myalgia, hepatotoxicity, and rare rhabdomyolysis.

  • MUSCLE/JOINT PAIN!

• Nursing Considerations: Monitor lipid panels, liver symptoms, and muscle pain or weakness. Review grapefruit and CYP3A4 drug interactions.

• Ex: atorvastatin, lovastatin, pravastatin, simvastatin

Bile acid sequestrants

• MOA: Bind bile acids in the intestine, causing increased fecal cholesterol excretion and decreased LDL.

• Adverse effects: Constipation, bloating, and GI upset.

  • They can decrease absorption of other drugs and vitamins A, D, E, and K.

• Nursing Consideration: Give other medications separately, commonly 2 hours before or 4 hours after.

• Ex: cholestyramine, colesevelam, colestipol

Niacin

• MOA: Decreases hepatic VLDL production and fatty-acid release, lowering triglycerides and LDL while increasing HDL.

• Adverse Effects: Causes flushing, warmth, nausea, hyperglycemia, hepatotoxicity, and possible gout exacerbation.

• Nursing Consideration: Monitor liver function and glucose

  • Teach patients about flushing and avoiding excess alcohol.

Fibrates

• MOA: Decrease triglyceride production and increase triglyceride clearance

• Use: Primarily for severe hypertriglyceridemia.

• Adverse effects: Include GI upset, hepatotoxicity, gallbladder disease, and myopathy.

• Nursing Consideration: Monitor lipids, liver and renal function, muscle pain, and possible anticoagulant interactions.

• Ex: fenofibrate, gemfibrozil

  • Middle/root word contains “fib”

Ezetimibe

• MOA: Blocks intestinal cholesterol absorption and lowers LDL.

• Class: Cholesterol-absorption inhibitor

• Adverse Effects: May cause GI effects, myalgia, and rare hepatotoxicity.

• Nursing Consideration: Monitor lipid levels, liver function when combined with a statin, and muscle symptoms.

  • Separate administration from bile acid sequestrants.

ARNI

• MOA: Sacubitril inhibits neprilysin, increasing vasodilation and natriuresis; valsartan blocks angiotensin II receptors.

• Use: For HFrEF; Heart failure

• Adverse effects: Include hypotension, hyperkalemia, renal impairment, and angioedema.

• Nursing Consideration: Monitor BP, potassium, and creatinine. Do not combine with ACE inhibitors; a 36-hour washout is required after an ACE inhibitor.

• Ex: sacubitril/valsartan

ACE inhibitors

• MOA: Decrease formation of angiotensin II and aldosterone, reducing afterload and fluid retention.

• Use: For hypertension and heart failure.

• Adverse effects: Include cough, hypotension, hyperkalemia, renal impairment, and angioedema.

• Nursing Consideration: Monitor BP, potassium, creatinine, cough, and facial or tongue swelling. Contraindicated in pregnancy.

• Ex: enalapril, lisinopril, captopril

ARBs

• MOA: Block angiotensin II receptors, reducing vasoconstriction, afterload, and aldosterone-mediated fluid retention.

• Use: When ACE-inhibitor cough or intolerance occurs.

• Adverse effects: Include hypotension, hyperkalemia, and renal impairment

  • Angioedema is less common than with ACE inhibitors.

• Nursing Consideration: Monitor BP, potassium, and creatinine. Avoid in pregnancy.

• Ex: losartan, valsartan, candesartan

Evidence-based beta blockers

• MOA: Decrease sympathetic stimulation, heart rate, cardiac workload, and long-term remodeling.

• Use: In stable chronic HFrEF and hypertension.

• Adverse effects: Include bradycardia, hypotension, fatigue, worsening congestion, and bronchospasm with nonselective agents.

• Nursing Consideration: Monitor HR, BP, weight, edema, and dyspnea. Start low, titrate gradually, and do not stop abruptly.

• Ex: metoprolol succinate, carvedilol, bisoprolol

Mineralocorticoid receptor antagonists

• MOA: Block aldosterone receptors, decreasing sodium and water retention while conserving potassium.

• Use: in HFrEF and selected cases of resistant hypertension.

• Adverse Effects: Main risks are hyperkalemia and renal impairment

  • Spironolactone may cause gynecomastia and decreased libido.

• Nursing Consideration: Monitor potassium and renal function. Avoid potassium supplements and salt substitutes unless prescribed.

• Ex: spironolactone, eplerenone

SGLT2 inhibitors

• MOA: Block sodium-glucose cotransporter 2 in the proximal tubule, increasing urinary glucose and sodium excretion.

• Use: For heart failure, diabetes, and kidney protection.

• Adverse effects: Include volume depletion, hypotension, urinary or genital infections, and rare ketoacidosis.

• Nursing Consideration: Monitor renal function, hydration, BP, and infection symptoms. Follow sick-day and perioperative instructions.

• Ex: dapagliflozin, empagliflozin

  • End in “flozin”

Loop diuretics

• MOA: Block sodium, potassium, and chloride reabsorption in the ascending loop of Henle

  • The most potent diuretics and reduce fluid overload.

• Adverse effects: Include hypokalemia, hyponatremia, hypomagnesemia, dehydration, hypotension, hyperuricemia, and ototoxicity.

• Nursing Consideration: Monitor daily weight, intake and output, BP, lung sounds, electrolytes, renal function, and hearing.

  • Give earlier in the day when possible.

• Ex: furosemide, bumetanide, torsemide

  • Ends in “ide”

Digoxin

• MOA: Inhibits the sodium-potassium ATPase, increasing contractility, while also slowing AV-node conduction and heart rate.

• Class: Cardiac glycoside

• Use: For selected heart-failure patients and some atrial-fibrillation patients.

• Adverse effects: Include nausea, vomiting, anorexia, visual halos or color changes, bradycardia, and dysrhythmias.

• Nursing Consideration: Monitor digoxin level, renal function, potassium, magnesium, and ECG.

  • Take the apical pulse for 1 full minute and hold according to the ordered parameter, commonly below 60 bpm.

Nitrates

• MOA: Produce nitric oxide and increase cGMP, causing vascular smooth-muscle relaxation and primarily reducing preload.

• Use: For angina and selected heart-failure treatment.

• Adverse effects: Include headache, hypotension, dizziness, syncope, and reflex tachycardia.

• Nursing Consideration: Monitor BP and orthostatic symptoms.

  • Never combine with PDE-5 inhibitors such as sildenafil because of potentially severe hypotension.

• Ex: nitroglycerin and isosorbide dinitrate

Hydralazine

• MOA: Decreases afterload. Often paired with isosorbide dinitrate in selected heart-failure patients.

• Class: Direct arterial vasodilator

• Adverse effects: Include hypotension, dizziness, reflex tachycardia, fluid retention, headache, and lupus-like syndrome.

• Nursing Consideration: Monitor BP, heart rate, edema, and prolonged-use symptoms such as joint pain or fever.

Milrinone

• MOA: Increases intracellular cAMP, improving contractility while causing vasodilation.

• Class: Intravenous PDE-3 inhibitor

• Use: Short term for advanced or acutely decompensated heart failure.

• Adverse effects: Include hypotension, hypokalemia, and ventricular dysrhythmias.

• Nursing Consideration: Monitor potassium, renal function, and rhythm.

  • Requires continuous ECG and BP monitoring

Nitroprusside

• MOA: Releases nitric oxide and decreases preload and afterload.

• Class: Rapid-acting arterial and venous vasodilator

• Use: Intravenously for hypertensive emergencies and acute cardiac afterload reduction.

• Adverse effects: Include severe hypotension and cyanide or thiocyanate toxicity with prolonged or high-dose therapy.

• Nursing Consideration: Continuously monitor BP, renal function, acid-base status, and neurologic changes

  • Protect the infusion from light.

Morphine

• MOA: Activates μ-receptors and decreases severe pain and anxiety.

• Class: Opioid analgesic

• Adverse effects: Include respiratory depression, sedation, hypotension, nausea, constipation, and altered mental status.

• Nursing Consideration: Monitor respiratory rate, oxygenation, BP, and level of consciousness. Keep naloxone available and use cautiously with other CNS depressants.

Sildenafil

• MOA: Increases cGMP and causes vasodilation.

• Class: PDE-5 inhibitor

• Adverse Effects: Severe, potentially life-threatening hypotension when combined with nitroglycerin or other nitrates.

• Nursing Consideration: Assess for nitrate use before administration and teach patients to avoid nitrates while the medication is active.

Amiodarone

• MOA: Prolongs repolarization and decreases abnormal cardiac conduction.

• Class: Class III antiarrhythmic

• Adverse effects: Include pulmonary toxicity, thyroid dysfunction, hepatotoxicity, bradycardia, QT prolongation, corneal deposits, and photosensitivity.

• Nursing Consideration: Monitor ECG, heart rate, thyroid function, liver function, and respiratory status.

  • Review interactions with warfarin and digoxin.

Diltiazem and verapamil

• MOA: Inhibit calcium entry, slowing AV conduction and decreasing heart rate and contractility.

• Class: Non-dihydropyridine calcium-channel blockers

• Adverse effects: Include bradycardia, hypotension, AV block, constipation, and worsening heart failure.

• Nursing Consideration: Monitor HR, BP, ECG, and signs of poor cardiac output.

  • Use caution with beta blockers and other rate-slowing drugs.

Aspirin

• MOA: Irreversibly inhibits COX-1 and decreases thromboxane A₂, reducing platelet aggregation for the life of the platelet.

• Class: Anti-platelet

• Use: For ACS, MI prevention, and ischemic-stroke prevention.

• Adverse effects: Include GI irritation, GI bleeding, hemorrhage, tinnitus, and bronchospasm or hypersensitivity.

• Nursing Consideration: Monitor for bleeding, GI symptoms, concurrent NSAID or anticoagulant use, and allergy.

P2Y12 inhibitors

• MOA: Block ADP-mediated platelet activation and aggregation.

• Class: Anti-platelet

• Use: For ACS, post-PCI or stent therapy, and secondary prevention.

• Adverse effects: Include bleeding, bruising, anemia, thrombocytopenia, GI bleeding, and rare thrombotic thrombocytopenic purpura.

• Nursing Consideration: Monitor CBC and bleeding.

  • Teach patients to report severe headache, neurologic changes, melena, hematuria, or hematemesis.

• Ex: clopidogrel, prasugrel, ticagrelor

GP IIb/IIIa inhibitors

• MOA: Block the final fibrinogen-binding pathway required for platelet aggregation.

• Class: Anti-platelet

• Use: Short term during high-risk ACS or PCI, usually with aspirin and heparin.

• Adverse effects: Severe bleeding and thrombocytopenia.

• Nursing Consideration: Monitor IV sites, gums, urine, stool, bruising, vital signs, hemoglobin, hematocrit, and platelet count.

• Ex: eptifibatide, tirofiban, abciximab

Unfractionated Heparin

• MOA: Binds antithrombin and inactivates thrombin and factor Xa, preventing fibrin formation.

  • Has a rapid onset and is administered IV or subcutaneously

• Class: Anticoagulant

• Adverse effects: Include bleeding, thrombocytopenia, heparin-induced thrombocytopenia, and hyperkalemia.

• Nursing Consideration: Monitor aPTT or anti-Xa, CBC, platelets, hemoglobin, hematocrit, potassium, and bleeding.

  • Reversal agent: protamine sulfate.

Low-molecular-weight heparins

• MOA: Primarily inhibit factor Xa and are administered subcutaneously.

• Class: Anticoagulant

• Use: For VTE prevention or treatment and as an ACS adjunct.

• Adverse effects: Include bleeding, thrombocytopenia, injection-site bruising, and accumulation with renal impairment.

• Nursing Consideration: Monitor renal function, CBC, platelets, and bleeding

  • Routine aPTT monitoring is not recommended

  • Protamine provides only partial reversal.

• Ex: enoxaparin, dalteparin

Warfarin

• MOA: Inhibits vitamin K-dependent synthesis of clotting factors II, VII, IX, and X.

• Class: Anticoagulant

• Use: For prevention or treatment of VTE, atrial-fibrillation embolic risk, and selected prosthetic valves.

• Adverse effects: Include bleeding, skin necrosis, purple-toe syndrome, and fetal harm.

• Nursing Consideration: Monitor PT/INR; a common target is 2.0–3.0.

  • Teach consistent vitamin-K intake and avoidance of unapproved NSAIDs, aspirin, herbals, and alcohol.

  • Reversal: vitamin K; severe bleeding may require PCC.

Direct factor Xa inhibitors

• MOA: Directly inhibit factor Xa, preventing thrombin generation and clot formation.

• Class: Anticoagulant

• Use: For atrial-fibrillation stroke prevention, DVT/PE treatment, and postoperative VTE prophylaxis.

• Adverse effects: Include bleeding and drug accumulation with renal impairment.

• Nursing Consideration: Monitor CBC, renal and liver function, adherence, and bleeding.

  • No routine INR monitoring is required

  • Reversal may involve andexanet alfa or PCC according to protocol.

• Ex: apixaban, rivaroxaban

Dabigatran

• MOA: Directly inhibits thrombin, preventing conversion of fibrinogen to fibrin.

• Class: Anticoagulant; Direct Thrombin Inhibitor

• Use: For atrial-fibrillation stroke prevention and DVT/PE treatment.

• Adverse effects: Include bleeding and dyspepsia-like GI symptoms.

• Nursing Consideration: Monitor renal function and bleeding

  • Emphasize strict adherence because stopping suddenly increases clot risk

  • Specific reversal agent: idarucizumab.

Alteplase

• MOA: Converts plasminogen to plasmin, breaking down fibrin clots.

• Class: Thrombolytic; Recombinant tissue plasminogen activator

• Use: Selected ischemic-stroke, STEMI, and other emergency situations.

• Adverse effects: Severe bleeding and intracranial hemorrhage; angioedema may occur in some stroke patients.

• Nursing Consideration: Verify eligibility and time of symptom onset, control BP, minimize invasive procedures, and perform frequent neurologic and bleeding assessments.

Tenecteplase

• MOA: Promotes conversion of plasminogen to plasmin.

  • Administered as a single IV bolus in selected MI or stroke protocols

• Class: Thrombolytic; Modified tissue plasminogen activator with a longer half-life

• Adverse effect: Major bleeding, especially intracranial hemorrhage.

• Nursing Consideration: Verify weight-based dosing and contraindications before administration.

Streptokinase

• MOA: Forms a complex with plasminogen and promotes plasmin generation.

• Class: Bacterial-derived thrombolytic

• Adverse effects: Include bleeding, hypotension, and allergic reactions.

• Nursing Consideration: Assess for previous exposure, allergy, bleeding risk, and hemodynamic instability.

Antifibrinolytics

• MOA: Inhibit plasminogen activation or plasmin activity, slowing fibrin breakdown and stabilizing clots.

• Use: For selected surgical, traumatic, obstetric, or mucosal bleeding.

• Adverse effects: Include thrombosis, visual changes, seizures at high exposure, hypotension with rapid IV administration, and accumulation in renal impairment.

• Nursing Consideration: Monitor bleeding, thrombosis, renal function, vision, neurologic status, and IV administration rate.

• Ex: tranexamic acid and aminocaproic acid

Protamine sulfate

• MOA: Heparin antidote that binds and neutralizes unfractionated heparin

  • It only partially reverses low-molecular-weight heparin.

• Adverse effects: Include hypotension, bradycardia, pulmonary hypertension, and severe hypersensitivity.

• Nursing Consideration: Administer slowly as ordered and monitor BP, respiratory status, and bleeding.

Vitamin K

• MOA: Promotes hepatic synthesis of vitamin K-dependent clotting factors and reverses warfarin’s anticoagulant effect

• Use: For elevated INR or warfarin-related bleeding.

  • The effect is not immediate

• Adverse Effect: Severe bleeding may require additional PCC or blood-product support.

• Nursing Consideration: Monitor INR and signs of continued bleeding