05 B CV System: Meds #1 flashcards |

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positive inotrope drugs & their MOA

intropin (dopamine), dobutamine (dobutrex), milrinone (primacor), digitalis (lanoxin) - used for CHF & shock to increase contractility - to increase CO

Dobutamine (dobutrex) MOA


Dobutamine (dobutrex) side effect

decreased BP bc it vasodilates, but can also increase BP by increasing CO

Intropin (dopamine) MOA

increases force of contraction (squeeze). particularly used for acute exacerbations of CHF where BP has fallen.

Intropin (dopamine) side effect

Increased BP

Furosemide (lasix) and Bumex MOA

diuretics used to decrease preload (volume)

Furosemide (lasix) and Bumex uses

diuretics used for HTN, CHF, renal failure

Furosemide (lasix) and Bumex side effect

electrolyte imbalances (especially hypokalemia - which makes a person more likely to have digoxin toxicity if on that as well)

ACE inhibitors (pril's) MOA

decreases afterload by preventing vasoconstriction, decreases preload by preventing sodium & water retention (inhibits aldosterone), vasodilator.

ACE inhibitors uses

used for HTN, for all post MI pts indefinitely, CHF. reduces mortality & CHF from AMI. Prevents scarring of LV that leads to HF (LV remodeling).

ACE inhibitors side effects

hypotension (orthostatic hypotension early on) - Monitor BP!, hyperkalemia, persistent cough (have to get off drug)


losartan (cozaar), valsartan (diovan), candesartan (atacand), irbesartan (avapro), telmisartan (micardis)

ARBs MOA, side effects

used for HTN, MI. side effect - hypotension, so monitor BP!

Beta blockers (lol's) uses

used for angina, MI (standard of care for all post MI pts indefinitely), CHF (only stable, chronic - not early mgmt), tachyarrhythmias.

Beta blockers MOA

they inhibit/block the SNS response - decrease HR, contractility, stroke volume, CO, BP, AV node conduction

Beta blockers side effect

hypotension (don't give if SBP < 100), bradycardia, AV block, extreme fatigue/lethargy, impotence

Beta blockers nursing considerations

monitor BP & HR. contraindicated if HR < 60 bpm, insulin dependent DM (monitor sugar more often), asthma, PVD

Natrecor (natriuretic peptide) MOA and use

causes diuresis - opposes renin so it causes excretion of sodium & water to treat fluid overload. used for ACUTE episodes of CHF.

Natrecor (natriuretic peptide) side effect

hypotension - monitor BP, HR, rhythm closely. may need to reduce dosage.

Calcium channel blockers (Cardizem, Procardia/nifedipine, Norvasc/amlodipine) MOA and uses

slows ventricular rate. decreases afterload. more of an antiarrhythmic. Used for HTN, Afib, Aflutter.

Nitro uses

angina, MI, HTN, CHF, shock. consider early admin. in select pts: suspected ischemic chest pain, UA (change in angina pattern), acute pulm. edema (if BP > 90 systolic).

Nitro actions

decreases pain of ischemia, venous blood return to heart, preload & cardiac O2 consumption. Increases venous dilation and cardiac collateral flow. Dilates coronary arteries.

Nitro side effect

mainly hypotension (bc it's a dilator). Extreme caution if systolic BP < 90 and w/RV infarction, limit drop to 10% if pt normotensive, limit drop to 30% if pt hypertensive. Watch for HA, syncope, tachycardia.

nitroprusside uses

brings BP down really quickly - monitor BP every minute! drug of choice for hypertensive crisis (malignant HTN)

Aspirin actions will reduce:

overall mortality from AMI, nonfatal reinfarction, nonfatal stroke. will not do anything to clot already there!

Aspirin administration

CHEW the tablet. standard therapy for pain suggestive of AMI. better to use baby aspirin bc it's flavored. if allergic give plavix.

aspirin uses

antiplatelet that PREVENTS clot formation, prevents platelet aggregation and vasoconstriction. used for CAD, post MI (STEMI and NSTEMI).

antiplatelet drugs side effect


GP-IIb/IIIa inhibitors - Reopro, Aggrastat, Integrilin

antiplatelet (PREVENTS clot formation & from getting bigger)

GP-IIb/IIIa inhibitors - Reopro, Aggrastat, Integrilin uses

ACS w/NO ST segment elevation (NSTEMI), non-Q wave MI, UA, CA reocclusion post PCI or with fibrinolytics given 24 hrs before balloon/stent.

GP-IIb/IIIa inhibitors - Reopro, Aggrastat, Integrilin - side effect

bleeding from ALL sites - urine, stool, sputum, puncture sites, nosebleeds. Monitor labs - Hb, Hct, platelets

Heparin MOA

PREVENTS clot formation & from getting bigger.

Heparin uses

used for DVT, PE, MI (STEMI & NSTEMI), DIC, A-Fib, post PTCA or CABG with some lytics if < 48 hrs. For STEMI with/without reperfusion up to 8 days.

LMWH (lovenox) uses

STEMI and NSTEMI, in combination with fibrinolytics. PREVENTS clot formation.

Fibrinolytics (thrombolytics) - end in "ase" MOA and uses

BREAK UP clots already formed. Used in MI (STEMI ONLY: w/chest pain > 20 min & < 12 hrs), CVA, PE. Max age for use - 75.

fibrinolytics time of administration

door to drug time - 30 minutes!

Fibrinolytics (thrombolytics) side effects

death from brain (intracerebral) hemorhage esp. if over age 75, reprofusion arrhythmias (PVB, PAB, Afib/Aflutter) - has plenty of O2 all of a sudden, go away on their own (means the drug is working!)

aldosterone blockers (end in "one") - spironolactone uses

potassium sparing diuretic used in MI and CHF

aldosterone blockers (end in "one") - spironolactone side effect


morphine sulfate indications

used for STEMI, consider in NSTEMI, evidence of acute pulmonary edema. also if systolic BP > 90 and no hypovolemia.

morphine sulfate actions

drug of choice for acute pain d/t MI. decreases pain of ischemia, decreases anxiety (gives feeling of euphoria), decreases extension of ischemia by decreasing O2 demands.

morphine sulfate dose and administration

give "low & slow." 2 to 4 mg every 5-10 min titrated to effect. no cap on the dose. given IV push over 5 min.

morphine sulfate goal

goal is to ELIMINATE pain (ZERO on the pain scale)

precautions with morphine sulfate

depression of ventilation (consult MD), N/V common (can premed w/zofran), bradycardia, drop in BP (increase fluids, elevate feet, lower head)

D/C these drugs if pt has MI

ALL NSAIDs except ASA (aspirin) must be DC'd for good.

Plavix indications

with or without lytics for 14 days, with or without reperfusion, NSTEMI - give for 6-9 mos, STEMI - gie for 1 year. ALL STEMIs and NSTEMIs get Plavix.

Plavix MOA

antiplatelet - inhibits platelet aggregation by selectively preventing binding of ADP to its receptor. Prolongs bleeding time.

Plavix major side effects

Watch for bleeding especially when given with NSAIDs, ASA, heparin, or coumadin

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