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| Question | Answer |
| CARDIAC GLYCOSIDES example and action | Example: Digoxin Action: Inhibits active transport of Na+ and K+ across myocardial cell membrane, and thus the sodium pump. Increases contractility, decreases HR |
| CARDIAC GLYCOSIDES indication and adverse reactions | Indication: Heart failure, atrial fibrillation, atrial flutter, atrial tachycardia, cardiac arrhythmias Adverse reactions: Bradycardia, ectopic beats, heart block, headache, confusion, nightmares, disturbed colour vision |
| CARDIAC GLYCOSIDES nursing care considerations | • Monitor serum levels • Pulse rate must be <60bpm before administration • Caution in PT with renal impairment • Monitor vital signs • PT education – med, condition • Serum urea and electrolyte monitoring |
| NITRATES example and action | Example: Glyceryl trinitrate [GTN] Action: Relax smooth muscle →vasodilation. Decrease myocardial oxygen demand by reducing preload and after load. Decrease BP |
| NiTRATES indication and adverse reactions | Indication: Prophylaxis and treatment of angina pectoris Adverse reactions: Reflex tachycardia, hypotension, flushing, headache, dizziness, dry mouth, abdominal pain, vomiting, restlessness, palpitations |
| NITRATES nursing care considerations | • Monitor vital signs • PT education • Take as early in the attack as possible, sitting down for 10-20 minutes after • Care with handling GTN as it can be absorbed through skin • SR – prevention of angina attacks • Fast acting – treats acute angina attacks |
| ANTIARRYTHMIC AGENTS CLASS I example and action | Example: Lignocaine Action: Block sodium channels during phase 0 of action potential, slow repolarisation and have local anaesthetic effects |
| ANTIARRYTHMIC AGENTS CLASS II example and action | Example: Atenolol Action: Beta adrenergic receptor blockers – prevent sympathetic stimulation |
| ANTIARRYTHMIC AGENTS CLASS II| example and action | Example: Amiodarone Action: Block potassium channels and prolong phase 3 of an action potential |
| ANTIARRYTHMIC AGENTS CLASS IV example and action | Example: Verapamil Action: Calcium channel blockers shorten the action potential, disrupting ineffective rhythms and rates |
| HEPARIN action | Augments the natural inhibitor of coagulation, antithrombin III, preventing the conversion of prothrombin to thrombin. Prevents further clotting but has no effect on existing clot. Administered parenterally |
| HEPARIN indication and adverse reactions | Indication: venous thromboembolism, prophylaxis for clot formation, extracorporeal circulation Adverse reactions: haemorrhage, local irritation, mild pain, haematoma, elevated liver enzymes, osteoporosis after prolonged high dose therapy, early/internal bleeding |
| HEPARIN nursing care considerations | • Monitor APTT (activated partial thromboplastin time) • Administering and maintaining the correct dosage within the therapeutic range by regular monitoring of blood concentration • Low dose heparin does not require monitoring • Antidote: protamine sulfate |
| WARFARIN action | Interferes with hepatic syntheses of prothrombin and factors VII, IX and X Prevents the extension of established clot/formation of new clots. Administered orally |
| WARFARIN indication and adverse reactions | Indication: prevention and management of DVT or pulmonary embolism Adverse reactions: bleeding, alopecia, fever, hypersensitivity |
| WARFARIN nursing care considerations | • Monitor INR (international normalized ratio) used to regulate dosage • Antidote: phytomenadione |
| ANTI-PLATELET AGENTS example and action | Example: Aspirin Action: Decrease platelet aggregation by effecting platelet adhesiveness and reducing thrombus formation |
| ANTI-PLATELET AGENTS indication and adverse reactions | Indication: Prophylaxis following cardiac valve replacement, increased risk of thromboembolic stroke, acute MI Adverse reactions: Bleeding (major and minor), thrombocytopenia, hypotension, bradycardia, chest pains, dyspnea |
| ANTI-PLATELET AGENTS nursing care considerations | • Platelet count monitored before starting therapy, 2-4 hours after bolus dose and at 24 hours or just before discharge • Caution and contraindications: presence of any known bleeding disorders, recent surgery, closed head injuries, pregnancy, lactation • Solution should be administered alone • Any haematoma measured and frequently checked for enlargement • Monitor vitals and neurological status closely • Educate PT about reporting signs of bleeding, avoid risky activities |
| THROMBOLYTICS example and action | Example: Alteplase Action: Activates plasminogen to form the proteolytic enzyme plasmin, which breaks down fibrin and therefore dissolves the clot |
| THROMBOLYTICS indication and adverse reactions | Indication: MI, pulmonary embolism Adverse reaction: Minor/major bleeding, haemorrhage (IV site), arrhythmias, tachy/bradycardia, hypotension, anaphylactic reactions |
| THROMBOLYTICS nursing care considerations | • Treatment should be started ASAP after onset of symptoms • Should only be used in hospital setting by experienced doctors • Recent puncture sites should be carefully monitored for bleeding • Avoid injections • Monitor vitals |
| HMG-CoA REDUCTASE INHIBITORS (STATINS) example and action | Example: Atorvastatin Action: Inhibit HMG-CoA reductase, lowering cholesterol synthesis, increasing liver LDL receptors (low density lipoprotein) → lowering LDL levels |
| HMG-CoA REDUCTASE INHIBITORS (STATINS) indication and adverse reactions | Indication: Hyperlipidaemia, prevention of CVD Adverse reactions: GI disturbances, headache, myalgia, insomnia, rash, constipation, alopecia, myopathy |
| HMG-CoA REDUCTASE INHIBITORS (STATINS) nursing care considerations | • Monitor serum lipid levels regularly throughout therapy • Liver function test should be performed before therapy at 6 and 12 weeks, then twice yearly • Caution: PT with history of liver disease, impaired liver function, or excessive alcohol consumption • Educate PT: report muscle pain, cramps, tenderness/weakness, malaise, dark urine/fever, avoid large amounts of alcohol |
| CHOLESTEROL ABSORPTION INHIBITOR example and action | Example: Ezetimibe Action: Inhibits absorption of cholesterol in the small intestine, decreasing the amount of intestinal cholesterol reaching the liver, → reduced liver cholesterol stores and increased clearance in blood |
| CHOLESTEROL ABSORPTION INHIBITOR indication and adverse reactions | Indication: Hypercholesterolaemia Adverse reactions: Myalgia (with statins), elevated liver enzymes and CPK |
| CHOLESTEROL ABSORPTION INHIBITOR nursing care considerations | • Any secondary causes of hypercholesterolaemia should be identified and treated before starting therapy • Liver function tests should be performed at start and regularly throughout therapy if given with statins • Not recommended for PTs with impaired liver function • Contraindicated with statins in those with active liver disease • Educate PT on reporting muscle pain, cramps, tenderness, weakness, malaise, fever → CPK concentration should be measured |
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