Cardiovascular System: Angina and Myocardial Infarction Study Guide

Pharmacological Principles and Fundamentals

An introduction to the study of medicine, covering the biological effects of chemicals on the body, drug naming conventions, and the processes of pharmacokinetics and pharmacodynamics.

• pharmacokinetics
• pharmacodynamics
• pharmacotherapeutics
• four phases of pharmacokinetics
• absorption, distribution, metabolism, and excretion
• bioavailability and first-pass effect
• chemical, generic, and trade names
• therapeutic and pharmacological classification
• mechanism of action
• drug label components

Drug Administration and Absorption Routes

An overview of how drugs are absorbed, the various routes of administration, and the impact of the first-pass effect.

• First-pass effect
• Drug absorption through membranes
• Enteral route administration
• Parenteral route administration
• Topical route administration
• Intravenous absorption speed
• Sublingual and buccal routes
• Intramuscular and subcutaneous administration
• Bioavailability and oral doses
• Therapeutic range

Pharmacological Principles and Patient-focused Considerations

An examination of how age, physiological development, and patient-specific factors affect drug absorption, distribution, metabolism, and excretion.

• age related changes in pharmacokinetics
• pediatric drug behavior and immature organs
• impact of gastric pH on absorption
• total body water and drug distribution
• immature blood-brain barrier
• liver enzyme production and metabolism
• kidney immaturity and drug excretion
• drug related concerns during pregnancy and lactation
• socioeconomic status impacts on pharmacotherapeutics
• ethno-cultural considerations in drug therapy

Legal and Ethical Principles of Medication Practices

An overview of the authority, standards, and responsibilities involved in medication practices, including prescription authority and nursing competence.

• Medication practices management and use
• Authority to engage in medication practices
• CNO practice standard for medication
• Risks of drug diversion
• Medication administration and dispensing
• Controlled drugs and substances act
• Liability for nurses regarding drug therapy

Pain Classification and Pharmacological Management

Pharmacotherapeutics for pain management involves the use of nonopioids, opioids, and miscellaneous drugs to address acute and persistent pain.

• Acute pain
• Persistent pain
• Nociception
• WHO pain ladder
• Neuropathic pain
• Referred pain
• Phantom pain
• Cancer pain
• Central pain
• Vascular pain
• Opioid analgesics
• Adjuvant drugs

Pharmacotherapeutics for Anti-infectives

Principles of antibiotic therapy, bacterial characteristics, antimicrobial stewardship, and clinical management of infections.

• Bacterial morphology
• Gram staining
• Empiric therapy
• Definitive/Targeted therapy
• Prophylactic therapy
• Antimicrobial stewardship
• Superinfection
• Therapeutic drug monitoring
• Antibiotic resistance

Cardiovascular System Dyslipidemia Overview

An overview of cholesterol homeostasis, lipid profiles, and risk assessment for primary and secondary prevention of coronary artery disease.

• Cholesterol homeostasis
• LDL vs HDL cholesterol
• Standard Lipid Profile
• Total Cholesterol
• Low-density lipoprotein
• High-density lipoprotein
• Triglycerides
• Lipoprotein (a)
• Primary prevention
• Secondary prevention
• Non-pharmacological interventions
• Statin indicated conditions
• Framingham Risk Score

Dyslipidemia Medications and Treatment Options

This content covers dyslipidemia treatment options, including HMG-CoA reductase inhibitors, their mechanism of action, adverse effects, and nursing considerations.

• Dyslipidemia
• HMG-CoA reductase inhibitors
• Statins
• Bile acid sequestrants
• PCSK9 Inhibitor
• Fibrates
• Ezetimibe
• Mechanism of action
• Triglycerides
• Adverse effects
• Myopathy
• Rhabdomyolysis
• Drug interactions
• Nursing considerations
• Canadian Cardiovascular Society guidelines

Cardiovascular System Hypertension Overview

This content discusses the prevalence, sequelae, causes, and goals of therapy for hypertension.

• Prevalence of HTN in Canada
• Cerebrovascular disease
• Dementia
• Retinopathy
• Coronary artery disease
• Heart failure
• Atrial fibrillation
• Chronic Kidney Disease
• Peripheral arterial disease
• Erectile dysfunction
• Essential hypertension
• Secondary hypertension
• Malignant hypertension
• Substances that may cause hypertension
• Goals of therapy

Cardiovascular System: Angina Overview

• Atherosclerosis
• Coronary Artery Disease (CAD)
• Ischemic Heart Disease
• Myocardial Infarction
• Infarction
• Nitrates
• Nitroglycerin
• Venous Vasodilation
• ß-Blockers
• Calcium Channel Blockers
• Myocardial oxygen demand
• Preload

• Cardiovascular System: Angina and Myocardial Infarction

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Coagulation Modifier Drugs and Hemostasis

This content explores hemostasis, the coagulation cascade, the fibrinolytic system, and the mechanisms of various anticoagulant medications.

• Hemostasis
• Coagulation cascade
• Intrinsic and extrinsic pathways
• Thrombus
• Embolus
• Fibrinolysis
• Plasminogen and plasmin
• Anticoagulants
• Low-molecular-weight heparins
• Thromboembolic events

Warfarin Mechanism and Clinical Management

Warfarin inhibits Vitamin K to decrease clotting factors and requires careful INR monitoring due to various drug interactions and dietary considerations.

• Warfarin mechanism of action
• Vitamin K inhibition
• INR monitoring
• Therapeutic INR ranges
• Drug interactions
• Vitamin K1 antidote
• Patient education

Mechanisms of Drug Distribution

An overview of how drugs are distributed throughout the body via blood flow, protein binding, cell membrane permeability, and volume of distribution.

• Blood flow and tissue perfusion
• Protein binding to albumin
• Pharmacologically active free drug
• Volume of distribution
• Cell membrane permeability
• Blood-brain barrier
• Lipid-soluble versus water-soluble drugs

Drug Metabolism, Bioavailability, and Excretion

An overview of how the body transforms medications through biotransformation, the influence of the CYP450 enzyme system, and the processes of drug absorption and elimination.

• Drug metabolism and biotransformation
• Cytochrome P-450 enzyme system
• Enzyme inhibitors and inducers
• Drug bioavailability and first-pass effect
• Pharmacokinetics of excretion
• Renal elimination of water-soluble drugs
• Biliary excretion and enterohepatic recirculation

Drug Half-Life and Pharmacodynamics

An examination of drug half-life, steady state, and the study of what a drug does to the body.

• Drug half-life definition
• Steady state physiological state
• Dosing frequency determination
• Drug elimination and absorption
• Pharmacodynamics and mechanism of action
• Rapidly cleared medications
• Slowly eliminated medications

Drug Therapy During Pregnancy and Lactation

An overview of drug transfer to the fetus and infant, considerations for maternal factors, and pharmacokinetics during pregnancy and lactation.

• diffusion across the placenta
• teratogen definition
• fetal gestational age risks
• maternal physiological changes
• pharmacokinetics during pregnancy
• Pregnancy and Lactation Labeling Rule
• drug transfer into breast milk
• risk and benefits of drug therapy

Medication Administration and Safety Practices

Guidelines for nursing competence, medication order components, controlled drug schedules, and safety protocols to prevent medication errors.

• Components of a medication order
• Competence in medication practices
• Expected knowledge for medication administration
• Safety in medication practices
• Controlled drugs and substances regulations
• Controlled drug schedules and descriptions
• High-alert medications
• Risks in medication safety
• Rights of medication administration

Pharmacotherapeutics for Non-Opioid Analgesics

Pharmacologic agents that treat pain without activation of opioid receptors, including acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).

• Non-Opioid Analgesic
• Acetaminophen
• NSAIDs
• COX-1 and COX-2 enzymes
• Prostaglandin synthesis
• Hepatotoxicity
• Ceiling effects
• Celecoxib
• Mechanism of Action

Antibiotic Mechanisms and Beta-Lactam Therapy

Antibiotics function through bactericidal or bacteriostatic mechanisms by targeting cell wall synthesis, protein synthesis, nucleic acid synthesis, or folate metabolism.

• Bactericidal vs Bacteriostatic
• Cell wall synthesis inhibition
• Protein synthesis inhibition
• Nucleic acid synthesis disruption
• Folate metabolism blockade
• Beta-lactam mechanism of action
• Penicillin-binding proteins (PBPs)
• Beta-lactamase resistance
• Penicillin hypersensitivity

Cardiovascular System Heart Failure Overview

Heart failure is a complex clinical syndrome resulting from functional or structural impairment to the heart and inadequate cardiac output due to ventricular dysfunction.

• Heart Failure
• Ventricular dysfunction
• Inadequate cardiac output
• HFrEF (Reduced ejection fraction)
• HFpEF (Preserved ejection fraction)
• Left ventricular ejection fraction (LVEF)

Direct Acting Oral Anticoagulants Overview

Direct Acting Oral Anticoagulants (DOAC) include direct thrombin inhibitors and direct factor Xa inhibitors used for stroke prophylaxis and VTE treatment.

• Direct Acting Oral Anticoagulants (DOAC)
• Direct Thrombin Inhibitor
• Direct factor Xa inhibitors
• Rivaroxaban
• Stroke prophylaxis
• VTE treatment
• Mechanism of Action
• Pharmacokinetics
• Idarucizumab
• Andexanent alpha

ACE Inhibitors and ARBs in Hypertension

Angiotensin-converting enzyme inhibitors and Angiotensin Receptor Blockers act on the RAAS system to manage hypertension, heart failure, and renal protection.

• Angiotensin-converting enzyme (ACE) Inhibitors
• Angiotensin Receptor Blockers (ARBs)
• Mechanism of Action
• Cardioprotective effects
• Renal protective effects
• Hypertension management in Black individuals
• Left ventricular hypertrophy
• Angioedema risk

Mechanisms of Drug Action and Pharmacotherapeutics

This material covers how drugs interact with receptors and enzymes, types of therapeutic responses, and considerations in pharmacotherapeutics.

• Receptor interactions
• Enzyme interactions
• Nonselective interactions
• Intracellular and cell surface receptors
• Agonists and antagonists
• Affinity and drug binding
• Competitive and noncompetitive antagonism
• Enzyme inhibitors and activators
• Therapeutic outcomes of therapy
• Types of therapy
• Therapeutic index
• Drug tolerance and dependence
• Adverse drug events and reactions

Pharmacotherapy Considerations for Older Adult Patients

An examination of physiological changes, pharmacokinetic alterations, and clinical considerations for managing medications in older adults.

• Pharmacokinetics in older adults
• Impact of aging on drug absorption
• Changes in drug distribution
• Metabolism and excretion in aging
• Renal failure and drug excretion
• Beers Criteria for inappropriate medications
• Assessing kidney and liver function
• Nephrotoxic drugs
• Polypharmacy and medication adherence
• Renal dose adjustments

Pharmacokinetics in Older Adults and Pediatric Patients

This material examines pharmacokinetic changes and physiological factors affecting medication administration in older adults and pediatric patients.

• pharmacokinetic changes in older adults
• decreased number of intact nephrons
• monitoring for adverse drug effects and toxicity
• physiologic factors affecting drug absorption
• decreased gastrointestinal motility
• immature liver and kidney function in pediatric patients

Drug Diversion in Healthcare Settings

An overview of drug diversion involving controlled substances, including its risks to patients and healthcare workers, common signs, and prevention strategies.

• Definition of drug diversion
• Risks to patients from drug diversion
• Risks to healthcare workers
• Prevention of drug diversion
• Common signs of drug diversion
• Legal and professional liability for nurses

Pharmacotherapeutics for Pain Management

This topic covers opioid analgesics, adjuvant drugs, and non-pharmacological interventions used to manage moderate to severe pain.

• Opioid Analgesics
• Fentanyl
• Methadone
• Naloxone
• Adjuvant Drugs
• Patient-Controlled Analgesia (PCA)
• Equianalgesic
• Non-pharmacological Interventions

Pharmacology of Major Antibacterial Classes

This topic covers the mechanisms, indications, and adverse effects of beta-lactams, sulfonamides, protein synthesis inhibitors, and tetracyclines.

• Beta-lactam cell-wall synthesis inhibition
• Cephalosporin generations
• Carbapenem broad-spectrum activity
• Sulfonamide folate metabolism blockade
• Ribosomal protein synthesis inhibition (30S and 50S subunits)
• Macrolide CYP450 inhibition
• Tetracycline chelation

Pharmacology of Specific Anti-infective Classes

This content details the mechanisms of action, indications, adverse effects, and nursing implications for tetracyclines, aminoglycosides, fluoroquinolones, vancomycin, clindamycin, metronidazole, and nitrofurantoin.

• Tetracycline chelation
• Aminoglycoside nephrotoxicity and ototoxicity
• Fluoroquinolone QT prolongation
• Vancomycin Red man syndrome
• Metronidazole alcohol intolerance
• Therapeutic drug monitoring trough levels
• Bactericidal vs. Bacteriostatic mechanisms

ACEI and ARB Pharmacological Management

ACEI and ARBs adverse effects, drug interactions, contraindications, and nursing implications including ACE inhibitor-induced cough.

• ACEI/ARBs adverse effects
• Angioedema
• Hypotension
• Dry cough
• Hyperkalemia
• Drug interactions
• Potassium-sparing diuretics
• Lithium
• NSAIDs
• Contraindications
• Bilateral renal artery stenosis
• Bradykinin accumulation
• Nursing implications
• Patient education

• Understanding ACE Inhibitors and ARBs in Cardiovascular Health

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Pharmacology of Calcium Channel Blockers and Beta-Blockers

This content discusses the mechanism of action, indications, adverse effects, drug interactions, and nursing implications for calcium channel blockers and beta-blockers used in hypertension management.

• Calcium Channel Blockers
• Dihydropyridines
• Non-dihydropyridines
• Vasodilation
• Systemic vascular resistance
• Beta-blockers
• Mechanism of action
• Adverse effects
• Drug interactions
• Nursing implications
• Patient education
• Contraindications

Antiplatelet Drugs and Thrombolytic Therapy

This content covers antiplatelet drugs, P2Y12 inhibitors, and thrombolytics used for platelet aggregation, clot breakdown, and treating conditions like ischemic stroke and myocardial infarction.

• Antiplatelet drugs
• Aspirin mechanism of action
• P2Y12 inhibitors
• Clopidogrel metabolism
• Platelet aggregation
• Thromboxane A2
• Adenosine diphosphate
• Thrombolytics
• Fibrinolysis
• Alteplase
• Tenecteplase
• Ischemic stroke reperfusion
• Myocardial infarction treatment
• Adverse effects of antiplatelets
• Inclusion and exclusion criteria for thrombolytics

Nursing Management of Coagulation Modifiers

Nursing implications for fibrinolytics, heparin therapy, and warfarin administration including monitoring laboratory results and managing bleeding risks.

• Nursing implications for fibrinolytics
• Warfarin administration
• Monitoring aPTT and PT/INR
• Bleeding risk management
• Pulmonary emboli management
• Vitamin K administration
• Hypersensitivity reactions