Cardiac Vascular Nursing Exam Pharmacology & Medications Flashcards

Which antiplatelet medication's mechanism involves irreversible inhibition of the P2Y12 receptor on platelets?

Answer: Clopidogrel (Plavix)

Clopidogrel is an irreversible P2Y12 ADP receptor antagonist; its active metabolite permanently blocks the receptor, preventing ADP-mediated platelet activation for the platelet's 7–10 day lifespan.

A nurse prepares to administer IV alteplase (tPA) for acute ischemic stroke. Which cardiac history represents an absolute contraindication?

Answer: Any prior intracranial hemorrhage

Prior intracranial hemorrhage is an absolute contraindication to tPA because the fibrinolytic activity dramatically increases risk of re-bleeding into the previous hemorrhage site.

Spironolactone improves outcomes in HFrEF through which pharmacological mechanism beyond its diuretic effect?

Answer: Blocking aldosterone receptors reduces cardiac fibrosis and maladaptive remodeling

Aldosterone promotes cardiac and vascular fibrosis; spironolactone's blockade of myocardial aldosterone receptors reduces interstitial fibrosis and sympathetic activation independent of its diuretic effect.

A patient receiving IV vasopressin for vasodilatory shock develops chest pain. The nurse suspects which complication related to vasopressin's mechanism?

Answer: Coronary vasoconstriction causing myocardial ischemia

Vasopressin (V1 receptor agonist) causes non-selective vasoconstriction including coronary arteries, potentially reducing myocardial perfusion and causing ischemia, especially in patients with CAD.

Which monitoring parameter is most critical for a patient starting sacubitril/valsartan (Entresto) for heart failure?

Answer: Blood pressure and renal function, as hypotension and worsening renal function are primary concerns

Sacubitril/valsartan lowers blood pressure significantly and can reduce renal perfusion; blood pressure and creatinine/potassium levels must be monitored at initiation and dose titration.

Heparin-induced thrombocytopenia (HIT) requires immediate discontinuation of heparin and initiation of which alternative anticoagulant?

Answer: A direct thrombin inhibitor such as argatroban or bivalirudin

HIT causes a prothrombotic state; all heparin products must be stopped and a non-heparin anticoagulant (direct thrombin inhibitor) started immediately to prevent thrombosis despite low platelets.