Cardiac

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Author:
CharlieSCC
ID:
183307
Filename:
Cardiac
Updated:
2012-11-12 22:09:04
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Cardiac med drugs
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Description:
Cardiac Drug Therapy
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  1. Nitroglycerin Sublingual

    Implications
    • Check BP/P prior - notify dr systolic >90-100
    • Give sip H2O
    • Under Tongue
    • Check BP/P q 5 Min administer another if needed up to 3
    • give no more than 3X
    • DO NOT LEAVE patient
    • 1 - 2 min for relief
    • Spray is more rapid 30 sec - 1 min
    • drink H2O before and 5 - 15 min after last
  2. Nitroglycerin long term prevention
    • Ointment - special paper
    • Apply to non hairy surface - don't shave
    • DO NOT rub
    • rotate sites
    • wear gloves
    • transdermal patch - aplly same time each day
  3. Nitroglycerin

    Name
    • Nitro-Bid
    • Isordil-pro

    isorbide (generic)
  4. isorbide
    generic for Nitroglycerin topical (prevention)
  5. Nitro-Bid
    Nitroglycerin transdermal
  6. Isordil-pro
    Nitroglycerin transdermal
  7. Nitroglycerin

    Side Effects
    • HA
    • Hypotension
    • Dizziness
    • Tachycardia - compensatory for hypotension
    • Dry mouth
  8. Beta Adrenergic Blocking Agents (“Beta Blockers”)
    Inderal (propranolol); Tenormin (atenolol)-  “olol”
  9. Beta Adrenergic Blocking Agents (“Beta Blockers”)
    Check BP & P before giving- hold if BP < 90; pulse < 60

    Used when nitrates alone to not prevent angina- NOT for acute angina

    Blocks SNS stimulation- decreased HR, decreased myocardial contraction, decreased BP = decreased myocardial O2 demand

    Decrease frequency & severity of angina

    Decrease need for SL Nitro

    Increase exercise tolerance

    SE: hypotension, bradycardia, CHF, bronchoconstriction, impotence
  10. Beta Adrenergic Blocking Agents (“Beta Blockers”)

    Side Effects
    SE: hypotension, bradycardia, CHF, bronchoconstriction, impotence
  11. Calcium Channel Blockers
    Procardia (nifedipine); Calan, Isoptin (verapamil)
  12. Calcium Channel Blockers

    Procardia (nifedipine); Calan, Isoptin (verapamil)
    If angina, improves blood supply to myocardium by dilating coronary arteries; decreased workload of heart by dilating peripheral arteries

    Prevents movement of extracellular Ca++ into cells: coronary & peripheral arteries to be dilated, decreased myocardial contractility; slows AV node conduction
  13. Calcium Channel Blockers

    Procardia (nifedipine); Calan, Isoptin (verapamil)

    Side effects
    SE: hypotension, dizziness, lightheadedness, weakness   HA, edema, CHF
  14. Activity level for Client with CAD/Angina
    Minimize precipitating events

    Smoking cessation

    Engage in regular exercise

    Wt reduction

    • Avoid caffeine
    • Regular medical followup
  15. Medical Treatment of MI
    Morphine
  16. Medical Treatment of MI
    24-48 hours in CCU to telemetry


    Promote healing through rest & decreased O2 demands of myocardium

    Morphine

    Reperfusion of occluded coronary artery
  17. Medical Treatment of MI

    Aspirin
    Aspirin given in ER or ambulance- chew for buccal absorption; antiplatelet effect
  18. Thrombolytics- fibrinolytic

    Medical Treatment of MI
    Given within 3-5 hours after onset of MI

    "clot buster”

    Dissolve clot- thrombi

    Acts by stimulating conversion of plasminogen to plasmin. Plasmin is a proteolytic enzyme that breaks down the fibrin framework of the thrombus

    Goal: re-establish blood flow & prevent or limit tissue damage

    Streptase (streptokinase); t-PA (tissue plasminogen activator (alteplase)

    SE: Bleeding- internal or external

    Must be given by specially trained personnel
  19. Thrombolytics- fibrinolytic

    Medical Treatment of MI
    Streptase (streptokinase)

    t-PA (tissue plasminogen activator (alteplase)
  20. Medical Treatment of MI

    Thrombolytics- fibrinolytic

    Streptase (streptokinase)

    t-PA (tissue plasminogen activator (alteplase)

    Side Effects
    SE: Bleeding- internal or external
  21. Anticoagulants
     Heparin

    Coumadin (warfarin)
  22. Anticoagulants

    Heparin
    given IV or subq: inactivates clotting factors & thrombin so that thrombus formation is prevented.

    Does NOT dissolve existing thrombus. Prevents it from getting larger until body can absorb.

    Check PTT daily.

    Antidote: Protamine Sulfate
  23. Anticoagulants

    Heparin

    Antidote
    Protamine Sulfate
  24. Anticoagulants

    Coumadin (warfarin)

    Antidote
    Antidote: Vitamin K
  25. Anticoagulants

    Coumadin (warfarin)
    given po: acts in liver to prevent synthesis of Vit K dependent clotting facts.

    Inhibits blood clotting mechanism.

    Protects against clot formation. Long term anticoagulation.

    Check PT/INR.

    Antidote: Vitamin K
  26. Anticoagulants

    Heparin

    Coumadin (warfarin)

    Side Effects
    Bleeding!!
  27. Anticoagulants

    Heparin

    Coumadin (warfarin)

    Implications
    Soft toothbrush, electric razors, medic alert bracelet.

    Don’t give ASA & Coumadin/Heparin until specifically ordered by DR.
  28. Antiplatelets
     Aspirin

    Ticlid (ticlopidine); Plavix (clopidogrel)- decreases platelet aggregation
  29. Ticlid (ticlopidine)
    Antiplatelet

    decreases platelet aggregation, prevents MI & CVA

    Usually once/day dosing if not on other antiplatelet or anticoagulant

    Do NOT crush enteric coating; give with food if not enteric coated

    Monitor for GI bleeding

    Monitor CBC for leukopenia; liver function

    Nursing Care & Teaching for client post MI
  30. Plavix (clopidogrel)
    Antiplatelet

    decreases platelet aggregation, prevents MI & CVA

    Usually once/day dosing if not on other antiplatelet or anticoagulant

    Do NOT crush enteric coating; give with food if not enteric coated

    Monitor for GI bleeding

    Monitor CBC for leukopenia; liver function

    Nursing Care & Teaching for client post MI
  31. Medications for CHF
    • Cardiotonic- Inotropic Cardiac Glycoside
    •        - Digoxin (Lanoxin)
  32. Digoxin (Lanoxin)
    • Cardiotonic- Inotropic Cardiac Glycoside
    •       for CHF
  33. Cardiotonic- Inotropic Cardiac Glycoside

    Digoxin (Lanoxin)
    Slows and Strengthens heart

    Increases myocardial contractility

    Exchange of Ca and Na into myocardial cells

    Improve CO quickly
  34. Acute CHF
    Loading dose

    Digitalis Toxicity

    • Dig Level: 0.5-2.0 Therapeutic
    •        Toxic: > 2.5

    Hypokalemia: Potentiates Digitalis

    Elderly

    Symptoms: Bradycardia, Anorexia, N/V, Confusion, Irritability, Vision changes
  35. Acute CHF

    Symptoms
    Bradycardia

    Anorexia

    N/V

    Confusion

    Irritability

    Vision changes
  36. Side Effects of Digoxin
    Bradycardia

    Dysrhythmias

    Anorexia

    N/V
  37. Medications for CHF

    Cardiotonic- Inotropic Cardiac Glycoside

    Digoxin (Lanoxin)

    Implications
    Check AP before giving

    Hold if < or = 60, call Dr

    Check Dig level, K+ level

    Monitor for SE

    Don’t give with antacids/laxatives
  38.  Diuretics - CHF
    Thiazides (chlorothiazide, hydrothiazide)

    Loop diuretics (furosemide, bumetanide)
  39. Thiazides (chlorothiazide, hydrothiazide)

    Loop diuretics (furosemide, bumetanide)
    CHF  Diuretics
  40. CHF Diuretics

    Thiazides (chlorothiazide, hydrothiazide)

    Loop diuretics (furosemide, bumetanide)
    Used for CHF to decrease Cardiac Workload by decreasing circulating blood volume

    Severe CHF or other Tx not effective

    Monitor for hypokalemia- dig toxicity, dysrhythmias
  41. CHF Diuretics

    Thiazides (chlorothiazide, hydrothiazide)

    Loop diuretics (furosemide, bumetanide)

    adverse reactions
    Increased Na & H2O excretion- dehydration

    Hypokalemia- muscle weakness, confusion, irritability, anorexia, bradycardia, dig tox

    Volume depletion- orthostatic hypotension

    Glucose intolerance
  42. CHF Diuretics

    Thiazides (chlorothiazide, hydrothiazide)

    Loop diuretics (furosemide, bumetanide)

    Implications
    I&O, Daily Wt

    Monitor postural BPs

    Monitor K+ levels

    Hyperkalemia- confusion, muscle cramps, dysrhythmias, arrest

    K+ rich foods- bananas, potatoes, OJ, tomatoes, raisins
  43. CHF Diuretics

    Thiazides (chlorothiazide, hydrothiazide)

    Loop diuretics (furosemide, bumetanide)

    Lab Assessments
    Serum Electrolytes- Na, K

    BUN

    Blood glucose levels

    Hct- fluid balance
  44. ACE Inhibitors
    Enalapril (Vasotec)

    Lisinopril (Prinivil, Zestril)

    Captopril (Capoten)
  45. Enalapril (Vasotec)

    Lisinopril (Prinivil, Zestril)

    Captopril (Capoten)
    ACE Inhibitors
  46. MOA of ACE Inhibitors

    Enalapril (Vasotec)

    Lisinopril (Prinivil, Zestril)

    Captopril (Capoten)
    Blocks effects of renin-angiotensin-aldosterone system

    Reduces vasoconstriction

    Reduces Na and H2O retention

    Decreases cardiac workload & edema
  47. NIs of ACE Inhibitors

    Enalapril (Vasotec)

    Lisinopril (Prinivil, Zestril)

    Captopril (Capoten)
    Don’t DC abruptly•

    Monitor BP before and after giving

    Monitor K+ levels

    Safety! Change positions slowly

    • Monitor for
    • orthostatic hypotension

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