Cardiovascular Drugs

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Cardiovascular Drugs
2013-07-14 18:34:12

For EKG/Telemetry
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  1. cardiac glycosides
    • digitalis
    • lanoxin (digoxin)
    • can be given PO of IV
  2. digitalis
    • derived from the foxglove plant 
    • has been used for over 400 years to treat symptoms of heart failure
  3. Lanoxin
    • a trademark for the drug digoxin
    • used to treat heart failure
  4. Lanoxin MOA
    1. Positive inotropic action - increases stregth of myocardial contraction causing increase in COP and decrease in O2 demand.2. Negative chronotropic action - decreases HR by decreasing impulse formation is the SA node. It indirectly simulates the vagus nerve. Together these actions lead to a decrease in compensatory tachycardia (sympathetic nervous system).3. Negative dromotropic action - slowed conduction of impulses through the AV node.
  5. Lanoxin uses
    CHF to treat sx of decreased COP, A-fib, A flutter
  6. Lanoxin adverse effects
    • Anorexia, N,V,D, fatigue,dizziness,visual disturbances (yellow vision, blurred vision, seeing halos around lights,double vision.)
    • These are helpful in dx of toxic levels. Dose reductions may be necessary due to decreased renal function in the elderly.
  7. digoxin
    • the generic name of Lanoxin
    • Digoxin has a narrow therapeutic range (0.5-2.0ng/ml). Levels are drawn just prior to a dose. Doses should be given at the same time each day.
  8. digoxin nursing measures
    • Take apical pulse for a full minute prior to each dose. Hold drug and notify HCP if pulse < 60. Be aware of factors that predispose to toxicity - hypokalemia, hypercalcemia, hypoxia related to heart of lung disease, and renal or liver disease.
    • Quinaglute and other antiarrhythmic drugs,calcium salts and calcium channel blockers,adrenergic drugs, and anticholinergic when given with digoxin cause increased digoxin levels.
    • Digoxin may have to be decreased by 50% when given with quinidine or amidrine and 25% for calcium channel blockers.
    • Antiacids, Questran (cholestyramine), laxatives, and neomycin decrease effects of oral digoxin.
    • Instruct patient regarding: Take pulse before each dose,take same time each day, do not double dose if misses a dose,report adverse effects,report weight gain of more than 1lb. per day or more than 3lbs. per week.
    • Antidote: Digibind
  9. antiarrhythmic drugs
    • This class of drugs alter the conduction
    • of electrical impulses in the heart and are primarily used for tachydysrhythmias.
    • Research has shown that patients treated for some dysrhythmias had a higher death rate than those who did not receive the therapy. These deaths were attributed to the effects of the drugs worsening existing dysrhythmias or causing new dysrhythmias.
    • These studies have lead to a decrease in use of some of these class I drugs (quinidine) and higher use of class II drug (beta blockers) and class III drugs (amiodarone).
    • There is now greater use of radiofrequency catheter ablation, surgically implanted cardioverter-defibrillators (ICDs).
  10. antiarrythmic drugs uses
    • Convert A-fib or flutter to NSR.
    • Maintain NSR after conversion from a-fib or flutter.
    • When ventricular rate is so fast that decreased COP leads to sx of decreased systemic, cerebral and coronary circulation.
    • To terminate dangerous dysrhythmias that may be fatal such as ventricular tachycardia.
  11. class 1 antidysrhythmias:class 1a
    • Quinaglute (quinidine) prototype for class 1a
    • Norpace (disopyramide)
    • Pronestyl (procainamide)
  12. class 1 antidysrhythmias class 1a uses
    symptomatic PVCs, SVT, V tach, prevent vfib.
  13. class 1 antidysrhythmias class 1b
    Xylocaine (lidocaine) prototype for class 1b
  14. class 1 antidysrhythmias class 1b uses
    symptomatic PVCs, V tach,prevent v-fib.
  15. Quinaglute (quinidine) adverse effects
    N,V,D, hearing loss,tinnitus,visual disturbances.
  16. Quinaglute (quinidine) Nursing Measures
    Inform all HCPs that patient is taking the drug. Report adverse effects and feeling faint (V-tach or fib). Best to take on empty stomach with glass of water, but may take with food if GI sx. Avoid excessive citrus juices because they change urine pH and decrease excretion of quinidine
  17. Pronestyl (procainamide)
    Similar to quinidine
  18. Pronestyl (procainamide) Adverse
    Anorexia, N, hypotension (IV), SLE like syndrome, V fib.
  19. Pronestyl (procainamide) Contraindications
    Allergy to procaine, 2nd or 3rd degree heart block, liver or renal disease.
  20. Pronestyl (procainamide) Nursing Measures
    • Give with food, avoid hazardous activities until effects are
    • known, avoid OTC drugs.
  21. Norpace (disopyramide)
    Similar to quinidine
  22. Norpace (disopyramide) Adverse Effects
    Dizziness, fatigue, HA, blurred vision, dry mouth, CHF, arrhythmias, hypotension, constipation, N, urinary retention, hypoglycemia.
  23. Norpace (disopyramide) Contraindications
    Cardiogenic shock, 2nd and 3rd degree blocks, sick sinus syndrome w/o pacemaker.
  24. Norpace (disopyramide) Interactions
    Many - cimetidine, warfarin, erythromycin, dilantin, etc.
  25. Xylocaine (lidocaine)
    • Local anesthetic, drug of choice for treating serious ventricular arrhythmias. Decreases myocardial irritability in the ventricles, but has little or no effect on the artria.
    • Differs from quinidine in that: Always given IV, no decrease in AV conduction or cardiac contractility in therapeutic doses, rapid onset, 1to2 minutes, and short duration, 20 min, of action, it is less likely to cause heart blocks, asystole, heart failure or arrhythmias.
  26. Lidocaine Adverse Effects:
    Drowsiness, tinnitus, blurred or double vision, anaphylaxis, seizures.
  27. Lidocaine Contraindications:
    Allergy to local anesthetics, heart blocks.
  28. Lidocaine Nursing Measures:
    • Ensure correct preparation and dose prior to
    • administration. Monitor EKG.
  29. Anticoagulants
    • Anticoagulants prevent formation of new clots and the extension of existing clots. They do not dissolve clots, improve blood flow to tissues, or prevent damage from ischemia
    • to tissues beyond the clot.
  30. Anticoagulants Uses:
    Prevention or management of thrombophlebitis, DVT, or pulmonary embolism.
  31. Anticoagulants Adverse Effects
  32. Heparin  Uses
    • Prevention and management of thromboembolic disorders, DVT, PE, and Afib with embolization.
    • a blood thinner
  33. Heparin MOA:
    Prevents the ultimate formation of fibrin in stage III of the clotting mechanism. Antagonizes thrombin and prevents conversion of fibrinogen to fibrin.
  34. Heparin Adverse Effects
    Bleeding – hematuria, nose bleeds, rash, alopecia, thrombocytopenia (decreased platelets, can be very severe).
  35. Heparin Contraindications
    Bleeding disorders, recent surgery, renal or liver disease. Pregnancy cat. C. Does not cross placenta.
  36. Heparin Route
    Given subcutaneously or IV.
  37. PTT and INR
    PTT (partial thromboplastin time) and INR (international normalized ratio) are labs used to evaluate therapeutic effect. Dose is adjusted based on these tests.
  38. Heparin Antagonist/Antidote:
    Protamine sulfate
  39. Heparin Nursing Measures
    Teach to wear or carry ID and notify all HCPs that he is taking drug. Smoking and alcohol may alter response to drug. Avoid ASA, NSAIDS, & OTC drugs w/o consulting HCP. May increase menstrual flow. Alopecia is reversible. Should be able to carry out normal activities such as shaving because it does not affect bleeding time when platelets are normal.
  40. Coumadin (warfarin) Uses:
    DVT, PE, A-fib, prosthetic valves prophylaxis.
  41. Coumadin (warfarin) MOA:
    Indirectly interferes with the hepatic synthesis of Vitamin K-dependent coagulation factors (II, VII, IX, X).
  42. Coumadin (warfarin) Adverse Effects:
    Bleeding, purple toe syndrome (microemboli to toes).
  43. Coumadin (warfarin) Contraindications:
    Pregnancy Cat. D (never use in first trimester), liver disease.
  44. Coumadin Nursing Measures
    • PT (prothrombin time) and INR are labs used to determine therapeutic effecs. Avoid IM injections while on Coumadin.
    • Teach patient regarding: Purpose, dose and S/S of adverse effects. Avoid all alcohol and excessive intake of foods high in Vit. K.
    • Carry ID & notify all HCPs he is taking drug.
  45. Coumadin Antidote
    Vitamin K
  46. Lovenox (enoxaparin)
    Low molecular weight heparin.
  47. Lovenox (enoxaparin) Uses
    Prevention and management of DVT and PE. Management of unstable angina, to prevent MI.
  48. Lovenox (enoxaparin) Adverse Effects:
    • Less thrombocytopenia than standard heparin. Can be used for outpatient therapy because they do not require close monitoring of labs.
    • Platelet counts should be monitored.
  49. Lovenox (enoxaparin) antidote
    protamine sulfate
  50. Antiplatelet Drugs
    • Antiplatelet effect lasts for the life of the platelet, 7-10 days.
    • Aspirin is an example
  51. Antiplatelet Drugs Uses
    • Long term for prevention of MI or CVA and for patients with prosthetic heart valves.
    • Immediate treatment for MI, TIA, or thrombotic CVA.
  52. antiplatelet drugs adverse effects
    • Low with therapeutic doses.
    • Bleeding and hemorrhagic strokes.
  53. antiplatelet drugs nursing measures
    teach to report GI irritation or signs of bleeding
  54. Thrombolytic Drugs Uses
    To dissolve thrombi in MI, CVA, and iliofemoral thrombosis and to dissolve clots in IV catheters.
  55. Thrombolytic Drugs MOA
    Stimulate the conversion of plasminogen to plasmin, a proteolytic enzyme that breaks down fibrin which is the framework of a clot.
  56. Thrombolytic Drugs Examples
    Urokinase and streptokinase. Urokinase can be used for patients who are allergic to streptokinase.
  57. Thrombolytic Drugs advers effects
  58. Antianginal Drugs
    • Relieve angina pain by reduction in myocardial O2 demand and increasing blood supply to the myocardium.
    • Nitrates, beta blockers and calcium channel blockers are used.
  59. Antianginal Drugs nitrates
    Nitroglycerine (prototype), Nitro-bid, Isordil
  60. Antianginal Drugs MOA
    Reduce PVD (afterload) results in decreased systolic BP which reduces workload of the heart. Reduce venous pressure and venous return to the heart which decreases volume and pressure in the heart (preload) which reduces O2 demand. At higher doses they dilate coronary arteries and increase blood flow to the heart muscle.
  61. Nitrates Routes
    Has a short half-life of 1-5 min. regardless of route. Sustained release oral or transdermal patch is used for prevention. PO – act slowly, used for prevention. Sublingual – acts within 1-3 min. and last for 30-60 min. Used for acute attacks and to prevent exercise induced angina. Transdermal - effective for 12 hours. IV is used when other agents are not effective.
  62. Nitroglycerine
    Patches must be removed for 10-12 hours each night to prevent nitrate tolerance.
  63. Nitroglycerine adverse effects
    HA, dizziness, hypotension, and tachycardia.
  64. Nitroglycerine contraindications
    Current use of Viagra, severe anemia.
  65. nitroglycerine interactions
    Viagra, antihypertensives, alcohol, haldol, anticholinergics.
  66. Nitroglycerine nursing measures
    Teaching restorage, safety, use of different preparations.
  67. Beta Blockers Examples
    Inderal, Tenormin, Lopressor, Corgard
  68. Beta Blockers MOA
    Decrease sympathetic stimulation to decrease HR and myocardial contractility, especially during increased exercise decreasing need for SL nitroglycerine. Also reduce BP which decreases workload of heart and O2 demand.
  69. Beta Blockers Uses
    Angina, hypertension, etc.
  70. Beta Blockers Contraindications
    Vasospastic Angina because they may increase frequency and severity of vasospasms.
  71. Calcium Channel Blockers Examples
    Cardizem (diltiazem), Calan (verapamil)
  72. Calcium Channel Blockers MOA
    Improve blood supply to heart muscle by dilating coronary vessels and decrease the workload of the heart by dilating peripheral vessels which lowers BP. They reduce coronary artery spasm. Verapamil and Calan are the only CCBs that slow the ventricular response to A-fib, flutter and SVT.
  73. Calcium Channel Blockers Uses
    Angina, hypertension, etc.
  74. Calcium Channel Blockers Contraindications
    2nd or 3rd degree blocks, cardiogenic shock, severe bradycardia, heart failure, hypotension.
  75. Calcium Channel Blockers
    CCB can be monotherapy, but are frequently used in combination with beta blockers.
  76. Antihyperlipidemics
    • Agents to decrease blood lipid levels. They are adjunct in antianginal therapy.
    • Bile Acid Sequestering Agents
  77. Antihyperlipidemics examples
    Questran (cholestyramine)
  78. Antihyperlipidemics MOA
    Decreases LDL levels by absorbing and combining with bile acid salts in the intestines to form an insoluble, nonabsorbable complex that is excreted in the feces.
  79. Antihyperlipidemics uses
    Decrease LDL
  80. questran adverse effects
    • GI sx which usually subside by a month, increased bleeding tendency. Decreases absorption of many drugs. Long term use may result in deficiencies of
    • fat soluble vitamins – A,D,E,K and Ca.
  81. questran nursing measures
    Give other meds 1 hour before or at least hours after. Dissolve in flavored liquids or semisolid foods to disguise taste. Teach S/S bleeding, need for Ca and vitamin supplements with long term use.
  82. Fibric Acid Derivatives examples
    Lopid (gemfibrozil)
  83. Fibric Acid Derivatives MOA
    Unclear, but decreases Triglycerides and VLDL, increases HDL, cholesterol may increase or decrease.
  84. Fibric Acid Derivatives uses
    Decrease triglycerides, decrease LDL is secondary effect.
  85. Fibric Acid Derivatives adverse effects
    • Myalgias, impaired liver function, gall stones, abd. pain, N, D.
    • Less hyperglycemic effect, best for diabetics.
  86. Fibric Acid Derivatives teach:
    • Restrict alcohol, fats, chol, and
    • sugar.
  87. HMG-CoA Reductase Inhibitors (statins) examples
    Zocor, Mevacor, Lipitor, Pravachol
  88. HMG-CoA Reductase Inhibitors (statins) MOA
    Inhibit HMG-CoA reductase, an enzyme essential in synthesis of cholesterol. Lower LDL and VLDL and triglycerides, and increase HDL. Many health benefits unrelated to lipids.
  89. HMG-CoA Reductase Inhibitors (statins) uses
    Decrease LDL in hypercholesterolemia/hypertriglyceridemia
  90. HMG-CoA Reductase Inhibitors (statins) adverse effects
    Myalgias, liver damage, HA, rash, GI sx.
  91. HMG-CoA Reductase Inhibitors (statins) nursing measures
    Monitor labs, give in evening, teach compliance with diet and sx to report.
  92. Antihypertensives
    • Review: Pathophysiology of hypertension
    • Antihypertensives work in three basic ways to decrease BP.
    • 1. Decrease fluid volume, diuresis.
    • 2. Decrease HR
    • 3. Decrease PVR
    • There are different classes that work in different ways. They may be used alone or in combinations.
  93. Central Sympatholytic (Central Acting Adrenergic Inhibitors) example
    Catapress (clonidine)
  94. Central Sympatholytic (Central Acting Adrenergic Inhibitors) MOA
    Stimulates alpha receptors in brain to inhibit peripheral sympathetic activity resulting in vasodilatation (decreased PVR) and decreased BP. Reduces HR.
  95. Central Sympatholytic (Central Acting Adrenergic Inhibitors) uses
    Hypertension. Off-label: Migraine prophylaxis, drug withdrawal sx.
  96. Central Sympatholytic (Central Acting Adrenergic Inhibitors) adverse effects
    • depression
    • Avoid alcohol & CNS depressants, gradual withdrawal to prevent rebound hypertension.
  97. Alpha-Adrenergic Blockers example
    Hytrin (terazosin) Minipress (prazosin)
  98. Alpha-Adrenergic Blockers MOA
    Decreases PVR and lowers BP by selectively blocking the alpha 1 adrenergic receptors in vascular smooth muscle.
  99. Alpha-Adrenergic Blockers uses
    Hypertension. Off-label: Urinary flow obstruction in BPH.
  100. Alpha-Adrenergic Blockers adverse effects
    Severe orthostasis, especially first dose – give at bedtime.
  101. Alpha-Adrenergic Blockers nursing measures
    standing BP
  102. Beta Adrenergic Blockers examples
    Tenormin (atenolol), Inderal (propanolol), Lopressor (metoprolol)
  103. Beta Adrenergic Blockers MOA
    Non-selective blockers of beta 1 and beta 2 receptors by competing with epinephrine and NE for available beta receptor sites. Lower COP and BP by decreasing HR, force of contraction and renin release from the kidneys.
  104. Beta Adrenergic Blockers uses
    Hypertension, angina, prevent 2nd MI, tachyarrythmias. Off-label: Migraine prophylaxis, antianxiety, acute panic sx.
  105. Beta Adrenergic Blockers contraindications
    CHF, COPD, Asthma (may cause bronchospasms), heart block > 1st degree. Caution: Diabetes (blocks sx of hypoglycemia).
  106. Beta Adrenergic Blockers nursing measures
    Teach that abrupt withdrawal may lead to angina, MI or death.
  107. ACE Inhibitors examples
    Quinipril (accupril), Capoten (captopril), Vasotec (enalapril), Lotensin (benaepril)
  108. ACE Inhibitors MOA
    Block the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor by specific inhibition of the angiotensin converting enzyme. This results in decreased PVR.
  109. ACE Inhibitors uses
    Hypertension, Used after MI if ejection fraction < 40, protects diabetics from renal failure.
  110. ACE Inhibitors adverse effects
    Dry cough, angioneurotic edema, hyperkalemia, ARF.
  111. ACE Inhibitors contraindications
    Pregnancy – renal failure in infants, renal impairment.
  112. ACE Inhibitors nursing measures
    Instruct regarding need for return to have K drawn.
  113. Vasodilators examples
    Apresoline (hydralazine), Nipride (nitroprusside), Nitroglycerine.
  114. Vasodilators MOA
    Vasodilators cause a direct relaxation of vascular smooth muscle to decrease PVR and lower BP. There are two types: arteriolar dilators and venous dilators.
  115. Vasodilators uses
    • Hypertension, angina
    • They are usually given with a beta blocker to prevent hypotension-induced compensatory mechanisms of tachycardia and fluid retention that raise BP.
  116. Calcium Channel Blockers examples
    Cardizem (diltiazam), Calan (verapamil), Procardia (nifedipine)
  117. Calcium Channel Blockers MOA
    • Selectively block Ca ions from crossing cell membranes in cardiac and vascular smooth muscles without affecting serum Ca levels. They relax and prevent coronary artery spasm and reduce myocardial O2 use and may reduce HR by slowing conduction through SA & AV nodes. Cause vasodilatation of
    • coronary and peripheral vessels.
  118. Calcium Channel Blockers uses
    • Hypertension, Angina (verapamil and diltiazem), SVT, cerebral spasm in SAH (nimodipine). Off-label: Migraine prophylaxis
    • Most effective in blacks and elderly.
  119. Agents for Anemia
    • Iron deficiency anemia is a symptom, not a disease. The cause should always be investigated, especially in men.
    • 80% of iron in the plasma goes to the bone marrow for use in erythropoesis – manufacture of RBC.
    • When iron stores are low, iron absorption increases by 20-30%. When iron stores are high the rate of absorption is 5-10%.
  120. Ferrous Sulfate
    • It is the gold standard.
    • Cheapest, just as effective as any.
  121. Ferrous Sulfate MOA
    Corrects erythropoetic abnormalities caused by iron deficiency. Does not stimulate erythropoesis.
  122. Ferrous Sulfate uses
    iron deficiency anemia
  123. Ferrous Sulfate adverse effects
    Generally mild in therapeutic doses. N, heartburn, constipation or diarrhea.
  124. Ferrous Sulfate contraindications
  125. Ferrous Sulfate absorption
    Better absorption on empty stomach – give with food for GI sx. Stains teeth. Milk, eggs and caffeine decrease absorption. Vit.C ncreases absorption.
  126. Imferon (iron dextran)
    Given IV or IM by Z tract.
  127. Imferon (iron dextran) uses
    Severe iron deficiency anemia
  128. Imferon (iron dextran) adverse effects
    • Anaphylaxis, stains tissues
    • Builds iron stores faster, but does not correct anemia any faster than oral iron.
  129. Imferon (iron dextran) nursing measures
    Skin test prior to IV dose. Test dose prior to IM. Give in dorsolateral. Change needle after drawing up med., use air lock. Monitor for adverse effects for 24 hr.
  130. Vitamin B 12 (cyanocobalamin) MOA
    Activates folic acid enzymes that are necessary for synthesis of RBC.
  131. Vitamin B 12 (cyanocobalamin) uses
    Pernicious anemia (IM). Arrests disease, does not reverse it.
  132. Vitamin B 12 (cyanocobalamin) nutritional supplement
    Must have intrinsic factor to absorb PO.
  133. Vitamin B 12 (cyanocobalamin) adverse effects
    Transient itching and pain at site, optic nerve atrophy, CHF.
  134. Overview of Four ACLS Algorithm Protocols
    IV Push, intravenous infusion, endotracheal administration, and use of algorithms
  135. IV Push
    • Route of most medications used
    • Convenient
    • Fast onset of action
    • Immediate bioavailability
  136. Intravenous Infusion: Medications for continuous infusion only
    • P – procainamide
    • I – isoproterenol
    • N – norepinephrine
    • D – dopamine
  137. Intravenous Infusion: Medications given IV push or infusion
    • A – amiodarone
    • L – lidocaine
    • E – epinephrine
  138. Endotracheal Administration
    • Tracheal administration of medications:
    • L – lidocaine (2-4 mg/kg)
    • E – epinephrine (2-2.5 mg)
    • A – atropine (2-3 mg)
    • N – naloxone (0.8-1.6 mg)
    • Doses usually 2-2.5 times those given IVP
    • Follow each dose with 10 ml NS; flush down tracheal tube if not diluted to that volume for administration
  139. Use of Algorithms
    • Meant to treat broadest range possible of patients
    • Meant to be good memory aids
    • Meant to be used “wisely,” not blindly
    • Not meant to replace clinical judgment