Cardiac drugs

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  1. Antihypertensives
    • Ace Inhibitors (end in pril)-block conversion of angiotensin I to angiotensin II a vasoconstrictor thus causing vasodilation and decreasing blood pressure. Aldosterone is also blocked and this causes a decrease in sodium and water retention
    • Captopril (capoten)
    • enalapril (vasotec)
    • benazepril (lotensin)
    • Beta-Blockers (end in olol)-prevent sympathetic stimulation of the heart, thus reducing heart rate and contractibility
    • propranolol (inderal)
    • atenolol (tenormin)
    • metoprolol (lopressor)
    • Calcium Channel Blockers-block the calcium into the beta-receptors, decreasing the force of the myocardial contraction, reducing the heart rate
    • veropamil (calon Isoptin)
    • diltiazem (cardizem)
    • nifedipine (procardia)
  2. Actions of antihypertensives
    act on the vascular, cardiac, renal, and sympathetic nervous systems they lower blood pressure, cardiac output and peripheral vascular resistance
  3. Uses for antihypertensives
    • control mild to severe hypertension
    • antianginal
    • hypertensive emergency
  4. Contraindications and percautions to consider when antihypertensives are ordered
    • hypersensitivity
    • artery stenosis; cerebrovascular insufficiency
    • severe bradycardia
    • uncontrolled congestive heart failure, thyrotoxicosis
    • beta blockers can mask symptoms of hypoglycemia in clients with diabetes
    • hepatic and renal dysfunction
  5. Side effects of antihypertensives
    • hypotension, sedation, sexual dysfunction
    • calcium channel blockers-bradycardia, peripheral edema, constipation
    • beta blockers-bradycardia, decreased AV conduction, reduced cardiac contractility, bronchoconstriction
  6. Nursing implications to consider when administering antihypertensives
    • monitor vital signs
    • initial drug selection starts with a thiazide diuretic, typically followed by a beta-adrenergic blockers or an ACE inhibitor or Calcium channel blocker
    • teach client about orthostatic hypotension for initial dosing (e.g., get up slowly) and other lifestyle changes- weight reduction, sodium restrictions, and daily exercise
    • monitor electrolyte, hepatic, and renal serum blood studies
    • avoid abrupt withdrawal of drug as it may cause rebound phenomenon of excessive rise in BP
    • do not double up on doses if you miss a dose
    • avoid over the counter medications
    • take caution in hot weather, hot showers, hot tub baths, or prolonged sitting or standing because these may aggravate low blood pressure
    • teach about multi drug therapy and not to discontinue previous antihypertensive medication when another is started unless directed to do so
  7. Beta-Blockers (end in olol)
    Propranolol (inederal)
    atenolol (tenormin)
    metoprolol (lopressor)
    • Action: blocks beta-receptors in the heart causing decreased heart rate, force of contraction, rate of AV conduction. Also blocks receptors in the lungs and can cause bronchoconstriction
    • Uses: uncomplicated hypertension, dysrhythmias; angina
    • Contraindications: bradydysrhythmias, atrioventricular (AV) block
    • Beta 2 in chronic respiratory problems
    • Precautions: hepatic and renal dysfunction, diabetes, history of depression, heart failure
    • Side effects: headache, flushing, dizziness, fatigue, weakness,bradycardia, postural hypotension
    • bronchospasm, broncoconstriction decreased cardiac output, congestive heart failure (CHF)
    • Nursing implications:
    • assess for symptoms of heart failure
    • instruct the client to report any weakness, dizziness, or fainting
    • before giving evaluate the client's blood pressure and pulse for significant changes. Hold if systolic blood pressure is below 90mmHg
    • monitor clients with diabetes as tachycardia as symptoms of hypoglycemia are often masked as a result of the beta1 blockade
    • propranolol (inderal) has both beta1- and beta2 receptor blocking actions and is considered nonselective
    • metopropolol (lopressor) is cardioselective which means it blocks only beta1
    • Atenolol (tenormin) is considered a cardioselective beta1 blocker but it blocks beta2 at high doses
  8. Ace Inhibitors (end in pril)
    captopril (capoten)
    enalapril (vasotec)
    benozepril (lotensin)
    • Actions: Angiotensin-converting enzyme suppress formation of angiotension II from the renin-angiotension-aldosterone system reduces peripheral resistance, and improve cardiac output
    • increases cardiac output, cardiac rate, cardiac contractility
    • Uses: hypertension, heart failure
    • Contraindications:
    • history of angio edema
    • second and third trimesters of pregnancy
    • renal aretery stenosis
    • Percautions:
    • renal impairment, collagen vascular disease
    • hypovolemia, salt depletion
    • Side effects:
    • headache, dizziness, postural hypotension
    • rash, angio edema
    • altered sense of taste
    • nagging, nonproductive cough
    • Nursing implications:
    • regularly monitor blood pressure, especially for 2 hours after the first dose, because severe first-dose hypotension often develops
    • teach client to rise slowly from a lying to a sitting position to reduce postural hypotensive effects
    • before administration, assess the client for history or presence of renal impairment
    • administer on an empty stomach for best absorption
    • teach client to notify health care provider if cough develops
    • teach client to avoid potassium supplements or potassium containg salt substitutes
  9. Calcium Channel Blockers
    Very Nice Drugs
    Verapamil (calan Isoptin)
    Nifedipine (cardizem)
    Diltiazem (procardia)
    • Action: block calcium access to the cells, causing decreased heart contractility and conductivity and leading to a decreased demand for oxygen
    • Uses: angina, hypertension (nifedipine), and dysrhythmias (verapamil and diltiazem)
    • Contraindications:
    • Nifedipine: hypersensitivity
    • verapamil: severe left ventricular dysfunction, decreased blood pressure, cardogenic shock, or heart block
    • diltiazem: sick sinus syndrome (arrhythmias caused by malfunction of the sinus node, abnormal electic activity), heart block, decreased blood pressure, acute myocardial infarction, or pulmonary congestion
    • Percautions:
    • renal or hepatic insufficiency
    • do not give verapamil or ditiazem with beta-blockers
    • Side effects:
    • decreased blood pressure, edema of the extremities, headache
    • constipation, nausea, skin flushing, dysrhythmias
    • Nursing implications:
    • administer before meals; may be taken with food if needed; do not crush or allow client to chew sustained-release medication preparations
    • monitor vital signs and watch for low blood pressure
    • teach about postural hypotension
    • check liver and renal function studies
    • weigh client report any edema or weight gain
    • teach client to avoid grapefruit
    • teach client that constipation can be minimized by increasing dietary fiber and fluid
  10. Nitroglycerin
    Quick acting:
    Sublingual tablets
    Translingual spray
    Slow acting:
    Nitro-Bid (patch)
    Nitro ointment
    Sustained release tablets
    • Classification: Nitrate vasodilator
    • Action: relaxes vascular (arterial and venous) with more prominent effects on veins decreases preload. Arteriolar relaxation reduces systemic vascular resistance, which decreases afterload.
    • Uses:
    • relief of anginal pain
    • in conjunction with beta blockers or calcium channel blockers to suppress tachycardia
    • Contraindications and precautions:
    • hypersensitive clients, severe anemia
    • erectile dysfunction medications (viagra)
    • severe hepatic or renal disease and use of other vasodilators (beta blockers, verapamil, diliazem)
    • Side effects:
    • Orthostatoc hypotension, headaches; tachycardia, dry mouth, blurred vision
    • Nursing implications:
    • clients with angina pectoris should carry nitrates with them at all times
    • teach proper storage for freshness (tingling, fizzle, sensation under tongue).
    • discard unused medication after 24 months
    • teach client to call 9-1-1, if pain is not relieved within 5 minutes of taking. May take for a total of three tablets while waiting for emergency care.
    • avoid alcoholic beverages during nitrate therapy
    • avoid swallowing or chewing sustained release tablets to help the drug reach the gastrointestinal system
    • rotate transdermal patches and remove after 12 to 14 hours to have a patch free interval of 10 to 12 hours daily
  11. Diltiazem (Cardizem)
    • Classification: Antidysrhythmic (Calcium Channel Blocker)
    • given PO, IV
    • Action: inhibits the transport of calcium into myocardial cells. relaxes both coronary and peripheral blood vessels, bringing more oxygen to the myocardium and reducing cardiac workload
    • Uses:
    • treatment of atrial dysrhythmias and hypertension
    • stable and vasospastic angina (given as sustained-release capsule administered once daily)
    • Contraindications and Percautions:
    • concurrent use of diltiazem with other cardiovascular drugs especially digoxin or beta-adrenergic blockers, may cause partial or complete heart block, heart failure, or dysrhythmias.
    • diltiazem may increase digoxin or quinidine levels when takem concurrently
    • additive hypotension may occur if used with ethanol, betablockers, or antihypertensives
    • Side effects:
    • headache, dizziness, and edema of the ankles and feet
    • abrupt withdrawal may precipitat and acute anginal episode
    • Nursing implications:
    • during IV administration patient must be continuously monitored and cardioversion equipment must be available
    • extended-release tablets and capsules should not be crushed or split
    • pregnancy category C
    • monitor cardiac rhythm, particularly during initial dose for effectiveness; report apical pulse <60 beats/min
    • report dysrhythmias or hypotension
    • instruct client to take all prescribed doses and not to catch up on missed doses
    • instruct client to report shortnesss of breath and irregular, fast or slow heart beats
  12. Propranolol (Inderal)
    • Classification: Class II antidysrhythmic (Beta-Blocker)
    • given PO, IV
    • Action: nonselective beta blocker affects beta1 recepters in the heart and beta2 receptors in pulmonary and vascular smooth muscle thus reducing heart rate, slows myocardial conduction velocity, and lowers blood pressure
    • Uses:
    • treatment of tachycardia that is caused by excessive sympathetic stimulation (via exersize, strenous activity, desease condition)
    • hypertension
    • angina
    • migraine headaches
    • prevention of MI
    • Contraindications and Percautions:
    • contraindicated in patients with cardiogenic shock, sinus bradycardia (greater then first-degree heart block) and heart failure
    • contraindicated in patiens with COPD because it constricts smooth muscle in the airways
    • percaution in patients with renal impairments
    • percaution in patients that are diabetic
    • Side effects:
    • fatigue, hypotension, and bradycardia
    • sexual disfunction
    • mask the symptoms of hypoglycemia in diabetic patients
    • may accumulate in patients with reduced renal output and cause toxic levels causing dysrhythmias
    • branchospasms, bradycardia, hypotension
    • Nursing implications:
    • abrupt discontinuation may cause MI, severe hypertension, and ventricular dysrhythmias
    • swallow exrended release tablets whole: so not crush or chew contents
    • if pulse is <60 beats/min notify the health care provider
    • pregnancy category C
  13. Quinidine sulfate (Novoquinine)
    • Classification: Antidysrhythmic (Sodium Channel Blocker)
    • given PO, IV
    • Action: prevent depolarization by slowing the action potential across the myocardium and areas of ectopic pacemaker activity will be suppressed
    • Uses:
    • atrial and ventricular dysrhythmias
    • Contraindications and Percautions:
    • AV block, bradycardia, cardiac failure, digitals toxicity
    • Side effects:
    • cinchonism effects (tennitus, headaches, nausea, vomiting, dizziness)
    • Hypotension, fatigue, bradycardia
    • can worsen existing dysrhythmias
    • diarrhea, immunologic reaction
    • Nursing indications:
    • monitor cardiac rhythm, particularly durting initial dose for effectiveness; report apical pulse <60 beats/min
    • report dysrhythmias or hypotension
    • teach patient how to take peripheral pules for 1 full minute before taking the drug
    • teach to rise slowly from lying or sitting to standing to avoid dizziness or falls
    • take first dose before bedtime
    • notify health care provider if BP is <90/60
    • teach to report servere shortness of breath, frothy sputum, profound fatigue or swelling of extremities these are possable signs of pulmonary toxicity, or heart failure
  14. Amiodarone (Cordarone)
    • Classification: Antidysrhythmic (Potassium channel blocker)
    • given PO, IV
    • Action: similar to thyroid hormone, blocks potassium thus delaying repolarization of myocardial cells and lengthening the refactory period
    • Uses:
    • treatment of resistant ventricular tachycardia that prove life threatening
    • artial dysrhythmias in patients with heart failure
    • Contraindications and Precautions:
    • IV infusion are limited to short term therapy normally only 2 to 4 days
    • orally it's onset may take several weeks however effects can last 4 to 8 weeks after the drug is discontiued
    • it has an extended half-life that may exceed 100 days the therapeutic serum level o f amiodarone is 0.5 to 2.5 mcg/mL
    • Contraindicated in patients with severe bradycardia, cardiogenic shock, sick sinus syndrome (abnormal electric activity), severe sinus node dysfunction, or third-degree heart block
    • Side effects:
    • Fatigue, hypotension, AV block, bronchospasm, pulmonary toxicity
    • the most serious is in the lungs with this drug causing pneumonia-like symptoms
    • blurred vision, rashes, photosensitivity, nausea, vomiting, anorexia, dizziness,
    • Nursing implications:
    • increases serum digoxin levels by as much as 70%
    • greatly
    • enhances the action of anticoagulants thus the dose of warfarin must be cut by as much as 1/2
    • use with beta-blockers or calcium channel blockers may cause or worsen sinus bradycardia, sinus arrest, or AV block
    • may increase phenytoin levels to - three fold
    • treatment of amiodarone overdose is targeted to reversing hypotension with vasopressors, and bradycardia with atropine or isoproterenol
    • same as with other antisysrhythmics
  15. Digitalis
    • Classification: Cardiac glycoside
    • given PO, IV
    • Action: increases mycardial contractility, alters the electrical activity in noncontractile tissue and ventricular muscle
    • Uses:
    • Heart failure-improves cardiac output
    • artial fibrillation and flutter
    • contraindications and Precautions:
    • hypersensitivity
    • ventricular tachycardia
    • renal insufficiency
    • hypokalemia
    • advanced heart disease
    • acute myocardial infarction
    • incomplete atrioventricular block
    • pregnancy
    • Side effects:
    • dizziness, headache, malaise (feeling of uneasyness), fatigue
    • muscle weakness, visual disturbances, anorexia
    • hypokalemia, dysrhythmias, bradycardia
    • Nursing indications:
    • monitor digoxin serum levels; check for toxicity (2mg/ml is considered toxic)
    • monitor pulse, and teach clients to take their pulse. Report a pulse rate <60 mm Hg for adults and <100mm Hg in pediatric patient hold the dose and notify a primary ealth care provider
    • administer intravenous (IV) doses slowly over 5 minutes
    • do not double up with missed doses
    • teach client to recognize early signs of hypokalemia (muscle weakness) and digitalis toxicity (nausea, vomiting, diarrhea, blurred or yellow visual disturbances), and notify primary health care provider
  16. Remember SAMS for Lidocaine toxicity
    • S- Slurred or difficult speach, paresthesias, numbness of lips/tongue
    • A- Altered central nervous system, drowsiness, dizziness, dysrhythmias, restlessness, confusion
    • M- Muscle twitching, tremmors
    • S- Seizures, convulsions, respiratory depression, respiratory and cardiac arrest
  17. Remember IDEA fro drugs used for bradycardia and to lower blood pressure
    • I-Isoprotenerenol
    • D-Dopamine
    • E- Epinephrine
    • A- Atropine
  18. Side effects of Alpha-blockers
    Doxazosin (Cardura)
    prazosin (Minipress)
    • orthostatic hypotension
    • tachycardia
    • vertigo
    • sexual dysfunction
  19. Actions of alpha-blockers
    Doxazosin (Cardura)
    prazosin (Minipress)
    stimulate central alpha receptors, which decreases sympathetic outflow from the central nervous system, causing a decrease in peripheral vascular resistance and a slight decrease in cardiac output
  20. Uses for alpha-blockers
    Doxazosin (Cardura)
    prazosin (Minipress)
    mild to moderate hypertension
  21. Contraindications, Precautions, and side effects of alpha-blockers
    Doxazosin (Cardura)
    prazosin (Minipress)
    • Contraindications: hypersensitivity to drug and sulfites
    • Precautions: clients with liver disease, blood dyscreasias, and pheochromocytoma (neuroendocrine tumor of the medulla of the adrenal glands)
    • Side effects: orthostatic hypotension, tachycardia, vertigo, sexual dysfunction, nasal congestion, dry mouth
  22. Nursing implications to consider when administering alpha-blockers
    Doxazosin (Cardura)
    prazosin (Minipress)
    • watch for orthostatic hypotension, which is intensified with prolonged standing, hot baths, or showers, hot weather, alcohol use, and strenuous exercise
    • client should consume no more thean four cups of caffeinated coffee, tea, or cola per/day
    • client should take at bedtime to avoid drowsiness during the day
    • discontinue slowly to avoid rebound hypertension
    • teach client about first dose effect of severe orthostatic hypotension and to avoid hazardous activities and driving for 12 to 24 hours after intial dose to decrease risk instruct client to take first dose at bed time
  23. Beta- Blockers Actions
    • Beta1 blockers affect the heart (1 heart)
    • Beta2 blockers affect the lungs (2 lungs)
  24. Review of Beta-blockers
    • Actions:
    • Beta1 blockers (cardioselective) have a predominant effect on the heart by decreasing rate and contractility and decreasing velocity of impulse conduction at the atrioventricular (AV) node
    • Beta2 blockers (nonselective) have the same actions as beta1 blockers; however they also affect the lungs, causing bronchoconstriction, and they block blood vessel receptors, causing vasoconstriction
    • Examples:
    • Beta1 (cardioselective)-metoprolol (Lopressor, Toprol XL) used for angina and hypertension
    • Beta1 and beta2 (nonselective)-propranolol (inderal) used for angina, hypertension, and dysrhythmias
    • Contraindications:
    • Beta1 and beta2 Bradycardia or cardiac block, hypotension
    • Beta2 chronic obstructive pulmonary problems
    • Percautions:
    • Diabetes-may interact with hypoglycemic agents; heart failure
    • Side effects:
    • Beta1: orthostatic hypotension, bradycardia, decreased libido, drowsiness
    • Beta2: bronchoconstriction, bronchospasm, hypotension, bradycardia, dizziness, impotence
    • Nursing implications:
    • assess blood pressure and heart rate before and after initial dose
    • instruct client regarding orthostatic hypotension
    • delay the dose and notify the health care provider when the client's systolic blood pressure is <90 mm Hg or a significant decrease in pulse rate (bradycardia) occurs <60 beats per/min
    • medications are used with extreme caution in clients wiht heart fialure; however, some of the beta blockers are used to treat heart failure
    • beta1 blockers may mask tachycardia, a primary sign of hypoglycemia
  25. Grouping all beta blockers togather what do they have in common
    Propranolol (Inderal)
    Atenolol (Tenormin)
    Meroprolol (Lopressor)
    Nadolol (corgard)
    • Actions: blocks sympathetic nervous system catecholamines, resulting in reduced renin and aldosterone release and fluid balance. vasodilation of arterioles leads to decrease in pulmonary vascular resistance and blood pressure
    • Uses:
    • hypertension, antianginal agents in long-term treatment of angia
    • dysrhythmias-suppress sinus and atrial tachydysrhythmias
    • Contraindications:
    • atrioventricular (AV) block, bradycardia
    • Precautions:
    • can cause bronchoconstriction: use with caution in clients with diabetes, cerebrovascular insufficiency, renal or hepatic dysfunction
    • history of depression, heart failure
    • Side effects:
    • postural hypotension, bradycardia, drowsiness, depression, symptoms of congestive heart failure
    • bronchospasm, bronchoconstriction, malaise, lethargy
    • Nursing indications:
    • assess vital signs; monitor closely if given with a calcium channel blocker
    • report any weakness, dizziness, bradycardia, or fainting
    • take medicaton before meals
    • report any edema or difficulty breathing
    • monitor clients with diabetes; tachycardia (a symptom of hypoglycemia) is often masked because of the beta1 blockade
  26. Antihyperlipidemics
    Atorvastatin (Lipitor)
    simvastatin (Zocor)
    pravastatin (Pravachol)
    lovastatin (Mevacor)
    rosuvastatin (Crestor)
    • Classification: HMG_CoA Reductse inhibitors (Statins)
    • Action: lower cholesterol levels by inhibiting the formation of HMG-CoA reductase, which is an enyzme that is required for the liver to synthesize cholesterol
    • Uses:
    • Hypercholesterolemia
    • primary and secondary prevention oc cardiovascular events
    • clients with type 2 diabetes and coronary heart disease
    • Contraindications:
    • Hepatitis, pregnancy
    • Precautions:
    • liver disease
    • excessive alcohol use
    • Side effects:
    • Myopathy (muscle waisting), rhabdomyolysis (severe form of muscle waisting)
    • Hepatoxicity-liver injury with increases in serum transaminasis
    • Nursing implications:
    • instruct client to report unexplained muscle pain or tenderness
    • monitor liver function studies
    • inform women to childbearing are about the potential for fetal harm should they become pregnant
    • administer medication in the evening without regard to meals
    • instruct client about dietary changes to reduce weight and cholesterol
Card Set
Cardiac drugs
Cardiac drugs
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