Cardiac Drugs Flashcards
medications for arrhythmias
lidocaine, metoprolol, amiodarone, diltiazem
medications for HF
digoxin, metoprolol, lisinopril, furosemide
medications for HTN
hydrochlorothiazide, lisinopril, losartan, metoprolol, diltiazem, nitroprusside
medications for angina
nitroglycerin, diltiazem, metoprolol
HF patho
heart does no adequately pump blood (systolic) or fill with blood (diastolic). Inability to meet metabolic (oxygen) demands of the body. Right ventricular failure, left ventricular failure, congestive failure.
Preload in terms of medications
increased preload causes increased workload on heart- venous return filling the heart.
reduce preload: furosemide
After-load in terms of medications
increased after-load increases workload on the heart- resistance the heart has to go through to pump
reduce after load (vascular resistance): metoprolol, lisinopril.
Contractility in terms of medications
heart enlarges, but weakens, resulting in poor contraction (decreased contraction force).
Increase contractility: digoxin (lanoxin) “digoxin digs deeper for deeper contraction”
Digoxin (lanoxin) class
cardiac glycoside
Digoxin (lanoxin) MoA
increase force of contraction, increasing cardiac output and renal perfusion; slows HR (goal: slower but more powerful heart)
Digoxin (lanoxin) indication
heart failure
Digoxin (lanoxin) routes
oral, IV (IV push over at least 5 minutes with tele monitor)
Digoxin (lanoxin) drug-drug
MANY! Amiodarone and other anti-dysrhythmic drugs (not going to double dose on meds that cause bradycardia)
Digoxin (lanoxin) caution
heart block (type of bradycardia) or decreased renal function
Digoxin (lanoxin) AE
GI effects, visual disturbances (green/yellow halo), arrhythmias (Bradycardia)
Digoxin (lanoxin) nursing considerations
take apical pulse 1 full min prior to admin. Hold if HR less than 60- notify provider; use same brand consistently- varied bioavailability
toxicity rare but serious- monitor blood levels q 3 months
Digoxin (lanoxin) toxicity manifestations
bradycardia, headache, dizziness, confusion, n/v, visual disturbances (green and yellow halo is not indicative).
Digoxin (lanoxin) reversal agent
digoxin immune fab (creates antigen-antibody immunes complexes with drug-inactivates)
CAD patho
atherosclerosis narrows coronary arteries (stable and unstable plaques that could result in rupture), decreased blood flow (decreased oxygen), myocardial infarction (tissue death)
stable angina patho
chest pain with exertion (increased metabolic needs), increased O2 demand of heart, relieved with rest and nitroglycerin
unstable angina patho
chest pain at rest, unrelieved with nitroglycerin, possible myocardial infarction
Nitroglycerin (nitrostat) class
antianginal agents
Nitroglycerin (nitrostat) MoA
relaxes vascular smooth muscle; dilates coronary arteries to increase blood flow.
Nitroglycerin (nitrostat) indication
acute angina
Nitroglycerin (nitrostat) route/dose
sublingual tablet q 5 min up to 3 doses; onset 1-3min; duration: 30-60 min
Nitroglycerin (nitrostat) caution
erectile dysfunction meds in last 24 hours
ex: sildenafil, because they both cause hypotension, that would be dangerous to ingest both.
Nitroglycerin (nitrostat) AE
hypotension (orthostatic), headache, dizziness, tachycardia, sweating
Nitroglycerin (nitrostat) nursing actions in acute care
may administer 1 dose every 5 min up to 3 doses- if no relief after 2nd dose, assume MI and call rapid response.
monitor blood pressure after administration
high fall risk
Nitroglycerin (nitrostat) teaching
administration as above (after 2nd dose call 911), med must be stored in a dry, dark place- keep in dark glass container, refill medication when it expires (wont work as well as it should and is light sensitive).
Arrhythmias patho
changes to automaticity or conductivity of heart cells- change in HR
uncoordinated heart muscle contractions
altered movement of impulses
Afib Patho
dyssynchronous firing of atria, uncoordinated with ventricles. can be acute and chronic (phase in and out)
Slow HR: Metoprolol, diltiazem, amiodarone
tachycardias patho
v fib, v tach,
medical emergencies- control V arrhythmia, administer lidocaine
class 1 of antidysrhythmic drug
sodium channel blockers- fast conducting
lidocaine
class 2 of antidysrhythmic drug
beta-adrenergic blockers
metoprolol
class 3 of antidysrhythmic drug
potassium channel blockers
amiodarone
class 4 of antidysrhythmic drug
calcium channel blockers
diltiazem
common use of lidocaine
life threatening ventricular arrhythmias during MI or cardiac surgery
common use of metoprolol
atrial fibrillation/flutter, supraventricular and ventricular dysrh. hypertension
common use of amiodarone
a fib/flutter
ventricular tachycardia or fibrillation
common use of diltiazem
supraventricular tachycardias, afib/flutter, hypertension
general considerations of antidysrhythmic drugs
all have potential AE: bradycardia, heart blocks, arrhythmias, and hypotension. Greater risk with IV administration (Cardiac monitor and BP monitor)
drug/drug: antidysrhythmic drugs, antihypertensives
contraindications: bradycardia, hypotension, heart block
Lidocaine class
sodium channel blockers
Lidocaine MoA
decreases depolarization, decreasing automaticity of the ventricular cells; increases ventricular fibrillation threshold.
Lidocaine indication
treatment of life threatening ventricular arrhythmias during MI or cardiac surgery
Lidocaine route
IV (topical lidocaine low systemic risk)
Lidocaine IV onset, peak, duration
onset: immediate
peak: immediate
duration: IV 20 min
Lidocaine AE
dizziness, headache, cardiac arrest, respiratory depression, anaphylaxis
Lidocaine nursing consideration
have resuscitation equipment available
Amiodarone class
potassium channel blockers
Amiodarone MoA
blocks potassium channels, delays repolarization; slows HR
Amiodarone indications
v-tach v fib; afib or flutter
Amiodarone dose
maintenance: oral; acute IV push/infusion on tele floors/ICU/ACLS
Amiodarone Drug-drug
many! increase digoxin levels (up yo 50-70% loading dose); decrease metabolism of warfarin requiring lower doses (50% increase in INR); decreases dose of either drug by 50%
Amiodarone AE
GI effects (n/v/d), corneal micro-deposits (cause visual issues- photophobia, visual halos, dry eyes), fatigue, dizziness, photosensitivity
Amiodarone black box
hepatotoxicity, pulmonary toxicity, pro-arrhythmias
Amiodarone nursing considerations
no grapefruit juice, use barrier sun block; cardiac monitoring (IV), monitor electrolytes
Beta blockers, calcium channel blockers, direct vasodilators, ace inhibitors, and ARBs affect what part of HTN
vasoconstriction and increase peripheral resistance
ACE inhibitors, ARBs, diuretics affect what part of HTN
renal salt and water retention and increase blood volume
ACE inhibitors block what part of RAAS system
conversion of angiotensin 1 to angiotensin 2
ARBs block what part of RAAS system
with the adrenal gland cortex and aldosterone secretion.
administration considerations for antihypertensive drugs (acute care)
Take BP prior to admin
if dosed once daily, give in the AM- do not split, crush or chew ER tablets
do not abruptly discontinue, especially adrenergic blocking agents (reflex HTN)
IV push meds- minimum of 2 min/tele monitor
PRN medications require evaluation- IVP recheck BP in 5-10 min, PO recheck BP in 1 hour
Lisinopril class
ACE inhibitor
Lisinopril MoA
blocks ACE, the enzyme responsible for converting angiotensin 1 to angiotensin 2 in the lungs, decreases vascular resistance, prevents aldosterone secretion, prevents breakdown of bradykinin (potent vasoconstrictor) ONLY BP
Lisinopril route
oral
Lisinopril contraindications/cautions
ACE inhibitor, ARBs, K+ sparing diuretics, NSAIDs (kidneys)
Lisinopril AE
common-persistant dry cough, orthostatic hypotension, hyperkalemia, rare-angioedema (swelling of blood vessels that compromise airway)
Lisinopril nursing considerations
monitor K+ and renal function
ACE acronym for AE
Angioedema
Cough
Elevated potassium
Losartan (Cozaar) class
angiotensin-receptor blocker ARB
Losartan (Cozaar) MoA
blocks binding of angiotensin II to specific receptors in blood vessels and adrenal gland; used as alternate to ACE inhibitors
ONLY BP
Losartan (Cozaar) route
oral
Losartan (Cozaar) contraindications/cautions
ACE inhibitor, ARBs, K+ sparing diuretics, NSAIDs (kidneys)
Losartan (Cozaar) AE
GI effects- n/v/d
Nitroprusside (Nitropress) class
direct vasodilator- different route than nitroglycerin
Nitroprusside (Nitropress) MoA
act directly on vascular smooth muscle (venous and arterial) to cause relaxation/vasodilation
ONLY BP
Nitroprusside (Nitropress) route
maintenance: oral or transdermal
Acute HTN crisis: IV push
Nitroprusside (Nitropress) caution
PVD, CAD, HF (weak heart and dilated vessels= poor perfusion), tachycardia, hypotension
Nitroprusside (Nitropress) AE
hypotension, reflex tachycardia, bradycardia
Diltiazem (cardizem) class
calcium channel blocker
Diltiazem (cardizem) MoA
inhibits flow of calcium ions into myocardial cells and vascular smooth muscle; slows HR and lowers BP
BP and HR
Diltiazem (cardizem) Indications
HTN, A fib, A flutter, supraventricular tachycardias
Diltiazem (cardizem) route
maintenance: oral
acute: IV infusion
Diltiazem (cardizem) caution
hypotension, acute MI, pulmonary congestion
Diltiazem (cardizem) AE
hypotension, bradycardia/heart block, peripheral edema
Diltiazem (cardizem) nursing considerations
teach patient to avoid grapefruit juice (increases levels)
Metoprolol (Toprol) class
beta adrenergic blocker
Metoprolol (Toprol) MoA
block beta 1 and beta 2 receptors of the SNS; slows HR and lowers BP
HR and BP
Metoprolol (Toprol) indications
HTN, HF, MI, A fib, A flutter
Metoprolol (Toprol) route
maintenance: oral
acute HTN or dysrhythmias: IV push
Metoprolol (Toprol) drug-drug
beta agonist inhaler (albuterol)
Metoprolol (Toprol) contraindications/cautions
bradycardia, hypotension, masks signs of hypoglycemia
Metoprolol (Toprol) AE
bradycardia, hypotension, bronchospasm, pulmonary edema, weakness, fatigue, decreases exercise intolerance, alterations in blood glucose
Metoprolol (Toprol) nursing considerations
monitor hypoglycemia closely in diabetes mellitus; immediate and extended release (XL, XR) prescribed
Drug therapy across the life span: cardiac drugs
children: safety and efficacy of meds not widely studied
adults: consider drug-drug interactions, co-morbidities; appropriate education
pregnancy: many meds are pregnancy category D (risk v benefit)
Older adults: more susceptible to AE of hypotension, bradycardia, toxic effects due to underlying disease that may interfere with metabolism and excretion. high fall risk
