Cardiac Drugs

Question 1

Vasopressin

Answer 1

ACTION: Potent vasoconstrictor; Also an antidiuretic USES: VF, asystole, PEA, septic shock SIDE EFFECTS: – NURSING IMPLICATIONS: IVP Alternative pressor to epinephrine

Question 2

Oxygen

Answer 2

ACTION : Enrich blood with O2 USES: Any emergency, SOB, CP, stroke or hypoxemia SIDE EFFECTS: Caution in COPD pts D/T hypoxic resp drive NURSING IMPLICATIONS: Pulse ox is useful in titrating O2; Pulse ox may be inaccurate in low CO states, extensive vasoconstriction or carbon monoxide poisoning.

Question 3

Lidocaine

Answer 3

ACTION: Suppresses ventricular arrhythmias by decreasing automaticity; Numbs the irritated ventricular electrical cell(s) USES: Common drug used to treat ventricular irritability like PVCs, VT, & V-fib SIDE EFFECTS: Toxicity-Neuro changes—drowsiness, disorientation, decreased hearing, slurred speech, heavy tongue, SEIZURES NURSING IMPLICATIONS: Watch for liver dysfunction & geriatric population—causes more toxic effects; need cardiac monitor; should be titrated off after 24 hours; given IVP & continuous drip

Question 4

Glycoprotein IIb/IIIa Inhibitor

Answer 4

ACTION: Inhibit platelet aggregation USES: ACS –NonSTEMI or unstable angina possibly with planned PCI SIDE EFFECTS: Recent active bleeding or disorder; Thrombocytopenia NURSING IMPLICATIONS: Bolus and infusion; Must use with heparin. Binds platelets irreversibly. Platelet ct

Question 5

Plavix (Clopidogrel)

Answer 5

ACTION: Antiplatelet agent USES: ACS SIDE EFFECTS: Bleeding precautions NURSING IMPLICATIONS: Do not give to pts planned to have CABG/PCI or active/risk for bleeding Watch in liver impairment

Question 6

Morphine sulfate

Answer 6

ACTION: Opioid analgesic, vasodilator USES: Chest pain SIDE EFFECTS: Hypotension, change in LOC, respiratory depression NURSING IMPLICATIONS: Administer slowly; watch BP & RR; can give lots in small increments to relieve pain; antidote: Narcan

Question 7

Aspirin

Answer 7

ACTION: Blocks platelet aggregation USE: ACS given to anyone with S/S of angina/ischemic injury; Reduces mortality SIDE EFFECTS: Bleeding precaution NURSING IMPLICATIONS: Contra in active ulcer or asthma; Give within minutes of arrival in ED, chewing better

Question 8

Atropine

Answer 8

ACTION: Parasympatholytic (increase conduction & thus HR by inhibiting acetylcholine) USE: Bradycardia; Asystole; PEA SIDE EFFECTS: Dry mouth, urinary retention, tachycardia, dilates pupils NURSING IMPLICATIONS: IV push

Question 9

Lovenox (LMWH)

Answer 9

ACTION: Inhibit thrombin/thrombus formation USES: ACS-NonSTEMI or unstable angina SIDE EFFECTS: Hemorrhage is complication NURSING IMPLICATIONS: SQ or IV Contraindicated if platelets <100,000 Contra if sensitive to heparin or pork products Very careful use in HIT pts Adjust dose for renal impairment Reversal agent protamine sulfate

Question 10

Calcium Chloride

Answer 10

ACTION: Replaces Ca; Binds K+ USES: Known or suspect hyperkalemia; Ionized hypocalcemia; Antidote for CCB NURSING IMPLICATIONS: Other forms of calcium avail. Check order.

Question 11

Furosemide/ Lasix

Answer 11

ACTION: Loop diuretic USES: Pulmonary edema, HTN SIDE EFFECTS: Hypokalemia, dehydration, arrhythmias, decreased BP NURSING IMPLICATIONS: Check K+ level, give slow IV push—watch BP; note how pt. is to void; Can give as a drip

Question 12

Magnesium sulfate—electrolyte

Answer 12

ACTION: Necessary for enzyme reactions USES: Treat hypomagnesium which can cause arrhythmias & sudden cardiac death SIDE EFFECTS: Rare toxicity—flushing, sweating mild bradycardia, decreased BP NURSING IMPLICATIONS: Watch for decreased BP or asystole; given IV piggyback

Question 13

Adenosine

Answer 13

ACTION: “chemical defibrillator,” interrupts or slows rapid, chaotic electrical conduction pathways; asystole 10-15 seconds USE: Convert SVT to sinus rhythm SIDE EFFECTS: Flushing, chest pain, asystole, near death experience NURSING IMPLICATIONS: *given fast IV push (1-3 sec.) chase with a flush, Continuous EKG strip needed. Watch how long asystolic pause & be ready for a Code.

Question 14

Heparin (unfractionated)

Answer 14

ACTION: Prevents clots from forming USES: ACS-AMI or other thrombotic events SIDE EFFECTS: Contra in recent active bleeding, surgery or bleeding disorders, Heparin Induced Thrombocytopenia (HIT) NURSING IMPLICATIONS: Bolus & infusion Contraindicated if platelets <100,000; Check PTT (partial thromboplastin time-maintain at 1.5-2 times control); Follow nomogram and platelet ct; antidote: protamine sulfate

Question 15

Beta blockers (-lol)

Answer 15

ACTION: Negative inotropic; Decreases HR and contractility. Puts the heart muscle to sleep; Bronchoconstricts USE: ACS pts to reduce angina & reduce incident of VF; Slow conduction in SVT; Emergent antihypertensive SIDE EFFECTS: Impotence (*noncompliance issue) NURSING IMPLICATIONS: Use cautiously with CCB—can cause severe hypotension; avoid in COPD & asthma pt. because of bronchoconstriction, contra if HR <60 bpm or low B/P, give slow IV push & watch BP & HR, Consider holding if patient is needing a heart that responds efficiently like before a heart cath

Question 16

Dopamine

Answer 16

ACTION: Depends on dose: Low- 1-5 mcg/kg/min-renal artery vasodilation Moderate and High dose 2-20 mcg/kg/min—beta effects (increase HR & contractility) & alpha effects (vasoconstriction) USES: Low dose Renal perfusion(controversial);Mod & High dose ; Used for hypotension; To increase HR SIDE EFFECTS: Tachycardia, hypotension, palpitations, sloughing of skin if infiltrates peripherally NURSING IMPLICATIONS: Not given push, instead by central line as continuous drip; Titrate to desired effect If given peripherally and infiltrates, saturate area with Regitine; Need to correct any hypovolemia before effective

Question 17

Sodium bicarbonate—electrolyte

Answer 17

ACTION: Alkaline agent USES: Management of metabolic acidosis; Hyperkalemia SIDE EFFECTS: Edema, sodium & water retention, alkalosis, hypernatremia, hypokalemia NURSING IMPLICATIONS: Need ABGs to give this drug correctly Monitor ABGs & electrolytes (K & Na), check for fluid overload, confusion, tetany; incompatible with most drugs

Question 18

Fibrinolytics/Thrombolytics (tPA- Alteplase, Streptokinase)

Answer 18

ACTION: Dissolves clots; Clot buster USES: AMI <12 hours from onset, Ischemic Stroke; Have a window of opportunity Timing is important SIDE EFFECTS: Bleeding anywhere, arrhythmias; Most significant bleeds are intracerebral bleeds because they are life threatening NURSING IMPLICATIONS: Dissolves both pathological and physiological clots; Strict inclusion and exclusion criteria

Question 19

Narcan

Answer 19

ACTION: Reverse resp depression & sedative effects USES: Resp & neuro depression D/T opiate overdose SIDE EFFECTS: May not outlast effect of narcotic Recurrent resp depression NURSING IMPLICATIONS: May cause opiate withdrawal; IVP; Assist ventilation often needed

Question 20

Dobutamine (Dobutrex)

Answer 20

ACTION: Positive inotropic, beta selective (no effect on HR or blood vessels) USES: To increase BP in CHF when no shock evident NURSING IMPLICATIONS: Not given push, instead by central line with infusion pump; measure BP closely

Question 21

ACE inhibitors (-pril)

Answer 21

ACTION: Prevents conversion of angiotensin I to II, preventing major vasoconstriction; also has a mild diuretic effect R/T aldosterone USE: HTN; Reduce mortality & improve LV dysfunction in post MI pt.; Heart failure SIDE EFFECTS: Dry, hacking cough; orthostatic hypotension NURSING IMPLICATIONS: First given at night because body not used to hypotension; Reduce dose in renal failure; Don’t give if K >5mEq/l; Don’t give if B/P low or hypovolemic

Question 22

Nitroglycerin (NTG)

Answer 22

ACTION: Vasodilator, especially of coronary arteries USES: Antianginal, MI, HTN SIDE EFFECTS: Severe headache, hypotension NURSING IMPLICATIONS: Sublingual, aerosol, IV drip, patch; remove old patches special IV tubing IV titrate until 1 of these occurs: 1.angina stops 2.severe headache 3. low BP <90 systolic ——————- SL-Repeat total of 3 doses at 5 min intervals; Aerosol-Max 3 sprays at 5 min intervals (do not shake); Have pt sit or lie down; Call EMS if unrelieved

Question 23

Epinephrine (Adrenaline)

Answer 23

ACTION: Peripheral vasoconstriction, increase BP & HR USES: Cardiac arrest; V-fib/V-tach, asystole, bradycardias & PEA; severe hypotension; Anaphylaxis reaction SIDE EFFECTS: Can potentiate myocardial ischemia NURSING IMPLICATIONS: Given IVP or continuous drip-titrate; incompatible with many drugs so flush before and after; measure BP closely; When in doubt in a code—give epi

Question 24

Calcium Chanel Blockers (CCB); Verapamil (Calan or Isoptin); Diltizem (Cardizem)

Answer 24

ACTION: Relaxes smooth muscle to decrease BP, slows HR via the conduction system suppression USE: Slow SVT & rapid atrial fib/flutter SIDE EFFECTS: Hypotension, bradycardia, heart block, CHF NURSING IMPLICATIONS: Monitor EKG, HR, & BP; give cautiously w/ beta blockers; slow IV push; IV Calcium is the antidote

Question 25

Norepinephrine (Levophed)

Answer 25

ACTION: Potent vasoconstrictor USES: Severe cardiogenic shock or significant hypotension SIDE EFFECTS: Arrhythmia NURSING IMPLICATIONS: IV drip only; Can cause necrosis of digits, nose, & ear lobes—use central line

Question 26

Digoxin

Answer 26

ACTION: Positive inotropic, negative chronotropic (decreased HR) USES: Rapid atrial fibrillation, CHF, SVT SIDE EFFECTS: Decreased HR, Toxicity -N/V, arrhythmias; Loss of appetite; Color changes in field of vision (green halos-textbook) NURSING IMPLICATIONS: Check labs- normal Dig level & K+ high or low can potentiate Dig. Effects; Always scheduled for 1400 so lab has plenty of time to result a dig level; antidote: Digibind; check apical pulse before giving. Renal failure/insufficiency pt. gets toxic easily.; Amiodarone interaction; Avoid cardioversion

Question 27

Nipride/nitroprusside

Answer 27

ACTION: Peripheral vasodilator USES: HTN emergency; Reduce afterload in HF SIDE EFFECTS: HA, N/V NURSING IMPLICATIONS:Light sensitive—has special cover over IV bag; should have arterial line; >48-72 hr. IV—breaks down into cyanide

Question 28

Amiodarone

Answer 28

ACTION: Antiarrhythmic USE: Ventricular tachycardia/fibrillation SIDE EFFECTS: Hypotension NURSING IMPLICATIONS: Very long half-life; Multiple complex drug interactions