Cardiac Drugs Flashcards
Furosemide
Loop Diuretic
MOA: Prevents passive reabsorption of water by blocking reabsorption of Na and Cl in the thick segment of the ascending loop of Henle.
Indications:
- Pulmonary edema (HF)
- Edema
- Uncontrolled HTN
Adverse Effects:
- Low Na, Cl, K, & BP
- Transient ototoxicity; increased risk with other ototox. meds
- Dehydration, with increased risk for thrombosis & emboli
- Ventricular dysrhythmias with dig. use
Nursing Considerations:
- Close I/O monitoring, VS, weight, hearing, and electrolytes
- Morning to early afternoon admin
- Slow IVP (10-20mg/min)
Hydrochlorothiazide
Thiazide Diuretic MOA: Prevents passive reabsorption of water by blocking reabsorption of Na and Cl in the early segment of the distal convoluted tubule. Indications: - Essential HTN - Edema (r/t HF, hepatic, or renal disease) - Diabetes insidipidus - Postmenopausal osteoporosis Adverse Effects: - Low Na, Cl, K, & BP - Dehydration - Ventricular dysrhythmias if on dig. Nursing Considerations: - Do not use in patients with low GFR! - Close I/O monitoring, VS, weight, and electrolytes - Morning to early afternoon admin
Spironolactone
Potassium-sparing Diuretic
MOA: Blocks aldosterone effects in the distal nephron (DCT) to produce modest diuresis
Indications:
- Essential HTN, often co-admin. with potassium-wasting diuretics
- Edema
- HF
Adverse Effects:
- Hyperkalemia
Endocrine effects; menstrual irregularities, impotence, hirsutism, and deepened voice
Nursing Considerations:
- Close I/O monitoring, VS, weight, and electrolytes, particularly when taking ACE inhibitors, ARBs, and DRI
- Educate patient about potassium-rich dietary source
Mannitol
Osmotic diuretic
MOA: Creates osmotic force that inhibits passive reabsorption of water; also increases serum osmolarity to draw fluid back into vascular and extravascular space
Indications:
- Prophylaxis of renal failure with hypovolemic shock and severe hypotension
- Reduction of intracranial and intraocular pressure
Adverse Effects:
- Edema (in patients with existing HF)
- Fluid & electrolyte imbalances
Nursing Considerations:
- Use filter needles & IV tubing to prevent administering crystals
- Monitor for changes in ICP
Lisinopril
ACE Inhibitor MOA: Inhibits ACE & blocks effects of ang. II; increases levels of bradykinin to dilate blood vessels and reduce blood volume Indications: - HTN - HF - Post-MI Tx - Prevention of MI, CVA, and death in patients with high CV risk - Diabetic nephropathy Adverse Effects: - First-dose hypertension - Cough (r/t bradykinin) - Angioedema (r/t bradykinin) - Hyperkalemia - Fetal injury Nursing Considerations: - Monitor BP & electrolytes closely - Educate patients to contact provider if cough and/or angioedema occurs
Losartan
Angiotensin II Receptor Blocker (ARB)
MOA: Blocks Ang. II receptors to produce vasodilation, prevent cardiac structural changes, and prevent aldosterone release
Indications:
- HTN
- Reduce risk of stroke, MI, and CV related death in high-risk patients
- Diabetic nephropathy & retinopathy
Adverse Effects:
- Angioedema (lower risk than ACEi)
- Fetal injury
Nursing Considerations:
- If ACEi not tolerated, ARBs given instead
- Monitor BP closely, especially if on multiple agents
- Educate patients to contact provider if angioedema occurs
Aliskiren
Direct renin inhibitor
MOA: Binds with renin to inhibit cleavage of angiotensinogen into angiotensin I to reduce influence of entire RAAS
Indications:
- Hypertension
Adverse Effects:
- Generally well-tolerated
- Diarrhea
- Low risk of hyperkalemia, angioedema, and cough
- Fetal injury
Nursing Considerations:
- Close I/O monitoring, vital signs, weight, and electrolytes especially if on multiple antihypertensive agents
Hydralazine
Vasodilator
MOA: Causes selective dilation of arterioles through actions on vascular smooth muscle to reduce peripheral resistance and blood pressure
Indications:
- Essential HTN
- Hypertensive crisis
- HF
Adverse Effects:
- Reflex tachycardia
- Increased BV
- Systemic Lupus Erythmateus (SLE)-like syndrome (serositis, oral ulcers, arthritis, photosensitivity, blood counts low, renal damage, antinuclear antibody, immunologic disorder, neurologic disorder, malar rash, discoid rash; SOAP BRAIN MD)
Nursing Considerations:
- Combine with isosorbide denigrate when used for treatment of heart failure
Co-admin. with beta-blocker to reduce reflex achy
Co-admin. with diuretic to reduce risk of sodium and water retention
Monitor VS closely, especially for excessive hypotension
Nitroprusside
Vasodilator
MOA: Causes both venous and arteriolar dilation to decrease BP
Indications:
- DOC for hypertensive emergencies!
- Controlled hypotension during surgery to reduce bleeding
Adverse Effects:
- Excessive hypotension
- Cyanide poisoning most likely in patients with liver disease
- Thiocyanate toxicity
Nursing Considerations:
- Minimal reflex tachycardia
- Continuously monitor VS and ECG & reassess patients for s/s that reflect changes in BP
- Initial infusion rates range from 0.3-0.5 mcg/kg/min and titrated to slowly bring down BP
- Co-admin. with PO antihypertensives
Immediate effects trigger Na and water retention; manage with furosemide admin.
Beta-Blockers (Metoprolol, Carvedilol, Lopressor, etc)
First-line tx for HF
Decreases contractility and allows ventricles to fill
Improves EF, exercise tolerance, and slows HF progression
Vasodilators
PO: BiDil (Isosorbide/Hydralazine)
- Approved for specific ethnic group (African Americans)
IV Nitroglycerin (NTG)
- Decreases pulmonary edema and angina
- Adverse Effects: hypotension, reflex tachycardia, and headache
IV Nitroprusside:
- Fast acting, short-term severe HF tx
- DOC for hypertensive emergencies/crisis
- AE: profound hypotension!
IV Nesirtide
- Synthetic form of BNP
- Short-term use for very severe/decompensated HF
- AE: V-tach, headache, and hypotenion
Digoxin
Cardiac Glycoside
Indications:
- Treats symptomatic HF and A-fib; does not prolong life
- 2nd line tx for HF due to its toxicity & adverse effects
+ inotrope (increases contractility; - chronotrope (decreases HR); - dromotrope (decrease conduction)
Adverse Effects:
- Fatigue
- Blurred/yellow tinged vision
- Dysrhythmias (most serious AE)
Nursing Considerations:
- Co-administer with K+ supplements
Antidotes for Toxicity:
- Digoxin Immune Fab (Digibind/Digifab); onset < 1 min; improvement in 15-30 minutes
- Activated charcoal & cholestyramine (Questran); decreases GI absorption
Kayexalate
Hyperkalemia tx MOA: Binds to K+ in large intestine and excreted in feces Indications: - Hyperkalemia - Administered PO or enema Adverse Effects: - Gastric irrigation - Nausea/Vomiting - Constipation (Impaction) - Hypokalemia Nursing Considerations: - Asses for bowel sounds/gastric motility prior to admin. - Monitor EKG - Monitor electrolytes
Regular Insulin
Hyperkalemia Tx
MOA: Pushes K+ back into cell
- IV glucose plus 5-10 units of reg. insulin
- Reduces serum insulin level within 10-20 minutes
- Lasts 4-6 hours
Class IA Antidysrhythmics (Sodium Channel Blockers)
Quinidine - DOC for malaria EKG changes: - Widens QRS/Prolong QT interval Indications: - A-fib/flutter - Ventricular dysrhythmias (sustained V-tach) - Torsades de pointes Adverse Effects: - Diarrhea - Vasodilation/hypotension Nursing Considerations: - Interacts with digoxin! (Doubles levels)
