Cardiac Meds

Question 1

Calcium Channel Blockers

Answer 1

• Nifedipine
• Amlodipine
• Verapamil
• Diltiazem

Facts:
- “-dipine”: pine trees in California
- lower blood pressure and HR, treat angina
- Verapamil and Diltiazem treat AFib, Aflutter, and SVTs
- use cautiously with digoxin and beta blockers
- do not give to patients with heart block or bradycardia (check apical pulse 1 minute)
- no grapefruit juice
- can cause constipation, reflex tachycardia, peripheral edema

Question 2

Beta Blockers

Answer 2

Selective (heart and renal):
- Metoprolol
- Atenolol
- Metoprolol Succinate

Non-Selective (muscles and organs):
- propranolol
- Nadolol
- Labetalol

Facts:
- Lower BP and HR, treat angina, tachydysrythmias, heart failure, and MI
- do not give to patients with heart block or bradycardia (check apical pulse 1 minute)
- Do not give nonselectives to patients with asthma, bronchospasms, or HF
- propranolol (nonselective) can mask symptoms of hypoglycemia – monitor blood glucose
- no labetolol with furosemide in the same IV

Question 3

ACE and ARBS

Answer 3

ACE Inhibitors:
- Catopril
- Enalapril
- Enalaprilat (IV)
- Fosinopril
- Lisinopril

ARBS:
- Losartan
- Valsartan
- Irbesartan

Facts:
- lower blood pressure, treat HF, MI, and diabetic nephropathy
- use with caution with diuretics
- ACE = Angio-edema, Cough, Elevated K+
- give epinephrine 0.5 mL IM if angioedema occurs
- ACE inhibitors 1 hour before meals

Question 4

Alpha Blockers and Alpha Agonists

Answer 4

Alpha Blockers:
- Prazosin
- Doxazosin mesylate

• lower BP
• do not take with NSAIDs
• take at bedtime to minimize effects of hypotension

Alpha Agonists:
- Clonodine
- Methyldopa

• lower HR and BP, treat severe cancer pain, given during hypertensive crisis
• do not take with antigoagulants or hepatic failure patients
• do not take with MAOIs
• do not use during lactation
• cause dry mouth, black or sore tongue, leukopenia, rebound hypertension, and drowsiness

Question 5

Vasodilators

Answer 5

• Nitroglycerine
• Enalaprilat
• Nitroprusside
• Hydralazine

Facts:
- lower blood pressure, used in hypertensive emergencies and chest pain
- do not give to clients with renal or hepatic diseases
- can cause headache but this means it is working, dizziness, cyanide toxicity, thiocyanate poisoning, profound hypotension
- do not mix nitroprusside with anything else
- apply protective cover to container, discard use after 24 hours
- nitro patch: remove patch each evening for a med free time of 12-14 hours before applying a new patch

Question 6

Cardiac Glycoside

Answer 6

-Digoxin

Facts:
- positive inoptropic drug (increase contractility or BP, but decreases heart rate (negative chromotropic) and AV node conduction rate (negative dromotropic)
- used for Afib and heart failure
- monitor potassium, magnesium and calcium (low K+ = high digoxin, high K+ = low digoxin) (low Mg+ = high digoxin, high Mg+ = low digoxin) (low Ca+ = low digoxin, high Ca+ = high digoxin)
- thiazide and loop diuretics (furosemide) can cause hypokalemia and digoxin toxicity
- ACE and ARBs cause hyperkalemia and low digoxin
- Verapamil causes digoxin toxicity
- Digoxin toxicity = anorexia, blurred vision, yellow/green halo vision, diplopia (double vision), weakness and fatigue
- apical pusle for 1 minute, do not give if <60
- if dysrhythmias occur, treat with phenytoin or lidocaine
- treat bradycardia with atropine
- antidote: digoxin immune FAB
- therapeutic levels: 0.8 - 2.0

Question 7

Anti-Anginals (Nitrates)

Answer 7

• sublingual tablet
• sustained-release tablet
• transdermal ointment (use gloves)
• transdermal unit patch
• used for acute anginal attack
  -prophylaxis for stable or variant angina
• do not take with erectile dysfunction agents
• do not give to patients with head injury
• how to give sublingial tablets:
  1. take tablet (place under tongue and sip water)
  2. wait 5 min.
  3. if pain not releived, call 911, and take second tablet (can take up to 3 tablets, 5 min. apart)
• can be used 5 to 10 min before exercise
• do not shake container
• replace tablets every 6 months
• keep in same dark container
• patches should be worn for 12 to 14 hours, then removed over night
• ointment should be on an area without hair

Question 8

Antidysrhythmic Agents

Answer 8

Adenosine
- slows AV node conduction, can cause asystole for a few seconds
- convert SVTs to NSR

Amiodarone
- prolonges repolarization, decreases vascular resistance
- treats VFib, unstable Vtach

Atropine (increases HR)
- treats bradycardia
-anticholinergic effects (DRY)
- should be used in emergencies, bradycardia with SOB, weak, fatigued, low BP

Question 9

Antilipemics

Answer 9

• Atorvastatin
• Simvastatin
• Lovastatin
• Pravastatin sodium
• Rosuvastatin
• Fluvastatin

Facts:
- no grapefruit juice
- muscle pain and aches = stop immediately, rhabdomyolysis (muscle breakdown) is occuring
- hepatotoxicity may occur
- take in the evening (cholesterol synthesis occurs)
- monitor liver and renal functions
- low fat, high fiber diet
- do not take with warfarin (prolonged bleeding may occur)
- MULTIPLE DRUG INTERACTIONS: digoxin, warfarin, thiazide diuretics, NSAIDs…