Cardiac Meds Flashcards
ACE Inhibitors
-pril
enalopril (Vasotec)
ACE your NCLEX in April
ACE Inhibitor Intended Response
vasodilation of blood vessel, diuresis, lower BP and workload of the heart and blood volume (stops aldosterone)
stops conversion of angiotensin 1 -> 2 by inhibiting ACE
can help slow kidney damage in people with diabetes
ACE Inhibitors SE
orthostatic hypotension
hyperkalemia
taste disturbance
HA
persistent dry cough
ACE Inhibitors ADE
angioedema!
fever/chills
hoarseness
stomach/chest pain
rash/itchy skin
yellow eyes/skin
neutropenia/agranulocytosis
ACE/ARB Inhibitors Nursing Interventions
kids more sensitive
older adults greater risk for OH
CI in pregnancy and potassium sparing diuretics (ex. spironolactone)
no salt substitutes!
check renal function (BUN/creatinine) and monitor electrolytes (K!)
assess BP prior (hold if <60)
monitor EKG (peaked T waves) or muscle spasms
fall precautions
can take weeks to be effective (ARB)
AA adults don’t respond with ACEI monotherapy
DONT STOP TAKING ABRUPTLY DUE TO REBOUND HTN
Angiotensin II Receptor Blockers (ARBs)
-sartan
valsartan (Diovan)
ARBs Intended Response
same as ACE inhibitors w/slightly different action; block the effects of angiotensin 2 (vasoconstriction, Na and water retention)
vasodilation and reduced BP
fewer SE, better tolerated
ARBs SE
hypotension
dizziness
HA
diarrhea/GI upset (n/v/d)
heartburn (pyrosis)
ARBs ADE
hyperkalemia
hyperglycemia
Calcium Channel Blockers (CCB)
SELECTIVE: nifedipine/amlodipine (-dipine); dihydropyridine
NON-SELECTIVE: diltiazem/verapamil; nondihydropyridine
Very Nice Drugs
CAN BE GIVEN WITH DIURETICS
blocks movement of Ca to slow conduction and HR
CCB Mechanism of Action
blocks Ca; lowers contractability, conductibility through nodes, and O2 demand
relaxes smooth muscle/blood vessels, increases blood supply to heart and reduces workload
selective: artery and arteriole vasodilation for BP (vascular smooth muscle only)
non-selective: also affects heart (used for A-Fib)
CCB SE
hypotension
bradycardia
flushing
constipation
nausea
HA
rash
drowsiness/fatigue
dizziness
CCB ADE
dysrhythmia
edema in legs (avoid in pts with HF)
worsening HF with verapamil and diltiazem
SJS
reflex tachycardia
CCB Nursing Interventions
NO GRAPEFRUIT DUE TO SEVERE OH
telemetry
DAILY WEIGHTS 1KG=1 L
no pediatric or pregnancy research
older folks more sensitive to SE; monitor symptoms of HF (REPORT INCREASED SOB OR ORTHOPNEA)
monitor BP/HR (hold for BP less than 90/60 (<100) or HR less than 60)
take with food or milk to help with absorption
Beta-Adrenergic Blockers (Sympatholytic)
-olol
atenolol (Tenormin) or propranolol
slows the speed of electrical conduction through the heart
Beta-Adrenergic Blockers Mechanism of Action
lowers HR, force of contraction, workload and BP (for SVT, rapid Afib or flutter)
blocks effect of epinephrine on CV system
leads to decrease O2 demand by heart
Beta 1: heart
Beta 2: lungs (bronchoconstriction, decreased airway to breathe)
Beta-Adrenergic Blockers SE
impotence
dizziness/light headedness
weakness
lethargy/fatigue
insomnia/nightmares
SOB
depression
cold hands/feet
peripheral edema
Beta-Adrenergic Blockers ADE
slow, fast or irregular HR (usually bradycardia)
dyspnea/bronchospasm (use Metoprolol for asthmatics; can cause/exacerbate asthma or HF) (only with propranolol)
chest pain
severe dizziness or fainting
cyanotic nail beds
seizures
hypotension
affect diabetic pts glucose lvls (blood sugar masking symptoms, no warning signs!)
Beta-Adrenergic Blockers Nursing Interventions
teach pt to check own BP and HR at home before taking meds
masks hypoglycemia (affects diabetics)
can cause or worsen asthma, COPD and HF
monitor VS, labs (BUN, creatinine, AST, LDH) and blood glucose
assess for signs of HF
avoid OTC meds
don’t abruptly stop due to rebound HTN!
cat C for pregnancy
Alpha Adrenergic Antagonists (Sympatholytic)
-zosin
prazosin (Minipress)
Alpha Adrenergic Antagonists Mechanism of Action
relax blood vessels and causes vasodilation and decreased BP by blocking alpha-1 receptors in arteries and smooth muscle
oppose effects of norepinephrine
intended response same as BBs; CI in pregnancy and hypotensives
Alpha Adrenergic Antagonists SE
impotence
dizziness
weakness
lethargy
insomnia/nightmares
SOB
1st dose hypotension common; start at bedtime
Alpha Adrenergic Antagonists ADE
slow, fast or irregular HR
dyspnea
avoid ED meds due to OH
Centrally Acting Alpha 2 Adrenergic Agonist
clonidine (Catapres)
Centrally Acting Alpha 2 Adrenergic Agonist Mechanism of Action
stimulate CNS receptors (alpha-2) to decrease constriction of blood vessels, dilate arteries, lower BP
used for difficult to control HTN
patches
Centrally Acting Alpha 2 Adrenergic Agonist SE
similar to BBs, but occur more often
DONT ABRUPTLY STOP
DECREASED HR AND BP
DRY MOUTH
DROWSINESS
DIZZINESS
CNS DEPRESSION (don’t combine with others)
Centrally Acting Alpha 2 Adrenergic Agonist Nursing Interventions
not researched with pregnancy; methyldopa used instead
for patches, rotate sites, remove old one before placing new one, wear gloves, no hairy sites; can stay on for 7 days
monitor BP and HR
avoid activities that require mental alertness
suck on hard candy/ice chips for dry mouth
Direct-Acting Arteriolar Vasodilators
hydralazine (Apresoline)
HTN CRISIS!!
Direct-Acting Arteriolar Vasodilator Mechanism of Action
acts directly on peripheral arteries, dilates, RAPIDLY lowers BP and workload of the heart
Direct-Acting Arteriolar Vasodilator SE/ADE
reflex tachycardia
hypernatremia
SJS with minoxidil
include more often
Direct-Acting Arteriolar Vasodilator Nursing Interventions
telemetry, monitor VS (HR); teach pt to monitor own HR
can be given IV
assess for fluid retention and SJS
monitor serum Na
report sustained increase in pulse >20 BPM
hydralazine safe to use for pregnancy
weight based dosing for peds
Cardiac Glycosides
digoxin (Lanoxin) for Afib (slows and strengthens heartbeat)
HF med; VERY NARROW TR OF 0.5-2
improves CO and inhibits the Na/K pump, increasing intracellular Ca
negative chronotrope (slows HR, lowers rate of conduction and O2 demand)
positive chronotrope (raises myocardial contractility)
negative DROMOTROPIC (slows electrical impulses through AV node, lowers conduction speed for controlling arrhythmias)
Cardiac Glycosides Nursing Interventions
look at potassium; Mg and Ca
monitor HR, take apical pulse >60 for 1 min (hold if HR <60)
hypokalemia increases toxicity
be mindful of loop/thiazide diuretics
teach pt to check own pulse and s/s of toxicity
obtain a baseline apical pulse rate for 1 full min before administration and future comparisons
determine signs of peripheral and pulmonary edema
older adults= confusion and delirium
check serum digoxin and K levels
take at same time everyday; don’t double doses if missed
consume high K foods to prevent hypoK
Digoxin Antidote
digoxin immune Fab (ovine, Digibind)
S/S of Digoxin Toxicity
green/yellow halos in vision; blurred vision
n/v
PVC
HA
diarrhea
confusion and delirium
anorexia
bradycardia and dysrhythmias (hypoK increases risks)
malaise
Organic Nitrates
nitroglycerin (Nitrostat)
short acting; FOR ANGINA
Organic Nitrates Mechanism of Action
vasodilation of both arterial and venous smooth muscle, helps reduce venous return to the heart, which decreases workload (preload and afterload) and lowers O2 demand
sublingual or patch (bypass 1st pass metabolism)
isosorbide dinitrate is longer acting for preventing angina attacks
converted to nitric oxide in body
Organic Nitrates SE
HA (tylenol)
hypotension
reflex tachycardia
flushing
dizziness
Organic Nitrates ADE
anaphylaxis
circulatory collapse (rare)
Organic Nitrates Nursing Interventions
avoid tachyphylaxis (overuse won’t work); give them drug free period at night to prevent tolerance
wear gloves!
in 5 min., if pain is still present take another and wait 5 min; can do up to 3 in a row…MORE THAN 3 CALL 911
lay pt down when administrating for OH
no alcohol!!
0 research done for pediatrics
class C for pregnancy
requires lower starting dose for older people
monitor VS (BP/HR) before and after administering
Anticholinergics (Parasympatholytics)
atropine
Anticholinergics Mechanism of Action
treats symptomatic bradycardia (dysrhythmia med)
blocks action of vagus nerve on heart to increase HR AND CO
often given pre-op to dry up respiratory secretions
Anticholinergics SE
can’t see, can’t spit, can’t pee, can’t shit
tachycardia
ADE are rare! not used for long term
Anticholinergics Nursing Interventions
no alcohol, caffeine or tobacco
can cause tachycardia in fetus
not for long term use
monitor HR and ECG and SEs (increase fluids, fiber, etc.)
Potassium Channel Blockers
amiodarone (Cordarone)
prolonged repolarization; slows conduction leading to decreased HR
Potassium Channel Blockers Mechanism of Action
converts afib/flutter to normal sinus rhythm and for life threatening ventricular dysrhythmias
lowers blood vessel constriction and HR
raises blood flow
slows impulse conduction
delays repolarization and prolong the action potential to slow down fast contraction
Potassium Channel Blockers SE
unique to amiodarone
neurological changes
photosensitivity (Blue Man Syndrome; blue-gray skin discoloration due to iodine)
peripheral neuropathy
n/v
hypo/hyperthyroidism (iodine)
microdeposits in corneas
hypotension
bradycardia
Potassium Channel Blockers ADE
(unique to amiodarone)
ARDS
pulmonary fibrosis
worsening of HF and dysrhythmias (QT prolongation and Torsades de Pointes)
decreased liver function
TEN (toxic epidermal necrolysis)/SJS
Potassium Channel Blockers Nursing Interventions
monitor for SE and arrhythmias
requires baseline and periodic monitoring of lungs, liver, thyroid, ECG (QT interval) and eyes
avoid excessive sun exposure (use sunscreen)
can cause blue/gray discoloration
takes consistently with/without food
report cough, vision changes, weight changes or SOB
Regulators of BP
kidneys
catecholamines
baroreceptors in aorta and carotid sinus
vasomotor center in medulla
hormones (ADH, ANP, BNP)
HF
1 cause is HTN
clinical syndrome that develops in response to myocardial insult, resulting in decline in function of the heart
triggers a neurohormonal response
Compensatory Mechanisms for HF
hypoxia stimulates the SNS to release catecholamines (increases force, speed of contractions; creates more work for heart)
RAS is activated (releases angiotensin II, a powerful vasoconstrictor and aldosterone, a sodium saver; creates more work for heart)
hypertrophy results as heart works harder (heart gets too big and outgrows blood supply and stiffens)
HFrEF (Reduced HF)
heart failure reduced ejection fraction EF < 40
old systolic HF
HFpEF (Preserved HF)
HF preserved ejection fraction EF > 50
old diastolic HF
CAD
one of leading causes of death in the US
narrowing/occlusion of a coronary artery with myocardial ischemia, even death typically due to artherosclerosis
Angina Pectoris
acute chest pain due to insufficient O2 to myocardium
accompanies physical exertion or emotional excitement
causes increases O2 demand
Angina
STABLE: occurs with predictable stress/exertion
UNSTABLE: occurs frequently unrelated to activity; unpredictable; PREINFARCTION
VARIANT (PRINZMETAL, VASOSPASTIC): occurs at rest
Myocardial Infarction (MI)
blockage and reperfusion following MI; blockage of left coronary artery with MI (1), infusion of thrombolytics (2), blood supply returning to myocardium (3), thrombus dissolving and ischemia clearing (4)
A Fib
electrical signals chaotically bombared AV node
ventricular response nearly always irregular
ACE/ARB Pt Teaching
change positions slowly
avoid K supplements or K rich foods (dark green leafy veggies, bananas, oranges, potatoes, spinach, avocados)
Sodium Channel Blockers
Quinidine
slows conduction and repolarization
