Cardiac Meds

Question 0

Phosphodiesterase Inhibitors

Common Examples: Milrinone (Primacor) Inamrinone (Inocor)

Answer 0

Indicated for the short-term management of heart failure.

• Adverse effects include ventricular arrhythmias, hypotension, chest pain, HA, hypokalemia, tremors and thrombocytopenia.
• Due to risk of toxicity theses are generally reserved for patients who do not respond to cardiac glycosides ore ACE inhibitors

Question 1

Cardiac Glycosides

Answer 1

Digoxin (Lanoxin, Digitek)

Indicated for the treatment of heart failure and dysrhythmias

• Monitor Digoxin levels, therapeutic levels should be between 0.5- 2ng/ml.
• Monitor K+, low serum potassium levels can increase the potential for toxicity.
• Monitor pulse and teach patient to take their pulse. Hold for pulse < 60 BPM in adults.
• Administer IV doses slowly over 5 minutes
• A loading or “Digitalizing” dose may be given to get the serum levels within therapeutic range.
• Common adverse effects include fatigue, anorexia and bradycardia. Monitor for signs of toxicity which include: HA, vertigo, photophobia, yellow-green halos, tachycardia and AV heart block
• Antidote: Digibind

Question 2

Direct vasodilator s

Answer 2

Nesiritide (Natrecor)

Indicated for acute treatment of heart failure in patients with dyspnea at rest and/or minimal activity.

• Common adverse effects include cardiac arrhythmias, hypotension, HA, fainting, and anxiety.
• Reduce dose or stop administration with hypotension
• Obtain a baseline creatinine level and continue to monitor, can be nephrotoxic with acutely decompensated heart failure.

Question 3

Organic nitrate/dilators

Answer 3

Nitroglycerin (Nitro-Bid), Isosorbide (Isordi)

Indicated for the treatment of stable and unstable angina. Rapid acting forms are indicated for the management of acute angina episodes and long acting forms are used for the prevention of angina attacks.

• HA is the most commonly reported adverse effect, others include hypotension, tachycardia and contact dermatitis with topical forms.
• Contraindicated with preexisting hypotension, head trauma or increased intracranial pressure, and pericardial tamponaade. *Adequate hydration status required for administration
• For IV administration: use IV pump, hold for systolic BP < 100
• For sublingual administration: store in dark, light resistant container, replace supply every 6 months, may administer up to 3 tabs SL
• For topical administration: apply with gloves, use non-hairy sites and rotate sites, avoid lower extremities

Question 4

Beta-adrenergic Antagonists (Beta Blockers)

Answer 4

Common Examples:
Atenlol (Tenormin), Metoprolol (Lopressor), Propanolol (Inderal)

Indicated for the treatment of angina, particularly angina caused by exercise. Mainstay treatment for the management of hypertension, cardiac dysrhythmias and MI.

Unlabeled uses include migraines, and tachycardia associated with stage fright.

• Well tolerated at low doses
• Adverse effects include: bradycardia, hypotension, second and third degree heart block, fatigue, lethargy, depression, wheezing, dyspnea, impotence and decreased libido, altered glucose and lipid metabolism.
• HoldforHR<60
• Withdraw gradually to avoid rebound hypertension, angina and MI.
• Periodically monitor blood sugar, cholesterol and triglycerides. * Use with caution in patient with history of asthma or diabetes

Question 5

Calcium channel blockers

Answer 5

Amlodipine (Norvasc), Diltiazem (Cardizem),Ranolazine (Ranexa)

Indicated for the management of angina, hypertension and dysrhythmias. Also indicated for migraines and Raynaud’s disease.

• Adverse effects include: bradycardia or tachycardia, heart block, hypotension, dyspnea, wheezing, GI complaints and dermatitis.
• Reduce dose with known liver disease and use caution * Taper dose

Question 6

Alpha adrenergic blockers

Answer 6

Clonidine (Catapres) Methyldopa (Aldomet)

Antihypertensive. Management of opiod withdrawal.

• Orthostatic hypotension is a common adverse effect, other adverse effects include bradycardia, reflex tachycardia, sedation, dizziness and HA.
• Do not discontinue abruptly.
• Aldomet often prescribed for pregnancy induced hypertension

Question 7

ACE inhibitor

Answer 7

Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril, Prinivil) Moexpril (Univasc) Ramipril (Altace)

Indicated for hypertension MI and heart failure.

• Adverse effects are generally mild and include dizziness, fatigue, HA, hypotension, dry nonproductive cough, chest pain, tachycardia, hyperkalemia, hypermagnesemia.
• Serious but rare adverse effect: Angioedema
• Monitor K+ and Mg levels.
• Enhance the effects of thiazide diuretics

Question 8

ARBS

Answer 8

**sartans

Antihypertensive, adjunctive therapy for heart failure.

• Adverse effects are generally mild and include HA, upper respiratory infections, dizziness, GI complaints and fatigue. * Potent vasodilator.
• Often used in combination therapy for the management of hypertension

Question 9

Direct acting vasodilator s

Hydralazine (Apresoline), Nitroprusside (Nipride)

Answer 9

Antihypertensive

• Adverse effects include HA, dizziness, reflex tachycardia, hypotension, rebound hypertension, hyperglycemia, Na+ and water retention
• Monitor I & O, blood glucose
• Nipride indicated for emergency management of hypertension, titrated IV infusion. Monitor VS frequently with continuous cardiac monitoring.
• Adverse effects eliminate use as drugs of first choice.