Cardiac Pharmacology Flashcards
What is the indication of propranolol?
- Angina pectoris
- Mortality reduction after MI
- Supra ventricular, ventricular, atrial arrhythmias
- Tachyarrhythmias caused by excessive catecholamines action during the anesthesia, hyperthyroidism, or phenocharomocytoma
- Hypertension
- Prevention of frequent, severe, uncontrollable, or disabling migraine or vascular headache
- Essential tremor
- Hypertrophic cardiomyopathy
Beta1-and beta2 -adrenergic blocker: propranolol
What is the action?
Action:
- reduce cardiac oxygen demand by blocking catecholamines-induced increases in HR, BP, and Myocardial contraction
- depresses renin secretion and prevents vasodilation of cerebral arteries
- Relieves anginal and migraine pain, lower BP, restores normal sinus rhythm, and helps limit myocardial infarction (MI) damage
What are the nursing considerations of propranolol?
- Apical pulse before giving the drug ( extreme pulse rate;hold it and call physician)
- Administer with food to increase absorption
- Notify prescriber if severe hypotension occur
- Notify anesthesiologist of using propranolol before surgery
- Dose adjustment for elder
- Do not stop it abruptly
- Over dose —–give IV atropine, isoproterenol, or glucagon; refractory cases may require a pacemaker.
Beta1 adrenergic blockers: metoprolol
What is the action?
Competes with beta adrenergic agonists 兴奋剂for available beta adrenergic receptor sites
What is the indication of metoprolol ?
Hypertension
Angina pectoris
What are the nursing considerations of metoprolol?
- Adverse effect: fatigue, dizziness, bradycardia, hypotension, HF, and atrioventricular block
- Withhold the drug (<60 beats/ min)
- Monitor BP
Calcium channel blocker: verapamil
What is the action?
- Inhibits calcium ion influx across the cardiac and smooth muscle cells
- Reduces myocardial contractility and oxygen demand
- Dilates coronary arteries and arterioles
What are the indications of verapamil?
Angina relief
Decrease BP
Abnormal sinus rhythm
What are the nursing considerations of verapamil ?
- A pts with severely compromised cardiac function or one taking beta- adrenergic blockers should receive lower doses of verapamil
- Monitor cardiac rhythm and BP during the start of therapy and with dose adjustments
- Notify physician if signs and symptoms of HF occur, such as swelling of the hands and feet and shortness of breath
ACE inhibitors: Captopril
What is the action?
Thought to inhibit angiotensin- converting enzyme (ACE), preventing conversion of angiotensin I to angiotensin II ( reduced formation of angiotensin II decreases peripheral arterial resistance, this decreasing aldosterone secretion)
What are indications of Captopril?
Sodium and water retention
High BP
Impaired renal function in patients with diabetes
What are the nursing considerations of Captopril?
- Monitor WBC and differential counts before therapy, and periodically thereafter
- Give drug an hour before meal because food reduce absorption
- Withhold and notify prescriber if pts develop fever, sore throat, leukopenia, hypotension, or tachycardia
- Keep in mind that lightheadedness and syncope can develop in hot water, with inadequate fluid intake, vomiting, diarrhea, and excessive perspiration.
Cardiac Glycoside: Digoxin
What are the actions?
- Inhibits sodium-potassium- activated adenosine triphosphate, an enzyme that regulates the amount of sodium and potassium inside of the cell, resulting in increased intracellular levels of sodium and calcium.
- Promotes movement of calcium from extra cellular to intracellular cytoplasm and strengthens myocardial contraction
- Acts on the CNS to enhance Chagall tone, slowing contractions though the sinoatrial and atrioventricular nodes and providing an anti arrhythmic effect.
What are the indications of Digoxin?
HF
Atrial fibrillation and flutter
Supra ventricular tachycardia
What are the nursing considerations of Digoxin?
- Adverse effect: fatigue, agitation, hallucinations, arrhythmias, anorexia, nausea, and diarrhea.
- Withhold the drug ( apical pulse <60beats/min); notify prescriber!
- Periodically monitor serum potassium and digoxin levels
- Assess renal function ( digoxin excreted from kidney)
What are toxicity signs of digoxin?
- Slow to rapid ventricular rhythms
- Nausea &. Vomiting
- Blurred vision
- Anoxia
- Abdominal discomfort
- Mental changes
PDE inhibitors ( inamrinone & milrinone) What are the actions?
- Increase CO by strengthening contraction
- Help move calcium into cardiac cell
- Calcium storage in sarcoplasmic reticulum
- Decrease afterload ( peripheral vascular resistance )
- Decrease preload (blood returning to the heart
What are the indications of PDE inhibitors?
- Used for pts did not respond cardiac glycoside, diuretic, and vasodilator.
- Short term management
- Long term management in pts awaiting heart transplant surgery.
What are the nursing considerations of PDE inhibitors?
Adverse effect: ventricular arrhythmias,
Nausea & vomiting, headache and fever, chest pain, hypokalemia, thrombocytopenia, mild increased heart rate
Monitor fluid balance, Electrolyte, BP, HR, kidney function, urinary output and ECG
Angiotensin II receptor blockers: Losartan
What is the action?
Inhibits vasoconstricting and aldosterone secreting effects of angiotensin II by selectively blocking binding of angiotensin II to receptor sites in many tissues including vascular smooth muscle and adrenal glands.
What is the indication of Losartan?
High blood pressure
What are the nursing considerations of Losartan?
Monitor BP before therapy and regularly thereafter
Regularly assess kidney function ( creatinine and BUN)
Action of Quinidine gluconate (class IA antiarrhythmics)
Cause direct and indirect effect on cardiac tissue
Decrease automaticity自动性, conduction velocity迅速, and membrane responsiveness
Prolong effective refractory难治的 不起反应的 period
Indication of Quinidine gluconate
Atrial fibrillation, flutter, and tachycardia
Premature atrial and ventricular contractions
Paroxysmal superaventricular tachycardia
Nursing consideration of Quinidine gluconate
Nursing consideration
Monitor adverse effect: vertigo, headache, arrhythmias, ECG changes, hypotension, HF, tinnitus, diarrhea, nausea, vomiting, hematologic disorders, hepatotoxicity, respiratory arrest, angioedema, fever, temporary hearing loss.
Frequently monitor pulse and BP
Keep in mind that anticoagulation my be performed before treatment
Class IB antiarrhythmics: Lidocaine
Actions:
Decrease depolarization, automaticity, and excitability in the ventricles during diastole by direct action on the tissues, especially the Purkinje network
Indication of lidocaine
Life-threatening ventricular arrhythmias
Nursing consideration of lidocaine
Adverse: confusion, tremor, restlessness, seizure, hypotension, new arrhythmias, cardiac arrest, tinnitus, blurred vision, respiratory depression, and anaphylaxis.
Monitor serum lidocaine level for toxicity
Monitor electrolyte, blood urea nitrogen, and creatinine levels!
Class IC arrhythmias: Propafenone
Action
Reduce inward sodium current in Purkinje and myocardial cells
Decrease excitability, conduction velocity, and automaticity in atrioventricular nodal ( AV), His-Purkinje, and intra ventricular tissue.
Prolongs refractory period in AV nodal tissue
Indication of Propafenone
Life threatening ventricular arrhythmias
Nursing consideration of Propafenone
Administer with food to minimize adverse GI reaction
Notify prescriber if QSR complex increase by more than 25%
During use with digoxin, monitor the ECG and digoxin levels freq.
Nitrates: Nitroglycerin
Actions?
Relaxes vascular smooth muscle
Causes general vasodilation
What is the indication of Nitroglycerin?
Acute or chronic anginal attacks
What are the nursing considerations?
Adverse effect: headache, dizziness, or tho static hypotension, tachycardia, flushing, palpitations, and hypersensitivity reactions.
Monitor vitals
Treat headache with acetaminophen and aspirin!
Centrally acting sympatholytics: Clonidine
What is the indication?
High blood pressure
Centrally acting sympatholytics: Clonidine
What are the actions?
Inhibits central vasomotor centers, decreasing sympathetic outflow ( heart, kidneys, and peripheral vasculature)
Decrease afterload ( peripheral vascular resistance)
Decrease blood pressure
Decrease heart rate
Centrally acting sympatholytics: Clonidine
What are the nursing considerations?
Depending on pts tolerance and BP, the drug is adjusted.
When stopping therapy in pts with Clonidine and beta adrenergic blocker, pts should gradually withdraw “beta” first to minimize the adverse reaction.
Do not discontinuing drug before surgery!
Alpha- adrenergic blocker: Doxazosin
What is its action?
Acts on peripheral vasculature to produce vasodilation
Alpha- adrenergic blocker: Doxazosin
What is its indication?
High blood pressure
Alpha- adrenergic blocker: Doxazosin
What are the nursing considerations?
Monitor BP
Monitor ECG for arrhythmia
Dosages must be increase gradually ( adjustment q2w)
Vasodilator: Nitroprusside
What is the action?
Relaxes arteriolar and venous smooth muscle
Vasodilator: Nitroprusside
What are the indications?
High blood pressure
Increase preload and afterload
Vasodilator: Nitroprusside
What are the nursing considerations?
Adverse effects and cyanide toxicity: profound hypotension, metabolic acidosis, dyspnea, headache, LOC, ataxia, and vomiting.
Monitor BP q5min at start infusion & q15min thereafter
IV solution must wrap in foil because sensitive to light
Monitor thiocyanate levels q72h (excessive dose or rapid infusion can cause cyanide toxicity)
Antilopemics: atorvastatin
What is the action?
Inhibits HMG-CoA reductase
Antilipemics: Atorvastatin
What are the indications?
High plasma cholesterol and lipoprotein levels
What are the nursing considerations?
Use the drug only on nonpharmacologic treatments prove ineffective.
Before starting the therapy, a baseline creatine kinase may be obtained and pts should be monitored routinely.
Before therapy, perform a baseline lipid profile
Liver function test
Increasing dose after 6-12 weeks
