Cardio Vascular Medications Flashcards
Diuretics what does it do
Work mainly by interfering with reabsorption of Na & Cl and passive reabsorption of water remember: water follows salt
This means less circulating volume and less resistance for the heart to work against
Diuretics med
Thiazide Loop Potassium-sparing -Aldosterone antagonists -Non-aldosterone antagonists
=↓ circulating volume and venous return to heart. ↓SVR.
Loop diuretics medication Med: Action: Uses: SE: NS: Evaluation:
furosemide
bumetanide
Action: block reabsorption of Na & Cl in the loop of Henle so it prevents passive reabsorption of water
Reduces ECF volume and venous return to heart
Uses: HF, Edema of cardiac, hepatic, or renal origin, HTN that can’t be controlled with thiazide diuretics
SE: ↓ Na, ↓Cl, ↓K, dehydration, ↓BP, orthostatic hypotension, ototoxicity
NS: teach gradual position change, K diet sources, S/S of lyte imbalances/dehydration, BP & wt record
Evaluation: weight, edema, intake/output, labs monitor lytes: K, Na, Cl and hydration: BUN & Creat, ortho BP
Thiazide diuretics Med: Action: Uses: SE: NS: Evaluation:
Med: metolazone, hydrochlorothiazide
Action: Works in distal tubule to increase renal excretion of Na, Cl, K and water. Dependent on adequate kidney function. Not as “strong” as loops
Uses: HTN, edema
SE: ↓ Na, ↓Cl, dehydration, ↓BP, orthostatic hypotension, ↓K
NS: teach gradual position change, K diet sources, S/S of electrolyte imbalances/dehydration, BP & wt record
Evaluation: weight, edema, intake/output, labs monitor electrolyte: K, Na, Cl and hydration: BUN & Creat, ortho BP
Potassium-sparing: aldosterone antagonist Med: Action: Uses: SE: NS: Evaluation:
Med: spironolactone
Action: blocks the action of Aldosterone in nephron, so ↑Na excretion ,↑ K reabsorption = limited diuresis. Also blocks aldosterone effects in heart & vessels
Uses: HTN ,or edema (often in combination with loop or thiazide diuretic), HF, hyperaldosteronism
SE: ↑K, endocrine effects (steroid derivative), N & V
NS: teach effect delayed, never combine with K supplements (including salt substitutes), recognize ACEs, ARBs, & renin inhibitors can ↑K RT ↓aldosterone
Evaluation: monitor K levels, wt., edema, endocrine effects: gynecomastia, impotence, menstrual irrg, hirsutism (condition in women that results in excessive growth of dark or coarse hair in a male-like pattern), deepening of voice
Potassium-sparing: non aldosterone antagonists
Med:
Action:
SE:
Med: triamterene
Action: This class of medications directly blocks the reuptake of Na and the excretion of K
SE: Can cause elevated K levels
Drugs that act on the Renin-Angiotensin-Aldosterone System
ACE inhibitors (ACEIs)
Angiotensin Receptor Blockers (ARBs)
Direct Renin Inhibitors
Aldosterone Antagonists
Interfere with RAAS effects
(vasoconstriction, ↑ blood volume, electrolyte changes, damage to heart & vessels)
what does angiotensin do?
These meds prevent the formation of Angiotensin II (ACEI) or block its action (ARB). So we keep the blood vessels from getting tight (we stop vasoconstriction)
AND
We stop release of ALDOSTERONE that says to the body “SAVE SALT SO THAT WATER WILL FOLLOW” (we drop volume)
By vasodilation and decreasing blood volume we can:
- drop blood pressure 2. improve circulation to the heart muscle 3. reduce the workload of the heart
- prevent nephropathy by dropping pressure in the glomerulus
By blocking the evil effects of angiotensin 2 we can
- improve outcomes after MI
- reduce cardiac death
- reduce remodeling of heart muscle
Direct Renin Inhibitors
aliskiren (Tekturna)
Prevent conversion of angiotensinogen into angiotensin I
This acts earlier in the RAAS than the ACEIS and ARBS do.
Approved to treat HTN
ACE Inhibitors: “pril" Med: Action: Uses: SE: NS: Evaluation:
Med: lisinopril, captopril
Action: 1) prevents conversion of angiotensin I to II: : so blocks vasoconstrictor, & aldosterone release & reduces hypertrophy & remodeling in CV & kidneys
2) ↑bradykinin (vasoodilator)
Uses: : HTN, HF, MI, nephropathy, prevent MI & stroke
SE: hypotension, ↑K, renal failure, fetal injury, cough, angioedema, renal failure
NS: NSAIDS ↓effectiveness, diuretic enhance drug effects, teach to report cough
Angiotensin II Receptor Blockers (ARBS): “sartan”
Action?
Effects?
The action is similar to ACEIs – ARBs prevent action of A II. These meds produce vasodilation & excretion of salt and water.
The effects are similar to ACEIS but delayed effect & less angioedema
Drugs that interfere with the RAAS
Basic effect of all drugs in this class is vasodilation, increased excretion of salt and water, and prevention of A2 damage to tissues
Calcium Channel Blockers
CCBs grow in the “pines”
by blocking the calcium channel, we allow less calcium into the cell which dials down the strength and length of contraction in the smooth muscle cells of the heart and vessel walls
