Cardiovascular Flashcards
Atenalol/ beta blocker
Management angina, HT, prevention MI
Blocks stimulation of beta 1 (cardiac) adrenergic receptors. Decreases BP and HR and anginal attacks,
Contraindicated- uncompensated heart failure, pulmonary oedema, cardiogenic shock, bradycardia, heart block
Dose- 50-100mg daily
Nursing considerations- monitor BP and pulse
Caution- rental impairment (GFR <35), diabetes (masks hypo), thyrotoxicosis
Side effects-
CNS- fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status change, nervousness, nightmares
ENT- blurred vision, stuffy nose
Resp- bronchospasm, wheezing
CVS- Heart failure, bradycardia, pulmonary oedema, hypotension, peripheral vasoconstriction
GI- constipation, diarrhoea, increased liver enzymes, nausea, vomiting,
Genitourinary- erectile dysfunction, decreased libido, urinary frequency
Endo- hyper/hypoglycaemia
Skin- rashes
Musculoskeletal- arthralgia, backpain, joint pain
Labetalol/beta blocker
Antianginal/ anti hypertensive
Blocks stimulation of beta 1 (myocardial) and beta 2 ( pulmonary, peripheral vascularture and uterine) adrenergic receptor sites. Also has alpha 1 adrenergic blocking activity which may result in more ortho static hypotension
Dose- 100-400mg 2-3times day
Nursing considerations- monitor BP and pulse, watch for orthostatic hypotension.
IV labetalol patients must be supine for administration and 3 hours post.
Monitor intake/output and daily weight
Contraindicated in- decompensated HF, pulmonary oedema, cardiogenic shock, bradycardia or heart block
Use cautiously in: pulmonary disease, thyrotoxicosis, diabetes, renal or hepatic impairment,
Adverse reactions- CNS- fatigue, weakness, anxiety, depression, dizzy, drowsiness, insomnia, memory loss, mental status change, nightmares
CVS- arrhythmias, bradycardia, CHf, orthostatic hypotension
Skin- itching, rash
ENT- blurred vision, dry eyes, intraoperative floppy iris syndrome, nasal stuffiness
Endo- hypoglycaemia, hyperglycaemia
GI- constipation, diarrhoea, nausea
Genitourinary- decreased libido, erectile dysfunction
Musculoskeletal- arthralgia, back pain, muscle cramps
Neuro- parasthesia
Resp- pulmonary oedema, bronchospasm, wheezing
Drug interactions- digoxin, verapamil, general anaesthesia,diltiazem cause added myocardial depression, bradycardia. Thyroid meds may decrease effectiveness. May alter effects of hypoglycaemics. Effects increased with propranolol and cimetidine. NSAIDs May decrease antihypertensive effects
Digoxin /antiarrhythmic, inotropic
Indication- heart failure, Atrial fib, atrial flutter, paroxysmal atrial tachycardia
Increases force of myocardial contraction, prolongs refractory period of AV node, decreases conduction through SA and AV nodes.
Increases cardiac output (positive inotropic) and slows heart rate (negative chronotropic)
Contraindicated: uncontrolled ventricular arrhythmias, AV block (no pacemaker), idiopathic hypertrophic subaortic stenosis, constrictive pericarditis
Midodrine/ vasopressor
Used for symptom management of refractory orthostatic hypotension in patients whose livers are impaired. Can also be used for urinary incontinence
Dose- 10mg TDS
Activation of alpha 1 adrenergic receptors in arteries and veins.
Increases vascular tone and BP
Nursing responsibility- monitor sitting and standing BP during therapy, Assess for urinary incontinence, monitor renal and hepatic function
Contraindicated in urinary retention, severe organic heart disease, acute renal disease, persistent excessive supine hypertension, pheochromocytoma, thyrotoxicosis
Use cautiously in: hypertension, renal impairment, hepatic impairment, diabetes, visual impairment, concurrent fludrocortisone,
Adverse effects: CNS- anxiety, confusion, head pressure/fullness, headache, nervousness
CVS- supine hypertension, bradycardia
Urinary- urge/frequency/retention, dysuria
Skin- facial flushing, piloerection, pruritis, rash
Neuro- parasthesia
Misc- chills and pain
Drug interactions- increased risk bradycardia with digoxin, beta blockers, antipsychotics
Increased BP with ephedrine, thyroid hormones, MAO inhibitors, droxidopa,
Effects reduced with alpha adrenergic blockers (prazosin, terazosin)
Telimisartan- micardis
Angiotensin II receptor antagonist
Antihypertensive
Dose- 40-80mg daily
Reduces risk of MI, stroke, cardiovascular death in patients over 55 who are at risk of cardiovascular events and can’t take ACE inhibitors
Blocks vasoconstrictor and aldosterone secreting effects of angiotensin II at various receptor sites including vascular smooth muscle and the adrenal glands
Nursing responsibility- assess lying and standing BP, pulse, assess signs of angioedema, monitor renal function, monitor potassium
Contraindicated- hypersensitivity, bilateral renal artery stenosis, concurrent use with aliskirin in patients with diabetes or mod-severe kidney disease
Use cautiously in- volume or salt depleted patients, use of diuretics, impaired renal function caused by primary renal disease or heart failure, obstructive biliary disorder or hepatic impairment, women of childbearing age,
Adverse reactions- CNS- dizziness, fatigue, headache,
CVS- hypotension
ENT- sinusitis
Metabolic- hyperkalaemia
GI- abdo pain, diarrhoea, dyspepsia
Renal- impaired renal function
Muscle- myalgia, back pain
Misc- angioedema
Drug-drug- risk hypotension with other antihypertensive, risk of hyperkalaemia with diuretics/potassium supplement, risk of hyperkalaemia/hypotension/renal impairment with use of ACE inhibitors, NSAID can decrease antihypertensive effect and increase risk of renal impairment
Milrinone
Use- inodilator, selectively inhibits cAMP PDE 3 (responsible for breakdown of cAMP) therefore increasing cAMp levels in cardiac and vascular muscle improving myocardial contractility independent of beta stimulation
Positive inotrope as increases calcium influx to cardiac muscle and vasodilator little chronotropic effect
-slight enhancement of AV node conduction
- increases velocity and magnitude of ventricular contraction, increased cardiac output
- increased rate ventricular relaxation and enhanced diastolic function
- arterial and venous dilation (reduced afterload and PVR)
Half life- 2.5-2.4hrs
Onset- 5-15mins
Usual dose- 5-50mcg/min= 1-10ml/hr
Prep- 10mg in 33mls glucose 5%
- 300mcg/ml= 5mcg/min
Indications- cardiogenic shock secondary to ADHF
- low output states post cardiac surgery
Contraindications- severe obstructive aortic or pulmonary vascular disease
Nursing considerations- correct electrolytes, continuous cardiac monitoring, monitor (CO index, PCWP, MAP, SVR, PVR if able )
- never cease abruptly, wean everyone 2-3hrs
Side effects- arrhythmias, hypotension, angina, headache, nausea, tremor, hypokalaemia, thrombocytopenia
Amiodarone
-Prep
- low sorb IV line
-loading dose 150mg in 250ml glucose 5% , give over 1hr
Dose range 5mg/kg -(150-350mg)
- 900mg in 100mls (remove 28ml) of glucose 5%
10mg/ml
Dose range 1-5ml/hr
Central line or large peripheral vein.
Sideline of normal saline/glucose
300mg can be given via push in emergency situations- 20mls glucose pre and post- saline of cardiac arrest
Class 3 antiarhythmic that prolongs the action potential duration and refractory period of atrial, nodal, ventricular tissues and accessory bypass pathways
- slows HR and AV conduction
- vasodilators action to increase coronary blood flow, decrease cardiac workload and myocardial oxygen consumption
-half-life 9-36 days for IV
Contraindications- brady, sick sinus, AV block, not given with antipsychotics that prolong QT
Precautions- hypotension and circulatory collapse, excessive doses may lead to atropine resistant bradycardia, caution with hepatic failure/lung disease, hypersensitivity to iodine, hypo/hyperthyroidism
Nursing consider- baseline ECG, baseline thyroid tests
Side effects- prolonged QT, bradycardia, AV block, hypotension, N&V, metallic taste, proarrhythmogenic atypical ventricular tachycardia
Labetalol
Initial dose 10-20mg over 1-2min
Rpt in 10min if high BP
20-40mg every 10-15min
Max 160mg in 1/24
Max with infusion 300mg in 24hrs
Prep- 100ml N/S or glucose 5%. remove 20mls, add 100mg labetalol
1mg/ml
Infusion rate commence at 20mg/hr then increase by 20mg every 15min till desired BP- max 200mg/hr
Half rate every 30min until off
If BP increases then restart at last effective rate or increase by 20mg/hr every 15min
Lignocaine
VT/VF 1-1.5mg/kg (usual 75-100mg)
Over 1-2min slow IV bolus
Can repeat at half dose every 5-10min
Max dose 300mg/hr
Infusion- 1200mg lignocaine (12mls of 500mg in 5mls) in 100mls N/S or glucose 5%. Remove 12mls.
12mg/ml
1ml/hr= 0.2mg/min
1mg/min= 5ml/hr
Commence 4mg/min (20ml/hr) for 1/24 then
3mg/min (15ml/hr) for 1/24 then
2mg/min (10ml/hr) for 24hrs
Action- class 1B antiarrythmic, sodium channel blocker, reduces Automacity of myocardial tissue with little effect on cardiac conduction- may favourably depress conduction in ischaemic myocardium
Half life for bolus 8-11min, for infusion 1.5-2 hours (prolonged in hepatic/heart failure)
Indication- ventricular arrhythmias associated with MI, VF/VT and symptomatic PVC, torsades de pointes
Contraindications- SVT, ventricular escape rhythm, severe heart blocks, stokes-adams syndrome, uncontrolled epilepsy, known hypersensitivity to local anaesthetics
Nursing considerations- resus equipment available, correct hypovolaemia and electrolyte imbalances, baseline ECG
Cease 24hrs after last episode of ventricular arrhythmia. Can be stopped abruptly, no weaning required
Side effects- lignocaine toxicity(drowsy, tingling, nystagmus-stop immediately), headache, dizzy, drowsy, confusion, N&V, tongue numbness, twitching/tremor, visual disturbances, tinnitus, resp arrest, hypotension, Brady, AV block, asystole
Metarominol
Dose range 0.25-0.5mg (1ml)
Rpt every 5min until effect
Infusion- 1-5mg/hr
20mg (2ml) made to 40mld of N/S or glucose 5%
0.5mg/ml
Potent synthetic sympathomimetic amine that acts on alpha and beta 1 receptors but no effect on beta 2 receptors
Peripheral vasoconstriction and positive inotropic effect causing increase in systemic blood pressure
No chonotropic effect and may cause reflex bradycardia
Uses- acute hypotension
Life span 20min-1hr
Onset 1-2mins
Clonidine
Prep- 900mcg in 100mls (remove 16ml) of N/S
10mcg/ml
25mcg/hr increase every 30min to effect
Wean by 25-50mg/hr
Dose range 50-200mcg/hr
GTN
Peripheral- 150mg (30ml) in 500mls N/S or glucose 5%
300mcg/ml
5mcg/min= 1ml/hr
Central access- 30mg (6mls) in 50mls N/S or glucose 5%
600mcg/ml
10mcg/min= 1ml/hr
Dose range 5-200mcg/min
Wean down 5mcg every 15min
Action- organic nitrate that relaxes smooth muscle, it causes dilation of arterial and predominately venous beds.
Venous dilation will reduce venous return (preload) to the heart and decrease myocardial O2 requirement.
Arterial dilation will reduce systemic vascular resistance and arterial pressure (after load) to reduce left ventricular workload.
Dilated coronary arteries to increase coronary perfusion and oxygen supply.
Increases collateral flow to coronary arteries.
Reduces systolic, diastolic and MAP
Half life- 1-4min
Indications- unstable angina and NSTEMI, reduce workload in MI/heart failure, acute HTN, reduce grafted vessel resistance post CABGS
Contraindications- hypersensitivity to nitrate, hypotension or hypovolaemia uncorrected, increased ICP, ICH, constrictive pericarditis, severe aprtic or mitral stenosis, severe anaemia and arterial hypoxaemia, use of sidenafil, hypotrophic obstructive cardiomyopathy
Nursing considerations- continuous cardiac monitoring, baseline ECG, review at 24hrs as tolerance may develop
Side effects- hypotension, headache, flushing, palpitations, reflex tachycardia, decreased arterial oxygen tension, abdominal pain, restlessness, peripheral oedema,
Hydralazine
100mg in 100ml N/S
1mg/ml
Bolus 5-10mg over 1minute rpt every 10mins
Max 40mg in 24hrs
Infusion- (no bolus =12-18mg/hr)
(Bolus 3mg/hr)
Titrate 3mg/hr every 10-15min to achieve target BP
Decrease rate when BP achieved
Typical dose range 3-9mg/hr
Max 18mg/hr
Noradrenaline
3mg in 50ml syringe of N/S
16mg in 26l glucose 5%
60mcg/ml
1mcg/min
Naturally occurring sympathomimetic amine
-acts on alpha 1& 2 (peripheral vasoconstriction)
- some beta 1 (increased contractility)
-some beta 2 (coronary vasodilation)
Half life 3mins
Onset- 1-2min
Duration 5-10mins
Use- low C/O, decreased SVR, vasodilatory/cardiogenic shock
Precautions with- hypotension with hypovolaemia, peripheral vascular thrombus, MAOI, hyperthyroid, IHD, glaucoma
Side effects- reflex bradycardia due to increased BP, arrhythmia, ischaemia, necrosis with extravasation, urinary retention, anxiety,
Signs of overdose- sweating, hypertension, headache, photophobia, vomiting
Assess for organ perfusion
Sodium nitroprusside
Usual dose 20-400mcg/min
2-40ml/hr
Prep- 50mg in 100ml glucose 5%, CSL or N/S (remove 19mls) total 83mls
600mcg/ml
10mcg/min
Cover with black bag
Wean gradually over 10-30min
Infusion at max dose only for 10min to avoid cyanide toxicity
Action- relaxes vascular smooth muscle to cause arterial and venous vasodilation- reduces preload and afterload
Onset action- 2mins, half life 2mins
Contraindications- compensatory HTN, uncorrected hypovolaemia, high ICP, severe renal disease
Side effects- hypotension, rebound HTN when ceased, cyanide toxicity (Venous hyeroxemia, metabolic lactic acidosis, air hunger, confusion, death), ischaemia, GIT disturbances, headache, tachycardia, rash, flushing
Nursing considerations- BP through artline, cardiac monitoring, serum thiocyanide for infusions >48hrs
