cardiovascular agents Flashcards
Furosemide (Lasix) MOA
effects the ascending limb of loop of henle to block reabsorption of NA and Cl, prevents reabsorption of water
Furosemide (Lasix) indication
Pulmonary edema from HF
edema non-responsive to other agents
HTN not controlled by other agents
Furosemide (Lasix) adverse effects
decrease Na+ Cl K+ and BP
ototoxicity (ringing in ears)
dehydration with higher risk of thrombosis and emboli
ventricular dysrhythmias if used with digoxin
Furosemide (Lasix) nursing considerations
close monitoring of I/O, vitals, weight, hearing and electrolytes
admin in morning-early afternoon
Slow IVP- give 10-2mg/min
educate on K+ rich sources in diet
Hydrochlorothiazide (HCTZ) MOA
in distal convoluted tubule to block reabsorption of Na and Cl preventing water reabsorption
Hydrochlorothiazide (HCTZ) indications
hypertension
edema secondary to HF, hepatic, or renal disease
diabetes insipidus
postmenopausal osteoporosis
Hydrochlorothiazide (HCTZ) adverse effects
decrease Na+ Cl K+ and BP
dehydration with higher risk of thrombosis and emboli
ventricular dysrhythmias if used with digoxin
Hydrochlorothiazide (HCTZ) nursing consideration
cant be used with patients with low GFR
watch I/O, vitals, weight, electrolyte
morning-afternoon administrations
education on K+ rich sources in diet
Mannitol (Osmitrol) MOA
pulls fluid from interstitial space and moves it into vascular and extravascular space via osmosis
Mannitol (Osmitrol) indications
Prophylaxis of renal failure with hypovolemic shock and severe hypotension
Reduction of intracranial and intraocular pressure
Mannitol (Osmitrol) adverse effects
Edema, especially in patients with existing heart failure
Fluid & electrolyte imbalances
Mannitol (Osmitrol) nursing considerations
use filter needles to avoid microscopic crystals
watch for changes in ICP
if urine output decreases severely, STOP
Spironolactone (Aldactone) MOA
blocks action of aldosterone in distal nephron
Spironolactone (Aldactone) indications
hypertension, often co-administered with K+ wasting diuretics
edema
HF
Spironolactone (Aldactone) adverse effects
hyperkalemia
ednocrine effects menstrual irregularities, impotence, hirsutism and deepened voice
Spironolactone (Aldactone) nursing considerations
Watch i/o, vitals, weight,a dn electrolytes
educate pt on K+ rich diet
Kayexalate MOA
binds to K+ in intestine and excreted in stool
Kayexalate adverse effects
Gastric irritation
N/V
Constipation OR diarrhea
Hypokalemia
Kayexalate nursing considerations
Assess for bowel sounds/gastric motility prior to administering!
Monitor EKG
Monitor electrolytes
Lisinopril (Zestril) MOA
ACE inhibitor
Lisinopril (Zestril) indications
Hypertension, heart failure, & post-MI therapy
Prevention of MI, CVA, and death in patients with high CV risk
Diabetic nephropathy
Lisinopril (Zestril) adverse effects
First-dose hypotension
Cough
Angioedema
Hyperkalemia
Fetal injury
Lisinopril (Zestril) nursing considerations
Monitor BP and electrolytes closely
Instruct patients to contact provider if cough and/or angioedema occurs
Daily weights
Losartan (Cozaar) MOA
ARBs
Losartan (Cozaar) indications
Hypertension
Reduce risk of stroke, possibly MI and death in patients with high CV risk
Diabetic nephropathy and retinopathy
Losartan (Cozaar) adverse effects
Angioedema, although risk may be lower
Fetal injury
Losartan (Cozaar) nurisng considerations
ARBs often used when ACEi are not tolerated due to cough
Monitor BP closely, especially if on multiple agents
Instruct patients to contact provider if angioedema occurs
Aliskiren (Tekturna) MOA
Binds with renin to inhibit cleavage of angiotensinogen into angiotensin I to reduce influence of entire RAAS
direct renin inhibitor
Aliskiren (Tekturna) indication
HTN
Aliskiren (Tekturna) adverse effects
Generally well tolerated
Diarrhea
Low risk of hyperkalemia, angioedema, and cough
Fetal injury and death
Aliskiren (Tekturna)
Close monitoring of I/O, vital signs, weight, and electrolytes, especially if on multiple anti-hypertensive agents
Nifedipine (Procardia) MOA
Blocks calcium channels on vascular smooth muscle, with minimal activity on heart
Nifedipine (Procardia) inidcations
angina pectoris and hypertension
Nifedipine (Procardia) adverse effects
Peripheral edema, flushing, headache, dizziness
Reflex tachycardia
Nifedipine (Procardia) nursing considerations
Reflex tachycardia suppressed when combined with a beta blocker
Diuretic for peripheral edema
Assess BP and HR pre-administration
Verapamil (Calan) MOA
Blocks calcium channels on the heart and blood vessels
Verapamil (Calan) indications
angina pectoris, essential hypertension, and dysrhythmias
Verapamil (Calan) adverse effects
Constipation is most common
Cardiosuppression with bradycardia, AV block, and decreased contractility with possible cardiotoxicity
Verapamil (Calan) nursing consideration
Monitor for interactions, particularly with other cardiac medications including digoxin and beta blockers, and grapefruit juice
Assess BP and HR pre-administration
Gastric lavage, activated charcoal, IVF, IV calcium gluconate, and Trendelenburg’s for toxicity
Hydralazine (Apresoline) MOA
Causes selective dilation of arterioles through actions on vascular smooth muscle to reduce peripheral resistance and blood pressure
Hydralazine (Apresoline) indications
Essential hypertension
Hypertensive crisis
Heart failure
Hydralazine (Apresoline) adverse effects
Reflex tachycardia
Increased blood volume
SLE-like syndrome
Hydralazine (Apresoline) nursing considerations
Combined with isosorbide dinitrate when used for treatment of heart failure
!Co-administer with beta blocker to reduce of reflex tachycardia!
Co-administer with diuretic to reduce risk of sodium and water retention
Monitor vital signs closely, especially for excessive hypotension
Nitroprusside (Nipride/Nitropress) MOA
causes both venous and arteriolar dilation to decrease BP
Nitroprusside (Nipride/Nitropress) indications
Drug of choice for hypertensive emergencies
Controlled hypotension during surgery to reduce bleeding
Nitroprusside (Nipride/Nitropress) adverse effects
Excessive hypotension
Cyanide poisoning most likely in patients with liver disease
Thiocyanate toxicity
Nitroprusside (Nipride/Nitropress) nursing consideration
minimal reflex tachycardia
continuous vitals and ecg, frequent BP checks
start infusion at 0.3-0.5 mcg/kg/min and tritate slowly
co-admin with PO antihtn
immediate effects trigger Na & water retention-manage with furosemide
Loop diuretic
severe HF
watch closely for dig toxicity
effective even with <GFR
Thiazide diuretics
produce modest diuresis
not effective with <GFR, this is why loops are preferred
Postassium sparing diuretics
produce little diuresis
used to counteract K+ loss from thiazide and loop diuretics
for patients also taking ACE or ARBs- watch K+ levels
