Cardiovascular agents Flashcards
Heart failure
Heart muscle weakens and enlarges
Right-Sided HF
Blood backs up in periphery
Left-Sided HF
Blood backs up in the lungs
Cardiac Glycoside
Prototype- Digoxin (Lanoxin)
Usually given for pts. in HF. Digoxin has a low therapeutic index.
Action of Digoxin
- Increases force of myocardial contraction
- Prolongs refractory period of the AV node.
- Decreased conduction through AV&SA node.
Contraindications of Digoxin
Shouldn’t be given to pt. W/ Ventricular disrhymias
- 2nd or 3rd degree heart block or
- Bradycardia.
Digoxin is used to treat
HF & Atrial fibrillation and Atrial Flutter. (used as an anti arrhythmic).
Side effects of Digoxin
Anorexia, nausea, vomiting, fatigue and confusion.
*Pt. can see yellow and green halos.
Adverse reactions of Digoxin
Bradycardia, ventricular disrhythmias and atria ventricular blocks.
Drug/lab/food interactions of Digoxin
If given with thiazide diuretics and loop diuretics. (loss of potassium).
Antidote for digoxin toxicity
Digiband
Nursing process:Digoxin
Monitor vital signs, magnesium and potassium levels.
*Base line pulse rate. Must have pulse of at least 60.
Look for decreased HR& S/S of HF (decreased edema and lung crackles).
Normal serum dig level
0.8-2ng mLs
Antianginal drugs
-Nitrates
reduction of venous tone, decreased workload of the heart, vasodilation
Antianginal drugs
-Beta blockers
decrease the workload of the heart and decrease oxygen demand
Antianginal drugs
-Calcium channel blockers
decrease the workload of the heart and decrease oxygen demands
Antianginal drugs
Prototype: Nitroglycerin (NTG)
Produces vasodilation.
Action of Nitroglycerin
Vasodilation in venous system more than arterial.
Increases coronary blood flow.
Decreased myocardial demand for oxygen to decrease chest pain.
Therapeutic effects of Nitroglycerin
Used to decrease anginal attacks and blood pressure.
Contraindications of Nitroglycerin
Cardiomyopathy, severe anemia, renal or hepatic disease, severe hypotension, hypovolemia and pregnancy.
Dosage of Nitroglycerin
SL:0.3, 0.4,0.6 mg repeat q 5min X 3 IV: 5mcq/min (titrate), topical (ointment, transdermal patch), buccal extended-release tablet, oral extended-release capsule and tablet, aerosol spray (inhalation)
Side effects of Nitroglycerin
Headache, hypotension, dizziness, syncope, weakness
Adverse reactions of Nitroglycerin
severe hypotension, reflex tachycardia and circulatory collapse.
Drug/lab/food interactions of Nitroglycerin
Vasodilation increased with alcohol & other antihypertensive medications.
NTG can decrease effects of heparin.
Nursing process: Antianginal drugs
Vital signs. Hold NTG for SBP less than 100.
Rotate sites of patch, avoid hairy areas. Store bottle away from light.
Antidysrhythmic drugs Class 1
Sodium channel blockers
•1A: slow conduction, prolongs
•1B: slow conduction, shortens repolarization
•1C: prolonged conduction with little/no effect on repolarization
Antidysrhythmic drugs class 2
Beta-adrenergic blockers
•Reduce calcium entry, decrease conduction velocity, automaticity, and recovery time
Antidysrhythmic drugs Class 3
drugs that prolong repolarization
Antidysrhythmic drugs Class 4
Block calcium influx (calcium channel blockers)
Antidysrhymics Prototype: Acebutolol HCL (Sectral)
Cardioselective beta-adrenergic antagonist
Used for ventricular arrhytmias
Therapeutic effect of Acebutolol HCL (Sectral)
Treats recurrent stable ventricular arrythmias, angina and hypertension
Action of Acebutolol HCL (Sectral)
Blocks beta 1 adrenergic receptors in the cardic tissue
Contraindicatons of Acebutolol HCL (Sectral)
2nd and 3rd degree heart block, severe bradycardia, severe HF, cardiogenic shock. Caution in renal and hepatic impairment.
Side effects of Acebutolol HCL (Sectral)
Diziness, nasusea, vomiting, fatigue, impotence, anorexia, Severe bradycardia, chest pain, palpitations
Drug/food/lab interactions of Acebutolol HCL (Sectral)
Increased effect if given with diuretics. Antagonist effect if given with albuterol. Can prolong effects of insulin
Nursing process: Acebutolol HCL (Sectral)
Avoid alcohol, caffine and tobacco. Monitor pulse and BP.
Hypertension
-Kidneys regulate BP by control of fluid volume and the renin-angiotensin-aldosterone system
-Kidneys control sodium and water elimination/retention
which affects cardiac output and systemic arterial blood pressure
-Baroreceptors in the aorta and carotid sinus and the
vasomotor center in the medulla also assist in regulation
-Catecholamine’s (norepinephrine/epinephrine) increase BP through vasoconstriction
-Hormones that contribute to BP regulation (ADH, ANP, BNP)
Antihypertensive treatments: diuretics
Thiazides: Hydrochlorothiazide
Loop Diuretics: Furosemide
*African Americans do not respond well to diuretics.
Beta blockers Prototype: Metoprolol (Lopressor)
Works by blocking the action of catecholomines (epinephrine and norepinephrine)
Therapeutic use of Metoprolol (Lopressor)
Hypertension, angina pectoris, prevention of MI, manage stable HF
Action of Metoprolol (Lopressor)
Stimulates the beta 1 adrenergic receptors
Contraindications of Metoprolol (Lopressor)
2nd and 3rd degree heart block, cardiogenic shock, hypotension, acute HF, sinus bradycardia. Hepatic, thyroid, renal disease.
Side effects of Metoprolol (Lopressor)
Fatigue, weakness, dizziness, headache, blurred vision, depression, impotence.
Adverse reactions of Metoprolol (Lopressor)
Bradycardia, thrombocypenia, complete heart block and agranulocytosis.
Drug/lab/food interactions of Metoprolol (Lopressor)
increased bradycardia if taken with digoxin, NSAIDS, Alcohol
Nursing process:
Beta- Adrenergic Blockers
Monitor BP and HR. Stopping drug can cause rebound hypertension. Cautious with OTC drugs. Orthostatic hypotension can be common.
Alpha-Adrenergic blockers
Prototype: Prazosin HCl (Minipress)
Used for antihypertensive and management of urinary outflow obstuction for men.
Action of Prazosin HCl (Minipress)
dilates peripheral blood vessles by blocking alpha adrenergic receptors in the blood vessles, eyes, bladder and prostate
Therapeutic uses of Prazosin HCl (Minipress)
Control mild to moderate hypertension, treat benign prostetic hypertrophy.
Contraindications of Prazosin HCl (Minipress)
Angina and renal insufficency
Side effects/ adverse reactions of Prazosin HCl (Minipress)
Orthostatic hypotension, nausea, headache, drowsiness and weight gain, Palpitaitons, bradycardia, tachy cardia and erectile dysfunction (drug encourrages sodium and water retention)
Drug/lab/food interactions of Prazosin HCl (Minipress)
can increase hypotensive effect of other antihypertensives, nitrates and alcohol.
Nursing process: Alpha-Adrenergic Blockers
Monitor VS, liver enzymes, I&Os, fluid retention and weight gain. Highly bound protein drug. May take 4 week for therapeutic effects. Can cause orthostatic hypotension(take drug at night)
Angiotension-Converting Enzyme Inhibitors
Prototype: Lisinopril (zestril)
Antihypertensive class
Action of Lisinopril (zestril)
- Acts by blocking the conversion of angiotension 1 to the vasoconstrictor angiotension 2
- Blocks release of aldosterone
Therapeutic use of Lisinopril (zestril)
treats hypertension and HF
Contraindications of Lisinopril (zestril)
Pregnancy, Caution with family Hx of angioedema and renal dysfunction.
Side effects of Lisinopril (zestril)
Irritating cough, taste disturbance, agranulocytosis, angioadema, hypotension, insomnia,
Drug/lab/food interactions of Lisinopril (zestril)
Hypotension can occur with other diuretics. hypokalemia can occur.
Nursing process Angiotension-Converting Enzyme Inhibitors
Evaluate labs, renal function and potassium levels. ACE inhibitors can increase BUN and creatinine levels. Avoid pregnancy and foods high in potassium. Monitor VS. (orthostatic hypotension)
Angiotension 2 Receptor Blockers
Prototype: Valsartan (Diovan)
Potent vasodilator
Action of Valsartan (Diovan)
inhibits binding of angiotension 2 (less likely to cause irritating cough that ACE inhibitors do).
Therapeutic uses of Valsartan (Diovan)
Tx of Hypertension,
Contraindications/Cautions of Valsartan (Diovan)
Pregnancy&breast feeding, renal&hepatic impairement. Hypovolemia
Side effects/ Adverse reactions of Valsartan (Diovan)
Dizziness, syncope, renal dysfuntion, hypotension, angioedema, headaches and fatigue.
Drug/lab/food interactions of Valsartan (Diovan)
Potassium suppliments, potassium sparing diuretics. drug may cause hyperkalemia, may increase BUN, Creatinine and liver enzymes.
Calcium Channel Blockers
Prototype: Diltiazem HCL (cardizem)
Antihypertensive drug
Action of Diltiazem HCL (cardizem)
Inhibits transport of calcium into the myocardial and vascular smooth muscle cells causing systemic vasodilation.
Therapeutic effects of Diltiazem HCL (cardizem)
Used as an antianginal and antiarhythmic
Side effects/Adverse Reactions of Diltiazem HCL (cardizem)
Peripheral edema, headache, dizziness, bradycardia, abnormal dreams and psychiatric disturbances. Steven-johnson syndrome, arrhythmias, HF.
Drug/Lab/Food interactions of Diltiazem HCL (cardizem)
Grapefruit juice increases effects. May increase
Drug/Lab/Food interactions of Diltiazem HCL (cardizem)
Grapefruit juice increases effects. Hypotension can occur if given with other antihypertensives, nitrates or alcohol. May increase digoxin levels. If given with NSAIDS may decrease antihypertensive effects. Concurrent use with beta blockers, clonadine and dig may result in bradycardia.
Anticoagulants
Prevent the formation of clots that inhibit circulation
Antiplatelets
Prevent platelet aggregation
Thrombolitics
Attack and dissolve blood clots that have already formed
Thrombus formation
Formation of clot in artery or vein
•Caused by decreased circulation, platelet aggregation on vessel wall, blood coagulation
Arterial clot formation
Platelets initiate process
•Fibrin formation occurs
•RBCs are trapped in fibrin mesh
Venous clot formation
Platelet aggregation with fibrin that attaches to RBCs
Anticoagulants Prototype: Heparin and Warfarin Sodium (coumadin)
Heparin-IV Drug-Used to treat/prevent DVTs and Acute pulmonary embolisms.
Warfarin-PO Drug-Used to prevent thrombophlebitis and Pulmonary embolism.
Actions of Heparin and Warfarin Sodium (coumadin)
Heparin-Inhibit thrombin, which prevents conversion of fibrinogen to fibrin.
Warfarin-Depress hepatic synthesis of vitamin k clotting factors.
Therapeutic uses of Heparin and Warfarin Sodium (coumadin)
Prevent blood clotting.
Contraindications/Cautions of Heparin and Warfarin Sodium (coumadin)
Bleeding disorders, uncontrolled bleeding, severe thrombocytopenia, peptic ulcers or severe hepatic or renal disease.
Side Effects/Adverse Reactions of Heparin and Warfarin Sodium (coumadin)
Heparin-Injection site reactions, anemia, itching, fever and chills. Hemorrhage, HIT,
Warfarin-Anorexia, nausea, cramps, fever. Bleeding, purple toe syndrome
Drug/lab/food interactions of Heparin and Warfarin Sodium (coumadin)
Heparin-Increased risk of bleeding, Vitamin K.
Warfarin-ASA. NSAIDS, Plavix
Nursing process: Warfarin and Heparin
Evaluate lab values. Review CBC’s. Be cautious of hepatic disease, alcoholism, monitor VS. Increased pulse of decreased BP can signify bleeding. Do not smoke. Tylenol instead of asprin.
Action of Clopidogrel Bisulfate (plavix)
inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors.
Therapeutic effects of Clopidogrel Bisulfate (plavix)
Works to prevent MIs, strokes, vascular death.
Contraindications/Cautions of Clopidogrel Bisulfate (plavix)
Intercranial hemorrhages, peptic ulcers or GI bleed.
Dosage of Clopidogrel Bisulfate (plavix)
PO:Loading dose 300mg and then 75mg/d
Side effects/adverse reactions of Clopidogrel Bisulfate (plavix)
Abdominal pain, dizziness, epitaxis(nose bleeds), headaches, agranulocytosis, thrombocytopenia (decreased platelets)
Drug/lab/food interactions of Clopidogrel Bisulfate (plavix)
May increase bleeding when taken with NSAIDS, interferes with metabolism of warfarin, ginger garlic, ginko and green tea and increase bleeding.
High-density lipoprotein (HDL)
(“good”)
•Removes cholesterol from blood
•Transports cholesterol to liver for elimination
Low-density lipoprotein (LDL)
(“bad”)
•Contains higher percent of cholesterol
Very low-density lipoprotein (VLDL)
•Contains mostly triglycerides, less cholesterol
Chylomicrons
- Contain mostly triglycerides
* Transport fatty acids and cholesterol to live
Nonpharmacologic methods for cholesterol reduction
Reduce saturated fats in diet
•Reduce total fat intake to 30% or less of caloric intake •Reduce cholesterol intake to 300 mg/day or less •Exercise as possible
•Stop smoking
Action of Rosuvastatin (crestor)
inhibit the enzyme HMG CoA reductase (hepatic production of cholesterol)
Therapeutic uses of Rosuvastatin (crestor)
Decrease serum lipids and cholesterol levels
Contraindications of Rosuvastatin (crestor)
Pregnancy X drug, active liver disease.
Side effects/Adverse reactions of Rosuvastatin (crestor)
Abdominal cramps, constipation, diarrhea, headache, flatulence, heartburn and rash. Photosensitivity, myalgia, hyperglycemia, and elevated liver enzymes. Rhabdomylosis(breakdown of skelletal muscle, can cause renal failure and death)
Drug/Lab/Food interactions of Rosuvastatin (crestor)
May increase digoxin levels. Do not take with microglyde antibiotics and antifungals.
Nursing process: Statins
Baseline chem values, 3-6mo for tiglycerides and cholesterol, AST and ALV(Liver enzymes)CBKs (Skelletal breakdown product)
-Take at night. report muscle tenderness and weakness.
