Cardiovascular medications

Question 1

foundations of cardiac meds

Answer 1

1) the exchange of potassium, sodium, and calcium across the cell membranes of both myocardial cells and “pacemakers” of the heart is required for depolarization, action potential and repolarization
2) delaying these ion exchanges, or prolonging depolarization, repolarization or refractory period will result in decreased HR
3) Vasodilators decrease preload and afterload
4) Beta receptors allow the sympathetic nervous system to increase heart rate and contractility
5) BP is partly related to blood volume

Question 2

Diuretics

Answer 2

Examples: furosemide/Lasix, spironolactone/Aldactone, Burmex, hydrochlorothiazide/Diuril
•Often given to decrease HTN, CHF, and edema
• Works by increasing the amount of Na and water excreted by the kidneys
•may cause hyperkalemia or hypokalemia, which could in turn cause arrhythmia
•can cause hypotension due to dehydration
• can cause short term urinary incontinence, polyuria
•works complimentary to compression therapy

Question 3

Alpha (Blocker) adrengic antagonists

Answer 3

• Ex: doxazosin mesylate/Cardura, prazosin/Minipress
• block sympathetic nervous system in arteries and veins
• causes vasodilation and decreased BP, decreased afterload and preload
• used for HTN and BPH
• AE: OH, myalgia (muscle pain), arthralgia (pain in one or more of your joints), arrhythmia

Question 4

ACE (angiotensin-converting enzyme) inhibitor

Answer 4

• Captopril/Capoten, enalapril/Vasotec, lisinopril
• used to reduce afterload and BP for HTN and CHF
• inhibits formation of angiotensin II which is a vasoconstrictor: this causes systemic vasodilation
• AE: hypotension, cough, proteinuria, dizziness, weakness
• PT: watch for OH, thermal modalities will add to vasodilation

Question 5

Beta blockers

Answer 5

• metoprolol/Lopressor, propranolol/Inderal
• HTN, angina, arrhythmia, CHF, migraines, tremor
• Bock sympathetic nervous system via Beta receptors, decreases HR and contractility, lowers afterload
• AE: bradycardia, arrhythmia, fatigue, depression, dizziness, weakness, blurred vision
• PT implications: HR may not reflect level of exertion, use RPE or BORG scale

Question 6

Calcium channel blockers

Answer 6

•diltiasem/cardizem, Cardene, Procardia, amlodipine/Norvasc
•For angina, HTN, arrhythmia, atrial flutter, Raynaud’s
• Decrease calcium channel entry into smooth muscle cells, vasodilation, decreased contractility, decreased O2 demand by the heart, coronary vasodilation
•AE: HA, peripheral edema, weakness, dyspnea, anemia, hyperglycemia
PT: often see patients with this med and peripheral edema with lymphedema therapy orders. Compression will work against this med
•HR may not reflect level of exertion, use RPE or BORG scale

Question 7

Antiarrhythmics

Answer 7

• amiodarone/Pacerone, Cordarone
• prolongs refractory period, decrease SA node rate, prolongs action potential
• used for life threatening ventricular rhythms, atrial fibrillation
• AE: arrhythmias, dizziness, fatigue, malaise, bradycardia, hypotension, ataxia, peripheral neuropathy, tremor hypothyroidism

Question 8

Nitrates

Answer 8

• nitroglycerin, nitrostat
• vasodilation of peripheral vessels, decreased ischemia, increase CO
• used for angina- sublingual, can be a paste used routinely
• AE: OH, dizzy, HA, tachycardia, hypotension
• drug effects 30-60 minutes, patients should lay down upon taking it due to orthostasis
• Pt’s who have this prescribed for angina should bring it to all physical activities

Question 9

Positive ionotropes

Answer 9

• digoxin: Lanoxin/Digitek
• increase contractility, decrease HR via AV node conduction slowing and sympathetic blocking increase cardiac output
• used for CHF and Afib, Aflutter, arrhythmias
• AE: arrhythmia, GI distress, dizziness, blurred vision
• PT implications: monitor HR, bradycardia and GI upset can indicate toxicity