Cardiovascular Meds (Part 2) Flashcards
Vasodilators
- Hydralazine (apresoline)
- Nitroglycerine
- Isosorbide
Hydralazine (apresoline)
-MOA:
Selective dilation of arterioles, no effect on veins. HR increases
-Indications:
Essential hypertension, Hypertensive crisis (IV), Heart failure
-Adverse Effects:
reflex tachycardia, increased blood volume, lupus like syndrome
-Interactions:
combine with beta blocker to avoid reflex tachycardia; excessive hypotension.
-Oral and IV
Nitroglycerine
*Vasodilator (Anti-anginal)
-MOA:
Relaxes smooth muscle vasculature by unknown mech.; reduces preload, afterload, and myocardial O2 consumption (reducing myocardial workload)
-Therapeutic Action:
reduces BP, chest pain
-Indications: Chest pain (Angina)
Nitroglycerine Cont..
-Sublingual tablet:
Give three q5minutes
- Sublingual Spray
- May take before known chest pain producing activity
- Nitrocream (topical) measure in increments
-Transdermal Patch:
Apply to hairless area (Upper chest, back, arms, thighs) - routine basis to PREVENT chest pain
- Put patch on in morning and off in evening so tolerance does not develop
- Capsule SR: taken to prevent CP
- IV (TRIDIL*): Titrate IV drip according to BP (only in ICU)
Nitroglycerine Cont…………
-Side Effects:
HEADACHE, postural hypotension, facial flushing; circulatory collapse
-Drug Interactions:
Alcohol can worsen hypotension; IV nitro may antagonize heparin
-Nursing Implications:
Give analgesics for headache; take BP before administering and one hour after for transdermal preps
Clean area after removing patch; local burning not significant (new patch on a different area)
- Unrelieved pain after 15 minutes after SL is usually indicative of an MI
- Swimming and bathing with patch okay
Cardiac Glycosides include:
Digoxin (Digitalis)
Digoxin (Digitalis)
-MOA:
Increases force of myocardial contraction; Increases contractility (positive inotropic action), increases PR time from SA Node to AV node (possible effect of heart block)
-Therapeutic Action:
increases diuresis; used in atrial fibrillation, CHF
-Indications: Heart Failure (now 2nd line drug)
Digoxin (Digitalis) Cont….
-Adverse Effects:
Bradycardia, heart blocks, other dysrhythmias, visual disturbances, N&V, confusion, agitation
*VISUAL DISTURBENCES – yellow tine, halos (early signs of adverse effects)
-Interaction:
Multiple; anti-acids, antibiotics, amiodarone, verapamil, quinidine, etc.
-Nursing Implications:
take apical pulse ONE FULL MINUTE before giving, must be above ordered parameter, usually 50-60 in adults, 60-70 in children
- Digoxin levels should be checked daily when first started and periodically later; HYPOOOOOOKALEMIA increases risk of dig toxicity and is the most common reason for toxicity.
- DIGIBIND can be used to reverse effects of high levels (normal is 0.5 - 0.8 ng/ml); cost is $2-3,000 for a single dose
ACC/AHA Heart Failure Class
There is also a New York Association class
Stage A:
Patients at risk for heart failure who have not yet developed structural heart changes (i.e. those with diabetes, those with coronary disease without prior infarct)
Stage B:
Patients with structural heart disease (i.e. reduced ejection fraction, left ventricular hypertrophy, chamber enlargement) who have not yet developed symptoms of heart failure
Stage C:
Patients who have developed clinical heart failure
Stage D:
Patients with refractory heart failure requiring advanced intervention (i.e. biventricular pacemakers, left ventricular assist device, transplantation)
Usual Meds for Heart Failure:
Inotropics - Digoxin, Dopamine (sympathomimetic), Dobutamine
*Others drugs listed on PowerPoint that have already been mentioned
Dopamine
- is a catecholamine;
- activates Beta 1 receptors in the heart causing tachycardia (low dosage- 1-5 mcg/kg/min),
- dopamine receptors in the kidney (5-10 mcg/kg/min);
- alpha 1 receptors in the blood vessels at high dosages (>10 mcg/kg/min) which reduces cardiac output and can CAUSE ISCHEMIC FINGERS/TOES at high doses.
- Mainly used to increase low B/P
Dobutamine
- can increase myocardial contractility;
- does not activate alpha 1 receptors and is frequently preferred to dopamine.
- IV infusion
Anti-dysrhythmic drugs
Adenosine (cordarone)
Adenosine
STOPS THE HEART AND RESETS THE HEART***
-MOA:
decreases automaticity in the SA node and slows conduction through AV node. Inhibits cyclic AMP-induced calcium influx
-Indications:
Terminating SVT and Wolf-Parkinson White Syndrome
-A/E:
last briefly, sinus bradycardia, bronchoconstriction.
-Dosage:
Short half life 1.5 to 10 seconds, give IV bolus as close to the heart as possible.
STOPS THE HEART AND RESETS THE HEART***
Antiarrhythmic agent
Amiodarone (IV)
