Drugs affecting cardiovascular and vascular system Flashcards
ACE AND ARBS
Lisino-pril (Chill pill)
Lo-sartan (relax man)
Lowers BP only not HR
Ace = 1st choice
Arbs = 2nd choice
We can give ACE and ARBs if the HR is low since they only affect the BP
ACE AND ARBS mechanism of action
Both block or inhabit the RAAS system (renin angiotensin aldosterone system) which retains fluid
Aldosterone is blocked from adding sodium and water in and letting potassium out
(no sodium and water can get in, no potassium can get out)
Problem = Retaining too much potassium
ACE AND ARBS Precautions
Avoid Pregnant women (not baby safe)
Angioedema (airway risk) = Only ACE
Cough = Only ACE
Elevated Potassium - avoid potassium rich food, salt substitutes and liver
First Dose phenomenon
Don’t leave patients bedside and assess for any adverse reactions
Beta Blockers
Ends in LOL
AtenoLOL
Lowers HR and BP
always check BP and HR before giving
Neg Chronotopic (lower rate)
Neg Inotropic (less force)
Neg Dromotopic (less beats)
or
Decreases resistance
Decreases workload
Decreases cardiac output
Beta Blockers Side Effects
Blocks beta receptors 1 and 2
Bradycardia HR less than 60, less than 100 sys
Breathing Problems: bronchospasm, Wheezing - Not for asthma, COPD
Bad for HF patients = new Edema, worsening crackles in the lungs, rapid weight gain, new JVD = question Dr. Orders
Blood sugar masking, Beta blockers hide symptoms of low sugar. Hold is sugar is less than 70. Monitor sugars closely
Calcium Channel Blockers
Calms the Heart
Lowers HR and BP
NifediPINE
CardiZEM
VerapAMIL
Blocks the movement of calcium = relaxes blood vessels and takes the strain off the heart
Neg Chronotropic (lower rate)
Neg Inotropic (less force)
Neg Dromotropic (less. beats)
Calcium Channel Blockers Precautions
Count HR and BP do not give iim BP less than 90, hR less than 60
Change positions slowly
Bad headache = normal
Stop or slow any IV meds if there is a big drop in HR or BP, big drops can kill patients
Digoxin
Lowers HR, digs for a deeper contraction and increased contractility
Inotropic Drug
Given for Afib and HF
Nothing to do with BP
No orthostatic hypotension and no need to do slow position changed
Toxic side effects
Cardiac Glycoside
Digoxin Precautions
Check apical pulse for a full 60 seconds, hold if HR less than 60
Toxicity - over 2.0 = vision changes, nausea, dizziness, notify HCP immediately
Decreased kidney function = higher risk fir digoxin toxicity, monitor BUN and creatinine Over 1.3 = kidney Injury
Potassium below 3.5 = increase risk for digoxin toxicity (does not cause low potassium only increases the risk for toxicity)
Digoxin Toxicity
Max range 2.0
1st signs of toxicity
Anorexia
Nausea and vomiting
Vision changes (difficulty reading)
Which patient is most at risk for digoxin toxicity
Patient taking potassium wasting diuretics or Kidney failure patients
Dilators
Vasodilators
Nitroglycerin
Commonly given for chest pain but also works in HF patients to lower BP
Opens up vessels (dilates vessels to decrease vascular resistance) = Decreased BP
Top 5 vasodilators
Nitroglycerin
Nitroprusside
Hydralazine
Isosorbide (caution - not a diuretic)
Minoxidil (only severe HF)
Dilators Precautions
No Viagra “afil” Sildenafil = Death
Stop if Low BP less than 100 or drop by 30mmHg sys
Stop if patient has: lack of coordination, irritability, sweating, pallor
Dilators side Effects
Headache
Hypotension (slow position changes)
Hot flushing “facial redness)
Diuretics
Potassium wasting and sparing
#1 drug used for HF
Decrease eBP
Drain FLuid
Dehydrate the body
Potassium Wasting Diuretics
Caution: Hypokalemia 3.5 or less
Decreases potassium
Eat green lady veggies, melons and avocados
avoid liquorice root
Only give potassium wasting if potassium is normal 3.5-5.0
Loop #1 worsening HF
Worsening Crackles
New Edema in legs
Rapid Weight gain
FurosemIDE
TorsemIDE
BumetanIDE
Block reabsorption of sodium in kidneys, less sodium retained = less swelling
Thiazide
HydrochlorothiazIDE
Chlorothiadone
Potassium Sparing
Caution: Avoid potassium Avoid green leafy, melons and avocados, salt substitute
Spironolactone blocks aldosterone directly
Watch for hyperkalemia
Peaked T waves
ST elevation
Diuretics Precautions
Always check the BP: hold if BP low
Monitor and check BUN and Creatinine before
Potassium imbalances, monitor potassium and place on cardiac monitor
Diuretic Key tips
Take in the morning not a night
Slow position changes
Daily wights Report 2-3 lbs
Sunburn
low sodium diet
Avoid OCT meds - contain high amounts of sodium = swells the body
Cough and Flu
Antacids like tums
Acetaminophen
NSAIDS: naproxen and ibuprofen
Furosemide
1 drug for HF
if give to fast (IV push) can be
Ototoxic (ear rining)
Hypotension Low BP not HR
if given too much can be nephrotoxic - kidney toxic, always check creatinine and BUN labs
Hypokalmia
Antihypertensives
Ace
Arbs
Beta blockers
Calcium Channel Blockers
Dilators
Diuretics
Cause low BP and Orthostatic hypotension/dizziness when standing
Change positions slowly
Antidysrhythmics
Class 1: Sodium channel blockers
Procainamide
Lidocaine
Given for: V tach and V Fib
Antidysrhythmics
Class 2: Beta Blockers
Propranolol
Given for: Hypertension, SVT, tachycardia
Afib and Aflutter
Antidysrhythmics
Class 3: Potassium channel blockers
Amidodarone
Given for: V tach and V fib
Antidysrhythmics
Class 4: Calcium channel blockers
Verapamil
Diltiazem
Nifedipine
Given for: Hypertension, SVT, tachycardia Afib and Aflutter
Antidysrhythmics
Lower BP, reassess BP every hour
Low oxygen to the brain, first sign = Dizziness
Slow position changes
Other Drugs for Antidysrhythmics
Adenosine: Decreases HR given for: SVT
Give fast: IV push 1-2 seconds, saline flush immediately after
Digoxin: cardiac glycoside
Given for: Afib
Atropine (anticholinergic)
Given for: symptomatic bradycardia (less than 60 that show signs of low oxygen = mental status changes, pallor) Push medication to make HR go crazy fast
Given for Atrial rhythms
Atropine
Adenosine
Beta Blockers
Calcium Channel Blockers
Digoxin
Given for Ventricular rhythms
Lidocaine
Amiodarone
Procainamide
Which drug causes Bradycardia?
Propanolol
What is the intended effect for Diltiazem?
Ventricular rate decreased from 160 to 70
Priority adverse effects to watch for when giving amlodipine?
Dizziness
Most important patient teaching when giving verapamil?
Slow position changes
A client on digoxin having difficulty reading a book or some type of vision problems
Toxicity for vision changes
Client on digoxin with a history of renal failure… key lab value to monitor
Creatinine over 1.3 = Bad kidney
Lidocaine Toxicity
Hypotension
Any neurological changes is the first sign of toxicity, neurological checks are priority
Only lasts a short while in the body - toxicity is easily treated
Amiodarone
Used 2nd if lidocaine doesn’t work
Pulmonary toxicity - lung toxicity =
Dry cough and sypnea
Difficulty breathing while ambulating
SOB
report all of these to HCP
Which drugs do we teach slow position changes due to orthostatic Hypotension
Atenolol
Amiodarone
Amlodipine
Diltiazem
Furosemide
Antihypertensive Clondine
Given to lower BP when High BP is persistent and not responsive to other medications
Very potent
Clondine Mechanism of Action
Alpha 2 antagonist
To decrease the sympathetic response from the CNS inside the brain stem to the peripheral vessels resulting in decreases peripheral vascular resistance and vasodilation = decrease cardiac output, HR and BP
Given either patch or will
Priority: never stop taking abruptly can result in rebound hypertension leading to hypertension crisis and health
Slowly tapper off over 2-4 days
Teach slow position changes
Clonidine Precautions
Given either patch or pill
Change patch every 7 days, apply patch to hairless intact skin on upper arm
Sometimes used to treat ADHD
Priority: never stop taking abruptly can result in rebound hypertension leading to hypertension crisis and health
Slowly tapper off over 2-4 days
Teach slow position changes
Clonidine Teaching
No Other CNS depressants
No alcohol
No antihistamines
No sedatives
No driving
INOtropic
Increase cardiac contractility
Increased forceful contraction
3 D’d for Deep contraction
Digoxin
Dopamine
Dobutamine
CHRONOtropic
Clock
Neg chronos - Neg Tim = less beats per min = Lower HR
Positive Chronos - positive time = more beats per minute = faster HR
DROMOtropic
Rhythm of Heart Beat
Neg Dromotropic to stable heart rhythm
Electrical impulses
Cholesterol lowering Agents
“Statin”
Atorvastatin
Simvastatin
lovastatin
Rosuvastatin
Cholesterol lowering Agents Mechanism of Action
Prevents cholesterol production in the liver by blocking an enzyme that is needed to make cholesterol
Lowers BAD cholesterol
Increases GOOD cholesterol
BAD Cholesterol
Total cholesterol 200
Triglyercides 150
LDL 100
GOOD cholesterol
HDL 40
Cholesterol Lowering Agents Indication
High cholesterol levels
Hypercholesterolemia
Hyperlipidemia
Cholesterol Lowering Agents Side effects
Liver Toxic Monitor liver labs (ALT and AST) do not give to patients with liver problems
Muscle pain - muscle cramps, spams and aches, report to HCP
Monitor Creatinine: muscle breakdown can clog kidneys
Avoid grapefruit and st johns wort
Take at night (dinner time or bed time)
MI Meds
Oxygen
Aspirin
Nitro
Morphine
Nitro Precautions
3 doses Max 5 min apart
No swallow: SL under the Tonge
Headache and hypotension is normal take when sitting
Call 911 if there is pain 5min after first dose
Morphine
Any chest pain after morphine indicates MI
More pain = more tissue death
Clot Busters
Throbectomy
Fibrinolytics x1 dose
TPA
Streptokinase (allergy risk)
Bleed risk 8 hour window
No sections (IV, SQ, IM, ABG)
Never through central lines
After MI
Rest and prevent Clots
Heparin IVL prevent and stabilize clot
Heart Rest:
Nitro IV drip
Beta blockers
CCB
Heparin
therapeutic Range
PTT 46-70
(3x MAX range)
Antitode: Protamine sulfate
Vasopressors Mechanism of Action
Vasopressors press on the vessel causing the blood pressure to increase and squeeze the oxygen back to the heart
Given to increase BP
During Cardiac Arrest
During Shock and decreased perfusion
Activate alpha and betas inside the heat and lining of the blood vessels
Alpha receptors
Alphas are responsible for constriction of the blood vessels so the blood squeezes back to the heart
Alpha agonist: Increases Blood pressure
Alpha Antagonist: Lowers the blood pressure
Beta receptors
Beta 1 = 1 heart
Beta 1 agonist = faster heart rate, stronger pump, increased cardiac output
Beta antagonist: Lower heart rate, less force
Beta 2 = 2 lungs Dilation of lungs and bronchi
Beta 2 agonist: Vasopressors and albuterol, opens up longs and vessels, lungs get more oxygen and organs get perfused. Since the blood vessels are dilated the blood pressure can drop
Main Vasopressors
Epinephrine
Norephinephrine
Vasopressin
Dobutamine
Dopamine
Epinephrine and Norepinephrine
EPI elevated blood pressure by activating the alpha 1receptorsto provide constriction
Epinephrine (brand: adrenaline)
Norepinephrine (brand: levophed)
Given for severe low blood pressure for example septic shock
Key difference:
Epinephrine 1st priority in:
Cardiac arrest (initiates heart contraction during cardiac arrest)
A-systole
PEA (Pulseless electrical activity)
Also used as a 1st line drug in anaphylaxis
Phentolamine
used to treat dopamine and epinephrine extravasation (IV dislodged and leaks into the tissues) can cause burning and blistering
Keep IV in place and give phentolamine immediatly
Vasopressin and Demopressin
Increases blood pressure
Synthetic ADH (antidiuretic hormone) does not affect the alpha and betas
Increases fluid in the body to increase blood pressure by making you stop urinating
Demopression: Given for Diabetes Insipidus
Dobutamine and Dopamine
Given for a deeper contraction
inotropic = increases cardiac contractility and increased forceful contraction
Treatment for cariogenic shock
Assess BP hourly
Monitor Vital signs
Dopamine:
Activates alpha 1 and beta 1 receptors
Therapeutic effects:
Low doses act on dopamine receptors
Moderate doses act on beta 1 receptors
High doses act on alpha 1 and beta 1 receptors
Assess IV site hourly for s/s of infiltration
Dopamine Given for a patient with hypotension what indicates effectiveness
Increased cardiac output
