Drugs Affecting the Cardiovascular System Flashcards
Heart does not adequately pump blood (systolic) or fill with blood (diastolic)
Preload / Afterload / Contractility - meds target diff aspects of heart
Review patho: HF
Inability/heart unable to meet metabolic (oxygen) demands of the body - not able push blood through body well enough
Right ventricular failure, left ventricular failure, congestive failure
Heart does not adequately pump blood (systolic) or fill with blood (diastolic)
Increased preload (blood volume heart receives) causes increased workload on heart
Increased afterload (big thing is PVR) increases workload on heart
Heart enlarges (with HF), but weakens, resulting in poor contraction (contractility - strength heart with each beat)
Preload / Afterload / Contractility - meds target diff aspects of heart
Reduce preload: Furosemide (diuretic), lisinopril
Increased preload (blood volume heart receives) causes increased workload on heart
Reduce afterload (vascular resistance): metoprolol, lisinopril
Increased afterload (big thing is PVR) increases workload on heart
Increase contractility: digoxin (Lanoxin)
Heart enlarges (with HF), but weakens, resulting in poor contraction (contractility - strength heart with each beat)
Increases force of contraction, increasing cardiac output and renal perfusion; slows HR (end goal: slower but more powerful heart - each beat heart is stronger)
MoA: - Cardiac glycoside: prototype: digoxin (Lanoxin)
treat Heart failure
Indication: - Cardiac glycoside: prototype: digoxin (Lanoxin)
oral, IV (IV push over at least 5 minutes with tele monitor - risk for bradycardia); IV: higher risk for AE
Routes: - Cardiac glycoside: prototype: digoxin (Lanoxin)
Amiodarone and other antidysrhythmic drugs
Drug-drug: - Cardiac glycoside: prototype: digoxin (Lanoxin)
heart block (bradycardia and digoxin can cause bradycardia which why not want give if HR already slow), decreased renal function
Caution: - Cardiac glycoside: prototype: digoxin (Lanoxin)
GI effects, visual disturbances (green/yellow halo), arrhythmias (bradycardia)
AE: - Cardiac glycoside: prototype: digoxin (Lanoxin)
take apical pulse 1 full min prior to admin. (adequate HR to admin) Hold if HR less than 60 –notify provider - diff bradycardias and have HF and perfusion and BP goes way down - adequately count HR before given; use same brand consistently- diff brands have varied bioavailability (amt drug avaiable work in bloodstream); Toxicity rare but serious – monitor blood levels q 3 months, narrow therapeutic range
Nursing: - Cardiac glycoside: prototype: digoxin (Lanoxin)
Pretty rare
Manifestations:
Reversal agent:
Digoxin toxicity
Bradycardia - apparent
Headache
Dizziness
Confusion
Nausea/vomiting
Visual disturbances
Manifestations:- Digoxin toxicity
Digoxin immune fab (creates antigen-antibody immunes complexes with drug – inactivates the drug)
Reversal agent:- Digoxin toxicity
Atherosclerosis narrows coronary arteries: Stable and unstable plaques
Plaque rupture: Decreased blood flow; Decreased oxygen to cardiac tissue
Myocardial infarction: Tissue death
Coronary Artery Disease (CAD)
Chest pain with exertion
Increased O2 demand of heart
Relieved with rest and nitroglycerin
Stable angina
Chest pain at rest
Unrelieved with nitroglycerin
Possible myocardial infarction
Unstable angina
Relaxes vascular smooth muscle; dilates coronary arteries to increase blood flow to myocardial tissue - restores blood flow and O2
MoA: - Antianginal Agents: Prototype: nitroglycerin (Nitrostat)
Acute angina - given if experiencing angina; relief for angina; restores blood flow to heart tissue; short term solution to MI
Indication: - Antianginal Agents: Prototype: nitroglycerin (Nitrostat)
Sublingual tablet (works quickly to resolve prob and restore flow; bypass first pass effect so directly into system and acts quickly) q 5 min up to 3 doses; onset: 1-3 min; dur.: 30-60 min
Route: - Antianginal Agents: Prototype: nitroglycerin (Nitrostat)
erectile dysfunction meds in last 24 hrs (sildenafil/Viagra - causes hypotension - taking together causes unsafe drop in BP)
Caution: - Antianginal Agents: Prototype: nitroglycerin (Nitrostat)
hypotension (relaxes vessels all over body; sig), headache, lightheaded and experience dizziness, tachycardia, sweating
Adverse effects: - Antianginal Agents: Prototype: nitroglycerin (Nitrostat)
May administer 1 dose every 5 minutes up to 3 doses - imp keep track time; give enough time work before give extra doses
If no relief after 2nd dose after 5 min, assume MI/cardiac event and call rapid response team and decide where to go
Monitor blood pressure after administration - check BP 3-5 min later; if trend low can deviate and difference in what do; hypotensive increased risk for falls take additional actions
High fall risk - may need lay them down; vasodilation
Nursing actions in acute care - Nitro: nursing and teaching
Administration as above (after 2nd dose call 911): May administer 1 dose every 5 minutes up to 3 doses - keep track time; enough time work before give extra doses; If no relief after 2nd dose after 5 min, assume MI/cardiac event and call 911
Med must be stored in a dry, dark place – exposed to sunlight decompose and alter med - keep in dark glass container; need med to work when need it
Refill medication when it is near expiration/expires
Teaching - Nitro: nursing and teaching
The nurse would instruct a client taking digoxin to do which of the following?
A.Make up a missed dose the next day
B.Report changes in heart rate
C.Avoid exposure to the sun
D.Switch to another brand if less expensive
Answer: B
Rationale: Digoxin can cause arrhythmias (bradycardia)
The nurse is preparing to administer digoxin to a client with an apical pulse of 48 beats per minute. What action should the nurse take next?
A.Give the drug and notify the primary care provider that the heart rate is low.
B.Retake the pulse in 15 minutes and give the drug if the heart rate is unchanged.
C.Retake the pulse in 1 hour and hold the drug if the heart rate is unchanged.
D.Hold the drug and notify the primary care provider that the heart rate is below 60 beats per minute.
Answer: D
Rationale: The best action is to hold the dose and notify the provider. Digoxin cannot be safely given to a patient who is bradycardic.
What is the mechanism of action of nitroglycerin?
A.Increase preload on the heart.
B. Increase the afterload on the heart.
C. Dilate coronary arteries.
D. Decrease fluid volume.
Answer: C
Rationale: Nitroglycerin dilates the coronary arteries to increase blood flow and therefore oxygenation to tissues.
Changes to automaticity or conductivity of heart cells: Change in HR
Uncoordinated heart muscle contractions
Altered movement of impulses
Atrial fibrillation
Tachycardias
Review patho: arrhythmias
Dyssynchronous firing of atria
Uncoordinated with ventricles
Most common arrhythmia
Acute and chronic
Slow HR: Metoprolol, diltiazem, amiodarone
Atrial fibrillation
Ventricular fibrillation
Ventricular tachycardia
Medical emergencies
Controls V arrhythmia- Lidocaine
Tachycardias
Delineate into classes
Antiarrythmic drug
Class I: Na channel blockers
Class II: beta-adrenergic blockers
Class III: K channel blockers
Class IV: Ca channel blockers
Antidysrhythmic drugs
IV Lidocaine
Life-threatening ventricular arrhythmias during MI/cardiac surgery
Class I: Na channel blockers
Metoprolol
afib/flutter
Suprventricular and ventricular dysrhythmia
HTN
Class II: beta-adrenergic blockers
Amiodarone
afib/flutter
vtach/fib
Class III: K channel blockers
Diltiazem
Supraventricular tachycardias
afib/flutter
HTN
Class IV: Ca channel blockers
Altering action potentials: All have potential adverse effects:
Drug-drug:
Contraindications:
Antidysrhythmic drugs: gen considerations
Bradycardia, heart blocks, arrhythmias, and hypotension (all can cause low HR, slow down HR lower BP at same time because decreasing CO)
Probs at Greater risk with IV administration
With IV: need be on Tele monitor (monitor rhythm closely), closely monitor BP (arterial line/cuff and check BP frequently)
Altering action potentials: All have potential adverse effects:
Two Antidysrhythmic drugs together (dangerous - sig increased risk of bradycardia), antihypertensives (lower HR and on these sig impact CO which lowers and on this lowers BP so can get too low BP)
Drug-drug:
Bradycardia (potentially lower HR), hypotension (potentially lower BP), heart block (lack of cardiac conduction somewhere in part cardiac tissue; diff grades and some more severe than others; type of bradycardia) - not give if already have low BP/HR because would drop them more
Contraindications:
Treatment of life-threatening ventricular arrhythmias during MI or cardiac surgery; small use for IV
Indication: - Sodium Channel Blockers: Prototype: Lidocaine
IV (topical lidocaine low risk systemic) - dangerous drug; POTENT
Routes: - Sodium Channel Blockers: Prototype: Lidocaine
IV-immediate; Peak: IV-Immediate; Duration: IV-20 min
Onset: - Sodium Channel Blockers: Prototype: Lidocaine