Interventions/ meds for cardiovascular disorders Flashcards
Angiotensin converting enzyme (ACE) inhibitors
Mechanism of action:
Antihypertensive
Prohibits angiotensin I from converting to angiotensin II, thus decreasing vasodilation and inhibiting aldosterone release, which results in less reabsorption of sodium and water.
African Americans do not respond to ACE inhibitors unless it is combined with diuretic.
Commonly used Ace inhibitors
Captopril,
Lisinopril
Enalopril
Benazopril
Side effects of ACE inhibitors
Chronic cough.
Hyperkalemia, Dizziness, orthostatic hypotension,tachycardia, chest pain, N/VD, fatigue and insomnia.
Heparin
Interferes with conversion of fibrinogen to fibrin and prolongs clotting time.
Does not destroy clots. Only helps prevent.
LMWH- Low Molecular weight heparins
Lovenox (enoxaparin sodium)
Prescribed prophylactically.
LMWH cause less bleeding than heparin and does bot require routine lab monitoring.
Heparin administration
Check the patients aPTT levels.
Teach Patient to report any blood in urine or stool and any other evidence of bleeding.
Other education includes using soft toothbrush and an electric razor.
Warfarin
Prevents clot formation By blocking the action of vitamin K and selected coagulation factors.
Coumadin therapy is frequently started when patient still receiving heparin since it takes 3 to 4 days for Coumadin to effectively inhibit coagulation.
Herbal products that can interact with actions of anticoagulants
Ginger, Ginko, bilberry can decrease effects.
Jensen, alfalfa and goldenseal can all decrease the effects of coumadin.
Many prescriptions especially antibiotics can interfere with metabolism of Coumadin and dramatically increase INR.
Centrally acting adrenergic drugs
Antihypertensive.
Clonidine and methyldopa.
Decrease BP by decreasing sympathetic nervous system output from the brain, causing decreased heart rate, decrease blood pressure and vasodilation.
May increase sodium and fluid retention, so are most effective when combined with diuretic.
What type if drugs are Clonidine and methyldopa?
Antihypertensive.
Central acting adrenergic drugs.
Clonidine should be tapered.
Methyldopa can be used to treat htn in pregnancy.
Alpha-Adrenergic blocking agents
Action and examples
Antihypertensive.
Praxosin, doxazosin, terazosin.
Block alpha receptors causing a decrease in peripheral vascular resistance and leading to vasodilation and a drop in blood pressure.
Prazosin, doxazosin, terazosin
Side effects and nursing interventions
Antihypertensive.
Alpha- adrenergic blocking agents.
Often need to be given with Diuretic.
Disadvantage is reflexive simulation of sympathetic nervous system resulting in increased heart rate and increased blood levels of norepinephrine.
Way patient daily and Monitor and I and O. side effects are fluid retention and orthostatic hypotension. Drowsiness can occur with first dose.
Antidysrhythmic agents supress automaticity of myocardial cells. Some also decrease conduction velocity and increase refractory period.
What are the 4 categories:
Class 1- fast (sodium) channel blockers
Class 2- beta-blockers
Class 3- prolong repolarization
Class 4-calcium channel blockers
Examples of class 1 antidysrhythmic agents (fast (sodium) channel blockers
Procainamide Disopyramide phosphate Quinidine sulfate Lidocaine Flecainide
Class 1 antidysrhythmic agents- fast(sodium) channel blockers
Mechanism of action:
Decrease influx of sodium into cardiac cells, slowing or prolonging conduction.
Used to treat paroxismal atrial tachycardia or supraventricular arrhythmias.
Common side effects include hypertension, dizziness and G.I. distress.
Can induce arrhythmias.
Quinidine (Norpace)
Class 1 antidysrhythmic agent- fast(sodium) channel blocker
Interacts with anti-arrhythmics, cardiac, CNS, antifungal, and anti-coagulant drugs.
Monitor potassium level.
Lidocaine
Class 1 antidysrhythmic agent- fast(sodium) channel blocker.
Used in emergency situations to treat ventricular arrhythmias.
Only administered intravenously.
Flecainide
Class 1 antidysrhythmic agent-fast(sodium) channel blocker
Are used to treat supra ventricular arrhythmias and ventricular arrhythmias that are life-threatening.
Not used to prevent ventricular arrhythmias in patients with severe heart disease because it has shown to increase mortality when used in patients who’ve had a recent myocardial infarction.
4 types of Anti-hyperlipidemic drugs
Bile-acid sequestrants
Nicotinic acid
Fibrates
Hepatic3-hydroxy-3thyglutaryl coenzyme (HMG-CoA) reductase inhibitors (statins)
Beta-Adrenergic blocking agents (beta blockers)
Mechanism of action:
And examples of drugs:
Used to treat angina, hypertension and dysrhythmias.
Affect the cardiovascular system by decreasing the heart rate, contractility, conduction velocity and cardiac output.
Metoprolol
Atenolol
Propranolol
Two classes of beta blockers:
Beta1 or beta2
Some drugs act on both.
Examples of beta blockers: metoprolol, atenolol, propranolol
Side effects of beta blockers
And nursing interventions
Bradycardia, hypotension, importance, insomnia, fatigue, G.I. upset and dizziness.
Take apical pulse before administering, if less than 60 or irregular, hold med and notify MD.
Monitor fluid retention.
Teach patient to take pulse.
Teach to not abruptly D/C med.
(Atenolol, metoprolol, propranolol)
Beta blockers (Atenolol, metoprolol) interact with which meds?
Epinephrine Verapamil Aminophylline Lidocaine Insuline Cimetidine Alcohol
Beta blockers are contraindicated in patients who have which medical problems?
Sinus bradycardia, peripheral vascular disease, second and third-degree heart block, heart failure and asthma.
Should also be used with caution in patients who have diabetes, COPD, hepatic disease and allergic disorders.
(Atenolol, metoprolol, propranolol)
Calcium channel blockers
mechanism of action:
Block influx of calcium across the cell membrane of cardiac and smooth muscle cells. Which Causes a decrease in myocardial contraction, automaticity in SA node and AV node.
Also decrease smooth muscle contraction, causing coronary artery dilation.
Used to treat hypertension, angina, cardiac arrhythmias and peripheral vascular disorders.
Two main groups of calcium channel blockers
Dihydropyridines
Non-Dihydropyridines
Examples of calcium channel blockers
Diltiazem Verapamil Amlodipine Felodipine Nifedipine Nicardipine Isradipine
Side effects and nursing interventions for calcium channel blockers
Diltiazem Verapamil Amlodipine Felodipine Nifedipine Nicardipine Isradipine
Hypotension, fatigue, dizziness, nausea and fluid volume excess.
constipation is very common.
A potential life-threatening side effect is the development of ventricular arrhythmias.
Monitor BP and pulse. If below 50 beats/ min, hold med.
Increase fluid and fiber to prevent constipation.
IV med, EKG and BP are continuously monitored. Solution protected from light.
Cardiac glycosides
Mechanism of action:
Affect heart function by increasing myocardial contraction strength and slowing rate.
Treats heart failure.
Digoxin
Nursing interventions for cardiac glycosides (digoxin):
And s/sx of dig toxicity:
Monitor for dig toxicity: visual disturbance, headache, dizziness, anorexia, N/V/D.
Monitor digitalis and potassium levels.
Apical pulse for one min: if below 60 or above 110, hold med.
Thiazide diuretics-
Example and mechanism of action
hydrochlorothiazide
Act on distal tube of nephron to promote to promote excretion of sodium and water.
Used to decrease the volume of circulating fluid in heart failure, essential hypertension, cirrhosis and chronic renal disease.
Side effects of thiazide diuretics and nursing interventions.
Hctz side effects:
Electrolyte imbalances, hypotension, dizziness, anorexia, N/V.
Nursing interventions:
Monitor electrolytes, especially K and Na.
I and O, BP and pulse.
Daily weights.
Diabetics may need to adjust diet and insulin to avoid hyperglycemia.
Loop diuretics-
Example and mechanism of action:
Furosemide
Act on Loop of Henle to prevent reabsorption of sodium and water.
Potent diuretics.
Side effects of loop diuretics (furosemide)
Potassium loss
GI distress
Ototoxicity may occur with high dose IV furosemide. Hearing loss is usually reversible, but is sometimes permanent.
Nursing intervention for furosemide:
Drug interactions:
Monitor I and O.
Potassium status.
Daily weight, BP and pulse.
Furosemide increases action of several drugs:
Anticoagulants, beta blockers, digitalis, lithium.
Examples of potassium- sparing diuretics
Spironolactone
Amiloride
Triamterene
Action of potassium sparing diuretics (spironolactone, amiloride, triamterene)
Act on distal tube to promote excretion of sodium and water.
Potassium is reabsorbed.
Considered weak diuretics- usually given in combination wig other diuretic to decrease K loss.
Side effects of potassium sparing diuretics. (spironolactone, amiloride, triamterene)
Hyperkalemia, especially in DM and elderly.
GI distress
Fluid and electrolyte imbalances.
Avoid foods high in K.
Foods high in potassium
Banana
Oranges
Apricots
Cabbage
Iron supplement
Nursing interventions of oral iron
Should be taken one hour before a meal. Take with OJ.
Liquid iron should be taken through straw to avoid staining teeth.
If iron needs to be taken with food to avoid GI distress, avoid with milk, eggs, chocolate, caffeine- can prevent absorption.
Iron should be taken 2 hours apart from tetracycline or antacids.
Side effects of iron supplement
Gi distress
Constipation
Heartburn
Black stools
IM iron injections
Precautions and technique:
Iron is irritating to skin.
Z-track injection
Change needles after drawing up.
Dont massage injection site.
Nitrates (nitroglycerine)
Use and side effects:
Treats acute angina and can be used prophylactically to prevent angina.
Side effects: headache, can be severe. Tachycardia, palpitations, hypotension
Thrombolytics
Examples and use:
Streptokinase
Urokinase
Tissue plasminogen activator
Used to disintegrate clots.
Can be used in MI and thrombus strokes.
Thrombolytics
(Streptokinase
Urokinase
Tissue plasminogen activator)
Side effects:
Nursing interventions:
Hypotension, bleeding, hemorrhage, anaphylaxis.
Aminocaproic acid (amicar) is “antidote”- given to stop thrombolysis and stop bleeding.
Vasodilators
Examples:
Side effects:
Hydralazine: side effect -lupus like symptoms
Minoxidil: side effect- excessive hair growth. Has black box warning of serious cardiac events.
When used alone, these meds cause reflex tachycardia and fluid retention, so they are used with beta blockers or diuretics.
Vasodilators (minoxidil and hydralazine)
Use and mechanism of action:
Treats hypertension.
Decrease BP by relaxing arterioles and decreasing peripheral resistance.
These drugs are not used alone for htn, used in combination with diuretics, betablockers.
Reasons sodium and fluid intake may need to be decreased:
Htn
Heart failure
MI
Helps Avoid fluid overload and reduces cardiac workload
