Prototype Drugs-Cardio/Renal Flashcards
Captopril
ACE Inhibitors
Angiotensin Converting Enzyme Inhibitors (blocks ACE from converting A1 to A2);
happens in the lungs;
indications: HTN, CHF;
dec aldosterone production, dec fluid retention, dec bp;
Suffix: -pril;
Contraindications: allergies, impaired renal fx, preg/lac, Caution: CHF
Adverse effects: Dizziness, tachycardia, headache, nausea, GI irritation (ulcers), renal insufficiency (proteinuria), Dry irritating cough
Losartan
ARBs
Angiotensin II Receptor Blockers;
Happens at the adrenal glands;
selectively binds to angiotensin II receptors to block vasoconstriction and the release of aldosterone;
Suffix: -artan;
Contraindications: allergies, preg/lac, Drug: Phenobarbital;
Adverse effects: Headache, dizziness, syncope, weakness, GI irritation, Skin rash, cough, fever
Hydralazine
Vasodilators;
Acts directly on smooth muscle (aka works directly on the blood vessels) to cause muscle relaxation leading to vasodilation and drop in bp;
Does not directly affect heart rate;
Emer Med;
Given IV;
Indications: severe HTN, hypertensive emergencies;
Contraindication: allergy, preg/lac (but still given to preg women), cerebral insufficiency (cuz dec bld flow to the brain);
Adverse Effects: headache, dizziness, weakness, diaphoresis, GI upset (nausea, vomiting, abdom pain);
Toxicity: Lupus-like syndrome, in acute care setting-no bp;
Nursing Considerations: Hx and physical, impaired kidney or liver fx, baseline VS and ECG
Lidocaine
Class 1 Anti-arrythmics
Sodium Channel Blockers;
Affect non-nodal cells more;
Depress the O phase (extend effectve refractory period=slows heart rate);
Used in life-threatening v-arrhythmias, SVT’s, WPW;
Dec action potential w/o significantly lowering heart rate;
Given IM or IV
Propranolol
Class 2 Anti-arrythmics;
Beta Blockers; block B receptors in the SA and AV nodes (=less sympathetic hormones being able to inc heart rate);
Diminishes phase 4 (prolongs time for action pot to be reached=slower conduction);
Tx Cardiac arrythmias (esp SVT, PVC), used post MI to prevent another MI;
Given: PO or IV (check apical pulse before giving; IV: 2 providers check order, dose, and calc);
Drug-drug interactions: Verapamil- potentiates low heart rate, dec action potential. Insulin- can inc likelihood of hypoglycemia
Amiodorone
Class 3 Anti-arrythmics
Potassium Channel Blockers;
Affect non-nodal cells more-acts directly on myocardial cells-acts on peripheral smooth muscle cells to dec periph vasc resistance;
Drug of choice for v-tach, Used for life threatening v-arrhythmias;
Extends effective refractory period => dec in heart rate;
Blocks outward movement of K during phase 3 (prolonging it);
Corresponds with QT interval- AVOID in patients with a prolonged QT interval;
Given: PO and IV;
Drug interactions: Digoxin or Quinidin-direct toxicity; Antihistamines, Phenothiazines, Tricyclic Antidepressents- Proarrhythmias.
Diltiazem
Class 4 Anti-arrhythmics
Calcium Channel Blockers;
Affects nodal cells;
Blocks movement of Ca across cell membrane-Depresses generation of action pot which slows automaticity and conduction = slow heart rate;
Used for SVT, A-fib, A-flutter;
Given IV or PO;
Drug interactions: Verapimil- potentiated dec in HR and bp, Digoxin-inc risk of toxicity, B-blockers- severer cardiac interactions, Cyclosporine- toxicity
Nitroglycerine
Antianginals;
Restore the appropriate supply and demand ratio in O2 delivery-dilate blood vessels (inc O2 supply), dec work load of the heart (dec O2 demand);
Has a direct action on coronary arteries that can respond to it;
Dec bp- dec both preload and afterload =>dec in overall cardiac work load;
Prevent angina, acts directly on smooth muscle of blood vessel;
Given: sublingual, transdermal patch, IV;
Onset is rapid: 1-3 mins;
Half-life is short: 1-4 mins;
Drug Interactions: Ergot derivatives (HTN, dec antianginal effects), Heparin (dec therapeutic effect of Heparin), ED Meds (risk for significant hypotension)
Aspirin
Antiplatelet Agent;
Dec the formation of the platelet plug;
Block platelet receptor sites thus preventing the physiological changes that lead to adhesion and aggregation;
Used prophylactically to prevent vascular accidents (ie TIA);
Adverse effects: bleeding/bruising, Direct GI irritation (nausea, abdominal cramping, heartburn, GI bleeding), skin rash, headache, dizziness, and weakness;
Drug Interactions: Do not use with other meds that affect blood clotting-serious bleeding event can occur;
1300 mg/day =>dec TIAs, 300-325 mg/day to dec MI risk
Heparin
Anti-thrombotics;
Interferes with blood clotting by interfering with the clotting cascade (stops conversion of prothrombin to thrombin and figrinogen to fibrin);
Prevent and Tx of venous thrombosis and PE; Tx of A-fib with embolization; Dx and Tx of DIC; prevention of clotting in blood samples and IV locks;
Given: IV or Subcu;
Labs: Platelet count and PT/PTT;
Adverse effects: bleeding/bruising, hair loss, fever, osteoporosis, suppression of renal fx (with long-term use);
Drug interactions: Do not use with other anticoagulants; penicillin/cephalosporins- inc bleeding; Nitroglycerine- dec bleeding
Coumadin (Warfarin)
Anti-throbotics;
Interferes with blood clotting by dec the production of Vit K-dependant clotting factors in the liver;
Leads to an overall dec in clotting factors and prolonged clotting time;
Used for prophylaxis for thrombus formation (a-fib, PE, DVT), after valve surgery, for active management of risks associated with MI;
Given: PO;
Labs: PT, PTT, INR;
Adverse effects: bleeding, alopecia, dermatitis, bone marrow depression, prolonged and painful erections;
Drug-drug interactions: MANY. Many meds will either potentiate or prevent anticoagulant properties of warfarin; Be careful with drug compatibility for patients taking warfarin.;
Drug-food interactions: Vit K containing foods (kale, spinach, brussel sprouts, parsley, collard greens, mustard greens, chard, green tea).
Digoxin
Cardiac Glycoside;
Inc force of myocardial contration;
Inc CO and renal perfusion;
Dec blood vol;
Slows conduction velocity through AV node (good for Tx a-fib too!)
Slows heart rate;
Mech of Action: inc intracellutalr Ca, allows more Ca to enter the myocardial cell during depolarization, reduced heart rate which improves CO and inc renal perfusion leading to improved diuresis;
Indications: Tx of heart failure, Tx of a-fib
Contraindications: allergy, V-arrhythmia, heart block, acute MI, renal insufficiency and electorlyte abnormalitites;
Caution: preg/lac, pediatric and geriatric populations;
Drug-drug Interactions: antiarrhythmics, erythromycin, tetracycline, cyclosporine, K-losing diuretics, many others;
Drug-Food Interactions: Licorice, ginseng, hawthorne;
Adverse effects: headache, weakness, drowsiness, vision changes, GI upset, anorexia, arrhythmia;
Given: PO w/o food;
Nursing considerations: assess apical heart rate before administration (hold if bp < 60), monitor (ECG changes, serum K, serum digoxin level), assess for signs of digitalis toxicity (bradycardia, anorexia, nausea, vomiting, diarrhea, dysrhythmias, altered vision, in males: gynecomastia, dec libido and impotence.
