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drugs for heart conditions

action of diuretics increase urine output & decrease fluid volume
action of calcium channel blockers block calcium ion channels in arterial smooth muscle from letting calcium in, promoting vasodilation
types calcium channel blockers selective (only work on blood vessels) nonselective (work on blood vessels and the heart)
DONTS with calcium channel blockers grapefruit juice (keeps mx in body longer, causing hypotension), generally not used as monotherapy (unless for dysryhthmias), avoid during heart failure
adverse effects of calcium channel blockers flushed skin, peripheral edema, headache, dizziness, bradycardia (AV heart block), rebound hypertension
used 2nd in angina, after beta blockers calcium channel blockers
examples of calcium channel blockers verapamil "Calan" (non-selective);dilitiazen " Cardizem" (non-selective); amlodipine "Norvasc" (selective); nifedipine "Procardia" (selective)
CCB's are effective in these hard to treat populations elderly & african americans
action of angiotensin II receptor blockers (ARB's) Block the angiotensin II from reaching its receptors; causing vasodilation and decreased BP
ARB medications end in what suffix "tan"
adverse effects of ARB's headache, dizziness, orthostatic hypotension, rash. Cough and angioedema less likely; don't work well in african americans
Direct Renin Inhibitors Act directly on renin-angiotensin system; inhibition of renin results in decreased formation of angiotensin II. (Ex.- aliskiren Tekturna) Side effects: cough, diarrhea
Angiotensin-Converting Enzyme Inhibitors (ACE inhibitors) usually end in what suffix "pril"
action of ACE inhibitors Inhibit the formation of angiotensin I to angiotensin II and block aldosterone secretion, causing decreased peripheral resistance and decreased fluid volume (which lowers BP)
side effects of ACE inhibitors dry irritating cough, insomnia, hyperkalemia, angioedema, postural hypotension (less effective in blacks)
nifedipine/Procardia selective calcium channel blocker
beta blockers end in "olol"
microalbuminurea Early marker of diabetic nephropathy that may be prevented or delayed by taking ACE or ARB mxs
contraindications of beta-blockers diabetics (mask signs of hyperglycemia), pts with COPD (may cause broncho-constriction)
beta blockers work by... inhibiting sympathetic (fight/flight) response; decreases HR, reduced CO and lowers BP
beta blockers are used for: HTN, heart failure, myocardial infarction, migraines, dysrhythmias (usually used for chronic conditions, not acute situations)
always check ___ prior to administering a beta blocker apical pulse (don't give if less than 50)
s/e of beta blockers Adverse effects: marked decrease in BP and HR, insomnia, depression, nightmares, fatigue, activity intolerance, decreased libido, erectile dysfunction, hypoglycemia, bronchospasm
abruptly stopping beta blockers may cause rebound hypertension; need to wean off
4 B's of beta blockers bradycardia; blood pressure; bronchial constriction; mask low blood glucose
Alpha1 Adrenergic blockers work by Inhibit sympathetic activation in arterioles, causing vasodilation (not considered first line drugs; used in combination usually with diuretics)
alpha 1 blockers end in "sin"
alpha 1 indications HTN, Useful in patient with lipid abnormalities or benign prostatic hypertrophy, seen in hypertensive urgency or emergency
alpha 1's interact with anti-inflammatory drugs and nitrates
alpha 1 side effects dizziness, nausea, fatigue, nervousness
alpha 2 agonists work by Decreasing outflow of sympathetic nerve impulses from the brainstem to the heart and arterioles, causing vasodilation
indications for alpha 2's pregnancy! (not considered a 1st line for HTN)
drugs that increase heart contractility positive inotropic (ie epinephrine, dopamine, digoxin)
direct acting vasodilators Direct action on smooth muscle of arterioles; used in hypertensive urgency or emergency
hydralazine (Apresoline) direct acting vasodilator
action of nitroglycerin form nitric acid to vasodilate blood vessels to improve blood flow to myocardium. Decrease preload and afterload
contraindications on nitro Viagra or Cialis may cause life-threatening hypotension. Use with alcohol or anti-hypertensive drugs may cause additive hypotension; tolerance is easily built up!
teaching pt. about PRN nitro take while sitting; h/a does not indicate whether working or not; teach about SL; take 1 every 5 minutes 3 times before calling 911
anti-anginal tx's nitro; CCB; Beta blockers
anti-dysrhythmic mx's sodium channel blockers (lidocaine), potassium channel blockers (amiodarone), beta blockers, calcium channel blockers, adenosine/Adenocard
action of lidocaine sodium channel blocker; anesthesia-like action; slows electrical impulses across the heart, decreases action potential and accelerates repolarization
indications for lidocaine severe ventricular dysrhythmias
adverse effects of lidocaine toxicity, drowsiness, confusion, seizures/convulsions, and can cause worsened or new dysrhythmias
action of amiodarone potassium channel blocker; slows repolarization, lengthens refractory period and increases duration of action potential
indications for amiodarone severe atrial and ventricular dysrhythmias (*1st in line for ACLS)
action of adenosine/Adenocard terminates serious atrial tachycardia by slowing conduction through the AV node and decreasing automaticity of the SA node: is like "chemical defibrillation"
indications for adenosine PSVT: paroxysmal supraventricular tachycardia
cardiac glycosides/ digoxin Digitalis: increases heart's contractility, slows the heart rate; greater efficiency and greater cardicac output
indications for digoxin usually advanced heart failure b/c doesn't decrease mortality and has a very narrow window of safety (>3 ng is toxic)
DDI for digoxin antacids and herbals; low potassium (hypokalemia increases risk for toxicity)
s/s toxicity with digoxin bradycardia (check apical pulse), cardiac dysrhythmias (heart block), blurred vision or halos, vomiting, fatigue, anorexia
antidote for digoxin Digibind
action of dobutamine/Dobutrex Increases myocardial contractility rapidly and effectively with minimal changes to HR or BP (acute situations: limited to 72 hours) Adverse effects: tachycardia and dysrhythmia
Created by: leh072487