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Cardio Drugs pt. 1


Diuretics: Increase urine output & decrease fluid volume
Angiotensin-converting enzyme (ACE) inhibitors/ Angiotensin II receptor blockers (ARB): RAAS, decrease vascular tone, inhibit aldosterone
Beta-adrenergic antagonist (Beta blockers): inhibit sympathetic stimulation decrease heart rate
Calcium channel blockers: prevent extracellular calcium into cell; dilate arteries
Vasodilators: direct relaxation of vascular smooth muscle
Antihypertensive Agents Goal: stable blood pressure Check BP & pulse before and after medication Teach patients to change positions slowly to prevent orthostatic hypotension, esp. the elderly
Types of Diuretics Loop diuretics Thiazide diuretics Potassium sparing diuretics Osmotic diuretics
Patients with diuretics Getting rid of volume and pt’s take it in the morning
Loop Diuretics – furosemide (Lasix) Use: hypertension, heart failure, edema Most potent diuretic, rapid onset
Types of Loop Diuretics bumetanide (Bumex), torsemide (Demadex) “body is dried”
Loop S/E the loss of water and electrolytes: hypokalemia
What is the action of loop diuretic? promotes the excretion of water, sodium, & potassium by blocking sodium and water reabsorption in the ascending loop of Henle; increased urination as an intended effect.
What are the adverse affects of loop diuretics? Rapid fluid and electrolyte depletion: hypokalemia (muscle cramps, muscle weakness, abnormal heart rhythms).
High doses of loop diuretics leads to what? ototoxicity
Long-term furosemide + digoxin= hypokalemia increases the effect of digoxin and can result in digoxin toxicity
What do you want to monitor with Loop diuretics? Monitor the BP frequently
Nursing Intervention for Loop Diuretics Monitor for hypokalemia, intake & output, vital signs including blood pressure (orthostatic hypotension), skin turgor, and monitor weight daily
What is the normal level for potassium? Normal blood potassium level is 3.5-5.0 mEq/L
Thiazide drugs: hydrochlorothiazide (HCTZ, Hydrodiuril), chlorothiazide (Diuril)
What is the MOA of Thiazide? promote excretion of sodium, potassium, and water by blocking their reabsorption in the distal convoluted tubule. Increased urination as an intended effect.
What is the adverse effects of thiazide? Hypokalemia and hyponatremia
Nursing Interventions of Thiazide? Monitor BP frequently – need to prevent falls Monitor decrease K+ levels (hypokalemia)
Drug-drug Interaction of Thiazides? Increased potassium loss may lead to toxic levels of digoxin
Potassium-Sparing Diuretics MOA: promote excretion of sodium & water by inhibiting Na-K exchange in distal tubule
Potassium-sparing diuretics: Spironolactone (Aldactone): Triamterene (Dyrenium) aldosterone antagonist (blocks aldosterone)
What is Potassium-Sparing Diuretics used for ? Hypertension, heart failure, edema
What are the adverse effects of PSD? Hyperkalemia-diarrhea, chest pain, palpitations, muscle weakness Avoid administering with other drugs that increase potassium levels (ACE inhibitors, ARBs)
What to avoid with PSD? Avoid excess ingestion of potassium-rich foods Avoid ACE inhibitors, ARBs to avoid hyperkalemia
Osmotic Diuretic MOA? most of the drug stays in the nephron, producing an osmotic effect. Pulls water into the renal tubules from the surrounding tissues. Inhibit tubular resorption of water and solutes, thus producing diuresis.
Osmotic Diuretic drug mannitol (Osmitrol) IV, give med slowly
What is the use Osmotic Diuretic? decrease intracranial pressure, decrease intraocular pressure, prevent renal failure
Adverse effect Osmotic Diuretic pulmonary edema, need to listen to lung sounds
Angiotensin-Converting Enzyme (ACE) Inhibitors MOA: Inhibit ACE, enzyme that converts angiotensin I to angiotensin II Decrease aldosterone secretion
ACE Results in: Inhibit formation of angiotensin II Vasodilation Decreased blood volume Slow cardiac remodeling Potassium retention
ACE Results in: Inhibit breakdown of bradykinin Vasodilation Cough (nonproductive) Angioedema
ACE Drugs end in? Drugs (note end in “pril”) lisinopril (Zestril) ramipril (Altace) captopril (Capoten) HYPOTENSION, A=Angioedema, C=Cough, E=Elevated potassium
What are ACE Inhibitors used for? Hypertension Heart failure (either alone or in combination with diuretics or other drugs) Myocardial infarction (MI)
What are the Adverse Effects of ACE Inhibitors? First dose postural (orthostatic) hypotension (worse 1-3 hours after first dose) Dry, nonproductive cough, which reverses when therapy is stopped Hyperkalemia Angioedema Can cause fetal toxicity; avoid in pregnancy
Angioedema and its treatment Angioedema: swelling of tongue and lips and can cause respiratory distress. Treatment: epinephrine
Nursing Intervention for ACE? Monitor electrolytes especially potassium, hyperkalemia Never use an ACE inhibitor if a patient has a history of angioedema from an ACE inhibitor or an ARB Assess for cough
MOA for Angiotensin II Receptor Blockers (ARBs) blocks receptors for angiotensin II
Drugs for ARBs end in? (-sartan): losartan (Cozaar), valsartan (Diovan)
ARBs results in: Dilation of arterioles & veins Block secretion of aldosterone Slow pathologic changes in cardiac structure Does NOT inhibit bradykinin metabolism (so no cough) – alternative to ACE inhibitors
What are the adverse effects for ARBs? Hypotension Angioedema Hyperkalemia Fetal toxicity (avoid in pregnancy) Worsening of renal function
What ARBs used for? Hypertension Heart failure May be used alone or with other drugs such as diuretics
Nursing Intervention for ARBs Monitor electrolytes especially potassium, hyperkalemia Monitor BP frequently for hypotension Never use an ARB if a patient has a history of angioedema from an ACE inhibitor or an ARB
MOA of Direct Renin Inhibitor Action: Inhibits renin, which then inhibits the activation of angiotensinogen into angiotensin I.
What is Direct Renin Inhibitor used for? hypertension
Drugs for Direct Renin Inhibitor only one drug available – aliskiren (Tekturna), do not take if pregnant (stop drug if becomes pregnant)
DRI Adverse effects Diarrhea Headache Rash
MOA of Aldosterone Antagonists block actions of aldosterone, promotes retention of K+, and excretion of Na+ & H2O  reduce blood volume and decrease BP
Drugs for Aldosterone Antagonist eplerenone (Inspra) spironolactone (Aldactone) – also a potassium-sparing diuretic
What are Aldosterone Antagonist used for? hypertension & heart failure
What the adverse effects of aldosterone antagonist? Hyperkalemia Renal impairment
Sympathetic Response "Fight or Flight"
Parasympathetic Response "Rest and Digest"
Adrenergic Antagonist MOA Inhibit/block stimulation of the sympathetic nervous system (SNS)
What do adrenergic antagonist they act on? Beta1 and beta2 receptors Alpha1 and alpha2 receptors
Beta Blockers MOA Action r/t HTN: inhibit sympathetic stimulation; which slows HR and decrease BP
Beta Blocker drugs end in generic name ends in “lol” propranolol (Inderal) metoprolol (Lopressor) atenolol (Tenormin) Double “L”s = Low BP & Low HR
What are Beta Blockers used for/ treat? Angina Hypertension Cardiac dysrhythmias Myocardial infarction Migraines Stage fright Reinfarction Syncope
Beta 1 Blocker action Side effect of beta-1 blockade bradycardia (heart)
Beta 2 Blocker action Side effect of beta-2 blockade bronchoconstriction/wheezing
Beta Blockers: Nonselective beta blockers: block beta1 & beta2 Nonselective beta blockers: block beta1 & beta2
Beta Blockers: Nonselective beta blocker w/vasodilating actions: block beta1, beta2, & alpha1 Labetalol (Normodyne) Carvedilol (Coreg)
Beta Blockers: Cardioselective beta blocker: block beta1 Metoprolol (Lopressor) Atenolol (Tenormin)
Propranolol reducing HR, BP, AV node conduction, contractility
What are propranolol adverse affect? -Beta1 blockade Bradycardia AV heart block (slow down conduction) -Beta2 blockade Bronchoconstriction, wheezing, caution in pts with asthma & COPD -CNS effects Depression, fatigue, unusual dreams, sexual dysfunction (impotence)
Nursing Interaction for propranolol Take HR and BP before administering drug (hold if HR < 50-60 bpm or if SBP < 100 mm Hg) -Take BP standing & supine -Review concurrent medical problems -Warn patient to not discontinue medication abruptly
Beta Blockers w/ vasodilating actions Carvedilol (Coreg) Labetalol (Normodyne) – can be given IV: used in hypertensive crisis Weight gain (fluid retention) is a side effect. Assess breath sounds. Remember weight is one of the best indicators of fluid gain or loss. Benefits:
Cardioselective beta blocker this is not “all or nothing”; higher doses, can see beta2 activity Safer drug to use in concomitant illnesses such as asthma or COPD
What are the side effects of Metoprolol? Beta1 blockade Bradycardia AV heart block May mask early symptoms of hypoglycemia such as tachycardia, tremor, or nervousness
Nursing Intervention of Beta Blockers? Before administering beta-blockers Obtain current BP and apical pulse rate Do not discontinue beta blockers suddenly.
Beta Blockers (-lol) Teaching -Obtain current BP and apical pulse rate; if HR < 50-60 beats per minute or if BP is too low, hold the drug and notify the health care provider -Do NOT discontinue beta blockers suddenly.
Indirect-Acting Antiadrenergic Drugs MOA : stimulate the alpha2 receptors (inhibitory in nature) in the CNS, which decreases sympathetic outflow of the neurotransmitter norepinephrine (NE).
Indirect-Acting Antiadrenergic Drugs clonidine (Catapres) methyldopa (Aldomet) – used to treat hypertension in pregnancy
What are Indirect-Acting Antiadrenergic used for? Mild to severe essential hypertension
What does Indirect-Acting Antiadrenergic result in? Decrease in blood pressure
Centrally acting Alpha2 Agonists: clonidine (Catapres) adverse effect Orthostatic hypotension Depression Drowsiness/fatigue: 35% Xerostomia (dry mouth): 40% Rebound HTN –r/t abrupt withdrawal Constipation – increase fiber & fluids intake Abuse – high doses can cause euphoria, sedation
Clonidine (Catapres) route of administration Transdermal patch changed every 7 days; place on hairless, intact skin; use only upper arms or torso, remove old patch before applying a new one
Nursing Intervention for Clonidine (Catapres) Caution pt. about sedation/drowsiness Rebound hypertension Teach patient not to discontinue drug abruptly
Methyldopa (Aldomet) Pregnancy risk: Category B Drug does not increase risk of miscarriages, birth defects, premature births
What do calcium channel blockers do? Decrease myocardial contractility by preventing influx of calcium ions into cells Dilate coronary & peripheral arteries by blocking calcium channels in smooth muscle Decreased oxygen demand
What are the 3 classes of calcium channel blockers? Dihydropyridines (nifedipine) Phenylalkylamine (only drug is verapamil) Benzothiazepine (only drug is diltiazem)
Nifedipine/Amlodipine Nifedipine blocks calcium channels in the blood vessels only, which causes vasodilation. Vasodilation (vessels) --> decrease BP and increase coronary perfusion
Nifedipine/Amlodipine used for? hypertension; stable, variant angina
Nifedipine/Amlodipine adverse effects? Hypotension Reflex tachycardia (decrease BP triggers baroreceptor reflex which increases HR and contractility of the heart) Peripheral edema (activation of RAAS System)
Verapamil MOA? Verapamil blocks calcium channels in the heart that leads to decreased BP, decreased HR, slowed conduction (hold if SBP <100 or HR <60)
Verapamil used for? hypertension & dysrhythmias
What are the side effects for verapamil? constipation – increase veggies/fiber intake Cardiac effects: hypotension, bradycardia, heart block (AV)
Verapamil drug and food interactions? -Verapamil can raise digoxin levels – can lead to dig toxicity; both drugs slows heart -Verapamil & beta blockers – both drugs  HR,  AV conduction, &  contractility. Risk of excessive cardiosuppression. -Avoid grapefruit juice – increases serum level
Diltiazem MOA? blocks calcium channels in blood vessels and in the heart
Diltiazem used for? hypertension; angina; dysrhythmias
Diltiazem adverse effects? Hypotension, bradycardia, heart block, flushing, & peripheral edema, constipation
Nursing Intervention for Diltiazem Do not give if pulse is low or BP is low
Diltiazem drug and food interactions same as verapamil Increase fiber and fluids to ease constipation
Nursing Intervention for Diltiazem Monitor BP & pulse Increase fiber and fluids to prevent constipation Assess lower limbs for edema Avoid grapefruit juice
Hydralazine (Apresoline) MOA causes dilation of arteries
Hydralazine (Apresoline) used for? hypertension, hypertensive crisis, heart failure
Hydralazine (Apresoline) adverse effects Reflex tachycardia (trigger of baroreceptors) Edema from sodium & water retention (as a response to decrease BP)
Minoxidil MOA causes direct relaxation of vascular smooth muscle --> vasodilation Can cause reflex tachycardia
Minoxidil used for? refractory, severe hypertension
Minoxidil adverse effect? Hypertrichosis (Overgrowth of hair) (80% taking > 4 weeks)
Sodium Nitroprusside (Nitropress) MOA dilate veins and arteries via nitric acid
Sodium Nitroprusside (Nitropress) used for? IV only for hypertensive emergencies
Sodium Nitroprusside (Nitropress) adverse effect? severe hypotension, cyanide poisoning
Nursing Intervention for Sodium Nitroprusside (Nitropress) Drug is normally brown in color and is sensitive to light (protect with opaque bag) If exposed to light, converts to thiocyanate – cyanide poisoning (see CNS changes including decreased LOC, disorientation, delirium)
General Nursing Care: Antihypertensive Agents Goal: Stable blood pressure & heart rate -Monitor BP & pulse – if too low, do not give the BP medication
General Nursing Care: Antihypertensive Agents pt 2 Prevent falls – orthostatic (postural) hypotension – teach patients to change position slowly Observe for dizziness, fatigue, postural hypotension, and changes in LOC (level of consciousness) -Abnormal potassium levels can cause muscle cramps/weakness &
Inotropic: force of contraction + inotropic: strengthen force - inotropic: decrease force
Chronotropic: heart rate + chronotropic: increase rate - chronotropic: decrease rate
Dromotropic: conduction + dromotropic: speeds conduction - dromotropic: slows conduction
Digoxin (Lanoxin) class: cardiac glycoside MOA: Influx of Ca++ in cells 1. Increasing myocardial contractility (+ inotropic) 2. Increase vagal activity: conduction slowed through AV node and refractory time (– chronotropic, – dromotropic)
Nursing Intervention of Digoxin Always take apical pulse for a full minute before administering If apical pulse < 60, do not administer
What is digoxin used for? Atrial fibrillation Heart failure
Normal digoxin level 0.5 to 2.0 ng/mL (narrow therapeutic index)
Digoxin nursing implications Dehydration and electrolyte imbalances (hypokalemia, hypomagnesemia) increase sensitivity to digoxin; making toxicity more likely even with a lower concentration of serum digoxin Normal Mg++ level: 1.7 to 2.2 mEq/L
Digoxin Toxicity Early signs: anorexia, nausea, vomiting, bradycardia Later: confusion, visual disturbances – blurred vision, yellow vision, seeing halos around bright objects; eventually, hyperkalemia
What is the antidote for digoxin? Digoxin immune Fab (Digibind, Digifab)
Epinephrine Emergency use: cardiac arrest, hypotension; used to elevate BP Serious allergy: anaphylactic shock; causes vasoconstriction Topical anesthesia Asthma: inhalation; activate beta 2 – causes bronchodilation of lungs
What are the adverse effects of Epinephrine? Hypertensive crisis Dysrhythmias, palpitations Angina, anxiety Hyperglycemia
Dopamine used for? Shock Heart Failure Acute renal failure
Atropine (anticholinergic) used for Sinus bradycardia Heart block Decrease secretions during surgery
Atropine MOA Inhibits acetylcholine sites in smooth muscles, secretory glands; causes increase in HR; monitor HR and rhythm
What are the adverse effects of Atropine? Urinary retention Dry mouth Palpitations, tachycardia Angle-closure glaucoma (be careful w/ pts that have this)
Created by: Xnamee
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