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Unit 5 Meds

Cardio Meds

Diuretics Lasix, Bumex, Hydrochlorothiazide, Zaroxolyn
Hydrochlorothiazide Thiazide diuretic most commonly used for HTN. Check K+. Less potent, less effective than Lasix & Bumex (won't get massive outputs)
Zaroxolyn Mild diuretic used for HTN, not a thiazide but it acts as one.
Lasix & Bumex Loop diuretics, want massive output if giving IV push 1000 mL/hr. Check K+ & Mag. S/E: ototoxic (ringing in ears). PO onset is within 60 min & lasts up to 8 hrs. IV onset is 5 min & lasts 2 hrs
Effects of Angiotensin II Vasoconstriction & Release of aldosterone which retains Na+ & H2O causing increase workload of heart
ACE inhibitors Used for: HTN, heart failure, MI, Diabetic & non-diabetic nephropathy & high cardiovascular risks. S/E: HTN, cough, hyperkalemia, renal failure, fetal injury, angioedema. Does not allow angiotension I to convert to angiotensin II
ACE drug interactions Diuretics & anti-hypertensives, drugs that raise K+. Watch when giving to asthma or COPD patient b/c of cough
ACE drugs enalapril, lisinopril, captopril (end in pril)
Angiotensin II Receptor Blockers (ARB's) Dilates arteries & veins, prevents pathological changes to heart, decreases release of aldosterone. Used for: HTN, Heart Failure, Diabetic Nephropathy, MI, Stroke prevention
ARB drugs losartan & valsartan (end in sartan)
ARB's S/E: Angioedema, fetal harm, renal failure. Allows Angiotensin I to go to Angiotensin II but it doesn't work, it blocks receptor site. Use this if develop cough from ACE inhibitor
Calcium Channel Blocker drugs Calan, Cardizen, Procardia, Norvasc
Calcium Channel Blockers Reduces heart rate, converts Afib to sinus or rate control, positive inotrope (contractility = increases efficiency of myocardium). Used for: HTN, Afib, cardiac dysrhythmias.
Calcium Channel Blockers S/E: Bradycardia, constipation, edema of ankles & feet
Alpha-2 Agonist drug Catapres
Catapres Blocks sympathetic stimulation. Causes vasodilation & lowers BP. S/E: dry mouth and sedation. Do NOT stop abruptly b/c you get reflux HTN
Alpha Adrenergic Antagonist drugs Prazosin, Terazosin, Doxazosin (end in azosin)
Prazosin, Terazosinm, Doxazosin Prevents stimulation of Alpha I receptors (vasoconstriction. Used for HTN & BPH. S/E: orthostatic HTN especially w/ 1st dose. Start w/ small dose & may get sinus tachy with that
Iron supplement drugs Ferrous Sulfate, INFeD, Sodium Ferric Gluconate & Desferal
Desferal Used for iron toxicity, given IV, excreted in urine. Avoid w/ kidney failure
Iron Avoid taking with antacids. S/E: constipation, dark stools, liquid form stains teeth (use straw)
Sodium Ferric Gluconate (INFeD) Must give with erythorpoietin. Can have severe allergic reaction so give test dose. Watch for hypotension, flushing, chest/back pain. If test dose goes okay can give full dose. Iron supplement given IV
Ferrlecit An iron supplement where test dose is given b/c can cause anaphylaxis. Not as bad a INFeD
Hydrea Inhibits DNA replication, anti-neoplastic, Category X. Increases level of Fetal Hgb (Sickle Cell Anemia Pts). Hold if platelets <95K or Hgb <5.DO NOT HANDLE WITHOUT GLOVES, TOXIC WHEN NURSING/PREGNANT
Vasodilator Drugs Sodium Nitroprusside (Nipride) & Nitroglycerin
Sodium Nitroprusside (Nipride) Venous & Arterial dilator (decreases BP drastically fast), metabolizes to Nitric Oxide causing cyanide poisoning. Only given in hypertensive emergencies in ICU on continuous drip for max 3 days. Needs to be light protected (brown plastic bag)
Nitroglycerin Primarily a venous dilator to decrease BP. S/E: BAD headache, hypotension. Uses: HTN, Angina. Given IV (drug in glass bottle, use special tubing b/c gets absorbed in tubing), Sublingual (spray/tablet), Sustained Release or Transdermal (dosed in inches).
Beta-1 Adrenergic Antagonist (Beta Blockers) Drugs Propranolol, Atenolol, Metoprolol, carvedilol, Labetolol (end in lol)
Non-selective Beta Blocker Propranolol
Cardioselective Beta Blockers Atenolol, Metoprolol
Beta blockers w/ vasodilating Carvedilol, Labetolol
Beta Blockers HTN, angina, cardiac dysrhythmias,MI, heart failure. S/E: impotence & sexual dysfunction, bradycardia, reduced cardiac output, AV heart block, bronchoconstriction (cough)
Digoxin Amino glycoside. + Inotrope (increase contractility), - chronotrope (slows down heart rate increasing cardiac output). Used for heart failure & dysrhythmias
Digoxin S/E: Cardiac dysrhythmias (WATCH K+), bradycardia, AV block, Vfib. Toxicity s/s: blurred/yellow tinged vision, appearance of halos around dark object. Tx: Digibind, charcoal
Antidysrhythmics Na+ (Lidocaine & Procainamide) & K+ (Amiodarone) channel blockers, & Adenocard
Na+ Channel Blockers (Lidocaine & Procainamide) Used for ventricular arrythmias -- ACCELERATES repolarization, slows conduction & reduces automaticity
K+ Channel Blocker (Amiodarone) Used for ventricular & atrial tachy dysrhythmias (runs of Vtach & Afib),SLOWS repolarization & conduction & reduces automaticity
Amiodarone S/E: Pulmonary Toxicity (congestion, pulmonary fibrosis), toxic in pregnancy/breast feeding, visual changes, blue/gray discoloration
Adenocard Used with tachy SVT's, wipes out electrical activity of heart puting you into asystole for 3-5 seconds then hopefully SA node kicks in. MUST MONITOR ECG
Anti-Platelets ASA (aspirin), Plavix, Pletal, Aggrenox. Used for MI, HTN, stroke
Aspirin Decreases platelet aggregation
Plavix Blocks receptor site on platelets and inhibits platelet aggregation. Will NOT increase INR or PTT. Used for coronary artery disease or peripheral vascular disease
Pletal Platelet inhibitor and vasodilator. Used for intermittent claudication
Aggrenox Combination of Dipyridamole/ASA -- together they decrease platelet aggregation
Anticoagulant Short-term blood thinner. Used for PE, DVT, AMI, Stroke. Monitor PTT and platelets. S/E: hemorrhage & Heparin induced thrombocytopenia (HIT)
Direct Thrombin Inhibitors drugs: Angiomax, Refludan, Agatroban
Angiomax, Refludan, Agatroban Used for patients requiring anticoagulation with HIT. Given IV drip and very expensive. Monitor PTT
Warfarin (Coumadin) Acts on Vit K dependent clotting factors. Used for DVT, PE, prosthetic heart valves & Afib. Monitor PT/INR. Category X Pregnancy S/E: Hemorrhage. Very high risk for bleeding when used w/ Aspirin or Plavix
Glycoprotein IIb/IIIa Receptor Antagonis Drugs Reopro, Integrilin
Reopro OR Integrilin Total block of platelet aggregation used short term post angioplasty for stent placement or acute coronary syndromes S/E: bleeding. Given IV continuous drip up to 48 hrs. Monitor ACT (activating clotting time), or BT (Bleeding Time)
Tissue Plasminogen Activator (tPA) Breaks up clots in acute stage only. Given IV bolus then drip at site where clot is. Used for AMI's, PE. Contraindicated: stroke in last 3 months, brain bleed, surgery <3 weeks, pregnancy, uncontrolled HTN
Cholesterol We either eat it or produce it within the liver from saturated fats. Cholesterol <200, Triglycerides <150, LDL <100, HDL >50-60
HMG-CoA Reductase Inhibitors Drugs: Atorvastatin, Lovastatin, Pravastatin, Simvastatin, Rosuvastatin
Statins Goal is to lower LDL's and increase HDL's, max effect seen in 4-6 weeks, given at night. Used to prevent CV events, post MI therapy & DM. S/E: Category X, Hepatotoxic & myopathy
Anti-cholesterol miscellaneous drugs: Niacin, Zetia, Lopid, Fish Oil & Estrogen
Niacin Lowers LDL's & Triglycerides and Increases HDL. S/E: Hepatotoxic, severe flushing of face, neck and ears
Zetia Blocks cholesterol absorption. S/E: Hepatotoxic
Lopid Primarily used to increase triglycerides. Do NOT use w/ statins. S/E: Increased risk for gallstones & Hepatoxic
Fish Oil Omega 3 Fatty Acids. Lowers triglycerides & LDL. Decreases inflammation & platelet aggregation. S/E: Belch up fishy taste
Estrogen Post menopausal women have higher risk of cardiovascular disease
Vasoconstrictor drugs Dopamine & Levophed
Vasoconstrictors Extremely caustic to tissues. Usually given thru central line, if given peripherally put REGITINE in bag to prevent infiltrate. Used to increase BP when fluid levels are acceptable in body. Do NOT use on dehydrated patients.
Dopamine Vasoconstrictor that increases heart rate
Beta I Adrenergic Receptor drug Dobutamine
Dobutamine Increases contractility. Used for heart failure. Given IV drip. S/E: tachycardia, may see BP go up OR down
Emergency Meds Epinephrine & Atropine
Epinephrine Given in emergent situations (code blue) IV push fast and hard or IV drip. Natural adrenaline. Goal is to increase heart rate & BP. Comes either 1:1,000 (subQ-IM/epi-pens) or 1:10,000 (emergent)
Atropine Used in emergency situations for brady cardia. Works by increasing sinus node output, need a heart beat to start with. Will NOT work with asystole
Created by: kristyd02