ATI Pharm: Cardiovascular System

Ethacrynic acid
a high-ceiling loop diuretic

can cause ototoxicity (hearing loss that can be permanent)

Nifedipine
calcium channel blocker
treats HTN

inhibits excitation of heart muscle

adverse effect:
can cause reflex tachycardia, this can worsen angina pain due to increase in cardiac oxygen demand

*administer propranolol to minimize adverse effects*

Verapamil
calcium channel blocker
*advise patient to avoid drinking grapefruit juice* due to juice increasing blood levels of verapamil by inhibiting its metabolism

excess amount of drug can intensify therapeutic effects like hypotension

(treats dysrhythmias on a long-term basis)

slows impulses through the AV node and can cause AV block

can cause:
-bradycardia
-dizziness

Catopril
ACE inhibitors

used to treat hypertension, CHF, kidney problems and improve survival after heart attack

can cause:
-rash
-distorted taste
-swelling of the tongue
-dry cough

Aliskiren
direct renin inhibitor

adverse effects:
-hyperkalemia
-throat swelling
-cough
-headache

Furosemide (Lasix)
(what other drug causes a risk?)
a high-ceiling loop diuretic
(treats hypertension)

take action if patient is also taking Lithium

diuretic increases sodium loss and can reabsorb lithium which puts patient at risk for lithium toxicity

Phenytoin (Dilantin)
(what other drug causes a risk?)
(for seizure disorders)

Lidocaine (a cardiovascular-system drug) interacts poorly

Erythromycin
(what other drug causes a risk?)
(for bronchitis)

Simvastatin (a cardiovascular-system drug) interacts poorly

Warfarin (Coumadin)
(what other drug causes a risk?)
(prevents blood clots)

Simvastatin (a cardiovascular-system drug) interacts poorly

Hydralazine therapy
direct-acting vasodilator

direct relaxation of vascular smooth muscle, producing vasodilation of arterioles decreasing afterload

*a systemic lupus-like syndrome can develop*
-facial rash
-joint pain
-fever
-nephritis
-pericarditis
-fluid retention
-edema

Amiodarone (Cordarone)
potassium channel blocker
treats A. fib

avoid drinking grapefruit juice due to possible toxicity

Eplerenone (Inspra)
blocks aldosterone
*avoid the use of salt substitutes containing postassium*
can cause hyperkalemia

treats CHF and HTN

Reserpine
adrenergic neuron blocker
depletes serotonin and norepinephrine

*do not use on patient with depression*

adverse effects:
-depression
-risk of suicide

Procainamide
antidysrhythmic-sodium channel blocker
(treats ventricular dysrhythmias)

*poor choice for long-term control* of dysrhythmias due to adverse effects of:
-cardiotoxicity
-arterial embolism

Nitroglycerin
a nitrate

treats severe unstable angina and heart failure after acute MI

Quinidine
sodium channel blocker
antidysrhythmic

treats dysrhythmias on long-term basis

Dobutamine
stimulates beta receptors to increase contractility

do not give to patient taking:
-MAO inhibitors
-general anesthetics
-tricyclic antidepressants
-beta blockers

Losartan
an angiotensin II receptor blocker

can cause angioedema (redness and swelling around the eyes and lips)

causes insomnia and diarrhea
treats peripheral edema

Milrinone (Primacor)
a phophodiesterase inhibitor

do not use on patient with acute MI and aortic or pulmonary valve disorders

Carvedilol (Coreg)
Beta Blocker
*caution for patients with diabetes*

diabetes patient at risk for hypoglycemia

can mask tachycardia in patient with hypoglycemia

Atenolol
beta blocker
treats HTN, prevents MI

asses pulse and BP prior to administering

can cause bradycardia and orthostatic hypotension
*hold med for apical heart slower than 60/min*

Protamine Sulfate
*antidote for severe heparin overdosage*

assess for bleeding and hemorrhage

Heparin
(-parin)
anticoagulant
prevents conversion of fibrinogen to fibrin

treatment of thromboembolic disorders:
-venous and arterial thrombosis
-embolism
-pulmonary emboli
-coagulopathies

*do not take with anti platelet agents*
-report unusual bleeding
-use soft toothbrush and electric razor

Warfarin (Coumadin)
anticoagulant
interferes with synthesis of vitamin K-dependent clotting factors

*do not eat excessive amount of food with vitamin K*

monitor:
-PT
-INR
-CBC

Clopidogrel (Plavix)
anti-platelet agent
inhibits binding of ATP to platelet receptors

avoid taking aspirin or NSAIDs

Propranolol
beta blocker
relieves migraine pain (vascular headaches)

*antacids and vitamin C can decrease the absorption*

adverse effects:
-blocks hypoglycemia
-bradycardia
-hypotension
-bronchial constriction

Clonidine (Catapres)
alpha agonist

can cause rebound HTN if patient abruptly discontinues med. (hypertensive crisis)

drug targets receptors in CNS decreasing sympathetic outflow- dilating blood vessels and slowing heart rate

Hydrochlorothiazide
a thiazide diuretic
-increases urine output by inhibiting reabsorption of sodium, chloride, and water in distal ascending loop of henle

adequate kidney function is essential to promote urine production and excretion effectively

Digoxin
antiarrhythmic agent
-slows and strengthens force of contractions

*therapeutic range: 0.5-2 ng/mL*
*antidote: fab antibody fragments (Digibind)*
(binds to digoxin and blocks its action)

treats:
-CHF
-A. fib
-arterial flutter
-tachyarrhythmias

prolongs refractory pored of AV node and decreases conduction through SA and AV nodes

Gemfibrozil (Lopid)
lipid-lowering agent, a fibrate

-take 30 min. before meal
-report new intolerance to fried foods, bloating, upper abdominal discomfort (med can cause gallstones)
-report muscle tenderness (can cause myopathy)
-expect periodic liver function testing (med can cause liver toxicity
-take medication twice a day

Nitroglycerin (transdermal)
antianginal agent/nitrate
management of angina pectoris and chronic CHF

produces vasodilation
reduces oxygen consumption

-apply patch to a hairless area and rotate sites
-apply a new patch each morning
-remove patches for 10-12 hours daily

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