Pharmacology, Cardiac Drugs

Alpha Blockers (central acting)
Purpose: decrease cerebral sympathetic blood flow, lower BP, treats hypertensive crisis
Drugs: Clonidine, Methyldopa

Alpha Blockers ( peripheral acting)
Purpose: decrease vascular resistance and increase vein capacity; lower BP treats benign prostatic hypertrophy (bph)
Drugs: Doxazosin, Prazosin, Tamsulosin, Terazosin

Anti- anginals include what groups of drugs?
BB, CCB, nitrates

Anticoagulants
Purpose: decreases clotting (coagulating ability of the blood. (refered to as blood thinners, does not acutally “think” the blood) DO NOT DISSOLVE EXISTING CLOTS. Used to treat blood vessel, heart, and lung conditions.
-Prevents harmful clots
-Prevents clots from becoming larger and causing more serious problems
-Prescribed to prevent first or recurring stroke
-Administered: cardiac catherterization, MI, DIC, evolving stroke, Pulmonary embolism and massive DVT.
Drugs:
-Rivaroxaban (xarelto) , dabigatran (pradaxa) : both used for atrial fib, or artificial heart valves
-Heparin (various) used IV first line drug of choice, often weaned to warfarin
-Warfarin (coumadin): PO, not during pregnancy (prego transferred to heparin)

What are some nursing considerations for anticoagulants?
-Initiate safety precautions and teaching for bleeding. Teach PT to avoid garlic, ginger, gingko, and ginseng.

What is the antidote for heparin toxicity?
protamine sulfate

What is the antidote for warfarin toxicity?
Vitamin K

Antiplatelet agent
Purpose: keep blood clots from forming by preventing blood platelets from sticking together.
-Helps prevent clotting in pt who have had a heart attack, unstable angina, ischemic strokes, TIA, other forms of cardiovascular disease, used preventatively when there is plaque buildup but no large obstruction
Drugs:
-aspirin, ticlopidine, clopidogrel (plavix), dipyridamole

What nursing considerations do we have to think about with antiplatelets?
teach patient to report tarry stools, ecchymosis, signs of bleeding

Thrombolytics, What do they do (patho)?
Purpose: dissolve clots by converting plasminogen to plasmin, which destroys fibrinogen and other clotting factors

Thrombolytic drugs and use and contraindications?
Drugs: alteplase (activase, tPa) tenecteplase (TNKase), reteplase (Retavase)
Used: treat acute MI, DVT, massive PE, ischemic stroke
Contraindicated: intracranial hemorrhage, active bleeding, aortic dissection, brain tumors.
Caution in pt with severe hypertension and concurrent use with antiplatelet or anticoagulant.
Adverse effects: bleeding

ACE inhibitors (angiotensin- Converting Enzyme)
(hint: -pril)
Purpose: expands blood vessels and decreases resistance by lowering levels of angiotensin II. allows blood to flow more easily and make hearts work easier. treat or improve symptoms of cardiovascular conditions including high BP and heart failure.
Drugs: benazepril (lotensin), captopril (capoten), enalapril (vasotec), lisinopril (prinivil, zestril)
S/E and A/E: dry, non productive cough, angioedema, hypotension, not for use in 2or3 trimester prego.

Angiotensin II receptor blockers or inhibitors (ARBS) (hint: sartan)
Purpose: blocks not just inhibits angiotensin II. stops BP from rising. treats or improve symptoms of cardiovascular conditions including high BP and heart failure
Drugs:
-Candesartan (atacand), Irbesartan (avapro), Losartan (cozaar), valsartan (diovan)

Angiotensin-Receptor Neprilysin Inhibitors (ARNI’s)
Purpose: neprilysin inhibitor and ARB. increases effects of these substances and improves artery opening and blood flow reducses sodium retening and decreases strain on the heart. treats heart failure
Drugs: sacubitril/valsartan (entresto)

Beta Blockers:
Purpose: Decreases HR and CO, lowers BP, heart beat more slowly with less force (-inotropic,-chronotropic). Treats: lower BP, cardiac arrythmias, chest pain, prevent heart attacks.

Where are Beta 1 receptors?
primarily in cardiac and renal

Where are Beta 2 receptors?
primarily lungs, GI tract, liver, uterus, vascular smooth muscle, skeletal muscle.

When your on a beta blocker will your HR accelerate when you excercise?
No

If the pt is a diabetic will the tachycardia that accompanies low blood sugar occur when taking a bb?
No

What are side effects of BB?
-Bradycardia
-Nasal stuffiness
-AV block
-Rebound myocardium excitation if stopped abruptly
-Bronchospasm

When would we hold a BB?
when systolic bp is less than 100, or pulse is less than 60 per min

Combined alpha and beta-blockers?
used as an IV drip for those experienceing hypertensive crisis. outpatient high BP if pt is at risk for heart failure

Antiarrhythmic
-Beta blockers, Calcium channel blockers We only discussed 3
Drugs: Adenosine, amiodarone, atropine

Adenosine:
used to convert SVT to sinus rhythm.
S/E include flushing, nausea, bronchospasm, potention prolonged asystole
****RAPID IV PUSH 1-2 seconds, followed by immedietly flush of 10 ml normal saline

Amiodarone:
treats ventricular fibrilation and unstable ventricular tachycardia
S/E include bradycardia, cardiogenic shock and pulmonary disorders. **IS NOT COMPATIBLE WITH HEPARIN** make sure line is flushed

Atropine:
used to treat bradycardia
S/E: anticholinergic effects, dry mouth, blurred vision, photophobia, urinary retention, constipation

What is the antidote for nerve gas poisoning?
atropine

What drug categories are included in antihypertensives?
-ACE inhibitors
-ARBS
-BB
-CCB’s
-Alpha blockers central
-Alpha blockers peripheral
– direct renin inhibitors
-Vasodilators

What are side effects of antihypertensives?
(OH Nancy Dear Frog)
orthostatic hypotension, headache, N/V, dizziness, fainting
OH Nancy Dear Frog

What are some nursing considerations of antihypertensives?
-do not administer if known adverse or sensitivity
-caution with hepatic or renal dysfunction
-outweigh risk and benefits if prego
-most likely cross in lactation
-elderly more susceptible and may need lower maintenance doses

What are patient teaching for antihypertensives?
-do not discontinue on your own.
-avoid sudden changes in position
M- medications
A- Activity
W- Weigh daily
D- diet -low salt, low fluids, low alcohol, heart healthy
S- symptoms

Calcium channel blockers
(most end in -pine)
Treat High BP, chest pain caused by reduced blood supply to heart muscle and some arrhythmias
*may decrease the hearts pumping strength and relax blood vessels
Drugs:
-pine:
amlodipine, felodipine, nifedipine, nimodipine, nisoldipine
others:
diltiazem, verapamil

What are the S/E of CCB’s
constipation, reflex tachycardia, peripheral edema, toxicity
CRTPET

Cholesterol-lowering meds?
*anything other than statin only use when the statins are not effective or have bad side effects. statins most effective
*take at night
*monitor liver and renal function
*low fat high fiber
S/E: muscle aches, hepatotoxicity, myopathy, rhabdomyolysis, peripheral neuropathy
Drugs:
statins: atorvastatin (lipitor), rosuvastatin (crestor).
**do not take w/ grapefruit juice**** statins interact with lots of meds****
Nicotinic acits: lovastatin (advicor)
Cholesterol absorption inhibitors: ezetimmibe (zetia)
**** alll tHESE DRUGS ARE USED TO LOWER LDL (bad) cholesterol.***

Digitalis preperations
-Increases force of hearts contractions
-positive inotropes and as cardiac glycosides (these inhibit the sodium potassium pump and increase the intracellular calcium resulting in improved cardiac contractility
-improved stroke volume increases perfusion to the kidneys and may decrese edema ind increase fluid excretion., reduce fluid in the lungs and extremities
used to relieve heart failure symptoms especially when pt is not responding to ACE inhibitors and diuretics. also slows certain types of irrecgular heart beat arrhythmias, particuarly atrial fib

What are the side effects of digoxin?
toxicity presented by: anorexia, N/V, abd pain, changes in vision, yelow-green or white halos around objects. monitor for hypokalemia as this increases the risk for digoxin toxicity.

What is used to treat digoxin toxicity?
digibind

Direct renin inhibitors
anti hypertensive: causes blood vessels to widen and relax lowering bp
meds: aliskiren (tekturna)
S/E: dizziness, light headed ness, cough, diarrhea, fatigue.
newer medication

Diuretics:
Purpose: cause the body to rid itself of excess fluids and sodium through urination. This helps relieve the hearts work load. Decreases the buildup of fluuid in the lungs and other parts of the body such as the ankles and legs.
Drugs:
bumetanide (bumex)
Chlorothiazide (diuril)
furoemide (lasix)
hydro-chlorothiazide (esidrix, hydrodiuril)
spironolactone (aldactone)

Hematopoietic agents
stimulate bone marrow to synthesize specific blood cells
Drugs:
epoitin alfa (procrit)
filgrastin (neupogen)
pegfilgrastim (neulasta)
oprelvekin (neumega)

Epoietin
stimulates red blood cell production in persons who have chronic kidney disease or are receiving therapies that suppress bone marrow such as chemotherapy.
Risk for DVT and hypertension

Filgrastim:
stimulates white blood cell production in persons who have neutropenia related to cancer
S/E bone pain and leukocytosis
monitor CBC

Oprelevekin:
stimulates platelet production in persons who have thrombocytopenia related to cancer. administered 6-24 hours after chemo

Vasodilators
also known as antianginals and nitrates.
Available in : topical, pills tablets to dissolve, sublingual spray, IV infusion
topical must be applied chest, flank, or upper arm on hairless area
Meds:
isosorbide dinitrate (isordil)
Nesiritide (natrecor)
hydralazine (apresoline)
nitrates
minoxidil
Purpose: used to ease chest pain (angina

What do you teach a patient at the onset of chest pain
Take on pill sublingual and sit or lie down, repeat the dose in 5 min if there is no relief and call 911. take another dose in 5 min.
meds should be kept in dark container and replace every 6 months

What medication should you absolutely not use with nitreates? Why?
any erectile dysfunction medication sildenafil, tadalafil
it can cause profound hypotension and death

Vasopressors
treat hemodynamic imbalances presint in cardiogenic shock due to MI, trauma, septicemia, cardiac surgery, renal failure, heart failure, heartblock etc. Adverse reactions to vasopressors include arrhythmias tachycardia chest pain hypertension vasoconstriction to the point of gangrene of extremities ect.
Drugs:
dobutamine
dopamine

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