Cardiac Drugs Spring Term

Front 1

Diuretics- first line for heart failure to off load fluids.

Back 1

Thiazides (hydrochlorthiazide)
Loops/High ceiling: Furosemide (Lasix) fast, decreases preload, watch for hypokalemia.
K+ sparing/aldosterone antagoinist: Spironolactone (Aldactone). not much diuresis, but used to stop cardiac remodeling and balance K+..

Front 2

Captopril (Capoten) , enalapril (Vasotec)

Back 2

Inhibit Raas. ACE inhibitors.
PRIL family,
increases vasodilation, decreases aldosterone formation, slows cardiac remodeling.
May cause dry cough, hyperkalemia, angioedema.
Decreases cardiac work load: both venous dilation and arterial dilation (Preload and afterload reductions).
can cause hypotension. Check BP 1st. Hold if SBP is >100.

Front 3

(Losaartan[cozaar]) Candesartan (adacand), Valsartan (diovan)

Back 3

NO COUGH.
ARBS- not as effective as ACE's, but will work for those who can't take an ACE.
venous dilation: reduces preload.

Front 4

Propranolol, carvedilol (Coreg: a combo alpha & beta), metoprolol, atenolol..

Back 4

reduces preload and afterload.
beta blocker. vasodilation.
helps with heart failure and antianginal drugs.
decreases heart rate (helps with dysrythmias, but watch for bradycardia.)
decreased contractility/stroke volume. Decreased preload helps angina, decreased afterload helps with hyper tension.
Watch for dizziness, Orthostatic hypotension, fluid retension in angina, depression, worsening CHF, lethargy...
also decreases HDL, LIbido, causes impotence, can cause w/d syndrome: rapid HR, elevated BP...so wean off meds.

Front 5

DIgoxin (lanoxin)

Back 5

cardiac glycoside.
increaes contractile force. inhibits Na+/K= pump.
take apical pulse 1 full minute before giving.
positive inotrope. doesn't prolong life, just decreases symptoms and trips to hospital.
toxic people look like they have the flu: n/v/diarrhea, visual disturbances...white paper might look yellow (Van gough and eating foxgloves)
decreases HR: used for rapid atrial fib. can cause brady cardia.
increases contractility: used for systolic heart failure...also leads to increase urine output/decreases fluid volume.
Better ejection fraction , decreased preload, decreased afterload (and renin release)
N/V/D, anorexia, visual disturbances..
NEED LOADING DOSE!
also normal blood levels with dif: 0.5-0.8 mg/ml.
decreased K+, Ca2+, careful if also using lasix.
verapamil can cause dig toxicity.
given around noon so labs are back and can direct dosing. oral drugs take 6 days to a week, hence to loading dose.

Front 6

Positive Inotropes: Sypathomimetics.

Back 6

Increase HR and force of contraction.
Dobutamine (dobutrex)-
Stims B1 receptors=better contractility. little effect on HR. Given IV only.
can cause HTN, PVC, arrhythmias, angina, tachycardia.
must monitor on telemetry check BP every 15 mins until stable than q hour.

Dopamine(Inotropin): supports BP. causes peripheral vasoconstriction.
2 RNs have to check doses on these.
side effects: arrhythmias, hypotensoin, tissue necrosis at IV site if infiltration occus.
Milrinone: pospodioesterase=given IV, short term..buys time.

Front 7

Nestiride (Natrecor)

Back 7

synthetic BNP. given IV for short term support.
suppresses RAAS
suppresses sympathetic outflow from CNS.
direct vasodilation.
short half life
may cause hypotension, decreased renal function... helps decrease preload via vasodilation

Front 8

Procainamide (Pronestyl)

Back 8

Class one antidysrhythmic.
Na+ blocker-used for ventricular and supraventricular dysrhythmias . Fast action postenitions. Phase 0.
SE: CNS Depression, N/V, agranulocytosis, ventricular tachycardia, weakness, blurred vision, bradycardia. contradicted for patients after an MI.

Front 9

Propranolol (Inderal)

Back 9

Class II antidyshythmic drug.
Beta blocker. controls ventricular rate
Used wit Afib.
more impact on phase 2. rapid ventricular response.
don't stop taking them abruptly.

can cause bradycardia, hypotension , CHF, impotence, depression, lethargy... the impotence makes people non-compliant.

Front 10

Amidorone (cordarone)

Back 10

Potassium channel blocker. used for highly symptomatic atrial and life threatening ventricular arrhythmias.
SE: hypotension, skin discolorations, pulmonary fibrosis, bradycardia, GI upset.
can cause permanent lung or heart damage... not used much. BAD side effects and only if person has failed on otehr drugs.

Front 11

Diltiazem (Cardizem)
(also Dipines, & verapamil)

Back 11

calcium channel blocker
decreases HR, Stroke volume, afterload, cardiac output and demand on heart. Used to treat varient angina as it reduces coronary artery spasm.
ALSO STAGE IV dysrhythmia agent that helps control rapid atrial arythmias & supravenntricular tachycardia.
can cause hypotention, CHF, headache, flushing and edema.
additionally reflex tachycardia, hypotension, bradycaredia, dilation of peripheral arterioles..., AV block and heart failure.
Practice good dental hygeine to prevent gingival hyperplasia.
NO Grapefruit juice with dipines or verapamil.

Front 12

Adenosine (Adenocard)

Back 12

inhibits cardiac pacemaker cells-slows conduction through AV node... slows a heart in super ventricular tachycardia.
IV bolus used for SVT.
can cause transient dyspnea, flushing , chest discomfort and bradycardia. mimics heart while exercising...

Front 13

atropine

Back 13

blocks parasympathetic receptors: acytlcholine. Increases ehart rate quickly... rescue drug for 3rd degree heartblock getting a pacemaker involved.
also given before surgery because it dries up secretions (in pupil for glaucoma testing),
used to treat symptomatic bradycardia. careful with someone who has had an MI.

Front 14

ANGINA Protocol

Back 14

MONA-not in that order:
Morphine
Oxygen
Nitroglycerin
Aspirin
Usually given : ONAM.

Front 15

Morphine

Back 15

vasodilator: increases coronary artery blood flow, decreases preload, decreases work of heart... given IV, dilute in 5 mls, and give over 5 mins. FOr angina will reduce pain, reduce O2 requirements and preload d/t venodilation. will also reduce afterload d/t reduced peripheral venous resistance. (probably given last of the MONA options)

Front 16

O2

Back 16

vasodilator
keep above 92% on 3L- if not working call RT.

Front 17

Nitroglycerin

Back 17

Give up to 3 o.4 mg SL tabs Q 5 mins until pain is gone... 3x or until pain is gone for angina. if not gone, call 911.
let ambulance drive you!
ALWAYS CHECK BP BETWEEN PILLS!
Increases myocardial Supply d/t vasodilation of coronary arteries.
DECREASEs myocardial DEMAND-decrease preload and decreases afterload (mild arterial dilator).
Adv. effects: headache, orthostatic hypotension, reflex tachycardia.
TOlerance develops quickly, so always work in at least 8hours drug free time...like night. If using a transdermal patch, take it off before bed, and reapply (WEAR GLOVES!). use lowest effective dose.
Isosorbide (Isordil) is the long acting formula.
can intesify any BP lowering drug. don't combine with phosphodiesterase type 5 inhibs. ,
good with betablockers, verapamil and diltiazem: can reduce nitro induced tachycardia.
store in dark/air tight container and discard after 6 months. avoid moisture. wean off rather than suddenly stopping.

Front 18

Aspirin

Back 18

81- 325 mg to prevent MI,
160-325 for Anginal pain-usually chewed.
blocks prostaglandin synthesis which prevents formation of platelet aggregating substance, thromboxane.