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136 Cards in this Set

  • Front
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Lipid Lowering Drugs (Statins)
HMG-CoA reductase inhibitors
Lipitor (Atorvastatin)
Mevacor (Lovastin)
Zocor (Simvastatin)
Pravachol (Pravastatin)
Lipitor (Atorvastatin)
Mevacor (Lovastin)
Zocor (simvastatin)
Pravachol (Pravastatin)
How do the Statins' work to lower lipid level?
The HMG-CoA reductase inhibitors (Statins) block an enzyme that converts HMG-CoA to cholesterol precursor-inhibits cholesterol synthesis
Largest and most potent class of lipid lowering
Lipid lowering drug

Niacin, nicotinic acid
Prescribed for someone who can't tolerate the HMG-CoA reductase inhibitors - less expensive
Side effects of HMG-CoA reductase inhibitors (Statins)
GI upset
liver enzyme elevation; (must check periodically)
myostitis (muscle pain)
rhabdomyolysis (rare)
Nursing considerations of HMG-CoA reductase inhibitors (Statins)
Take with evening meal to avoid GI upset (fattiest meal of the day)
report muscle pain
Can increase the effect of coumadin, monitor PT more closely
Photosensitivity - use sunscreen
Avoid grapefruit
Side effects of Niacin, nicotinic acid
Liver toxicity is the major problem
Triggers release of histamine and prostaglandins so itching and flushed skin are common - this improves in time
Gastritis
Hyperglycemia
hyperurecemia
Nursing considerations of Niacin, nicotinic acid
Can use sustained-release form but this is more toxic to liver
Can take ASA 30 min. before aspirin to reduce prostaglandin production
Not typically used in diabetics
Fibric acid derivatives
Lopid (Gemfibrozil)
Atromid-S (Clofibrate)

Action
Action: decrease triglyceride levels and raise HDL levels so they're also used to reduce triglycerides to prevent pancreatitis; less effect on LDL but can be used with caution with statins if LDL and triglycerides are high
Fibric acid derivatives
Lopid (Gemfibrozil)
Atromid-S (Clofibrate)

side effects
Dyspepsia
abdominal pain
vomiting
diarrhea
rash
myalgia
drowsiness
dizziness
blurred vision
biliary disorders
Fibric acid derivatives
Lopid (Gemfibrozil)
Atromid-S (Clofibrate)

nursing considerations
If used with HMG-CoA reductase inhibitors can cause sever myositis (monitor for upset stomach)
Lipid lowering drugs
Bile acid sequestrants
Questran (Cholestyramine)
Colestipol (Colestid)
Used to be the first-line prescribed but so awkward to take (granules) and cause GI upset - not so much prescribed anymore
Lipid lowering drugs
Bile acid sequestrants
Questran (Cholestyramine)
Colestipol (Colestid)

Side effects
Poor palatability
GI complaints - nausea, vomiting, heartburn, abd pain, belching, bloating, constipation
Lipid lowering drugs
Bile acid sequestrants
Questran (Cholestyramine)
Colestipol (Colestid)

Nursing Considerations
They decrease LDL levels but may actually increase triglycerides
Medications for Acute Coronary Syndrome: Nitrates (Vasodilators)
May be given SL, IV, PO, or transdermal
Names of drugs
Nitroglycerine SL; nitrolingual spray, SL, nitroglycerine IV
Nitrobid ointment
Nito-transderm
Long acting: isosorbide dinitrate
(Isordil) Isosorbide
Mononitrate (Imdur)
Medications for Acute Coronary Syndrome: Nitrates (Vasodilators)

Action
Relax smooth muscle of coronary and peripheral blood vessels causing an increase in their diameter. Preload is reduced by increased venous dilation

Afterload is reduced by decreasing peripheral resistance decreases, workload on heart is reduced (decreasing demand).
Myocardial perfusion is improved by increasing blood flow through collateral coronary vessels. (Increasing supply) demand/supply ration improves

Indication: Angina, hypertension
Medications for Acute Coronary Syndrome: Nitrates (Vasodilators)

Side effects
Flushing
headache
dizziness
hypotension
tachycardia
Contraindicated:
severe anemia
cerebral hemorrhage
head trauma
glaucoma
hyperthyroidism

Can cause vascular collaspe if pt took Viagra within 24 hours (viagra causes vasodilation also)
Nitrates: Vasodilators

Nursing Considerations
Check BP before each dose.
Monitor BP closely; Postural hypotension may occur - have client change position slowly, esp after taking SL NTG.
Give tylenol for HA
Treating angina: instruct client to take up to 3 SL NTG tabs in 5-minute intervals if necessary. If pain is not relieved after 15 minutes, physician should be contacted immediately or client should report to hospital.
Tablets are inactivated by light, heat, cold, air, and moisture; store at room temperature, in tight fitting amber glass container.
Medication for Acute Coronary Syndrome
Analgesics: Morphine Sulfate
Action
Action: Narcotic analgesic used to relieve severe pain and anxiety associated with acute MI; peripheral vasodilation reduces venous return, thereby decreasing myocardial workload
Medication for Acute Coronary Syndrome
Analgesics: Morphine Sulfate
Indications
Indications:
Acute MI
Pulmonary edema
Pain
Medication for Acute Coronary Syndrome
Analgesics: Morphine Sulfate
Side effects
Side effects:
Respiratory depression
hypotension
nausea, vomiting
constipation
Medication for Acute Coronary Syndrome
Analgesics: Morphine Sulfate
Nursing considerations
Nursing considerations:
When administering IV monitor closely for hypotension and respiratory depression
In acute care setting - give until patient is free from chest pain or to relieve pulmonary congestion
Medication for Acute Coronary Syndrome
Beta-adrenergic blocking agents
Beta-Blockers
Metoprolol (Lopressor)
Atenolol (Tenormin)
Carvidol (Coreg)
Propanolol (Inderol)
Medication for Acute Coronary Syndrome
Beta-adrenergic blocking agents
Action
Action:
Block sympathetic stimulation of beta receptors;
1. Decreases automaticity of SA node
2. Decreases velocity of conduction through AV node
3. Decreases myocardial contractility
Decreases myocardial workload & O2 demand by decreasing contractility, HR & BP
Medication for Acute Coronary Syndrome
Beta-adrenergic blocking agents
Indications
Indications:
Hypertension
angina
arrhythmias
prevention of MI
heart failure
Medication for Acute Coronary Syndrome
Beta-adrenergic blocking agents
Side effects
Side effects:
May cause bradycardia
fatigue
depression
Can cause erectile dysfunction
Contraindicated in heart block greater than 1st degree without pacemaker
Contraindicated with asthma
Medication for Acute Coronary Syndrome
Beta-adrenergic blocking agents
Nursing considerations
Nursing considerations
Use with caution in patients with asthma. May mask signs of hypoglycemia, and hyperthyroidism; Warn patient not to discontinue suddenly as it could exacerbate angina or precipitate MI.
Use glucagon to reverse effects of overdose.
Used to treat dysrhythmias caused by excessive sympathetic stimulation of the heart - SVT's and ventricular dysrhythmias
Medication for Acute Coronary Syndrome
Calcium channel blockers
(2nd line drugs)
Calcium channel blockers:
Diltiazem (Cardizem)
Verapamil (Calan, Isoptin)
Nifedapine (Procardia)
Medication for Acute Coronary Syndrome
Calcium channel blockers
(2nd line drugs)
Action
Action:
Inhibit calcium influx across slow channels of myocardial and vascular smooth muscle cell; dilates peripheral arteries and arterioles, and coronary arteries; inhibits coronary spasm.
Causes vasodilation, increased myocardial oxygen supply & decreased peripheral resistance. Slows AV conduction and prolongs repolarization. Two types of calcium channel blockers: ones that primarily affect heart rate by slowing, and ones that primarily affect BP by lowering.
Medication for Acute Coronary Syndrome
Calcium channel blockers
(2nd line drugs)
Indications
Indications:
Angina
Mild to moderate hypertension
tachydysrhythmias such as rapid atrial fibrillation
Medication for Acute Coronary Syndrome
Calcium channel blockers
(2nd line drugs)
Side effects
Side effects:
bradycardia
peripheral edema
hypotension
Medication for Acute Coronary Syndrome
Calcium channel blockers
(2nd line drugs)
Nursing considerations
nursing considerations
Monitor BP at start of therapy and during dosage adjustment. Smaller doses for elderly or frail patients.
Diltiazem (Cardizem) may be given as an IV infusion for rapid atrial fibrillation. This is titrated to effect, and require frequent BP and continuous cardiac monitoring. It may also be given PO.
Verapamil (Calan, Isoptin) is also given for tachyarrhythmias
Nifedapine (Procardia) is primarily a vasodilator.
Medications for Acute Coronary Syndrome
Angiotensin-converting enzyme (ACE)inhibitors:
Captopril (capoten)
Lisinopril (Zestril)
Elanapril (Vasotec)
Quinapril (Accupril)
Ramipril (Altace)
Decrease Preload
Decrease Afterload
Action: Prevent conversion of Angiotensin I to Angiotensin II. (Angiotensin II is a potent vasoconstrictor, so the effect of ace inhibitors is vasodilation; this reduces afterload with a reflex increase in HR). They also decrease adrenocortical secretion of aldosterone, reduce sodium and water retention and extracellular fluid volume. They preserve renal function in diabetic patients. Decrease vascular and ventricular remodeling
Medications for Acute Coronary Syndrome
Angiotensin-converting enzyme (ACE)inhibitors:
Captopril (capoten)
Lisinopril (Zestril)
Elanapril (Vasotec)
Quinapril (Accupril)
Ramipril (Altace)
Decrease Preload
Decrease Afterload
Indications:
hypertension
heart failure
post myocardial infarction (MI)
Medications for Acute Coronary Syndrome
Angiotensin-converting enzyme (ACE)inhibitors:
Captopril (capoten)
Lisinopril (Zestril)
Elanapril (Vasotec)
Quinapril (Accupril)
Ramipril (Altace)
Decrease Preload
Decrease Afterload
Side effects:
hyperkalemia
dizziness
hypotension
Cough -- should switch to ARB;
Angioedema - should stop using immediately
Medications for Acute Coronary Syndrome
Angiotensin-converting enzyme (ACE)inhibitors:
Captopril (capoten)
Lisinopril (Zestril)
Elanapril (Vasotec)
Quinapril (Accupril)
Ramipril (Altace)
Decrease Preload
Decrease Afterload
Nursing implications
Start slowly, 24 hours after MI with gradual dose increase
Monitor BP, electrolytes, BUN, and creatinine
Teach patients about orthostatic hypotension
Contraindicated with pregnancy
Medications for Acute Coronary Syndrome
Angiotensin II Blockers (ARBs)
Losartin (Cozaar)
Ibesartan (Avapro)
Action:
Block angiotensin II receptor sites in many tissues, leading to vasodilation and decreased aldosterone secretion. They also help preserve renal function in diabetic patients.
Medications for Acute Coronary Syndrome
Angiotensin II Blockers (ARBs)
Losartin (Cozaar)
Ibesartan (Avapro)
Indications:
Hypertension and patients who develop a cough on ACE Inhibitors
Medications for Acute Coronary Syndrome
Angiotensin II Blockers (ARBs)
Losartin (Cozaar)
Ibesartan (Avapro)
Side effects:
Hyperkalemia
dizziness
muscle cramps
angioedema
Medications for Acute Coronary Syndrome
Angiotensin II Blockers (ARBs)
Losartin (Cozaar)
Ibesartan (Avapro)
Nursing considerations
Usually given once a day, but some patients need BID treatments
Contraindicated with pregnancy
Medications for Acute Coronary Syndrome
Antiplatelet agents Glycoprotein IIb/IIIa Inhibitors
Aggrastat (Tirofiban)
Integrilin (Eptifibatide) IV Med
Action:
Blocks GpIIb/IIIa receptor, a surface receptor involved in the final common pathway of platelet aggregation--prevents platelet aggregation
Medications for Acute Coronary Syndrome
Antiplatelet agents Glycoprotein IIb/IIIa Inhibitors
Aggrastat (Tirofiban)
Integrilin (Eptifibatide) IV Med
Indications:
acute coronary syndrome
Non-Q wave MI
Unstable angina
Coronary stenting
Medications for Acute Coronary Syndrome
Antiplatelet agents Glycoprotein IIb/IIIa Inhibitors
Aggrastat (Tirofiban)
Integrilin (Eptifibatide) IV Med
Side effects:
Bleeding
Medications for Acute Coronary Syndrome
Antiplatelet agents Glycoprotein IIb/IIIa Inhibitors
Aggrastat (Tirofiban)
Integrilin (Eptifibatide) IV Med
Nursing considerations:
Monitor for bleeding, know how to calculate rate--given as an infusion; know indications and contraindications
calculate dose
guaiac stools
soft toothbrushes
Medications for Acute Coronary Syndrome
Antiplatelet agents
Aspirin (ASA)
Clopidogrel (Plavix)
Action:
decreases platelet aggregation (ASA has other actions)
ASA decreases mortality by 71% in the acute phase of MI
Medications for Acute Coronary Syndrome
Antiplatelet agents
Aspirin (ASA)
Clopidogrel (Plavix)
Indications:
Prophylaxis MI, angina
(+ purposes)
post stent
Medications for Acute Coronary Syndrome
Antiplatelet agents
Aspirin (ASA)
Clopidogrel (Plavix)
Side effects:
GI, allergy
bleeding
Medications for Acute Coronary Syndrome
Antiplatelet agents
Aspirin (ASA)
Clopidogrel (Plavix)
Nursing considerations:
Do not crush enteric product, give with food or milk
Chew ASA 4 (81 mg tablets)
Medications for Acute Coronary Syndrome
Fibrolytic Agents
Alteplase (t-Pa, rtPA)
Reteplase
Streptokinase
Action:
Lyse clots by converting plasminogen to active plasminogen -- plasminogen, the enzyme responsible for degradation of fibrin clots
Medications for Acute Coronary Syndrome
Fibrolytic Agents
Alteplase (t-Pa, rtPA)
Reteplase
Streptokinase
Indications:
Lyse intracoronary clot to restore blood flow, salvage ischemic myocardium, limit infarct size, and save LV function
Medications for Acute Coronary Syndrome
Fibrolytic Agents
Alteplase (t-Pa, rtPA)
Reteplase
Streptokinase
Side effects:
Hemorrhagic stroke or bleeding from other sites
Allergic reaction
Medications for Acute Coronary Syndrome
Fibrolytic Agents
Alteplase (t-Pa, rtPA)
Reteplase
Streptokinase
Nursing considerations:
Important to recognize S/S of MI ASAP to initiate treatment
Selection criteria: <65 - 70 yrs; <6 hrs since onset
Contraindications: CVA, recent surgery or trauma, HTN, coagulopathy
Medications for Acute Coronary Syndrome
Anticoagulation Agents
1. Heparin
2. Low-molecular wt heparin: Lovenox (enoxaparin)
(LMWH is now used for ACS)
Action:
Heparin prevents conversion of fibrinogen to fibrin and prothrombin to thrombin by enhancing inhibitory effects of antithrombin III (keep clots stable)
Lovenox: Prevents conversion of fibrinogen to fibrin and prothrombin to thrombin
Medications for Acute Coronary Syndrome
Anticoagulation Agents
1. Heparin
2. Low-molecular wt heparin: Lovenox (enoxaparin)
(LMWH is now used for ACS)
Indications:
Unstable angina
MI
DVT, PE
Lovenox: Improved bioavailability, longer 1/2 life, and less bleeding than heparin
Medications for Acute Coronary Syndrome
Anticoagulation Agents
1. Heparin
2. Low-molecular wt heparin: Lovenox (enoxaparin)
(LMWH is now used for ACS)
Side effects:
Bleeding
hematoma
hypochromic anemia
Thrombocytopenia
cardiac toxicity
infection at site
hematoma
Guaiac all stools
Medications for Acute Coronary Syndrome
Anticoagulation Agents
1. Heparin
2. Low-molecular wt heparin: Lovenox (enoxaparin)
(LMWH is now used for ACS)
Nursing considerations:
Monitor PTT for IV heparin -- be able to calculate units per hour for heparin
Reverse with protamine sulfate
Lovenox - give SC, don't aspirate or rub
Medications used to control heart rate and rhythm
Sodium Channel Blocker
IV Lidocaine
Used for ventricular dysrhythmias only
Action:
Blocks sodium channels; slows conduction
Reduced automaticity in ventricles
Accelerates repolarization
decreases action potentials
Raises fibrillation threshold
Fine narrow window of being therapeutic or toxic to the Central Nervous System
Medications used to control heart rate and rhythm
Sodium Channel Blocker
IV Lidocaine
Used for ventricular dysrhythmias only
Indications:
V-tach; V-fibrillation not responding to defibrillation
Significant ventricular ectopy in ischemic setting
Medications used to control heart rate and rhythm
Sodium Channel Blocker
IV Lidocaine
Used for ventricular dysrhythmias only
Side effects:
Signs of toxicity:
drowsiness
disorientation
decreased hearing ability
paresthesia
muscle twitching
Respiratory arrest
Medications used to control heart rate and rhythm
Sodium Channel Blocker
IV Lidocaine
Used for ventricular dysrhythmias only
Nursing implications:
Given IV as a bolus followed by an infusion
Reduce dose in elderly
Rapidly metabolized so easy to control levels
GIVEN IV ONLY
Beware of CNS toxic effects esp in elderly, monitor levels
Medications used to control heart rate and rhythm
Potassium Channel Blocker
Amiodorone
First line for serious ventricular dysrhythmias--ACLS protocols
Bolus, IV drip initially 18 hrs. change to PO dose
Action:
Suppresses ventricular and atrial ectopy.
Delays repolarization
reduces automaticity in SA node; reduced conduction velocity in AV node
Reduces contractility
Affects sodium, potassium, and calcium channels as well as alpha and beta adrenergic blocking properties
Medications used to control heart rate and rhythm
Potassium Channel Blocker
Amiodorone
First line for serious ventricular dysrhythmias--ACLS protocols
Bolus, IV drip initially 18 hrs. change to PO dose
indications:
V-tach, V-fib as well as SVT, A-fib, A-flutter
Medications used to control heart rate and rhythm
Potassium Channel Blocker
Amiodorone
First line for serious ventricular dysrhythmias--ACLS protocols
Bolus, IV drip initially 18 hrs. change to PO dose
Side effects:
Widening QRS, Prolonged PR and QT interval
Dilates coronary arteries and peripheral blood vessels
Hypotension, and may have negative inotropic effects and long half-life (14-50 days)
Serious side effects:
1. Pulmonary (Pulmonary fibrosis)
2. Optic neuropathy (corneal micro-deposits
3. Increased dysrhythmias
Hyper or Hypo thyroidism
skin pigmentation
Medications used to control heart rate and rhythm
Potassium Channel Blocker
Amiodorone
First line for serious ventricular dysrhythmias--ACLS protocols
Bolus, IV drip initially 18 hrs. change to PO dose
Nursing implications:
given IV as bolus followed by an infusion
Also given PO as maintenance dose
May be given orally
Monitor QT interval
Long-term use:
Lund and eye toxicity
Need to mix in D5W NOT STABLE IN NORMAL SALINE
Glass bottle, not plastic
Medications used to control heart rate and rhythm
Procainamide (pronestyl)
Sodium Channel Blocker
Given IV only
action:
blocks sodium channels leading to decreased conduction speed in atria, ventricles & Purkinje system
Delays repolarization
Widens QRS, prolongs QT
Suppresses ventricular and atrial ectopy, increases ventricular threshold, prolongs QT interval
Medications used to control heart rate and rhythm
Procainamide (pronestyl)
Sodium Channel Blocker
Given IV only
Indications:
Control ventricular dysrhythmias
May also be useful for SVT with or without aberrancy
Medications used to control heart rate and rhythm
Procainamide (pronestyl)
Sodium Channel Blocker
Given IV only
Side effects:
May cause decrease WBC, platelets, lupus like syndrome
negative inotropic
Widens QT (if >50% stop administering)
Medications used to control heart rate and rhythm
Procainamide (pronestyl)
Sodium Channel Blocker
Given IV only
Nursing considerations:
Given IV as slow bolus followed by an infusion
Monitor QT interval
May terminate VT or VT
Medications used to control heart rate and rhythm
Digoxin
Should be on a cardiac monitor
Action:
Increases force of myocardial contraction; prolongs refractory period of the AV node; decreases conduction through the SA and AV node therefore: Increases cardiac output (positive inotropic effect) and slows heart rate (negative chronotropic effect)
Medications used to control heart rate and rhythm
Digoxin
Should be on a cardiac monitor
Indications:
Heart failure
Tachy-dysrhythmias
Medications used to control heart rate and rhythm
Digoxin
Should be on a cardiac monitor
Side effects:
Increased PR interval, bradycardia
Digitalis toxicity:
CV: BRADYCARDIA, tachycardia, ectopic beats, pulse deficit
GI: Anorexia, NAUSEA & VOMITING; abdominal pain, diarrhea
Neuro: HEADACHE, DOUBLE, BLURRED, OR COLORED VISION; RESTLESSNESS, CONFUSION, drowsiness, muscle weakness
Medications used to control heart rate and rhythm
Digoxin
Should be on a cardiac monitor
Nursing implications:
Factors predisposing to dig toxicity:
hypokalemia, severe liver and kidney disease -- detoxified in liver, secreted in kidney
Myocardial disease, elderly
MONITOR AP FOR 1 FULL MINUTE PRIOR TO ADMINISTERINE; WITHHOLD DOSE AND NOTIFY PHYSICIAN IF HR <60
MONITOR CONTINUOUSLY DURING IV ADMINISTRATION
Medications used to control heart rate and rhythm
Magnesium
Action:
Natural calcium channel blocker
Medications used to control heart rate and rhythm
Magnesium
Indications:
Torsades de pointes
Mg deficiency
Dig toxicity
Medications used to control heart rate and rhythm
Magnesium
Side effects:
Flushing, sweating, bradycardia, hypotension, depressed reflexes
Medications used to control heart rate and rhythm
Magnesium
Nursing considerations:
given as a bolus for VF, VT, or torsades de pointes only
Medications used to control heart rate and rhythm
Adenosine
Supraventricular tachycardia
Action:
Slows conduction through the AV node, interrupts AV-nodal reentry pathways
Vasodilator
Medications used to control heart rate and rhythm
Adenosine
Supraventricular tachycardia
Indications:
Converts SVT to SR
Cardiac imaging
Medications used to control heart rate and rhythm
Adenosine
Supraventricular tachycardia
Side effects:
Sinus bradycardia, ventricular ectopy, chest pain

Flushing
Medications used to control heart rate and rhythm
Adenosine
Supraventricular tachycardia
Nursing implications:
Given as rapid bolus - 1-3 seconds followed by flush; short half-life

given as slow infusion for myoview procedure
Medications used to control heart rate and rhythm
Atropine
Action:
Blocks effects of acetylcholine on vagus nerve
Medications used to control heart rate and rhythm
Atropine
Indications:
Symptomatic bradycardia, asystole, heart block
Medications used to control heart rate and rhythm
Atropine
Side effects:
tachycardia, chest pain
Medications used to control heart rate and rhythm
Atropine
Nursing considerations:
Given IVP
Medications used to control heart rate and rhythm
Ca Channel Blockers:
Diltiazem - IV or PO
Verapamil - IV or PO
Action:
Suppresses SA node and AV node - reducing heart rate
Decreases force of contraction
Medications used to control heart rate and rhythm
Ca Channel Blockers:
Diltiazem - IV or PO
Verapamil - IV or PO
Indications:
PSVT
AF for rate control
Medications used to control heart rate and rhythm
Ca Channel Blockers:
Diltiazem - IV or PO
Verapamil - IV or PO
Side effects:
HYPOTENSION
Heart block, CHF Use with caution after administering Beta-blockers
Avoid use with AV blocks
Medications used to control heart rate and rhythm
Ca Channel Blockers:
Diltiazem - IV or PO
Verapamil - IV or PO
Nursing considerations:
Diltiazem may be given as a bolus followed by an infusion; Verapamil is less frequently used and can be given as a bolus; Both Diltiazem and Verapamil can be given PO
Medications used to control heart rate and rhythm
Beta-blockers
Lopressor - IV or PO
Sotolol - Given PO, has beta-blocking properties
Inderol
Action:
Slows HR and conduction through AV node
Decreaes automaticity
Medications used to control heart rate and rhythm
Beta-blockers
Lopressor - IV or PO
Sotolol - Given PO, has beta-blocking properties
Inderol
Indications:
Ventricular and supraventricular dysrhythmias
Medications used for Heart Failure
Diuretics:
Loop -
Furosemide (Lasix)
Action:
Loop diuretics inhibit sodium and chloride reabsorption in the ascending loop of Henle, increasing renal excretion of sodium, chloride, and water. They increase excretion of potassium
Medications used for Heart Failure
Diuretics:
Loop -
Furosemide (Lasix)
Indications:
Hypertension
Peripheral and pulmonary edema,
Heart failure
Medications used for Heart Failure
Diuretics:
Loop -
Furosemide (Lasix)
Side effects:
Hypokalemia
rapid parenteral administration may cause hearing loss and tinnitus
Medications used for Heart Failure
Diuretics:
Loop -
Furosemide (Lasix)
Nursing considerations:
administer in morning if possible
May be given IV (slowly) or PO.
Monitor serum potassium - may need potassium replacement; monitor creatinine
Medications used for Heart Failure
Diuretics:
Thiazide and thiazide-like
Action:
Interferes with sodium transport across tubules of nephron's cortical diluting segment, thereby increasing renal excretion of sodium, chloride, water, potassium, and calcium; Antihypertensive effect and a direct effect on arteriolar dilation
Medications used for Heart Failure
Diuretics:
Thiazide and thiazide-like
Indications:
Peripheral edema, mild to moderate left-sided heart failure, hypertension
Medications used for Heart Failure
Diuretics:
Thiazide and thiazide-like
Side effects:
Hypokalemia, increased uric acid levels
Medications used for Heart Failure
Diuretics:
Thiazide and thiazide-like
Nursing considerations: Administer in am if possible.
Monitor serum potassium levels; monitor creatinine, BUN, and uric acid
Medications used for Heart Failure
Aldosterone antagonist:
Spiroaldactone
Aldactone
Action:
Interferes with RAAS activation
Increases urine NA & H20 excretion, sparing potassium
Decreases vascular and ventricular remodeling
Medications used for Heart Failure
Nestritide (Natrecor)
Human B-type natriuretic peptide
action:
Relaxes vascular smooth muscle
Inhibits sodium and water retention; suppresses renin secretion; reduces aldosterone secretion, decreases PCWP
Medications used for Heart Failure
Nestritide (Natrecor)
Human B-type natriuretic peptide
Indications:
Acutely decompensated heart failure who have dyspnea at rest or with minimal activity
Medications used for Heart Failure
Nestritide (Natrecor)
Human B-type natriuretic peptide
Side effects:
HYPOTENSION
Cardiac dysrhythmias; angina; back pain, HA; anxiety; nausea
Medications used for Heart Failure
Nestritide (Natrecor)
Human B-type natriuretic peptide
Nursing considerations:
Given as a weight-based infusion; continuous cardiac monitoring with frequent BP; I&O; report CP, SOB
Inotropic Medications
Dopamine
Chemical precursor of norepinephrine
Naturally occurring catacholamine
Alpha 1, Beta 1, and dopaminergic receptor stimulation
Actions are dose related:
1-5 mcg/kg/min "renal dose"
dopaminergic stimulation
renal and mesenteric vasodilation
increased renal perfusion
increased urine output
Inotropic Medications
Dopamine
Chemical precursor of norepinephrine
Naturally occurring catacholamine
Alpha 1, Beta 1, and dopaminergic receptor stimulation
Actions are dose related:
5-10 mcg/kg/min
+Inotropic effect
Beta 1 stimulation
Increased myocardial contractility
Increased cardiac output
May increase heart rate
No increase in Oxygen demand
Decreases afterload
Inotropic Medications
Dopamine
Chemical precursor of norepinephrine
Naturally occurring catacholamine
Alpha 1, Beta 1, and dopaminergic receptor stimulation
Actions are dose related:
10 mcg/kg/min
Alpha stimulation and beta
vasoconstriction
increased blood pressure
may damage kidney and mesentery
Inotropic Medications
Dopamine
Chemical precursor of norepinephrine
Naturally occurring catacholamine
Alpha 1, Beta 1, and dopaminergic receptor stimulation
Indications:
Cardiogenic shock
Trauma
Endotoxic sepsis
Post-op renal failure
CHF
Dopamine and nitropresside are frequently used together - nipride counteracts the adrenergic constrictive effects of dopamine
Inotropic Medications
Dopamine
Chemical precursor of norepinephrine
Naturally occurring catacholamine
Alpha 1, Beta 1, and dopaminergic receptor stimulation
Nursing considerations:
Vesicant - should be given in a central line
Can cause necrosis
Regitine to counteract
Inotropic Medications
Dopamine
Chemical precursor of norepinephrine
Naturally occurring catacholamine
Alpha 1, Beta 1, and dopaminergic receptor stimulation
Side effects:
tachyarrythmias
ectopy
hyper or hypotension
Don't use in hypovolemic state
Monitor HR, BP, PCWP, CO, Urine output
Discontinue slowly - wean
Dobutamine (dobutrex) (increases contractility of heart)
Dobutamine is a synthetic catecholamine. It is a direct acting inotropic agent with predominant beta 1 stimulator activity, and mild beta 2.
It's predominant effects are to increase cardiac output by improving increasing myocardial contractility, minimal increase in heart rate and BP, and decreased peripheral vascular resistance.
Dobutamine (dobutrex) (increases contractility of heart)
It is used for short-term inotropic support in cardiac decompensation resulting from depressed contractility (organic heart disease or post-op cardiac surgery), for left ventricular failure, and cardiogenic shock. May be used to treat chronic CHF on a short-term basis in hospital (Dobutamine holiday) or at home.
Dobutamine (dobutrex) (increases contractility of heart)
Effective dose range is from 2.5-20 mcg/kg/min
Usual dosage range on D5W is 2.5-5 mcg/kg/min
Standard concentration is 500 mg in 250 mL D5W
Dobutamine (dobutrex) (increases contractility of heart)
Side effects:
ventricular irritability
tachycardia
may increase myocardial ischemia in patient having MI
May cause precipitous hypotension
Dobutamine (dobutrex) (increases contractility of heart)
contraindicated:
hypovolemia
IHSS (ideopathic hypertrophic subaortic stenosis)
Hypersensitivity to sulfites
Shock without adequate fluid replacement
Dobutamine (dobutrex) (increases contractility of heart)
Nursing considerations:
Monitor heart rate/rhythm continuously
Monitor BP when titrating up or down
Usually start at 0.5 to 1 mcs/kg/min and titrate up at 2-10 minute intervals (monitoring bP and MP) until desired rate or effect is reached
Be prepared to show me your calculations for mcs/kg/min
Strict I&O, daily weights, monitor electrolytes
Milirone (expensive)
Works the same as Dobutamine (dobutrex)
Vasodilation
Monitor BP
Epinephrine
Naturally occurring catecholamine
Produced by the adrenal gland secondary to stress
Effects:
Increased systemic vascular resistance, increased BP, HR, and myocardial contractility
Epinephrine
Naturally occurring catecholamine
Produced by the adrenal gland secondary to stress
Indications:
First line agent in cardiac arrest
Asystole
Profound bradycardia
anaphylactic shock
Post-op esp. after cardiac surgery to improve cardiac output
Epinephrine
Naturally occurring catecholamine
Produced by the adrenal gland secondary to stress
Side effects:
Hyperglycemia
tachycardia
V-fib
Cerebral hemorrhage with rapid increase in BP
Prolonged use may elevate lactic acid and increase metabolic acidosis
Epinephrine
Naturally occurring catecholamine
Produced by the adrenal gland secondary to stress
Nursing implications:
Increased heart rate may precipitate ventricular ectopy especially with ischemic hearts
Monitor cardiac output and hemodynamic profile every 4 hours and 30 min after any dose change
Monitor blood sugar levels frequently - may require insulin drip while on epi
Norepinephrine (Levophed)
Naturally occurring catecholamine; similar to epinephrine
Alpha and beta 1 stimulation
Indications:
hypotension due to trauma, sepsis, vasodilation medications, MI; shock
Norepinephrine (Levophed)
Naturally occurring catecholamine; similar to epinephrine
Alpha and beta 1 stimulation
Side effects:
Extravasation leads to necrosis and tissue sloughing
Increases myocardial oxygen demand (use with caution with ischemic heart disease)
Norepinephrine (Levophed)
Naturally occurring catecholamine; similar to epinephrine
Alpha and beta 1 stimulation
Nursing implications:
Monitor CO and hemodynamic profile every 4 hours and 30 minutes after every dose change
Monitor peripheral pulses when dose is >2 mcg/kg/min
Give via pump
Atrial monitoring of BP is best
Neosynephrine
Stimulates alpha receptors
Pronounced vasoconstriction; Increases SVR (afterload); increases blood pressure
Indications:
hypotension due to shock states; vasodilating medications; and sepsis
Neosynephrine
Stimulates alpha receptors
Pronounced vasoconstriction; Increases SVR (afterload); increases blood pressure
Side effects:
hypertension
HA
reflex bradycardia due to vagus nerve stimulation
blurred vision and dry eyes
restlessness
Neosynephrine
Stimulates alpha receptors
Pronounced vasoconstriction; Increases SVR (afterload); increases blood pressure
Nursing implications:
Monitor BP, hemodynamic profile, and HR
Produces vasoconstriction in skin, mucous membranes and pupils
Monitor peripheral circulation frequently
Monitor infusion sites for extravasation
Vasodilators:
Nitroprusside (Nipride)
Potent vasodilator in both veins and arteries
Veins dilate -- venous pooling; reduces systemic vascular resistance of arteries
Reducing preload and afterload
Reduces BP
Increases Cardiac Output
Indications:
Heart failure
Hypertension
Vasodilators:
Nitroprusside (Nipride)
Potent vasodilator in both veins and arteries
Veins dilate -- venous pooling; reduces systemic vascular resistance of arteries
Reducing preload and afterload
Reduces BP
Increases Cardiac Output
Nursing considerations:
Light sensitive - cover with aluminum foil or paper bag
replace every 24 hours
no other medication can be added (no mixing)
Discontinue slowly
Vasodilators:
Nitroprusside (Nipride)
Potent vasodilator in both veins and arteries
Veins dilate -- venous pooling; reduces systemic vascular resistance of arteries
Reducing preload and afterload
Reduces BP
Increases Cardiac Output
Side effects:
hypotension
prolonged use can lead to cyanide poisoning (blurred vision, tinitus, delirium
Nitroglycerine
Nitrate, vasodilator, anti-anginal
Mechanism of action/effects:
Relaxes vascular smooth muscle more effective on venous system
Decreases preload
Decreases ventricular volume
Increases perfusion
Peripheral vasodilation (mild arterial dilation)
Decreases afterload
Decreases ventricular workload
Decreases myocardial oxygen demand
Dilate coronary arteries, improving oxygen supply to heart
Nitroglycerine
Nitrate, vasodilator, anti-anginal
Indications:
Angina
MI
CHF
Hypertension
Nitroglycerine
Nitrate, vasodilator, anti-anginal
Side effects:
hypotension
bradycardia or reflex tachycardia
Headache
Nitroglycerine
Nitrate, vasodilator, anti-anginal
Nursing considerations:
glass bottle only
Special administration set--readily absorbed into plastic
No other medication added to nitro
Monitor CP, BP, PCWP, heart rate and rhythm, CO and urinary output
Anticoagulation agent:
Coumadin
Action:
Depresses hepatic synthesis of vitamin K dependent coagulation factors
ONSET is 12-25 hours, peak 1 1/2 - 3 days; duration 3-5 days metabolized in liver
Anticoagulation agent:
Coumadin
Indications:
Valve replacement; PE, DVT, MI
atrial dysrhythmias
Anticoagulation agent:
Coumadin
Side effects:
Bleeding
agranulocytosis
Anticoagulation agent:
Coumadin
Nursing considerations:
Monitor PT/INR for Coumadin (given coumadin in the evening after labs are back and dose can be calculated) - reverse with Vitamin K and/or fresh frozen plasma