The Cardiovascular System (Pharm Made Easy 3.0)

Front 1

Goal of Drug Therapy

Back 1

The goal of cardiovascular meds is to treat:

-Hypertension

-Heart failure

-Coronary Artery disease

-Cardiac dysrhythmias

Front 2

Drug therapy for hypertension

Back 2

-RAAS suppressants

-Calcium channel blockers

-Sympatholytic

-Direct-acting vasodilators

Front 3

4 types of RAAS suppresants

Back 3

-ACE inhibitors

-Angiotensin 2 receptor blockers (ARBs)

-Aldosterone antagonist

-Direct renin inhibitors

Front 4

ACE inhibitors

Back 4

•Treat: hypertension, heart failure, diabetic neuropathy & left ventricular dysfunction after a myocardial infarction

•Examples:

-Captopril

-Enalapril

-Lisinopril

•Block production of angiotensin 2 by inhibiting angiotensin converting enzyme

•Side effects:

-SEVERE hypotension

-HYPERkalemia (monitor potassium levels)

-Angioedema (life threatening/stop ACE inhibitor therapy)

-Neutropenia (monitor WBC)

-Dry, nonproductive cough due to an increase in bradykinin

•Give captopril 1 hour BEFORE meals for adequate absorption

•Do not take ACE inhibitor if pregnant (pregnancy category D)

•Do not give to those allergic to ACE inhibitor

•Do NOT give to patients with liver disease (elevated LFT lab values)

Front 5

Angiotensin 2 receptor blockers (ARBs)

Back 5

•Treats: hypertension, prevent stroke, manage diabetic neuropathy, heart failure, migraine headache

•Examples:

-Valsartan

-Irbesartan

-Candesartan

•Block angiotensin 2 receptors, which inhibits angiotensin 2 action (VASODILATION & excretes sodium and water)

•Side effects:

-Angioedema (life threatening/stop ARBs if this occurs)

-Headache

-Insomnia

-HYPERkalemia

-SEVERE hypotension with overdose or volume depletion ☆

•ARBs can be taken with or without food

•Do not take if pregnant (pregnancy category D for 2nd and 3rd trimester)

•Do not give to children younger than 6 years or children older than 6 years with low creatinine clearance

•Do not give if allergy to losartan

Front 6

Aldosterone antagonist

Back 6

•Treats: hypertension and heart failure after a myocardial infarction

•Examples:

-Eplerenone

-Spironolactone

•Block aldosterone receptors (excretes sodium and water and retains potassium)

•Side effects:

-HYPERkalemia

•Monitor potassium for hyperkalemia

•Monitor kidney function (BUN & creatinine)

•Assure that patients are NOT taking potassium containing foods

•Do not give to patients with elevated potassium serum level of 5.0 mEq per liter or higher

•Do NOT give to diabetic type 2 patient with low albumin in the urine

•Do NOT give to lactating moms

•Do NOT give to patients with decreased creatinine clearance or increased serum creatinine (kidney labs)

Front 7

Direct renin inhibitors

Back 7

•Treats: hypertension

•Example:

-Aliskiren

•Binds with renin: INHIBITS activation of angiotensin 1 (causes VASODILATION)

•Side effects:

-HYPERkalemia (monitor potassium level)

-Persistent cough

-Angioedema (life threatening)

-Diarrhea and abdominal cramping

•Monitor kidney function (BUN & creatinine)

•Assure that the patient is NOT taking food containing potassium

•Do NOT give aliskiren with a high fat meals because it DECREASES its absorption

•Do NOT give if pregnant (pregnancy category D)

•Do NOT give to children younger than 18 years old

•Do NOT give hyperkalemic patient (serum of 5.0 or higher)

Front 8

Calcium channel blockers

Back 8

•Treats: hypertension

•Dihydropyridines (-dipine): treat MILD to MODERATE hypertension & stable angina

•Examples:

-Nifedipine

-Verapamil (non-dihydropyridine)

•Block calcium channel in muscle cells of peripheral and cardiac arterioles and cardiac arteries (negative inotropic)

•Side effects:

-Reflex tachycardia (calcium channel blockers might be given with beta blockers to DECREASES tachycardia) ☆

-Lightheadedness

-Peripheral edema ☆

-HYPOtension with overdose

-Gingival hyperplasia (swollen gums)

-Constipation

•Do NOT give to patients with:

-Acute myocardial infarction

-Unstable angina

-Obstruction of the G.I

-Children

-Allergy to nifedipine

-Aortic stenosis

Front 9

Sympatholytics

Back 9

-Alpha 1 adrenergic blockers

-Beta adrenergic blockers

-Adrenergic neuron blockers

-Centrally acting alpha 2 blockers

-Alpha/beta blockers

Front 10

Alpha 1 adrenergic blockers

Back 10

•Treats: hypertension and benign prostatic hypertrophy (BPH)

•Examples:

-Doxazosin

-Prazocin

•Block alpha 1 adrenergic receptors: blocks vasoconstrictive effects, which causes VASODILATION

•Side effects:

-Orthostatic hypotension (give close to bedtime)

-Reflex tachycardia ☆

-Headache

•Do NOT give if there is a history of syncope or hypotension

•Do NOT give to children

•Do NOT give if allergic to doxazocin or other alpha 1 adrenergic blockers

Front 11

Beta adrenergic blockers

Back 11

•Treats: hypertension, angina pectoris, decrease mortality following MI, cardiac dysrhythmias and heart failure

•Examples:

-Atenolol

-Metoprolol

-Esmolol

•Block beta 1 receptors in the heart (DECREASES heart rate and contraction/negative chronotropic & negative inotropic )

•Block renal beta 1 receptor (decrease renin, which decreases blood pressure because water + sodium is released through kidneys)

•Decrease peripheral resistance of blood vessels

•Side effects:

-Bradycardia (reduces cardiac output) ☆

-Heart failure

-Rebound tachycardia (causing angina or MI with sudden withdrawal of beta blocker in patients with coronary heart disease)

•Monitor heart rate, hold beta blocker if heart rate is less than 60 beats per min

•Monitor for HF (shortness of breath, peripheral edema, night coughs) REPORT to doctor

•Teach patients to not ABRUPTLY discontinue beta blockers, taper the dose slowly over 1 to 2 weeks

•Do not give to patients with sinus bradycardia 1st degree AV block

•Do NOT give to patients with asthma or other chronic respiratory disease

•Do NOT give to patients with moderate to severe heart failure

•Do NOT give to patients with peripheral vascular disease (PVD, like Raynaurd's disease)

•Do NOT give to children younger than 6 years

Front 12

Adrenergic neuron blockers

Back 12

•Treats: hypertension

•Example:

-Reserpine ☆

•BLOCK norepinephrine receptors and move norepinephrine from synapse, BLOCK REUPTAKE of dopamine into synaptic vesicles, and drug takes effect in 1 to 2 weeks

•Side effects:

-Severe depression (suicidal) ☆

-Bradycardia ☆ (due to blocked norepinephrine)

-Orthostatic hypotension

-G.I symptoms (GASTRIC IRRITATION & diarrhea)

•Administer with food or milk to PREVENT gastric irritation ☆

•Do NOT take reserpine when pregnant (pregnancy category D)

•Do NOT give to patients with depressive disorders

•Do NOT give to patients with peptic ulcer or ulcerative colitis (due to gastric irritation)

•Do NOT take concurrently with MAOI antidepressants (hypertensive crisis!)

•Do NOT give to children

•Do NOT give reserpine to patients with rauwolfia alkaloids allergy

Front 13

Centrally Acting Alpha 2 Agonist

Back 13

•Treats: hypertension, severe pain relief, migraine, alcohol withdrawal symptoms, dysmenorrhea & hot flashes and ADHD

•Examples:

-Clonidine

-Methyldopa

•Inhibit innervation of sympathetic neurons in the central nervous system (CAUSES bradycardia, DECREASES cardiac output and peripheral VASODILATION of blood vessels which lowers blood pressure)

•Side effects:

-CNS effects (drowsiness, dizziness)

-Dry mouth

-Rebound hypertensive crisis if clonidine is abruptly discontinued

•Do NOT give to patients with anticoagulant therapy (centrally acting meds INCREASE bleeding risk)

•Do not apply transdermal patch to patients who have polyarteritis nodosa or scleroderma

Front 14

Alpha/beta blockers

Back 14

•Treats: hypertension, heart failure along with digoxin, ACE inhibitors and diuretics and lowers chance of survival following an MI

•Examples:

-Carvedilol

-Labetalol

•Block peripheral alpha 1 receptors (vasodilation of arterioles), Block cardiac beta 1 receptors (decrease heart rate and contraction) and blocks kidney beta 1 receptors (decrease renin, which lowers BP)

•Side effects:

-Hypotension

-Bradycardia ☆

-Dizziness

•Monitor heart rate, and hold drug if 60 beats per min or less and blood pressure (less than 100 mm Hg systolic normally indicates to withhold med)

•Do NOT give to patients with unstable heart failure

•Do NOT give to patients with asthma or other respiratory diseases

•Do NOT give to patients with heart blocks or severe bradycardia

•Do NOT give to lactating moms

•Do not give to patients with cardiogenic shock (due to hypertensive side effect, it is contraindicated)

Front 15

Direct Acting Vasodilators

Back 15

•Treats: hypertensive crisis (I.V), moderate to severe hypertension and used along with digitalis and others vasodilators to treat heart failure on short basis

•Examples:

-Hydralazine ☆

-Minoxidil

-Nitroprusside ☆

•Dilates arterioles (DECREASES blood pressure), INCREASES heart rate and heart contractility (POSITIVE chronotropic & POSITIVE inotropic )

•Side effects:

-Headache

-Palpitations

-Tachycardia ☆

-Systemic lupus erythematosus symptoms (facial rash, joint pain, fever, nephritis, pericarditis) ☆

-Fluid retention, edema

-Abrupt withdrawal may cause hypertensive crisis and heart failure

•Do NOT give to patients with rheumatic heart disease caused by mitral valve

•Do NOT give to patients with myocardial infarction

•Do NOT give to patients with tachycardia (greater than 100 beats per minute)

Front 16

Drugs for heart failure

Back 16

•Diuretics

•Cardiac glycosides

•Sympathomimetics

•Phosphodiesterase Inhibitors

Front 17

Diuretics

Back 17

•Thiazides

•Potassium

•Loop

Front 18

Thiazides Diuretics

Back 18

•Treats: heart failure, hypertension and cirrhosis of the liver and renal failure

•Examples:

-Hydrochlorothiazide

-Chlorothiazide

•Acts on proximal portion of the distal convoluted tubules (excretes water, sodium, chloride and potassium)

•Adequate kidney perfusion and glomerular filtration rate is needed for this drug work (kidneys need to work)

•Side effects:

-Fluid and electrolytes imbalances (low sodium, low chloride, low potassium and dehydration)

-HYPERglycemia

-INCREASE uric acid levels (HYPERuricemia)

•Do NOT give thiazide if allergic to SULFATE

•Do NOT give patient with little to no urine output

•Do NOT give to a patient with electrolytes imbalance

Front 19

Loop Diuretics

Back 19

•Treats: pulmonary edema in heart failure, edema and hypertension

•Examples:

-Furosemide

-Ethacrynic acid

-Bumetanide

•Acts on ascending loop of Henle in renal tubules (excretes water, sodium, chloride, and potassium)

•Side effects:

-Electrolyte imbalance (hyponatremia, hypochloremia, severe fluid loss and hypokalemia)

-HYPERglycemia

-INCREASED uric acid levels (HYPERuricemia)

•Do NOT give if allergy to furosemide

•Do NOT give to pre-eclampsia or eclampsia pregnant women

•Do NOT give to patients with hepatic coma

•Do NOT give to patients with electrolytes imbalance or dehydration

•Do NOT give to patients who urinate very little (oliguria)

Front 20

Potassium sparing Diuretics

Back 20

•Treats: hypertension, edema caused by heart failure, cirrhosis of the liver, nephrotic syndrome and hypokalemia

•Examples:

-Spironolactone (aldosterone antagonist)

-Triamterene (non-aldosterone antagonist)

-Amiloride (non-aldosterone antagonist)

•Acts on the distal portion of the nephron unit: blocks aldosterone action (excretes lots of sodium, some water and retains potassium)

•Side effects:

-Hyperkalemia (monitor potassium, if hyperkalemia does occur monitor patient’s heart with EKG for dysrhythmias)

-Menstrual irregularities & gynecomastia (spironolactone acts like a hormone that shifts hormonal levels in both men and women)

•AVOID potassium supplements and foods containing potassium

•Do NOT take spironolactone while pregnant (pregnancy category D)

•Do NOT give to patients with renal failure and severe renal insufficiency

•Do NOT give spironolactone to patients with hyperkalemia

Front 21

Cardiac Glycosides

Back 21

•Treats: maintenance therapy for heart failure, cardiac dysrhythmias, A-fib, A-flutter, and paroxysmal atrial tachycardia

•Example:

-Digoxin

•Inhibits the Sodium/Potassium pump, INCREASES intracellular calcium which INCREASES contractility (positive ionotropic effect), INCREASES cardiac output, DECREASES angiotensin 2 + renin (DECREASES blood pressure and INCREASES excretion of sodium and water), SLOWS electrical conduction of the heart (negative chronotropic/which causes BRADYCARDIA)

•Side effects:

-G.I effects (nausea, vomiting, anorexia)

-CNS symptoms (visual disturbances, like blurred vision and yellow vision and headache)

-Cardiac dysrhythmias (due to digitalis toxicity, AV block is the most common dysrhythmia)

•Monitor APICAL pulse, withhold digitalis if heart rate is less than 60 beats per min

•Antidote: Digoxin immune fab

•Monitor for HYPOkalemia (less than 3.0) because this increases risk of toxicity (signs muscle weakness, shallow respiration)

•Do not give to patients with V-fib or V-tach unless caused by heart failure

•Do not give digitalis if digitalis toxicity occurred in the past

Front 22

Sympathomimetics

Back 22

•Treat: heart failure by increasing cardiac output (short term use only)

•Examples:

-Dobutamine

-Dopamine

•Dobutamine activates beta 1 adrenergic receptors (INCREASES cardiac contractility, force, cardiac output, kidney perfusion which increases urine output and excretion of sodium and water and decreased fluid load (fluid overload/edema) decreases workload of the heart)

•Side effects:

-Tachycardia ☆

-Cardiac dysrhythmias

-Possible angina pain

•Monitor patient with EKG due to risk of cardiac dysrhythmias

•Do NOT give dobutamine to dehydrated patients

•Do NOT give sympathomimetics (dobutamine) to patient with sulfate allergy

•Do NOT give to patients with V-Tach

•Do not give to patients with hypertrophic aortic stenosis

•Do not give to children younger than 2 years

Front 23

Phosphodiesterase Inhibitors

Back 23

•Treat: low cardiac output in heart failure

•Examples:

-Milrinone

-Inamrinone

•Inhibits PDE3 (phosphodiesterase), an enzyme that breaks down cAMP, this means that more cAMP will be available to INCREASES cardiac contractility and as a result cardiac output

•Side effects:

-HYPOkalemia

-Cardiac dysrhythmias

-HYPOtension

-Angina chest pain

•Correct fluid deficit and low potassium levels (hypokalemia) before giving the infusion

•Monitor patient on EKG due to risk for cardiac dysrhythmias

•Do NOT give to patients with aortic or pulmonary valve disorder

•Do NOT give to patients with acute myocardial infarction

•Do not give to patients with allergy to phosphodiesterase inhibitor

Front 24

Drugs Therapy for Coronary Heart Disease

Back 24

•Antilipemics

•Antianginals

Front 25

Antilipemics

Back 25

•HMG-CoA Reductase inhibitor (statins)

•Fibrates

Front 26

HMG-CoA Reductase inhibitor (Statins)

Back 26

•Treat: Reduces LDL and VLDL, increases HDL, reduce mortality in diabetic type 2 patients and reduce risk of cardiovascular disease such as heart attack

•Examples:

-Atorvastatin

-Simvastatin

-Lovastatin

-Rosuvastatin

•Statins inhibit HMG-CoA reductase, an enzyme that synthesizes cholesterol in the liver, decrease triglycerides (VLDLs) by inhibiting the production of a lipoprotein (apolipoprotein C-III) responsible for stimulating production of triglycerides by liver cells

•Side effects:

-Myopathy (pain in muscles and joints) can progress to rhabdomyolysis (breakdown of muscle protein that LEADS to kidney damage)

-Liver toxicity ☆

•Monitor CPK if muscle pain occurs

•Monitor liver function (AST or ALT, bilirubin)

•Monitor and report muscle pain while on statins

•Do NOT take statins while pregnant (pregnancy category X)

•Do not give to patients with liver disease or elevated liver enzymes (AST or ALT)

•Do NOT give to patients with renal failure

•Do NOT give to patients with rhabdomyolysis or myopathy

•Do NOT give to patients with multiple sclerosis

•Do not give to patients younger than 10 years of age

Front 27

Fibrates

Back 27

•Treat: reduce high levels of plasma triglycerides and reduce LDL cholesterol (less effectively than statins)

•Examples:

-Gemifibrozil

-Fenofibrate

-Fenofibric acid

•Activates a substance, PPAR alpha, found in the liver and in certain adipose tissue, PPAR alpha increases production of an enzyme called LPL, which decreases production of triglycerides (VLDLs) and moderately decreases LDLs. PPAR alpha also increases HDL levels by increasing the production of apolipoprotein A-1 and A-2

•Side effects:

-GI effects (nausea, vomiting and diarrhea)

-Gallstones

-Myopathy ☆

-Liver toxicity ☆

•Do NOT give to patients with gallbladder stones

•Do NOT give to patients with liver dysfunction

•Do NOT give to patients with renal impairment

Front 28

Antianginals

Back 28

•Nitrates

•Beta Blockers

•Calcium channel blockers

Front 29

Nitrates

Back 29

•Treats: treatment of angina pectoris

•Examples:

-Nitroglycerin

-Isosorbide

-Amyl nitrite

•Dilates smooth muscles of the coronary veins (relief of angina), decreases venous return to the heart, decreases preload and relaxes spasm in coronary arteries to increase cardiac perfusion

•Side effects:

-Headache ☆

-Orthostatic hypotension

-Tachycardia ☆

-Tolerance develops, which decreases effectiveness of the drug

•Monitor heart rate and blood pressure before giving a nitrate med, if less than 60 beats per min or a systolic less than 100 mm Hg, withhold the drug

•Do NOT give to patient if allergy to any of the nitrates

•Do NOT give to patients with head injury, ICP or severe anemia

•Do NOT give to patients with glaucoma

•Do not give to patients with G.I disease

•Do not give to patients with constructive pericarditis and hypotension (I.V form)

•Do not give to hypovolemic patients

Front 30

Drugs Therapy for Cardiac Dysrhythmias

Soon you'll Be Put under Control (SBPC equals Sodium, Beta, Potassium and Calcium blockers)

Back 30

•Class 1 (Sodium channel blockers)

•Class 2 (Beta adrenergic blockers)

•Class 3 (Potassium channel blockers)

•Class 4 (Calcium channel blockers)

Front 31

Class 1 (sodium channel blockers) subtypes:

Back 31

• A (MODERATE sodium blockade; INCREASES refractory period)

• B (MILD sodium blockade; SLIGHT DECREASE on refractory period)

• C (GREATEST sodium blockade; DECREASES refractory period)

Front 32

Class 1 A (sodium channel blockers)

Some Block Potassium Channels

Sodium (class 1) -ine, -mide

Back 32

Treat: broad spectrum anti dysrhythmic; treat A-fib and flutter, supraventricular tach and ventricular tach

•Long term therapy (Quinidine)

•Short term therapy (procainamide; severe adverse effects)

•Examples:

-Quinidine

-Procainamide

-Disopyramide

•Slow impulse conduction, decrease automaticity and lengthens refractory period (increases refractory period)

•Side effects:

-G.I symptoms (Nausea, vomiting and diarrhea)

-HYPOtension

-V dysrhythmias

-Arterial embolism (due to A-fib) ☆

-Speed shock with too rapid I.V infusion

-Quinidine causes cinchonism

-Procainamide causes systemic lupus erythematosus (50% of patients) and agranulocytosis (low WBC)

•Monitor EKG continuously with I.V form of class 1 A anti dysrhythmics

•Monitor pulse rate, blood pressure and G.I system

•Monitor plasma drug levels of class 1 A anti dysrhythmic to detect early toxicity

•Do NOT give if allergic to quinine or quinidine

•Do NOT give if allergic to procainamide or procaine or yellow dye #5

•Do not give if patient has severe dysrhythmia or heart block

•Do not give quinidine if patient has severe heart failure, hypotension and thyrotoxicosis

•Do NOT give procainamide if patient has low WBC or agranulocytosis, myasthenia gravis or systemic lupus

Front 33

Class 1 B (sodium channel blocker)

Some Block Potassium Channels

Sodium (class 1) -ine, -mide

Back 33

•Treat: V-dysrhythmias caused by myocardial infarction, cardiac surgery or procedures, digitalis toxicity

•Examples:

-Lidocaine

-Mexiletine

•Slows impulse conduction, decreases automaticity of ventricles, bundle of his and purkinje fibers and shortens refractory period (decreases refractory period)

•Side effects:

-CNS effects (toxicity): confusion, drowsiness, restlessness

-HYPOtension, bradycardia and heart block

-Small decrease in QT interval

•Monitor vital signs and cardiac rhythm on EKG

•Do NOT give to patients with allergy to lidocaine or amide anesthesia

•Do NOT give to patients with supraventricular dysrhythmias

•Do NOT give to patients with untreated bradycardia and heart block

Front 34

Class 1C (sodium channel blocker)

Some Block Potassium Channels

Sodium (class 1) -ine, -mide

Back 34

•Treat: serious supraventricular and ventricular tachydysrhythmia & used long-term for some supraventricular dysrhythmias

•Examples:

-Flecainide

-Propafenone

•Slow impulse conduction, decreases automaticity of ventricles, bundle of his and purkinje fibers and slight increase in the refractory period (decrease in refractory period)

•Side effects:

-Visual effects: blurred vision, difficulty focusing

-Worsening of heart failure; edema ☆

-Widen QRS & prolonged QT and PR intervals

-Potential for 1st degree heart block ☆

•Monitor for edema and crackles in the lungs

•Monitor EKG periodically

•Monitor flecainide levels to detect early toxicity

•Do NOT give if patient has any heart block

•Do NOT give if patient has a recent myocardial infarction

•Do NOT give if patient has an electrolyte imbalance

•Do NOT give if the patient is in shock (flecainide causes HYPOtension)

Front 35

Class 2 (Beta adrenergic blocker)

Some Block Potassium Channels

B-Beta (Class 2) -olol

Back 35

•Treats: Tachydysrhythmias (atrial or ventricular tach), hypertension, prevent angina pectoris, decreases mortality following a myocardial infarction and prophylaxis against migraine headache

•Examples:

-Esmolol

-Sotalol

-Acebutolol

-Propranolol

•Decreases sympathetic nervous system, decreases SA node automaticity, decreases conduction through AV node, decreases contractility and closes calcium channels and prolongs PR interval on EKG

•Side effects

-Bradycardia ☆

-Heart failure ☆

-Rebound tachycardia

-Peripheral arterial insufficiency

-CNS effects: confusion, fatigue, drowsiness

•Monitor heart rate, blood pressure, edema and signs of heart failure and REPORT these findings and a heart rate less than 60 beats per min

•Neurovascular checks (monitor color, temp and pulse on extremities)

•Do NOT give to patient if the patient has sinus bradycardia or any heart block

•Do NOT give to patients with pulmonary edema

•Do NOT give to patients with mitral or aortic valve disease (due to side effect of worsening heart failure)

•Do not give to patients with asthma, severe COPD or other chronic respiratory disorder

Front 36

Class 3 (potassium channel blocker)

Some Block Potassium Channels

P-Potassium (class 3) -tilide, -darone

Back 36

•Treats: manages V-tach or fib that is resistant to other drugs, A-dysrhythmia, such as A-fib

•Examples:

-Amiodarone

-Bretylium

-Ibutilide

-Sotalol

•Decreases automaticity, slow conduction through AV node, ventricles and purkinje fibers, decrease contractility, dilate coronary and peripheral vessels

•Amiodarone: widens QRS complex and prolongs both PR and QT interval

•Side effects:

-GI effects: nausea, vomiting and constipation

-Pulmonary toxicity with pneumonitis (monitor chest X ray and pulmonary function test)

-Visual effects: optic neuropathy

-Cardiac effects: BRADYCARDIA and HYPOTENSION

-Heart failure may be worsened by amiodarone ☆

-Blue-grey discoloration of skin

-CNS effects: dizziness, tremors and hallucinations

•Monitor blood pressure and pulse while on this drug

•Monitor EKG continuously during infusion

•Monitor weight for edema and weight changes ☆

•Auscultate the lungs and report adventitious (abnormal) sounds ☆

•Take drug with milk or food

•Monitor pulse rate and REPORT rates slower than 60 beats per min

•If pregnant do NOT take this drug (pregnancy category D)

•The patient should NOT take this drug if allergic to amiodarone or benzyl alcohol

•The patient should NOT take this drug if bradycardic, has a heart block or sinus node dysfunction

•If the patient has hepatic disease, the patient should NOT take this drug

Front 37

Class 4 (Calcium channel blocker)

Some Block Potassium Channels

C-Calcium (class 4) -pamil & -zem

Back 37

•Treat: supraventricular tach, A-fib and flutter, angina and hypertension

•Examples:

-Verapamil

-Diltiazem

•SLOW automaticity of the SA node, slow the conduction through the AV node and DECREASES myocardial contractility and prolongs PR interval

•Side effects:

-HYPOtension

-Bradycardia ☆

-Heart failure (worsen)

-Lightheadedness, dizziness

•Monitor blood pressure (anything less than a systolic pressure of 100 mm Hg is too low) and pulse (anything less than 60 beats per min is too low) and report if abnormally low

•Monitor for edema and I & O ☆

•Monitor for crackles in the lungs

•Do NOT give to patients with severe hypotension

•Do not give to patients with cardiogenic shock (due to hypotension side effect)

•Do NOT give to patients with any heart block

•Do not give to patients with Wolff-Parkinson White syndrome

•Do not give to patients with sick sinus syndrome