Pharmacology - Cardiac Meds

Front 1

Alpha Adrenergic Blockers
(examples/uses)

Back 1

Hypertension

prazosin (Minipress)
doxazosin mesylate (Cardura)

Front 2

Alpha Adrenergic Blockers
(SE and contraindications)

Back 2

orthostatic hypotension, reflex tachycardia, nasal congestion, impotence

Front 3

Alpha Adrenergic Blockers
(Nursing considerations)

Back 3

*Administer first dose at bedtime to avoid fainting
*Change positions slowly
*Monitor BP, weight, BUN/Creatinine, edema

Front 4

Centrally Acting Alpha-Adrenergics
(examples/uses)

Back 4

Hypertension (decreases rate and force of contraction)

clonidine (Catapres)
methyldopa (Aldomet)

Front 5

Centrally Acting Alpha-Adrenergics
(SE and contraindications)

Back 5

drowsiness, dry mouth, rebound hypertension, orthostatic hypotension, CHF

Medication interactions: Prazosin, MAOIs and TCAs can counteract the antihypertensive effect of clonidine. Additive CNS depression can occur if used with other CNS depressants.

Front 6

Centrally Acting Alpha-Adrenergics
(Nursing considerations)

Back 6

*Don't discontinue abruptly
*Monitor for fluid retention

Front 7

Beta Adrenergic Blockers
(examples/uses)

Back 7

Hypertension (decreases excitability of the heart)

atenolol (Tenormin)
metoprolol (Toprol)
nadolol (Corgard)
metoprolol (Lopressor)
carvedilol (Coreg)

Front 8

Beta Adrenergic Blockers
(SE and contraindications)

Back 8

Beta1 Blockers - bradycardia, decreased cardiac output, AV block, orthostatic hypotension, gastric pain, tachycardia, impotence, nightmares, depression, dizziness

Beta 2- bronchospasm

Front 9

Beta Adrenergic Blockers
(nursing considerations)

Back 9

*Do not discontinue abruptly
*Take with meals
*Provide rest periods
*For diabetic patients, blocks normal signs of hypoglycemia (sweating, tachycardia); monitor blood glucose
*Medications have antianginal and antiarrhythmic actions

Front 10

Angiotensin-Converting Enzyme (ACE) Inhibitors
(examples/uses)

Back 10

Hypertension (blocks vasocontriction)

captopril (Capoten)
enalapril (Vasotec)
lisinopril (Prinivil)

Front 11

Angiotensin-Converting Enzyme (ACE) Inhibitors
(SE and contraindications)

Back 11

orthostatic hypotension, persistent non-productive cough, hyperkalemia, rash, angioedema, neutropenia, gastric irritation, tachycardia, MI, proteinuria, peripheral edema

Contraindications: Pregnancy category D, renal stenosis, hypersensitivity, use cautiously in clients with renal impairment and disorders

Medication Interactions: diuretics, antihypertensives (additive effect), potassium supplements and potassium sparing diuretics, lithium, NSAIDs

Front 12

Angiotensin-Converting Enzyme (ACE) Inhibitors
(Nursing considerations)

Back 12

*Decreased absorption if taken with food - give 1 hr before or after
*Small frequent meals
*Frequent mouth care
*Change position slowly
*Can be used with thiazide diuretics

Front 13

Angiotensin II Receptor Blockers (ARBs)
(examples/uses)

Back 13

Hypertension (vasodilation; decrease Na and K+ retention)

losartan (Cozaar)
valsartan (Diovan)
candesartan (Atacand)

Front 14

Angiotensin II Receptor Blockers (ARBs)
(SE and contraindications)

Back 14

angioedema, hypertension, HF, diabetic nephropathy, myocardial infarction, stroke prevention

Contraindications: Pregnancy category D, renal stenosis

Front 15

Angiotensin II Receptor Blockers (ARBs)
(nursing considerations)

Back 15

*Change positions slowly
*Monitor for edema
*Instruct client to notify provider in edema occurs

Front 16

Calcium Channel Blocker
(examples/uses)

Back 16

Hypertension, angina, dysrhythmias (slows impulse conduction)

nifedipine (Procardia)
amlodipine (Norvasc)
verapamil (Calan)
diltiazem (Cardizem)

Front 17

Calcium Channel Blocker
(SE and contraindications)

Back 17

nifedipine (reflex tachycardia, edema, toxicity)
verapamil and diltizem (orthostatic hypotension, edema, constipation, bradycardia, heart failure, dysrhythmias)

Medication/Food Interactions: grapefruit juice can lead to toxicity, beta-blockers, digoxin

Front 18

Calcium Channel Blocker
(nursing considerations)

Back 18

*Monitor vital signs
*Do not chew or divide sustained release tablets
*Contraindicated in heart block
*Contact health provider if blood pressure <90/60
*Instruct client to avoid grapefruit (verapamil)
*Monitor for signs of heart failure
*If giving IV push, administer slowly over 2 – 3 minutes

Front 19

Nitrates
(examples/uses)

Back 19

Angina, HF, perioperative BP control (decreases cardiac o2 demand)

IV nitroglycerin
SL nitroglycerin (Nitrostat),
isosorbide dinitrate (Imdur)

Front 20

Nitrates
(SE and contraindications)

Back 20

Side/Adverse Effects: Headache, orthostatic hypotension, reflex tachycardia, tolerance, dizziness

Medication Interactions: antihypertensives can contribute to hypotensive effect, sildenafil (Viagra)

Front 21

Nitrates
(nursing considerations)

Back 21

*Take sublingual tablets under tongue or in buccal pouch; tablet should "fizzle" or burn
*Check expiration date
*Discard unused med after 6 months
*Take sustained-release tablets with water, don't chew them
*Administer topically over 6 X 6 inch area using applicator, cover with plastic wrap, rotate sites
*Administer transdermal to skin free of hair, do not apply to distal extrem, remove before defibrillation or cardioversion
*Administer transmucosal tablets between lip and gum above the incisors or between the cheek and gum, do not chew
*Administer translingual spray into oral mucosa; do not inhale
*Withdraw medication gradually over 4-6 weeks
*Provide rest periods
*Teach to take medication when chest pain anticipated
*May take q 5 min X 3 doses
*Beta-adrenergic blockers and calcium-channel blockers also used for angina

Front 22

Cardiac Glycosides
(examples/uses)

Back 22

HF, dysrhythmias (increases cardiac output and blood flow to the kidneys)

Digoxin (Lanoxin, Digitek)

Front 23

Cardiac Glycosides
(SE and contraindications)

Back 23

dysrhythmias, cardiotoxicity leading to bradycardia, anorexia, N/V, abdominal pain, vision changes, confusion

Herbal interactions: licorice, hawthorn, ginseng, ma-huang (ephedra)

Front 24

Cardiac Glycosides
(nursing considerations)

Back 24

*Administer with caution to elderly or clients with renal insufficiency
*Monitor renal function and electrolytes
*Instruct clients to eat high-potassium foods (low K+ increases risk of digitalis toxicity)
*Take apical pulse for 1 full min before admin; notify physician if AP less than 60
*Maintenance dose 0.125-0.5 mg
*Therapeutic blood levels 0.5-2 nanograms per mL
*Toxic blood levels greater than 2 nanograms pr mL
*Digibind - antidote

Front 25

Antidysrhythmics
(examples)

Back 25

procainamide (Pronestyl)
lidocaine
amiodarone (Cordarone)
adenosine (Adenocard)
ibutilide (Corvert)

Front 26

Antidysrhythmics
(SE and contraindications)

Back 26

*Procainamide – systemic lupus syndrome, blood dyscrasias, cardiotoxicity
*lidocaine – CNS effects, respiratory arrest
*amiodarone – pulmonary toxicity, sinus bradycardia, hypotension, liver and thyroid dysfunction

Front 27

Bile Acid Sequestrants
(examples)

Back 27

antilipemic agent (increases loss of bile acid in feces; decreases cholesterol)

cholestyramine (Questran)
colestipol (Colestid)

Front 28

Bile Acid Sequestrants
(SE and contraindications)

Back 28

constipation, rash, fat-soluble vitamin deficiency, abdominal pain and bloating

Front 29

Bile Acid Sequestrants
(nursing considerations)

Back 29

*Sprinkle powder on noncarbonated beverage or wet food; let stand 2 min; stir slowly
*Administer 1 hr before or 4-6 hrs after meals to avoid blocking absorption
*Instruct patient to report constipation immediately
*Avoid taking Digoxin, warfarin, thiazides or tetracyclines 1 hr before or 4 hrs after taking Bile sequestrants.

Front 30

HMG-CoA reductase inhibitors (Statins)
(example)

Back 30

Decreases LDL cholesterol levels

lovastatin (Mevacor)
pravastatin (Pravachol)
Simvastatin (Zocor)
Atorvastatin (Lipitor)
Fluvastatin (Lescol)
Rosuvastatin (Crestor)

Front 31

HMG-CoA reductase inhibitors (Statins)
(SE and contraindications)

Back 31

myopathy, increased liver enzymes

causes vasodilation

Front 32

HMG-CoA reductase inhibitors (Statins)
(nursing considerations)

Back 32

*Take with food; avoid alcohol
*Grapefruit juice must be avoided
*Contact physician if unexplained muscle pain occurs; esp with fever or malaise
*Take at night
*Give with caution to clients with decreased liver function

Front 33

Nicotinic Acid
(example)

Back 33

Decreases total cholesterol, LDL & triglycerides; increases HDL

Niacin

Front 34

Nicotinic Acid
(SE and contraindications)

Back 34

flushing, hyperglycemia, gout, upper GI distress, liver damage

Front 35

Nicotinic Acid
(nursing considerations)

Back 35

*Flushing occurs several hours after med is taken, will decrease over 2 weeks
*Also used for pellagra and peripheral vascular disease
*Avoid alcohol

Front 36

Folic Acid Derivatives
(example)

Back 36

Decreases total cholesterol, VLDL and triglycerides

fenofibrate (Tricor)
Gemfibrozil (Lopid)

Front 37

Folic Acid Derivatives
(SE and contraindications)

Back 37

abdominal pain, myalgia and swollen joints

increased risk of gallbladder disease

Front 38

Folic Acid Derivatives
(nursing considerations)

Back 38

*Administer before meals
*Instruct clients to notify health care provider if muscle pain occurs

Front 39

Heparin
(uses)

Back 39

anticoagulant

thrombotic strokes, pulmonary embolism, deep vein thrombosis (DVT) and DVT prophylaxis, DIC, MI

Front 40

Heparin
(SE and contraindications)

Back 40

hemorrhage/bleeding, heparin induced thrombocytopenia (HIT), hypersensitivity reactions, anemia, fever

Contraindicated in clients with thrombocytopenia, uncontrolled bleeding, use cautiously in clients with hemophilia, peptic ulcer disease, severe hypertension.

Front 41

Heparin
(nursing considerations)

Back 41

*Monitor for signs of bleeding. Stop heparin if platelet count is less than 100,00/mm3
*Monitor therapeutic PTT at 1.5-2.5 times the normal (68-80 sec)
*Use IV pump; deep SQ (never IM)
*Antidote (protamine sulfate)

Front 42

warfarin (Coumadin)
(uses)

Back 42

Antagonizes vitamin K, preventing the synthesis of four coagulation factors: VII, IX, X and prothrombin (PT)

Uses: prevention of thrombosis in clients with atrial fibrillation and prosthetic heart valves

Front 43

warfarin (Coumadin)
(SE and contraindications)

Back 43

Hemorrhage/Bleeding, diarrhea, rash, fever

Contraindications: Pregnancy category X, low platelet count, uncontrolled bleeding, liver disorders, use cautiously in clients with hemophilia, peptic ulcer disease, severe hypertension

Medication/Food Interactions: heparin, aspirin, glucocorticoids, acetaminophen, sulfonamides, cephalosporin, phenobarbital, carbamazepine, phenytoin, vitamin K and foods high in vitamin K

Front 44

warfarin (Coumadin)
(nursing considerations)

Back 44

*Monitor PT at 1.5-2.5 times normal (18-24 seconds)
*Monitor INR at 2.0-3.0
*Antidote: Vitamin K, whole blood, plasma
*Teach measures to avoid venous stasis
*Emphasize importance of regular lab testing
*Patient should avoid foods high in Vitamin K

Front 45

Adenosine diphosphate (ADP) receptor antagonists

Back 45

Antiplatelet agent (prevent platelets from clumping together (aggregating) by inhibiting enzymes and factors that normally lead to clotting)

clopidogrel (Plavix)
ticlodipine (Ticlid)

Front 46

Adenosine diphosphate (ADP) receptor antagonists
(SE and contraindications)

Back 46

thrombocytopenic purpura, GI upset, bleeding

Front 47

Salicylates

Back 47

Antiplatelet agent

Asprin

Front 48

Salicylates
(SE and contraindications)

Back 48

Short term use - GI bleed, heartburn, occasional nausea

Prolonged high dosage - salicylism: metabolic acidosis, respiratory alkalosis, dehydration, fluid and electrolyte imbalance, tinnitus

Contraindications: GI disorders, severe anemia, vitamin K def

Front 49

Salicylates
(Nursing considerations)

Back 49

*Observe for bleeding gums, bloody or black stools, bruises
*Give with milk, water or food

Front 50

Thrombolytics
(examples/uses)

Back 50

Dissolve clots that have already formed

tenecteplase (TNKase)
tissue plasminogen activator (t-PA)
streptokinase (Streptase)

Front 51

Thrombolytics
(SE and contraindications)

Back 51

bleeding, allergic reaction

contraindications: active bleeding, recent stroke, surgery or trauma, severe hypertension, pregnancy