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CARDIAC DRUGS

Anticoagulants Heparin, Lovenox, Coumadin Helps to prevent harmful clots from forming in the blood vessels. May prevent the clots from becoming larger and causing more serious problems including DVT and PE. Often prescribed to prevent first or recurrent stro es. Anticoagulants decrease the clotting ability of the blood by reducing the formation of fibrin. Coumadin is a vitamin ! antagonist that inhibits the synthesis of clotting factors" including factor # and thrombin. Heparin and Lovenox $lo% molecular %eight Heparin& inhibit the activity of the clotting factors. 'ursing (onsiderations) Adverse effects include the ris of hemorrhage and hypersensitivity reactions. Patients should be assessed for signs of blood loss including decreased *P" increased H+" bruises" hematomas" red or blac stools" pain" headache and faintness. Possible signs of allergic responses to assess patients for include fever" chills and urticaria $hives&. Antiplatelet Agents Aspirin Helps prevent clotting in patients %ho have had a heart attac " unstable angina" ischemic stro es" T,A" and other forms of cardiovascular disease. -sually preventive %hen pla.ue buildup is evident but there is not yet a large obstruction in the artery. Antiplatelet agents eeps blood clots from forming by preventing blood platelets from stic ing together. Aspirin suppresses platelet aggregation by causing irreversible inhibition of cycloo/ygenase" an en0yme re.uired by platelets to synthesi0e thrombo/ane A1" a factor that promotes platelet activation. 'ursing (onsiderations) Even in lo% doses" aspirin increases the ris of 2, bleeding and hemorrhagic stro e. *enefits of treatment must be %eighed against bleeding ris s. Angiotensin3 (onverting En0yme $A(E& ,nhibitors Lisinopril. E'D 4,TH P+,5 -sed to treat or improve symptoms of cardiovascular conditions including HT'" M," and H6. Prevention of M," stro e and death in patients at high cardiovascular ris Also used for treatment of diabetic neuropathy. A(E inhibitors dilate blood vessels" reduce blood volume and decreases resistance by lo%ering levels of angiotensin ,, and increasing levels of brady inin. This allo%s blood to flo% more easily and ma es the heart7s %or easier or more efficient. 'ursing (onsiderations) The reduction of angiotensin ,, can cause adverse effects including first dose hypotension and hyper alemia. *lood pressure should be assessed for several hours follo%ing the first dose. Patients should be instructed to avoid potassium supplements and potassium containing salt substitutes to avoid potassium retention by the indeys. Elevation of brady inin can cause cough and angioedema. (ough occurs in 839:; of patients and is the most common reason for discontinuing therapy. Angioedema is a potentially fatal reaction %ith symptoms of edema of the tongue" glottis and pharyn/. Epinephrine %ill treat severe angioedema reactions and A(E inhibitors must be discontinued. Angiotensin ,, +eceptor *loc ers $A+*s& Candesartan, Eprosartan, Irbesartan, Losartan -sed to treat or improve symptoms of cardiovascular conditions including high blood pressure and heart failure. +ather than lo%ering levels of angiotensin ,, $as A(E inhibitors do& angiotensin ,, receptor bloc ers prevent this chemical from having any effects on the heart and blood vessels. This

CARDIAC DRUGS
eeps blood pressure from rising. 'ursing (onsiderations) A+*s do not cause cough or hyper alemia li e A(E inhibitors do and are generally %ell tolerated. Patients should still be assessed for angioedema. $These are ne%er and more e/pensive" patient is usually started on an A(Ei and if not tolerated they consider the A+*s& *eta3 Adrenergic *loc ers Atenolol, Metoprolol, Propanolol, Cardevilol -sed to lo%er blood pressure. -sed %ith therapy for cardiac arrhythmias and in treating angina. -sed to prevent future heart attac s in patients %ho have had a heart attac . *eta bloc ers decrease heart rate and cardiac output" %hich lo%ers blood pressure and ma es the heart beat more slo%ly and %ith less force. The bloc ade of beta receptors decreases heart rate and contractility causing cardiac output to decline" suppresses refle/ tachycardia" and reduces vasoconstriction" volume e/pansion and peripheral vascular resistance. 'ursing (onsiderations) <tart %ith a lo% dose and titrate slo%ly. *eta bloc ers have a variety of possible adverse effects including bradycardia" decreased AV conduction" reduced contractility and bronchoconstriction. They should not be used for patients %ith AV bloc and should be used cautiously in patients %ith heart failure. Patients %ith asthma should also avoid use. Additionally" beta bloc ers can mas signs of hypoglycemia and should be used %ith caution in diabetic patients. Do not stop ta ing these abruptly==== $<%eating" headaches" palpitations& Patients on beta bloc ers %ill have a decreased H+ and H+ may not be a proper indicator of pain" activity tolerance" etc. -se ++ to ob>ectively assess those things that %ould normally increase H+ such as pain?e/ertion. Diuretics !ia"ide #H$dro%!lorot!ia"ide&, Loop #'urosemide&, ( Sparin) #Spironola%tone& -sed to help lo%er blood pressure. -sed to help reduce edema from e/cess buildup of fluid in the body. Diuretics cause the body to rid itself of e/cess fluids and sodium through urination and are the first line drugs for patients %ith volume overload. They help to relieve the heart7s %or load and decrease the buildup of fluid in the lungs and other parts of the body" such as the an les and legs. Different diuretics remove fluid at varied rates and through different methods. 'ursing (onsiderations) Thia0ide diuretics produce moderate diuresis and are used for long term therapy of H6 %hen edema is not too e/cessive. Thia0ide@s principal adverse effect is hypo alemia. 5oop diuretics produce profound diuresis and are preferred %hen cardiac output is greatly reduced. 5oop diuretics can cause hypo alemia and severe hypotension secondary to e/cessive volume reduction. Potassium sparing diuretics promote only scant diuresis and are employed to counteract potassium loss caused by thia0ide and loop diuretics. The hypo alemia caused by diuretics greatly increases the ris for digo/in to/icity. Aldosterone Antagonists Spironola%tone, eplerenone #Inspra& ! sparing diuretics that promote 'a and %ater e/cretion and retain ! also bloc the effects of aldosterone on cardiac blood vessels. 'ursing (onsiderations) 2ynecomastia can occur in males %ith long term use of spironolactone Morp!ine +educes preload?afterload" used in the treatment of ADH6 and pulmonary edema. Dilates pulmonary and systemic blood vessels" decreases o/ygen demands" dyspnea and an/iety.

CARDIAC DRUGS
'ursing (onsiderations) Morphine3related respiratory depression is rare" but monitor ++. Positive ,notropes Di)italis, beta*adrener)i% a)onists Digitalis Preparations Di)oxin -sed to relieve H6 symptoms" especially %hen the patient isn7t responding to A(E inhibitors and diuretics. Decrease conduction speed in myocardium and slo% H+" allo%ing for complete emptying of the ventricles. $(O and <V increase +?T improved contractility&. Also slo%s certain types of arrhythmias" particularly atrial fibrillation. Digo/in increases the force of contractions" %hich can be beneficial in H6 and for irregular heart beats. 'ursing (onsiderations) The most serious adverse effect of digo/in is cardiac dysrhythmias caused by the alteration of electrical properties of the heart. All patients should be evaluated fre.uently for changes in heart rate and rhythm. Monitor for hypo alemia" as this can cause digitalis to/icity and more dysrhythmias. Digo/in has a large number of significant drug3drug interactions including interactions %ith diuretics" A(E inhibitors and A+*s" sympathomimetics" .uinidine and verapamil. +is factors for to/icity) idney?liver disease" elderly" slo%ed body metabolism" !" (a" Mg <?< of to/icity) anore/ia" nausea" vomiting" visual disturbances $yello%& and dysrhythmias. T/ for to/icity) %ithhold drug until s?s subside. Antidote) digo/in immune 6ab if life3 threatening. *eta3adrenergic agonists Dopamine, dobutamine <hort3term treatment of ADH6 in units %ith E(2 monitoring capability. ,ncrease myocardial contractility. -sed for H6 %ith hemodynamic instability $hypotension and tachycardia&. Dopamine also dilates renal blood vessels and enhances urine output and <V+. 'ursing (onsiderations) monitor urinary output %ith dopamine" only to be used as short term treatment that has not responded to conventional therapies $diuretics" vasodilators" morphine& <tatins) HM23 (oA +eductase ,nhibitors Simvastatin, Atorvastatin, Rosuvastatin -sed to lo%er 5D5 $AbadA& cholesterol" raise HD5 $AgoodA& cholesterol and lo%er triglyceride levels. Hypercholesterolemia is a ma>or ris factor for coronary heart disease. <tatins can lo%er blood cholesterol levels. They may be prescribed individually or in combination %ith other drugs. They %or in the body in different %ays. <ome affect the liver" some %or in the intestines and some interrupt the formation of cholesterol from circulating in the blood. 'ursing (onsiderations) Adverse side effects from statins are uncommon but some patients develop headache" rash or 2, disturbances. Hepatoto/icity can occur and therefore it is important for liver function tests to be done before treatment and every B391 months thereafter. +ia%in 4ater3soluble * vitamin" lo%ers 5D5?triglycerides and increases HD5. 'ursing (onsiderations) adverse effects) severe flushing" pruritus" 2, symptoms" ortho hypo. Aspirin or '<A,D before administration may reduce flushing. #+ 'iacin may also reduce side effects.

CARDIAC DRUGS
*ile3acid <e.uestrants C!olest$ramine #,uestran& *ind %ith bile acids in intestine" decrease hepatic cholesterol content $5D5&. *ad taste" can cause 2, disturbances" and interfere %ith the absorption of many drugs. (holesterol Absorption ,nhibitor) e"etimibe #-etia& ,nhibits absorption of dietary?biliary cholesterol across intestinal %all. (an be combined %ith a statin to further reduce 5D5 cholesterol. 'ot for patients %ith liver impairment. May have headache and mild 2, symptoms. (alcium (hannel *loc ers .erapamil, Diltia"em, +i/edipine, Amlodipine -sed to treat high *P" angina caused by reduced blood supply to the heart muscle and some arrhythmias. ,nterrupt the movement of (a into the cells of the heart and blood vessels to decrease the heart7s pumping strength and rela/ blood vessels. *loc ade reduces arterial pressure" increases coronary perfusion" reduces heart rate" decreases AV nodal conduction and decreases the force of contraction. 'ursing (onsiderations) Adverse effects include constipation" flushing" di00iness" headache" edema of the an les and feet and refle/ tachycardia. (aution must be used for patients %ith heart failure and ((*s must not be used in patients %ith sic sinus syndrome or AV bloc . Vasodilators H$drala"ine, +itrates, Minoxidil, Isosorbide dinitrate Principal indications are hypertension" heart failure and M, -sed to ease angina. Vasodilators rela/ blood vessels and increase the supply of blood and O1 to the heart %hile reducing its %or load. 'ursing (onsiderations) Adverse effects related to vasodilation include postural hypotension" refle/ tachycardia and e/pansion of blood volume. Teach patients about symptoms of hypotension and to minimi0e hypotension by avoiding abrupt transitions from supine or seated to an upright position. +efle/ tachycardia can be pretreated %ith a beta bloc er %hich %ill bloc sympathetic stimulation of the heart. 4hen using ,V nitro or ,V nipride" chec *P .839: minutes. $'ipride given only in ,(-& 'ipride can cause headache" nausea" di00iness" dyspnea" blurred vision" s%eating and restlessness. 'esiritide ,V is a form of *'P" causing arterial and venous dilation for short term t/ of ADH6 Antidysrhythmics: I. Adenosine) a a Adenocard -sed for paro/ysmal supraventricular tachycardia $P<VT& %hen valsalva maneuver doesn@t %or . Also sometimes given during pharmacological stress echocardiogram. 2ive ,V push over 1 min" monitor E(2 continuously. *rief period of asystole common. 4atch for flushing" di00iness" chest pain" and palpitations. 4ill feel li e they are dying. 4arn them Vasopressor: cause blood pressure to rise. Epi/Nori s: Bronchodilation. Maintenance of heart rate and blood pressure. Localization/prolongation of local/spinal anesthetic. ner ousness! restlessness! tremor! headache! insomnia. "esp: parado#ical bronchospasm $e#cessi e use of inhalers%. &V: angina! arrhythmias! hypertension! tachycardia. '(: nausea! omiting. Endo: hyperglycemia. AnticholingericC Atropine #brady& <E) dry mouth" blurred vision" elevation of intraocular

CARDIAC DRUGS
pressure" urinary retention" photophobia" constipation" lac of s%eat" tachycardia" asthma" hyperthermia )heophylline* cause tachy Bronchodilator. (hronic <table Angina) 'itrates" *eta bloc ers" A(Ei or A+*s" (a channel bloc ers ,6 beta bloc ers are poorly tolerated?do not %or (hronic Heart 6ailure) A(Ei" beta bloc ers" diuretics