Cv Drugs Nursing2007

7/28/2019 Cv Drugs Nursing2007

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Cardiovascular Drugs

Unit 7

Nursing Pharmacology


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Electrical Activity of the HeartWhat are the 2 nodes of the heart that generate

electrical impulses???

What mineral is needed for this to occur???


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Normal Heart Rates per Age Infants:

Toddler: Preschoolers:

School-age:

Adolescents:Adult:


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Terms to KnowBradycardia

Tachycardia Systole

Diastole

Loading dose


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More Terms to Know Positive inotropic effect

Negative inotropic effect Positive chronotropic effect

Negative chronotropic effect

Positive dromotropic effectNegative dromotropic effect


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More Terms to Understand Parasympathetic Nervous System (cholinergic)

vagus stimulation = neurotransmitter acetylcholine

= Slows the heart by inhibiting impulse formation

Sympathetic Nervous System (adrenergic)when

stimulated = neurotransmitter norepinephrine =increase in heart rate by promoting impulseformation


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What is Congestive Heart Failure??

(CHF) 3 things happen:

1. Cardiac distention result from inability ofventricles to pump all blood

2. Cardiac hypertrophyfrom prolonged

stretching

3. Sodium and water retentionpartly due to

decreased blood to kidneys


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S/S of CHFWeight gain

Edema Shortness of breath

Pulmonary congestion


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Cardiac Glycosides Primary use???

Method of action???

Common DrugsDigoxin (Lanoxin), Digitoxin


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S/S of Digoxin Toxicity 1. GI distressdiarrhea, excessive salivation,

abdominal pain

2. Neurologicalrestlessness, irritability., HA,

weakness, lethargy, drowsiness, confusion, visual

disturbancesblurred or colored vision, halo

vision, amblyopic, diplopia


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More s/s of toxicity 3. Cardiac effectcardiac arrhythmiasextra

beats, bradycardia, AV block, bigeminy

What are risk factors for toxicity???

AB

C


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Action to Take if Digoxin ToxicMonitor blood levels of drug

--Digoxin 0.5-2 ng/ml Therapeutic

--Digitoxin 14-26 ng/ml Therapeutic

If too high???

1. Stop/hold drug 2. If life threatening = digoxin immune fab

(Digibind)


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Other Nursing Implications for

Cardiac Glycosides 1. Give it with meals to decrease GI problems

2. Assess apical pulse for 1 minutes before

givingnote rate and rhythm

3. If pulse less than 60 beats per min., 90 in infant,

70 in children/adolescences = DO NOT GIVE

4. Call MD for bradycardia and tachycardia.

5. Report any irregular rhythmespecially if new.


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Implications continued 6. Assess and report toxicity: HA, visual

disturbances, anorexia, disorientation, weight

gainweight pt. every day 7. If on potassium-losing diuretics = increases

chance of toxicity

8. Monitor potassium level closelyreportabnormals to MD

9. Encourage food high in potassium


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Implication continued 10. Teach patienttake pulse before taking med,

what to do with findings for HR, what to do if miss

medication dose, action of med, importance of

follow-up with MD

11. Monitor drug levels as ordered by MD


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Inamrinone Lactate (Inocor) &

Milrinone Lactate (Primacor)Method of action???

1. Positive inotropic effect

2. Direct relaxant effect on vascular smooth

muscle

Uses?? Short term for CHF


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Side EffectsLeast likely to cause arrhythmiasInamrinone

Ventricular arrhythmias more likely--Milrinone

1. Thrombocytopenia

2. Drug fever

3. GI disturbances


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Administration of Inocor/Primacor 1. IV route

2. Chemical reaction with dextrose solutionsdo

not dilute

3. With Lasix = precipitate immediately forms

4. Protect ampules from light 5. If diluted = use within 24 hours


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Antiarrhythmic DrugsWhat is happening in the heart to cause

arrhythmias???

Treatments for arrhythmias??

--No treatment for some --Cardioversion --Pacemakers

--Drugs therapy


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Major Groups of AntiarrhythmicsGroup 1Sodium Channel Blockers

Group 2Beta-adrenergic Blockers

Group 3Potassium Channel Blockers

Group 4Calcium Channel Blockers


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Antiarrhythmic Agents quinidine (Duraquin, Cardioquin) Group 1

procainamide (Procan) Group 1 --Common routes????

amiodarone (Cordarone) Group 3

verapamil (Calan) Group 4

lidocaine (Xylocaine) Group 1

propranolol (Inderol) Group 2

atenolol (Tenormin) Group 2

diltiazem (Cardizem) Group 4


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Antiarrhythmic Agents continuedMechanism of action??

1. Decrease automaticity of cardiac tissues from

the SA node

2. Alter the rate of conduction of electrical

impulses

3. Alter the refractory period of cardiac muscle

between consecutive contractions


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Nursing Implications for

Antiarrhythmic Agents 1. Monitor the apical pulse for 1 minute before

administration

2. Record rate and rhythm of heart beat

3. Patient should be supine when IV dose is given

to prevent postural hypotension

4. If receiving lidocaine, tocainide, procainamide

= question if any allergies to local anesthetics


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Nursing Implication continued 5. If drug causes GI irritation = give with meals

6. Assess vital signs after administration

7. Assess for any S/S of toxicity

--Dizziness, HA, dyspnea, chest pain, edema,

hypotension, bradycardia, etc. --Know the specific medication you are giving

look it up!!!!


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Cardiac Stimulants (Sympathomimetic

Agents)When would we need to use a cardiac stimulant???

Mechanism of action???

--Adrenergic or sympathomimetic drugs mimic theaction of norepinephrine (the sympathetic nervousstimulation)----MAY CAUSE:

1. Vasoconstriction of peripheral vessels 2. Vasodilation of vessels in skeletal muscles

3. Increased HR (Positive chronotropic effect)


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Mechanism of Action continued 4. Increase in the force of contraction of the heart

(Positive inotropic effect)

5. Increased rate of glycogenolysis in the liver &

skeletal muscles

6. Stimulation of the CNS

***Not all drugs produce the effects to the same

degree***


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Examples of Action of Specific Drugs If drug works at alpha-adrenergic receptors =

profound vasoconstriction of peripheral vessels, no

real effect of heart/respiratory systems

If drug works at beta-adrenergic receptors =

increase heart rate and force of contraction along

with bronchodilation, but no real effect onperipheral blood vessels


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Examples of DrugsDobutamine (Dobutrex)

Dopamine (Intropin)

Ephedrine

Epinephrine (Adrenalin)

Isoproterenol (Isupril) Phenylephrine (Neosynephrine)


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Common Side Effects 1Nervousness and restlessness

2Sweating

3Hypertension

4Tachycardia and palpitations

5Hyperglycemia 6N/V


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Sympathomimetic Agents 1. Assess vital signs and condition continuously

2. IV line is to be patentwatch for tissue

necrosis

3. Keep track of the names and dosages of drugs

administered during an emergency

4. Record


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Nursing Implications continued 5. Assess for CNS stimulation, HA, palpitations,

tremors, elevated blood sugars, abnormal lung

sounds

6. Be aware of the many drug interactions


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NitratesUsed for angina therapy

Actions (Theories): ***Vasodilators***

1Improve the delivery of O2 to ischemic tissue

by increasing coronary blood flow

2Cause favorable redistribution of blood flow 3Reduce the O2 consumption by coronary blood

vessels


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Examples of Nitrates nitroglycerine (Nitrostat, Nitro-Bid, NTG)

nitroglycerine SR tabs

isosorbide dinitrate (Isorbid)

isosorbide mononitrate (Imdur)

Routes??? (7)


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Side Effects of Nitrates 1HA

2Postural hypotension

3Dizziness

4Weakness

5Syncope 6Increase in introcular &/or intracranial pressure


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Other Drugs (Non-Nitrates) Used for

AnginaBeta-adrenergic blocker (propranolol, nadolol)

--Decrease HR & contractility = decreased

myocardial O2 demand

Calcium channel blocker (nifedipine, diltiazem,verapamil)

--Vasodilator = more blood to heart


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Nursing Implications for Nitrates and

Others for Angina 1. Assess the frequency, nature, precipitants of

angina

2. Teach patient to modify life styles

3. Assess the effectiveness of the drugs and for

side effects

4. Monitor vital signs, especially BP and HR


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Other Nursing Implications 5. Give medications while sitting or lying

6. Use Nitro cautiously in patients with glaucoma

7. Follow routes carefully (eg: SL = do not

swallow)

8. Nitro needs to be protected from heat, light,

should feel stinging sensation if working, get new

every 3 months


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Implications continued 9. IV Nitrodilute in IV solution, no other drugs

in the same lines, use Glass IV bottles and IV

tubing from manufacturer

10. If severe hypotension = elevate legs for 2-3

minutesif does not work slow rate and call MD

11. Teach patient to follow-up with MD, carry ID

card with information


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Implications continued 12. When beta-adrenergic blocking agent also

ordered ---give beta blocker first

13. Hold the drugs if BP lower than 90mmHG for

adult or HR less than 60 beats/min. Notify MD.

14. Assess BP and HR frequently


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Myocardial Infarction (MI)What is happening???

Reasons for MI??

1. Decrease flow of O2 to heart muscle

-- thrombus formation, embolism 2. Increased demand for O2 by myocardium

--Stress, heavy exertion, abrupt increase in BP


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Treatment of MIGoal???

1. AspirinWhy?? 7. Calcium Channel

2. NitroglycerinWhy?? BlockerWhy??

3. IV MorphineWhy??

4. Beta-BlockerWhy?? 5. ACE inhibitorWhy??

6. LidocaineWhy??


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Peripheral VasodilatorsUsed to treat???

1. Obstructive disorders (arteriosclerosis)

2. Vasospastic disorders (Raynauds)Mostly

effective with this type***

Some Drugs: Posicor, cilostazol, nylidrin


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Nursing Implications for Peripheral

Vasodilators 1. Assess the disease process, skin for color, hair,

lesions, pulses, temperature, turgor, auscultate for

arterial sounds

2. Watch for hypotensionlight headedness,

dizzy = lie down until effect passes

3. Educateno smoking, care of feet, effects of

meds, safety


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ThromboemboliHow does the body form a clot???

1. There is injury to the wall of a blood vessel

2. Activation of many different clotting factors

3. Formation of a fibrin clot

4. These clots can break loose and travel todifferent areas of the body causing more problems


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Anticoagulants 2 Purposes:

1. Prevent the formation of a thrombus

2. Inhibit the extension of the existing ones

Problems: 1. Many drug interactions

2. If not properly controlled, hemorrhagic risk


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Drug Groups the Affecting Blood

Clotting 1. Anticoagulants

2. Thrombolytic agents

3. alteplase, anistreplase

4. Hemostatic agents


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Heparin **MOST COMMON anticoagulants used**

Action = interfere with the conversion of

prothrombin to thrombin = prevents the conversion

of fibrinogen to fibrin = inhibits clots

Routes???


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Heparin continuedLab test measured by??

--Partial thromboplastin time (PTT)Therapeutic

1.5-2x normal range

Contraindicated in which type of patients??? (6)


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Heparin continuedWhat would you treat an overdose with???

--Protamine sulfate = combines with heparin to

form a stable complex with no anticoagulant action


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Oral Anticoagulantswarfarin (Coumadin) used most frequently

Method of action??

--1. Interferes with the synthesis of vitamin K

dependent clotting factors (II, VII, IX, X) in the

liver

Takes 12-24 hours to see any effect after

administered


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Coumadin continuedLab test used to measure drug???

--Prothrombin time (PT) = want it 1.5-2 x normal

value to be therapeutic level of drug

--INRInternational Normalized Ratio

Many drug interactions


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Coumadin continued If overdose: Vitamin K (phytonadione)

--Also blood transfusion if needed

Need frequent lab tests as inpatient and outpatient


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Antiplatelet Agents (Anticoagulants)Action:

--Used to inhibit the aggregation of platelets

Drugs: dipyridamole (Persantine), sulfinpyrazone

(Anturane), ticlopidine (Ticlid), abciximab

(ReoPro), chopidogrel bisulfate (Plavix),

acetylsalicylic acid (ASA, Aspirin)


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Anticoagulants 1. Assess for S/S of bleeding: #1 SIDE FFECT*

--Hematuria --Tarry stools --Excessive vaginal

bleeding --Abdominal, flank, or joint pain --HA

--Changes in neuro status --Hematomas or

ecchymotic areas --Vomiting blood (coffee

ground) --Bleeding from nose/gums/IV

sites/dressing, etc. --Weak, rapid pulse --Restless


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Nursing Implications continued 2. Nurse need to be familiar with the drugs being

used and treatment goal of MD

3. Make sure is into fat layer, short needle (5/8

inch), could use TB syringe, do NOT aspirate,

rotate sites, prefer abdominal area, do NOT

rub/massage after injection


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Nursing Implications continued 4. IVUse IV pump for steady rate, only hang a

portion of drug for several hour time period-

WHY??, do not mix/give with other drugs in sameline

5. Avoid IM injections = risk for hematomas

6. Avoid trauma, shaving = electric razor, soft

bristle toothbrush, assistance with ambulation


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Nursing Implications continued 7. Caution/Avoid use of aspirin products, alcohol,

NSAIDs

8. Use Tylenol for HA, aches/pains

9. Keep diet consistentdo not add/change meds

10. Keep follow-up appt. with MD

11. Teach proper dosageif need 7.5 mgyou

only have 5 mg tabswhat do you do???


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Thrombolytic AgentsAction?? 2-6 hour window for use????

1. Convert the substance plasminogen to the

enzyme fibrinolysin = dissolves the fibrin clots

Drugs: urokinase (Abbokinase), streptokinase

(Streptase), TPA (tissue plasminogen activator)

Used for which type of patients???

Side Effects???


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Thrombolysis 1. Assess patient for MIsevere pain, high

anxiety, location, nature, duration of pain, VS,

color, respiratory function, evidence of shockcold, clammy skin

2. After drug givenwatch for bleeding

cerebral, GI, pericardial. Assess VS, neuro status,visual signs of bleeding


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Nursing Implication continued 3. Apply pressure for 20-30 minutes on all

puncture sites during and after drug received

4. Assess urine for blood and hemoccult stool


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DiureticsAction???

Which type of patient would need these drugs???


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How does the Body Balance H2O and

NA??? 1. Maintained by the reabsorption of sodium along

the entire length of the nephron:

A. Proximal tubule = 70-80% reabsorbed

B. Ascending loop of Henle = 10-20 % reabsorbed

C. Distal tubule = 5% reabsorbedthis is

dependent on the concentration of the hormone

aldosterone


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Why is Potassium Imbalance a Big

Concern????Low Level = Hypokalemia:

*** Serious, life-threatening problems***

1. Potassium is needed for the neurotransmitters to

conduct impulse to the muscleslike heart, etc.

= cardiac arrhythmias, muscle weakness, lethargy,

paresthesias, hyporeflexia, altered mental status


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Treatment for Hypokalemia 1. Supplement with potassium chloride

--Come in tablets, capsules, liquids, effervescent

solutions, IV

Also can take in a food =fruits, vegetables,

almonds, peanuts, molasses, wheat germ


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Problems with High Levels of

Potassium???Hyperkalemia = ***Serious, life-threatening

problems***

Signs: Cardiac arrhythmias, muscle spasms,

muscle weakness to paralysis


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Hyponatremia Signs/symptoms:

Confusion, lethargy, muscle excitability,

convulsions, coma


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Thiazide DiureticsAction: Distal tubule = inhibits sodium and

chloride reabsorption along with chloride and

potassium from the Loop of Henle

Side effects???? (7)


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Common Agents chlorothiazide (Diuril)

hydrochlorothiazide (HydroDIURIL)

metolazone (Diulo, Zaroxolyn)


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Loop DiureticsMost potent diuretics

Site of action????

Remains effectiveeven with impaired

glomerular filtration ratesgood for young and

old


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Common Agentsbumetanide (Bumex)

ethacrynic acid (Edecrin)

furosemide (Lasix)


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Potassium-Sparing Diuretics Site of action???

**Not real potent diuretic**

What could happen the potassium level for thispatent????


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Common Agents amiloride (Midamor)

spironolactone (Aldactone)

triamterene (Dyrenium)


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Osmotic Diuretics Site of action???

Common agents: glycerin (Osmoglyn), mannital

(Osmitrol)

Uses? To treat intracranial pressure, Acute renal

failure, intraocular and intraspinal fluid pressure


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Combination Potassium-Sparing &

HCTZHCTZ = hydrochlorothiazide

Purpose of combining these drugs???

Common drugs: Aldactazide = spirolactone &HCTZ, Dyazide and Maxide = triamterene &

HCTZ


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HypertensionDefinedas sustained elevated arterial blood

pressure** Greater than or equal to 140/90* *

Possible causes???

Complications???


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Hypertension continuedRisk factors??? (7)

Mechanisms the control of blood pressure:

***CO x SVR = BP***


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Treatment for Hypertension 1. Life styleLike what changes???

**Add in medication:

2. Diuretics (Review earlier slides)

3. Centrally acting anti adrenergic agents

4. Peripherally acting anti adrenergic agents 5. Beta-adrenergic blockers

6. Vasodilators (Review earlier slides)


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Treatment continued 6. Angiotensin-Converting Enzyme (ACE)

Inhibitor

7. Aniotensin II Antagonists

8. Calcium Channel Blocking Agents

9. Combination ProductsWHY??

10. Agents used to treat Hypertensive

Emergencies


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Central Acting Antiadrenergic Agents **Potent antihypertensive but sedation biggest side

effect

Common agents: methyldopa (Aldomet), clonidine

(Catapres), guanfacine HCL (Tenex)

Action?? Block the sympathetic nervous system =

dilation of per ipheral blood vessels and reduced

HR


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Peripherally Acting Antiadrenergic

AgentsAction?? Works similar to Central Acting but

side effects = dizziness, weakness, syncope D/T

hypotensionCommon agents: prazocin (Minipress), terazosin

(Hytrin), doxazosin (Cardura)


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Beta-Adrenergic Blocking AgentsAction: Block the sympathetic nervous system

stimulation = decreased HR, decreased force of

contraction, & bronchoconstriction (Who shouldnot get this drug??)

Common agents: propranolol (Inderal), nadolol,perbutolol, timolol, pindolol, carteolol, labetalol,atenolol (Tenormin), metoprolol (Lopressor)


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Angiotensin-Converting EnzymeAction???

1. Are antagonists of the renin-angiotensin system

2. Interferes with the conversion of angiotension 1

from turning to angiotension 2 (which is a very

strong vasoconstrictor) = vasodilation = decreased

BP


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Common ACE Inhibitorsbenazepril (Lotensin), captopril (Capoten),

enalapril (Vasotec), fosinopril (Monopril),

lisinopril (Prinivil, Zestril), Quinapril (Accupril),ramipril (Altace)

One Unique Side Effect for this Class: Cough in15% on patients


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Angiotensin II AntagonistsAction???

1. Blocks the binding of angiotensin II on its

receptors = reduction in aldosterone concentrationsin the blood = less NA and H2O retention =

decreased BP

Common drugs: losartan (Cozaar), valsartan(Diovan), irbesartan, (Avapro)


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Calcium Channel Blocking AgentsAction???

1. Prevent Calcium across the cell membrane =

smooth muscle relaxation = vasodilation 2. Decreases myocardial contractility = decreases

workload of heart = decreases CO

Common drugs: diltiazem (Cardizem), nifedipine(Procardia), verapamil (Calan), amlodipine(Norvasc)


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Nursing Implications for Hypertension 1. Assess blood pressure and other vitals correctly

2. Teaching about disease, complications,

treatments, life-style changes needed, importanceof follow-up with MD

3. Teach on sodium-restricted dietread food

labels, not to add salt to cooking, watch processedfoods


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Nursing Implications continued 4. Assess fluid and electrolyte balance = daily

weight, I & O, s/s of potassium and sodium

problems 5. Assess for other side effects: orthostatic

hypotension, hyperglycemia, increased uric level

levels, dizziness, lightheadness, HA


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Nursing Implication continued 6. Teach patients to avoid heavy meals, exercise

of meals, highly stressful situations, avoid

straining at stool, safety to prevent falls/injuries


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Agents to Treat Hypertensive

EmergenciesBP is so high = permanent bodily damage or death

All IV route

Common drugs: diazoxide (Hyperstat), sodium

nitroprusside (Nitropress, Nipride), trimethaphan

camsylate (Arfonad)


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Time to Study All This!!!

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Cv Drugs Nursing2007