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  • PYRAMID POINTS MODULE 52:CARDIOVASCULAR MEDICATIONS

    Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.Slide *

    Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    ADULT HEALTH:Cardiovascular Medications

    PYRAMID POINTSI. AnticoagulantsDescriptionPrevent extension and formation of clots by inhibiting factors in clotting cascade and decreasing blood coagulabilitySide effectsBleedingHeparin sodiumNormal activated partial thromboplastin time (aPTT) 20 to 30 secondsAntidote is protamine sulfateEnoxaparin (Lovenox)Warfarin sodium (Coumadin)Normal prothrombin time (PT) is 11 to 12.5 secondsNormal international normalized ratio (INR) is 0.7 to 1.8Antidote is vitamin K (phytonadione [AquaMEPHYTON])

    Slide *Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    ADULT HEALTH:Cardiovascular Medications

    PYRAMID POINTSII. Thrombolytic MedicationsDescriptionDissolve clotsContraindicationsActive bleeding, stroke or other intracranial problems, surgical client, hepatic or renal disease, uncontrolled hypertension, recent cardiopulmonary resuscitation, or hypersensitivitySide effectsBleedingInterventionsMonitor for bleedingImplement bleeding precautionsAntidoteAminocaproic acid (Amicar) is antidote for streptokinase

    Slide *Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    ADULT HEALTH:Cardiovascular Medications

    PYRAMID POINTSIII. Antiplatelet MedicationsDescriptionInhibit aggregation of platelets and prolong bleeding timeSide effectsBleedingInterventionsMonitor for bleedingImplement bleeding precautions

    Slide *Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    ADULT HEALTH:Cardiovascular Medications

    PYRAMID POINTSIV. Positive Inotropic-Cardiotonic MedicationsDescriptionStimulate myocardial contractilitySide effectsDysrhythmias, hypotension, thrombocytopeniaToxic, adverse reactionsHepatotoxicity, hypersensitivityInterventionsMonitor for side effects and adverse effectsClosely monitor pulse and blood pressure

    Slide *Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    ADULT HEALTH:Cardiovascular Medications

    PYRAMID POINTSV. Cardiac GlycosidesDescriptionIncrease the force of myocardial contraction and slow the heart rateSide effects, toxic effectsGastrointestinal (GI) disturbances (anorexia, nausea, vomiting, diarrhea)Visual disturbancesBradycardiaInterventionsMonitor for toxicity; digoxin level above 2 ng/mLMonitor potassium level for hypokalemiaMonitor apical pulse; if less than 60/min, hold medication, notify health care provider

    Slide *Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    ADULT HEALTH:Cardiovascular Medications

    PYRAMID POINTSVI. Antihypertensive MedicationsThiazide diureticsSide effects include hypercalcemia, hyperglycemia, hyperuricemia, hypokalemia, hyponatremia, hypovolemiaInterventions include monitoring vital signs, appropriateness of laboratory values, intake and output (I&O), intake of potassium-containing foodsLoop diureticsSide effects include hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, orthostatic hypotensionInterventions include monitoring vital signs, appropriateness of laboratory values, I&O, intake of potassium-containing foods

    Slide *Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    ADULT HEALTH:Cardiovascular Medications

    PYRAMID POINTS VI. Antihypertensive Medications (continued) Osmotic diureticsCarbonic anhydrase inhibitorsPotassium-sparing diureticsSide effects include hyperkalemiaInterventions include monitoring potassium blood level

    Slide *Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    ADULT HEALTH:Cardiovascular Medications

    PYRAMID POINTSVII. Peripherally Acting -Adrenergic BlockersDescriptionCause vasodilation and decrease blood pressureUsed to treat hypertension and to maintain renal blood flowSide effectsHypotensionTachycardiaSodium and water retentionGI disturbancesInterventionsMonitor blood pressure and apical heart rateMonitor for fluid retention and edema

    Slide *Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    ADULT HEALTH:Cardiovascular Medications

    PYRAMID POINTSVIII. Centrally Acting Sympatholytics (Adrenergic Blockers)DescriptionInhibit vasoconstriction and reduce peripheral resistanceUsed to treat hypertensionSide effectsSodium and water retentionBradycardiaHypotensionInterventionsMonitor blood pressure and apical heart rateMonitor for fluid retention and edemaInstruct client that abrupt withdrawal can cause rebound hypertension

    Slide *Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    ADULT HEALTH:Cardiovascular Medications

    PYRAMID POINTSIX. Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotension II Receptor Blockers (ARBs)DescriptionPrevent peripheral vasoconstrictionUsed to treat hypertension and heart failureSide effectsPersistent dry coughHypotensionTachycardiaHyperkalemiaHypoglycemia in diabetic clientInterventionsAvoid use with potassium supplements and potassium-sparing diureticsMonitor vital signs and for signs of hyperkalemiaInstruct diabetic client about the risk for hypoglycemiaInstruct client to report persistent dry cough

    Slide *Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    ADULT HEALTH:Cardiovascular Medications

    PYRAMID POINTSX. Antianginal MedicationsNitratesSide effectsSublingual medicationsTranslingual medications (spray)Sustained-release medicationsTransmucosal-buccal medicationsTransdermal patchTopical ointmentsClient education

    Slide *Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    ADULT HEALTH:Cardiovascular Medications

    PYRAMID POINTSXI. -Adrenergic BlockersDescriptionDecrease the workload of the heart and decrease myocardial oxygen demandsDecrease heart rate and blood pressureMay mask symptoms of hypoglycemia in diabetic clientSide effectsBradycardiaHypotensionBronchospasmInterventionsMonitor apical pulse rate and blood pressureMonitor for respiratory distress Instruct the diabetic client to monitor for signs of hypoglycemia

    Slide *Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    ADULT HEALTH:Cardiovascular Medications

    PYRAMID POINTSXII. Calcium Channel BlockersDescriptionDecrease the workload of the heart and decrease myocardial oxygen demandsPromote vasodilation of coronary and peripheral vesselsUsed to treat angina, dysrhythmias, and hypertensionUsed with caution in heart failure, bradycardia, or atrioventricular blockSide effectsBradycardiaHypotensionReflex tachycardiaInterventionsMonitor apical heart rate and blood pressureMonitor for signs of heart failureInstruct the client to report dizziness or fainting

    Slide *Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    ADULT HEALTH:Cardiovascular Medications

    PYRAMID POINTSXIII. Peripheral VasodilatorsDescriptionDecrease peripheral resistance Increase blood flow to extremitiesUsed to treat peripheral vascular disorders and cerebral vascular insufficiencySide effectsHypotensionTachycardiaFlushingInterventionsMonitor apical heart rate and blood pressureMonitor for signs of inadequate blood flow to extremitiesInstruct client to change positions slowly

    Slide *Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    ADULT HEALTH:Cardiovascular Medications

    PYRAMID POINTSXIV. Direct-Acting Arteriolar VasodilatorsDescriptionRelax smooth muscles of blood vessels, resulting in vasodilationPromote an increase in blood flow to the brain and kidneysUsed to treat hypertensionSide effectsHypotensionReflex tachycardiaEdemaInterventionsMonitor apical heart rate and blood pressureMonitor for fluid retention and edemaSodium nitroprussideMonitor cyanide and thiocyanide for signs of toxicity

    Slide *Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    Copyright 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.

    ADULT HEALTH:Cardiovascular Medications

    PYRAMID POINTSXV. Miscellaneous VasodilatorsDescriptionNesiritide (Natrecor) dilates arteries and veins and is used to treat decompensated heart failureSide effectsHypotensionDysrhythmiasInterventionsMonitor apical heart rate and blood pressure, urine output, and body weightMonitor for signs of resolving heart failureSlide *Copyright 2