cardiac meds

PYRAMID POINTS PYRAMID POINTS

MODULE 52:MODULE 52:CARDIOVASCULAR MEDICATIONS CARDIOVASCULAR MEDICATIONS

Copyright © 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc. Slide 1

ADULT HEALTH:Cardiovascular Medications

PYRAMID POINTSPYRAMID POINTS

I. AnticoagulantsI. Anticoagulants DescriptionDescription

• Prevent extension and formation of clots by inhibiting factors in clotting Prevent extension and formation of clots by inhibiting factors in clotting cascade and decreasing blood coagulabilitycascade and decreasing blood coagulability

Side effectsSide effects• BleedingBleeding

Heparin sodiumHeparin sodium• Normal activated partial thromboplastin time (aPTT) 20 to 30 secondsNormal activated partial thromboplastin time (aPTT) 20 to 30 seconds• Antidote is protamine sulfateAntidote is protamine sulfate

Enoxaparin (Lovenox)Enoxaparin (Lovenox) Warfarin sodium (Coumadin)Warfarin sodium (Coumadin)

• Normal prothrombin time (PT) is 11 to 12.5 secondsNormal prothrombin time (PT) is 11 to 12.5 seconds• Normal international normalized ratio (INR) is 0.7 to 1.8Normal international normalized ratio (INR) is 0.7 to 1.8• Antidote is vitamin K (phytonadione [AquaMEPHYTON])Antidote is vitamin K (phytonadione [AquaMEPHYTON])

Slide 2Copyright © 2013, 2010, 2006, 2003, 2000 by Saunders, an imprint of Elsevier Inc.



II. Thrombolytic MedicationsII. Thrombolytic Medications DescriptionDescription

• Dissolve clotsDissolve clots ContraindicationsContraindications

• Active bleeding, stroke or other intracranial problems, surgical Active bleeding, stroke or other intracranial problems, surgical client, hepatic or renal disease, uncontrolled hypertension, client, hepatic or renal disease, uncontrolled hypertension, recent cardiopulmonary resuscitation, or hypersensitivityrecent cardiopulmonary resuscitation, or hypersensitivity

Side effectsSide effects• BleedingBleeding

InterventionsInterventions• Monitor for bleedingMonitor for bleeding• Implement bleeding precautionsImplement bleeding precautions

AntidoteAntidote• Aminocaproic acid (Amicar) is antidote for streptokinaseAminocaproic acid (Amicar) is antidote for streptokinase




III. Antiplatelet MedicationsIII. Antiplatelet Medications DescriptionDescription

• Inhibit aggregation of platelets and prolong bleeding timeInhibit aggregation of platelets and prolong bleeding time Side effectsSide effects

• BleedingBleeding InterventionsInterventions

• Monitor for bleedingMonitor for bleeding• Implement bleeding precautionsImplement bleeding precautions




IV. Positive Inotropic-Cardiotonic MedicationsIV. Positive Inotropic-Cardiotonic Medications DescriptionDescription

• Stimulate myocardial contractilityStimulate myocardial contractility Side effectsSide effects

• Dysrhythmias, hypotension, thrombocytopeniaDysrhythmias, hypotension, thrombocytopenia Toxic, adverse reactionsToxic, adverse reactions

• Hepatotoxicity, hypersensitivityHepatotoxicity, hypersensitivity InterventionsInterventions

• Monitor for side effects and adverse effectsMonitor for side effects and adverse effects• Closely monitor pulse and blood pressure Closely monitor pulse and blood pressure




V. Cardiac GlycosidesV. Cardiac Glycosides DescriptionDescription

• Increase the force of myocardial contraction and slow the heart Increase the force of myocardial contraction and slow the heart raterate

Side effects, toxic effectsSide effects, toxic effects• Gastrointestinal (GI) disturbances (anorexia, nausea, vomiting, Gastrointestinal (GI) disturbances (anorexia, nausea, vomiting,

diarrhea)diarrhea)• Visual disturbancesVisual disturbances• BradycardiaBradycardia

InterventionsInterventions• Monitor for toxicity; digoxin level above 2 ng/mLMonitor for toxicity; digoxin level above 2 ng/mL• Monitor potassium level for hypokalemiaMonitor potassium level for hypokalemia• Monitor apical pulse; if less than 60/min, hold medication, notify Monitor apical pulse; if less than 60/min, hold medication, notify

health care providerhealth care provider




VI. Antihypertensive MedicationsVI. Antihypertensive Medications Thiazide diureticsThiazide diuretics

• Side effects include hypercalcemia, hyperglycemia, Side effects include hypercalcemia, hyperglycemia, hyperuricemia, hypokalemia, hyponatremia, hypovolemiahyperuricemia, hypokalemia, hyponatremia, hypovolemia

• Interventions include monitoring vital signs, appropriateness of Interventions include monitoring vital signs, appropriateness of laboratory values, intake and output (I&O), intake of potassium-laboratory values, intake and output (I&O), intake of potassium-containing foodscontaining foods

Loop diureticsLoop diuretics• Side effects include hypokalemia, hyponatremia, hypocalcemia, Side effects include hypokalemia, hyponatremia, hypocalcemia,

hypomagnesemia, orthostatic hypotensionhypomagnesemia, orthostatic hypotension• Interventions include monitoring vital signs, appropriateness of Interventions include monitoring vital signs, appropriateness of

laboratory values, I&O, intake of potassium-containing foodslaboratory values, I&O, intake of potassium-containing foods



PYRAMID POINTS PYRAMID POINTS

VI. Antihypertensive Medications (continued) VI. Antihypertensive Medications (continued) Osmotic diureticsOsmotic diuretics Carbonic anhydrase inhibitorsCarbonic anhydrase inhibitors Potassium-sparing diureticsPotassium-sparing diuretics

• Side effects include hyperkalemiaSide effects include hyperkalemia• Interventions include monitoring potassium blood levelInterventions include monitoring potassium blood level




VII. Peripherally Acting VII. Peripherally Acting -Adrenergic Blockers-Adrenergic Blockers DescriptionDescription

• Cause vasodilation and decrease blood pressureCause vasodilation and decrease blood pressure• Used to treat hypertension and to maintain renal blood flowUsed to treat hypertension and to maintain renal blood flow

Side effectsSide effects• HypotensionHypotension• TachycardiaTachycardia• Sodium and water retentionSodium and water retention• GI disturbancesGI disturbances

InterventionsInterventions• Monitor blood pressure and apical heart rateMonitor blood pressure and apical heart rate• Monitor for fluid retention and edemaMonitor for fluid retention and edema




VIII. Centrally Acting Sympatholytics VIII. Centrally Acting Sympatholytics (Adrenergic Blockers)(Adrenergic Blockers) DescriptionDescription

• Inhibit vasoconstriction and reduce peripheral resistanceInhibit vasoconstriction and reduce peripheral resistance• Used to treat hypertensionUsed to treat hypertension

Side effectsSide effects• Sodium and water retentionSodium and water retention• BradycardiaBradycardia• HypotensionHypotension

InterventionsInterventions• Monitor blood pressure and apical heart rateMonitor blood pressure and apical heart rate• Monitor for fluid retention and edemaMonitor for fluid retention and edema• Instruct client that abrupt withdrawal can cause rebound Instruct client that abrupt withdrawal can cause rebound

hypertensionhypertension




IX. Angiotensin-Converting Enzyme (ACE) IX. Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotension II Receptor Inhibitors and Angiotension II Receptor Blockers (ARBs)Blockers (ARBs) DescriptionDescription

• Prevent peripheral vasoconstrictionPrevent peripheral vasoconstriction• Used to treat hypertension and heart failureUsed to treat hypertension and heart failure

Side effectsSide effects• Persistent dry coughPersistent dry cough• HypotensionHypotension• TachycardiaTachycardia• HyperkalemiaHyperkalemia• Hypoglycemia in diabetic clientHypoglycemia in diabetic client

InterventionsInterventions• Avoid use with potassium supplements and potassium-sparing Avoid use with potassium supplements and potassium-sparing

diureticsdiuretics• Monitor vital signs and for signs of hyperkalemiaMonitor vital signs and for signs of hyperkalemia• Instruct diabetic client about the risk for hypoglycemiaInstruct diabetic client about the risk for hypoglycemia• Instruct client to report persistent dry coughInstruct client to report persistent dry cough




X. Antianginal MedicationsX. Antianginal Medications NitratesNitrates

• Side effectsSide effects• Sublingual medicationsSublingual medications• Translingual medications (spray)Translingual medications (spray)• Sustained-release medicationsSustained-release medications• Transmucosal-buccal medicationsTransmucosal-buccal medications• Transdermal patchTransdermal patch• Topical ointmentsTopical ointments• Client educationClient education




XI. XI. -Adrenergic Blockers-Adrenergic Blockers DescriptionDescription

• Decrease the workload of the heart and decrease myocardial Decrease the workload of the heart and decrease myocardial oxygen demandsoxygen demands

• Decrease heart rate and blood pressureDecrease heart rate and blood pressure• May mask symptoms of hypoglycemia in diabetic clientMay mask symptoms of hypoglycemia in diabetic client

Side effectsSide effects• BradycardiaBradycardia• HypotensionHypotension• BronchospasmBronchospasm

InterventionsInterventions• Monitor apical pulse rate and blood pressureMonitor apical pulse rate and blood pressure• Monitor for respiratory distress Monitor for respiratory distress • Instruct the diabetic client to monitor for signs of hypoglycemiaInstruct the diabetic client to monitor for signs of hypoglycemia




XII. Calcium Channel BlockersXII. Calcium Channel Blockers DescriptionDescription

• Decrease the workload of the heart and decrease myocardial Decrease the workload of the heart and decrease myocardial oxygen demandsoxygen demands

• Promote vasodilation of coronary and peripheral vesselsPromote vasodilation of coronary and peripheral vessels• Used to treat angina, dysrhythmias, and hypertensionUsed to treat angina, dysrhythmias, and hypertension• Used with caution in heart failure, bradycardia, or atrioventricular Used with caution in heart failure, bradycardia, or atrioventricular

blockblock Side effectsSide effects

• BradycardiaBradycardia• HypotensionHypotension• Reflex tachycardiaReflex tachycardia

InterventionsInterventions• Monitor apical heart rate and blood pressureMonitor apical heart rate and blood pressure• Monitor for signs of heart failureMonitor for signs of heart failure• Instruct the client to report dizziness or faintingInstruct the client to report dizziness or fainting




XIII. Peripheral VasodilatorsXIII. Peripheral Vasodilators DescriptionDescription

• Decrease peripheral resistance Decrease peripheral resistance • Increase blood flow to extremitiesIncrease blood flow to extremities• Used to treat peripheral vascular disorders and cerebral Used to treat peripheral vascular disorders and cerebral

vascular insufficiencyvascular insufficiency Side effectsSide effects

• HypotensionHypotension• TachycardiaTachycardia• FlushingFlushing

InterventionsInterventions• Monitor apical heart rate and blood pressureMonitor apical heart rate and blood pressure• Monitor for signs of inadequate blood flow to extremitiesMonitor for signs of inadequate blood flow to extremities• Instruct client to change positions slowlyInstruct client to change positions slowly




XIV. Direct-Acting Arteriolar VasodilatorsXIV. Direct-Acting Arteriolar Vasodilators DescriptionDescription

• Relax smooth muscles of blood vessels, resulting in vasodilationRelax smooth muscles of blood vessels, resulting in vasodilation• Promote an increase in blood flow to the brain and kidneysPromote an increase in blood flow to the brain and kidneys• Used to treat hypertensionUsed to treat hypertension

Side effectsSide effects• HypotensionHypotension• Reflex tachycardiaReflex tachycardia• EdemaEdema

InterventionsInterventions• Monitor apical heart rate and blood pressureMonitor apical heart rate and blood pressure• Monitor for fluid retention and edemaMonitor for fluid retention and edema• Sodium nitroprussideSodium nitroprusside

Monitor cyanide and thiocyanide for signs of toxicityMonitor cyanide and thiocyanide for signs of toxicity




XV. Miscellaneous VasodilatorsXV. Miscellaneous Vasodilators DescriptionDescription

• Nesiritide (Natrecor) dilates arteries and veins and is used to Nesiritide (Natrecor) dilates arteries and veins and is used to treat decompensated heart failuretreat decompensated heart failure

Side effectsSide effects• HypotensionHypotension• DysrhythmiasDysrhythmias

InterventionsInterventions• Monitor apical heart rate and blood pressure, urine output, and Monitor apical heart rate and blood pressure, urine output, and

body weightbody weight• Monitor for signs of resolving heart failureMonitor for signs of resolving heart failure




XVI. Antidysrhythmic MedicationsXVI. Antidysrhythmic Medications DescriptionDescription

• Suppress dysrhythmias by inhibiting abnormal pathways of Suppress dysrhythmias by inhibiting abnormal pathways of electrical conduction through the heartelectrical conduction through the heart

• Classifications Classifications Class I: sodium channel blockersClass I: sodium channel blockers Class II: Class II: ββ-blockers-blockers Class III: potassium channel blockersClass III: potassium channel blockers Class IV: calcium channel blockersClass IV: calcium channel blockers

Interventions for antidysrhythmicsInterventions for antidysrhythmics• Monitor heart rate, respiratory rate, and blood pressureMonitor heart rate, respiratory rate, and blood pressure• Provide continuous cardiac monitoring Provide continuous cardiac monitoring • Administer intravenous antidysrhythmics via an infusion pumpAdminister intravenous antidysrhythmics via an infusion pump• Monitor for signs of fluid retentionMonitor for signs of fluid retention• Monitor for effective responseMonitor for effective response




XVII. Adrenergic AgonistsXVII. Adrenergic Agonists Dobutamine hydrochlorideDobutamine hydrochloride

• Increases myocardial force and cardiac output Increases myocardial force and cardiac output Dopamine hydrochlorideDopamine hydrochloride

• Increases BP, cardiac output, and renal blood flowIncreases BP, cardiac output, and renal blood flow EpinephrineEpinephrine

• Used for cardiac stimulation in cardiac arrestUsed for cardiac stimulation in cardiac arrest Isoproterenol hydrochloride (Isuprel)Isoproterenol hydrochloride (Isuprel)

• Used for cardiac stimulation and bronchodilationUsed for cardiac stimulation and bronchodilation Norepinephrine bitartrate (Levophed)Norepinephrine bitartrate (Levophed)

• Stimulates the heart in cardiac arrest and vasoconstricts and Stimulates the heart in cardiac arrest and vasoconstricts and increases the BP in hypotension and shockincreases the BP in hypotension and shock




XVII. Adrenergic Agonists (continued)XVII. Adrenergic Agonists (continued) Side effectsSide effects

• DysrhythmiasDysrhythmias• AnginaAngina• RestlessnessRestlessness• Urgency or urinary incontinenceUrgency or urinary incontinence

InterventionsInterventions• Monitor vital signsMonitor vital signs• Monitor urinary outputMonitor urinary output• Monitor electrocardiogramMonitor electrocardiogram




XVIII. Antilipemic MedicationsXVIII. Antilipemic Medications DescriptionDescription

• Reduce cholesterol, triglyceride, or low-density lipoprotein levelsReduce cholesterol, triglyceride, or low-density lipoprotein levels Bile sequestrantsBile sequestrants

• Side effectsSide effects ConstipationConstipation

• InterventionsInterventions Increase fluid intake and fiber in dietIncrease fluid intake and fiber in diet

3-Hydroxy-3-methyl-glutaryl–coenzyme A (HMG-CoA) reductase inhibitorsMG-CoA) reductase inhibitors• Side effectsSide effects

GI disturbances, visual disturbances, elevated serum liver GI disturbances, visual disturbances, elevated serum liver enzyme levelsenzyme levels

• InterventionsInterventions Instruct client to report visual problems or GI disturbancesInstruct client to report visual problems or GI disturbances




XVIII. Antilipemic Medications (continued)XVIII. Antilipemic Medications (continued) General interventionsGeneral interventions

• Monitor serum cholesterol and triglyceride levelsMonitor serum cholesterol and triglyceride levels• Instruct client about foods low in fat and cholesterolInstruct client about foods low in fat and cholesterol• Instruct client to follow an exercise programInstruct client to follow an exercise program



Question 1Question 1

The nurse has provided discharge instructions to a The nurse has provided discharge instructions to a client being placed on long-term anticoagulant client being placed on long-term anticoagulant therapy with warfarin (Coumadin). The nurse tells the therapy with warfarin (Coumadin). The nurse tells the client to do which of the following?client to do which of the following?

1.1. Avoid taking products containing acetylsalicylic acid Avoid taking products containing acetylsalicylic acid (aspirin).(aspirin).

2.2. Reduce alcohol intake to 12 oz daily. Reduce alcohol intake to 12 oz daily. 3.3. Take any over-the-counter medications as needed.Take any over-the-counter medications as needed.4.4. Alternate the timing of the daily dose.Alternate the timing of the daily dose.



Question 2Question 2

The nurse has a prescription to give a client a The nurse has a prescription to give a client a scheduled dose of digoxin (Lanoxin). Before scheduled dose of digoxin (Lanoxin). Before administering the medication, the nurse routinely administering the medication, the nurse routinely screens for which of the following manifestations screens for which of the following manifestations that could indicate digoxin toxicity?that could indicate digoxin toxicity?

1.1. Dyspnea, edema, and palpitationsDyspnea, edema, and palpitations2.2. Chest pain, hypotension, and paresthesiasChest pain, hypotension, and paresthesias3.3. Constipation, dry mouth, and sleep disorderConstipation, dry mouth, and sleep disorder4.4. Double vision, loss of appetite, and nauseaDouble vision, loss of appetite, and nausea


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