Cardiac Medications

• Cardiac medications treat cardiovascular pathology.

Antiarrhythmic Medications

• These drugs affect the electrical conduction system of the myocardium.
• They block the SA node, AV node, His-Purkinje system, or electrical membrane current within myocardial cells.
• They block electrolyte channels (sodium, calcium, potassium) or beta receptors in the myocardium.
• The aim is to suppress excess electrical conduction and decrease arrhythmia production.
• Common drugs: lidocaine, procainamide, flecainide, disopyramide, mexilitine, moricizine, amiodarone, atenolol, metoprolol, acebutolol, esmolol, labetolol, sotalol, propafenone, diltiazem, verapamil, adenosine, ibutilide, dofetilide, and digoxin.

Antihypertensive Medications

• These drugs lower blood pressure to safe levels.
• Also assist in heart failure by decreasing the pressure against which the heart pumps.
• They allow the heart to pump more efficiently.
• They lower blood pressure through vasodilation, decreased heart rate, decreased sympathetic nerve outflow, reduced sodium and water retention, inhibition of the renin-angiotensin-aldosterone system, or direct vasodilatory effects.
• Common drugs: verapamil, diltiazem, nifedipine, nicardipine, amlodipine, nisoldipine, captopril, enalopril, fosinopril, lisinopril, trandolapril, ramipril, quinapril, moexipril, perindopril, valsartan, olmesartan, candesartan, telmisartan, propranolol, acebutolol, atenolol, metoprolol, labetolol, nadolol, penbutolol, bisoprolol, pidolol, furosemide, bumetanide, torsemide hydrochlorothiazide, chlorothiazide, amiloride, sprionolactone, eprenolone, metolazone, hydralazine, isosorbide mononitrate, isosorbide dinitrate, bosentan, prazocin, terazosin, minoxidil, clonidine, guanethidine, methyldopa, and reserpine.

Heart Failure Medications

• These drugs have a positive inotropic effect, which is an increased force of contraction.
• Digoxin increases myocardial contraction force by stimulating calcium release.
• Digoxin also blocks the AV node to prevent excessive atrial beats from reaching the ventricle in patients with atrial fibrillation.
• The following are intravenous medications that increase contraction force: dobutamine, milrinone, dopamine, norepinephrine, and epinephrine.
• Dopamine, norepinephrine, and epinephrine also increase blood pressure.
• Patients on these five medications are less stable, and acute problems can occur rapidly.

Lipid-Lowering Medications

• They lower serum cholesterol and help patients with coronary syndromes or hypercholesterolemia.
• Common drugs: lovastatin, simvastatin, pravastatin, ezetimibe, fluvastatin, atorvastatin, gemfibrozil, colestipol, cholestyramine, and niacin.

Diuretics

• These drugs eliminate excess fluid and sodium from the bloodstream.
• They decrease pressure within the vessels.
• Overuse can cause dehydration and kidney failure.
• Common drugs: hydrochlorothiazide, chlorthalidone, furosemide, torsemide, bumetanide, acetazolamide, amiloride, chlorothiazide, ethacrynic acid, spironolactone, triamterene, metalo-zone, and indapamide.

Anticoagulant, Antiplatelet, and Thrombolytic Medications

• Patients on these are at risk for bleeding.
• Severe bleeding can lead to hemorrhagic stroke, especially with thrombolytics.
• Imaging technologists should report stroke signs.

Anticoagulant Medications

• Used in patients with a history or potential for blood clots.
• Warfarin prevents vitamin K absorption, preventing blood-clotting factor formation.
• Other drugs (heparin, enoxaparin, deltaparin, fundoparinox, bivalirudin, lepirudin, argatroban) affect thrombin to inhibit clot formation.

Antiplatelet Medications

• Used in patients after an acute ischemic event in the heart or brain.
• They prevent blood clot formation by targeting platelets.
• Common oral medications: aspirin, clopidogrel, and dipyridamole.
• Common intravenous medications: eptifibatide, abciximab, and tirofiban.

Thrombolytic Medications

• These drugs break up newly formed clots.
• Used in acute myocardial infarction, stroke, or lower leg ischemia.
• Common drugs: alteplase, retaplase, streptokinase, tenecteplase, and urokinase.
• Patients are at high risk for bleeding.
• Caution should be used with IV sites, and lines should not be started without physician orders.

Analgesic Medications

• Prescribed more frequently than any other medication.
• Treat acute and chronic pain syndromes, arthritis, headaches, muscle sprains, cancer pain, surgical pain, traumatic pain, and nerve pain.

Narcotic Medications

• They stimulate opioid receptors in the central nervous system, decreasing pain perception.
• They are potent analgesics with addiction potential.
• Highly controlled class of drugs.
• Can cause respiratory depression.
• Naloxone reverses effects of narcotic agents.
• Common drugs: morphine, meperidine, fentanyl, hydromorpone, hydrocodone, codeine, oxycodone, alfentanyl, remifentanyl, tramadol, pentazocine, nalbuphine, and butorphanol.

Nonsteroidal Antiinflammatory Drugs (NSAIDs)

• These drugs treat pain associated with inflammation.
• They relieve pain by inhibiting chemical mediators responsible for stimulating pain receptors.
• They can cause platelet dysfunction and increase bleeding risk.
• Ulceration of the stomach and kidney failure are common adverse effects.
• Common drugs: ibuprofen, naproxen, nabumetone, diclofenac, ketorolac, indomethacin, fenoprofen, rofecoxib, celocoxib, and valdecoxib.
• Aspirin has similar actions.

Muscle Relaxants

• Treat pain associated with muscle spasms.
• Used for whiplash, spinal cord injury, and muscle strains.
• Can affect breathing by weakening respiratory muscles.
• Common drugs: cyclobenzaprine, baclofen, diazepam, lorazepam, clonazepam, alprazolam, methocarbamol, and metaxalone.

Acetaminophen

• A common analgesic, often in combination medications.
• Thought to inhibit prostaglandins in the central nervous system.
• It is a low-potency pain reliever.
• Doses must not exceed 4000 mg per day due to liver damage risks.
• Long-term use can cause renal and cardiac damage.

Antihistamine Medications

• These drugs block histamine to prevent itching, inflammation, respiratory distress, and allergic reactions.
• Common drugs: hydroxyzine (Vistaril, Atarax) and diphenhydramine (Benadryl).
• Newer drugs, like fexofenadine (Allegra), loratadine (Claritin), and cetirizine (Zyrtec), are less sedating.
• Antihistamines are sedating and may lead to respiratory depression when used in combination with analgesic medications.

Endocrine Medications

• Diabetes and hypothyroidism are common conditions treated with drugs.

Antidiabetic Medications

• These are required for patients to maintain blood sugar balance.
• Type 1 diabetics are insulin-dependent.
• Type 2 diabetics have poor receptor sensitivity to insulin.
• Types of insulin: ultrashort acting, short acting, intermediate acting, long acting, and ultralong acting.
• Patients taking insulin need regular meals.
• Non-insulin-dependent diabetics may require oral medications.
• Common drugs: glimeprimide, glipizide, glyburide, rosiglitazone, pioglitazone, nateglinide, and metformin.
• Metformin should be held before and for 48 hours after contrast administration to prevent metabolic acidosis.

Thyroid Medications

• Used to treat hypothyroidism due to lack of thyroid hormone production or thyroid gland removal.
• Thyroid hormone regulates metabolic processes.
• Common hormones to enhance thyroid function: levothyroxine, thyroxine, liothyronine, and desiccated thyroid.
• Common preparations to block or inhibit thyroid function: methimazole and propylthiouracil.

Central Nervous System Medications

• These drugs have direct effects on the central nervous system.

Antiseizure (Anticonvulsant) Medications

• Used to prevent and treat seizure disorders.
• Goals are to stop seizure activity and prolong intervals between events.
• Examples: phenytoin, fosphenytoin, ethotoin, metphenytoin, diazepam, clonazepam, lorazepam, valproic acid, divalproex, topiramate, carbamazepine, oxcarbazine, phenobarbital, amobarbital, pentobarbital, secobarbital, ethosuximide, methsuximide, felbamate, gabapentin, lamotrigine, tiagabine, zon-isamide, and levetiracetam.

Antipsychotic Medications

• Treat psychotic episodes and disorders.
• Take weeks to months to reach full effect.
• Common drugs: haloperidol, valproic acid, divalproex, olanzapine, clozapine, quetiapine, aripiprazole, chlorpromazine, fluphenazine, triflupromazine, loxapine, mesoridazine, thioridazine, amoxepine, perphenazine, risperidone, ziprasidone, thiothixine, and pimozide.

Antidepressant Medications

• Treat clinical depression.
• They enhance CNS levels of serotonin and norepinephrine.
• Require weeks of therapy.
• Common drugs: amitriptyline, nortriptyline, desipramine, imipramine, protriptyline, trimipramine, amoxapine, maprotiline, isocarboxazid, tranylcypromine, sertraline, citalopram, escitalopram, fluoxetine, venlafaxine, mirtazapine, trazadone, buproprion, and nefazodone.

Antianxiety Medications

• Treat acute and chronic anxiety.
• Patients may require sedatives for CT and MRI scans because of claustrophobia.
• They enhance the effect of gamma-aminobutyric acid or serotonin in the brain.
• Drugs: diazepam, lorazepam, midazolam, alprazolam, chlordiazepoxide, clonazepam, and buspirone.

Antiinfective Agents

• These agents kill or suppress pathologic microorganisms.
• Antibiotics treat bacteria.
• Antifungals treat fungi.
• Antivirals suppress viruses.
• They destroy, inhibit, or suppress the cell wall, enzymatic activity, or ribosomal or DNA function.
  • Antibiotics:
    • penicillins (oxacillin, cloxacillin, nafcillin, ampicillin, ticarcillin, piperacillin)
    • cephalosporins (cefazolin, cefuroxime, ceftriaxone, cefpodoxime, cefotetan, cefamandole, cefaclor, cefalexin, cefadroxil, ceftazidime, cefipime)
    • carbapenams (meropenam, imipenam, ertapenam)
    • tetracyclines (tetracycline, minocycline, doxycycline)
    • macrolides (erythromycin, clarithromycin, azithromycin)
    • lincosamides (clindamycin)
    • nitroimidazoles (metronidazole).
  • Antifungals: amphotericin B, fluconazole, voriconazole, caspofungin, clotrimazole, flucytosine, itraconazole, miconazole, ketoconazole, nystatin, and terbinafine.
  • Antivirals: acyclovir, famciclovir, ganciclovir, ribavirin, valacyclovir, valganciclovir, rimantidine, foscarnet, and interferon.

Chemotherapy Agents

• These are toxic compounds that kill rapidly growing cancerous cells.
• They are toxic to all cells in a growth stage.
• Special precautions should be taken to avoid contact.
• Contact can cause serious side effects.
• Universal precautions and special gloves/gowns should be worn.
• Examples: adriamycin, etoposide, vincristine, VP-16, cyclophosphamide, bleomycin, flurouracil, doxirubucin, paclitaxel, docetaxel, methotrexate, and nitrogen mustard.