Perfusion Medications Review

• This reviews various medications, their uses, mechanisms, and considerations in perfusion.
• Includes drugs for hypertension, arteriosclerosis & peripheral arterial disease (PAD), and myocardial infarction.
• Also lists medications for heart failure and related contraindications.

Drugs for Hypertension

• Hydrochlorothiazide (Thiazide Diuretic)

  • Blocks reabsorption of sodium and chloride in the distal convoluted tubule
  • Not effective for fluid loss with low GFR
  • Decreases preload
  • Used for hypertension and to mobilize edema in mild to moderate heart failure
  • Adverse effects include loss of sodium, chloride, and water leading to hyponatremia, hypochloremia and dehydration; hypotension and hypokalemia can also occur
  • Withhold if dehydrated or hypotensive, monitor for drug interactions with digoxin
  • Desired outcome is BP 130/80 and reduced edema with weight check

• Furosemide (Loop Diuretic)

  • Blocks reabsorption of sodium and chloride in the loop of Henle and promotes fluid loss in chronic kidney disease
  • Decreases preload
  • Used for hypertension not controlled with other diuretics, heart failure, and edema
  • Adverse effects include loss of sodium, chloride, and water causing hyponatremia and hypochloremia; dehydration may occur
  • Withhold if dehydrated or hypotensive and monitor for drug interactions with digoxin
  • Evaluate for fluid decrease, reduce edema, check weight, JVD, and BNP with BP 130/80 readings

• Spironolactone (Potassium-Sparing Diuretic)

  • Blocks aldosterone action in the distal nephron
  • Promotes sodium uptake while retaining potassium and excreting sodium
  • Used for hypertension and edema
  • Can cause hyperkalemia and gynecomastia
  • Should be withheld if potassium is above 5mEq/L
  • Do not give with potassium supplements, salt substitutes, or potassium-sparing diuretics
  • Use ACE or ARBs cautiously, as they suppress aldosterone and increase potassium
  • Administer with thiazide or loop diuretics to maintain potassium levels between 3.5-5 mEq/L
  • Expect lower BP and decreased edema

• Lisinopril, Enalapril, or Captopril (Angiotensin-Converting Enzyme (ACE) Inhibitor)

  • Inhibits angiotensin I, increasing bradykinin levels and promoting vasodilation
  • Used for hypertension, heart failure, acute myocardial infarction, and neuropathy and can prevent MI
  • May cause increased bradykinin levels, leading to vasodilation, cough, and angioedema
  • Be cautious of first-dose hypotension and fall risk
  • Advise the patient to rise slowly, and temporarily discontinue diuretics for 2-3 days and treat hypotension when necessary
  • Expect lower BP and lowered volume in heart failure

• Valsartan or Losartan (Angiotensin II Receptor Blocker)

  • Blocks angiotensin II, dilates blood vessels, and reduces blood volume by preventing sodium and water reabsorption
  • Decreases preload and afterload
  • Treats hypertension and heart fialure
  • Prevents myocardial ifarction and stroke in at-risk patients
  • Side effects include angioedema and hypotension
  • Fall reisk is possible
  • Lower BP is expected

• Receptor Blockers

  • Powerful vasoconstrictors
  • ARBs are the second choice if ACE inhibitors cannot be tolerated
  • Causes dilation of arterioles & veins, blocking angiotensin II can prevent pathologic changes in cardiac structure
  • Decreases aldosterone release and increase renal excretion of Na & H2O
  • Decreases preload and afterload
  • Used in pts at risk for CV events, specifically those with hypertension
  • Hyperkalemia can result
  • Monitor for wheals, edema of tongue, glottis, lips, eyes, pharynx; treat with epinephrine and be carful in patients with renal artery stenosis

Medications for Angina and Blood Pressure control

• Labetalol, Atenolol, or Metoprolol (Beta-Adrenergic Blockers)

  • Blocks beta 1 receptors to decrease HR and contractility, reducing cardiac output
  • Decreases afterload
  • Suppresses reflex tachycardia caused by vasodilators
  • Blocking beta 1 receptors on juxtaglomerular cells of kidney reduces renin release
  • longer use reduces PVR leading decreased BP effects
  • First-line treatment for exertional angina, hypertension, cardiac dysrhythmias, myocardial infarction, and heart failure
  • May cause bradycardia and fatigue
  • Do not prescribe to patients in cardiac arrest/low HR
  • Use with caution on patients with asthma
  • Monitor lower BP & HR for treatment of angina

• Nifedipine, Verapamil, or Diltiazem (Calcium Channel Blockers)

  • Blocks calcium channels in blood vessels and heart muscles
  • Reduces HR by blocking the SA node, decreasing cardiac output
  • Suppresses AV node
  • Vasodilation reduces afterload, lowers BP
  • Increases coronary perfusion
  • Treats angina, hypertension, and cardiac dysrhythmias(A-fib, A-flutter, paroxysmal SVT)
  • Causes hypotension, bradycardia, edema, and dizziness in those with compromised CV function
  • Can mask hypoglycemia
  • Do not take with digoxin
  • Monitor for lower BP & HR for treatment of angina

Arteriosclerosis & Peripheral Arterial Disease (PAD)

• Atorvastatin (HMG-CoA Reductase Inhibitor/Statin)
  • Inhibits HMG-CoA reductase and decreases production of apolipoprotein B-100
  • Used for hypercholesterolemia
  • Reduces the risk of myocardial infarction, angina, and stroke
  • Side effects include headaches, memory loss, GI issues, and rhabdomyolysis
  • Expect to observe lowered lipid levels, lowered cholesterol and LDLs, and increased HDLs while monitoring liver function

Antiplatelet and Anticoagulant Medications

• Aspirin (Acetylsalicylic Acid/ASA)

  • COX2 inhibitor
  • Reduces pain, fever, and inflammation
  • Inhibits COX1 which controls important clotting pathways
  • Prevents blood clot formation by blood clots by blocking COX-1
  • Reduces the risk of heart attack or stroke
  • Suppresses platelet aggregation
  • Reduces inflammation, analgesia, and fever
  • May cause GI bleeding during long-term therapy or anemia
  • Contraindicated in patients with bleeding disorders
  • Discontinue high-dose ASA one week prior to procedures
  • Check for tinnitus
  • Not signs of MI, PAD complications/stroke

• Clopidogrel (Antiplatelet)

  • Blocks P2Y12 ADP receptors on platelets, preventing ADP-stimulated platelet aggregation
  • Used to reduce thrombotic events in coronary artery stents, MI, ischemic stroke, and peripheral arterial disease
  • Can cause GI bleeding and bruising
  • Discontinue five days prior to surgery and teach bleeding signs
  • Used with caution on children
  • Prevention of thrombotic event is expected

• Heparin (Anticoagulant)

  • Suppresses coagulation by binding with antithrombin and inactivating clotting factor Xa
  • Treats MI, PAD, PE, DVT, and post-op DVT prevention
  • Contraindicated in patients with bleeding disorders
  • May causes hemorrhaging
  • Must monitor for bleeding and a PTT between 4-6 hours
  • Only give to patients with a-fib
  • Protamine sulfate is the antidote
  • Prevention of thrombosis is expected

• Cilostazol

  • Inhibits platelet aggregation
  • Promotes vasodilation
  • Treats intermittent claudication
  • May cause headache and bleeding
  • Avoid smoking/nicotine or grapefruit juice while taking this drug

Medications for Myocardial Infarction

• Nitroglycerine (Nitrate)

  • Vasodilator acting directly on vascular smooth muscle
  • Decreases preload and afterload
  • Treats angina and STEMI; assists with heart failure
  • Contraindicated in patients with HA
  • May cause orthostatic hypotension and reflex tachycardia
  • Check BP prior to administering and advise patients to sit or lie down if lightheaded or dizzy
  • Avoid other hypertensive drugs and alcohol

• Morphine Sulfate (Opioid Agonist)

  • Binds to opiate receptors, producing generalized CNS depression
  • Venodilation reduces cardiac preload and arterial dilation reduces afterload
  • Reduces preload and afterload, lowering cardiac oxygen demand which preserves ischemic myocardium
  • Treats pain and relieves dyspnea
  • Monitor BP, respirations, and HR
  • Use naloxone as an antidote

• Oxygen

  • Begin if saturation id less than 90%

• Aspirin

  • Give an immediate does to those experiencing chest pain and/or a heart atack
  • Start immediately after heart attack/stroke event

• Metoprolol XL, Carvedilol CR (Beta Blocker)

  • Reduces HR and contractility
  • Reduces CO and and oxygen
  • Used on those who are experiencing STEMI
  • Begin use 24 hours after experiencing STEMI

• Alteplase and Tenecteplase(Fibrinolytic)

  • Converts plasmin which digests fibrin, and is used for short- term mortality
  • Should be given 30 of entering the emergency departmen
  • Used on those displaying ischemic paint (no more that 12-24 hours"
  • Reduce or eliminates chest pain by reducing St elevation or infarction

Heart Failure Medications

• Enalapril
  • Lowers arteriolar tone to improve blood flow
  • Reduces cardiac afterload and venous dilation
  • Lowers pulmonary congestion and peripheral edema
  • Promotes Na and H2O excretion to reduced venous return to heart
  • May cause increased levels bradykinin that increase cough and cause angioedema
  • Teach patients too limit the amount of K supplements