Pharmacology for Heart Conditions

Diuretic Therapy

• A desired effect of diuretic therapy is increased urination (polyuria).
• The goal of anti-cholesterol drugs is to lower LDL levels.

Hyperlipidemia Teaching

• Lifestyle changes may help avoid medication.
• Statin drugs are common hyperlipidemia medications.
• These medications may be needed for life.

Bumetanide

• A loop diuretic medication.

Heart Failure Management

• Clients with heart failure should follow a low-sodium diet.
• Fluid intake should be monitored.

Lidocaine Side Effects

• IV lidocaine can cause central nervous system (CNS) toxicity, including confusion and psychosis.
• Lidocaine can also cause numbness and tingling.
• Fluid overload from IV crystalloids can lead to heart failure.

Medications and Combinations

• Beta-blockers can cause arrhythmias, thyroid issues, PTSD, angina, and heart problems.
• Aspirin should not be taken with apixaban.
• Alteplase is a thrombolytic medication used to dissolve blood clots.
• Monoclonal antibodies inhibit LDL cholesterol production.
• Furosemide should be administered slowly to avoid hearing loss.
• Furosemide is a loop diuretic.
• Right heart failure (Right HF)
• Atorvastatin inhibits HMG-CoA reduction
• Atorvastatin adverse effects include muscle pain, weakness and dark urine.

Lipid Panel and Statins

• A lipid panel should be ordered before statin medications.
• Pregnant women should not be given atorvastatin (pregnancy category X).
• Patients on atorvastatin need regular lipid checks.
• Atorvastatin is used for hyperlipidemia and prevention of cardiovascular disease in clients with hypertension, diabetes, or those who smoke.
• Side effects include Rhabdomyolysis, hepatotoxicity, which should be evaluated through AST/ALT levels.

Cholesterol Management

• Cholestyramine reduces serum cholesterol and LDL levels.
• It should be taken 2 hours before or 4 hours after other medications.
• It should be given with 60-80ml of liquid.
• Gemfibrozil increases HDL and reduces VLDL.
• It can cause gallstones, RUQ abdominal pain, GI distress.
• Ezetimibe lowers cholesterol
• It can cause angioedema
• Alirocumab binds to LDL receptors on the liver.
• It can cause flu-like symptoms and is given subcutaneously.

Rivaroxaban

• Rivaroxaban is an oral medication.
• Andexanet alfa is the antidote.
• It does not require INR monitoring.

Metoprolol

• Slows heart rate and lowers blood pressure.
• Clients should not abruptly stop taking metoprolol.

Lisinopril

• ACE inhibitor.
• Pregnancy is a contraindication for lisinopril.

Amiodarone

• Used for atrial and ventricular dysrhythmias.
• Has a half-life of up to 50 days.
• Clients should be educated to use reliable forms of contraception while on this medication.

Milrinone

• Used to increase myocardial contractility, increasing cardiac output (short term use).
• Used for advanced heart failure.
• Clients have continuous electrocardiogram monitoring.
• Digoxin is a cardiac glycoside.

Verapamil

• Calcium channel blocker that treats dysrhythmias and should avoid grapefruit juice.

Heparin

• aPTT should be monitored while taking heparin.

Warfarin

• Contraindicated with gingko and many antibiotics
• PT and INR are monitored.
• Clients should not increase their dietary broccoli intake while on warfarin.
• INR can be 2-3 times higher than normal when taking warfarin.
• Vitamin K is the reversal agent.
• Education should include taking warfarin at the same time every day and for regular blood tests.

Clopidogrel

• Anti-platelet medication.
• Assess for bleeding and bruising prior to administration.
• SATA (Bleeding gums, black tarry stools, flu-like symptoms, petechiae).

Nitroglycerin

• Common side effect is headache.
• Heart rate and blood pressure should be monitored prior to administration

Carvedilol

• Heart rate and blood pressure are priority assessments before administration.

Enalapril, Enoxaparin

• ACE inhibitor used for hypertension and heart failure (HTN and HF).
• Enoxaparin is a lower molecular weight heparin given by injection (subQ, abdomen).