cardio medication from fadavis ppt

Antianginal Medications

• These medications dilate arteries and veins.
• Nitroglycerin is an example.
• Routes of administration include sublingual, buccal, spray, or IV, with sublingual being the most common.
• Nitroglycerin can be administered transdermally for both treatment and prevention of angina.
• For sublingual administration, it can be given every 5 minutes, up to a maximum of three times; if pain persists after this, EMS should be called.

Medications for the Clotting Process: Anticoagulants

• Anticoagulants prevent clot formation by interrupting the production of cofactors involved in the clotting process.
• DVT risk factors include being on bed rest, having fractures to the pelvis, obesity, recent surgery, and a family history of blood clots.
• Heparin and enoxaparin (Lovenox) are given as subcutaneous injections to patients at risk for developing deep vein thrombosis (DVT).
• Warfarin is administered orally.

Anticoagulant Precautions

• When administering anticoagulants, avoid profuse bleeding by using an electric razor.
• Patients should also reduce their intake of foods high in vitamin K and watch for signs of abnormal bleeding or bruising.
• Blood needs to be drawn regularly to monitor the effects of anticoagulants, specifically PT/INR which measures how long the blood takes to clot.

Medications for the Clotting Process: Antiplatelet Medications

• These medications prevent platelets from clumping together to form clots.
• Examples include aspirin, ticlopidine (Ticlid), clopidogrel (Plavix), abciximab (ReoPro), eptifibatide (Integrilin), and tirofiban (Aggrastat).
• Antiplatelet medications may increase the survival rate of heart attack patients if taken with initial symptoms.
• These medications may also prevent subsequent heart attacks.

Medications for the Clotting Process: Antifibrinolytic Medications

• These medications help to form clots when a patient is hemorrhaging.
• They provide hemostasis, which means they stop bleeding.
• Examples include aminocaproic acid (Amicar) and tranexamic acid (Cyklokapron).

Other Antiplatelet Medications

• Adenosine diphosphate (ADP) receptor blockers prevent clots from forming and provide long-term prevention against clot formation.
• Clopidogrel (Plavix) is an example of an ADP receptor blocker.
• Glycoprotein IIb/IIIa inhibitors prevent the enzyme that aggregates platelets from working.
• These inhibitors are given prior to surgery to prevent clots.
• Examples include abciximab (ReoPro), eptifibatide (Integrilin), and tirofiban (Aggrastat).

Medications for the Clotting Process: Thrombolytic Medications

• These medications are "clot busters" that can dissolve blood clots.
• A thrombus is a clot in a blood vessel, while an embolus is a clot that breaks loose and travels.
• Clots can cause MI, CVA, or pulmonary embolus.
• Symptoms of DVT include pain and swelling of the extremity.

Thrombolytic Medications: Tissue Plasminogen Activator (tPA)

• Tissue Plasminogen Activator (tPA) is given IV for acute stroke.
• A side effect is hemorrhage.
• Frequent testing is required to monitor clotting times.
  • Prothrombin Time (PT) evaluates the ability of blood to clot.
  • Activated Partial Thromboplastin Time (aPTT) evaluates heparin therapy.
  • International Normalized Ratio (INR) measures how long it takes blood to clot.
  • Patients taking warfarin (Coumadin) require INR monitoring.

Medications That Promote Blood Cell Development: Hematopoietic Stimulant Medications

• These medications stimulate the growth of blood cells.
• They treat anemias (such as sickle cell and pernicious anemias) and low blood iron levels.
• They are also used with patients on chemotherapy who experience bone marrow suppression.

Examples of Hematopoietic Stimulant Medications

• Ferrous sulfate (Feosol, Fer-in-Sol, Ferra-TD) is taken orally for iron deficiency anemia.
• Cyanocobalamin (vitamin B12) is given via injections for those with pernicious anemia.
• Filgrastim (Neupogen), pelfilgrastim (Neulasta), and sargramostin (Leukine) stimulate blood cell development.

Medications That Decrease Blood Pressure: Antihypertensives

• Hypertension is treated with antihypertensives.
• Angiotensin-converting enzyme (ACE) inhibitors stop the enzyme that converts angiotensin I to angiotensin II which normally causes constriction of blood vessels.
• Examples include captopril (Capoten), enalapril (Vasotec), and fosinopril (Monopril).

Antihypertensives: Angiotensin Receptor Blockers (ARBs)

• Angiotensin receptor blockers (ARBs) block the action of angiotensin, preventing constriction of blood vessels.
• They are used when ACE inhibitors are not tolerated.
• Examples include irbesartan (Avapro), losartan (Cozaar), and valsartan (Diovan).

Antihypertensives: Autonomic Nervous System Agents

• Adrenergic blockers are autonomic nervous system agents.
• Beta-adrenergic blockers (beta blockers) relax the fight or flight response.
• Examples include atenolol (Tenormin), bisoprolol (Zebeta), nadolol (Corgard), and propranolol (Inderal LA).

Medications That Decrease Blood Pressure: Diuretics

• Diuretics clear excess fluid from the body, decreasing peripheral vascular resistance.
• Thiazide diuretics are the most common class of diuretics.
• They decrease sodium and chloride reabsorbed by the kidneys.
• Examples include hydrochlorothiazide (HydroDIURIL) and chlorothiazide (Diuril).

Diuretics: Potassium-Sparing Diuretics

• Potassium-sparing diuretics interrupt the sodium-potassium exchange in the distal tubule, sparing potassium loss.
• Examples include amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium).

Diuretics: Loop Diuretics

• Loop diuretics, such as furosemide (Lasix), are the most potent diuretics.
• They act on the loop of Henle to inhibit sodium and chloride reabsorption.
• Loop and thiazide diuretics cause loss of valuable potassium, requiring supplemental potassium.
• Potassium is critical to the functioning of the heart; too much or too little may cause fatal cardiac arrhythmias.

Medications That Decrease Blood Pressure: Calcium Channel Blockers

• Calcium channel blockers dilate arteries to decrease peripheral vascular resistance.
• They reduce the workload of the heart, thus lowering blood pressure.
• Examples include amlodipine (Norvasc), diltiazem (Cardizem), nicardipine (Cardene), nifedipine (Procardia XL), and verapamil.

Blood Pressure Medications: Administration

• Always assess BP & HR prior to administering the medication and follow orders for holding.
• Typically hold for SBP <100.