Cardiovascular and Renal System Drugs Flash Card PDF

1 Cardiovascular & Renal System Drugs – Part 1 Directions for Activity: For Slides the First Bullet for each section is the front of slide and the bullets underneath are on the back of each slide. ACE Inhibitors – Mechanism of Action o End in “pril” o First line drugs for...

1 Cardiovascular & Renal System Drugs – Part 1 Directions for Activity: For Slides the First Bullet for each section is the front of slide and the bullets underneath are on the back of each slide. ACE Inhibitors – Mechanism of Action o End in “pril” o First line drugs for HF (heart failure) and hypertension (HTN) o Block ACE (Angiotensin Converting Enzyme) o Result: Decreased SVR (afterload), vasodilation, and decreases preload (diuresis - decreases water reabsorption) – Decreased BP and Decreased Work of the Heart. ACE Inhibitors - Indications o Hypertension (HTN) o Heart Failure (HF) – either alone or in combination with diuretics or other drugs – Drug of Choice o Cardioprotective o Renal Protective for Diabetics ACE Inhibitors – ProDrugs – What does this mean? o Liver must metabolize the drug into its active form. o Captopril and lisinopril are NOT prodrugs – Can be used in Patient with Liver Dysfunction ACE Inhibitors: Adverse Effects o Fatigue o Dizziness o Headache o Mood changes o Impaired taste o Possible hyperkalemia o Dry, nonproductive cough – Reversed therapy is stopped o Angioedema: Rare but potentially fatal o Note: First dose hypotensive effect may occur. ACE Inhibitors: Contraindications o Hyperkalemia Normal Potassium & Creatinine Levels – Why Important with BP Drugs? o Potassium Level – 3.5 to 5.2 mEq/L - Monitor Potassium Levels – Risk for Hyperkalemia or Hypokalemia. o Serum Creatinine – 0.5 to 1.4 mg/d/dL – BP drugs can cause renal impairment o Monitor Liver Function – ACE Inhibitors are ProDrugs – Require Liver to metabolize into active form.  2 Captopril (Capoten) o Drug Class: ACE Inhibitor o Uses: Cardioprotective: Prevention of ventricular remodeling after MI ▪ Reduce the risk of HF after MI o Shortest Half-Life – 3 to 4 doses a day. Enalapril (Vasotec) o Drug Class: ACE Inhibitor o Prodrug – Oral and also IV o Given IV – Does not Require Cardiac Monitoring ▪ Required for Beta Blockers and Calcium Channel Blockers o Cardioprotective Angiotensin II Receptor Blockers (ARBs) – Mechanism of Action o End in “sartan” o Block the binding of Angiotensin II to Type 1 Angiotensin II receptors in the smooth muscle and adrenal gland. ▪ Prevents vasoconstriction ▪ Prevent aldosterone secretion Prevents water and sodium reabsorption Comparison – ACE Inhibitors & ARBs o Equally effective treatment for HTN. o Both are well tolerated. o ARBs do not cause cough. o ARBS better tolerated o ARBs lower mortality after MI o Protective Effects – Unclear if ARBs are better than ACEs. Angiotensin II Receptor Blockers (ARBs) - Indications o Hypertension o Adjunctive drugs for the treatment of HF o Used alone (monotherapy) or with other drugs – such as diuretics. Angiotensin II Receptor Blockers (ARBs) – Adverse Effects o Chest pain o Fatigue o Hypoglycemia o Diarrhea o Urinary tract infection o Anemia o Weakness o Note: Hyperkalemia and cough are less likely than with the ACE inhibitors.  3 Losartan (Cozaar) o Drug Class: ARB o Used for hypertension and HF o Use with caution – Kidney (renal) and hepatic (Liver) dysfunction patients ▪ Also renal artery stenosis (narrowing). Diuretics – Information in Cardiovascular and Renal System Drugs – Part 2 Vasodilators – Mechanism of Action o Directly relax arteriolar or venous smooth muscle (or both) o Results in: ▪ Decreased SVR ▪ Decreased afterload ▪ Peripheral vasodilation Vasodilators – Indications o Treatment of hypertension o May be used in combination with other drugs o Sodium nitroprusside and IV diazoxide – Used only for management of hypertensive Emergencies Vasodilators – Adverse Effects o Adverse Effects: Multiple undesirable o Rarely Used – Better drugs with less side effects (Used instead). Hydralazine (Apresoline) o Drug Class: Vasodilator o Orally: Routine cases of essential hypertension o Injectable: hypertensive emergencies o Adverse Effects: Dizziness, headache, anxiety, tachycardia, edema, dyspnea, nausea, vomiting, diarrhea, hepatitis, systemic lupus erythematosus, vitamin B6 deficiency, and rash Sodium Nitroprusside (Nitropress) o Drug Class: Vasodilator o IV – Hypertensive Emergency (ICU setting). o Half-life is 10 minutes. o Contraindications: Known hypersensitivity to the drug, severe HF, and known inadequate cerebral perfusion (especially during neurosurgical procedures) Epleronone (Inspra) o Drug Class: Selective aldosterone blockers – new class of drugs. o Blocks the action of aldosterone at its corresponding receptors – kidney, heart, blood vessels, and brain. o Reduces BP o Indications: routine treatment of HTN and post-MI HF  4 Adrenergic Drugs: Five Subcategories -Used to treat HTN o Adrenergic neuron blockers (central and peripheral) o Alpha2 receptor agonists (central) o Alpha1 receptor blockers (peripheral) o Beta receptor blockers (peripheral) o Combination alpha1 and beta receptor blockers (peripheral). Centrally Acting Adrenergic Drugs – Mechanism of action o Ex: Clonidine and methyldopa o Stimulate alpha2-adrenergic receptors in the brain ▪ Decreasing sympathetic outflow – Decreases norepinephrine – which stimulates the alpha2-adrenergic receptors – which reduces renin activity in the kidneys o Ultimately decreased BP o Not a first line Antihypertensive Drugs o Use with other antihypertensives – diuretics. Clonidine (Catapres) o Drug Class: Adrenergic Drug – Centrally Acting o Uses: Hypertension & Management of Opioid Withdrawal o Do not stop abruptly; may lead to rebound hypertension Peripherally Acting Alpha1 Blockers o End in “osin”. o Block alpha1-adrenergic receptors – decreasing BP o Dilate arteries and veins – Reducing peripheral vascular resistance and BP. Beta Blockers o End in “lol” o Propranolol, metoprolol, and atenolol o Reduction of the heart rate through beta1 receptor blockade ▪ Ultimately prevents vasoconstriction and volume expansion. o Long-term use – Causes reduced peripheral vascular resistance. Nebivolol (Bystolic) – o Drug Class: Beta Blocker – Cardioselective o Uses: hypertension and HF o Action: Blocks beta1 receptors (selective) ▪ Produces vasodilation – decreases SVR o Less sexual dysfunction than other HTN drugs. o Do not stop abruptly; must be tapered over 1 to 2 weeks.  5 Lebetalol and carvedilol o Dual-action alpha1 and Beta Receptor Blockers (beta1 and beta2) o Dual antihypertensive effects ▪ Reduction in heart rate (beta1 receptor blockade) ▪ vasodilation (alpha1 receptor blockade) Carvedilol (Coreg) o Drug Class: Alpha1 and Nonselective Beta Blocker (beta1 and beta2) o Widely used – Well tolerated o Uses: HTN o Mild to moderate HF in conjunction with digoxin, diuretics, and ACE inhibitors o Contraindications: known drug allergy, cardiogenic shock, severe bradycardia or HF, bronchospasm conditions such as asthma, and various cardiac problems involving the conduction system ▪ Remember what effects the drug has – will give you the contraindications. Calcium Channel Blockers – Mechanism of Action o Mechanism of Action: Block the binding of calcium to its receptors thus preventing muscle contraction o Results in ▪ Decreased peripheral smooth muscle tone – Muscle relaxation. ▪ Decreases SVR ▪ Decreased BP Calcium Channel Blockers - Indications o Angina o Hypertension: amlodipine (Norvasc) o Will be Discussed in Chapter 23 (next week) o Supraventricular Tachycardia o Coronary artery spasms (Prinzmetal angina) o Dysrhythmias o Migraine headaches o Raynaud’s disease o Prevent the cerebral artery spasms after subarachnoid hemorrhage: nimodipine Antihypertensives: Nursing Implications o Assess for Hypotension – All Antihypertensives o Beta Blockers – Assess BP and apical heart rate prior to administration o Hold if systolic BP less than 90 or Apical HR less than 60. o Notify Physician o Administer IV forms with extreme caution  6 Nursing Implications – Patient Education o Never Stop the medication abruptly o Take with meals o Medication is only part of therapy. o Report S & S of fluid overload: Shortness of breath, swelling of the feet, ankles, face, or around the eyes, weight gain or loss, chest pain, palpitations and excessive fatigue. o If experiencing severe adverse effects notify physician – such as sexual dysfunction. Antihypertensives & Cultural Considerations o Research studies have documented differences in responses to antihypertensives among different racial and ethnic groups. ▪ Some ethnic groups respond less favorable to certain drugs than others, Crystalloids: Indication o Solution that contains fluid and electrolytes that are normal found in the body. ▪ Do not contain proteins (colloids) o Indication: Treatment of Dehydration o Maintenance fluid: ▪ Compensate for insensible fluid losses ▪ Replace fluids ▪ Manage specific fluid and electrolyte disturbances ▪ Promote urinary flow Crystalloids: Adverse Effects & Interactions o Adverse Effects: Edema (peripheral and pulmonary). ▪ Prolonged use – Worsen alkalosis or acidosis o Interactions: Rare – identical or almost to normal physiological substances Sodium Chloride (Normal Saline) o Drug Class: Crystalloid o Concentrations – Multiple – Know NS (0.9%). ▪ 0.9%: physiologically normal concentration of sodium chloride (isotonic), and it is referred to as NS. ▪ 0.45% (“half-normal”) ▪ 0.25% (“quarter-normal”) ▪ 3% (hypertonic saline) ▪ 5% (hypertonic saline) Colloids - Indications o Loss of plasma volume o Are protein substances  7 Colloids: Adverse Effects o Rare: Safe o Note: No clotting factors or oxygen carrying capacity. Albumin o Drug Class: Colloid o Natural protein - Responsible for most of the COP (colloid osmotic pressure) o Contraindications: Heart Failure, Severe anemia, renal insufficiency. Blood Products: Indication o Are Fluids that carries oxygen o Indications: Specific to blood product ▪ Whole Blood – Contains plasma and plasma proteins – Replace lost blood. ▪ Packed Red Blood Cells (PRBCs) – Increase Oxygen Carrying Capacity. ▪ Fresh Frozen Plasma (FFP) – Clotting Factors ▪ Platelets Blood Products: Adverse Effects o Incompatibility with recipient’s immune system – Require crossmatch testing. ▪ Transfusion reaction and Anaphylaxis o Transmission of pathogens to recipient (hepatitis, human immunodeficiency virus) Potassium – Function & Food Sources o Muscle contraction o Transmission of nerve impulses o Regulation of heartbeat o Maintenance of acid-base balance o Isotonicity (maintaining osmotic pressure). o Food Sources: fruit and fruit juices, bananas, oranges, apricots, dates, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat bread, and legumes. Hypokalemia- Level & Causes o Serum potassium level less than 3.5 mEq/L o Caused by Certain Medications: Diuretics, Steroids, Beta Blockers, and aminoglycosides. Hyperkalemia – Level, Causes, and Symptoms o Serum potassium level over 5.5 mEq/L o Caused by Certain Medications: ACE inhibitors, potassium-sparing diuretics, and potassium supplements. o Symptoms: Muscle weakness, paresthesia, paralysis, cardiac rhythm irregularities (potential cardiac arrest)  8 Potassium: Drug - Uses o Uses: Treatment of hypokalemia o Other Uses: Stop irregular heartbeats and management of tachydysrhythmias. ▪ Remember: Lethal injection when given IV. o Adverse effects ▪ Oral preparations: Diarrhea, nausea, vomiting, GI bleeding, ulceration ▪ IV administration: Pain at injection site and Phlebitis ▪ Excessive administration: Hyperkalemia Sodium Polystyrene Sulfonate (Kayexalate) o Use: Treatment of Hyperkalemia o Mechanism of Action: Cation exchange resin – Works in the intestine o Must have: Normal bowel function Sodium – Function & Food Sources o Control of water distribution o Fluid and electrolyte balance o Osmotic pressure of body fluids o Participation in acid-base balance o Food sources: Salt, fish, meats, foods flavored or preserved with salt Hyponatremia – Level & Symptoms o Serum levels below 135 mEq/L o Symptoms: Lethargy, stomach cramps, hypotension, vomiting, diarrhea, seizures Hypernatremia – Level and Symptoms o Serum levels over 145 mEq/L – Serum Excess o Symptoms: Water retention (edema), hypertension ▪ Red, flushed skin; dry, sticky mucous membranes; increased thirst; elevated temperature; decreased urine output Fluid & Electrolyte - Nursing Implications o Assess baseline fluid volume and electrolyte status (Lab values). o Assess baseline vital signs. o Assess skin, mucous membranes, daily weights, and input and output. o Monitor for therapeutic response. ▪ Normal lab values ▪ Red blood cells, white blood cells, electrolyte levels ▪ Improved fluid volume status ▪ Increased tolerance to activities o Monitor for adverse effects.