Drugs Used for Cardiac Interventions PDF

DRUGS USED FOR CARDIAC INTERVENTIONS NP02L019 ELO B · Version 2.0 Introduction to Clinical Pharmacology, 10th ed. pp. 155-157; pp. 225- 227; pp. 279-282; pp. 287-289 Introduction to Critical Care Nursing, 8th ed., p. 301; pp. 306-307 ENABLING LEARNING OBJECTIVE Perform safe and effective nursin...

DRUGS USED FOR CARDIAC INTERVENTIONS NP02L019 ELO B · Version 2.0 Introduction to Clinical Pharmacology, 10th ed. pp. 155-157; pp. 225- 227; pp. 279-282; pp. 287-289 Introduction to Critical Care Nursing, 8th ed., p. 301; pp. 306-307 ENABLING LEARNING OBJECTIVE Perform safe and effective nursing care given a clinical scenario of a patient with acute coronary syndrome without further harm. TREATMENT GOALS Establish reperfusion Reduce infarct size Prevent and treat complications Provide emotional support and education MEDICAL TREATMENT Pain relief Oxygenation (myocardium) Prevent platelet aggregation Restore blood flow NURSING IMPLICATIONS Assess immediately Intravenous access Oxygen Aspirin Nitroglycerin Morphine CHECK ON LEARNING If the arteries become plugged with thrombi, what can happen to the body’s tissues? a. Oxygen is prohibited from reaching the tissues, which may result in death. b. Emboli can break off and cause bleeding in other parts of the body. c. Clots can damage legs or ankles and cause permanent neuropathy. d. Glucose is prohibited from reaching the muscles, which may cause weakness. PAIN RELIEF DURING ACUTE MYOCARDIAL INFARCTION (AMI) PAIN RELIEF Initial pain Treated with morphine sulfate Given intravenously MORPHINE SULFATE Pain relief and anxiety reduction Mechanism of action Binds to opioid receptor in the CNS Change the perception of pain MORPHINE SULFATE Side Effects Adverse Effects Hypotension Respiratory depression Respiratory depression Severe hypotension Bradycardia Oliguria Nausea, anorexia Hypothermia Sedation, euphoria Excessive sedation NURSING INTERVENTIONS Titrate for chest pain 2-4 mg IVP every 5-10 minutes Monitor LOC and vital signs Naloxone (Narcan) readily available NITRATES NITRATES Vasodilator Reduction of ischemic pain Mechanism of action Directly relaxes smooth muscle Decreased myocardial oxygen demands Increase coronary artery perfusion NITRATES Side Effects Adverse Effects Headache Severe postural hypotension Flushing Reflex tachycardia Tachycardia Paradoxical bradycardia Dizziness Vertigo, weakness Orthostatic hypotension DRUG INTERACTIONS Antihypertensive drugs Increase the effect Pseudoephedrine Methylphenidate Decrease the effect Sildenafil Severe hypotension SUBLINGUAL ADMINISTRATION Patient Teaching Take while sitting or lying down Store bottle in dark glass container Administer 5 minutes apart Maximum of 3 times (15 minutes) Call 911 if symptoms Do not get better Do not continue after second dose Chest pain does not go away NURSING IMPLICATIONS Patient history Baseline vital signs Administer nitroglycerin SUBLINGUAL ADMINISTRATION Patient Teaching Take while sitting or lying down Store bottle in dark glass container Administer 5 minutes apart Maximum of 3 times (15 minutes) Call 911 if symptoms Do not get better Do not continue after second dose Chest pain does not go away TOPICAL ADMINISTRATION Wear gloves Measure the paste carefully Remove patchers or ointment, per order. Rotate sites with each dose CHECK ON LEARNING If a patient has a strong adverse reaction or overdose after taking an opioid agonist, such as morphine, how can the effects be reversed? a. Induce vomiting by administering an emetic. b. Administer an opioid antagonist such as naloxone. c. Inject fentanyl intramuscularly or subcutaneously. d. Keep the patient awake and help them move as much as possible until effects diminish. CHECK ON LEARNING Which of the following are side effects and/or adverse effects of nitrates? (Select all that apply.) a. Throbbing headaches caused by rapid blood vessel dilation in the head can occur. b. Severe postural hypotension when a person suddenly stands up. c. Reflex tachycardia or paradoxical bradycardia. d. Vitamin B deficiency. CHECK ON LEARNING You should not administer nitroglycerin if your patient’s blood pressure goes below which of the following readings? a. 90/60 b. 110/60 c. 120/65 d. 100/70 PREVENTING PLATELET AGGREGATION PLATELET AGGREGATION Alteration in platelet function Contribute to occlusion of coronary arteries Aspirin (325 mg) Given immediately to all patient with suspected acute coronary syndrome (ACS) PLATELET INHIBITORS Work in cardiovascular system Mechanism of action to prevent clotting Inhibits platelet clumping Unstable angina Acute myocardial infarction (AMI) Coronary interventions Examples: Aspirin Clopidogrel (Plavix) Prasugrel (Effient) PLATELET INHIBITORS Side Effects Adverse Effects Bleeding Excessive bleeding Epigastric discomfort New onset cardiovascular event Bruising Thrombocytopenia Gastric ulceration Neutropenia Rash, pruritis, purpura DRUG INTERACTIONS Alcohol – increase bleeding risk Vitamin K Oral contraceptives Diet Herbal supplements NURSING IMPLICATIONS Assess Medications Signs of bleeding Monitor labs Patient Teaching Take with food Teach signs of bleeding CHECK ON LEARNING Select all items that describe what should be taught to patients and families about platelet inhibitors. a. Take these drugs at least 2 hours before meals. b. Look for symptoms of bleeding. c. Avoid foods, supplements, and OTC drugs that can interfere with these drugs. d. Do not stop taking these drugs are any reason. CHECK ON LEARNING How does platelet aggregation protect the body when it is injured? a. Platelet aggregation prevents clots in the cardiovascular system. b. Platelet aggregation keeps the blood thin so that clots are unable to be formed when there are injuries. c. Platelets aggregate and seal the entry to the vascular system to prevent blood from accessing the body tissues. d. Platelets aggregate and inhibit clots from breaking off and moving to other parts of the body. RESTORE BLOOD FLOW TO THE MYOCARDIUM FIBRINOLYTICS “Clot busters” Patient symptomatic for