Drugs Affecting Cardiovascular System PDF

Drugs that Affect the Cardiovascular System NP02L021 ELO A · Version 2.0 Care of the Patient with a Cardiovascular Disorder Introduction to Clinical Pharmacology, 10th ed., pp. 134 – 138; pp, 140 – 162 Introduction to Critical Care Nursing, 8th ed., pp. 297 – 328 TERMINAL LEARNING OBJECTIVE Deter...

Drugs that Affect the Cardiovascular System NP02L021 ELO A · Version 2.0 Care of the Patient with a Cardiovascular Disorder Introduction to Clinical Pharmacology, 10th ed., pp. 134 – 138; pp, 140 – 162 Introduction to Critical Care Nursing, 8th ed., pp. 297 – 328 TERMINAL LEARNING OBJECTIVE Determine nursing care for a patient with a disorder of the heart without error. LEARNING STEP ACTIVITIES 1. Explain the use of antihyperlipidemic drugs 2. Explain the use of antihypertensive drugs 3. Explain the use of drugs for angina and myocardial infarction 5 MOST COMMON TYPES OF CARDIOVASCULAR DRUGS Antihyperlipidemics Antihypertensives Drugs for angina Drugs for heart failure Antidysrhythmics ANTIHYPERLIPIDEMIC DRUGS HYPERLIPIDEMIA High level of lipids, primarily cholesterol and other fatty acids in the blood- primarily produced by the liver. HMG-CoA (STATINS) Action HMG-CoA is a liver enzyme Controls cholesterol production Use Lower blood LDL levels Reduces risk SIDE EFFECTS Abdominal pain Sore throat Headache Heartburn Diarrhea Elevated glucose Myalgia levels Joint discomfort HMG-CoA (Statins) Adverse Effects Liver dysfunction Pancreatitis Myositis Rhabdomyolysis Life Span Considerations Not used in pregnancy and breastfeeding Examples Atorvastatin Simva statin Lova statin Pravastatin Rosuvastatin HMG-CoA (Statins) Drug interactions Alcohol and acetaminophen Liver toxicity Aspirin and antacids Decrease effectiveness Grapefruit juice Risk for toxic effects NURSING IMPLICATIONS Monitor liver function tests and CK levels Assess for signs of rhabdomyolysis Assess for pregnancy or breastfeeding Review low-cholesterol diet Take in the evening for best effectiveness PATIENT TEACHING Avoid alcohol Report severe muscle aches, changes in urine color or decreased urine output Avoid grapefruit juice Follow up care is required for regular lab work Signs of liver problems CHECK ON LEARNING A patient states they can now eat whatever they like because the medication “will take care of it.” The nurse explains the patient must follow a low-cholesterol diet because HMG-CoA reductase inhibitors (Statins) work by_____________________________. a. Lowering LDL levels by increasing liver cholesterol production b. Diet change isn’t necessary since the drugs remove dietary cholesterol c. Lowering LDL levels by slowing liver cholesterol production d. Preventing blood clots from forming NON-STATIN HYPERLIPIDEMIC Use: Lower LDL levels Selective Cholesterol Absorption Inhibitors Action: Limits the absorption of cholesterol from food through the intestinal wall Example: ezetimibe Fibric Acid Derivatives (Fibrates) Action: Lowers triglycerides and increases HDL levels Example: gemfibrozil, fenofibrate Cause liver toxicity and cholelithiasis NON-STATIN HYPERLIPIDEMIC Bile Acid Sequestrants Action: Increase excretion of cholesterol and reduces LDL levels by bile loss through the feces Example: cholestyramine, colestipol Niacin or Nicotinic Acid Action: Inhibits a hormone-sensitive lipase in adipose tissue Example: Niacin Not commonly used due to adverse effects NON-STATIN HYPERLIPIDEMIC Nursing Implications Assess diet history Assess liver function test and cholesterol Avoid alcohol Give supplemental vitamins K, A, D, E Give at appropriate times Fibric give 30 minutes before meals BID Bile sequestrants give 1-2 times a day before meals and mix with water, milk, or juice Patient Teaching Notify healthcare provider that you are taking cholesterol-lowering drug CHECK ON LEARNING True/False: Liver function tests should be closely monitored for patient take non-statins. ANTIHYPERTENSIVE DRUGS HYPERTENSION Disorder in which patient’s blood pressure is consistently elevated Without treatment may cause organ damage Heart Brain Kidney Primary Cause unknown Secondary Blood pressure change is due to a specific cause DIURETICS Action: Indirectly lowers blood pressure by reducing fluid volume Thiazide: prevents reabsorption of water, Na, K and Cl and dilates arterioles Example: hydrochlorothiazide Thiazide-like: prevents reabsorption of water, Na, K and Cl and dilates arterioles Example: indapamide Loop diuretics: increase urine output by blocking active transport in Loop of Henle Example: furosemide Potassium-sparing: increase excretion of water and Na Example: spironolactone Uses Treat HTN, heart failure, and cirrhosis of the liver  SIDE EFFECTS ADVERSE EFFECTS Urinary urgency and Dehydration frequency Hypokalemia Sign of decreased volume Thiazides Fluid and electrolyte Loop imbalances Hyperkalemia Increased uric acid Potassium-sparing (Thiazide) Hyponatremia INTERACTIONS Antibiotics Lithium Medications that cause potassium imbalances NURSING IMPLICATIONS Assess change in vital signs Hold with blood pressure < 90/60 Assess for dehydration Monitor daily weight Assess lab work Administer in the morning Provide bedside commode or urinal Monitor peripheral edema Strict intake and output PATIENT TEACHING Stand up slowly to prevent orthostatic hypotension Signs of low or high potassium Report tinnitus Diet changes by increasing/decreasing foods high in potassium Avoid salt substitutes Diabetics should monitor glucose levels closely CHECK ON LEARNING What laboratory values must be closely monitored while a patient is taking a diuretic? a. Glucose b. Potassium c. BUN and creatinine d. All of the above RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM DRUGS RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM DRUGS Use: Hypertension and heart failure Actions: Angiotensin-converting enzyme inhibitor (ACE-I): stops conversion of angiotensin I to angiotensin II Examples: captoPRIL, enalaPRIL, lisinoPRIL, Angiotensin II receptor blocker (ARB): blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II Examples: loSARTAN, valSARTAN, irbeSARTAN, candeSARTAN SIDE EFFECTS Hyperkalemia Dry cough with ACE-I Angioedema Not take during pregnancy CHECK ON LEARNING Most ACE-Inhibitors end in ____________, while morse ARBs end in ______________. CALCIUM CHANNEL BLOCKERS CALCIUM CHANNEL BLOCKERS Uses: Chronic stable angina, hypertension, dysrhythmias Actions: Inhibits the calcium influx across the cell membrane which relaxes coronary artery smooth muscle, dilation of coronary arteries and peripheral veins (decreases workload) Slow conduction of electrical impulses through SA & AV nodes (slows heart rate) Examples: verapamil, nifedipine, diltiazem, amlodipine CALCIUM CHANNEL BLOCKERS SIDE EFFECTS CONTRAINDICATIONS Dysrhythmias Cardiogenic shock Fatigue Heart block Dizziness Hypotension Headache Heart failure Flushing Steven-Johnson Syndrome Avoid grapefruit and grapefruit juice CHECK ON LEARNING What is the mechanism of action for calcium channel blockers? (Select all that apply) a. Inhibits the ability of calcium to enter heart muscle cells, which slows conduction of electrical impulses through the SA and AV nodes b. lower blood pressure by preventing water, sodium, potassium, and chloride from going through the walls of the nephron to be reabsorbed into the blood c. stops the conversion of angiotensin I to angiotensin II d. Inhibits the calcium influx across the cell membrane reducing the amount of calcium available for arterial smooth muscle contraction ADRENERGIC DRUGS BETA BLOCKERS Uses: CAD, hypertension, angina pectoris, heart failure, dysrhythmias, MI, PVCs Action: Blocks the beta 1 receptor from the effects of norepinephrine and epinephrine Lowers blood pressure Slows heart rate Dilates smooth muscle of arteries, increasing oxygen supply to heart Examples: propranOLOL, metoprOLOL, nadOLOL, atenOLOL BETA BLOCKERS SIDE EFFECTS CONTRAINDICATIONS Bradycardia Cardiogenic shock Hypotension Heart blocks Masks signs of hypoglycemia Bradycardia Decreased sexual ability Dizziness Drowsiness Difficulty sleeping Weakness DO NOT STOP – Rebound HBP CHECK ON LEARNING What is a condition that can be masked by beta blockers? a. Tachypnea b. Bleeding c. Hypoglycemia d. Stomach irritation ALPHA 1 ADRENERGIC ANTAGONIST Alpha Blockers Uses: Hypertension Action: Blocking alpha 1 adrenergic receptor sites leading to decreased peripheral vascular resistance and decreased blood pressure. Examples: doxAZOSIN, prAZOSIN, terAZOSIN Side effects: First dose effect – sudden hypotension Severe orthostatic hypotension – give at night Fluid retention CHECK ON LEARNING Why should a patient not drive or operate machinery after taking the first dose of an Alpha-1 antagonist (blocker)? ALPHA 2 ANTAGONIST Uses: Hypertension that is difficult to manage Action: Works in brain to activate alpha 2 receptors causing vasodilation and decreased blood pressure Examples: clonidine, clonidine transdermal patch, methyldopa Side effects: Dry mouth and nasal congestion DO NOT STOP – rebound hypertension CHECK ON LEARNING Why are Alpha 2 agonists only used in patients with difficult to manage HBP? a. They act centrally on the CNS cause a high risk of side effects. b. They are cheaper than all the other drugs. c. They are given in transdermal patches. d. They are easier to get than all the other drugs. VASODILATORS Uses: Hypertension Action: Dilatation of artery and venous systems to decreased PVR, improving blood flow and decreasing workload of the heart Examples: hydralazine, minoxidil Side effects: Significant hypotension Daily weights and report swelling of hands or feet – fluid retention DO NOT STOP – rebound HBP NURSING IMPLICATIONS AND PATIENT TEACHING Avoid sudden changes in position Take medication at the same time everyday as prescribed Avoid alcohol Avoid OTC meds Withhold medication HR< 60 BPM or SBP < 90 mm HG Patient with IV calcium channel blocker needs a cardiac monitor Monitor BP Daily weight Teach proper techniques for home BP and HR monitoring ANGINA AND MYOCARDIAL INFARCTION DRUGS ANGINA VS. MYOCARDIAL INFARCTION Chest pain caused by lack of oxygen to the heart muscle  Angina Blood flow to heart muscle significantly reduced and muscle dies  Myocardial infarction NITRATES Uses: chronic stable angina pectoris, prophylaxis for angina pain Action: Dilate blood vessels by relaxing smooth muscle in the peripheral venous system (preload) and reducing resistance to blood flow in the arterial system (afterload) Reduces work of the heart Examples Nitroglycerine (NTG): only nitrate (SL, lingual spray, IV) may be used form acute attack of angina Isosorbide mononitrate: management of angina  SIDE EFFECTS ADVERSE EFFECTS Throbbing headaches Severe postural Slight drop in blood hypotension pressure Reflex tachycardia Paradoxical bradycardia Vertigo Severe weakness DRUG INTERACTIONS Alcohol, antihypertensive drugs, opioids, and diuretics Caffeine, pseudoephedrine, methylphenidate and antidiabetic medications Erectile dysfunction medications NURSING IMPLICATIONS/ PATIENT TEACHING Assess BP and HR before and during treatment Acute attacks give NTG sublingual Repeat the dose every 5 minutes X 3 doses. If no relief, call 911 Wear gloves Store NTG is a dark container Assess for lightheadedness, dizziness and headache Teach patient to keep nitroglycerin bottle on their person Place the buccal tablet between check and gum or under the tongue Place NTG patches on skin in the morning and remove at bedtime Do not drink alcohol Change positions slowly Caution use when taking medication for erectile dysfunction CHECK ON LEARNING Why should the nurse wear gloves when applying NTG ointment (Select all that apply) a. PPE and hygiene requirement b. Avoid absorption into skin c. Wearing gloves is not necessary d. To auscultate the apical pulse better ANTIDYSRHYTHMIC DRUGS DYSRHYTHMIA Abnormal heart rhythm caused by irregularity of the cardiac conduction system Cells do not have enough oxygen or damaged Disease Electrolyte imbalance Result is alteration in cardiac output ANTIDYSRHYTHMIC DRUGS Use: Restore the rhythm to normal and maintain adequate cardiac output Action: Class I (Sodium channel blockers) Examples: quinidine, procainamide) Class II (Beta blockers) Example: propranolol Class III (Potassium channel blockers) Example: amiodarone Class IV (calcium channel blockers) Example: diltiazem, verapamil Other Drugs Examples: digoxin, magnesium sulfate SIDE EFFECTS/ADVERSE EFFECTS Side Effects Hypotension Other dysrhythmias Adverse Effects Other dysrhythmias NURSING IMPLICATIONS/ PATIENT TEACHING Sodium channel blockers Monitor the heart rate and BP Avoid OTC medications Quinidine can cause significant GI side effects Give med exactly as scheduled Monitor patient weight and urine output Teach family members to assess for confusion NURSING IMPLICATIONS/ PATIENT TEACHING Potassium channel blockers Monitor for common side effects Monitor the respiratory status Teach patient about light sensitivity Side effects may not appear for several days to weeks May cause bluish discoloration of face, neck and arms Schedule regular eye exams Report pain or selling in scrotum to healthcare provider Assess apical heart rate before giving medication Obtain EKG before giving medication Telemetry CHECK ON LEARNING Why is it important to assess an apical pulse, instead of a radial pulse, before administering and antidysrhythmic medication? INOTROPIC DRUGS CARDIAC GLYCOSIDE PHOSPHODIESTERASE INHIBITORS Use: Advanced heart failure and in critical care areas to improve cardiac output Action: Decreases the speed of conduction through the AV node Activates contractile proteins in the heart muscle, increasing their ability to contract Example: digoxin, milrinone, dobutamine DIGOXIN ADVERSE EFFECTS DRUG INTERACTIONS Toxicity: anorexia, nausea, Beta blockers, calcium vomiting, diarrhea, yellow gluconate, calcium chloride, vision, palpitations succinylcholine and Anxiety verapamil Depression Any drug that changes electrolyte balance Confusion Older adults at risk for toxicity NURSING IMPLICATIONS/ PATIENT TEACHING Monitor closely for digoxin toxicity Monitor potassium levels May be given a loading dose of medication Monitor therapeutic level of medication Take apical pulse before administration Give at the same time every day Take missed dose within 12-hours of scheduled time, never double dose Report signs of toxicity Report chest pain, dyspnea or peripheral edema Teach sources of potassium CHECK ON LEARNING What electrolyte level can significantly increase the risk of digoxin toxicity? a. Low sodium b. High potassium c. High sodium d. Low potassium REVIEW OF MAIN POINTS 1. Explain the use of antihyperlipidemic drugs 2. Explain the use of antihypertensive drugs 3. Explain the use of drugs for angina and myocardial infarction QUESTIONS