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Cardiac Drugs Presented by: Cynthia Bartlau, RN, PHN, MSN Types of Cardiac Medications Cardiotonics (cardiac glycosides) Regulate heart contraction Anti-dysrhythmics/Anti-arrythmics (classified by their effects on cardiac conduction) Anti-Anginals (beta...

Cardiac Drugs Presented by: Cynthia Bartlau, RN, PHN, MSN Types of Cardiac Medications Cardiotonics (cardiac glycosides) Regulate heart contraction Anti-dysrhythmics/Anti-arrythmics (classified by their effects on cardiac conduction) Anti-Anginals (beta blockers, calcium channel blockers, nitrates) Decreases heart pain Cardiac Drugs (cont.) Antihypertensives (adrenergics, aldosterone antagonists, ACE inhibitors, angiotensin II receptor antagonists, beta blockers (selective & non-selective, calcium channel blockers, centrally acting antiadrenergics, loop diuretics, peripherally acting antiadrenergics, thiazide diuretics, thiazide-like diuretics, vasodilators [based on site of action]) Decreases high blood pressure Anticoagulants (antithrombotics, coumarins, thrombin inhibitors, heparins (low molecular weight/heparinoids) Decreases blood clotting Anticoagulant Antagonist (protamine sulfate, aquaMEPHYTON-aka vitamin K) Reverses effect of anticoagulant Cardiotonics: inc. the efficiency & improve Contraction of Heart muscle *digoxin (Lanoxin) Inotropics or cardiac glycosides or digitalis glycosides – from leaves of foxglove plant or “Digitalis purpurea” Digibind = antagonist Cardiotonics Inc. cardiac output & depress/slow the “SA node” or “pacemaker” of the heart electrical conduction system, thus, dec. Heart Rate and allowing heart to function normally (+ positive inotropic = heart beats harder or more forcefully; - negative chronotropic = heart beats more slowly)  Cardiotonics for CHF =SOB, cough, orthopnea, weakness, anorexia, weight gain, pitting edema in legs/abdomen… Cardiotonics- digoxin (Lanoxin)* is the most common Pt. teaching: at home take radial pulse for 1 full min. nurse counts the apical pulse for 1 full minute * If rate is 60 bpm or less: Don’t give the drug! Cardiotonics (cont.) Common s/e: anorexia, n/v/blurred vision, green/yellow vision, halo effect around dark objects, and dysrhythmias /bradycardia - espec.*if toxic. Hold dose of digoxin & call MD for any of above S/S since may indicate toxicity. Low levels of K+ can increase risk of dig toxicity. *Normal Digoxin bld. levels: 0.5-2 ng/ml Digibind (digoxin immune Fab) reverses toxicity Digoxin Anti-dysrhythmia or Anti-arrythmia Drugs “Abnormalities in Cardiac rate or rhythm” irregular, slow, too fast, etc. Atrial flutter Atrial fibrillation PVC V-tach V-fib Normal EKG/ECG Heart Rhythms Normal Sinus Rhythm Sinus Bradycardia Sinus Tachycardia Dysrhythmias A-fib A-flutter V-tach V-fib Anti-dysrhythmia classifications & Prototypes Class I: Sodium Channel Blocker: IA – Norpace (disopyramide) [vent dys] Quinaglute (quinidine) [vent dys + a fib + PAT] Pronestyl/Procanbid (procainamide) [vent dys] IB – Xylocaine (lidocaine) [vent dys] – a local anesthetic IC – Tambocor (flecainide), Rythmol (propafenone) [atrial dys] Anti-arrhythmics (cont.) Class II: β-Adrenergic Blockers: Inderal (propranolol) [tachycardia + arrhythmias) Is the pulse & b/p too low? Hold dose? Decreases risk of death post-MI Class III: Potassium Channel Blockers Cordarone (amiodarone), Corvert (ibutilide) used for life-threatening ventricular dysrhythmias when less toxic drugs fail* used more (rather than lidocaine) Anti-arrhythmics (cont.) Class IV: Calcium Channel Blockers* Calan (verapamil), Cardizem (diltiazem), Norvasc (amlodipine) *monitor b/p & H.R. [SVT, a-fib/flutter, angina, HTN] Pt Teaching: Report dizzy/faintness, Take pulse each day to see if rhythm is regular? Rate? Avoid ETOH, caffeine Take drug same time every day Check for drug-drug interactions/drug food *Avoid grapefruit juice with Ca Channel blockers=toxicity Anti-Anginals Relieve chest pain associated with little/no O2 to heart Antianginals (cont.) Organic Nitrates: Discovered in 1857 Nitroglycerin (NTG) - shorter acting Isordil (isosorbide) or “Nitro-paste/patch” - longer acting Action is to promote Vasodilation of bld. vessels (arterial & venous) & dilation of coronary arteries….s/e: check b/p dips low, pulse high (tachycardia), flushing, H/A  NTG: given sublingually (under the tongue) for chest pain x 3 doses @ 5min apart. Kept in brown glass jar (no sunlight gets through) & good for 6 mos after bottle opened Should feel a “tingle” under tongue if fresh Also available in a new “Nitro”-spray S/L for quick relief! Anti-anginals (cont.) Calcium channel Blockers: inhibit transport of Ca+ into myocardial cells & relax coronary & peripheral bld vessels (so helps in HTN, atrial dysrhythmias, and angina too!) Norvasc (amlodipine), diltiazem (Cardizem), nifedipine (Procardia/ Adalat), verapamil (Calan) No grapefruit juice Anti-anginals (cont.) B-Adrenergic Blocker: Decrease the workload of the heart & used for angina prophylaxis ** *More cardio-selective B-1 Blockers used - little effect on lungs like **atenolol (Tenormin), **metoprolol (Lopressor) Also found cardio-selective drugs reduce the chance of recurrent Heart attack or stroke Asthma client stay away from non-selective B-1&B-2 blockers like propranolol (Inderal) or nadolol (Corgard), or timolol All B-adrenergic blockers: will dec. pulse and B/P; so prior to giving: check the b/p and Pulse (< 60 ) hold; call PCP for parameters Anti-anginals (cont.) Pt. Teaching: Assess for chest pain, monitor b/p and pulse frequently Notify your physician if pulse is < 60 bpm If taking oral nitroglycerin (Isordil), do not stop taking it without MD advice Smoking aggravates angina or chest pain If use Nitro-Patches or/paste (Nitrobid) apply to hairless areas on upper arms or trunk (rotate sites) Anti-hypertensives= used to lower the blood pressure BP < 120/80 = Normal BP 120-139/80-89 = Pre-hypertension BP 140-159/90-99 = Stage I HTN BP > 160/100 = Stage II HTN Weight loss Stress reduction Exercise Stop smoking Moderate ETOH Diet – DASH -↓Na, fat, cholesterol Anti-hypertensives (cont.) Diuretics: (urinary chapter) hydrochlorothiazide (HTCZ) and spironolactone (Aldactone) reduce blood volume by increasing urinary output! https://www.heartfailurematters.org/en_GB/Animation/ Pages/animation_8.aspx Anti-hypertensives (cont.) B- Adrenergic Blockers: dec. stimulation of SNS resulting in dilation bld. vessels = dec. b/p and dec. pulse “olol” drugs like propranolol (Inderal), atenolol (Tenormin), and metoprolol (Lopressor), sotol (Betapace) A desirable effect is lower B/P & pulse rate-but not too low! * Check for postural/orthostatic hypotension! Anti-hypertensives (cont.) Alpha 1 & alpha 2 Adrenergic meds A-1 adrenergic blocker = Cardura (doxazosin), Minipress (prazosin), Hytrin (terazosin) risk of “First Dose Syncope” b/p falls very low with initial dose: Give at bedtime to prevent syncope and orthostatic/postural hypotension. A-2 adrenergic agonist = also used for pain/mngmnt of opiate withdrawal - clonidine (Catapres) Anti-hypertensives (cont.) Calcium Channel Blockers:-dec. calcium availability for transmission of nerve impulses = relaxation of blood vessels Calan (verapamil), Norvasc (amlodipine), Procardia (nifedipine), Cardizem (diltiazem) No grapefruit juice! Anti-hypertensives (cont.) ACEI (angiotensin converting enzyme inhibitors) benazepril (Lotensin), enalapril (Vasotec), captopril (Capoten) works in the kidneys to block angiotensin-1 to angiotensin-2= (which is a potent vaso-constrictor! -raises the b/p) s/e: “cough”*, spontaneous “angio- edema” drug is somehow less effective in African Americans? Anti-hypertensives (cont.) ARBs = angiotensin II receptor blockers Blocks binding of angiotensin II at various receptor sites = dec. BP losartan (Cozaar) valsartan (Diovan) Dizziness, URI sx Anti-hypertensives (cont.) Teaching Always take pulse & b/p before giving med Give same time each day, never stop drug abruptly or your b/p may rise very high! Minimize caffeine/ ETOH, OTC cold & sinus medications which may raise b/p If feel dizzy when arising, change positions slowly, dangle feet at bedside for 1-2 min, avoid hot baths, avoid standing in one place too long. ***Some meds may make you drowsy? Give at bedtime to off-set this s/e? Anti-coagulants Used to prolong bleeding time to prevent blood clots forming Anticoagulants Oral Parenteral Miscellaneous Antiplatelet Agents Thrombolytics Anticoagulant antagonists Anti-coagulants (cont.) Oral Warfarin (Coumadin) They interfere with the clotting mechanisms in the blood, and blood clotting values must be monitored closely PT (1.2-1.5 X control) & INR (INR 2-3; > 5 dangerous) Dosage is adjusted frequently or daily according to lab values (sometimes pharmacy designates dosage) Anti-coagulants (cont.) Parenteral Heparin-given SQ or IV *APTT Check for evidence of bleeding, (ex. mouth, gums, urine, stool, bruising) *low dose heparin: Lovenox (enoxaparin) S.C. used (prophylactically) to prvnt bld clots Similar to Heparin SQ (give lower Abdomen and do not aspirate or rub injection site) Anti-coagulants (cont.) Antidote Warfarin: Vitamin K (AquaMEPHYTON) oral or I.M. Diet high in Vit K foods (green leafy vegetables, spinach, yogurt, cheese, liver, egg yolks) will interfere with the therapy of warfarin! Remember: effects of Warfarin may increase when given w/aspirin (ASA), NSAIDs, Tagamet : Decrease Warfarin if given with antacids, diuretics, estrogens Antidote for Heparin: Protamine Sulfate Anti-coagulants (cont.) Anti-platelet Drugs: Drugs that prvnt platelet aggregation or hypercoagulability (prolongs bleeding time) Drug: Ticlid (ticlopidine), Persantine (dipyridamole), ASA, and Plavix (clopidogrel)* Look for s/s bleeding, bruising, should not mix with ASA or NSAIDs *Drugs used for athero-sclerosis, or post- M.I or a CVA (stroke) or stent placements * especially Plavix! The new wonder drug! Anti-coagulants (cont.) Alert for bleeding Frank or occult Inc HR, dec BP Apply pressure to topical bleeds ID alert Anti-coagulants (cont.) Thrombolytics aka fibrolytics Dissolve blood clots Tx DVT, PE, MI, CVA (caused by clot), occluded central catheters Streptase (streptokinase), Activase (alteplase recombinant), tenecteplase (TNKase) Questions???