Cardiovascular Drugs PDF

CARDIOVASCULAR PHARMA REVIEW ON CARDIAC PHYSIOLOGY REVIEW ON CARDIAC ACTION POTENTIAL  ANTI HYPERTENSIVE DRUGS GOAL : TO DECREASE BP TO NORMAL  ANTI HYPERTENSIVE DRUGS SECONDARY HYPERTENSION CAUSE : PHEOCHROMOCYTOMA  ANTIHYPERTENSIVE DRUGS...

CARDIOVASCULAR PHARMA REVIEW ON CARDIAC PHYSIOLOGY REVIEW ON CARDIAC ACTION POTENTIAL  ANTI HYPERTENSIVE DRUGS GOAL : TO DECREASE BP TO NORMAL  ANTI HYPERTENSIVE DRUGS SECONDARY HYPERTENSION CAUSE : PHEOCHROMOCYTOMA  ANTIHYPERTENSIVE DRUGS IF THE PROBLEM IS INCREASED SNS 1. ALPHA ADRENERGIC ANTAGONIST PRAZOSIN DOXAZOSIN TERAZOSIN  ANTIHYPERTENSIVE DRUGS IF THE PROBLEM IS INCREASED SNS 2. ALPHA 2 ADRENERGIC AGONIST CLONIDINE METHYLDOPA  ANTIHYPERTENSIVE DRUGS IF THE PROBLEM IS INCREASED SNS 3. BETA BLOCKERS PROPRANOLOL METOPROLOL ATENOLOL  ANTIHYPERTENSIVE DRUGS ALTERATION OF R – A – A – S ( RENIN – ANGIOTENSIN – ALDOSTERONE SYSTEM )  R –A – A – S SYSTEM ACE RENIN ANGIOTENSINOGEN ANGIOTENSIN 1 ANGIOTENSIN 2 INCREASE BV INCREASE SODIUM & WATER REABSORPTION RECEPTOR INCREASE BLOOD PRESSURE VASOCONSTRICTION  ANTI HYPERTENSIVE DRUGS IF THE PROBLEM IS ALTERED RAAS 4. ACE INHIBITORS CAPTOPRIL QUINAPRIL ENALAPRIL  ANTI HYPERTENSIVE DRUGS IF THE PROBLEM IS ALTERED RAAS 2. ANGIOTENSIN RECEPTOR ANTAGONIST LOSARTAN CANDESARTAN TELMISARTAN  ANTIHYPERTENSIVE DRUGS IF THE PROBLEM IS ALTERED RAAS 6. DIURETICS THIAZIDE DIURETIC HYDROCHLORTHIAZIDE  ANTIHYPERTENSIVE DRUGS VASODILATORS DIRECT ACTING VASODILATORS INDIRECT ACTING VASODILATORS  ANTIHYPERTENSIVE DRUGS DIRECT ACTING ANTIHYPERTENSIVE DRUGS HYDRALAZINE ( APRESOLINE ) NITRATES NITROGLYCERINE ISOSORBIDE DINITRATE OR MONONITRATE NITROPRUSSIDE  ANTIHYPERTENSIVE DRUGS INDIRECT ACTING VASODILATORS ( CALCIUM CHANNEL BLOCKERS) NIFEDIPINE AMLODIPINE FELODIPINE VERAPAMIL DILTIAZEM  ANTI HYPERTENSIVE DRUGS qThe most common side effect of the different antihypertensive drugs is orthostatic hypotension qTake meds at regular basis qAssume sitting or lying position for few minutes qChange position gradually qAvoid very warm bath, prolonged sitting or standing qAvoid tyramine rich food  DRUGS FOR ANGINA ANGINA PECTORIS – IMBALANCE BETWEEN DECREASED OXYGEN AND INCREASED CARDIAC WORKLOAD GOALS 1. TO INCREASE OXYGEN 2. TO DECREASE CARDIAC WORKLOAD  DRUGS FOR ANGINA NITROGLYCERINE ISOSORBIDE DINITRATE/MONONITRATE BETA BLOCKERS LONG ACTING CALCIUM CHANNEL BLOCKERS  ANTI ANGINAL DRUGS qNitroglycerin intravenous (Nitro-Bid IV, Tridil) qSublingual (Nitrostat) qTopical (Nitro-Bid, Nitrol, Nitrong, Nitrostat) qNursing Considerations: qMake position changes slowly and avoid prolonged standing. qOral route, take on an empty stomach with a full glass of water. qMonitor BP and apical pulse before administration and periodically after dose.  ANTI ANGINAL DRUGS qAssume sitting or supine position when taking the drug. qGradual change of position qBurning or stinging sensation under the tongue qSubligual route – onset of action 1-2 minutes; duration is 30 minutes qAdvise to carry 3 tablets always; NOT in pockets qStore nitroglycerine in cool, dry place; use dark, amber colored air tight container qChange stock every 6 months qObserve for side effects: headache, flushed face, dizziness, faintness tachycardia qRotate sites of transderm patch  DRUGS FOR DYSRHYTHMIAS CLASS I CLASS II CLASS III CLASS IV  DRUGS FOR DYSRHYTHMIAS CLASS 1 ACTS ON PHASE 0 – INHIBITS DEPOLARIZATION OF ABNORMAL RHYTHM LIDOCAINE  DRUG FOR DYSRHYTHMIAS CLASS II – ACTS ON PHASE 4 PROLONGED RESTING TO SLOW DOWN IMPULSES AND REMOVE ABNORMAL RHYTHM PROPRANOLOL  DRUG FOR DYSRHYTHMIAS CLASS III – ACTS ON PHASE 3 PROLONG CARDIAC REPOLARIZATION AMIODARONE  DRUGS FOR DYSRHYTHMIAS CLASS IV – ACTS ON PHASE 2 BLOCKS CALCIUM ENTRY DILTIAZEM, VERAPAMIL  DRUGS FOR DYSRHYTMIAS FOR HEART BLOCKS ANTICHOLINERGIC DRUGS ATROPINE SULPHATE  DRUGS FOR HEART FAILURE LEFT SIDED AND RIGHT SIDED HEART FAILURE  DRUGS FOR HEART FAILURE 1. DIURETICS FUROSEMIDE SPIRONOLACTONE  DRUGS FOR HEART FAILURE 2. CARDIOTONIC DRUGS SYMPATHOMIMETIC DRUGS CARDIAC GLYCOSIDES PHOSPHODIESTERASE INHIBITORS MILRINONE  DRUGS FOR HEART FAILURE SYMPATHOMIMETIC DRUG DOPAMINE DOBUTAMINE  DRUGS FOR HEART FAILURE DIGOXIN DIGITALIS  DRUGS FOR HEART FAILURE NURSING CONSIDERATIONS: MONITOR HEART RATE BEFORE ADMINISTRATION MONITOR POTASSIUM LEVEL. NORMAL IS 3.5 – 5.5 meq/L MONITOR ECG MAINTAIN THERAPEUTIC LEVEL ( 0.5 – 1.5 meq/L) DO NOT COMBINED WITH CALCIUM CHANNEL BLOCKERS AND AMIODARONE MONITOR FOR SIGNS OF TOXICITY ANTICIPATE ANTIDOTE : DIGIBIND  DRUGS AFFECTING COAGULATION REVIEW ON HEMOSTASIS VASOCONSTRICTION PLATELET PLUG FORMATION BLOOC COAGULATION  ANTI PLATELET DRUGS ASPIRIN CLOPIDOGREL  ANTOCOAGULANT DRUGS PARENTERAL HEPARIN ANTIDOTE: PROTAMINE SULFATE ORAL WARFARIN ANTIDOTE: VITAMIN K  THROMBOLYTIC DRUGS UROKINASE STREPTOKINASE ALTEPLASE  DRUGS AFFECTING COAGULATION Nursing Considerations: Check VS, platelet count, APTT (N=20-36 sec) Observe for bleeding Review bleeding protocol (i.e. electric razors, soft toothbrushes, etc.) Avoid ASA, may use Acetaminophen  DRUGS AFFECTING COAGULATION Nursing Considerations: CBC, Hgb,Hct - monitor Look for Dysrhythmias Observe for bleeding The vital signs must be monitored Small frequent feeding  ANTIFIBRINOLYTIC DRUGS TRANEXAMIC ACID AMINOCAPROIC ACID