Cardiac Drugs - NUR210/BSL 101 PDF

Cardiac Drugs Cardiac Glycosides, Antianginals, and Antidysrhythmic NUR210/BSL 101  Acute heart failure Heart muscle weakens and enlarges. Loses ability to pump blood adequately Compensatory mecha...

Cardiac Drugs Cardiac Glycosides, Antianginals, and Antidysrhythmic NUR210/BSL 101  Acute heart failure Heart muscle weakens and enlarges. Loses ability to pump blood adequately Compensatory mechanisms fail Heart Failure Lungs and periphery become congested. Right-sided Blood backs up in periphery Left-sided Blood backs up in lungs  Nonpharmacologic treatment Limit salt and saturated fat intake. Heart Failure Limit or avoid alcohol intake; stop smoking. Perform mild exercise.  Cardiac Glycosides - Digoxin Uses Heart failure (CHF) Atrial arrhythmias Actions Inhibits sodium-potassium ATPase Positive inotropic ▪ Increases myocardial contractility ▪ Increases stroke volume (increases cardiac output) ▪ Increases blood flow ▪ Decreases preload ◦ Negative chronotropic ▪ Decreases heart rate ◦ Negative dromotropic ▪ Decreases conduction of heart cells  Cardiac Glycosides - Digoxin Side effects Dizziness, weakness, headache Adverse Reaction Digoxin toxicity ◦ Anorexia, nausea, vomiting, diarrhea ◦ Blurred vision, green or yellow halos ◦ Bradycardia, premature ventricular contractions, cardiac dysrhythmias  Cardiac Glycosides - Digoxin Drug interactions Diuretics ◦ Hypokalemia Cortisone ◦ Sodium retention, potassium release Antacids ◦ Decrease digitalis absorption Contraindications Ventricular dysrhythmias Bradycardia Hypokalemia Renal disease  Nursing Process - Digoxin Assessment Obtain a baseline pulse rate for future comparisons. Apical pulse for one minute Medical/medication history Electrolytes Signs and symptoms of HF/atrial arrhythmia/edema/lung sounds Assess for evidence of digitalis toxicity.  Nursing Process - Digoxin Nursing interventions Monitor serum digoxin level – 0.5-2ng mL. Toxic is over 2.2 ng/mL Monitor serum potassium level and report if hypokalemia. Monitor edema/signs and symptoms of CHF, pulse Teaching Take drug same time every day Take pulse and notify HCP if less than 60 above 100 S/S to report, for example s/s of dig toxicity If taking diuretic take potassium supplement as prescribed  Classic (stable) Occurs with predictable stress or exertion Unstable (preinfarction) Occurs frequently with progressive severity Angina unrelated to activity; unpredictable regarding stress/exertion and intensity Variant (Prinzmetal, vasospastic) Occurs during rest  Nitrates action: Promotes vasodilation Decrease preload and afterload Acute anginal pain: Sublingual – works in 1-3 min, lasts about 30 min Aerosol spray IV Nitroglycerin Prevention: Topical (ointment, transdermal patch) Oral extended-release capsule and tablet Examples  Nitroglycerin Side effects Contraindications ◦ Headache ◦ Increased intracranial pressure ◦ Flushing ◦ Severe hypotension – caution ◦ Dizziness, weakness Interactions ◦ Syncope ◦ Other antihypertensive meds ◦ Other meds that vasodilate Adverse Reactions ◦ Alcohol ◦ Hypotension Do not abruptly discontinue  Action ◦ Block the action epinephrine and norepinephrine (vessels of the heart relax and dilate) ◦ Decrease workload of heart and oxygen demands Beta blockers Side effects ◦ Dizziness, Depression, fatigue, sexual dysfunction, peripheral edema For angina prevention Adverse Reactions ◦ Bronchospasms, bradycardia, hypotension Caution ◦ Do not abruptly discontinue.  Action ◦ Relax coronary arteries and decrease coronary artery spasm (variant angina) ◦ Reduce cardiac workload and oxygen demands Calcium Channel Blockers Side effects ◦ Dizziness, flushing, headache, peripheral For angina prevention edema, fatigue Adverse Reactions ◦ Hypotension, bradycardia Nursing Process: Antianginal Drugs Assessment Obtain baseline vital signs for future comparisons Medication/medical history Pain level for acute episode History of angina attacks, frequency and severity Nursing Process: Antianginal Drugs Nursing interventions Monitor vital signs Position the client sitting or lying down when administering a nitrate for the first time Use gloves when applying topical patch or paste Apply to clean, dry, little hair area – may choose back of arm Administer SL nitroglycerin tablet if chest pain occurs. Give SL every 5 minutes up to 3 times evaluating pain between doses Monitor effects of fast acting nitro – including SL and IV Must keep out of light Nursing Process: Antianginal Drugs Teaching Sit down and rest when chest pain occurs and take nitro. If chest pain not relieved or worse call 911 Demonstrate how SL tablets are administered Storage of nitro in original container away from heat, moisture, and light Rotate sites with patch or paste may apply on arms or thighs to keep from hairy areas. May use acetaminophen for headache relief Do not stop beta blocker or calcium channel abruptly- teach to monitor heart rate and blood pressure Notify HCP for consistent dizziness or faintness Antidysrhythmic Drugs: Mechanism of Action **Beta-adrenergic blockers – olol’s Block epinephrine and norepinephrine Reduce calcium entry **K channel blockers - amiodarone Decrease conduction velocity, Prolong repolarization automaticity, and recovery time Prolong action potential duration **Calcium channel blockers – diltiazem Block calcium influx Slow conduction velocity Decrease myocardial contractility Increase refraction in atrioventricular node  Acebutolol (Beta blocker) & Diltiazem (Calcium Channel blocker) Atrial and supraventricular arrhythmias Antidysrhythmic Drugs Side effects Dizzy, headache, flushing, edema, orthostatic hypotension Adverse Reactions Bradycardia, hypotension, dyspnea  Antidysrhythmic Drugs Amiodarone ◦ Class: Class III (potassium channel blocker) antiarrhythmic ◦ Method of Action ▪ Increased refractory (recovery) time ▪ Prolongs duration of action potential ◦ Uses ▪ Life threatening ventricular arrythmias unresponsive to other drugs: V-tach; V-fib ◦ Side Effects ▪ Fatigue, confusion, dizziness, GI distress ◦ Adverse Effects ▪ Pulmonary toxicity, elevated liver enzymes, dysrhythmias, hypotension, neuropathy, tremors, blue-gray skin discoloration  Assessment Nursing Process: Obtain baseline vital signs and ECG for future Antidysrhythmic comparison. Medical/medication history Palpitations, apical pulse compared to radial pulse Cardiac enzymes – if ordered  Nursing interventions Monitor vital signs for hypotension and bradycardia Monitor lung sounds Nursing Process: If giving IVP, give slowly Antidysrhythmic Monitor ECG for abnormal patterns and report findings Client should be on a cardiac monitor  Teaching Monitor their blood pressure and pulse, ECG (if available on wearable electronic device) Take drug as ordered – do not stop any cardiac drug Nursing Process: abruptly Beta blockers can take 1-3 months for full effect Antidysrhythmic Tell client to report side effects and adverse reactions to a health care provider, for example palpitations, slow heart rate Teach to get up slowly Advise client to avoid alcohol, caffeine, and tobacco.  Practice Question #1 A client has angina pectoris. The client’s BP is 100/60 mm Hg. The nurse administers nitroglycerin 0.4 mg sublingual (SL). It is most important for the nurse to assess the client for the development of A. bradycardia. B. hypotension. C. bradypnea. D. hypokalemia. ANS: B A side effect of nitroglycerin is hypotension owing to the vasodilation of blood vessels. Copyright © 2018, Elsevier Inc. All rights reserved.  Practice Question #2 A nurse is administering digoxin, 0.125 mg, to a client. Which nursing interventions will the nurse implement? (Select all that apply.) A. Checking the apical pulse rate before administration. B. Monitoring the client’s serum digoxin level. C. Instructing client to report pulse rate less than 60. D. Advising client to avoid foods high in potassium. E. Always giving an antacid with digoxin to reduce GI distress. Copyright © 2018, Elsevier ANS: A, B, C The apical pulse should be taken before digoxin administration and the drug withheld if the heart rate is less than 60. The client’s serum digoxin level should be monitored and withheld if in toxic range. Therapeutic level is 0.5 to 2 ng/mL. client should be advised to eat foods high in potassium. client should be advised to avoid taking antacids with digoxin because they decrease absorption.  Practice Question #3 A client is ordered to receive digoxin to treat congestive heart failure. The nurse is most concerned about which assessment finding? A. Heart rate 56 beats/min B. BP 138/90 mm Hg C. RR 18 breaths/min D. 1+ pitting edema of the lower extremities ANS: A A baseline pulse rate for the client should be obtained for future comparisons. Apical pulse should be taken for a full minute and should be greater than 60 beats/min. The prescriber should be notified if the client’s pulse is less than 60 beats per minute.  Practice Question #4 A nurse is preparing to administer digoxin to a client. Which laboratory result is the nurse most concerned about? A. Sodium 138 mEq/L B. Potassium 3.0 mEq/L C. Digitalis level 1.8 ng/mL D. BNP 200 pg/mL ANS: B A low serum potassium level enhances the action of digoxin and can cause digitalis toxicity.  Practice Question #5 When administering antianginal drugs, the nurse identifies which as the most common response? A. Tachycardia B. Bradypnea C. Hypotension D. Dry mouth ANS: C The most common side effect of antianginal drugs is hypotension.  Practice Question #6 The nurse should teach the client to report which of the following to the health care provider immediately if experienced after taking nitroglycerin? A. Dizziness B. Faintness C. Headache D. Persistent pain ANS: D Dizziness, faintness, and headache can occur when taking nitroglycerin. It is important to teach the client about avoiding complications related to orthostatic hypotension. Persistent pain indicates the possibility of acute coronary syndrome.  Practice Question #8 A client with angina and a long history of severe chronic obstructive pulmonary disease is ordered beta blocker therapy. Which beta blocker would be most effective for this client? A. Propranolol B. Nadolol C. Pindolol D. Atenolol ANS: D Cardioselective beta blockers act more strongly on the beta1 receptor, which decreases the heart rate but avoids bronchoconstriction. Examples of selective beta blockers are atenolol (Tenormin) and metoprolol (Lopressor, Toprol-XL). Examples of nonselective beta blockers are propranolol (Inderal), nadolol (Corgard), and pindolol (Visken). These drugs decrease the heart rate and can cause bronchoconstriction.