Chapter 25 Cardiovascular Drugs

? is used the most frequently because it can be administered ? and ? and has intermediate duration of action (cardiac glycosides)

Digoxin (Lanoxin), orally, parenterally

Nurse should observe the pt for signs of ? when administering Digoxin and Quinidine

Digoxin Toxicity

Hypotension in pts taking a beta-blocker is potentiated when the pt also takes a ?, another antihypertensive drug, muscle relaxants, sedatives or alcohol.

Diuretic

With ?, remove old paper first, ointment is spread lightly (not massaged or rubbed) over any hairless skin area and the applicator paper is taped in place. Care is taken to avoid touching the ointment when applying.

Nitro-Bid

Beta - Blockers can benefit hypertensive pts with:

Angina, Post MI, Ischemic Heart Disease, HF, Certain Arrhythmias and Diabetes

Hypertension is defined as a BP of ?

140/90

Interactions of Amiodarone

Warfarin, digoxin, phenytoin, grapefruit juice, beta-blockers, calcium channel blockers, lidocaine

? is equal in effectiveness to diltiazem or verapamil in converting PSVT, but is less likely to cause Hypotension.

Adenosine

? is considered a broad spectrum antiarrythmic.

Amiodarone

? is a class III oral and injectable antiarrhythmic agent approved for the treatment of refractory life-threatening ventricular arrhythmias

Amiodarone (Cordarone)

Toxic Side effects of Digoxin

Anorexia, Headache, Fatigue, Muscle Weakness, Vertigo, Irritability, Tremors, Seizures, Visual disturbances including blurring, diplopia, or halos, Caridac arrhythmias of all kinds including Bradycardia, electrolyte imbalance, esp Potassium, Insomnia, confusion, mental disorders, esp in older adults

Early signs of digoxin toxicity are:

Anorexia, N/V

Interactions of Digoxin may occur with:

Antacids, Cholestyramine, neomycin, and rifampin reduce absorption of digoxin, Diuretics, Calcium, and corticosteroids can increase chance of arrhythmias, Macrolides, antiarrhythmias (especially quinidine and verapamil) may potentiate digoxin toxicity. Adrenergics increase the risk of Arrhythmias

Drugs that control or prevents cardiac irregularities

Antiarrhythmic

? do not cure HTN, only control it.

Antihypertensives (Hypotensives)

transdermal form, ?, is a skin patch that is applied q 24 hrs to clean, dry, hairless areas of the upper arm or boddy. Do NOT apply below the elbow or knee. Sites should be rotated to avoid skin irritation and raw, scarred or callused areas should be avoided. Patch dosage varies widely, from 0.1 to 0.8 mg per hr daily. Remove old patch

Nitro-Dur

? is also available in timed release capsules and tablets, and in an injectable formulation that must be diluted carefully.

Nitroglycerin

S/E of Lidocaine are usually of short duration, are dose related and can include:

CNS symptoms (tremors, seizures, dizziness, confusion, and blurred vision), Hypotension, Bradycardia, Heart Block, Dyspnea, Respiratory Depression and Arrest.

? counteract arrhythmias by suppressing the action of Calcium in contraction of the heart muscle, reducing cardiac excitability and dilating the main coronary arteries.

Calcium channel Blockers

Medication used primarily in the treatment of heart failure

Cardiac Glycosides

Calcium Channel Blockers such as ? and ? are an initial therapy option for hypertensive patients with Diabetes or High Coronary Disease risk. They are more effective in treating African-American pts, older adults, and pts with higher pretreatment BP readings.

Cardizem and Procardia

? is available in several forms and can be administered in SL tablets, or SL spray during an acute attack, additional tabs may be given in 5 min intervals, with NO more than 3 doses given in a 15 minute period.

Nitroglycerin

? are used in the treatment of Angina

Coronary Vasodilators

The ? are used commonly for relief of acute angina pectoris, as well as for long term prophylactic management are ? and ?.

Nitroglycerin and Isosorbide

Treatment of Digoxin Toxicity includes:

D/c the drug immediately, Monitoring electrolytes for hyperkalemia, hypokalemia, hypomagnesemia, hypercalcemia, drugs such as atropine for symptomatic bradycardia, Digoxin-specific Fab fragments (Digibind) as antidote in life-threatening toxicity

the process of establishing the correct therapeutic dos of digoxin for maintaining optimal functioning of the heart without toxic effects.

Digitalization

Symptoms of heart failure include:

Fatigue, weakness, dyspnea, cyanosis, increased heart rate, cough, pitting edema

Contraindication or extreme caution with Nitrates applies to:

Glaucoma, GI hypermotility or malabsorption, Intracaranial Pressure, Severe Anemia, Hypotension

S/E of Nitrates can include:

Headache, Postural hypotension, including dizziness, weakness, and syncope, blurred vision and dry mouth, hypersensitivity reactions enhanced by alcohol, including N/V, diarrhea, cold sweats, tachycardia and syncope

? is a widespread epidemic that affects one billion people worldwide and approx. 60 million adults in the US

Hypertension

Short-acting Calcium Channel blockers should never be used to manage ? because of reports of increased risks of MI and mortality

Hypertension

Calcium channel blockers contraindicated with:

Hypotension and heart block, certain arrhythmias and severe heart failure

S/E of Calcium Channel Blockers:

Hypotension with vertigo and headache, Bradycardia with heart block, Edema, Constipation, Nausea, Abd discomfort

S/E of Beta Blockers:

Hypotension, Bradycardia, CNS symptoms, Branchospasm, hypoglycemia

? is typically administered as prophylactic therapy to maintain normal rhythm after the pts rhythm has been converted by other methods.

IA Procainamide

Patient Educations for taking Antiarrhythmics:

Immediate reporting of adverse effects (palpitations, irregular/slow HR, faintness, dizziness, weakness, respiratory distress, visual disturbances) Rising slowly from reclining position Modification of lifestyle to reduce stress Mild exercise on a regular basis as MD ordered NOT DC meds if feeling better taking proper dosages on time w/o skipping if med is forgotten, no double dosing Take meds w/a full glass of water on an empty stomach, 1 hr before or 2 hrs after meals Avoid taking other meds, including OTC meds, unless approved by MD Discard expired meds/renew prescription Avoid comparisons with other pts on similar drugs

Practices used to encourage pts to initiate or continue healthy lifestyle practices include:

Weight Reduction, Uses of Dietary Approaches to Stop Hypertension (DASH) eating plan, dietary sodium reduction, increased physical activity, modified alcohol use, and smoking cessation

In pt's with HF, the cardiac glycosides act by ? the force of the cardiac contractions w/o increasing oxygen consumption, thereby increasing Cardiac Output.

Increasing

?, an antiarrhythmic agent combats arrhythmias by inhibiting sympathetic nerve receptors.

Inderal (Propranolol)

Another nitrate used for acute relief of angina pectoris is ? it is available in SL tablets, regular release tabs, and timed release cap and tabs.

Isosorbide

Local anesthetics, ?, are administered for their antiarrhythmic effects and membrane-stabilizing action.

Lidocaine

Glycosides act directly on the ? to increase the force of myocardial contractions. Used to SLOW the ventricular response in pts with Afib or flutter

Myocardium

Coronary vasodilators used in the treatment and prophylactic management of angina include ?

Nitriates, beta-blockers, and calcium channel blockers

One type of Nitro that is absorbed thru the skin is ? ointment, applied with an applicator-measuring paper. Usual dosage is 0.5-2 inches applied q 8 hours.

Nitro-Bid

electrolyte surveillance, especially for disorders of ? and ? is very important for pts on antiarrhythmic agents.

Potassium and Magnesium

? is contraindicated in pts with CHF

Procainamide

Syncope and tachycardia are S/E of these Meds

Procainamide and Quinidine

? and ? may cause tachycardia

Procainamide and quinidine

? is used in the tx of hypertension and some forms of chronic angina, because it also blocks the beta 2 receptors in the lungs, it can lead to bronchospasm.

Propranolol (Inderal)

Contraindications or extreme Caution of Lidocaine applies to:

Pts hypersensitive to local anesthetics of this type (amide type) Heart block and respiratory Depression, Pregnancy, Lactation and Pregnancy

Antiarrhythmic agents, ? and ? while having the potential to lower B? and slow the HR, may cause tachycardia

Quinidine and Procainamide

contraindications or extreme cautions with Digoxin include

Severe pulmonary disease, hypothyroidism, acute MI, acute Myocarditis, severe HF, Impaired Renal function, hypokalemia, hypomagnesemia, Arrhythmias not caused by HF, High doses in older adults

For long-term prophylactic management of Angina pectoris, NItro is frequently applied topically as a ? system

Transdermal

? are administered to dilate blood vessels and stop attacks of angina or reduce the frequency of angina when administered prophylactically.

Vasodilators

Only ? and ? of the Calcium Channel Blockers contain antiarrhythmic activity & are class IV agents indicated for treatment of AFib/flutter and PSVT. Also used in the treatment of Angina and HTN

Verapamil (calan) and Diltiazem (Cardizem)

When there is insufficient blood supply (ischemia) to a part of the heart, the result is

acute pain

Interactions of nitrates occur with:

alcohol, PDE inhibitors,

If chest pain is not relieved or worsens in 5 mins after a dose, EMS should be activated because unrelieved chest pain can indicate?

an acute MI

The most common form of angina is ? , chest pain resulting from decreased blood supply to the heart muscle

angina pectoris

Obstruction or constriction of the Coronary arteries which supply the heart muscle with oxygenated blood results in

angina pectoris.

High BP increases the risk of :

angina, MI, HF, Stroke, Retinopathy, PAD, Kidney Disease

Check ? pulse for one full minute before administering Digoxin. If less than ?, it needs to be withheld until MD is consulted. Remember to document this action.

apical, 60

Patient Education with Digoxin

avoid taking other meds at same time w/o MD approval, Avoiding all OTC meds, especially antacids and cold remedies, Avoid abrupt withdrawal after prolonged use; check HR and BP on a regular basis, not changing brand or dosage form being taken.

? are also used in the treatment of angina and hypertension

calcium channel blockers

Cardiac Glycosides are used primarily in the tx of ? to decrease pulmonary and systemic congestion by increasing the force of cardiac contractions and increasing cardiac output.

congestive Heart failure

Beta-adrenergic Blocking agents inhibit sympathetic nerve receptors which cause a ? in the BP and HR

decrease

Contraindications or Extreme Caution with Beta Blockers

diabetes, Renal and hepatic impairment, Ashtma and allergic rhinitis, Bradycardia, heart block, CHF, Pediatric Use, Pregnancy, Lactation, COPD

The most commonly used Cardiac Glycosides are ? products

digitalis

Serum ? levels are required to determine the therapeutic maintenance dose.

digoxin

Digoxin in available in tablet form, elixir or IV therapy and ? adjustments may be required when changing from one form to another.

dosage

Antiarrhythmic agent Adenosine's S/E include:

facial flushing, lightheadedness, headache, dyspnea, and chest pressure. and contraindicated in pts with second or third degree heartblock or symptomatic bradycardia

Nitroglycerin tablets and capsuls must be stored only in ? with tightly metal screw tops away from heat.

glass containers

Thiazide Diuretics are used FIRST in treating ? and should be given either alone or in combination with a drug of one of these classes:

hypertension, ACE inhibitors, Angiotensin Receptor Blockers, Beta-Blockers, or Calcium Channel Blockers

The health care practitioner assessing a pt receiving Digoxin must always be aware of the pt's most recent serum potassium level, assessing for either:

hypo or hypercalemia

When administering Antiarrhythmic meds, be alert for signs of ? and ? which could lead to cardiac arrest.

hypotension, bradycardia

S/E of Antihypertensives are common and the most common s/e is:

hypotension, especially postural hypotension, Bradycardia. Exceptions include Hyrdralazine, which can cause Tachycardia

In older adults, digoxin toxicity may be manifested by:

insomnia, Confusion, and Mental Disorders

S/E of Amiodarone, some of which are severe and potentially fatal, but may be less of a problem in a lower dose:

pulmonary fibrosis, Cardiac arrhythmias, hypotension, N/V, constipation, anorecia, hepatitis, hyper or hypothyroidism, Neurotoxicity, Visual Disturbances; optic neuropathy and/or neuritis, Dermatologic reactions, esp Photosensitivity.

drug of choice varies according to the ? of hypertension, other physical factors, and effectiveness in individual cases.

stage

Avoid ? while taking a calcium channel blocker because it increases risk of hypotension

taking meds with grapefruit juice

Impaired potency of the SL tablets can be detected by the pt if there is an absence of the ? sensation under the tongue common to this form of administration

tingling

When using long lasting nitrates, a 12-14 h nitrate free interval between the last dose of the day and the firs dose of the following day is recommended to lessen the risk of nitrate ?.

tolerance

ACE's lowers BP by decreasing ?

vasoconstriction; there are not significant changes in HR or cardiac Output

A class IB agent, Lidocaine is now considered second choice behind other alternative agents for the treatment of

ventricular arrhythmias