Cardiac Drugs

Cardiac Drugs

• ACE inhibitors

• aminodarone

• atropine

• BB

• CCBs

• Digoxin

• Dopamine

• Epinephrine

• Furosemide

• Nitrates

ACE inhibitors

enalapril, captopril

Enalapril action

inhibits ACE, preventing conversion of angiotensin I to II, a potent vasoconstrictor.

Enalapril indication

HTN

Enalapril key S/E

dizziness, fatigue, HA, vertigo, hypotension, orthostatic hypotension

Enalapril nursing considerations

closely monitor BP response to drug, monitor CBC with differential counts before and during therapy, monitor potassium intake and potassium levels, monitor kidney function, monitor pt for angioedema, monitor for s/sx of liver toxicity

Captopril action

inhibits ACE, preventing conversion of angiotensin I to II, a potent vasoconstrictor

Captopril indication

HTN, diabetic nephropathy, HF, left ventricular dysfunction after acute MI

Captopril key s/e

• thrombocytopenia

• hyperkalemia

• dizziness

• HA

• fatgiue

• fever

• insomnia

• tachycardia, hypotension, chest pain, palpitations

• leukopenia

• agranulocytes

• panccytopenia

captopril nursing considerations

• BOXED warning

• Black Patients may have adverse reactions: angioedema

• assess for angioedema

• Drug causes cough

Amiodarone action

inhibits adrenergic stimulation and blocks sodium and potassium channels, leading to prolongation of action potential duration

Amiodarone Indication

V fib or hemodynamically unstable v tach

Amiodarone key s/e

asystole, bradycardia, a fib, v tach, HF, cardiogenic shock, sinus arrest, fever, fatigue, ataxia, insomnia, HA, dizziness, nausea, vomiting, anorexia, constipation, abd pain, hypothryoidism, hyperthyroidism, alopecia

Amiodarone nursing considerations

• BOXED WARNING

• be aware of high risk of adverse reactions

• obtain baseline thyroid function

• Drug may cause HYPERTHYROIDISM or hypothyroidism

• Drug is highly toxic

• Monitor for liver toxicity

• Monitor electrolyte levels, potassium and magesium

Atropine action

inhibits muscarinic actions of acetylcholine at parasympathetic neuroeffector junction blocking vagal effects on SA and AV nodes, enhancing conduction through AV node and increasing HR

Atropine indication

• bradycardia

• asystole

• Stress echocardiography

• Diminish secretions and block cardiac vagal reflexes

atropine key s/e

• HA, insomnia, dizziness, ataxia

• bradycardia, prolonged QT

• seizure

• constipation, nausea, vomiting, abd distention, abd pain

• urinary retention, ED

• hypoglycemia, hypokalemia

• bradypnea, pulmonary edema, dyspnea

• anaphylaxis, death

• cyanosis

atropine nursing considerations

• Dose low in 0.5 for adults: may increase risk of paradoxical bradycardia

• Dose low in 0.1 for children: may increase risk of paradoxical bradycardia

• Watch for tachycardia

• Monitor fluid intake and urine output

• Monitor closely for respiratory tract mucus plug formation in patient with chronic lung disease

BBS

metoprolol, labetalol

Metoprolol action

selectively blocks beta 1 receptors; decreases cardiac output, peripheral resistance, and cardiac oxygen consumption; and depresses renin secretion

metoprolol indication

• HTN

• acute MI

• angina pectoris

• HF

metoprolol key s/e

• stroke

• bradycardia

• bronchospasms

• fatigue, dizziness, depression, HA, insomnia

• nausea, diarrhea, constipation, flatulence, vomiting

• dyspnea, wheezing, bronchospasms

• prurtius

Labetabol action

may be r/t reduced peripheral vascular resistance as a result of alpha and beta blockade

Labetabol indication

• HTN

• severe HTN, hypertensive emergencies

Labetabol key s/e

dizziness, fatigue, HA, orthostatic hypotension, vertigo, dyspepsia, nausea, vomiting, wheezing, dyspnea, diaphoresis, pruritus

Labetabol nursing considerations

• frequently monitor BP and heart rate and rhythm in pt receiving IV therapy

• Monitor pt for bronchospasm

• Monitor for hypersensitivity reactions

CCBS

• Amlodipine

• nifedipine

• Diltiazem

• Verapamil

digoxin action

inhibits sodium potassium activated adenosine triphosphatase, promoting movement calcium from extracellular to intracellular cytoplasm and stregthening myocardial contractions

Digoxin indication

• HF

• a fib

Digoxin key s/e

• confusion

• dizziness

• headache

• anxiety

• depression

• delirium

• arrhythmias

• heart block

digoxin nursing considerations

• May increase HF and hypotension

• be careful with hypothyroid patients

Dopamine action

stimulates dopaminergic, alpha, and beta receptors of a SNS, resulting in positive inotrophic effect and increased cardiac output. Action dose related

Dopamine indication

to improve hemodynamic status in pts in shock

dopamine key s/e

• HA, anxiety

• hypotension, arrhymias, tachycardia, palpitations

• N/V

• dyspnea

Dopamine nursing considerations

• most pts require less than 20 mck/kg/min

• Correct hypovolemia, acidosis, and hypoxia before giving dopamine

Epinephrine action

potentiates alpha and beta receptors. Relaxes bronchial smooth muscle by stimulating beta 2 receptors. Stimulates alpha and beta receptors in the SNS

epinephrine indication

• anaphylaxis

• Type 1 allergic reactions

• cardiac resusitation

epinephrine key s/e

• cerebral hemorrhage, stroke, subarachnoid hemorrhage

• MI, shock, tachycardia, palpitations

• hypoglycemia, hypokalemia

• dyspnea, pulmonary edema

• diaphoresis, pallo, urticaria

epinephrine nursing considerations

• Use phentolamine to prevent tissue sloughing and necrosis if epinephrine extravasation occurs

• closely observe pt for and notify prescriber of adverse reactions

Furosemide action

inhibits sodium and chloride reabsorption at the proximal and distal tubules and ascending loop of Henle

Furosemide indication

• acute pulmonary edema

• edema

• HTN

furosemide key s/e

• dizziness, fever, HA, paresthesia

• hypotension, thrombophlebitis

• hearing impairment, tinnitus, vertigo

• anorexia, constipation, diarrhea, pancreatitis, nausea, vomiting

• polyuria, nocturia

• thrombocytopenia, agranulocytes

• hypoglycemia, hypokalemia, hypomagnesemia

• pruritus, gout

furosemide nursing considerations

• BOXED WARNING

• watch for signs of hypokalemia

• Monitor uric acid level

• monitor glucose level

• Monitor weight, BP, and pulse

Nitrates action

class of vasodilators that primarily work by releasing nitric oxide (NO) into the body

Nitrates indication

angina (chest pain)

Nitrates key s/e

• HA

• low BP

• flushing

• tachycardia

• blurred vision or other visual disturbances

nitrates nursing considerations

• drug interactions (severe with ED meds)

• Iv administration (special tubing, glass bottles)

• tolerance (nitrate free intervals)

Isordil action

reduces cardiac oxygen demand by decreasing preload and afterload; also may increase blood flow through the collateral coronary vessels

Isordil indications

HF, angina pectoris

Isordil key s/e

• dizziness, fatigue, HA, syncope

• chest pain, orthostatic hypotension

• abd pain, nause

• pruritus

Isordil nursing considerations

• Monitor BP, HR, and intensity of drug response

• drugs may cause HA