Unit 6 - flash cards Cardiac Medications

Cardiac Medications Flashcards

Heart Disease

Most common cause of hospitalization in Canada, consisting of HTN, Angina, Heart Failure, Dysrhythmias, CAD.

Hypertension

Blood pressure greater than 140/90, increasing risk for CAD, CVD, CVA, PVD, heart and kidney failure.

Antihypertensive Drugs

Goal is to decrease BP to less than 140/90 using diuretics, adrenergic drugs, ACE inhibitors or ARBs, CCB, vasodilators.

Hawthorn

Historically used for heart disease, but benefits are not confirmed. Side effects include dizziness, nausea, and GI symptoms.

Angiotensin Converting Enzymes (ACE) inhibitors

Used for HTN & Heart failure. Can stop the progression of left ventricular hypertrophy. Drug names end in ‘pril’.

Patient and Nurse Information for ACE Inhibitors

Monitor BP, change positions slowly, take on an empty stomach, avoid potassium supplements, and remember a side effect is a dry nagging cough.

Angiotensin Receptor Blockers (ARB)

Similar to ACE inhibitors, end in ‘Sartan’, affect vascular smooth muscle by blocking angiotensin II binding to receptor sites, potent vasodilator.

Angina

Chest pain that occurs when there is decreased O2 supply to meet the demands of the heart.

Antianginal Drugs

Correct the imbalance between myocardial O2 supply & demand, decreasing heart rate & contractility. Includes Nitrates & nitrites, beta-blockers, and Calcium channel blockers.

Antianginal Therapeutic Goals

Minimize the frequency of attacks, improve patient symptoms, and prevent or delay an MI.

Nitrates

Available as patches, SL tabs & spray, ointment, capsules & IV. Relaxes smooth muscle and dilates large & small coronary arteries. Used for all types of angina.

Chest Pain and Nitro SL dosing

Take SL dose at the 1st sign of chest pain and sit or lie down. If not relieved after 3 doses ( 5 min apart), call an ambulance.

Cardiac Drug Therapy Overview

Medications that either positively or negatively affect Inotropic (force of contraction), Chronotropic (heart rate), or Dromotropic (conduction).

Heart Failure

Heart has difficulty pumping blood in forward motion, leading to congestion in pulmonary and systemic circulation.

Treatment of Heart Failure - New Guidelines

Reduce the effects of the Renin-Angiotensin-Aldosterone system using ACE inhibitors or ARBs, beta-blockers, loop diuretics, or Digoxin.

Digoxin - Cardiac Glycoside

Positive inotropic drug for Atrial fibrillation, also used for patients with a normal sinus rhythm; negative chronotropic and dromotropic effects.

Atrial Fibrillation

Cardiac arrhythmia with rapid & irregular contractions of the atria, leading to incomplete blood pumped into ventricles and potential stroke.

Digoxin Mechanism of Action

Promotes the movement of cellular Ca2+ from ECF to ICF, slowing contractions through the SA and AV node; increases Diastolic filling between heart beats.

Nursing Implications - Digoxin

Monitor for adverse effects, assess apical pulse (hold if less than 60 bpm), monitor serum potassium & digoxin levels, and assess renal function.

Antiarrythmic Drugs

Drugs used to restore normal rhythm & conduction by altering the excitability of cardiac cells and divided into 4 classes.

Class 1 antiarrhythmic drugs

Na+ channel blockers, subdivided into a/b/c, affecting the action potential in varying amounts.

Class 2 antiarrhythmic drugs

Beta blockers (atenolol, metoprolol), block receptor sites in the conduction system, decreasing heart rate, delay AV node conduction and decreasing contractility.

Class 3 antiarrhythmic drugs

K+ channel blockers (amiodarone).

Class 4 antiarrhythmic drugs

Ca2+ channel blockers (verapamil hydrochloride) work on the SA and AV node to decrease heart rate.

Beta Blockers

Used for heart failure, angina, post MI, HTN, arrhythmias. End in ‘olol’, protect the heart from being stimulated by catecholamines.

Beta blocker Effect

Reduce workload of the heart by decreasing heart contractility, slowing heart rate, decreasing myocardial O2 demand, and suppressing the release of renin.

Ca2+ Channel Blockers (CCB)

Used to treat HTN & Angina & dysrhythmias; cause smooth muscle relaxation by not allowing Ca2+ to bind to receptor sites.

Calcium Channel Blockers Action:

Blocks calcium access to cells causing contractility and conductivity of the heart to decrease, ultimately decreasing demand for oxygen

Dyslipidemia

Increased lipids in the blood including Cholesterol & Triglycerides.

Antilipemic Drugs

HMG-CoA inhibitors (Statins), Bile Acid Sequestrants, Fibric Acid derivatives, Nicotinic Acid.

HMG-CoA Inhibitors (Statins)

Decrease the rate of cholesterol production by inhibiting the enzyme needed by the liver, promoting the breakdown of cholesterol, and being the first line of drug used for hypercholesteremia.

Bile Acid Sequestrants

2nd line drugs to decrease cholesterol levels; prevent the reabsorption of bile acids in the small intestine.

Nicotinic Acid

Classified as a lipid-lowering agent and a vitamin (B3); inhibits lipolysis in adipose tissue and increases enzyme lipase breakdown