Cardiovascular System Meds

High-ceiling loop diuretics MOA

blocks reabsorption of sodium and chloride in the loop of helen to preven the reabsorption of water

High-ceiling loop diuretics therapeutic uses

congestive heart failure (edema caused by CHF)

When can high-ceiling loop diuretics not be used?

Hypotension, on digoxin or antihypertensives

Side effects associated with high-ceiling loop diuretics

frequent urination, hypotension, ototoxicity and tinnitus, hypokalemia

High-ceiling loop diuretics common ending

-ide (oddball is ethacrynic acid)

Thiazide-Like Diuretics common ending

-azide

Thiazide-Like Diuretics MOA

blocks the reabsorption of sodium and chloride and prevents the reabsorption of water at this site

thiazide-like diuretics therapeutic uses

pulmonary edema, essential hypertension

Thiazide like diuretics side effects

dehydration, hyponatremia, hyperglycemia

When can thiazide like diuretics not be used?

renal impairment and pregnancy

Potassium-Sparing Diuretics MOA

block the action of aldosterone, causing potassium retention and excretion of sodium and water

Potassium-Sparing Diuretics therapeutic use

heart failure and hypertension

Potassium-Sparing Diuretics side effects

hyperkalemia, endocrine effects, drowsiness, metabolic acidosis

Potassium-Sparing Diuretics drugs in class

spironolactone, triamterene, amiloride

Osmotic diuretics MOA

reduces intracranial and intraocular pressure

Osmotic diuretics therapeutic use

prevent kidney failure, decrease pressure, promote sodium retention

Osmotic diuretics side effects

heart failure, pulmonary edema, rebound increased intracranial pressure, fluid and electrolyte imbalances (metabolic acidosis)

Osmotic diuretic drug in class

mannitol

When is mannitol not an option?

taking ginko or cardiac glycosides, pregnant

What is the RAAS system?

renin-angiotensin-aldosterone system

How does the RAAS system work?

1. Renin converts angiotensinogen to angiotensin I
2. Angiotensin I --> angiotensin II (ACE enzyme)
3. Angiotensin II causes vasoconstriction which increases BP and causes release of aldosterone from adrenal gland
4. Aldosterone increases sodium reabsorption from distal and collecting tubules of nephrons
5. Water follows sodium
6. Sodium and water are retained in blood

What does the RAAS system do?

regulates blood pressure

What are the first line drug classes for blood pressure?

Which types of diuretics are commonly used with HTN?

ACE Inhibitors MOA

renin released to blood, reduces production of angiotensin II by blocking conversion of angiotensin I, triggers aldosterone release, causing vasoconstriction

How do ACE inhibitors benefit HF and HTN patients?

proven to decrease mortality and myocardial workload

Side effects of ACE Inhibitors

Cough, hyperkalemia, angioedema, orthostatic hypotension, headache, dizziness

Common ending for ACE Inhibitors

-pril

Angiotensin II Receptor Blockers MOA

block the action of angiotensin in the body resulting in vasodilation and excretion of sodium and water

Common ending for Angiotensin II Receptor Blockers

-sartan

Angiotensin II Receptor Blocker Therapeutic Use

can't tolerate an ACE

Angiotensin II Receptor Blocker Side Effects

No cough, angioedema, fetal injury, hypotension, dizziness/lightheadedness

Aldosterone Antagonist MOA

reduce blood volume by blocking aldosterone receptors in the kidney, promoting excretion of sodium and water and retention of potassium

How do aldosterone antagonists benefit HF and HTN patients?

reduces effort of heart muscle due to retention of potassium, diuretic

Side effects of aldosterone antagonists

hyperkalemia, hyponatremia, flu-like symptoms, endocrine changes, dizziness fatigue

Common ending for aldosterone antagonists

-one

Direct Renin Inhibitor MOA

binds with renin to inhibit production of angiotensin I to decrease the production of angiotensin II and aldosterone

Direct Renin Inhibitor Therapeutic Use

relieves HTN

Side effects of Direct Renin Inhibitor

angioedema, rash, cough, hyperkalemia, diarrhea, hypotension

Additional teaching for Direct Renin Inhibitors

avoid high fat foods

Drug in Direct Renin Inhibitor Class

aliskiren

Calcium Channel Blockers MOA

vasodilation of peripheral arteries of the heart resulting in decreased force of contraction, decreased heartrate, and slow conduction through AV node

Calcium Channel Blockers therapeutic use

cardiac dysrhythmias

Calcium Channel Blockers side effects

acute toxicity (hypotension, bradycardia, AV block), orthostatic hypotension, and peripheral edema

Common ending for Calcium Channel Blockers

-ipine (but also verapamil and dilitazem)

Therapeutic use for diltiazem

heart and vascular effects, to regulalte heart rate for A. Fib

Alpha Adrenergic Blockers MOA

causes peripheral dilation, relaxes smooth muscle of bladder and prostate, reducing BPH symptoms

Alpha Adrenergic Blockers therapeutic use

HTN, urinary outflow obstruction, obstruction/irritation associated with benign prostatic hyperplasia (not as strong as B-Blockers and CCBs)

Alpha Adrenergic Blockers side effects

dizziness, asthenia, headache, edema

Common ending for Alpha Adrenergic Blockers

-zosin

Centrally Acting Alpha2 Agonists MOA

acts within the CNS to decrease the simulation of adrenergic receptors in the heart and the peripheral vascular system

Centrally Acting Alpha2 Agonists therapeutic uses

Primary hypertension, severe cancer pain, management of ADHD

Centrally Acting Alpha2 Agonists Side Effects

Decrease heart rate and dilate vessels: drowsiness and sedation, dry mouth, rebound hypertension if abruptly discontinues, constipation, dizziness

Meds in Centrally Acting Alpha2 Agonists class

clonidine, guanfacine, methyldopa

Beta-Adrenergic Blockers MOA

blocks effects of epinephrine
B1: heart
B2: lungs

Beta-Adrenergic Blockers Therapeutic Use

primary hypertension, angina, tachydysrhythmias, heart failure, and MI
(helpful in returning shape and function of LV)

Beta-Adrenergic Blockers side effects

Bradycardia, AV block, decreased cardiac output, orthostatic hypotension, bronchoconstriction

What to monitor before giving Beta-Adrenergic Blockers?

baseline ECG, blood glucose levels, and BP

Instructions for taking Beta Blocker

Self monitor HR and BP daily, sit or lie down if experiencing dizziness or faintness, avoid sudden changes of position, do not d/c med without provider consultation

When would you hold Beta Blocker?

rebound myocardium excitation, shortness of breath, edema, weight gain, fatigue

Which patients should receive Beta Blocker with caution?

heart failure and asthma

Beta-Adrenergic Blocker common ending

-olol

Medications for hypertensive crisis MOA

nitroglycerin dilates veins and decreases venous return, which decreases cardiac oxygen demand

Medications for hypertensive crisis therapeutic use

acute heart failure, acute angina attack

Medications for hypertensive crisis side effects

headache, orthostatic hypotension, reflex tachycardia, tolerance, fluid retention

Medications for hypertensive crisis (drugs in class)

nitroglycerin, nitroprusside, nicardipine, clevidipine, enalaprilat, esmolol

Cardiac Glycosides drug in class

digoxin

Cardiac Glycosides MOA

positive inotropic effect: increased force of myocardial contraction
negative chronotropic effect: decreased heart rate (give ventricles more time to fill with blood, increasing stroke volume and cardiac output)

Cardiac glycosides therapeutic use

second-line medication for heart failure

What to monitor before giving Cardiac Glycosides?

pulse rate (hold if HR is less than 60 bpm) and blood levels of potassium (3.5-5.0)

What to give for cardiac glycoside overdose?

digibind

Adrenergic Agonists MOA

activation of alpha 1 receptors (vasoconstriction), beta 1 receptors, beta 2 receptors, and dopamine receptors (vasodilation, increased HR)

Adrenergic Agonist therapeutic uses

anaphylactic shock, absorption of local anesthetics, superficial bleeding, decreased nasal congestion, increased BP, treatment of AV block, HF, shock, cardiac arrest, asthma

Side effects of Adrenergic Agonists

Hypertensive crisis, cardiac complications, necrosis

Meds in Adrenergic agonist class

epinephrine, dopamine, dobutamine, isoproterenol, norepinephrine