Cardiovascular Medications

Alpha 1 Adrenergic Blockers

Indications: HTN, BPH, Pheochromocytoma

Contraindications: Acute Heart Failure, Peptic Ulcer, Liver/Kidney disease, Asthma

Side Effects: orthostatic hypotension, reflux tachycardia, nasal congestion, impotence

Drug Interactions: warfarin, ED meds, alcohol, epinephrine, beta blockers

Nursing Considerations: two doses (first dose lay down 90 min), change positions slowly, priapism teaching, careful before you know the effects

-zosin!

Doxazosin

Alpha 1 Adrenergic Blocker

1-8mg dose

matrix excreted in the stool

Prazosin

Alpha 1 Adrenergic Blocker

Terazosin

Alpha 1 Adrenergic Blockers

Alpha 2 Receptor Agonist

Indication: HTN

Contraindication: heart failure, peptic ulcer, severe liver + kidney disease

Side Effects: drowsiness, sedation, orthostatic hypotension, congestive heart failure

Drug Interactions: TCA, MAOIs, amphetamines, diuretics, nitrates, betablockers

Nursing Considerations: tapered dosing, monitor fluid retention, side effects worse in the elderly

Clonidine

Alpha 2 Receptor Agonist

0.2-0.6 BID PO or 0.1-0.3 g/24hr patch

remember to remove the patches

Methyldopa

Alpha 2 Receptor Agonist

Beta Receptor Blockers

Indications: HTN, heart failure, angina, MI prevention, SVA tachycardia

Contraindications: conduction abnormalities, bradycardia, asthma

Side Effects: brady/tachy cardia or dysrhythmias, acute severe heart failure, impotence, low exercise tolerance, bronchospasm

Drug Interactions: antacid, digoxin, diuretics, neuromuscular meds, hypoglycemic meds/insulin

Nursing Considerations: check HR + BP, cardio selective and nonselective, glucose monitoring, don’t stop med abruptly, take w/ meals

-Lol

Atenolol

Beta Receptor Blocker

50-200mg/day

cardioselective

Metroprolol

Beta Receptor Blocker

50-400mg/day PO

cardio selective

Propranolol

Beta Receptor Blockers

nonselective

Combination alpha 1 and Beta Receptor Blockers

everything is the same as Beta Receptor Blockers

Labetolol

Combination alpha 1 and Beta Receptor Blockers

IV and PO

Carvedilol

Combination alpha 1 and Beta Receptor Blocker

PO only

avoid in bronchospastic conditions, bradycardia, conduction system problems

ACE inhibitors

what does it do: lower hypertension (heart failure, MI)

what class does it belong to: antihypertensives

monitor: edema (no sudden movements either)

side effects: Angioedema, Cough, Elevated Potassium, dizziness, renal dysfunction (ACE Dr.?)

what to avoid: pregnancy, renal artery stenosis, NSAIDs, diuretics, antihypertensives, lithium

-pril

Captopril

ACE inhibitor

25-150 mg BID

shorter life on empty stomach

Lisinopril

ACE inhibitor

2.5-40mg daily

not food dependent

Enalapril

ACE inhibitor

route dependent

Angiotensin II Receptor Blockers (ARBs)

what does it do: HTN (heart failure)

what class: Antihypertensives

monitor: K levels, HR and BP

side effects: orthostatic hypotension, chest pain, diarrhea, hypoglycemia, anemia

avoid: pregnancy, NSAIDs, antihypertensives, diuretics, rifampin, lithium

-artan

Losartan

ARB

25-100 PO BID/daily

not food dependent

Valsartan

ARB

80-320 PO daily

take with meals

Calcium Channel Blockers

what does it do: smooth muscle relaxation —> dec HTN

what class: antihypertensives

side effects: hypotension, edema, palpitations, bradycardia, constipation

consider: monitor vitals, 90/60 BP is a no go

avoid: grapefruit juice, beta blockers, digoxin, amiodarone, anti-infectants, statins, cyclosporin, cerebral edema, head injury, MI, CAD

Diltiazem

Calcium Channel Blocker

good for afib

Amlodipine

Calcium channel blocker

good for HTN

Verapamil

calcium channel blocker

good for HTN

Vasodilators

what it does: decrease peripheral resistance (smooth muscle relaxation)

good for HTN crisis

class: antihypertensive

consider: pt ed on vasodilating activities (heat, saunas, bathtub)

side effects: dizziness, headache, tachycardia, edema, n/v/d, dyspnea, rash

avoid: additive effects w/ antihypertensives, CAD, cerebral edema, MI

Hydralazine

Vasodilator

PO or IV

Sodium Nitroprusside

Vasodilator

IV

Black box: hypotension and cyanide toxicity

intracranial pressure

Nitrates/Nitrites

what it dose: relaxes vascular smooth muscle; raynauds disease

what class: antianginals

consider: protect from light, wet tablet w/ saliva then insert under tongue

side effects: flashing, hypotension, headache, tachycardia, blurred vision, dizziness

avoid: ED drugs, alcohol, severe anemia, head injury, closed angle glaucoma

Nitroglycerin

Nitrate/Nitrite

avoid first pass in emergency (SL)

administer while pt is laying down when SL

Isosorbide

Nitrate/Nitrite

Cardiac Glycosides

what it does: inc force of myocardial contraction (heart failure/dysrhythmia)

what class: Heart Failure

consider: monitor potassium, HR, and for toxicity (low therapeutic index)

side effects: hypotension, seizure, slurred speech, bradycardia, confusion, drowsiness

avoid: licorice, hawthorne, ginseng, ma-huang, administration following MI or EKG changes

Digoxin

Cardiac Glycoside

PO or IV

monitor electrolytes

Antidote: Digoxin Immune Fab

Class 1B

what it does: decreases action potential

what class: Antidysrhythmic

consider: monitor VS and for CNS adverse effects

side effects: hypotension, seizure, slurred speech, bradycardia, confusion, drowsiness

avoid: licorice, hawthorne, ginseng, and ma-huang

Lidocaine

Class 1B antidysrthythmic

Class 1C

does Class 1B but better

Flecainide

Class 1C antidysrhythmic

Class III

what it does: increase action potential

what class: antidysrhythmic

consider: continuous cardiac rhythm monitoring, also monitor QT interval and HR/BP, pt should wear sunglasses and sunscreen

Amiodarone

Class III antidysrhythmic

Heparins

what does it do: inhibits thrombin and factor x (prophylaxis and treatment for thromboembolic disorders

what class: anticoagulants

consider: dosing

side effects: bleeding, thrombocytopenia (HIT), anemia

avoid: unknown bleeding, trauma, NSAIDs, anticoagulants, antiplatelets, thrombolytics

Heparin

Heparins

Sub cut or IV

need PTT q6 hrs

antidote: protamine sulfate

Enoxaparin

heparin

subcut

don’t eject the bubble!

no epidurals

antidote: protamine sulfate

Heparin Induced Thrombocytopenia (HIT)

Type 1: gradual drop in platelets (concerning but can continue to administer med)

Type 2: acute drop in platelets (>50% from baseline), stop med

Direct Thrombin Inhibitors

what does it do: inhibit thrombin (treat HIT or prevent strokes/embolis induced afib)

what class: anticoagulants

consider: monitor liver and kidney function; no coags

side effects: bleeding, dizziness, SOB, fever, urticaria

avoid: hepatic dysfunction, phenytoin, carbamazepine, rifampin, st john’s wort, CYP3A4 inhibitors

Argatroban

Direct thrombin inhibitor

IV

used with history of (or to treat) HIT

Dabigatran

Direct Thrombin Inhibitor

stroke and thrombosis induced afib prevention

antidote: Idarucizumab

Select factor Xa inhibitor

what it does: inhibits factor Xa (prevent/treat DVT and PE)

what class: anticoagulant

side effects: bleeding, hematoma, dizziness, rash, GI distress, anemia

consider: hold 6-8 hr post-op

avoid: epidurals, renal impairment, unknown bleeding, warfarin

Fondaparinux

Select factor Xa inhibitor

subcut

increased risk of spinal hematoma w/ epidurals

Warfarin

what does it do: inhibits vit K synthesis (treatment/prevention of DVT, PE, afib, CAD, post-MI status)

what class: anticoagulant

consider: PT/INR monitoring and diet education

side effects: bleeding, lethargy, muscle pains, purple toes

avoid: trauma, amiodarone, fluconazole, erythromycin, metronidazole, sulfonamide antibiotics, and cimetidine, vitamin K, dong quai, garlic, gingko, and St John’s wort

Warfarin (Coumadin)

warfarin

PO

antidote: Vit K

2 Anticoagulant Orders

ALWAYS question!

during transition b/w two anticoagulants both are prescribed and one is tapered off as the other is increased so as to not create a window where they don’t have enough anticoagulant (4-5 day transition)

Salicylate antiplatelet

what does it do: inhibits prostaglandin synthesis/ dec platelet aggregation (anti-inflammatory, antipyretic, PET prevention, MI and TIA prophylaxis)

what class: Antiplatelet drug

consider: watch for bleeding gums and stool change, take with milk/water/food, reye’s syndrome (child asprin disease)

side effects: GI bleeding, heartburn, nausea, longterm-salicylism (salicylic toxicity)

avoid: NSAIDs, GI disorders, severe anemia, Vit K deficiency, NSAID allergy, children/teens

Aspirin

Salicylate antiplatelet

Po (enteric coating), rectal

ADP inhibitor

what does it do: inhibits binding of ADP to platelet receptors (decrease atherosclerotic events)

what class: antiplatelet

consider: CV assessment, monitor CBC and coags

side effects: thrombocytopenic purpura (purple toes), GI upset, bleeding

avoid: amiodarone, calcium channel blockers, NSAIDs, proton pump inhibitors, some genetic anomalies

Clopidogrel

ADP inhibitor

PO

Tissue Plasma Activator (TPA)

what does it do: converts plasminogen to plasmin (treatment of MI, CVA, PE, DVT)

what class: Thrombolytic

consider: good for bedrest, move carefully to prevent injury, monitor CBC/D-dimer/fibrinogen /PT/PTT/Thrombin time

side effects: bleeding risk, dysrhythmia, vomiting, MS pain

avoid: anticoagulants/antiplatelets, internal bleeding, severe HTN

Alteplase

TPA

IV

Antifibrinolytic

what does it do: STOP the bleed (reduce blood loss post op, dec surgical oozing, prevent/treat excessive bleeding

what class: coagulation modifier

consider: monitor for DVT, PE, and Vitals

side effects: thrombotic events, hypotension, dysrhythmia, dizziness, fatigue, N/V/D

avoid: disseminated intravascular coagulation (DIC), estrogen/oral anticontraceptive (cause they already inc blood clot risk)

Aminocaproic Acid

Antifibrinolytic

IV or PO

Tranexamic Acid

Antifibrinolytic

IV or PO

hypotension w/ IV

Cholesterol

fat soluble steroid (animal fats, throughout body)

steroid hormones, cell membranes, bile acids

Triglycerides

Fatty Acids + Glycerol (stored unused calories released for energy)

Antilipemic Drugs

Primary: prevention of first cardiac event

Secondary: prevention of subsequent cardiac events

LIFESTYLE CHANGES FIRST! (flax seed, green tea, and soy are really good)

Rhabdomyolysis

Muscle breakdown → myoglobinuria → kidney damage → kidney failure

increased risk: drug combinations (ex: antilipidemic + antibiotic), grapefruit juice, >65, hypothyroidsim, renal insufficiency

s/s: muscle soreness and changes in urine color

Statins

what does it do: inhibit cholesterol building enzyme → decreased LDLs (hypercholesterolemia and mix dyslipidemia)

what class: antilipemic

consider: take w/ food at night, monitor lipid profile and LFTs, rhabdomyolysis

side effects: abdominal pain, rash, headache, inc liver enzymes (liver stress makes enzymes)

avoid: pregnancy, liver disease, inc liver enzymes, antirejection meds, CYP3A4 fam, anticoagulants, grapefruit juice

Atorvastatin

Statin

PO

Simvastatin

Statin

PO

more restricted

Bile Acid Sequestrants

what does it do: binds bile acids in GI tract (treat hypercholesterolemia or mix dyslipidemia)

what class: Antilipidemic

consider: administer 1 hr before or 4-6 hrs after other meds, often a powder

side effects: constipation/GI upset, burnt urine

avoid: billiary/bowel obstruction, Phenylketonuria (PKU), digoxin, thyroid meds, diuretics, gemifibrozil, or steroids

Colesipol

Bile Acid Sequestrant

PO

watch for constipation

Cholestyramine

Bile Acid Sequestrant

PO

watch for constipation

Vitamin B3

what does it do: treats hypertriglyceridemia and hyperlipidemia

what class: antilipemic

consider: take w/ meals, monitor LFTs

side effects: flushing, pruritus, GI distress

avoid: statins (rhabdo), liver disease, peptic ulcer, lactation, unknown bleeding, gout

Nicotinic acid

Vitamin B3

PO

OTC and prescription options

Fibric Acid Derivatives (Fibrates)

what does it do: activate lipase to breakdown cholesterol (treat hypertriglyceridemia)

what class: antilipidemic

consider: monitor lipids, CBC, LFTs, coags

side effects: ab discomfort, diarrhea, nausea, headache, prolonged clotting time)

avoid: liver/kidney/bladder disease, coumadin, statins

Gemfibrozil

Fibric Acid Derivatives

PO

administer 30 min prior to breakfast and dinner