Cardiac Medications and IV Therapy

What are the first line drugs for treatments of HF?

* Diuretics
* Ace Inhibitors
* ARBs
* Beta adrenergic blockers

HF is a complication of…

MI

HTN

Hyperthyroidism

Some lung diseases like COPD

Chronic COPD leads to -- HF?

Right sided

Right sided HF symptoms?

systemic fluid overload -- weight gain is the most objective indicator

MI or Chronic HTN lead to -- HF?

Left sided

Left sided HF symptoms?

Lung - Left

Pulmonary congestion and decreased CO

Most common Cardiac Glycoside medication?

Digoxin

DIgoxin has -- inotropic effects and -- chromotropic effects

postive; negative

Positive inotropic effects cause what?

Increases ==force== of myocardial contraction

Negative chromotropic effects cause what?

==Decreases HR==

Slows SA node

Depolarization

Digoxin improves?

SV and CO

Digoxin gives the ventricles more time to fill because…

the heart is beating slower

What MUST you do before administering Digoxin?

Check Apical pulse --

Normal range for digoxin?

0\.5 - 0.9 ng/mL

Why is Digoxin not a first line medication for cardiac treatment?

Narrow TI

Digoxin is contraindicated in client with -- dysrhythmias?

Ventricular

\*only used to treat atrial dysrhythmias

Complication of Digoxin is that it can cause what with HR?

Bradycardia

With Digoxin, other sympathomimetic medications can accentuate the inotropic action putting a patient at increased risk of…

Tachydysrhythmias

Early signs of “Dig” toxicity?

Nausea

Vomiting

Anorexia

Loss of appetite

* with an infant they may begin feeding less

Dig toxicity causes…

Hypokalemia

Blurred vision with a yellowish tint seen

HA

GI issues

Hyperkalemia causes a -- effect on Digoxin

Reduced

Nursing considerations for Digoxin?

* Check pulse rate and rhythm
* Administer same time daily
* Monitor levels (0.5-0.9 ng/mL)
* Monitor for signs of hypokalemia (toxicity is unique to this SE)
* low potassium levels, muscle weakness, fatigue

To reverse the effects of Digoxin administer…

Digibind

Adrenergic agonists?

Alpha1 receptors

Beta1 receptors

Beta2 receptors

Dopamine receptors

Alpha1 receptors cause?

Vasoconstriction

Dilation of the pupil

Beta1 receptors cause?

Increased HR

Myocardial contractility

Conduction through AV node

Release of renin

Beta2 receptors cause?

Vasodilation

Bronchodilation

Relaxation of uterine smooth muscle

Glycogenolysis

* increases BG and promotes production of glucose

Muscle contraction

Dopamine receptors cause?

Dilation of renal blood vessels

Adrenergic agonists given -- can help kidneys by promoting renal perfusion?

IV

Adrenergic agonists catecholamines?

Life saving medications

Contraindicated in pregnant women

* epinephrine
* dopamine
* dobutamine
* isoproterenol
* norepinephrine (levophed)
* albuterol
* ephedrine (vasoconstrictor so not good for patients with underlying cardiac diseases)

Epinephrine (IV push)

* Vasoconstricts
* Increases:
* HR
* Myocardial contractility
* Rate of AV node conduction
* CO
* improved tissue perfusion

Epinephrine (IV push) is used for treatment of…

Cardiac arrest

Shock

HF

Complications of Epinephrine (IV push)

Hypertensive crisis

Dysrhythmias

Increases oxygen demand

Dopamine and Dobutamine (IV infusion)

* potent vasoconstrictor
* increases HR and myocardial contractility
* used for shock and HF to maintain BP and CO
* able to maintain good renal perfusion on a low/medium dose but if you give a higher dose then it will cause vasoconstriction of kidneys and blood vessels

Complications of Dopamine and Dobutamine (IV infusion)

* dysrhythmias
* increasing workload on heart
* increasing oxygen demand
* makes you more alert -- anxiety or insomnia

Infuse Dopamine and Dobutamine through a central line if possible because

it is caustic to the veins

Angina

* Pain which radiates to the left shoulder, arm, jaw
* Inadequate oxygen for myocardial demand

Medications given to patients with Angina?

* NTG
* CCBs
* BBs
* Aspirin

Chronic angina is managed with?

* antiplatelet agents
* cholesterol lowering agents
* ACE inhibitors

Anti-angina agent?

Nitroglycerin

Comes in many different forms:

* ER capsules
* SL tabs
* Translingual spray
* Topical ointment
* Transdermal patch
* ==dont put over an open wound==
* IV (titrating)
* ==given for hypertensive crisis==

Uses of NTG?

Treatment of acute angina

Prophylaxis of chronic stable angina or Prinz metal angina

Most common SE of Nitrates (NTG)?

HA

Other SE of Nitrates (NTG)?

* orthostatic hypotension
* reflex tachycardia
* tolerance
* cumulative effect with other cardiac meds

Nitrates (NTG) is contraindicated in patients with…

* severe anemia
* further decrease of perfusion to peripheral extremities
* Closed angle glaucoma
* increases IOP further
* TBI (traumatic brain injury) or Stroke
* CPP further decreases
* Concurrent use with PDE5 inhibitors (erectile dysfunction meds)- viagra

How long do you wait after taking a NTG SL tablet before calling 911?

5 min

Stop activity and rest!!

How many SL tablets of NTG do you take in the home setting before calling 911?

1 dose

\*after calling

In the hospital setting, how many NTG SL tablets do you give before contacting provider?

3 doses

\*wait 5 min in between each

Which Nitrate medications are for daily use?

* isosorbide dinitrate
* isosorbide mononitrate
* they have a slow onset and long duration
* do not chew or crush

Adjunct angina medication?

Ranolazine -- maintenance drug

Purpose of Ranolazine?

Typically used with what medications?

* Lowers cardiac oxygen demand thereby improves exercise tolerance and decreases pain
* Used with cc blocker, beta blocker or a nitrate

review ati book for angina/nitroglycerin meds

…

Anti lipemic agents are used with…

* regular exercise
* proper diet
* weight control

Anti lipemic agents lower -- and raise -

LDL and possibly VLDL cholesterol

HDL cholesterol

Anti lipemic agents initial labs?

* total cholesterol
* LDL
* HDL
* tryglycerides
* liver and kidney function

Cholesterol comes from…

liver

what is the main assessment with anti limepic agents?

Liver function tests

ALT and AST

Specifically monitor ALT because this is a bigger indicator of liver toxicity

Total cholesterol level?

LDL levels?

* In general…
*

HDL levels in males and females?

Males: >40 mg/dL

Females: >50 mg/dL

Cardioprotective: >50 mg/dL

Triglyceride levels?

Classifications of Anti lipemic agents?

* HMG-CoA reductase inhibitors  ==(statins) – most common==
* cholesterol absorption inhibitors
* bile-acid sequestrants
* nicotinic acid
* fibrates

Statin medications?

* Atorvastatin - MOST COMMON
* Simvastatin
* Pravastatin
* Rosuvastatin

Statins are pregnancy risk category

X!!!!

Statins decrease -- and increase --

LDL, VLDL

HDL

Statins promote?

* vasodilation
* decrease in
* plaque site inflammation
* thromboembolism
* risk of atrial fibrillation

Statins are used for?

* hypercholesteremia
* protection against MI, stroke
* primary prevention

What time of day should you take Statins?

Evening - medications are more active at night

What food and juice do you NOT want to have while taking Statins (or any cardiac medications)?

Grapefruit and Grapefruit juice

Complications of Statins?

==Hepatotoxicity==

* Monitor LFTs (ALT and AST) after 12 weeks and then Q6 months
* Observe for liver dysfunction (elevated ALT or AST)
* Avoid alcohol

\
==Myopathy - muscle aches, pain, tenderness==

* Can progress to rhabdomyolysis – breakdown of proteins

If patient taking Statins has a HA or Fever and wants to take a Tylenol, what do they need to be aware of?

Tylenol is toxic to the liver so only take 4 g/day

Cholesterol absorption inhibitor medication?

Ezetimibe

Ezetimibe actions?

* Inhibits absorption of cholesterol secreted in the bile and from food
* Lowers LDL

Ezetimibe is used…

alone or in combination

Ezetimibe complications?

Hepatitis

Myopathy

Bile acid sequestrants (BAS) medications?

* colesevelam
* colestipol

Bile acid sequestrants can be used alone or with?

Statins

BAS do what?

Decreases LDL by decreasing metabolism of fats

BAS complication

constipation

administer colesevelam with

food, 8oz of water

admin colestipol

30 minutes before a meal

What do you want to advise client to do when taking BAS?

Advise clients to increase high fiber food and oral fluids

Use BAS cautiously with client who have…

Biliary disorders

Nicotinic Acid or Niacin (Vitamin B3)

* Decreases LDL and triglyceride levels
* Dosage is much larger than dosage in a vitamin supplement

If the patient experiences flushing (redness) while taking Niacin…

take aspirin 30 min before dose

SE of Niacin?

* Hepatotoxicity
* Hyperglycemia
* Hyperuricemia

Use caution with Niacin in what patientss?

diabetic and renal patients

Fibrate medications?

* Gemfibrozil
* Fenofibrate

Fibrates cause a decrease in…

triglycerides

Complications of Fibrates?

* gallstones
* myopathy
* hepatotoxicity
* GI distress

when taking fibrates, warfarin increases risk of

bleeding

when do you take fibrates

orally, 30 min before bfast and dinner

Intravenous therapy

\++

What can you administer through IV therapy?

* fluids
* meds
* electrolytes
* nutrients

IV therapy is administered how?

* continuous
* intermittent
* bolus
* fluids or medications

Document -- with IV therapy?

I&O

Patients who are at a higher risk with IV therapy?

* liver issues
* renal issues
* heart issues

Advantages of IV therapy?

* Rapid effects
* Precise amounts
* No discomfort from administration (push slowly)
* Constant therapeutic blood levels

How should you infuse antibiotics?

* intermittently ==(be sure to give it as close as possible to exact time)==

What should you never push with IV?

Potassium - can cause cardiac arrest

You should always assess your IV sites in order to prevent

infection