Pharmacology of Cardiac Drugs, NSAIDs, and Anticoagulants

Cardiac glycosides

Meds: Digoxin; Mech of action: increases intracellular calcium allowing more calcium to enter myocardial cells during depolarization... increases force of myocardial contraction and lowers HR; Adverse effects: headache, weakness, drowsiness, visual disturbances (yellow halos), arrhythmias, GI upset, anorexia; Therapeutic effects: used to treat HF and Afib by increasing the force of myocardial contractions and lowering HR.

Nonselective adrenergic blockers

Meds: Amiodarone, Labetalol, Carvedilol; Mech of action: bind to alpha and beta receptors in the SNS blocking norepinephrine; Adverse effects: dizziness, vertigo, fatigue, gastric pain, bronchospasm, dyspnea, hypotension; Therapeutic effects: lowers BP, slows HR, increases renal perfusion which decreases renin production.

Beta blockers

Meds: end in -lol, metoprolol, propranolol, acebutolol; Mech of action: bind to the beta receptors in the SNS and lower HR and BP; Adverse effects: proarrhythmic, headache, fatigue, dizziness, depression, bradycardia, heart block, HF, low BP, pain nausea, vomiting, diarrhea, low exercise tolerance; Therapeutic effects: lower blood pressure.

ACE inhibitors

Meds: captopril, enalapril, lisinopril; Mech of action: lower blood pressure and also help treat HF; Adverse effects: angioedema, neutropenia, hypotension, tachycardia, gastric irritation, ulcers, proteinuria, renal impairment, hyperkalemia, COUGH!!; Therapeutic effects: lowers BP but doesn't decrease HR.

Proton Pump Inhibitors (PPI)

Meds: omeprazole, pantoprazole; Mech of action: suppress the secretion of hydrochloric acid; Adverse effects: dizziness, headache, vertigo, insomnia, diarrhea, rash, abd. Pain, N/V, cough; Therapeutic effects: treatment of duodenal ulcers, esophageal reflux, heartburn, indigestion, and gastritis.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Meds: ibuprofen, naproxen, ketoralac, celecoxib; Mech of action: inhibit prostaglandin synthesis, blocking COX-1 and COX-2; Adverse effects: headache, dizziness, fatigue, nausea, bleeding, dyspepsia, constipation, bone marrow suppression, MI, stroke, KIDNEY damage; Therapeutic effects: reduces fever and inflammation.

Opioids

Meds: Fentanyl, buprenorphine, methadone, levophanol, oxymorphone, hydromorphone, oxycodone, hydrocodone; Mech of action: mimic the body's natural pain relievers (endorphins) to bind to opioid receptors in the brain, spinal cord, and gut, blocking pain signals and altering pain perception; Adverse effects: analgesia, euphoria, sedation, decreased RR and depth, decreased HR and BP, N/V, altered fluid dynamics, constipation; Therapeutic effects: pain relief.

Furosemide

Uses: Edema associated with HF, acute pulmonary edema, HTN; Adverse effects: patient loses potassium, watch for hypokalemia; Nursing considerations: drug of choice for rapid, extensive diuresis.

Hydrochlorothiazide

Uses: for "hy" blood pressure, edema caused by HF, liver disease or renal disease; Adverse effects: not for use in hypovolemia, severe renal disease, systemic lupus, erythematous, diabetes.

Spironolactone

Uses: HTN, adjunct for edema in HF, liver and renal disease, treatment of hypokalemia, hyperaldosteronism; Adverse effects: not for use in severe renal disease, anuria, not used in pregnancy.

Mannitol

Uses: elevated intracranial pressure used to treat cerebral edema; Adverse effects: can cause abrupt fluid shifts, so be aware of hypotension or dehydration.

Oxybutynin

Uses: treats spasms which can cause dysuria, urinary urgency, incontinence; Adverse effects: DRY MOUTH, GI upset, nervousness, tachycardia, vision changes.

Propranolol

Uses: Hypertension, angina, prevention of repeat MI, SVT, prophylaxis of migraine headache; Adverse effects: bradycardia, HF, stroke, cardiac arrhythmias.

Midodrine

Uses: treatment of orthostatic hypotension; Adverse effects: can cause serious supine hypertension.

Nitroglycerin

Uses: acute treatment and prevention of angina; Adverse effects: low BP, headache, dizziness, reflex tachycardia.

Simvastatin

Uses: lowers LDL, lowers risk of CAD, MI, stroke, and angina; Adverse effects: headache, flatulence, abd. Pain, cramps, constipation, rhabdomyolysis.

Pravastatin

Uses: lowers LDL, lowers risk of CAD, MI, stroke, and angina; Adverse effects: headache, flatulence, abd. Pain, cramps, constipation, rhabdomyolysis.

Cholestyramine

Class: Bile Acid Sequestrants; Uses: to decrease total cholesterol levels, lower LDL; Adverse effects: anxiety, fatigue, abd. Pain, constipation.

Warfarin

Class: anticoagulant; Uses: DVT or PE after surgery, prevention of clots; Adverse effects: bleeding, bruising.

Enoxaparin

Class: anticoagulant

Enoxaparin Uses

DVT or PE after surgery, prevention of clots

Enoxaparin Adverse effects

bleeding, bruising, bleeding with teeth brushing

Enoxaparin Nursing considerations

caution with other meds that affect clotting, stop prior to invasive procedures, watch INR!!

Diltiazem Uses

treatment of prinzmental, effort associated with angina (hypertension and supraventricular tachycardia)

Diltiazem Adverse effects

dizziness, light headedness, headache, asthma, peripheral edema, low HR, atrioventricular block, flushing, rash, nausea

Dopamine Uses

treatment of shock

Dopamine Adverse effects

arrhythmias, low BP, chest pain, palpitations

Dopamine Nursing considerations

correct hypovolemia with fluid prior to starting dopamine

Dopamine Patient education

monitor all the things you're changing- HR, BP, pulse pressure, ECG, urine output

Hydralazine Class

Vasodilators

Hydralazine Uses

used to treat severe hypertension and HYPERTENSIVE CRISIS, lowers the BP and lowers the after load in patient with HF

Hydralazine Adverse effects

low BP, dizziness, headache, high heart rate, GI upset, drowsiness, arrhythmias

Hydralazine Nursing considerations

monitor BP and pulse

Hydralazine Patient education

may be combined with isonade denigrate for HF treatment (especially effective in African American males)

Digoxin Uses

treat heart failure and atrial fibrillation

Digoxin Adverse effects

headache, weakness, drowsiness, visual disturbances (yellow halos), arrhythmias, GI upset

Digoxin Nursing considerations

has VERY NARROW RANGE- S/E are the first sign of digoxin toxicity

Enalapril Class

Angiotensin-converting enzyme (ACE) Inhibitors

Enalapril Uses

treatment of hypertension, can also be used as an adjunct therapy in HF

Enalapril Adverse effects

angioedema, neutropenia, hypotension, tachycardia, gastric irritation, ulcers, proteinuria, renal impairment, hyperkalemia, COUGH

Enalapril Nursing considerations

Do NOT use during pregnancy due to birth defects, caution in renal failure, causes increase in serum potassium, decrease in sodium and fluid volume

Amiodarone Class

Non-selective Adrenergic Antagonists

Amiodarone Uses

drug of choice for arrhythmias: ventricular fibrillation and tachycardia, a-fib

Amiodarone Adverse effects

dizziness, vertigo, fatigue, gastric pain, bronchospasm, dyspnea, hypotension

Amiodarone Nursing considerations

use cautiously in pts with bronchospasm and asthma, do not stop abruptly, monitor BP and HR

Metoclopramide Class

Gastrointestinal Stimulant

Metoclopramide Uses

prevention and alleviation of N/V

Metoclopramide Adverse effects

restlessness, drowsiness, fatigue, extrapyramidal effects, parkinson-like reactions, seizures, nausea, diarrhea

Metoclopramide Nursing considerations

not for use in pts with bowel obstruction, contraindicated for pts with seizure disorders and Parkinson's

Ondansetron Uses

control of severe N/V associated w/ chemotherapy, radiation, and post op

Ondansetron Adverse effects

headache, dizziness, drowsiness, myalgia, urinary retention, constipation, diarrhea

Loperamide Class

loperamide

Loperamide Uses

relief of diarrhea from viral infections, chronic diarrhea from IBS, reduction of volume from ileostomies

Loperamide Adverse effects

abd. Pain, distention, dry mouth, nausea, constipation, dizziness, drowsiness

Loperamide Nursing considerations

do not use for unknown abd. Pain or c-diff, monitor I/Os

Magnesium hydroxide Class

osmotic laxative

Acetaminophen Adverse effects

liver damage

Morphine Uses

severe pain

Morphine Adverse effects

resp. Depression, hypotension, bradycardia, constipation, confusion, sedation, hypoxemia, cardiac arrest, coma

Morphine Nursing considerations

be alert for signs of CNS and respiratory depression, pain assessment, bowel function, watch for s/s of addiction/dependence

Cyclobenzaprine Uses

acute painful musculoskeletal conditions associated with muscle spasm

Cyclobenzaprine Adverse effects

arrhythmias, dry mouth, blurred vision, dizziness, drowsiness, confusion, fatigue, headache, nervousness, constipation

Cyclobenzaprine Nursing considerations

do not give with MAO inhibitors, immediately after an MI, severe CV disease, assess for serotonin syndrome

Codeine Uses

acute and chronic pain, cough suppressant

Hydromorphone Class

opioid

Hydromorphone Adverse effects

respiratory depression

Sumatriptan Class

triptan

Sumatriptan Uses

rapid treatment of acute attacks of migraines in adults and tx of cluster HA

Sumatriptan Adverse effects

related to vasoconstriction: numbness, tingling, burning sensation, muscle pain, tingling, BP changes

Fentanyl Uses

extreme pain

Fentanyl Adverse effects

constipation, respiratory depression

Lidocaine Uses

ophthalmic, caudal, epidural, spinal, cervical, dental, skin, mucous membrane, topical patch

Lidocaine Adverse effects

headache, backache, hypotension, urinary retention, urinary incontinence, puritis, seizures, local: burning, stinging, swelling, tenderness