drugs affecting the cardio vascular system and blood pressure

digoxin (Class)

cardiac glycoside

digoxin (MoA)

increases force of contraction, increasing cardiac output and renal perfusion; slows HR (goal: slower but more powerful heart)

digoxin (indications)

heart failure

digoxin (routes)

oral, IV

IV push over at least 5 minutes with tele monitor

digoxin (drug-drug)

amiodarone and other antidysrhtmic drugs

digoxin (caution)

heart block, decreased renal function

digoxin (AE)

GI effects, visual disturbances (green/yellow halo), bradycardias

digoxin (nursing)

take apical pulse 1 full min prior to admin. Hold if HR less than 60 –notify provider; use same brand consistently-varied bioavailability; narrow therapeutic index -toxicity rare but serious – monitor blood levels q 3 months

nitroglycerin (class)

antianginal agents

nitroglycerin (MoA)

Relaxes vascular smooth muscle; dilates coronary arteries to increase blood flow

nitroglycerin (indication)

acute angina

nitroglycerin (route/dose)

Sublingual tablet q 5 min up to 3 doses;

onset: 1-3 min;

dur.: 30-60 min

nitroglycerin (caution)

sildenafil within last 24 hours (severe hypotension)

nitroglycerin (adverse effects)

hypotension, headache

lidocaine (class)

sodium channel blockers

lidocaine (MoA)

Decreases depolarization, decreasing automaticity of the ventricular cells; increases ventricular fibrillation threshold

lidocaine (indication)

Treatment of life-threatening ventricular arrhythmias during MI or cardiac surgery

lidocaine (routes/drug)

IV (topical lidocaine low risk systemic)

Onset: IV-immediate;

Peak: IV-Immediate;

Duration: IV-20 min

lidocaine (AE)

Cardiac arrest, respiratory depression/arrest, anaphylaxis

bradycardia, heart block, arrhythmias, hypotension

lidocaine (nursing)

Have resuscitation equipment available

amiodarone (class)

potassium channel blockers

amiodarone (MoA)

Blocks potassium channels, delays repolarization; slows HR

amiodarone (indications)

v-tachycardia and v-fibrillation; Atrial fib or flutter

amiodarone (dose)

Maintenance: oral;

Acute: IV push/infusion (tele floors/ICU/ACLS)

amiodarone (drug-drug)

many! Increase digoxin levels (up to 50-70%); decrease metabolism of warfarin requiring lower doses (50% increase in INR); decrease doses of either drug by 50%

amiodarone (AE)

Corneal microdeposits (photophobia, visual halos, dry eyes), fatigue, dizziness, photosensitivity, thyroid dysfunction

amiodarone (BBW)

Hepatotoxicity, pulmonary toxicity, pro arrhythmias (new/existing)

amiodarone (nursing)

Teach - no grapefruit juice

use barrier sun block

telemetry monitoring (IV)

lisinopril (class)

ACE-inhibitor

lisinopril (MoA)

Blocks ACE, the enzyme responsible for converting angiotensin I to angiotensin II in the lungs; decreases vascular resistance, prevents aldosterone secretion, prevents breakdown of bradykinin (potent vasoconstrictor)

lisinopril (route)

oral

lisinopril (contra/caution)

ACE-inhibitors, ARB’s, K+ sparing-diuretics, NSAIDs (kidneys)

lisinopril (AE)

Common-Persistent dry cough (bradykinin), orthostatic hypotension, hyperkalemia (block aldosterone); Rare-angioedema

lisinopril (nursing)

monitor K+, renal function, change positions slowly (esp first dose)

ACE acronym for AE

A= Angioedema

C= Caution

E= Elevated potassium

losartan (class)

angiotensin-receptor blocker (ARB)

losartan (MoA)

Blocks binding of angiotensin II to specific receptors in blood vessels and adrenal gland; used as alternate to ACE-inhibitors

losartan (route)

oral

losartan (contra/caution)

same as ACE-1

losartan (AE)

hypotension

nitroprusside (class)

direct vasodilator

nitroprusside (mOA)

Act directly on vascular smooth muscle (venous and arterial) to cause relaxation/vasodilation

nitroprusside (route)

Maintenance: oral or transdermal;

Acute HTN crisis: IV push

nitroprusside (caution)

PVD, heart failure

nitroprusside (AE)

significant hypotension

diltiazem (class)

calcium-channel blocker

diltiazem (MoA)

Inhibits flow of calcium ions into myocardial cells and vascular smooth muscle; slows HR, lowers BP

diltiazem (Indication)

HTN, A-fib, A-flutter, supraventricular tachycardias

diltiazem (route)

maintenance: oral

acute: IV infusion

diltiazem (AE)

Hypotension, bradycardia/heart block, peripheral edema

arrhythmias

diltiazem (nursing)

teach- avoid grapefruit juice (increase levels)

metoprolol (class)

beta adrenergic blocker

metoprolol (MoA)

Block beta₁ and beta₂ receptors of the SNS; slows HR and lowers BP

metoprolol (indications)

HTN, Heart failure, s/p MI, A-fib/flutter

metoprolol (route)

Maintenance: oral ;

acute HTN or dysrhythmias: IV push

metoprolol (drug-drug)

Beta-agonist inhaler (albuterol, salmeterol, etc.)

metoprolol (AE)

bradycardia, heart blocks, arrhythmias, and hypotension

metoprolol (contra/caution)

bradycardia, hypotension, masks signs of hypoglycemia

metoprolol (AE)

Bradycardia, hypotension, bronchospasm, pulmonary edema, weakness, fatigue, decreased exercise intolerance, alterations in blood glucose, heart blocks, arrhythmias

metoprolol (nursing)

monitor hypoglycemia closely in diabetes mellitus; immediate and extended release (XL, XR) prescribed