CARDIOVASCULAR SYSTEM PT.2

vonal declosion-stereolab

positive inotropic medications

increase strength of heart muscle contraction, stroke volume, and cardiac output. used when the heart can’t pump enough blood to the body’s tissues (ex: heart failure).

digoxin (cardiac glycoside)

inhibits Na⁺/K⁺ pump to allow calcium to collect in heart cells, increasing contractility and decreasing vasoconstriction. also stimulates the vagus nerve which lowers HR. ADRs include cardiac dysrhythmias (bradycardia and AV blocks) and possible toxicity (s/s include nausea & vomiting, anorexia, fatigue, and vision changes/halos). take apical pulse for a full minute before admin, hold if <60. monitor and report GI and CNS symptoms (vision changes); monitor med and potassium levels along with EKG. antidote is immune fab. client should report any ADRs and hypokalemia; they should take the med at the same time everyday and know how to take their own pulse. not recommended for preexisting cardiac dysrhythmias, toxicity, or hypokalemia, hypercalcemia, or diuretics.

dobutamine (sympathomimetics)

stimulates beta 1 receptors to increase contractility, CO, kidney perfusion, urine output/Na⁺ excretion, and decrease fluid volume and heart workload. ADRs include tachycardia, cardiac dysrhythmias, and anginal pain. monitor cardiac rhythm and vital signs; report any tachydysrhythmias or chest pain. use dedicated IV line for infusion and frequently monitor as this med has a 10 minute peak. client should report chest pain immediately. use caution with heart disease, HTN, preexisting tachycardia, and hypovolemia.

milrinone (phosphodiesterase inhibitor)

inhibits PDE3 (drives muscle contractility and vasodilation by breaking down cAMP) and increases cAMP (increases HR and contractility) to increase CO and contractility. ADRs include ventricular dysrhythmias, hypokalemia, hypotension, and anginal chest pain. monitor potassium levels, vital signs, cardiac rhythm, and for chest pain. use dedicated IV line. patient should continuously monitor for ADRs and know that there will be frequent lab work. not recommended for aortic or pulmonic valve disorders, renal impairments, hx of dysrhythmias, and electrolyte imbalances.

atorvastatin

inhibits HMG-CoA reductase enzyme (produces cholesterol), effectively lowering LDL, VLDL, and total cholesterol while raising HDL. used to treat coronary heart disease (plaque formation). ADRs include myopathy, rhabdomyolysis, and hepatotoxicity (abdominal pain, jaundice, and fatigue). monitor patient for muscle pain and creatine kinase and perform periodic liver function tests. client should report unexplained muscle pain, s/s of liver dysfunction, and avoid grapefruit. teratogenic; not recommended for those with liver disorders, alcoholism, and renal disorders.

gemfibrozil (fibrates)

activates PPAR alpha (regulates lipid metabolism), effectively raising LPL (enzyme that breaks down triglycerides), HDL, and lowering VLDL and LDL. ADRs include GI symptoms, gallstones, hepatotoxicity, and myopathy. monitor and report GI and gallbladder symptoms and monitor for unexplained muscle pain and CK levels. perform periodic liver function tests. client should report any ADRs and new intolerances of fried foods. taking with a -statin increases risk of toxicity. not recommended for those with gallbladder disease, liver dysfunction, and severe renal impairment.

nitroglycerin (nitrates)

causes vasodilation to decrease preload (EDV), oxygen demand, and increase oxygen supply while relaxing coronary artery spasms. ADRs include headache, hypotension, tachycardia, and tolerance. do NOT touch ointment form of medication, always wear gloves. check baseline BP and HR and monitor frequently. give 3 doses q5 min for chest pain. if chest pain persists after first dose, call 911 then finish last 2 doses. remove topical patch for part of the day and place it low to reduce risk of headache (can be helped with Tylenol). not recommended for those on ED drugs as it can lead to hypotension, liver dysfunction, or severe renal impairment.

class 1

sodium channel blockers

class 2

beta blockers

class 3

potassium channel blockers

class 4

calcium channel blockers

quinidine (long term) & procainamide (short term)

moderately block sodium channels in the myocardium to slow conduction, automaticity (automatic pumping of heart), and prolong the refractory period (period in which contraction is inhibited). treats a-fib, supra ventricular, and ventricular tachycardias. ADRs include GI symptoms, hypotension, dysrhythmias, speed shock, cinchonism in long term form (tinnitus, visual disturbances, headache, nausea, and vomiting), and SLE-like syndrome in short term form. monitor BP and cardiac rhythm, assess for stroke or PE s/s if a-fib progresses, and monitor for cinchonism or SLE. client should take med with food, know how to take pulse, and report dizziness, syncope, chest pain, or SOB. not recommended for those with preexisting dysrhythmias, heart blocks, or HF and MI.

lidocaine

exerts a small blockade of the sodium channels in the myocardium to slow conduction, automaticity (automatic pumping of heart), and prolong the refractory period (period in which contraction is inhibited). treats ventricular dysrhythmias caused by MI or surgery, as well as those caused by digoxin toxicity. ADRs include CNS effects (confusion, drowsiness, paresthesias, twitching, etc.), hypotension, bradycardia, and heart block. monitor and report CNS changes, monitor vitals, and monitor the cardiac monitor. client should report paresthesias and understand that they will need frequent cardiac monitoring and vital sign checks. not recommended for preexisting dysrhythmias, bradycardia, heart failure, renal or liver disorders, or for those with respiratory depression or low O2 levels.

flecainide

exerts a large blockade of sodium channels in the myocardium to slow conduction, automaticity (automatic pumping of heart), and slightly prolong the refractory period (period in which contraction is inhibited). treats life-threatening supraventricular and ventricular tachydysrhythmias that cannot be controlled by less toxic medications, along with long term maintenance of certain dysrhythmias such as a-fib. ADRs include dizziness & visual disturbances, dyspnea, worsening heart failure, and EKG artifacts such as a widened QRS complex and a prolonged QT interval. monitor for all ADRs and s/s of worsening HF such as edema/weight gain. also monitor EKG and drug trough levels. client should report SOB, edema, have frequent eye exams, and understand that a temporary Holter monitor may be needed. not recommended for those with heart blocks, prolonged QT intervals, recent MIs or cardiogenic shock, a-fib, or cardiac, renal, or liver disease. treat electrolyte imbalances if present before starting medication.

propranolol

blocks beta 1 and 2 receptors, decreasing HR, contractility, and slowing conduction (prolonging the PR interval). treats/manages heart failure in short- and long-term timelines. ADRs include bradycardia, hypotension, low CO leading to HF (bruh), arterial insufficiency, and CNS effects. monitor HR and report if below 60, also monitor SOB, edema, night cough, color, temp, pulses, and possible CNS effects. discontinuing requires tapering. client should check pulse daily, not abruptly stop medication, and report any ADRs. not recommended for asthma or COPD, PVD or Raynaud’s, renal or liver disease, and for use alongside other HTN meds as this can lead to hypotension.

amiodarone

blocks K⁺ channels to decrease automaticity, contractility, slow conduction, and to dilate coronary and peripheral vessels. treats/manages life threatening v-tach or fibrillations that are resistant to other medications; may also treat some atrial dysrhythmias such as a-fib. ADRs include GI symptoms, ARDS, pulmonary toxicity, bradycardia and hypotension, and blue gray skin with sun exposure. monitor client for GI distress, obtain a baseline chest x-ray, monitor lung sounds, vital signs, and EKG. client should take with food and report any ADRs; they should also understand that skin discoloration may occur and know how to take their own pulse. teratogenic; not recommended for bradycardia, heart block, severe hepatic disease, or HF or pulmonary disease.

verapamil

blocks Ca⁺⁺ channels to slow automaticity, conduction, reduce contractility, and prolong PR interval. converts supra v-tach to a regular sinus rhythm and can slow the rate of a-fib and flutter. also treats angina and HTN. ADRs include hypotension, bradycardia, HF (edema, SOB), dizziness, and lightheadedness. monitor EKG and vital signs, hold if BP or HR is too low, keep supine for 1 hr during IV admin, monitor I&Os, and report edema, lung crackles, and decreased urine output. client should report ADRs and take pulse daily. not recommended for heart block, hypotension, severe hepatic dysfunction, HF, v-tach, or with use alongside beta blockers for risk of hypotension.