cardio (hypertension, heart failure)(exam 1)

Mannitol (osmitrol)

For: prophylaxis renal failure with hypovolemic shock and severe hypotension, decrease blood volume

Class: Osmotic diuretic

MOA: remains in nephron draws fluid into vascular and extravascular space, temporary increase blood volume then decrease

AE: edema, hyponatremia early and hypernatremia late

NC: avoid If ESRD, heart failure, only give iv, NEEDS FILTER WHEN GIVING, if urine output declines severely then stop

Furosemide (lasix)

For: pull edema in hf, stubborn edema (causes massive fluid loss), HTN

Class: loop diuretic

MOA: sodium goes back into blood, potassium into pee, thick part of ascending loop of Henle blocks reabsorption of Na+ and Cl-, preventing reabsorption of water

AE: decreases serum sodium, chloride, potassium and B/P, OTOTOXICITY, dehydrationdysrhymias bc of hypokalemia

NC:, monitor I and o and VS, hearing and electrolytes, morning to early afternoon admin so u dont pee at night, SLOW IV, carful, gentomycin and digoxin bc lowers potassium, increase pee, BV goes down

Hydrochlorothiazide (HCTZ)

For: HTN, HF edema, renal disease, post menopause osteoporosis

Class: thiazide diuretics

MOA: early distal convoluted tubule blocks reabsorption of Na+ and Cl-

AE: decreases serum sodium, chloride, potassium, and B/P, dehydration, dysrhythmia abc hypokalemia, elevated uric acid and glucose, ** potassium wasting*

NC: risk for gout and kidney stones, Dont use with DM or CKD

Spironolactone (aldactone)

For: HTN, Heart failure and edema and people at risk for hypojalemia

Classs: potassium sparing diuretics/aldosterone antagonist

MOA:blocks aldosterone in distal nephron, prevents Na+ reabsorption, effects RASS

AE:hyperkalemia, in women menstrual issues, helps with acne

NC;can add to loop if not good enough, interactions with ACEI, ARB, DRI, AVOID POTASSIUM RICH FOODS

Sodium polystyrene sulfonate (kayexalate)

For: hyperkalemia(often CKD)

Class: cation-exchange resin

MOA:binds to k+ in large intestine and pooped out

AE: gastric irritation, N, V, hypokalemia

NC:Contra with pts with hypoactive bowels, monitor egg

Aliskiren (tekturna)

For: hypertension

Class: direct renin inhibitor (DRI)

MOA: binds with renin (makes It usedless) no aldosterone, no water, no Na+ waso diliation to decrease BP

AE": no pregnant ladies, no CKD and diabetic

NC: I and O bc lots of water and sodium

Lisinopril (Zestril)

For: hypertension, heart failure, post MI, CV event prevention, diabetic nephropathy

Class: ACE inhibitor

MOA: reduce angiotensin 2 level through inhibition of ace and increase bradykinin levels to dilate blood vessels, reduce blood volume

AE: first dose postural hypotension, dry cough, angioedema (autoimmune, face flush, bronchi edema, congestion, lip swelling, fix with epi), hyperkalemia, no pregnancy

NC: monitor BP, and electrolytes, increase potassium, lower sodium

Losartan (Cozaar)

For: hypertension, reduce risk of stroke and MI, improve nerve blood flow in diabetic nephropathy

Class:Angiotensin receptor blocker ARB

MOA: blocks angiotensin 2 by blocking access to receptors in blood vessels, and other tissues to dilate vessels and prevent release of aldosterone

AE: angioedema, no pregnancy

NC: ARB often used with ACEI not toleratedbc cough but also increases potassium and increases angeoedema

Valsartan + Sacubitril (Entresto)

For: hypertension and heart failure

Class: Angiotensin receptor neprilysin inhibitor (ARNI)

MOA: blocks angiotensin2 by blocking access to receptors in blood vessels but also blocks neprilysin to break down natriuretic peptides, also prevents vasoconstriction and fluid retention

AE: angioedema, hypotension and or hyperkalemia

NC: is switching from ACEI to an ARNI there is minimum wash out period of 36 hrs to prevent toxicity, BNP may increase but BNP is a reliable biomarker in HF patients, increases bradykinin levels so dont combine w ACE bc angioedema

Nifedipine (Procardia)

For: angina pectoris and hypertension

Class: Dihydropyridine CCB

MOA: blocks calcium channels on vascular smooth muscle, specifically in the arterioles, minimal activity on heart, vasodiliation

AE: peripheral edema, flushing, headache, dizziness, reflex tachycardia, bc BP drops, orthostatic hypotension

NC: increase capillary hydrostatic pressure and fluid leakage, relax tachy is suppressed when combined with a beta blocker, may need diuretic for edema, monitor for low BP

Verapamil (calan), dilitazem

For: angina, hypertension, dysrhythmias

Class: non dihydropyridine Calcium channel blocker

MOA: blocks calcium channels on both the heart and blood vessels, slow AV node conduction, increase digoxin levels, bradycardia, heart block, hypotension

AE: constipation is most common, orthostatic hypotension, cardio suppression with Brady, AV block, decreased contractility

NC: interactions with digoxin and beta blockers and grapefruit juice, monitor EKG, overdose may need gastric lavage

Hydralazine (apresoline)

For: hypertension, heart failure

Class: direct vasodilator

Route: PO(45 min onset, 6 hr duration) IV(10 min onset, 2-4hr duration)

MOA: direct selective dilation of arterioles through actions on vascular smooth muscle to reduce resistance and blood pressure

AE: relex tachy, increase blood volume

NC: combined with isosorbide dinitrate when used for tx of heart failure, COadmin with beta blocker to reduce reflex tachy or with diuretic to reduce risk of sodium and water retention

Nitroprusside (Nitride/nitropress)

For: hypertensive emergencies, controlled hypotension during surgery to reduce bleeding

Classs: vasodilator

MOA: causes both venous and arteriolar dilation to decrease blood pressure, releases cyanide ions which must be detoxified, converted into thiocyanate in the liver, which is renally excreted

AE: hypotension, cyanide and thiocyanate toxicity in patients receiving prolonged infusion or hepatic or renal inpairments

NC: reflex tachy, monitor vitals, slowly increase

SGLT2 inhibitors

For: HFpEF and HFrEF

MOA: blocks SGLT2 protein in proximal tubule of the nephron, reducing amount of glucose and sodium into the blood

causes lower blood glucose levels, osmotic diuresis, natriuresis, cardiovascular protection

Ex. empagliflozin (jardiance)

Canagliflozin (invokana)

Dapagliflozin (farxiga)

Ertugliflozin (steglatro)

LEADS TO GLUCOSURIA

BiDil

first med approved for specific ethnic group African Americans (vasodilator) for HF

Nitroglycerin

decreases pulm edema and angina

AE: hypotension, reflex tachy, headache

vasodilator

Nesiritide (Natrecor)

For: short term use for very severe decompensated heart failure

AE: tach, headache, hypotension

Cardiac Glycoside-Digoxin (lanoxin)

For: atrial dysrhythmias, second one heart failure

MOA: inhibits Na+, K+, ATPase and leads to increased cardiac output by 1. increasing force of contractions(+ inotrope) 2. decreasing heart rate and allowing more fill time (-chronotrope) and 3. decreasing AV conduction (-dromotrope)

AE: HYPERKALEMIA, toxicity, N, V, D, anorexia, fatigue, blurry vision, life threatening arrhythmias

NC: monitor digoxin and potassium levels, check ekg and vitals, Narrow therapeutic range

ANTIDOTES: digoxin immune fab (digibind/digifab)

activated charcoal and cholestyramine (questran) decrease gi absorbtion of digoxin