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Cardiovascular Medications

Introduction to Cardiovascular Medications

  • The lecture by Miss Buchanan focuses on cardiovascular medications for Nursing 102.

  • Reference: ATI book, "RN Pharmacology for Nursing 7.0."

  • Directions: Print slides, follow video, and focus on specific topics of review regarding medications.

Learning Objectives

  • Upon completion, students will be able to:

    • Identify common cardiovascular drugs within each class.

    • Explain therapeutic indications for each medication class.

    • Recognize common and serious side effects of these medications.

    • Discuss key nursing implications regarding administration:

    • Patient assessment

    • Lab monitoring

    • Safe administration

    • Patient education

    • Evaluate client responses to medications.

Medications Affecting Urinary Output

Indications

  • Management of blood pressure.

  • Excretion of edematous fluid related to:

    • Heart failure

    • Kidney disease

    • Liver disease

  • Prevention of kidney failure.

  • Key focus: Heart failure and edema.

Types of Diuretics

  • Focus on diuretics:

    • High Ceiling Loop Diuretics

    • Thiazide Diuretics

    • Potassium-Sparing Diuretics

    • Osmotic Diuretics

Review of Nephron Function

  • Each kidney contains about a million nephrons.

  • Components of the nephron include:

    • Glomerulus: Tangle of capillaries.

    • Bowman's capsule: Surrounds the glomerulus.

    • Tubules: Extend from the cortex to medulla.

  • Diuretics function to decrease excess fluid (edema) and lower blood pressure.

Types of Diuretics Explained

High Ceiling Loop Diuretics

  • Prototype: Furosemide

  • Mechanism: Blocks sodium and chloride reabsorption in the loop of Henle, preventing water reabsorption.

  • Indications: Rapid fluid loss, effective even in severe renal impairment.

  • Results: Leads to reduced swelling and lowered blood pressure.

  • Complications: Dehydration, hyponatremia, hypochloremia, ototoxicity.

  • Nursing Implications:

    • Monitor electrolytes and urine output; notify provider for urine output < 30 mL per hour.

    • Watch for hypotension, ototoxic symptoms like tinnitus.

    • Hypokalemia must be noted, hold medication if potassium < 3.5 mmol/L.

Thiazide Diuretics

  • Examples: Hydrochlorothiazide.

  • Mechanism: Blocks sodium and chloride reabsorption in the distal convoluted tubule.

  • Indications: Promotes mild diuresis when renal function is not impaired.

  • Results: Reduces blood pressure, mild swelling.

  • Complications: Dehydration, hyponatremia, hypochloremia, hyperglycemia, hyperuricemia.

  • Nursing Implications:

    • Monitor urine output, electrolytes, and weight.

    • Instruct patients to take in the morning to avoid nocturia.

Potassium-Sparing Diuretics

  • Example: Spironolactone.

  • Mechanism: Blocks aldosterone action leading to potassium retention and sodium/water excretion.

  • Results: Decreases swelling, lowers blood pressure without potassium loss.

  • Complications: Hyperkalemia, gynecomastia, menstrual irregularities.

  • Nursing Implications:

    • Monitor potassium levels, educate on potential endocrine side effects.

Osmotic Diuretics

  • Prototype: Mannitol.

  • Mechanism: Pulls water into kidneys to reduce intracranial and intraocular pressure.

  • Results: Reduces fluid quickly, flushes toxins.

  • Complications: Heart failure, pulmonary edema, electrolyte imbalances.

  • Nursing Implications:

    • Monitor for heart failure symptoms, increased intracranial pressure, urine output.

Medications Affecting Blood Pressure

Importance of Blood Pressure Control

  • High or low blood pressure can strain the heart and blood vessels.

  • Medications can be used alone or in combination to manage blood pressure.

Key Classes of Blood Pressure Medications

Angiotensin and Aldosterone Antagonists

  • Important for understanding how medications lower BP through the renin-angiotensin-aldosterone system (RAAS).

Renin-Angiotensin-Aldosterone System (RAAS)

  • Triggers: Decrease in blood pressure detected by kidneys.

  • Process:

    • Kidneys secrete renin.

    • Renin converts angiotensinogen (from liver) to angiotensin I.

    • Angiotensin I is converted to angiotensin II in lungs by ACE.

    • Actions of angiotensin II:

    • Vasoconstriction.

    • Aldosterone secretion from adrenal glands increases sodium reabsorption, hence water reabsorption, increasing blood volume and blood pressure.

ACE Inhibitors

  • Examples: Captopril, Lisinopril, Benazepril.

  • Function: Block enzyme that produces angiotensin II leading to blood vessel relaxation.

  • Complications: First-dose orthostatic hypotension, cough, hyperkalemia, angioedema.

  • Monitoring: Blood pressure, change positions slowly to avoid dizziness.

Angiotensin II Receptor Blockers (ARBs)

  • Examples: Losartan, Valsartan.

  • Function: Block angiotensin II from binding to its receptors.

  • Complications: Angioedema, hypotension, dizziness.

Aldosterone Antagonists

  • Example: Spironolactone (also a potassium-sparing diuretic).

  • Function: Blocks effects of aldosterone which retains fluid thus lowering BP.

Direct Renin Inhibitors

  • Prototype: Aliskiren.

  • Function: Prevents renin from increasing blood pressure.

Calcium Channel Blockers

  • Examples: Amlodipine, Diltiazem, Verapamil.

  • Function: Prevents calcium entry into muscle cells, leading to muscle relaxation and lower BP.

  • Complications: Reflex tachycardia, peripheral edema, suppression of cardiac function.

Centrally Acting Alpha-2 Agonists

  • Example: Clonidine.

  • Function: Decreases sympathetic outflow, thus lowering BP.

  • Complications: Drowsiness, dry mouth, rebound hypertension.

Beta-Adrenergic Blockers

  • Examples: Metoprolol, Atenolol (beta-1), Propranolol (beta-2).

  • Function: Blocks adverse effects of adrenaline on heart rate and blood pressure.

  • Complications: Bradycardia, AV block, rebound excitation.

Medications Treating Heart Disease

Cardiac Glycosides

  • Example: Digoxin.

  • Function: Increases force of heart contraction and slows heart rate.

  • Complications: Dysrhythmias, GI effects, CNS effects (vision changes, halos).

Adrenergic Agonists

  • Prototype: Epinephrine.

  • Function: Mimics sympathetic nervous response, increases heart rate and blood pressure.

Medications for Angina

Organic Nitrates

  • Example: Nitroglycerin.

  • Function: Vasodilates blood vessels, increasing blood flow and oxygen supply.

  • Complications: Headache, orthostatic hypotension, reflex tachycardia.

Anti-Anginal Agent

  • Example: Ranolazine.

  • Function: Treats chronic chest pain, lowers cardiac oxygen demand.

Anti-Dysrhythmic Medications

Classes Explained

  • Sodium Channel Blockers: Procainamide, Lidocaine. Suppress dysrhythmias.

  • Potassium Channel Blockers: Amiodarone, Sotalol. Help maintain normal rhythms.

  • Calcium Channel Blockers: Amlodipine, Diltiazem.

Anti-Lipemic Agents (Cholesterol Management)

Statins

  • Example: Atorvastatin.

  • Function: Decrease LDL cholesterol to prevent coronary events.

  • Complications: Hepatotoxicity; monitor liver function.

Ezetimibe

  • Function: Inhibits cholesterol absorption.

Niacin

  • Function: Lowers LDL and triglycerides.

  • Complications: Hyperglycemia; watch blood sugar levels.

Fibrates

  • Example: Gemfibrozil.

  • Function: Decrease triglycerides; possible increase in HDL cholesterol levels.

Medications Affecting Coagulation

Coagulation Medications

  • Purpose: Prevent clot formation and dissolve existing clots.

  • Risks: All carry bleeding risks.

Heparin

  • Function: Activates antithrombin to inhibit thrombin and factor Xa, keeping blood thin.

  • Monitoring: Check PTT, and monitor for bleeding and thrombocytopenia.

Warfarin

  • Function: Antagonizes vitamin K, preventing coagulation factor synthesis.

  • Monitoring: Requires regular checks of PT/INR.

Antiplatelets

  • Example: Aspirin, Plavix.

  • Function: Prevent platelet aggregation.

Thrombolytics

  • Example: Alteplase (tPA).

  • Function: Dissolves blood clots; high risk of bleeding.

Conclusion

  • Importance of familiarity with medication protocols for effective nursing practice.

  • Students are encouraged to utilize ATI resources and seek further clarification in Q&A sessions.

  • For optimal patient outcomes, understand drug classifications, nursing implications, and patient education.

Additional Notes

  • Take comprehensive notes while studying each drug class in the ATI book.

  • Observe for potential interactions and effects related to concurrent medications.