Cardiovascular Medications

NP110 Unit 4 Cardiovascular Medications

The Heart

  • Anatomy of the Heart:
    • Right Atrium: Receives deoxygenated blood from the body.
    • Right Ventricle: Pumps deoxygenated blood to the lungs via the pulmonary valve.
    • Left Atrium: Receives oxygenated blood from the lungs.
    • Left Ventricle: Pumps oxygenated blood to the body through the aortic valve.
    • Valves:
    • Pulmonary Valve: Regulates blood flow from the right ventricle to the pulmonary artery.
    • Tricuspid Valve: Allows blood to flow from the right atrium to the right ventricle.
    • Mitral Valve: Leads blood from the left atrium to the left ventricle.
    • Aortic Valve: Controls flow from the left ventricle to the aorta.

Drugs that Affect Urine Output

Diuretics
  • Definition: Medications that promote the excretion of urine by altering the reabsorption of electrolytes in the kidneys.
  • Uses: Treat excessive fluid retention (edema), heart failure, hypertension, kidney/liver disease, and endocrine disturbances.
  • Types:
    • Loop Diuretics
    • Thiazide Diuretics
    • Potassium-Sparing Diuretics
    • Osmotic Diuretics (used in critical situations)
    • Carbonic Anhydrase Inhibitors (primarily for intraocular pressure in glaucoma)
Diuretic Education
  • Administration:
    • Take in the morning to avoid nocturia.
    • Change positions slowly.
  • Risks:
    • Increased risk of hypotension when combined with other antihypertensives.
    • Do not stop or skip doses without notifying a physician.
  • Lifestyle Recommendations:
    • Avoid alcohol and consult with an MD before using OTC medications.
    • Weigh yourself regularly; report a weight gain of 2 lbs in 1 day or 3 lbs in 1 week.
    • Photosensitivity reaction may occur with some diuretics.
  • Need to Notify MD if:
    • Irregular heart rate (less than 60 or more than 100 bpm).
    • BP is less than 90/60 mmHg.
Thiazide Diuretics
  • Mechanism: Retain sodium, potassium, and water in the urine.
  • Examples: Chlorothiazide, Metolazone, Hydrochlorothiazide.
  • Side Effects:
    • Hypotension
    • Hypokalemia (low potassium)
    • Hyponatremia (low sodium)
    • Nausea/Vomiting
  • Adverse Effects: Falls due to position changes, blurred vision, muscle weakness.
  • Nursing Actions:
    • Take the pulse for a full minute prior to administration.
    • Monitor potassium levels and look for allergic reactions/dehydration.
    • Caution in pediatric and geriatric populations due to specific vulnerabilities.
Loop Diuretics
  • Most Powerful Diuretics: Remove greater amounts of sodium, potassium, and water; can also lead to calcium loss.
  • Examples: Furosemide, Bumetanide, Torsemide.
  • Side Effects: Hypotension, hypokalemia, hyponatremia, photosensitivity.
  • Education:
    • Limit alcohol intake.
    • Report tinnitus or hearing loss.
    • Protect skin from sunlight.
Potassium-Sparing Diuretics
  • Mechanism: Slow down sodium pumps, facilitating the excretion of sodium and water while retaining potassium.
  • Examples: Spironolactone, Triamterene, Amiloride.
  • Side Effects: Hyponatremia, hyperkalemia, nausea, breast enlargement, hirsutism in women.
  • Adverse Effects: Fainting, hyperkalemia.
  • Patient Teaching: Avoid salt substitutes and monitor potassium intake.
Drugs for Overactive Bladder
  • Urinary Antispasmodics: Help with symptoms such as urgency and incontinence.
  • Examples: Oxybutynin, Tolterodine, Solifenacin.
  • Side Effects: Dry mouth, dry eyes, headache, constipation.
  • Adverse Effects: Tachycardia, allergic reactions, risk of heat stroke.
  • Education: Instructions on intake methods and monitoring weight.

Drugs for Hypertension

Blood Pressure Definition
  • Definition: The force produced by the volume of blood in the arterial walls, influencing heart efficiency, arterial elasticity, and blood volume.
  • Systolic Pressure: Force during ventricular contraction.
  • Diastolic Pressure: Pressure during ventricular relaxation.
Antihypertensive Drugs
  • Types:
    • Diuretics
    • Beta-Adrenergic Blocking Agents
    • Centrally Acting Antiadrenergic Drugs
    • Calcium Channel Blockers
    • ACE Inhibitors
    • Angiotensin II Receptor Blockers (ARBs)
    • Alpha-Beta Blockers
    • Vasodilators.
  • General Principles of Use:
    • Monitor pulse and blood pressure.
    • Gradual position changes.
    • Notify healthcare providers for notable findings.
ACE Inhibitors
  • Action: Block production of substances that narrow blood vessels; relax vessels, decrease workload.
  • Examples: End in “pril”.
  • Side Effects: Hypotension, headache, dry cough, potential angioedema.
  • Teaching: Advisories on alcohol and dietary considerations.
Angiotensin II Receptor Blockers (ARBs)
  • Action: Block angiotensin II effects (vasoconstriction, sodium retention).
  • Examples: End in “sartan”.
  • Side Effects: Fatigue, headache, hypotension.
  • Adverse Effects: Monitor kidney function and potassium levels.
Calcium Channel Blockers
  • Action: Prevent calcium from entering heart muscle and arteries, reducing contractions.
  • Examples: Amlodipine, Diltiazem, Nifedipine.
  • Side Effects: Constipation, hypotension, dizziness.
  • Teaching: Gradual cessation and precautions in specific environments.
Beta Blockers
  • Action: Decrease heart rate and contraction force.
  • Examples: End in “olol”.
  • Side Effects: Fatigue, dizziness, potential bronchoconstriction.-
  • Teaching: Advisories on risky symptoms and environmental factors.
Alpha Blockers
  • Action: Relax blood vessel receptors, improving blood flow.
  • Examples: End in “zosin”.
  • Teaching: Safety measures after dosage initiation and weight monitoring.
Alpha-Beta Blockers
  • Action: Relax vessels and slow heart rate.
  • Examples: Labetalol, Carvedilol.
  • Teaching: Instruction regarding abrupt cessation risks and monitoring vital signs.
Central-Acting Adrenergic Agents
  • Mechanism: Stimulate CNS receptors to lower vessel constriction and blood pressure.
  • Examples: Clonidine, Methyldopa.
  • Side Effects: High incidence of dry mouth and lethargy; can safely use methyldopa in pregnancy.
Direct Vasodilators
  • Mechanism: Act on peripheral arteries to induce dilation, lowering BP.
  • Examples: Hydralazine, Minoxidil.
  • Side Effects: Risk of tachycardia; monitor for significant blood pressure changes.

Drugs for Heart Failure

Heart Failure Definition
  • Definition: Condition where the heart cannot pump effectively to meet bodily demands.
  • Causes: Hypertension, MI, coronary artery disease, etc.
  • Heart Failure Types:
    • Left Heart Failure: Results in lung congestion due to poor left ventricle function.
    • Right Heart Failure: Leads to systemic congestion due to poor right ventricle emptying.
Symptoms of Right vs. Left Heart Failure
  • Left Heart Failure Symptoms: Fatigue, respiratory distress, pulmonary congestion, etc.
  • Right Heart Failure Symptoms: Jugular distention, liver enlargement, dependent edema.
Management of Heart Failure
  • Goals: Treat underlying causes, manage symptoms, and lifestyle modifications. Commonly used medications include diuretics and ACE inhibitors.
Cardiac Glycosides (Digoxin)
  • Mechanism: Increases contractility and slows heart rate.
  • Example: Digoxin.
  • Monitoring: Apical pulse before administration; hold if <60 bpm.
  • Education: Report weight changes and adhere to dietary guidelines on potassium.
Human B-Type Natriuretic Peptides
  • Function: Increase water elimination and vasodilation.
  • Example: Nesiritide, given IV.
  • Monitoring: Heart function and urine output during treatment.
Positive Inotropes
  • Function: Enhance cardiac contractility; given IV.
  • Examples: Dobutamine, Dopamine.
  • Monitoring: Watch for signs of adverse cardiovascular effects.
Potassium & Magnesium Supplements
  • Roles: Maintain healthy heart rhythm.
  • Monitoring: Blood levels and educate on dietary sources during therapy.
Entresto
  • Composition: Combination of sacubitril and valsartan for chronic heart failure treatment.
  • Monitoring: Requires careful monitoring of renal function and electrolytes.

Drugs for High Blood Lipids

Hyperlipidemia Definition
  • Definition: Increased lipids in the blood, contributing to cardiovascular disease.
  • Types: Includes LDL (bad cholesterol) and HDL (good cholesterol).
Antihyperlipidemic Drugs
  • Statins: HMG-CoA reductase inhibitors that lower cholesterol.
  • Examples: Atorvastatin, Simvastatin.
  • Adverse Effects: Rare but may include liver dysfunction.
Bile Acid Sequestrants
  • Action: Bind bile acids and decrease cholesterol.
  • Examples: Cholestyramine.
  • Warnings: May interfere with other medications.
Cholesterol Absorption Inhibitors
  • Used: In conjunction with statins for improved lipid control; Examples: Ezetimibe.
Fibric Acid Derivatives (Fibrates)
  • Action: Bind cholesterol and enhance excretion; Examples: Fenofibrate.
  • Cautions: Monitor for increased bleeding or liver enzyme levels if taken with statins.
Nicotinic Acid Agents
  • Deficiency: Affects cholesterol and triglyceride levels; Example: Niacin.
  • Cautions: Risk of hepatotoxicity and monitoring for blood sugar changes in diabetes patients.

Drugs that Affect Clotting

Anticoagulants and Thrombolytic Drugs
  • Coagulation Cascade: Process that occurs when blood vessels are injured to form clots.
  • Risks: Clot discrepancies can cause embolisms.
Thrombin Inhibitors
  • Direct Action: Block thrombin effects, preventing clot formation; Examples: Dabigatran.
  • Monitoring: Watch blood pressure and coagulation parameters closely.
Vitamin K Antagonists
  • Mechanism: Interfere with vitamin K metabolism; Example: Warfarin.
  • Monitoring: Maintain INR levels between therapeutic ranges.
  • Patient Education: Dietary implications, including vitamin K intake.
Antiplatelet Drugs
  • Function: Prevent platelet aggregation; commonly used in cardiovascular prevention.
  • Examples: Aspirin, Clopidogrel.
Thrombolytic Drugs
  • Indications: Remove blood clots in acute settings; Example: Alteplase.
  • Administration: Requires specialized monitoring due to hemorrhagic risks.
Colony Stimulating Factors
  • Definition: Promote bone marrow production of blood cells; Includes ESA and TSA.
  • Monitoring: Assess for signs of hypertension and clots.
ESA & TSA Actions
  • Function: Increase RBC and platelet levels, respectively; Monitoring for adverse effects requires attention to patient history and compliance in administration.