Cardiac Medications and Concepts

Class Management and Conduct

• Sign Sheet

  • Sign in necessary for points due to in-class activity.

• Reminder to stay engaged during class.

  • Acknowledged distractions (looking at screens).

  • Emphasized the importance of eye contact and engagement.

• Fall Break Announcement

  • Break occurring in approximately six hours.

Course Structure and Objectives

• Overview of Daily Agenda

  • Complete discussion on cardiac medications.

  • Engage in activity related to class content.

  • Provide test-taking tips before Math Study Session led by Dr. Mo.

  • Emphasized optional nature of the Math Study Session while encouraging participation for preparation.

• Importance of mastering medication calculations for med check-offs and passing the course.

Understanding Heart Failure Through Visual Aids

• Utilized an episode clip from "I Love Lucy" to explain pathophysiology of heart failure.

• Metaphor of candy-wrapping process to illustrate how blood circulates through the heart:

  • The conveyor belt symbolizes blood flow.

  • Chaotic packing represents heart dysfunction in heart failure.

• Importance of visual learning in complex medical concepts.

Pathophysiology of Heart Failure

• Definition of Heart Failure

  • Heart’s inability to pump effectively leads to blood pooling either systemically or in the lungs.

• Types of Heart Failure:

  • Right-sided Heart Failure:

  • Ineffective pumping leads to blood backing up in the liver.

  • Symptoms include abdominal swelling (ascites).

  • Left-sided Heart Failure:

  • Blood pooling in lungs leads to pulmonary hypertension.

  • Symptoms include difficulty breathing (dyspnea) and crackles on lung assessment.

Cardiac Medications Overview

Purpose of Cardiac Medications

• Aim to lower heart's workload.

• Medications either reduce excess body fluid or enhance heart's pumping efficiency.

Diuretics

Types of Diuretics

1. Thiazide Diuretics

   • Mechanism:

     • Act on proximal distal convoluted tubule.

     • Cause loss of sodium, chloride, water, and potassium.

   • Use cases: Hypertension, fluid retention.

   • Example: Hydrochlorothiazide (HCTZ).

2. Loop Diuretics

   • Mechanism:

     • Act on the loop of Henle, responsible for 20% of water reabsorption.

     • Causes more significant loss of sodium, potassium, and chloride.

   • Commonly prescribed: Furosemide (Lasix).

   • Important safety measures when administering, such as slow IV push to avoid ototoxicity.

3. Potassium-Sparing Diuretics

   • Mechanism:

     • Diuretics that cause sodium loss without potassium depletion.

   • Examples: Spironolactone.

   • Monitor potassium levels closely due to risk of hyperkalemia.

Diuretics Clinical Considerations

• Monitor electrolyte levels, especially potassium.

• Patients should be educated on dietary potassium intake as per medication (i.e., Lasix vs. spironolactone).

• Education on potential for orthostatic hypotension, particularly in elderly patients and during medication shifts.

Inotropic Agents

Digoxin

• Mechanism:

  • Increases calcium levels in heart cells, enhancing contraction force.

• Indications:

  • Low ejection fraction heart failure.

• Administration must be IV slow push and is associated with serious side effects and toxicity risks.

  • Symptoms of toxicity include visual disturbances and gastrointestinal symptoms.

Dobutamine

• Mechanism:

  • Acts as a sympathomimetic agent increasing contractility of the heart.

• Indications:

  • For critically ill patients in the ICU on continuous IV infusion.

Statins: HMG CoA Reductase Inhibitors

• Purpose:

  • Lower LDL cholesterol levels, decrease triglycerides, and increase HDL cholesterol.

• Administration goals and contraindications regarding liver function and muscle integrity.

• Regular liver function tests required due to hepatotoxicity risk, especially in long-term use.

Nitroglycerin

• Mechanism:

  • Potent vasodilator increasing oxygen delivery to heart muscle; primarily used for angina pectoris.

• Common side effects include headaches and hypotension.

• Monitoring required post-administration for blood pressure changes.

Amiodarone

• Mechanism:

  • A potassium channel blocker, primarily used for life-threatening dysrhythmias.

• Requires careful monitoring for respiratory symptoms and GI distress.

Test-Taking Strategies for Pharmacology

• Distinguishing specific drug-related symptoms and contraindications are crucial in a test environment.

• Adapt responses based on lab values, especially concerning potassium levels, in medications.

• Continuous review of mechanisms of action, side effects, and supported clinical practices is vital for success.

Class Activities and Wrap-Up

• Engagements planned to transition from lecture material to tests and practical applications.

• Encouraged to use knowledge in scenarios to determine medication safety and appropriateness for patient care.