Cardiovascular Drugs

Cardiovascular drugs effect the
function of the heart and blood vessels
4/13/2015
1
Calcium Channel Blockers
(Calcium Ion Antagonists)

Examples:
 Nifedipine
(Procardia)
 Verapamil (Calan)
 Diltiazem (Cardizem)
 Nicardipine (Cardene)
 Amlodipine (Norvasc)
4/13/2015
2

Actions:
– Decrease SA node automaticity and AV
node conduction
 Decrease
heart rate and contraction strength
– Decrease work of L ventricle and O2 demand,
suppresses dysrhythmias
– Relax blood vessels
 Decrease
BP and increase blood flow to
coronary arteries
– Increase O2 to heart muscle
4/13/2015
3

Side Effects:
– Potentiate CHF
– Hypotension
– AV blocks
– Bradycardia
– Constipation
– Gastric distress
4/13/2015
4

Nursing Implications:
– May cause hypotension after IV
administration
– May be used after invasive procedure to
prevent vasospasm
4/13/2015
5
Cardiac Glycosides
(Digitalis)

Examples:
– Digoxin (Lanoxin)
– Digitoxin (Crystodigin)

Antidote:
– Digibind may be used to decrease
available digitalis in serum
4/13/2015
6

Actions:
– Increases strength of heart contraction
and slows conduction through AV node
 Increases
L ventricular output, decreases s/s
CHF, and increases ability to perform ADLs
– Enhances diuresis
4/13/2015
7

Used to treat:
– CHF
– Atrial fibrillation
– Atrial flutter
4/13/2015
8

Nursing Implications:
– Check heart rate before giving digitalis;
hold dose and call Dr. if HR <60
– Screen for factors that potentiate digitalis
toxicity:
 Hypokalemia,
impaired renal function, oral
antibiotics, quinidine, amiodarone, Ca++
channel blockers
4/13/2015
9
– Watch for s/s of digitalis toxicity:
 Anorexia,
N/V
 Fatigue, depression, malaise
 Changes in heart rhythm
 Vision changes
 Abdominal pain
 Bradycardia
4/13/2015
10
Nitrates
(Nitroglycerin)

Examples:
– Nitrostat sublingual
– Nitro-bid ointment
– Transderm Nitro patch
– Isosorbide dinitrate (Isordil)
– Nitroglycerin IV
4/13/2015
11

Actions:
– Dilates veins
 Venous
pooling results in decreased preload
– Dilates Arteries
 Prevents
vasospasm and increases blood
flow through coronary arteries and collateral
arteries
 Decreases BP and afterload
4/13/2015
12

Nursing implications:
– Teach:




4/13/2015
NTG needs to absorb from mouth so don’t swallow,
may crush tab with teeth to speed absorption if pain is
severe
If chest pain continues after taking 3 SL tablets at 5minute intervals then seek emergency care
Carry with you at all times
Keep in dark glass bottle and get new supply every 6
months
13
 Take
before any activity that usually
precipitates chest pain
 Side effects may include flushing, throbbing
headache, hypotension, and tachycardia
 With paste rotate sites and don’t apply over
scars or hairy areas
 May develop tolerance to NTG so many
physicians want patch removed at 10 pm for
6-8 hours without nitrates in system
 Monitor BP and pain closely if IV route used
4/13/2015
14
Thrombolytic Enzymes

Examples:
– Tissue-type Plasminogen Activator (t-PA or
Activase)
occurring – less allergic reactions
 Heparin often used with it
 More expensive than streptokinase
 Naturally
– Streptokinase
 Made
from bacteria so may produce allergic
response
 Don’t use if had strep infection in last 6
months
4/13/2015
15

Actions/Contraindications
– Break down clots in coronary arteries to
reperfuse heart muscle and reduce
damage
 Also
breaks down clots in other areas of body
so is contraindicated in presence of recent
surgery/injury, hemorrhagic stroke, active
bleeding, vessel malformation in brain, high
BP, or pregnancy
4/13/2015
16

Nursing implications:
– Should be started less than 24 hours after onset
of pain – the sooner the better
– Aim for 30 minutes “door to needle” time after
enters ER
– Start multiple IVs (usually 2 or 3 with 1 for lab
draws) and draw lab when IV started
– Avoid IM injections and frequent use of NIBP
cuff
– Monitor for s/s of bleeding and treat prn
4/13/2015
17
Hemostatic

Amicar (Aminocaproic acid)
– Used to manage hemorrhage due to
increased fibrinolysis from thrombolytic
agents
4/13/2015
18
Antilipemic
(Lipid lowering)

Examples:
– Nicotinic acid (niacin-B3)
– Gemfibrozil (Lopid)
– Cholestyramine (Questran)
– Lovastatin (Mevacor)
4/13/2015
19
Anticoagulants

Used with MI, DVT, Atrial fib/flutter, and after valve
replacement
– Heparin



Monitor with PTT
Antidote is protamine sulfate or FFP
Given IV
– Warfarin (Coumadin)



4/13/2015
Monitor with PT or INR
Antidote is Vitamin K or FFP
Given PO
20

Heparin
– Prevents formation of new clots
– In suspected MI give bolus based on
body weight then continuous infusion
– Therapeutic effect is monitored by PTT
every 6 hours and dose adjusted to
achieve PTT 1.5-2.0 times normal level
4/13/2015
21

Nursing Implications for heparin
– Monitor for s/s bleeding: low HR,
tachycardia, epistaxis, decreased H&H
– Avoid injuries
– Hold injection sites longer than usual
4/13/2015
22

Coumadin
– Used to prevent or treat thrombus or
embolus formation in atrial fibrillation, MI,
pulmonary embolism, and after valve
surgery
– Side effects: cramps, nausea, bleeding
4/13/2015
23

Nursing Implications for Coumadin:
– Teach:
 observe
for signs of bleeding and report
bleeding from gums/nose or in BM/urine
 Use soft toothbrush and electric razor
 Avoid using aspirin or NSAIDS or any meds
that may potentiate
 Frequent lab tests are necessary to monitor
4/13/2015
24
Antiplatelet Drugs

Examples:
– Aspirin
– Dipyridamole (Persantine)
– Ticlid
4/13/2015
25
Prevents platelet aggregation so
clotting is reduced
 Used to reduce death rate in patients
with MI and CAD and to reduce
thrombus formation after valve
prosthetic placed
 GI irritation with bleeding is common

4/13/2015
26
Peripheral Vasodilators

Examples:
– Vasodilan
– Cyclospasmol
– Hydergine
– Pavabid
– Trental
4/13/2015
27
– Used for intermittent claudication to
increase the flexibility of RBCs and
decreasing blood viscosity thereby
increasing blood flow to extremities
– Teach patient to
 avoid
driving until know it won’t cause
dizziness or blurred vision
 Avoid smoking - nicotine constricts vessels
 Notify Dr. if N/V, GI upset, HA, dizziness
persist
4/13/2015
28
Antihypertensives
Angiotensin-converting enzyme
inhibitors (ACE inhibitors)
 Angiotensin II Receptor Blockers
 Antiadrenergics
 Calcium Channel Blocking Agents
 Diuretics
 Vasodilators

4/13/2015
29
Adrenergic Drugs

Epinephrine (adrenalin) and
norepinephrine (Levophed)
– Epinephrine affects cardiac receptors to
maintain HR and BP; used in cardiac
arrest (given IV or intracardiac (by Dr.).
Don’t use suspension IV
– Norepinephrine is vasopressor used in
shock
4/13/2015
30

Dopamine: Small doses improve renal
function. Larger doses increase BP
and cardiac output
– Monitor BP frequently (q 15 min) and
titrate to keep BP in desired range
4/13/2015
31

Dobutamine: Stimulates cardiac
adrenergic receptors to increase CO
without increasing HR; used in CHF
– Monitor for chest pain, dyspnea, tingling
or burning of extremities
– Monitor IV site frequently for infiltration
4/13/2015
32

Amrinone (Inocor)
– Increases cardiac contractility and
decreases preload and afterload
– Used for short term tx of CHF that is
unresponsive to digitalis,diuretics, and
vasodilators
– Don’t confuse with amiodarone
(Cordarone) which treats dysrhythmias
4/13/2015
33
ANTIDYSRYTHMICS
CLASS I
Sodium Channel Blockers

Class IA
– Quinidine
– Quinidine salts
– Dysopyramide
– Procainamide
4/13/2015
34

Class IB
– Lidocaine
– Mexiletine and tocainide
– Phenytoin

Class IC
– Flecainide
– Propafenone

Miscellaneous Class I Drug
– Moricizine
4/13/2015
35
Antidysrhythmics

Fast sodium channel blockers
– Quinidine sulfate, Procainamide,
Disopyramide (Norpace)
Decreases myocardial irritability, slows
conduction, depresses contractility to
suppress a variety of dysrhythmias
 Side effects: seizures, asystole, heart block,
ventricular dyrhythmias, low BP,
agranulocytosis

4/13/2015
36

Nursing implications for procainamide:
– Monitor ECG, pulse, and BP
– Notify Dr. if QRS widens by 50%, PR
interval is prolonged, BP drops >15 mm
Hg
– Monitor for leukocytopenia
4/13/2015
37

Fast Sodium channel blockers II
– Examples: Lidocaine, Dilantin
– Actions of Lidocaine: Suppresses
automaticity and spontaneous
depolarization of ventricles in diastole by
changin the movement of sodium ions
across cell membranes
– Adverse reactions: seizures, cardiac
arrest, anaphylaxis
4/13/2015
38

Nursing implications for Lidocaine IV:
– If mixed 1 gm/250ml D5W (4 mg/ml) then
1
mg/min=15cc/hr
 2 mg/min=30cc/hr
 3mg/min=45cc/hr
 4mg/min=60cc/hr
– Monitor ECG, HR, Resp frequently
4/13/2015
39
– May cause drowsiness or dizziness
– S/s of toxicity (Notify Dr of these): N/V,
confusion, excitation, vision blurred or
double, ringing in ears, tremors, dizziness
or syncope, very slow HR
4/13/2015
40
Beta Blockers: Inderal
 Slow Channel Calcium Blockers:
verapamil

4/13/2015
41

Drugs that prolong repolarization:
– Bretylium (Bretolol), Amiodarone
(Cordarone)
 Side
effects of Cordarone can include ARDS,
CHF, worsening of dysrhymias, toxic
epidermal necrolysis
 Nursing implications for Cordarone: monitor
ECG continuously, observe for s/s ARDS
4/13/2015
42

Adenosine (Adenocard)
– Actions: interupts re-entry pathways in AV node
to restore NSR in SVT, slows conduction thru AV
node, causes coronary artery vasodilation
– Nsg Implications: Monitor ECG continuously.
Have crash cart available in room. Give IV over
1-2 seconds followed with rapid flush. May have
1st, 2nd, or 3rd degree heart block or may stop
until SA node takes over again
– If give too slow causes vasodilation/tachycardia
4/13/2015
43
CLASS II
Beta-Adrenergic Blockers
i risk of ventricular fibrillation by
blocking sympathetic NS stimulation
of cardiac beta receptors
i automaticity by blocking receptors in
SA node and ectopic pacemakers
h refractory period by blocking receptors
in AV node
4/13/2015
44

Actions:
– Block beta-adrenergic (sympathetic)
stimulation of the heart thereby reducing
cardiac oxygen demand
– Heart rate and blood pressure are lower
and cardiac force of contraction is less
4/13/2015
45

Side effects:
 Hypotension,
bradycardia, worsening CHF
 Bronchoconstriction which may potentiate
asthma
 Increased hyperlipidemia, depression, fatigue
 Decreased libido
 Masks s/s of hypoglycemia
4/13/2015
46
Beta-Adrenergic
Antagonists

Examples:
 Propranolol
(Inderal)
 Atenolol (Tenormin)
 Metoprolol (Lopressor)
 Nadolol (Corgard)
4/13/2015
47

Nursing implications:
– Caution patients not to stop taking them
abruptly because that can precipitate
angina and MI
– Instruct diabetics to monitor blood
glucose levels more often at vulnerable
times
– Screen for asthma patients on beta
blockers
4/13/2015
48
ANTIDYSRYTHMICS
CLASS II
Beta-Adrenergic Blockers
Acebutolol – oral /chronic / exercise
induced
 Esmolol – short term / IV / SVT
 Propranolol – oral for chronic / IV short
term emergent

4/13/2015
49
ANTIDYSRYTHMICS
CLASS III
Potassium Channel Blockers
Prolong action potential
 Slow repolarization
 Prolong refractory period in atria and
ventricles
 Class III drugs are associated with less
ventricular fibrillation and decreased
mortality compare with Class I drugs

4/13/2015
50
ANTIDYSRYTHMICS
CLASS III
Potassium Channel Blockers

Amiodarone: also has characteristics of sodium
channel blockers, beta blockers and calcium
channel blockers
– IV use:
 refractory V tach or fib
– Oral use:
 V tach or fib
 maintain NSR after conversion of A fib
and flutter
4/13/2015
51
Effects of Amiodarone
Vasodilation g decreases SVR
Prolongs conduction in cardiac tissue
i HR
i contractility of left ventricle
4/13/2015
52