Class 11 Cardiac, renal and
hematological medications
Chapter 15 & 20
Learning Objectives
 Identify the approved way to give different forms of
antianginal therapy
 Discuss the uses and general actions of cardiac drugs used to
treat dysrhythmias
 Describe the common treatment for various types of
lipoprotein disorders
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Antianginals and Peripheral
Vasodilators
Antianginals
 Nitrates: “Universal Vasodilators”
 Directly cause vascular smooth muscle to relax in arterial and
venous circulation
 Decrease myocardial oxygen use
 Increase collateral-vessel circulation to the heart
 Calcium Channel Blockers
 Dilate coronary arteries and arterioles
 Reduce response of electrical conduction system
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Antianginals and Peripheral
Vasodilators (cont.)
Adverse Reactions
 Nitrates: Flushing, postural hypotension, tachycardia, confusion,
dizziness, fainting, headache, lightheadedness, vertigo, weakness,
drug rash, localized pruritus, skin lesions, eye and mouth
edema, local burning in mouth, nausea and vomiting
 Peripheral Vasodilators: Headache, weakness, tachycardia,
flushing, postural hypotension, dysrhythmias, confusion, severe
rash, nervousness, tingling, and sweating
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Nitrate Products
 Any drug with NITR- in the generic with cause vasodilation
 Nitroglycerin**
 isosorbide dinitrate
 isosorbide mononitrate
 These are the main drugs in this category. Nitroglycerin
(NTG) can be given in multiple forms: PO pills & spray;
sublingual; IV medication; ointment; & slow release topical
patches.
5
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Peripheral vasodilator
 Apresoline (hydralazine)
 Treatment of hypertension and high afterload heart failure
 Causes blood dyscrasias so monitor the CBCs
Question 2
Which are the best drugs for treating coronary artery
disease?
1.
2.
3.
4.
7
Beta blockers
Calcium channel blockers
Diuretics
Nitrates
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Antidysrhythmics
Four Classes
 Class I: disopyramide, procainamide, quinidine
 Lengthen the refractory period
 Decrease cardiac excitability
 Class II: acebutolol, esmolol, propranolol
 Reduce sympathetic excitation (reduce loading)
 Class III: amiodarone
 Lengthen the time it takes for one cell to fire and recover
 Class IV: verapamil
 Blocks calcium entry into the myocardium, prolongs resting phase
**A good reference for understanding classes.
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Antidysrhythmics
 CLASS 1 A
 CLASS 1B
 Norpace (V)
 Xylocaine (V)
 dysopyramide
 Pronestyl (V,A)
 Procainamide
(V) = ventricular action
(A) = atrial action
 lidocaine
Antidysrhythmics
 Class 2 Beta blockers
 Class 3
 Brevibloc (V)
 Cordarone / Pacerone (V)
 esmolol
 Inderal (V)
 propranolol
 Amiodarone
 100 day half life !!
 Betapace (V)
 sotalol
Antidysrhythmics
 Class 4
 Calcium channel blocker
 Adenocard (V)
 Calan / Isoptin
 adenosine
 Verapamil
 Given rapid IV push &
 Can cause hypotension
flush
 Causes SOB & dyspnea
 Facial flushing
 Can not have any
grapefruit while on any
calcium channel blockers
Antidysrhythmics (cont.)
Action and Uses
 Quinidine and Procainamide
 Treat rapid and irregular dysrhythmias by decreasing the
excitability of myocardial cells
 Bretylium
 Slows conduction rate in the ventricles, slows norepinephrine
release in the myocardium
 Disopyramide
 Slows the depolarization of cardiac cells
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Antidysrhythmics (cont.)
 Lidocaine
 Increases the strength of electrical impulses
 Adenosine
 Stops the heart for several seconds to allow it to convert to
normal sinus rhythm
 Beta-adrenergic blockers (propranolol)
 Decrease the heart’s beta-receptor response to epinephrine and
norepinephrine
13
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Antihyperlipidemics
Types of Lipoproteins
 Chylomicrons (mostly triglycerides)
 Formed from absorption of dietary fat in intestine
 Very low-density lipoproteins (VLDLs)
 Made up of large amounts of triglycerides that were made in the liver (pre-beta
lipoproteins)
 Low-density lipoproteins (LDLs)
 Breakdown of VLDLs linked with cholesterol and protein
 High-density lipoproteins (HDLs)
 Clear out excess cholesterol from tissue
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Antihyperlipidemics
 Bile Acid Sequestrants
 HMG-COA reductase
(chole or cole = bile)
 Questran
inhibitors (-statins)
 Lipitor
 Cholestyramine resin
 Colestid
 colestipol
 WelChol
 colesevelam
 atorvostatin calcium
 Pravachol
 pravastatin
 Zocor
 simvastatin
Antihyperlipidemics
 Miscellaneous
 Make sure you check what
 Tricor
time of day the drugs must
be given.
 Some are with food, others
are before food.
 Some do not matter.
 fenofibrate
 Lopid
 genfribrozil
 Niaspan
 nicotinic acid or naicin
Cardiotonics
Actions
 Increase the contraction strength or force (positive inotropic
action)
 Slow the heart rate
Uses
 Treatment of CHF and rapid or irregular heartbeats (atrial
fibrillation, atrial flutter, frequent PVCs or paroxysmal atrial
tachycardia)
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Cardiotonics (cont.)
Adverse Reactions



Digitalis toxicity: serum digoxin levels verify
The amount of medication that is helpful (therapeutic) and the amount
that is harmful (toxic) are not very different. This is called a narrow
therapeutic window.
Don’t confuse the sound-alikes digoxin and digitoxin
Drug Interactions
Nursing Implications and Patient Teaching
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Cardiotonics
 Lanoxin / Digitek
 Digoxin
 Primacor
 milrinone
 dobutamine
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Mrs. Moskaluk’s HTN Guide
A = ACE inhibitors (vasodilation and decrease plasma volume)
and ARBs for vasodilation (-pril & - sartan drugs)
B = Beta blockers – lowers heart rate and vasodilates (-lol)
C = Calcium channel blockers (-dipine drugs)
D = Diuretics (-thiazide and loop are K+ losers; aldactone is
K+ sparing)
E = Exercise to clean the vessels
‘F’ diet = fish, fluid, fiber, and fruit
-zosin drugs are alpha 1 adrenergic blockers
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Urinary incontinence drugs
 Antispasmotics/
 BPH meds
anticholinergics
 Ditropan (p in the pan)
 Proscar (think prostate)
 oxybutynin
 Pro-Banthine
 propantheline
 finasteride
 Flomax
 Tamulosin
 ‘maximize the flow’
 Detrol
 Tolterodine
 ‘Gotta go right now’ TV
commercial
• Urinary Tract Analgesic
• Pyridium
• phenazopyridine
Hematologic Products
Chapter 20 7th ed.
Learning Objectives



Describe the influence of anticoagulants on
blood clotting
Identify drugs that act in the formation, repair, or
function of red blood cells
Identify at least three adverse reactions
associated with hematologic products.
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Anticoagulants
Two Categories
• Coumarin and indandione derivatives
• Limit the formation of blood coagulation factors
II, VII, IX, and X in the liver by interfering with
vitamin K
• Antidote: Vitamin K injection/ infusion
•
Heparin sodium
• Increases the action of antithrombin III (heparin
cofactor) on several other coagulation factors to
slow new clot development
• Antidote: Protamine sulfate
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Low Molecular Weight Heparins

Lovenox **


Fragmin



enoxaparin
dalteparin
Used to prevent clotting
Require less lab monitoring than Heparin
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Anticoagulants (cont.)
Nursing Implications and Patient Teaching
 Monitoring blood values


Coumadin = prothrombin time (PT); therapeutic is 1.5
to 2.5 × normal or an INR of 2.0 to 3.0
Heparin = activated partial thromboplastin time
(aPPT); therapeutic is 2.5 to 3 × the control value
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Thrombolytic Agents
Action
 Convert plasminogen to the enzyme plasmin,
which breaks down fibrin clots, fibrinogen,
and other plasma proteins
Uses






Acute myocardial infarctions
Acute pulmonary emboli
Acute ischemic stroke
Acute arterial occlusion
Activase (altepase; recombinant)
Retevase (reteplase)
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Antiplatelet Agents
Action
 Inhibit platelet aggregation (clumping)
 Reduce thrombus formation
Uses
 Salicylic acid (aspirin)



Reduces incidence of myocardial infarction-related
deaths in men over 50
Drug of choice in ischemic stroke
81 mg used prophylactically
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Antiplatelet Agents

ASA


Pletal


clopridogrel
Persantine


cilostazol
Plavix


acetylsalicyclic acid
dipyridamole
Ticlid

ticlopidine
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Question 1
Cellular damage first results in the formation
of:
1.
2.
3.
4.
Prothrombin.
Thrombin.
Thromboplastin.
Fibrinogen.
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Question 2
Which is true about emboli?
1.
2.
3.
4.
Emboli are not life threatening.
The function of heparin is to dissolve existing
blood clots that may form emboli.
Emboli can only travel to nearby blood
vessels.
An embolism can cause stroke or death.
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Question 3
Which is the anticoagulant of choice when
an immediate effect is needed?
1.
2.
3.
4.
Warfarin
Plavix (clopidogrel bisulfate)
Heparin
Aspirin
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 Questions?