Transcript COMMON USED CARDIAC MEDICATIONS

COMMON USED
CARDIAC MEDICATIONS
By: Lisa Nie
RN, MSN, CMSRN
Clinical Nurse Specialist
in Cardiology
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Preload
 Preload is the volume of
blood present in a ventricle of
the heart, after passive filling
and atrial contraction.
 most accurately described as
the initial stretching of a single
cardiac myocyte prior to
contraction
 Preload is affected by venous
blood pressure and the rate of
venous return. These are
affected by venous tone and
volume of circulating blood.
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Afterload (Ventricular systole. Red arrow is path
from left ventricle to aorta. Afterload is largely dependent
upon aortic pressure.
 Afterload is used to mean the
tension produced by a chamber
of the heart in order to contract.
 Afterload can also be described
as the pressure that the
chamber of the heart has to
generate in order to eject blood
out of the chamber. Everything
else held equal, as afterload
increases, cardiac output
decreases
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Cardiac Medications
Overview
 Drug therapy for
CAD
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Antiplatelet aggregation
therapy
 The 1st line of
pharmacologic
intervention in the
treatment of angina.
 Common meds:
 Aspirin
 Plavix
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Indications
 Reduces atherosclerotic events in
patients with documented atherosclerosis
by recent CVA, MI or Peripheral artery
disease (PAD).
 Reduces atherosclerotic events in
patients with ACS (acute coronary
syndrome) such as PTCA with or without
stent placement or CABG
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Nursing Intervention
 Use in caution in patients at risk for
bleeding
 Platelet aggregation will not return to
normal for at least 5 days once drug in
stopped
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Nitrates
 Vasodilators
 2nd line of
pharmacologic
intervention
 Decrease O2
demand and allow
more blood to
coronary arteries
 Nitroglycerin
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Indications
 Prophylaxis to prevent or
decrease anginal attacks
from stressful events or
against chronic anginal
attacks.
 Heart failure after an MI
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Nursing Interventions
 Use with caution with patients with volume
depletion or hypotension
 Monitor VS closely
 For the ointment, measure the prescribed
amount on the application paper, place on a
hairless area, don’t rub in, and cover. Remove
all excess ointment from previous site before
applying the next dose.
 Remove patch before defibrillation
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Beta-adrenergic Blockers
 Direct decrease in myocardial
contractility, HR, BP all of which
reduce the myocardial O2 demand
 Decrease morbidity and mortality
rates in pts with CAD (e.g. AMI)
 Atenolol, Coreg, Toprol XL, Inderal
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Indications
 Hypertension
 Angina secondary to
atherosclerosis
 Cardiac arrhythmias,
especially: SVT, VT
(induced by digitalis)
 Prevention of another
MI
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Nursing Intervention
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Monitor BP, HR
Monitor activity tolerance
Monitor liver enzymes, renal function studies
Instruct patient to change positions slowly to
avoid syncope episodes
 Monitor for S/S of respiratory distress
 Monitor for hyper and hypoglycemia
 Take with foods to decrease GI side effect
(nausea, diarrhea).
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Calcium Channel Blocking
Agents
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Systemic vasodilation
Decreased myoardial contractility
Coronary vasodilation
Depressant effect on the SA node rate of
discharge, and the condution velocity
through the AV node, thus slowing the
HR.
 Carizem, Norvasc, Verapamil, plendil
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Indications
 Hypertension
 Prinzmetal’s angina:
 Chest pain caused by vasospasm of the coronary
arteries usually occurring at rest rather than
during exercise.
 Chronic stable angina
 A-fib or flutter; Paroxysmal
supraventricular tachycardia
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Nursing Interventions
 Monitor BP, HR, heart rhythm
 Monitor liver enzymes, renal function
 Do not chew or divide, sustained-release
tabs (SR or XL tabs)
 Take with food to increase absorption
 Assure stool softener is ordered to
prevent constipation
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Positive Inotropics Drugs
 Increase the heart’s pumping
action (contractility) and slow
down the electrical
conduction of the heart.
 Slowing of HR
 Decrease velocity through
AV node
 Digitalis
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Indications
 Heart failure
 Atrial fibrillation & Flutter
 Paroxysmal
Supraventricular
Tachycardia (PSVT)
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Nursing Interventions
 Monitor renal function studies:
 Renal impairment leads to decrease excretion of
Digoxin: Dig toxicity (altered color perception, see
yellow-green halos around visual images, or feel
weak or dizzy. Notify MD immediately if you notice
any of these changes)
 Monitor electrolyte levels:
 K+ predisposes the patient to Dig toxicity
 Mg++ predisposes the patient to Dig toxicity
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Con. Nursing Interventions
 Monitor rhythm
 Prolonging of PR
 ST wave depression from baseline
 AV block
 Assess apical pulse before administration, hold
& call MD for HR < 60.
 Call monitor tech immediately before beginning
IV push, administer IV Dig slowly over 5 min or
longer.
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Angiotensin-Converting
Enzyme (ACE) Inhibitors
 Decrease high BP and prevent or treat
CHF
 Improve blood flow in blood vessels
throughout the body
 ACEIs block the body’s production of
angiotensin, a chemical that causes the
blood vessels to constrict.
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Prinzmetal's angina
(variant angina)
 What can you tell
about Prinzmetal’s
angina?
 How is it different
from typical angina?
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 Prinzmetal’s angina, also called variant
angina, is chest pain (angina) that occurs
at rest for no apparent reason – unlike
typical angina which usually follows
physical exertion. Attacks of Prinzmetal’s
angina are brief but painful and occur
most often at night
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 The cause of Prinzmetal’s angina is a coronary
artery spasm, in which the walls of the artery
briefly narrow (constrict). This temporarily
reduces or obstructs blood flow to the heart
muscle, resulting in chest pain. Coronary artery
spasms can be associated with
atherosclerosis.
 Treatment of Prinzmetal’s angina is directed at
the underlying cause, such as atherosclerosis.
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QEUSTIONS??????
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