Transcript Cardiac Meds

Pharmacotherapy for CAD, Angina,
ACS, Heart Failure
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Drugs to Decrease Angina
Drugs to Improve Cardiac Output
Drugs to Decrease Fluid Volume
Drugs to Decrease Clot Formation
Drugs to Decrease Cholesterol and Decrease
Risk of Cardiac Events
Herbals
Drugs to Decrease Angina and
Cardiac Workload
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Nitrates-nitroglycerin
Calcium channel blockers-diltiazem
Beta-adrenergic blockers-atenolol
Vasodilators-hydralazine (direct vasodilator),
lisinopril, losartan (angiotensin inhibitors)
Nitrates
Prototype: NTG
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Action: dilates coronary arteries, decreases
preload and afterload
Indication: treatment of acute and chronic
angina and prophylaxis
Side effects: headache, hypotension,
dizziness, tachycardia
Nursing considerations: assess pain,
monitor blood pressure before, during, and
after administration.
Calcium Channel Blockers
Prototype: diltiazem
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Action: inhibits calcium; dilates coronary and
peripheral arteries
Indications: Prinzmetal’s and chronic stable
angina, hypertension
Side effects: HA, fatigue, drowsiness,
dysrhythmias, CHF, heart block, ARF
Nursing considerations: Monitor VS, hold for
SBP<90, Heart rate<60; monitor ECG
Beta-blockers
Prototype: atenolol
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Note that all generic names end in –lol
Action: blocks beta receptors, slows heart rate,
decreases oxygen demand
Indications: chronic angina, MI, hypertension
Side effects: fatigue, dizziness, hypotension,
bradycardia, bronchospasm (do not use in
obstructive or restrictive respiratory diseases),
agranulocytosis, thrombocytopenia
Nursing considerations: apical/radial pulse before
adm. Notify prescriber for P<50, I&O, daily wts.
Monitor BP. Do not stop suddenly (chest pain).
Vasodilators
Prototype: hydralazine
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Action: relaxes arteriolar and venous smooth
muscle
Indications: to reduce preload and afterload
in cardiac pump failure
Side effects: HA, dizziness, bradycardia
Nursing Considerations: obtain VS before
beginning tx; keep pt in supine position when
starting or titrating tx
Vasodilators: AngiotensionConverting Enzyme Inhibitors
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Prototype: lisinopril (note that all generic names end
in –pril)
Action: inhibits ACE; blocks conversion of angiotensin
I to angiotensin II.
Indications: manage symptomatic heart failure
Side effects: asthenia; dry, persistent, tickling, nonproductive cough; angioedema
Nursing Considerations: monitor BP, K+ level and
intake, CBC
Vasodilators: Angiotension
Receptor Blockers
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Prototype: losartan
Action: inhibits vasoconstrictive and aldosteronesecreting action of angiotensin II by blocking
angiotensin II receptor on the suface of vascular
smooth muscle
Indication: to reduce risk of stroke in patients with
HTN and left ventricular hypertrophy
Side effects: angioedema
Nursing Considerations: monitor BP, BUN,
creatinine, acute renal failure (if patient depends on
compensatory mechanisms)
Drugs to Increase Cardiac Output
Inotropics: digoxin
 Adrenergics (sympathomimetics):
dobutamine
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Cardiac Glycosides
Prototype: digoxin
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Action: increases Ca++ influx, strengthens
heart muscle and slows HR
Indications: CHF, atrial arrhythmias
Side effects: HA, nausea, anorexia, visual
changes, dysrhythmias, heart block (all
indicate toxicity)
Nursing considerations: AP x 1 min. Call
MD for P<60. Monitor serum level (0.5-2
ng/dl). Monitor lytes and kidney function.
Adrenergics (sympathomimetics)
Prototype: dobutamine
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Action: stimulates heart’s beta receptors to increase
myocardial contractility and stroke volume
Indications: short-term treatment of cardiac
decompensation caused by decreased contractility
Side effects: hypertension, increased HR, asthma
attacks, anaphylaxis
Nursing considerations: before beginning tx, give
digoxin and volume expander to correct hypovolemia;
monitor K+, VS, ECG, PAWP, CO, UOP
Drugs to Decrease Fluid Volume
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Diuretics: furosemide
Diuretics
Prototype: furosemide
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Action: inhibits reabsorption of sodium and
chloride at the tubules and in the loop of Henle
Indications: pulmonary edema, edema in
CHF, HTN
Side effects: Lyte imbalances, orthostatic
hypotension, loss of hearing, renal failure,
pancytopenia, rash
Nursing considerations: Monitor lytes and
fluid status, do postural BPs, monitor for
hearing difficulties.
Drugs to Reduce Blood Clot
Formation
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Antiplatelet: aspirin
Antiplatelets
Prototype: aspirin
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Action: makes platelets less sticky
Indication: post-MI, prophylaxis of MI
Side effects: NV, rash, GI bleeding,
pancytopenia, anaphylaxis, tinnitus
Nursing considerations: hepatic, renal, and
blood studies, monitor for ototoxicity and
allergic reactions.
Drugs to Decrease Cholesterol and
Decrease Risk of Cardiac Events
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Antilipidemics: simvastatin
Antilipidemics
Prototype: simvastatin
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Action: inhibits HMG-CoA reductase, an early step in
cholesterol biosynthesis
Indication: to reduce risk of death from CVD and CV
events in patients at high-risk for coronary events; to
reduce total and LDL cholesterol levels
Side effects: nausea, vomiting, myalgia,
rhabdomyolysis
Nursing considerations: monitor hepatic studies;
may increase CK levels; don’t take with grapefruit; take
with evening meal to enhance absorption