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Cardiovascular Drugs James Shockley RN, BSN

Cardiovascular Drugs James Shockley RN, BSN. Overview: Rules of Engagement. Review of Learning Objectives Explanation/Discussion Anticoagulants Cardiotonics Anti-arrhythmics Anti-anginals Antihypertensives Review and Questions. Important Vocabulary .

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Cardiovascular Drugs James Shockley RN, BSN

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  1. Cardiovascular Drugs James Shockley RN, BSN

  2. Overview: Rules of Engagement • Review of Learning Objectives • Explanation/Discussion • Anticoagulants • Cardiotonics • Anti-arrhythmics • Anti-anginals • Antihypertensives • Review and Questions.

  3. Important Vocabulary • Positive inotropic effect – increased strength of contraction • Clients with PUMP failure • Positive chronotropic effect – increased cardiac rate • Bradyarrhytmias • Negative chronotropic – decreased cardiac rate • SVT • Positive dromotropic effect increased AV conduction • Used in pt with heart block • Negative dromotropic effect – block conduction of disorders • Afib

  4. Anticoagulantsor there are no such things as blood thinners! • Prevent extension and formation of clots by inhibiting the factors in the clotting cascade. • USES • Thrombosis • PE • MI

  5. Anticoagulants • Side Effects • Hemorage • Hematuria • Ecchymosis • Bleeding gums • THROMBOCYTOPENIA

  6. Anticoagulants • Heparin • Prevents thrombin from converting fibrinogen to fibrin • DOES NOT DISOLVE CLOT • Test for is aPTT ( activated partial thromboplastin time) • Normal 20 – 36 seconds • Maintain a therapeutic level 1.5 to 2 times normal

  7. Anticoagulants • Heparin uses • Prophylaxis and treatment of DVT • PE • Afib with embolization • Used in DIC • Low-melecular weight heparins • Prevention of thromboembolic phenomena including DVT.

  8. Anticoagulants • Nursing – • Monitor aPTT q 4-6 hours or per MD discretion. • Observe for S/S of bleeding…bleeding precautions • Gums • Stool • Urine • ANTIDOTE = PROTAMIN SULFATE

  9. Anticoagulants • Warfarin (coumadin) • Decreases PT activity and prevents use of vitamin K by liver. • For long term anticoagulation • Thrombophlebitis • PE • Embolism formation from AFIB

  10. Anticoagulants • Warfarin • Test – • PT /INR( prothrombin time and international normalized ratio) • Normal PT is 9.6 – 11.8 seconds • Goal is 2-3 times normal but may be higher • ANTIDOTE – VITAMIN K PHYONADIONE (AQUAMEPHYTON)

  11. Antiplatelets • Inhibits aggregation of platelets in clotting process. • ASA • Plavix ( clopidogrel bisulfate) • Side effects • GI upset / bleeding • Bruising tarry stools

  12. Cardiotonics:General Information • Cardiotonics=Cardiac/Digitalis Glycosides • Glycoside = sugar+ attached to steroid nucleus

  13. Cardiotonics:General Information • Digitalization-being started on therapy • Loading dose- series of doses until get full therapeutic effect (variations as per doctor’s orders) • Maintenance dose-placed on a schedule once therapeutic effect obtained

  14. Cardiotonics:General Information • Increases cardiac output and efficiency • Slows heart rate • Increases cardiac output (CO) • Blood to kidneys and other organs • H2O, electrolytes and waste removed • Symptoms of CHF relieved

  15. Cardiotonics:General Information • Inhibits sodium-potassium pump, increasing intercellular calcium which causes heart muscles to contract more efficiently. • Produces a POSITIVE INOTROPIC EFFECT • Affects electrical impulses along pathway of cardiac conduction system via a negative chronotropic action • Depresses SA node and slows conduction of electrical impulses to AV node • Decreases number of impulses and number of ventricular contractions per minute

  16. Cardiotonics:General Information • Examples: • Digoxin (Lanoxin) -Rapid onset and short a short duration of action. • Digitoxin -Slowed onset and longer duration of action.

  17. CardiotonicsIndications for use • Congestive Heart Failure • Atrial Fibrillation • Atrial Flutter • SV Tachycardia • Paroxysmal and atrial tachycardia

  18. Adverse Reactions • Digitalis Toxicity/Intoxication • Toxic drug effects can occur when ANY cardiotonic is administered. • Hypokalemia plays a role in toxicity • Normal Serum Levels: • Digoxin: 0.5-2 Ng/ml. Toxic >2.5 Ng/ml • Digitoxin: 14-26 Ng/ml. Toxic > 35 Ng/ml

  19. Dig toxicity • Signs and symptoms • Cardiac: Brady/tachycardia, PVC’s, bigeminy, trigeminy, other EKG changes • Neuro: Headaches, drowsiness, apathy, visual disturbances, confusion, disorientation, delirium

  20. Digitalis Toxicity • Muscular: fatigue and weakness (asthenia) • GI: N/V/D

  21. Digitalis Toxicity • Treatment • Withhold drug immediately • Blood tests. Serum Dig level • KCL IV or PO • {Digibind in presence of life threatening arrythmias. Throws off serum levels.} • Atropine for severe bradycardia

  22. Nursing Process & Implications • Physical Assessment • Blood Pressure, Apical Pulse, RR • Auscultation of lungs • Edema of extremities • JVD • Weight • Sputum ( clear, frothy red, etc.)

  23. Nursing Process & Implications • Lab & diagnostic tests- EKG, renal and hepatic function, enzymes, CBC, B11, Drug levels

  24. Nursing Process & Implications • Weigh Daily • Monitor I&O • Monitor for Hypokalemia • Patient becomes more susceptible to Digitalis toxicity. • Administer the right dose at the right time. • ANY questions about administration, talk to the charge nurse or the MD.

  25. Please Note • Dig toxicity can occur even when normal doses are being administered or when patient has been on a maintenance dose for a period of time.

  26. Nursing Process & Implications • Patient & family teaching usually night • Same time each day • Take pulse prior to taking med • DO NOT discontinue drug unless instructed to do so by an MD. • Avoid OTC drugs. • Notify MD if S&S of toxicity occurs • Follow diet • Keep all appointments with MD.

  27. Anti-Arrhythmics • General Information • Indications for Use • Adverse reactions • Nursing Process/Implications

  28. Anti-Arrhythmic:General Information • Causes of Cardiac Dysrhythmias • Atrial vs Ventricular- abnormal impulses may generate from the SA node or may be generated from other areas of the myocardium. • Mechanisms of Action: • Suppresses impulse that triggers the arrhythmia

  29. Examples of Anti-Arrhythmics • Amiodarone hydrocloride – afib with RVR. • Pulmonary fibrosis • Increases effects of digoxin • Cut dose by half • Adenosine (Adenocard) –for paroxysmal supraventricular tachycardia (PSVT)

  30. Anti-Arrhythmics:Indications for use • Used to treat dysrhythmias • (atrial tachycardia/AFib/flutter, PSVT, PVC’s, VT/VF) • Control angina pectoris caused by atheroschlerosis and hypertrophic subaortic stenosis

  31. Anti-Arrhythmic:Adverse Reactions • Cardiac dysrhythmias • Hypotension • Nausea • Dizziness • Headache • Cinchonism: Related to Quinidine Administration-ringing in ears

  32. Anti-Arrhythmic: Nursing Process & Implications • Assessment: • NBP, Apical & Radial Pulses, RR • Pt’s general condition is assessed. • Subjective assessment. • Laboratory and Diagnostic tests. • EKG, Renal and Liver Function tests, CBC, serum electrolytes and drug levels.

  33. Anti-Arrhythmic: Nursing Process & Implications • Take BP, P, RR usually every 1-4 hours • If pulse rate >120 or < 60, hold drug and call MD • If patient is acutely ill or receiving one of these drugs parentally, the I+O should be measured and recorded

  34. Anti-Arrhythmic: Nursing Process & Implications • Planning and Implementation: • Instruct in monitoring patient’s pulse rate and BP prior to taking med. • If pulse >120 or < 60, hold med and call doctor. • Instruct patient to take BP periodically

  35. Anti-Arrhythmic: Nursing Process & Implications • Patient Family Teaching: • Teach technique for NBP, pulse monitoring. • Avoid OTCs • Avoid alcohol or smoking • Follow directions on label • Do now chew tablets or capsules, swallow the whole

  36. Anti-Arrhythmic: Nursing Process & Implications • Patient Family Teaching: • Instruct on side effects of medications • Do not drive or perform hazardous tasks if lightheadedness occurs • Dry mouth: sip water, or ice chips may be used. • Wax matrix; is not absorbed, may be found in stool.

  37. Anti-Arrhythmic: Nursing Process & Implications • Patient Family Teaching: • Keep all appt’s: MD, lab etc. • Adhere to diet restrictions • Report any problems to MD immediately.

  38. Anti Anginals • General Information • Indications for Use • Adverse reactions • Nursing Process/Implications • Examples of Anti-anginals: • Nitrates: Nitroglycerin, Isosorbide dinitrate • Calcium Channel Blockers: Cardizem

  39. General Information:Anti Anginals • Used to treat Angina • Consists of Nitrates, Calcium Channel Blockers, beta blockers • Increases blood supply and decreases myocardial O2 demand.

  40. Examples:Anti Anginals • Nitrates: produce vasodilation • Decreases preload and afterload:reduces myocardial O2 consumption - Nitroglycerine 1 tablet q5-10min x 3 store in a cool dark place - Isosorbide ( Isordil)

  41. Anti Anginals • Beta-blockers • Interrupt adrenergic stimulation • Inhibit B2 receptors cause vasodilation in skelatal muscle arterioles • Used to control angina by lowering BP • Mainstay treatment of CHRONIC STABLE ANGINA • DO NOT STOP ABRUPTLY – Titrate down • Propanolol, Atenolol • Beta blockers mask the S/S of hypoglycemia

  42. Anti Anginals • Calcium Channel Blockers • Decreases cardiac contractility and work load of heart thus decreasing O2 consumption • Relaxes coronary vascular smooth muscle • Dilates coronary arteries and peripheral arteries causing vasodilation. - Verapamil ( Canan, Isoptin) - Diltiazem (Cardizem) - Nifedipine (Procardia, Adalat) - Amlodipine ( Norvasc)

  43. Indications for use: • Prophylaxis and long term treatment of Angina Pectoris. • Acute attacks of Angina Pectoris • Treatment of Prinzmetal Angina • Treatment of coronary artery spasm

  44. Adverse Reactions: • Nitrates: • Headaches common in early therapy • Dizziness, vertigo, weakness, hypotension, flushing. • Reactions lessen/disappear with prolonged use • Doses are adjusted to avoid or decrease adverse reactions and treatment of symptoms. • Goal: alleviate Anginal pain.

  45. Adverse Reactions: • Calcium Channel Blockers • Hypotension, pulmonary edema, CHF, dizziness, nausea, skin rash, dermatitis, fever, and chills • Usually not serious and rarely requires discontinuing drug

  46. Nursing Process • Assessment • Record thorough description of Anginal pain (type, radiates, events) • Thorough physical assessment (rest) • Vital signs (AP) • Weight, extremity inspection, auscultate lungs

  47. Nursing Process • Planning and implementation: • Monitor Blood pressure and pulse q 3-4 hours. • Record patient’s response to treatment. • EX: Chest pain relieved? Monitor Chest pain

  48. Nursing Process Sublingual nitroglycerine: • Placement tablet in mouth under the tongue • May be ordered to be left at the bedside

  49. Nursing Considerations. • Nitrogylcerine Topical ointment: • Measured in inches or millimeters • Ambulatory patient should rest for 10-15 minutes and have BP and P checked before applying. • Rotate sites • Remove paper from previous application

  50. Nitro “paste” • May use chest (front/back), abdomen, upper or lower arms and legs • Ointment IS NOT rubbed into patient’s skin • Do not get ointment on YOUR fingers!!! • Assist with ambulation • Administer while pt is sitting or lying down

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