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Cardiovascular Pharmacology

Presented by
Marcia Cornell RN, BSN, EMT-P
Teresa Peck BSN, RN
Cardiac Anatomy

Coronary arteries
Nitrates / Vasodilators
Examples
Nitroglycerin (NTG)
Isosorbide (long-acting) (iso-Bid, Isordil, Sorbide, Srbitrate)
Nitrates / Vasodilators
Purpose / Causes
Reduce peripheral resistance
Reduce workload on heart
Provide a better balance of oxygen supply and demand
Angina attacks
MI
Nitrates / Vasodilators
Adverse Effects
Decrease in BP
Dizziness
Headache
Syncope (fainting)
Flushed face
Nitrates / Vasodilators
Nursing Interventions
Sit quietly after taking
Assess B/P
If not effective after 3 doses, seek help

Beta-Blockers
Examples
Metoprolol (Toprolol) (Lopressor)
Atenolol
Propranolol (Inderal)
Meliletine HCL (Mexitil)
Propafenone HCL (Rythmol)
Tocainide HCL (Tonocard)
Sotalol HCL (Betapace)
Acebutolol HCL (Sectral)
Esmolol HCL (Brevibloc)

Carvedilol (Coreg)

Beta-Blockers
Purpose / Causes
Tx angina, HTN, arrhythmias (SVT, VT, ST)
Block beta-adrenergic receptors
Prevent SNS from increasing heart activity
Decreases excitability of cardiac muscle
Slows HR, decreases BP
Decreases myocardial O2 demand

Beta-Blockers
Adverse Effects
Low HR
Low BP
Dizziness, fainting, headache
Beta-Blockers
Nursing Interventions
Monitor HR, BP
Monitor for diarrhea, visual disturbances, respiratory distress.
Use with caution w/ pt w/ lung dx.
Monitor for dysrhythmias, dizziness, sleep disturbances
Calcium Channel Blockers
Examples
Diltiazem (Cardizem)
Verapamil (Calan, Isoptin)
Nifedipine (Adalat)
Calcium Channel Blockers
Purpose / Causes
Block movement of calcium ions into cardiac and smooth muscle fiber.
Decrease cardiac contractility
Anti-arrhythmic excessive atrial activity
Anti-hypertensive
Vasodilator coronary arteries
Angina

Calcium Channel Blockers


Adverse Effects
Dizziness
Fainting
Headache
Fatigue

Peripheral edema
Nausea/ vomiting
Tachycardia
Use caution w/ CHF
Increase toxicity of digoxin
Calcium Channel Blockers
Nursing Interventions
Monitor apical pulse and BP
Watch for dizziness
Cardioglycoside
Examples
Digoxin (Lanoxin)

Cardioglycoside
Purpose / Causes
Tx heart failure
Anti-arrhythmic atrial dysrhythmias
A-fib w/ RVR, PSVT
Slows conduction of impulses / HR
Increases contractility
Increases Cardiac Output (CO)
Cardioglycoside
Adverse Effects
Toxic S/S
Nausea / vomiting
Fatigue
Headache
Weakness
Cardioglycoside
Nursing Interventions
Observe for signs of toxicity
N/V, anorexia, dysrhythmias, bradycardia, tachycardia, HA, fatigue,
visual disturbance.
Blood levels checked
Monitor apical pulse and BP
Antihypertensives
Examples
Adrenergic blocking agents
Sympathetic blocking agents
Calcium channel blockers
Diuretics
ACE inhibitors
Antihypertensive

Purpose / Causes
Used to lower BP with minimal side effects
Inhibit SNS
Decrease sympathetic tone
Activate alpha receptors in medulla to decrease HR, BP, CO.
Antihypertensive
Adverse Effects
Decreased HR
Low BP
Nasal congestion
Reflex tachycardia
Dry mouth
Fluid retention
Depression
drowsiness
Antihypertensive
Nursing Interventions
Monitor HR, BP
Monitor Diet, Wt.
Monitor Electrolytes.
Angiotension Converting Enzyme Inhibitor / ACE Inhibitors
Examples
Enalapril (Vasotec)
Ramipril (Altace)
Captopril (Capoten)
Losartan (Cozaar)
ACE Inhibitors
Purpose / Causes
Tx HTN, CHF
Block conversion of angiotension I to angiotensin II
Reduce peripheral resistance
Reduce aldosterone secretion
Decreases preload and afterload
ACE Inhibitors
Adverse Effects
Headache
Dizziness
Hypotension
Angioedema*
COUGH
ACE Inhibitors
Nursing Interventions

Monitor HR,BP
Wt, diet
Monitor for swelling of the face
Diuretics (Water pill)
Examples
Hydrochlorothiazide (HCTZ)
Furosemide (Lasix)
Spironolactone (Aldactone)

Diuretics
Purpose / Causes
Remove excess sodium and water
Block reabsorption of sodium and water
Tx HTN, CHF
Diuretics
Adverse Effects
May remove excessive potassium
Nausea / vomiting
Diarrhea
Dizziness
Diuretics
Nursing Interventions
Monitor potassium levels
Monitor fluid intake
Monitor Wt.
Monitor urinary output
Cholesterol / Lipid lowering-STATINS
Examples
Simvastatin (Zocor)
Lipitor
Lovastatin (Mevacor)
Crestor
All of these are statins
Take on empty stomach

Cholesterol / Lipid lowering-Bile Acid Resins


Questran
Colestid
These are bile acid resins
Increased fluids and vitamins(D,E,K)
Cholesterol / Lipid lowering-Niacin
Niacin (Niacor, Niaspan, Slo-Niacin)

Flushing due to increased release histamine


Cholesterol / Lipid lowering-Fibric Acid Medications
Tx high triglycerides and high cholesterol
Ex-gemfibrozil (Lopid)

Cholesterol / Lipid lowering


Purpose / Causes
Reduce low density lipoprotein (LDL) and cholesterol content.
Cholesterol / Lipid lowering
Adverse Effects
Digestive discomfort
Bloating, N/V, constipation
Muscle cramps
Impotence
Flushing-Niacin
Wt. loss
Insomnia
Water retention
Cholesterol / Lipid lowering
Nursing Interventions
Restrict intake of fats, cholesterol, alcohol
STOP SMOKING
Exercise
Anti-platelets / Anti-coagulants
Examples
Aspirin (ASA)(PO)
Warfarin (Coumadin) (PO)
Heparin (IV or SQ)
Plavix (PO)
Ticlid (PO)
Fragmin (SQ)
Lovenox (SQ)
Arixtra(SQ)

Anti-platelets / Anti-coagulants
Purpose / Causes
Reduce risk of blood clot formation
Block coagulation process
Coumadin interferes with vitamin K synthisis of clotting factors
ASA prevents platelet adhesion
Anti-platelets / Anti-coagulants
Adverse Effects

Bleeding
Avoid Trauma
Gastric irritation
Anti-platelets / Anti-coagulants
Nursing Interventions
Monitor clotting ability
PT / APTT
Observe for bleeding
Monitor diet for foods high in vitamin K.
Rotate injection sites if SQ
Anti-dysrhythmics
Examples
Procainamide (Pronestyl, Procan SR)
Lidocaine
Disopyramide (Norpace CR)
Quinidine sulfate (Quinidex Extentabs)
Adenosine (Adonocard)
Antidysrythmics-Oral
Norpace
Procanbid
Quinidine
Tambocor
Cordarone
Anti-dysrhythmics
Purpose / Causes
IV for severe ventricular dysrhythmias
Suppress impulse triggering dysrhythmias.
Long term tx of V-tach, a-fib
Slows conduction thru AV
Anti-dysrhythmics
Adverse Effects
Dry mouth
Blurred vision
Low BP
Nausea/vomiting
Dizziness
Visual disturbances
HA
GI discomfort
dysrythmias
Anti-dysrhythmics

Nursing Interventions
Monitor HR (apical) and BP
No caffeine within 4-6 hrs of adenocard inhibits effects
Inotropics
Examples
Dobutamine (Dobutrex) (IV)
Dopaminie (Intropin) (IV)

Inotropics
Purpose / Causes
Increases myocardial contractility
Increases cardiac output
Increases BP
Improves renal blood flow
Used w/ severe CHF/ Pulmonary Edema
Inotropics
Adverse Effects
Elevated BP, HR
Decreased peripheral circulation
Inotropics
Nursing Interventions
Monitor BP, HR, Urinary output
Palpate peripheral pulses
Notify physician if extremities are cold/mottled.
Vasopressors
Examples
NTG (IV)
Nipride (IV)
Dopamine
Levophed
Vasopressors
Purpose / Causes
Increase BP, CO
Vasopressors
Adverse Effects
HA, elevated BP
N/ V
dizziness
Vasopressors
Nursing Interventions
Monitor Vital signs
Tranquilizers / Anti - anxiety

Examples
Diazepam (valium)
Ativan

Tranquilizers
Purpose / Causes
Decrease restlessness and anxiety
Tranquilizers
Adverse Effects
Sedation
Dizziness
Tranquilizers
Nursing Interventions
Use safety precautions
Thrombolytic Agents
Examples
Streptokinase (Streptase)
Alteplase
Recombinant Activase
Tissue plasminogen activator (TPA)

Thrombolytic Agents
Purpose / Causes
Dissolves blood clots when MI S/S less then 6 hr old.
Prefer within 30 -60 min.
Restores blood flow
Limits size of infarction
Thrombolytic Agents
Adverse Effects
Bleeding
Stroke
Thrombolytic Agents
Nursing Interventions
Monitor VS, telemetry
Monitor for signs of stroke
Stool Softeners
Examples
Surfak
Colace
Stool Softeners
Purpose / Causes
Reduce straining

Prevent constipation
Stool Softeners
Adverse Effects
diarrhea
Stool Softeners
Nursing Interventions
Monitor stools
Electrolytes
Examples
Potassium
Magnesium
Calcium

Electrolytes
Purpose / Causes
Restore electrolyte balance
Electrolytes
Adverse Effects
Electrolytes
Nursing Interventions
Monitor electrolyte levels
Analgesics
Examples
Morphine
Analgesics
Purpose / Causes
Control pain
Decrease myocardial oxygen demand
Analgesics
- Adverse effects
- Low BP
- N/V
- Sedation

Analgesics
Nursing Interventions
Acute MI
M-Morphine
O- Oxygen
A-Aspirin
N-Nitroglycerin
Peripheral Vascular Medications
Trental-decreases blood viscosity, improves flow

Papaverine-relaxes and dilates muscle in vessels


Pletal-vasodilator, decrease platelet aggregation
Questions
Early signs of dig toxicity are:
A sustained pulse rate >60
N/V
Diarrhea and rectal bleeding
Elevated respiration and BP
Early signs of dig toxicity are:
N/v
A pt in ICU goes into Cardiogenic shock. The primary effect that the nurse
would look for after a Levophed drip is initiated is:
Decreased hyperventilation
Decreasing polyuria
Increasing BP
Increasing orientation
Increasing BP
A 62yo pt has an acute angina attack. The nurse knows that the treatment
of choice will be
Calcium channel blockers
Beta blockers
Nitrates
Narcotic analgesics
Nitrates