COMMON USED CARDIAC MEDICATIONS

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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, dont 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

• 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

• 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
• Prinzmetals 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 hearts 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 lt 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 bodys 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 Prinzmetals angina?
• How is it different from typical angina?

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• Prinzmetals 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
  Prinzmetals angina are brief but painful and
  occur most often at night

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• The cause of Prinzmetals 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 Prinzmetals angina is directed at
  the underlying cause, such as atherosclerosis.

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QEUSTIONS??????