Cardiovascular drugs

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Cardiovascular drugs

• Barbara S. Hays
• Winter, 2006

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Cardiac Glycosides(AKA Digitalis
Glycosides_(Easy p 182 186)

• Digoxin/Lanoxin
• Slows and strengthens heart contractions
• positive inotropic action increase force of
  contractions p 183)
• b) depress SA node (allows for better blood
  flow to myocardium)
• c) Urine output a good indicator of cardiac
  output and tissue perfusion

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Cardiac Glycosides

• Conduction system of the heart

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Digoxin/Lanoxin(Prototype Pro p 182)

• Digitalization
• loading dose, then maintenance
• Frequent PB, pulse checks

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Digoxin/Lanoxin

• Adverse reaction narrow margin of safety
• Therapeutic serum levels 0.5 2 nanograms
• Toxic level gt2.5 nanograms
• Digitalis toxicity symptoms
• GI n/v/d loss of appetite early symptom
• CNS headache, visual disturbances
• Cardiac slow pulse (lt60) also watch gt128

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Digoxin/Lanoxin

• Beware of HYPOKALEMIA (often from Lasix therapy)
  causes increased risk of digitalis toxicity

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Digoxin/Lanoxin

• Nursing considerations
• Administration
• Take apical pulse for full minute (lt60, gt128?)
• IV dilute and give very slowly
• IM rotate sites
• Assessment
• BP, pulse
• s/s heart failure
• Left lungs SOB, cyanosis, dyspnea at rest
• Right edema, weight gain
• Watch for toxicity if taking Lasix (hypokalemia)

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Vasodilation

• Circulation of the heart

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Calcium Channel Blockers

• Vasodilation
• Supraventricular arrhythmias

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Calcium Channel Blockers(Easy p 219 223)

• Examples
• Calan (Verapamil)
• Cardizem (diltiazem)

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Organic nitrates(Easy p 212 215)

• Vasodilation

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Organic Nitrates

• Nitroglycerin increase blood flow to heart
• Vasodilation
• Relieves vasospasms in blood vessels
• reduces myocardial oxygen consumpton
• Decreases peripheral resistance afterload

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Organic Nitrates

• Teaching point
• Sublingual
• 1 every 5 minutes X3, then call physician
• Under tongue/buccal pouch. Do not swallow
• Keep away from heat/light
• Renew supply every 3 6 months (stinging OK)
• Take prior to activity that brings on pain
• Note how long it takes to obtain relief
• Transdermal
• Nurse wear gloves when applying
• Client may need nitro holidays

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Organic Nitrates

• Other routes for nitrates
• Chewable, IV, inhaled
• Side effects of nitrates
• Flushing
• Headaches (Tylenol works for this)
• Hypotension/rebound tachycardia

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Antilipemics

• Coronary artery disease
• Arteriosclerosis tissue of blood vessel wall is
  more brittle, thickening, loss of elasticity,
  calcification
• Atherosclerosis abnormal accumulation of lipids
  and fibrous tissue in vessel wall leads to
  changes in arterial structure/function and
  decreased blood to the heart

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Coronary Artery Disease (CAD)

• Waxy atheroma builds up, interferes with
  nutrients to vessel wall itself tissue becomes
  necrotic, scarred, rough clots
• Obstruction of blood flow
• Fibrous cap ruptures
• Ischemia (angina) perhaps heart attack
• EKG changes, dysrhythmias
• Heart angina, MI
• brain TIA, stroke

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Antilipemics

• Plaque buildup

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Lipid lowering medications(Easy p 254)

• Bile-sequestering drugs
• HMB-CoA reductase inhibitors

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Cholesterol lowering meds(antilipemics)

• Questran (cholestryamine)
• Resin that binds with bile acids in intestine.
  Binds to/helps excrete cholesterol (implications
  for fat soluble vitamins)
• Colestid (colestipol)
• Newer resin, similar to Questran (lowers LDLs)

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Antilipemics(Easy p 254 267)

• Statin familiy HMG-CoA reductase inhibitors.
  Inhibit synthesis of cholesterol in liver
• Slightly increase HDL and lowers LDL
• Effective within weeks
• Caution liver disease

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Statin family (Easy p 212)

• Lipitor (atorvastatin)
• Lescol (flulvastatin)
• Mevacor (lovastatin)
• Pracachol (pravastatin)
• ZoCor (simvastatin)
• Its your future. Be there
• (alas, dont confuse the trade name statins, like
  Mycostatin for fungal infections)

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Platelet aggregation inhibitors

• ASA
• Plavix
• Persantine
• Ginkgo Biloba

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