12. Cardiovascular Agents

CARDIOVASCULAR AGENTSMrs. MICHELLE A. IDURIA, RN, MANLecturerANTIHYPERTENSIVESHYPERTENSIONIncrease in blood ressure S!stolic is "reater t#an $%&'' #"Diastolic is "reater t#an (& '' H"SI) CATEGORIES O* ANTIHYPERTENSIVE AGENTSDiureticsS!'at#ol!ticsDirect actin" arteriolar +asodilatorsACE in#ibitorAn"iotensin II recetor bloc,ersCalciu' c#annel bloc,ersDiuretics Pro'ote sodiu' deletionDecreases e-tracellular .luid +olu'e*irst line .or treatin" 'ild #!ertensionH!droc#lorot#ia/ide 0 H!droDIURIL12ost co''onused diuretic2a! be co'bined ot#er anti#!ertensi+e dru" to increase e..ecti+enessRe.er to 3o- %45$67( .or e-a'lesThiazide with K sparing diuretics Spironolactone ( Aldactone/Aldactazide)T#ia/ide 8it# ACE in#ibitorsCatoril 0 Caoten9Cao/ide1T#ia/ide 8it# An"iotensin II anta"onistLosartan 0 H!/aar1S#ouldnot be used i. #!ertension results .ro' renin5an"iotensin5aldosterone s!ste'Renal insu..icienc! 0 creatinine clearance less t#an 4& 'l 9'in1SY2PATHOLYTICS S!'at#ol!tics 3eta adrener"ic bloc,ersCentrall! actin" al#a : a"onistsAl#a adrener"ic bloc,ersAdrener"ic neuron bloc,ersAl#a $ and beta$ adrener"ic bloc,ers3eta adrener"ic bloc,ers9beta bloc,ersReduce cardiac outut b! di'inis#in" t#e SNS resonse to decrease basal s!'at#etic toneVascular resistance is di'inis#ed3lood ressure is lo8eredReduce #eart rate contractilit! and renin releaseNon selecti+e beta bloc,ersProranolol 0 Inderal1;#! is not re.erredERSAl#a Adrener"ic 3loc,ersE..ect on t#e recetorERSCalciu' Increases #eart 'uscle contractilit! = eri#eral resistance and blood ressureCalciu' c#annels*ound in t#e '!ocardiu' and +ascular s'oot# 'usclesCalciu' c#annel bloc,ers3loc,s calciu' c#annel in VS2Pro'otes +asodilationCalciu' C#annel 3loc,ersdru"s RouteUses Veraa'il 0 Calan1 PO Hn= an"ina ectorisDiltia/e' #cl 0 Cardi/e'1PO DA'lodiine 0 Nor+asc1PO 2ild to 'od #n*elodiine 0 Plendil1 PO Sta"e $ and sta"e :=t- o. an"inaNi.ediine 0Procardia1PO Hn= an"inaNicardiine0 Cardene1PO9IV Essential #nVeraa'il $&& '"Ni.ediine 6& '"A'lodiine $& '"Side e...ects and Ad+erse reactions*lus# Headac#eDi//inessAn,le ede'a3rad!cardiaCAV bloc,CLIENT HEALTH TEACHINGSInstruct client not to ta,e OTC dru"s;arn t#at rebound #!ertension 'a! occur i. dru" suc# as catoril is suddenl! discontinuedTeac# client #o8 to 'onitor blood ressure at #o'eIn.or' client to consult t#e #!sician i. conte'latin" on "ettin"re"nantANTI ANGINALS= ANTIDYSRHYT2ICS= CARDIAC GLYCOSIDESCardiac .ailure*or'erl! called Con"esti+e Heart *ailureHeart 'uscle 8ea,ens and loses its abilit! to u' blood 2a!be le.t or ri"#t sidedCardiac "l!cosides*ound in nu'ber o. lants 0 urle and 8#ite .o-"lo+e lant1Grou o. dru"s t#at in#ibits t#e sodiu'5otassiu' u'= resultin" in an increase intracellular sodiu'Leads to in.lu- o. calciu' causin" cardiac 'uscles to contract 'ore e..ecti+el!Cardiac "l!cosidesUsed to correct atrial .ibrillation 0 cardiac d!sr#!t'ia 8it# raid uncoordinated contractions o. '!ocardiu'Atrial .lutter 0 :&&54&& b'1Di"italisObtained .ro' urle and 8#ite .o-"lo+e lantE..ects o. di"italis rearation on t#e #eartPositi+e inotroic action5 increases '!ocardial contraction stro,e +olu'eNe"ati+e c#ronotroc action5decreases #eart rateNe"ati+e dro'otroic action5decreases conduction o. t#e cardiac cellsDi"o-in 0Lano-in1Dru"dosa"e CI Ad+erse R-nLano-inA? PO? &B75$ '" in : di+ided doses initiall!2aint? &B$:75&B7 '" dail!IV? sa'e "i+en o+er 7 'insElderl!? &B$:7 '" 9dail!Ventricular ds!r#!t'iasSecond or t#ird de"ree #eart bloc,3rad!cardiaVisual disturbancesAV bloc,Cardiac d!sr#!t'iasDi"o-in &B:7 '"Di"o-inHal. li.e is 46 #oursT#eraeutic seru' le+el&B7 to :B& n"9'lDi"italis to-icit!Anore-iaDiarr#eaNausea and +o'itin"3rad!cardiaP+cEsHeadac#e2alaise3lurred +isionCon.usionDeliriu' Di"italis to-icit!Di"o-in i''une *ab 0o+ine= Di"ibind1F6& '"= IV diluted in 7& 'l o. NSS in.use o+er 4& 'insDru" interactionUsed cautiousl! 8it# ts ta,in"?*urose'ideH!droc#lorot#ia/ideCortisoneNURSING RESPONSI3ILITIES9CLIENT HEALTH EDUCATIONObtain baseline ulseAssess .or to-icit!? anore-ia= nausea= +o'itin"= brad!cardia=cardiac d!sr#!t'ias= +isual disturbancesC#ec, seru' di"o-in le+elTa,e PR be.ore ta,in" t#e dru"C#ec, seru' otassiu' le+elIncrease inta,e o. .ood ric# in otassiu'ANTIANGINAL DRUGSAn"ina ectorisAcute cardiac ain caused b! inadeGuate blood .lo8 to t#e '!ocardiu'2a! lead to 2I or #eart attac,T!es o. an"ina Classic 0 stable15 occurs 8it# stressor e-ertionUnstable 0 re in.arction15 occurs .reGuentl! o+er t#e course o. t#e da! 8it# ro"ressi+e se+erit!Variant 0 Prin/'etal15 occurs durin" restDru"s to treat an"ina ectorisNitrates 3eta bloc,ersCalciu' c#annel bloc,ersGoal o. #ar'acot#era!Increase blood .lo8 b! increasin" o-!"en sul! or decreasin" o-!"en de'and b! '!ocardiu'Dru" "rou Variant an"ina Classic an"inaNitratesRela-ation o. coronar! arteries= decreases +asosas' and increases O: sul!Dilation o. +eins= 8#ic# decreases reload and decreases O: de'and3eta bloc,ers Not e..ecti+e Dec #eart rate and contractilit!= decreases O: de'andCa c#annel bloc,ersRela-ation o. coronar! arteriesDilation o. arteriolesNitratesCause "enerali/ed +ascular and coronar! +asodilationsReduces isc#e'ia but can cause #!otensionDru"Dosa"eCI Ad+erse R-nS#ort actin"?Nitro"l!cerin 0 Nitrostat= Nitro53id=Transder'5Nitro1Lon" Actin"?Isosorbide dinitrate 0Isordil= Sorbitrate1Isosorbide 'ononitrate 0 I'dur1A? SL?:B75$& '" GBiBdBC#e8able?75$& '" PRNPO?:B754& '" GBiBdB Ac and bedti'eSR? %& '" G 65$: #2ar,ed #!otensionA2IIncreased ICPane'iaH!otensiontac#!cardia Nitro"l!cerin&B% '" or "r $97&0SL1Oint'ent Transder'al atc#NURSING RESPONSI3ILITIESC#ec, +ital si"ns es blood ressureHa+e client sit or lie do8n 8#en ta,in" a nitrate .or t#e .irst ti'eRise slo8l! to a standin" ositionO..er sis o. 8ater be.ore "i+in" t#e dru"Al! Nitro 3id oint'ent to t#e desi"nated 'ar,= use ton"ue blade or "lo+esDo not al! t#e atc# in t#e +icinit! o. de.ibrillator Hcardio+erter addle lace'entNitro"l!cerin tabletGi+e Nitro SL .or c#est ainReeat in 7 'ins i. ain #as not subside and a"ain a.ter 7 'inutesDO NOT GIVE 2ORE THAN THREE TA3LETS2edication bottle 'ust be stored a8a! .ro' li"#t and ,et dr!Nitro"l!cerin :B7 '" casuleTransder' atc#Al! onl! once dail!Rotate s,in sitesA+oid #air! areaANTIDYSRHYTH2IC DRUGSCardiac d!sr#!t#'iaAn! de+iation .ro' t#e nor'al rate or attern o. t#e #eartbeatHeart rate is too slo8Or too .astCardiac d!sr#!t'ia*ollo8 an 2ICan result .ro'?H!o-iaH!ercaniaT#!roid diseaseCADCardiac sur"er!E-cess catec#ola'inesElectrol!te i'balanceT!es o. antid!sr#!t#'ic dru"sSodiu' c#annel bloc,ers 0 Class $13eta bloc,ers 0 Class II1Dru"s t#at rolon" reolari/ation 0 Class III1Calciu' c#annel bloc,ers0 Class IV1P#ar'acod!na'ics o. antid!sr#!t#'ics3loc,s adrener"ic sti'ulation o. t#e #eartDeresses '!ocardial contractilit! and e-citabilit!Decreases conduction +elocit! in cardiac tissueIncreases reco+er! ti'eSuresses auto'aticit!Antid!sr#!t#'ics Dru"sClass $ Route Proacaina'ide 0Pronest!l1 C$APO=I2=IVLidocaine 0)!locaine1 C$3IV*lecainide 0 Ta'bocor1 C$CPOProa.enone HCL 0 R!t#'ol1POAntid!sr#!t'icsDru"sClass II 3eta adrener"icRoute Acebutolol HCL 0 Sectral1POProranolol HCL 0 Inderal1PO= IVAntid!sr#!t#'icsClass III5dru"s t#at rolon" reolari/ationRouteA'iodaroneHCL0 Cordarone1POAdenosine 0 Adenocard1IVIbutilide 0 Cor+ert1 IVAntid!sr#!t#'icsClass IV HCalciu' C#annel 3loc,ersRoutes Vera'il 0 Calan 1 PO= IVDiltia/e' 0 Cardi/e'1IVOt#ers Dru"sRoutes P#en!toin 0 dilantin1 IVDi"o-in 0 Lano-in1IVNURSING RESPONSI3ILITIES9HEALTH EDUCATIONObtain baseline VS and ECGC#ec, cardiac en/!'es I. dru" is "i+en IV us# or bolus= ad'inister o+er :54 'ins or as rescribedPro+ide seci.ic instructionsDi//iness= .aintness= nausea and +o'itin" are co''on side e..ectsANTICOAGULANTS= ANTIPLATELETS I THRO23OLYTICST#ro'bosis*or'ation o. a clot in an arterial or +enous +esselAnticoa"ulantUsed to in#ibit clot .or'ationUsed .or client 8it# #i"# ris, .or clot .or'ationHearin 0SJ= IV1 Indicated .or DVTPul'onar! e'bolis'E+ol+in" stro,eOen #eart sur"er!To 'onitor #earin t#era! 'onitorPartial t#ro'bolastin ti'e 0PTT1Acti+atedartial t#ro'bolastin ti'e 0aPTT1Prota'ine Sul.ateAntidote .or #earin;ar.arin 0 Cou'adin1Onl! oral anticoa"ulant rescribed toda!In#ibit #eatic s!nt#esis o. Vita'in > a..ectin" clottin" .actors II= VII= I) and );ar.arinHas a lon" #al. li.e and lon" durationProt#ro'bin Ti'e2easures t#e ti'e it ta,es blood to clot in t#e resence o. certain clottin" .catorsInternational Nor'ali/ed Ratio 0INR1Lab test use to reort PT resultNor'al is $B4 to :2aintained at : to 4AntidoteVita'in > 0#!tonadione1 $5$& '"Ta,es :%5%@ #rs to be e..ecti+eSide e..ects and ad+erse reactions3leedin" Petec#iaeEcc#!'osesHe'ate'esis ANTIPLATELETAntilatelet dru"sPre+ents t#ro'bosis in t#e arteries b! suressin" latelet a""re"ationE-a'les o. antilateletAsirin Cloidro"el 0 Pla+i-1D!irida'ole 0 Persantin1Ticloidine 0 Ticlid1THRO23OLYTICST#ro'bol!tics Pro'otes .ibrinol!tic 'ec#anis'Con+erts las'ino"en to las'in5555destro!s .ibrin in blood clotE-a'les Streto,inaseUro,inaseAltelaseRetelase 0 Reta+ase 1Tenectelase