Cardiac Drugs

High Ceiling Loop Diuretics

Mechanism of action Therapeutic uses Side Effects/ precautions Interactions Nursing/ Patient teaching Common drugs block reabsorption of sodium and chloride, prevent reabsorption of water hypertension, need for rapid dieresis is needed such as pulmonary edema, heart failure dehydration, hyponatremia, hyponatremmia, hypochloremia, hypokalemia (note: loop diuretics do not spare potassium), hypoglycemia Digoxin toxicity if hyokalemic, additive hypotensive effects with other HTN drugs, monitor I&O, IV bolus should be 20 mg/min or slower, patients most likely will be on potassium supplement, teach client to report weight loss, dizziness, weakness, and signs for low magnesium levels (twitching) furosemide (Lasix), bumetanide (Bumex)

Thiazide Diuretics
Mechanism of action Therapeutic uses Side Effects/ precautions Interactions Nursing/ Patient teaching Common drugs Block reabsorption of sodium and chloride, prevent reabsorption of water. (but in a different site than loop diuretics) often first choice medication for HTN, edema and mild heart failure, liver and kidney disease same as loop diuretics, these are also not potassium sparing Same as loop diuretics same as loop diuretics hydrochlorothiazide (Hydrodiuril) most commonly referred to as HCTZ, chlorothiazide (Diuril) Note: a lot of these end in azide

Potassium Sparing Diuretics

Mechanism of action Therapeutic uses Side Effects/ precautions Interactions Nursing/ Patient teaching Common drugs block the action of aldosterone (sodium and water retention), which results in potassium retention but secretion of sodium and water Often combined with other diuretics for its potassium sparing effects, heart failure, hyperaldosteronism hyperkalemia (note this is hyper not hypo), endocrine effects (impotence, menstrual cycle) use with ACE inhibitors increases risk of hyperkalemia monitor potassium levels, teach client to self monitor BP spironolactone (Aldactone)

Osmotic Diuretics
Mechanism of action Therapeutic uses reduce intracranial pressure and intraocular pressure by raising serum osmolality, and drawing fluid back into vascular and extravascular space prevent renal failure in causes of hypovolemic shock and hypotension, decrease intracranial and intraocular pressure, promote sodium retention and water excretion caution with patients with heart failure furosemide contributes to overall effect by promoting excretion of the fluid that is drawn into the vascular space daily I&O and serum electrolytes, signs for dehydration mannitol (Osmitrol)

Side Effects/ precautions Interactions Nursing/ Patient teaching Common drugs

Angiotensin-Converting Enzyme (ACE) Inhibitors

Mechanism of action Therapeutic uses Side Effects/ precautions Interactions Nursing/ Patient teaching Common drugs blocks production of angiotension II which leads to vasodilation, excretion of sodium and water, retention of potassium Hypertension, heart failure, Myocardial infarction, Diabetic/ non-diabetic nephropathy, patients at high risk for CAD or MI orthostatic hypotension, cough, hyperkalemia, rash, edema of tongue pharynx, neutropenia (low WBC) additive hypotensive effects, increase levels of lithium, NSAIDS decrease effectiveness almost all are PO, monitor BP, captopril 1 hour before meals, all others does not matter with or without food, must notify if cough develops captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil) Note: most end in pril

Angiotensin II Receptor Blockers (ARBs)

Mechanism of action Therapeutic uses Side Effects/ precautions Interactions Nursing/ Patient teaching Common drugs block action of angiotensin II in body, results in vasodilation, excretion of sodium and water, retention of potassium hypertension, heart failure, stroke prevention, delay progression of diabetic nephropathy Angioedema, fetal injury. Biggest difference between ACE and ARBs is that cough and hyperkalemia are NOT major side effects of ARBs. additive hypotensive effects with other antihypertensives with or without food losartan (Cozaar), valsartan (Diovan), irbesartan (Avapro), olmesartan (Benicar)

Calcium Channel Blocker

Mechanism of action Therapeutic uses Side Effects/ precautions Interactions Nursing/ Patient teaching Common drugs blocks calcium channels in blood vessels, leads to vasodilation, decreased force of contraction in myocardium Angina, Hypertension, cardiac dysrhythmias, tachycardia, edema, orthostatic hypotension, constipation, suppression of cardiac function, no grapefruit juice with nifedipine, verapamil, and diltiazem do not chew sustained release tabs, IV bolus over 2 - 3 minutes nifedeipine (Procardia), diltiazem (Cardizem), amlodipine (Norvasc) Note: most end in pine

Alpha Adrenergic Blockers (sympatholytics)

Mechanism of action Therapeutic uses Side Effects/ precautions Interactions Nursing/ Patient teaching Common drugs alpha blockade results in venous and arterial dilation, smooth muscle relaxant primary hypertension, some used for BPH orthostatic hypotension additive hypotensive effects, NSAIDS decrease effects taken with food, take initial dose at bedtime to reduce the first dose hypotensive effect prazosin (Minipress), mesylate (Cardura)

Centrally acting Alpha agonists

Mechanism of action Therapeutic uses Side Effects/ precautions Interactions Nursing/ Patient teaching Common drugs act withing CNS to decrease sympathetic outflow, results in decreased stimulatino of adrenergic receptors, decreased cardiac output, vasodilation, decrease BP primary hypertension, possible for migraines, flushing from menopause, ADHD drowsiness, sedation, dry mouth, rebound hypertension additive hypotensive effect, MAOIs couteract antihypertensive effects of clonidine, additive depressant effects with other CNS depressants larger dose at bedtime to decrease the occurrence of daytime sleepiness clonidine (Catapres)

Beta adrenergic Blockers (sympatholytics), aka Beta Blockers

Mechanism of action Therapeutic uses Side Effects/ precautions Interactions Nursing/ Patient teaching Common drugs blockade results in decreased HR, decreased myocardial contractility, decreased rate of conduction through AV node primary hypertension, angina, tachydysrhythmias, heart failure, MIs Bradycardia, decreased cardiac ouput, AV block, orthostatic hypotension, rebound myocardium excitation, bronchoconstriction calcium channel blockers intensify effects of beta blockers, additive hypotensive effects patients not to discontinue medication without consulting provider, monitor HR, BP before giving med metoprolol (Lopressor), atenolol, metoprolol, note: most end in lol

All of the above generally used for hypertension, some for angina and heart failure Cardiac Glycosides
Mechanism of action Therapeutic uses Side Effects/ precautions Interactions Nursing/ Patient teaching Common drugs positive inotropic effect: increased force of myocardial contraction (improving cardiac ouput), negative chronotropic effect: decreased heart rate (giving ventricles more time to fill with blood) heart failure, dysrhythmias dysrhythmias, cardiotoxicity:such as weakness, fatigue, anorexia (levels should be 0.8 to 2.0 ng/ml), GI upset, CNS effects (weakness) with diuretics may lead to hypokalemia, ace inhibitors may lead to decreased effects of glycoside, quinidine increases toxicity monitor digoxin levels closely, avoid OTC medications, observe for symptoms of hypokalemia digoxin

Adrenergic Agonists
Variety of drugs that includes: Epinephrine: increases BP, treatment of AV block during cardiac arrest, bronchodilator, vasocontrictor Dopamine: treatment for shock and heart failure, renal blood vessel dilator, vasoconsrtictor Dobutamine: treatment for heart failure, increases heart rete, myocardial contractility

Cardiac Glycosides/ Adrenergic Agonists above generally used for heart failure Nitrates
Mechanism of action Therapeutic uses Side Effects/ precautions Interactions dilation of veins, decreases venous return (preload) which decreases oxygen demand acute angina attack, or prophylaxis for chronic angina h/a, orthostatic hypotension, tolerance additive hypotensive effect with alcohol, and other antihypertensives, contraindication with Viagra

Nursing/ Patient teaching Common drugs

sublingual tablets for rapid onset, sustained release tabs for long onset, during angina attack instruct patient to stop activity, patient can take up to three doses in five minute intervals Nitrostat, Isordil, isosorbide (Imdur)

Antidysrhythmic Medications
variety of drugs are used, most of them already discussed above, book goes into great deal of detail Sodium channel blockers: Lidocaine (Xylocaine) Beta blcokers: propanolol (discussed above) Potassium channel blockers: amiodarone (Cordarone) Calcium channel Blockers: verapamil (Calan) (discussed above)

Fibrates
Mechanism of action Therapeutic uses Side Effects/ precautions Interactions Nursing/ Patient teaching Common drugs decrease triglyceride levels, increase HDL levels reduction of triglycerides, increase HDL GI upset, myopathy (muscle pain), hepatotoxicity concurrent use with coumadin increased risk for bleeding, bile acid sequestrants interfere with absorption take meds 30 min prior to breakfast and dinner gemfibrozil (Lopid), fenofibrate (TriCor)

HMG COA reductase Inhibitors (Statins)

Mechanism of action Therapeutic uses Side Effects/ precautions Interactions Nursing/ Patient teaching Common drugs decrease manufacture of LDLs, increase HDL, promotion of vasodilation, decrase in plaque site formation, decreased risk for thromboembolism hypercholesterolemia, prevention of coronary events hepatotoxicity, myopathy, peripheral neuropathy with fibrates increased risk of myopathy, grapefruit juice suppresses effects of Statins obtain baseline liver, renal test, monitor HDL, LDL, tri levels simvastatin (Zocor), pravastatin (Pravachol), note: all end in statin

Cholesterol Absorption Inhibitor

Mechanism of action Therapeutic uses Side Effects/ precautions inhibits absorption of cholesterol help lower LDL levels with modified diets, used alone or with statins hepatitis, myopathy

Interactions Nursing/ Patient teaching Common drugs

bile acid sequestrants interfere with absorption instruct client to report muscle aches and pain, discontinue if CK levels are elevated Zetia. This is the only one according to ATI

Bile -Acid Sequestrants

Mechanism of action Therapeutic uses Side Effects/ precautions Interactions Nursing/ Patient teaching Common drugs decrease in LDL used as adjunct with a Statin to lower cholesterol levels decrease absorption of some medications and fat soluble vitamins interfere with digoxin, warfarin, thiazides, tetracyclines patients should drink adequate amounts of fluid while taking sequestrants colesevelam (WelChol), cholestyramine (Questran)

Misc LDL and triglyceride lowering drugs:

Nicotinic acid Niacin (Niacor), also raises HDLs

Anticoagulants/ Parenteral: inactivation of thrombin formation, inhibition of fibrin

heparin enoxaparin (Lovenox)

Anticoagulants/ Oral: antagonize vitamin K, prevents synthesis of coagulation factors, vitamin K is

used for warfarin overdose warfarin (Coumadin)

Antiplatelets: prevents platelets from sticking together Aspirin clopidogrel (Plavix) Thrombolytic Medications: dissolve clots that have already been formed, by conversion of
plasminogen to plasmin which destroys fibrinogen and other clotting factors, treatment for acute MI, PE, DVT, stroke streptokinase (Streptase) alteplase (tPA)