Cardiac Drugs

Kynthia James, MSN,RN,CNL

Cardiac Glycosides/Digoxin

Cardiac Glycoside
Client Teaching Action UseSide EffectsCommonly Used Drugs- Di-gox-in, La-noxi-caps Contraindications-heart block Nursing Implications Antidote- digibind

Nitrites/Nitroglycerin

Nitrite Drugs
Patient Teaching
Instruct patient to change position slowly Protect medication from light Replace tablets 6 months after opening Void alcohol, hot baths- causes vasodilation If tablet does not tingle under tongue, it is not effective Severe headache common side effect of drug If more than 3 tablets required to relieve chest pain; call 911
New EBP suggest that you call 911 after one tablet

Action-relax smooth muscle Use- to treat angina Side Effects

Postural hypotension Headache dizziness

Nitrite Drugs (cont)

Interactions
When used with viagra, levitra, cialis, alcohol, beta blockers increased hypotensive effect

Commonly used drugs

I-sor-bide mono-nitrate Nitro-glycerin I-sor-bide di-ni-trite

Contraindications-allergy, hypotension Nursing implications

Monitor pulse and B/P IV nitroglycerine administered in glass bottle with special tubing Wear gloves when applying ointment To not cut or trim transdermal patch Keep medication out of direct sunlight

Beta Blockers

Beta-Blockers (olol drugs)

Client teaching Action-block cardiac andrenergic receptors to decrease heart rate, blood pressure, contractility Use Commonly Used Drugs- (a-ten-olol), (me-to-pro-lol), (pro-pan-olol) Side Effects Contraindications Nursing implications

Calcium Channel Blockers

Calcium Channel Blockers

Client teaching-teach patient to take pulse, rise slowly Action-decrease afterload and oxygen demand by dilating arterioles Use-angina, HTN Commonly Used Drugs- dil-tia-zem, ni-fed-i-pine, Ve-rap-a-mil Side Effects--bradycardia, palpitations, peripheral edema Contraindications-heart block Nursing implications-monitor B/P and pulse, assess for chest pain

Duiretics

Client teaching for all diuretics

Consult physician before taking OTC or herbal meds Each high potassium foods except with potassium sparing diuretics Change position slowly Monitor weight Monitor for hypokalemia Consume adequate fluids Wear sunscreen

Loop Diuretics

Loop diuretics
Commonly used drugs-fu-ros-o-mide, bu-met-a-nide Action-acts on ascending limb of loop of Henle, inhibit reabsorption of sodium and chloride Use-CHF, HTN, Side Effects-hypotension, headache, dizziness, tinnitus, hearing loss Contraindications-allergy to thiazides and sulfa, anuria Nursing implications-assess for sulfa allergies, assess for tinnitis and hearing loss

Potassium sparing Diuretics

Potassium-sparing diuretics
Commonly used drugs-Al-dac-tone Action-blocks aldosterone receptors and work In the collecting ducts and distal convoluted tubules and interfere with sodium potassium exchange, it excretes sodium and retains potassium Use-edema, HTN Side Effects-headache, dizziness, nausea, vomiting Contraindications-hyperkalemia Nursing implications-avoid salt substitutes (contain potassium)

Osmotic Diuretics

Osmotic diuretics
Commonly used drugs-Man-ni-tol Action-works on proximal tubule to increase osmotic pressure of glomerular filtrate which inhibits absorption of water and electrolytes; decreases intraocular pressure. Use-acute renal failure, edema, increased intracranial pressure Side Effects-headache, confusion, tachycardia Interactions-given with digoxin, increases the toxicity Contraindications-dehydration, anuria

Thiazide Diuretics

Thiazide diuretics
Commonly used drugs-chlor-thia-zide, hy-drochlor-o-thi-zide Use-CHF, renal dysfunction, cirrhosis, HTN, diabetes insipidus Side Effects-dizziness, drowsiness Nursing implications-give with food to minimize GI upset

Anti-hypertensive Medications

Client teaching for all antihypertensive drugs

Decrease salt intake Exercise Relieve stress Do not abruptly stop taking meds Consult physician before taking OTC or herbal meds Avoid alcohol Avoid sauna, hot baths Monitor B/P Avoid straining during bowel movements May cause impotence

Beta-Andrenergic Blockers
Action-blocks beta receptors causing decrease in heart rate, cardiac output and renin release from kidneys Use-HTN, CHF Commonly used drugs- a-ten-o-lol, me-topr-olol, pro-pan-olol Side Effects-bradycardia, exacerbates asthma Contraindications-allergy, asthma, heart block Nursing implications-monitor B/P, monitor electrolytes, do not abruptly stop taking medication

Selective Alpha Andrenergic Blockers

Action-block stimulation of sympathetic nervous system and causes vasodilation and reduce B/P Use-HTN Commonly Used Drugs- doxa-zo-sin, pra-zo-sin, tera-zosin Side Effects-hypotension, palpitation, dizziness, headache, impotence Contraindications-allergies Interactions-alcohol, nitrates

Central Alpha Agonists

Use-HTN, usually not prescribed first line tx due to side effects Side Effects-hypotension, bradycradia, palpitations, dizziness Commonly used drugs- clon-i-dine, methyl-dopa Contraindications-allergy Interactions-causes CNS depression when used with narcotics, alcohol, sedatives Nursing Implications- transdermal patch applied for 7 days.

ACE inhibitors
Use-HTN Commonly Used Drugs-,e-nal-a-pril, li-sin-opril, quin-april , ram-i-pril, Cap-to-pril Side Effects-first dose hypotension, dizziness, agranulocytosis Contraindications-pregnancy Interactions-causes hypotension when used with duiretics, nitrates Nursing implications-monitor CBC, assess for cough (will go away when meds discontinued), monitor for angioedema

Vasodilators

Commonly Used Drugshy-dra-lazine Use-HTN Side Effects-orthostatic hypotension, dizziness, headache Interactions- will cause severe hypotension when used with alcohol, nitrates. Nursing implications-monitor B/P, assist patient to rise slowly

Angiotensin II receptor Antagonist

Commonly Used Drugs- val-sar-tan, ir-be-sartan, can-de-sar-tan Use-HTN, CHF Side Effects-fatigue, dizziness,headache Interactions-NSAIDS decrease effects, used with diuretics cause hypotension.

Anticoagulants
Purpose
To inhibit clot formation They do not dissolve clots Use for people at high risk for clot formation
What types of people are at risk?

Heparin
Origin Action Use Route Side Effects/Adverse Effects Contraindications Patient Teaching Nursing Considerations

Case Study
70-year-old retired bus driver who has just been admitted to your medical floor with right leg DVT. L.J. has a 48-pack-year smoking history, although he states he quit 2 years ago. He has had pneumonia several times and frequent episodes of atrial fibrillation (A-fib). He has also had a past history of DVT.

More Case Study Data

Has SOB on exertion and noticed swelling of his right lower leg that became progressively worse until it also involved his thigh to the groin. His wife brought him to the hospital when he C/O increasingly severe pain in his leg. Doppler study indicated a probable thrombus of the external iliac vein extending distally to the lower leg, he was admitted for bed rest and to initiate heparin therapy. Significant admission lab values are PT 12.4 sec,INR 1.11, PTT 25 sec, Hgb 13.3 g/dl, Hct 38.9%, cholesterol 206 mg/dl.

Questions to answer
What problems in his history puts him at risk for DVT? According to his history which medication should he have been taking? Heparin 75 units/kg was ordered as loading dose, patient weighs 156 pounds. How many units will you administer?

 What pertinent laboratory values/test results would you expect the physician to order and you to monitor?

What instructions will you give L.J. about his activity?

Low Molecular Weight Heparin

Commonly used brands
Ex-on-a-prin Dal-te-par-in

Action Uses Route Side Effects/adverse Effects Nursing consideration

Oral anticoagulants-War-a-fin sodium

Action Uses Side Effects/Adverse Effects Contraindications Patient Teaching Nursing Consideration
PT-prothrombin time INR-international normalized ratio

Antiplatelet Drugs
Action- suppresses platelet aggregation and prevents clots Uses-prevention of MI, CVA Commonly Used Drugs
Aspirin Plavix

Statins/Vastatins
Function List of statins
Flu-va-sta-tin Lova-sta-tin Pra-va-sta-tin sodium Sim-va-sta-tin

Statins/Vastatins (contd)
Combination of anticholesterol drugs Side and adverse effects: liver impairment, rhabdomyolysis (skeletal muscle disorder) Nursing interventions: monitor liver enzymes, report unexplained muscle tenderness or weakness, fever, and malaise

NCLEX Review Questions

What should the nurse include in a teaching plan aimed at reducing the side effects associated with taking calcium channel blockers such as diltiazem (Cardizem)?
A. B. C. D. Lie down after meals Change positions slowly Avoid Dairy products in diet Take drug with an antacid

 The nurse should teach a client to suspect sublingual tablets have lost their potency when:
A. Sublingual tingling is experienced B. The tablets are more than 3 mos. old C. Pain is unrelieved but facial flushing is increased D. Onset of relief is delayed, but the duration of relief is unchanged

 The client is diagnosed with angina is prescribed nitroglycerin (Nitrobid) and tell the nurse, I dont understand why I cant take my viagra. I need to take it so that I can make love to my wife.
A. If you take the medications together, you may have a very low blood pressure B. You are worried your will will be concerned if you cannot make love. C. If you wait at least 8 hrs after taking the NTG, you can take your Viagra. D. You should get clarification with your HCP about your taking Viagra.

 The nurse in the HCPs office is completing an assessment on a client who has been prescribed the cardiac glycoside digoxin (Lanoxin) for congestive heart failure (CHF). Which data indicates the medication has been effective?
A. B. C. D. The clients sputum is pink and frothy The client has 2+ pitting edema of the sacrum The client has clear breaths sounds bilaterally The client heart rate is 78 beats per minute

NCLEX Review Questions

The nurse must observe for signs of hyperkalemia when administering:
A. B. C. D. Furosemide (lasix) Metolazone (Zaroxolyn) Spironolactone (Aldactone) Hydrochlorthiazide (HydroDiuril)

 A client is taking spironolactone (Aldactone) for hypertension reports to the ambulatory clinical with bilateral edema in the lower legs. After receiving the laboratory test results, the nurse instructs the LPN to withhold the additional dose that was just ordered because of which value?
A. B. C. D. Blood glucose 160 mg/ml Sodium 142 mEq/L BUN 18mg/dL Serium potassium 6.0 nEq/L

NCLEX Review Questions

The nurse should question an order for metoprolol (Lopressor) when it is prescribed for a client with:
A. B. C. D. Hypertension Angina Pectoris Sinus Bradycardia Myocardial Infarction

 Which medication would the nurse question administering?

A. Lisinopril (Zesteril), an ace inhibitor, to a client with a BP of 118/84. B. Carvedilol (Coreg), a beta blocker, to a client with an apical pulse of 62. C. Verapamil (Calan), a calcium channel blocker, to a cleint with angina. D. Furosemide (Lasix), a loop duretic, to a cleint complaining of leg cramps.

 The client is diagnosed with high blood pressure is ordered the ACE inhibitor captopril (Capoten). Which statement by the client indicates to the nurse that the discharge has been effective?
A. I should get up slowing when getting out of bed. I should check my blood pressure once a week If I get leg cramps, I should increase my potassium supplements If I forget to take my medications, I should take two doses the next day.

Practice Question #1
ALs serum lipids were as follows: cholesterol 197 mg/dl, low-density lipoprotein (LDL) 110 mg/dl, and high-density lipoprotein (HDL) 35 mg/dl. ALs cholesterol, LDL, and HDL are which of the following? A. Serum lipids are within desirable values. B. Cholesterol is within desirable value, but LDL and HDL are not. C. Cholesterol is not within desirable value, though LDL and HDL are. D. Cholesterol, LDL, and HDL are not within desirable values.

Practice Question #1 (contd)

Answer: B

Practice Question #2
AL was prescribed atorvastatin (Lipitor) 10 mg to prevent coronary artery disease (CAD). The drug classification of atorvastatin is a: A. fibrate. B. bile-acid sequestrant. C. combination of anticholesterol drugs.
D.

statin.

Practice Question #2 (contd)

Answer: D

Practice Question #3
A serious adverse reaction of Lipitor is:
A. B. C. D. pharyngitis. rash/pruritus. rhabdomyolysis. agranulocytosis.

Practice Question #3 (contd)

Answer: C

Practice Question #1
Which of the following is true regarding a second-generation antihistamine?
A. B. C. D. Leads to frequent urination May cause hypotension Cause little or no drowsiness Is used as a nasal decongestant

Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

Practice Question #1 (contd)

Answer: C. Rationale: Second-generation antihistamines cause little or no drowsiness.

Practice Question #1
When ipratropium, a bronchodilator, and a glucocorticoid inhaler are ordered together, the: (Select all that apply.)
A. bronchodilator is given 5 minutes before a glucorticoid. B. combination is more effective than when given alone. C. glucocorticoid is administered 10 minutes before the bronchodilator. D. glucocorticoid should be administered immediately after the bronchodilator.

Practice Question #1 (contd)

Answer: A, B. Rationale: When a bronchodilator and a glucocorticoid inhaler are given together, the bronchodilator is given first. The nurse should wait for 5 minutes before administering the glucocorticoid. This drug combination is more effective than when given alone.