MODULE VI: Cardiac Medications
MODULE VI: Cardiac Medications
MODULE VI: Cardiac Medications
4. Pumping action of the heart Note: Check apical pulse, heart rate Nursing Action: take on empty
(Part 1) 5. Elasticity of the vessel wall should be more than 60 before stomach. Monitor proteinuria.
administering a drug. Right sided heart failure
Heart- muscular organ Normal Ejection Fraction- 50-70% is Drug Interactions: +K-wasting Diuretics, ARBs (Angiotensin II Receptor Blockers)
Preload- volume of blood in ventricles at pumped out during each contraction amiodarone, Ca, propafenone, Blocks angiotensin II from its
the end of diastole. Note: Less than 50% pumped blood per omeprazole, cyclosporine, macrolides. receptors, preventing
Increased in: Hypervolemia, contraction causes left sided heart Side Effects/Adverse Effects: vasoconstriction and
Regulation of cardiac valve, Heart failure failure. bradycardia, N/V, diarrhoea aldosterone-secreting effect of
Afterload- resistance left ventricle must Nursing Action: check apical pulse, serum angiotensin, thus, lowering BP.
overcome to circulate blood. Heart Failure- inability of the heart to drug levels, electrolytes. Left sided heart failure
Increased in: Hypertension, pump enough blood to meet the body’s Ends with TAN.
Vasoconstriction needs. This is due to any structural or 2. Beta Blockers Side Effects; headache, fatigue
Increase afterload= increase cardiac functional impairment of ventricular Blocks beta 1 receptors on the Nursing Action: monitor BP and
workload filing. heart which decreases maintain fluid intake.
Left Sided Heart Failure- myocardial contractility (HR, Nitrates/Nitrites
Regulators of Blood Pressure afterload. BP) the results in decrease Vasodilator, decreases preload
1. Renin-Angiotensin Aldosterone Right Sided Heart Failure- myocardial oxygen demand. and afterload, decrease
System preload Ends with OLOL myocardial O2 consumption.
activated when circulating Side Effects: bradycardia, decrease BP, Ex: isosorbide mononitrate,
blood volume is low. 4 Stages of Chronic Heart Failure N/V, bronchospasm, AV block isosorbide dinitrate,
Increased BP by increasing Na 1. Breathlessness or tiredness Note: Do not give beta blockers to left nitrogylcerin.
reabsorption (increased water 2. Heart races or breathlessness when sided heart failure patients. Side Effects: headaches,
reabsorption) walking or taking the stairs. Drug Interaction- +digoxin, CCB, dizziness, orthostatic
2. Baroreceptors in the aorta and carotid 3. Palpitation or tiredness with simple cimetidine= increase effect and toxicity. hypotension.
sinus tasks like getting up from the sofa and +antacid, Ca salts, NSAIDS= decrease Nursing Action: teach client on
Detects changes in BP. walking over to the kitchen. effect. proper use of sublingual
Sends signals to vasomotor 4. Heart and breath go faster even at Nursing Action: taper. Abrupt D/C may tablets. Inform client that
center in medulla, triggering rest. Tiredness even while sitting. Anxiety cause rebound HPN. headache is common and will
sympathetic/ parasympathetic and palpitations almost all the time. subside. Avoid alcohol. Monitor
response. 3. Vasodilators for tolerance.
3. Hormones Drugs for Heart Failure- minimised Dilate blood vessels which
Antidiuretic Hormone (ADH)- adrenergic responses. decrease BP, improve 4. Diuretics
released by posterior pituitary 1. Inotropic (Cardiac Glycosides) symptoms, functional capacity Loop Diuretics- acts in the loop of
gland due to hypotension to Promote movement of Ca from and survival. Henley.
increase water reabsorption of extracellular to intracellular Anti-hypertensive inhibits chloride and sodium
kidneys. Strengthens myocardial ACE inhibitor reabsorption in Loop of Henle
Atrial Natriuretic peptide contractility: Positive inotropic (Angiotensin-converting (ACE) an distal tubule, increase
(ANP)- released by cardiac action enzymes) sodium and water excretion by
muscle due to HPN to increase Enhance vagal tone, slowing Given as anti-hypertensive inhibiting sodium absorption in
renal Na excretion. contractility through SA and AV Right sided heart failure. o=proximal tubule
node Side effects: proteinuria, non- Thiazide Diuretics- increase
Factors that affect Blood Pressure Ex. Digoxin productive cough, water excretion by increasing
1. Blood volume Antidote: Digifab angioedema, increase BUN and GFR or decrease sodium
2. Blood viscosity creatinine reabsorption in the tubules
3. Peripheral vascular resistance
Upright position reducing myocardial oxygen Potassium Sparing Diuretics-act on distal
Nitrates demand. tubule to excrete Na, bicarbonate, and Ca
Lasix Very Nice Drugs but conserve potassium.
Oxygen Side Effects: hypotension,
ACE inhibitors palpitations, tachycardia or Potassium Deficit:
Digoxin bradycardia, constipation Alkalosis
Nursing Action: monitor VS. Shallow Respi
Fluids decrease 4. Diuretics Irritability
Afterload decrease Accelerate the rate of urine Confusion and drowsiness
Sodium restriction formation.
Test (digoxin level, AGBs, Potassium Side Effects: metabolic Weakness, Fatigue
Level) alkalosis, hypovolemia, Arrythmias= tachycardia, Irregular
dehydration, hyponatremia, Rhythm and/or bradycardia
B. Anti-Anginas hypokalemia.
Angina Pectoris- chest pain is due to Contraindications: when less Lethargy
insufficient O2 in the blood to meet potent diuretics are sufficien, Thready Pulse
myocardial demand. hypersensitivity, anuria, hepatic
Ischemia- lack of blood flow and oxygen coma, severe uncorrected Decrease intestinal motility
to the heart muscles. It causes angina electrolyte depletion, sulfa Nausea
pectoris. energy. Vomiting
Infarct- obstruction of the blood supply Carbonic Anhydrase Inhibitors (CAI)- Ileus
to the heart causing tissue death. block the action of carbonic anhydrase
thus preventing the exchange of H+ ions
Types of Angina with sodium and water.
1. Chronic Stable- aka classic or effort Osmotic Diuretics- mannitol is given IM
angina. Caused by stress. Relieved by or IVF. Inhibits proximal tubule
stress and NTG. reabsorption of water and solutes
2. Unstable Angina- aka pre-infarction or producing and osmotic effect: rapid
crescendo angina. Occurs at rest, many diuresis.
progress to MI. Indication: cerebral edema, to
3. Vasospastic Angina- aka prinzmetal’s decrease ICP.
or variant angina. Occurs at rest, relieves Loop Diuretics- inhibit Cl and Na
bt NGT and Ca blockers. reabsorption in Loop of Henle and distal
tubule. Increase Na and water excretion
Anti-Angina Drugs by inhibiting sodium absorption in
1. Nitrates/Nitrites’ proximal tubule.
vasodilation Indications: edema in HF,
2. Beta Blockers- blocks beta 1 hepatic cirrhosis, HPN, renal
disease, cerebral edema
3. Calcium Channel Blockers Left sided heart failure
blocks Ca from entering the Thiazide Diuretics- increase water
cell, which case coronary artery excretion by increase GFR or decrease
vasodilation decreasing Na.
systemic vascular resistance,