adult health nursing ii block 7.0 topic: cardiovascular pharmacology module: 2.1

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Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

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Page 1: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Adult Health Nursing IIBlock 7.0

Topic: Cardiovascular PharmacologyModule: 2.1

Page 2: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Cardiovascular

Pharmacology

Block 7.0 Module 2.1A Good Resource:http://www.cvpharmacology.com/index.html

Page 3: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Concept Map: Selected Topics in Cardiovascular Nursing

PATHOPHYSIOLOGYMyocardial InfarctionAcute Coronary SyndromeValvular Heart DiseasePacemakersCABGAbdominal Aortic AneurysmPericarditisPeripheral Vasc Disease (PVD)Fem-Pop Bypass GraftShock / Fluid DeficitRaynaud’s PhenomenonArrhythmias / Dysrhythmias

PHARMACOLOGYCardiac GlycosidesACE InhibitorsBeta BlockersAntiarrhythmicsCatecholaminesAnticoagulants

ASSESSMENTPhysical Assessment Inspection Palpation Percussion AuscultationCardiac MonitoringLab Monitoring

Care PlanningPlan for client adl’s, Monitoring, med admin.,Patient education, more…

Nursing Interventions & EvaluationExecute the care plan, evaluate for Efficacy, revise as necessary

Block 7.0 Module 2.1

Page 4: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Cardiovascular Pharmacology

ACEInhibitors

AlphaBlockers

Anti-Anginals

Anti-Arrhythmics

Anti-Hypertensives

Anti-Lipemics

Beta Blockers

Calcium Channel Blockers

Digitalis Glycosides

Loop Diuretics Platelet Aggregation

Inhibitors

Potassium – Sparing /

Combination Diuretics

Thiazide / Related

Diuretics

Block 7.0 Module 2.1

Page 5: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

• -pril------------------------------- ACE Inhibitor

• -lol or –olol ------------------Beta Blocker• -pine --------------------- Ca Channel Blocker• -statin --------------- anti-lipemic• -nitr ------------- nitrates• -zosin --------------- alpha blockers

-pril-zosin

-nitr

-statin -lol

-olol

-pine

Block 7.0 Module 2.1

Page 6: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

• Alpha Blockers• Beta Blockers• Ca Channel Blockers• ACE Inhibitors• Anti-Lipemic• Nitrates

• -olol• -pril• -pine• -statin• -nitr-• -zosin• -lol

atenolol (Tenormin ®)carvedilol (Coreg ®)metoprolol (Toprol XL ®, LoPressor ®)propranolol HCl (Inderal ®)

doxazosin mesylate (Cardura®)prazosin HCl (Minipress®)

amlodipine besylate (Norvasc ®)diltiazem HCl (Cardizem ®, Dilacor ®)nifedipine (Adalat ®, Procardia XL ®)Verapamil HCl (Calan ®, Isoptim ®, Covera ®)

benazepril HCl (Lotensin ®)captopril (Capoten®)enalapril maleate (Vasotec®)lisinopril (Prinivil ®, Zestril®)

• atorvastatin calcium (Lipitor ®)• lovastatin ( Mevacor ®)• pravastatin (Pravachol ®) • rosuvastatin calcium (Crestor ®)• simvastatin (Zocor ®)

• isosorbide dinitrate (Isordil ®)• isosorbide mononitrate (Ismo®)• Nitroglycerin

Block 7.0 Module 2.1

Page 7: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

ACE Inhibitors

• benazepril HCl (Lotensin ®)• captopril (Capoten®)• enalapril maleate (Vasotec®)• lisinopril (Prinivil ®, Zestril®)

-prilhypertension

CHF

Left VentricularDysfunction AfterMI

Diabetic Neuropathy

ACUTE M.I.

“The Multi-Purpose Group !”Block 7.0 Module 2.1

Page 8: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Prototype: captopril

• ACE Inhibitors produce desired effect by blocking production of angiotensin II, resulting in arteriolar vasodilation, excretion of sodium and retention of potassium

• Indications: Heart failure, HTN, MI (reduce mortality, reduce heart failure), diabetic & non-diabetic nephropathy.

• Nursing Implications: orthostatic hypotension, cough, potential hyperkalemia

Block 7.0 Module 2.1

Page 9: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

The –pril’s: ACE Inhibitors

• Treatment of Hypertension• captopril, enalapril, lisinopril—tx of HTN, CHF,

decreased L ventricular function after MI• Always check BP before administering—hold

PRN (parameters)• Teach patient to change positions slowly to

avoid postural hypotension• “cough” C.O. = HR x SV

BP = C.O. x PVRBlock 7.0 Module 2.1

Page 10: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Alpha Blockers

• doxazosin mesylate (Cardura®)• prazosin HCl (Minipress®)

-zosin

Block 7.0 Module 2.1

Page 11: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Prototype: prazosin

• Alpha blockers cause venous and arterial dilation, smooth muscle relaxation of prostate

• Indications: HTN • Nursing Implications: monitor BP closely after

initial dose; orthostatic hypotension

Block 7.0 Module 2.1

Page 12: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

The –zosin’s: Alpha Blockers sympatholytic

Uses: • Treatment of HTN• BPH (doxazosin (Cardura®)

Nursing Implications• Teach patient to avoid

changing positions rapidly (postural hypotension)

• Check blood pressure prior to administration; hold med PRN (Parameters)

C.O. = HR x SV

BP = C.O. x PVR

Block 7.0 Module 2.1

Page 13: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Anti-Anginals

• isosorbide dinitrate (Isordil ®)• isosorbide mononitrate (Ismo®)• Nitroglycerin • Nitro-dur®, • Transderm Nitro ®• Nitrol ®• Nitrostat ®• Nitrotab ®

-nitr-

Block 7.0 Module 2.1

Page 14: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Prototype: nitroglycerin

• Vasodilation of coronary artries increases myocardial oxygen supply; decreases myocardial oxygen demand via vasodilation and reduction of preload

• Indications: angina treatment and/or prophylaxis;

• Nursing Implications: hypotension, orthostatic hypotension, cough, potential hyperkalemia

Block 7.0 Module 2.1

Page 15: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

The –”NITR’s” Anti-Anginals(effect: vasodilation)

• nitroglycerin sl, nitropaste, nitroderm• Chest pain regimen: 1 tab NTG sl, q5 min X 3

• Isosorbide dinatrate (Isordil®) • Treatment / Prophylaxis of angina, CHF

C.O. = HR x SV

BP = C.O. x PVR

Block 7.0 Module 2.1

Page 16: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Anti-Arrhythmics( Anti-Dysrhythmics )

• amiodarone HCl (Cordarone ®, Pacerone® )• lidocaine HCl (Xylocaine ®)• procainamide (Procanbid ®, Pronestyl ®)• quinidine (Quinaglute ®)

Block 7.0 Module 2.1

Page 17: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Prototype: lidocaine

• Class Ib antiarrhythmic; decreases electrical conduction, decreases automaticity, increases rate of repolarization

• Indications: short-term use for ventricular dysrhythmias; monitor respirations—respiratory arrest. Cardiac monitor—vital signs

• Nursing Implications: CNS effects—drowsiness, altered mental status, paresthesias, seizures

Block 7.0 Module 2.1

Page 18: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

A “Slight” Side-Effect of IV Amiodarone !

Block 7.0 Module 2.1

Page 19: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

• Lidocaine HCl—the old reliable; used for PVC’s, ventricular ectopy, ventricular tachycardia

• Amiodarone –Management of life-threatening ventricular arrhythmias unresponsive to less toxic meds; assess for pulmonary toxicity

• Both of these: Infusion pumps, monitor v.s. frequently, cardiac monitorBlock 7.0 Module 2.1

Page 20: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Anti-Hypertensives

• clonidine (Catapres ®, Catapres Patch ®, Catapres TTS ®)

• hydralazine HCl (Apresoline ®)• hydroclorothiazide / lisinopril (Prinzide ®,

Zestoretic ®)• minoxidil (Loniten ®)

Block 7.0 Module 2.1

Page 21: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Prototype: clonidine

• Sympatholytic—decreases HR causes decrease in C.O., peripheral vasodilation—decreases BP

• Indications: HTN, severe cancer pain • Nursing Implications: hypotension, orthostatic

hypotension, administer twice daily in divided dose

Block 7.0 Module 2.1

Page 22: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

• Hydralazine—tx of essential hypertension• HCTZ/Lisinopril—combination drug –essential

hypertension• Always check BP prior to administration—hold

PRN (Parameters)• Postural hypotension precautions

Block 7.0 Module 2.1

Page 23: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Anti-Lipemics

• atorvastatin calcium (Lipitor ®)• colestipol (Colestid ®)• gemfibrozol (Lopid ®)• lovastatin ( Mevacor ®)• Niacin ( Niacor ®, Niaspan ®)• nicotinic acid (Slo-Niacin ®, Vitamin B)• pravastatin (Pravachol ®) • rosuvastatin calcium (Crestor ®)• simvastatin (Zocor ®)

-statin

Block 7.0 Module 2.1

Page 24: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Prototype: atorvastatin

Block 7.0 Module 2.1

Page 25: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Beta Blockers

• atenolol (Tenormin ®)• carvedilol (Coreg ®)• metoprolol (Toprol XL ®, LoPressor ®)• propranolol HCl (Inderal ®)

-lol-olol

Block 7.0 Module 2.1

Page 26: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Prototype: metoprolol

• Remember that there are cardioselective and non-selective Beta blockers; Beta1 adrenergic blockage to reduce heart (- chronotrope) rate, decrease myocardial contractility (-inotrope), decrease rate of conduction through the AV node

• Indications: angina, HTN, dysrhythmias, MI, Heart failure,

• Nursing Implications: Apical pulse; monitor VS; • Contraindicated in AV Block, SB. Block 7.0 Module 2.1

Page 27: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

• Used for tx of HTN, MI, angina prophylaxis, CHF

• Cardioselective vs nonselective B-Blockers and Respiratory

• Nursing: Apical Pulse

C.O. = HR x SV

BP = C.O. x PVR

Block 7.0 Module 2.1

Page 28: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Calcium Channel Blockers

• amlodipine besylate (Norvasc ®)• diltiazem HCl (Cardizem ®, Dilacor ®,

Tiamate ®, Cardizem SR ®, Cardizem CD ® )• nifedipine (Adalat ®, Procardia XL ®)• Verapamil HCl (Calan ®, Isoptim ®, Covera ®)

-pine

Block 7.0 Module 2.1

Page 29: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Prototype: nifedipine • Vasodilation of peripheral arterioles; clocking

of CA+ channels in heart causes decreased force of contraction, decreased heart rate, decreased pulse. (-inotrope, -chronotrope)

• Indications: HTN, angina, selected dysrhythmias

• Nursing Implications: hypotension, orthostatic hypotension, cardiac monitor, monitor pulse rate

• Contraindications: AV blocks, hypotension, bradycardia, aortic stenosis, severe heart failureBlock 7.0 Module 2.1

Page 30: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

• Treatment of HTN, vasospastic angina, angina prophylaxis, Atrial Fibrillation (sometimes) , rapid atrial dysrhythmias

• Nursing: Check BP, hold PRN (Parameters) • Postural Hypotension Precautions C.O. = HR x SV

BP = C.O. x PVR

Block 7.0 Module 2.1

Page 31: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Digitalis Glycosides• digoxin (Lanoxin ®)

• (+) Inotrope, (-) Chronotrope• CHF, Atrial Tachy-arrhythmias (A-Fib, A-

Flutter), Cardiogenic Shock• Assess Apical Pulse• Dig Toxicity—anorexia, fatigue, weakness, yellow-green halo’s

around lights• Role of K+ ! (Can be Dig Toxic with therapeutic Dig levels if K+

is low!) Therapeutic Level = 0.5-2.0 ng/ml• Low K+: Possible U Waves on EKG

Block 7.0 Module 2.1

Page 32: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Prototype: digoxin

• (+) inotropic effect; (-) chronotropic effect; improves stroke volume and C.O.

• Indications: treatment of heart failure; treatment of atrial fibrillation

• Nursing Implications: AP, monitor dig levels, monitor K+

• Contraindicated: Ventricular rhythm disturbances: VF, VT, 2nd -3rd degree AV block

Block 7.0 Module 2.1

Page 33: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Loop Diuretics

• bumetanide (Bumex ®)• furosemide (Lasix ®)

• Monitor serum K+ 3.5 – 5.0 mEq/L• Potassium rich foods

Block 7.0 Module 2.1

Page 34: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Prototype: furosemide

• Block reabsorption of NA and Cl, prevent reabsorption of H2O, causing extensive diuresis;

• Indications: Pulmonary edema d/t Heart failure

• Nursing Implications: I&O, daily weights, hypotension, diuresis (foley?), orthostatic hypotension, monitor K+, RELATE THIS MED IN RELATION TO OTHER MEDS. Dietary counseling. Block 7.0 Module 2.1

Page 35: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Platelet Aggregation Inhibitors

• clopidogrel bisulfate (Plavix ®)• dipyridamole (Persantine ®)• ticlopidine HCl (Ticlid ®)

• Prevention of TIA’s, CVA; combined with warfarin or ASA for heart valves, MI, bypass grafts, stents.

Block 7.0 Module 2.1

Page 36: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Prototype: aspirin

• Prevent platelets from clumping or aggregating;

• Indications: Primary prevention of MI; prevention of CVA (stroke);

• Nursing Implications: bleeding , GI Upset ; use cautiously in those with anticoagulants and NSAID’s (potentiates).

Block 7.0 Module 2.1

Page 37: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Potassium Sparing / Combination Diuretics

• hydrochlorothizide / triamterene• (Dyazide ®, Maxzide ®)

• spironolactone (Aldactone ®)• Treatment of edema and hypertension

• Avoid high K= foods (oranges, bananas, salt substitute, dried apricots, dates,

• Weigh Daily Block 7.0 Module 2.1

Page 38: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Prototype: spironolactone

• Spironolactone is classified as a potassium-sparing diuretic.

• Indications:congestive heart failure, cirrhosis of the liver, and kidney disease. It can also be used in combination with other drugs to treat elevated blood pressure.

• Nursing Implications: Used with other diuretics; Give with meals; Avoid salt substitutes containing potassium;

• Monitor I and O Block 7.0 Module 2.1

Page 39: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Thiazides / Related Diuretics

• chlorthalidone • (Hygroton ®, Hylidone ®, Thalitone ®

• hydrochlorothiazide [hctz] (Hydrodiuril ®)• indapamide (Lozol ®)• metolazone (Zaroxylyn ®)

Block 7.0 Module 2.1

Page 40: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

• NOTE THAT MORE THAN ONE HYPERTENSIVE –SOMETIMES SEVERAL--MAY BE NEEDED TO CONTROL HTN; USED IN COMBINATION WITH DIURETICS; Tx edema, HTN

• Monitor for hypokalemia

Block 7.0 Module 2.1

Page 41: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Anti-Coagulants

• Heparin• Enoxaparin• Warfarin

• Antidotes:• Heparin = protamine sulfate• Coumadin = vitamin K• Digoxin = Digibind, Digifab,

Block 7.0 Module 2.1

Page 42: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Prototype: heparin

• Inactivation of thrombin formation vis inhibition of fibrin formation,

• Indications: DIC, stroke, prophylaxis agains post-op DVT,

• Nursing Implications: bleeding (remember: internal & external bleeding) Heparin Induced Throbocytopenia (HIT)—stop if platelets <100,000; monitor aPTT (< 2 x baseline)

• Antidote: Protamine sulfateBlock 7.0 Module 2.1

Page 43: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Thrombolytic Medications

Block 7.0 Module 2.1

Page 44: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Prototype: streptokinase

• Act by dissolving clots.• Indications: Acute MI; DVT; Pulmonary emboli,

ischemic stroke (alteplase) • Nursing Implications: MONITOR FOR BLEEDING;

monitor VS; (see p. 310, ATI Pharm)• Contraindications: prior intracranial

hemorrhage, active internal bleeding, significant trauma within 3 months, acute pericarditis, brain tumors.

Block 7.0 Module 2.1

Page 45: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

EMERGENCY CARDIACPHARMACOLOGY

Block 7.0 Module 2.1

Page 46: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

• Oxygen• Epinephrine• Atropine• Adenosine• Lidocaine (or amiodarone)

Block 7.0 Module 2.1

Page 47: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Block 7.0 Module 2.1

Page 48: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Oxygen

• 100 % ! (during resuscitation, for all clients, including those with chronic respiratory conditions, e.g., COPD)

Block 7.0 Module 2.1

Page 49: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Epinephrine(Adrenaline)

catecholamine • Pharmacologic action: vasoconstriction;

increased heart rate (+ chronotrope); increased rate of conduction; increased BP; increased myocardial contractility.

• Indication: Cardiac arrest; ventricular fibrillation

• Administration: IV, IV push• Dose: 1 mg IV push q3-5min• Nursing Implications: Monitor blood pressure,

peripheral pulses, urinary outputUse infusion pump Block 7.0 Module 2.1

Page 50: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Atropine sympathomimetics

• Pharmacologic Action: • Indication: SYMPTOMATIC BRADYCARDIA• Administration: IV • Nursing Considerations: weigh the risks to

increased myocardial oxygen demand in CV patient

• 1 mg rapid IV. Repeat q3-5 minutes up to maximum total dose of 0.04 mg/kg.

Block 7.0 Module 2.1

Page 51: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Adenosine class V antiarrhythmic

• Pharmacologic Action: Class V anti-arrhythmic; causes transient heart block in the AV node

• Indication: SVT & WPW• Administration: IV Bolus• Nursing Considerations: after IV bolus, causes

a transient asystole• 6 mg rapid IV, followed by saline flush. If no response in 1-2 minutes give 12 mg

rapid IV. May repeat in 1-2 minutes if needed.

Block 7.0 Module 2.1

Page 52: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Lidocaine anti-arrhythmic

• Indications: ventricular fibrillation, ventricular tachycardia

• Pharmacologic Actions: anti-arrhythmic• Administration: IV • Nursing Considerations: monitor the patient!

If received bolus, needs to receive a continuous infusion afterwards; CNS effects—drowsiness, altered mental status, seizures

• 1 to 1.5 mg/kg q3-5min. Maximum total: 3 mg/kg.

Block 7.0 Module 2.1

Page 53: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Amiodarone anti-arrhythmic

• Indications: • Pharmacologic Actions:• Administration: • Nursing Considerations:

Block 7.0 Module 2.1

Page 54: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

MatchingColumn A

• Alpha Blocker

• Beta Blocker

• Calcium Channel Blocker

• Anti-Anginal

• Anti-Arrhythmic

• Anti-Hypertensive

• Anti-Lipemic

• Digitalis Glycosides

• Loop Diuretics

• Platelet Aggregation Inhibitors

• Potassium Sparing / Combination Diuretics

• Thiazide Diuretics

Column B• A. isosorbide dinitrate (Isordil ®)• B. digoxin (Lanoxin ® )• C. prazosin HCl (Minipres ®)• D. amiodarone HCl (Cordarone®, Pacerone ® )• E. hydralazine HCl (Apresoline ®)• F. dipyridamole (Persantine ®)• G. nitroglycerin (Nitrostat ®)• H. lidocaine HCl (Xylocaine ®)• I. simvastatin (Zocor ®)• J. doxazosin mesylate (Cardura®)• K. quinidine (Quinaglute ®)• L. clonidine (Catapres ®)• M. atorvastatin calcium (Lipitor ®)• N. gemfibrozol (Lopid ®)• O. lovastatin ( Mevacor ®)• P. spironolactone (Aldactone ®)• Q. hydrochlorothiazide [hctz] (Hydrodiuril ®)• R. clopidogrel bisulfate (Plavix ®)• S. carvedilol (Coreg ®)• T. furosemide (Lasix ®)• U. colestipol (Colestid ®)• V. propranolol HCl (Inderal ®)• W. nifedipine (Adalat ®, Procardia XL ®)• X. ticlopidine HCl (Ticlid®)• Y. verapamil HCl (Calan ®)• Z. bumetanide (Bumex ®)

• ACE Inhibitors

A

B

C

D

E

F

G

H

I

J

K

L

M N O

PQ

R

S

T

U

V

W

X

Y

ZBlock 7.0 Module 2.1

Page 55: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Appendix: Electrolytes & Imbalances

related to: Cardiac Effects

Sodium (Na+) • Normal level = • 135 to 145 mEq/L (adult) • Required in acid-base and

osmotic pressure balance, nerve function and water equilibrium.

Effects:• >Decreased

Hypotension, headache, nausea, vomiting, abdominal cramps, muscle tremors, twitching, fatigue, headache, nausea, vomiting, diarrhea, abdominal cramps, muscle tremors, twitching, weakness, confusion, seizures, and coma

• <Increased Lethargy, irritability, muscle twitching, tremors, dry skin and mucous membranes, fever, hypotension, disorientation, delirium, cerebral

hemorrhage, coma Block 7.0 Module 2.1

Page 56: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Potassium (K+)

• Normal level = • 3.5 to 5 mEq/L (adult) • Major factor in

carbohydrate metabolism, osmotic pressure balance, acid-base balance and normal muscle contraction.

Effects:• > Decreased

Cardiac arrhythmia, depressed S-T segment, flattened/inverted T wave, U wave, confusion, lethargy, muscle weakness, paralysis, abdominal distention, constipation, paralytic ileus, thirst, frequent voiding

• < Increased Muscle weakness, paralysis, numbness and tingling, ventricular fibrillation, cardiac arrest, tall tented T waves

!Block 7.0 Module 2.1

Page 57: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Calcium (Ca++) • Normal level = • 8.5 to 10 mg/dL • Involved in bone and tooth

formation, blood coagulation, nerve function, muscle contraction.

Effects• >Decreased

Frequent hives, chronic fatigue, canker and cold sores, muscle cramps (Charlie Horses), and itchy skin dementia, depression, psychosis, tetany (Chvostek's and Trousseau's signs), laryngospasm, or generalized convulsions, cardiac arrhythmias with lengthened QT segments

• <Increased Muscle weakness, bone fragility, kidney stones, loss of appetite, thirst, frequent urination, lethargy, fatigue, joint pains, memory loss, depression, constipation, anorexia, nausea and vomiting, abdominal pain, ileus, polyuria, nocturia, and polydipsia, emotional lability, confusion, delirium, psychosis, stupor, coma, cardiac arrhythmias with shortened QT segment Block 7.0 Module 2.1

Page 58: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Magnesium (Mg2+) • Normal level = • 1.3 to 2.1 mEq/L • Required for activation of

an enzyme necessary for energy metabolism and bone formation.

• >Decreased Muscle weakness, fatigue, confusion, restlessness, hyperexcitability, vertigo, seizures, muscle tremors, nystagmus, tachycardia, hypotension, PAC, PVC, Toursades de Pointes arrhythmia, anorexia, nausea, vomiting, personality change, tetany (eg, positive Trousseau's or Chvostek's sign or spontaneous carpopedal spasm), and tremor and muscle fasciculations

• <Increased Muscle weakness, drowsiness, lethargy, hypotension, paralysis, coma, cardiac and respiratory problems

Block 7.0 Module 2.1

Page 59: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Blood Glucose

Hypoglycemia Hyperglycemia • Diabetic Ketoacidosis · Fatigue ·

Flushed, dry skin· Dry mouth · Increased thirst · Increased urination· Blurry vision · Headache· Nausea and Vomiting· Dehydration· Weak, rapid pulse· Hypotension· High blood glucose levels (>240 mg/dL).· Ketones in urine· Increased thirst and urination · Nausea, vomiting, and/or stomach pain· Changes in or difficulty breathing (Kussmaul’s respirations)· Acid or fruity smell on breath (Acetone breath)· Flushing · Dehydration · Fatigue · Stupor and coma

Restlessness· Irritability· Confusion· Trembling· Slurred speech · Headache · Tingling lips · Paresthesia· Diaphoresis (cool skin) · Pallor· Tachycardia· Shallow respirations· Hypertension· Weakness · Hunger · Coma · Tremors 

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Page 60: Adult Health Nursing II Block 7.0 Topic: Cardiovascular Pharmacology Module: 2.1

Hypokalemia: ST depression,

decreased or inverted T waves, U waves² Hyperkalemia: peaked T waves, decreased P waves, short QT, widened QRS, sine wave² Hypocalcemia: prolonged QT, flat or inverted T waves² Hypercalcemia: short or absent ST, decreased QTc interval² Hypomagnesemia: prolonged QT, flat T waves, prolonged PR, aFib, torsade² Hypermagnesemia: short PR, heart block, peaked T waves, widened QRS0² Digitalis toxicity: ST depression (scoop), flat T waves² Quinidine: prolonged QT, widened QRS² Pericarditis: diffuse ST elevation with PR interval depression

Hypomagnesemia: prolonged QT, flat T waves, prolonged PR, aFib, torsade² Hypermagnesemia: short PR, heart block, peaked T waves, widened QRS0² Digitalis toxicity: ST depression (scoop), flat T waves

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Appendix: A Med-Surg Nurses description of cardiac care—things to think

about with patient care

• Monitor your patient's response to drug therapy by assessing his blood pressure, heart rate, heart sounds, ECG results, breath sounds, urine output, and weight. Also, assess him for peripheral edema.

• If the physician prescribes a digitalis glycoside, take your patient's apical pulse for a full minute before administering the drug. Withhold the drug if his apical pulse is less than 60 beats per minute.

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• Begin digitalis glycoside therapy by administering a loading dose (AS ORDERED) to achieve a therapeutic level more quickly. Monitor your patient's serum digoxin level to ensure that it remains in the therapeutic range of 1 to 2 ng/ml. Also, assess him for signs and symptoms of digitalis toxicity.

• If he's also receiving a thiazide or loop diuretic, monitor his serum potassium level; a low potassium level can lead to digitalis toxicity.

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• Other drugs that increase the risk of digitalis toxicity include beta-blockers, anticholinergics, quinidine, verapamil, nifedipine, amiodarone, and propafenone.

• If your patient is receiving one of these drugs during digitalis glycoside therapy, monitor his heart rate and rhythm and assess for signs of digitalis toxicity, such as gastrointestinal, neurologic, or vision disturbances. If he shows evidence of toxicity, HOLD THE MEDICATION & NOTIFY THE PYSICIAN--the digitalis glycoside will most likely be on hold until his level returns to the therapeutic range.

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• During therapy, reduce your patient's cardiac workload by restricting his activity. Provide oxygen through a face mask or nasal cannula, as prescribed, to support his heart's oxygen demands

• After therapy, your patient may be referred to an occupational therapist to learn how to conserve oxygen and energy while performing daily activities. The therapist also may help your patient modify his environment to reduce cardiac workload. For ex ample, the therapist may suggest moving bed room furniture to the first floor and obtaining a bedside commode.

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• Teach your patient and his family about his prescribed drug therapy. If a digitalis glycoside has been prescribed, instruct him to take his pulse before taking the drug. Tell your patient that he may need potassium supplements with diuretic and digitalis glycoside therapy.

• Tell him to withhold the dose and call the physician if his pulse is lower than 60 beats per minute. Also, teach him the signs and symptoms of digitalis toxicity, such as nausea, vomiting, diarrhea, fatigue, vision changes, and an abnormally slow pulse rate; hypokalemia, such as weakness, fatigue, nausea, abdominal cramps, and diarrhea; and hyperkalemia, such as muscle tenderness, fatigue, and constipation.

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• Tell your patient that he may need potassium supplements with diuretic and digitalis glycoside therapy.

• If your patient is taking more than one drug, help him devise a dosage schedule that accommodates his lifestyle. For example, advise him to take twice-daily drugs before breakfast and dinner (if not contraindicated) to avoid forgetting to take them during a busy workday.Block 7.0 Module 2.1

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• Instruct the patient to follow a low-sodium diet. If necessary, refer him to a dietitian. Tell him to record his daily weights in a log and to report a weight gain greater than 3 pounds over 2 days or less.

• Tell him to conserve his energy by resting frequently. Explain how to obtain and use supplemental oxygen, if prescribed.

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• Most patients with heart failure benefit from a home care referral. If your patient will have a home care nurse, tell him that the nurse will perform a complete assessment of his cardiac and respiratory status. And the nurse will answer questions about his drug regimen and monitor his compliance with the drug regimen and dietary restrictions.

• The home health nurse will also instruct him and his family about using home oxygen therapy, if prescribed.

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