pp drug classes and indications

7/29/2019 Pp Drug Classes and Indications

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CardiovascularPharmacology

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Presentation,

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Concept Map: Selected Topics in Cardiovascular Nursing

PATHOPHYSIOLOGYMyocardial Infarction

Acute Coronary Syndrome

Valvular Heart Disease

Pacemakers

CABG

Abdominal Aortic AneurysmPericarditis

Peripheral Vasc Disease (PVD)

Fem-Pop Bypass Graft

Shock / Fluid Deficit

Raynauds Phenomenon

Arrhythmias / Dysrhythmias

PHARMACOLOGY

Cardiac Glycosides

ACE Inhibitors

Beta Blockers

Antiarrhythmics

Catecholamines

Anticoagulants

ASSESSMENTPhysical Assessment

Inspection

Palpation

Percussion

Auscultation

Cardiac Monitoring

Lab Monitoring

Care PlanningPlan for client adls,

Monitoring, med admin.,

Patient education, more

Nursing Interventions & Evaluation

Execute the care plan, evaluate for

Efficacy, revise as necessary


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Cardiovascular Pharmacology

ACEInhibitors

Alpha

Blockers

Anti-Anginals

Anti-

ArrhythmicsAnti-

Hypertensives

Anti-Lipemics

Beta Blockers

Calcium

Channel

Blockers

DigitalisGlycosides

Loop Diuretics PlateletAggregation

Inhibitors

Potassium

Sparing /

Combination

DiureticsThiazide /

Related

Diuretics


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

-lol orolol ------------------Beta Blocker

-pine ---------------------

Ca Channel Blocker -statin --------------- anti-lipemic

-nitr ------------- nitrates

-zosin --------------- alpha blockers


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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


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ACE Inhibitors

benazepril HCl (Lotensin ) captopril (Capoten)

enalapril maleate (Vasotec)

lisinopril (Prinivil , Zestril)

hypertension

CHF

Left

Ventricular

Dysfunction

After

MI

Diabetic

Neuropathy

ACUTE M.I.

The Multi-Purpose Group !


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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


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The prils: ACE Inhibitors

Treatment of Hypertension

captopril, enalapril, lisinopriltx of HTN, CHF,

decreased L ventricular function after MI

Always check BP before administeringhold

PRN (parameters)

Teach patient to change positions slowly toavoid postural hypotension

cough C.O. = HR x SV

BP = C.O. x PVR


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Alpha Blockers

doxazosin mesylate (Cardura)

prazosin HCl (Minipress)


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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


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The zosins: 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


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Anti-Anginals

isosorbide dinitrate (Isordil )

isosorbide mononitrate (Ismo)

Nitroglycerin

Nitro-dur,

Transderm Nitro

Nitrol

Nitrostat

Nitrotab


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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


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TheNITRs 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


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Anti-Arrhythmics( Anti-Dysrhythmics )

amiodarone HCl (Cordarone , Pacerone )

lidocaine HCl (Xylocaine )

procainamide (Procanbid , Pronestyl ) quinidine (Quinaglute )


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Prototype: lidocaine

Class Ib antiarrhythmic; decreases electrical

conduction, decreases automaticity, increases

rate of repolarization

Indications: short-term use for ventricular

dysrhythmias; monitor respirationsrespiratory

arrest. Cardiac monitorvital signs

Nursing Implications: CNS effectsdrowsiness,

altered mental status, paresthesias, seizures


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A Slight Side-Effect

of IV Amiodarone !


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Lidocaine HClthe old reliable; used for

PVCs, ventricular ectopy, ventricular

tachycardia

AmiodaroneManagement of life-threatening

ventricular arrhythmias unresponsive to lesstoxic meds; assess for pulmonary toxicity

Both of these: Infusion pumps, monitor v.s.

frequently, cardiac monitor


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Anti-Hypertensives

clonidine (Catapres , Catapres Patch ,

Catapres TTS )

hydralazine HCl (Apresoline )

hydroclorothiazide / lisinopril (Prinzide ,

Zestoretic )

minoxidil (Loniten )


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Prototype: clonidine

Sympatholyticdecreases HR causes decrease

in C.O., peripheral vasodilationdecreases BP

Indications: HTN, severe cancer pain


hypotension, administer twice daily in divided

dose


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Hydralazinetx of essential hypertension

HCTZ/Lisinoprilcombination drugessential

hypertension

Always check BP prior to administrationhold

PRN (Parameters)

Postural hypotension precautions


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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 )


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Prototype: atorvastatin


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Beta Blockers

atenolol (Tenormin )

carvedilol (Coreg )

metoprolol (Toprol XL , LoPressor ) propranolol HCl (Inderal )


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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.


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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


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Calcium Channel Blockers

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

Tiamate , Cardizem SR , Cardizem CD )

nifedipine (Adalat , Procardia XL ) Verapamil HCl (Calan , Isoptim , Covera )


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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


hypotension, cardiac monitor, monitor pulse

rate

Contraindications: AV blocks, hypotension,

bradycardia, aortic stenosis, severe heart failure


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Treatment of HTN, vasospastic angina, angina

prophylaxis, Atrial Fibrillation (sometimes) ,

rapid atrial dysrhythmias

Nursing: Check BP, hold PRN (Parameters)

Postural Hypotension PrecautionsC.O. = HR x SV

BP = C.O. x PVR

Digitalis Glycosides


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Digitalis Glycosides digoxin (Lanoxin )

(+) Inotrope, (-) Chronotrope

CHF, Atrial Tachy-arrhythmias (A-Fib, A-

Flutter), Cardiogenic Shock Assess Apical Pulse Dig Toxicityanorexia, fatigue, weakness, yellow-green halos

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


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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


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Loop Diuretics

bumetanide (Bumex )

furosemide (Lasix )

Monitor serum K+ 3.5 5.0 mEq/L

Potassium rich foods


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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?), orthostatichypotension, monitor K+, RELATE THIS MED IN

RELATION TO OTHER MEDS. Dietary

counseling.


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Platelet Aggregation Inhibitors

clopidogrel bisulfate (Plavix )

dipyridamole (Persantine )

ticlopidine HCl (Ticlid )

Prevention of TIAs, CVA; combined with

warfarin or ASA for heart valves, MI, bypassgrafts, stents.


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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

NSAIDs (potentiates).


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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


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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 otherdiuretics; Give with meals; Avoid salt

substitutes containing potassium;

Monitor I and O


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Thiazides / Related Diuretics

chlorthalidone

(Hygroton , Hylidone , Thalitone

hydrochlorothiazide [hctz] (Hydrodiuril )

indapamide (Lozol )

metolazone (Zaroxylyn )


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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


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Anti-Coagulants

Heparin

Enoxaparin

Warfarin

Antidotes:

Heparin = protamine sulfate Coumadin = vitamin K

Digoxin = Digibind, Digifab,


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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


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Thrombolytic Medications


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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.


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EMERGENCY

CARDIAC

PHARMACOLOGY


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Oxygen

Epinephrine

Atropine Adenosine

Lidocaine (or amiodarone)


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Oxygen

100 % ! (during resuscitation, for all clients,

including those with chronic respiratory

conditions, e.g., COPD)

h


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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 output

Use infusion pump

At i


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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.

d


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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.

Lid i


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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.

A i d


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Amiodarone

anti-arrhythmic

Indications:

Pharmacologic Actions:

Administration:

Nursing Considerations:

MatchingColumn A Column B


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Column 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

P

Q

R

S

T

U

V

W

X

Y

Z

Appendix:


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Appendix:Electrolytes & Imbalances

related to: Cardiac Effects

Sodium (Na+)

Normal level =

135 to 145 mEq/L (adult)

Required in acid-base andosmotic 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


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Potassium (K+)

Normal level =

3.5 to 5 mEq/L (adult)

Major factor incarbohydrate 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

!


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Calcium (Ca++)

Normal level =

8.5 to 10 mg/dL

Involved in bone and toothformation, 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, cardiacarrhythmias with lengthened QT

segments


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Magnesium (Mg2+)

Normal level =

1.3 to 2.1 mEq/L

Required for activation ofan enzyme necessary for

energy metabolism and

bone formation.

>DecreasedMuscle 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


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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 difficultybreathing (Kussmauls 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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Hypokalemia: ST depression,

decreased or inverted T waves, U waves

Hyperkalemia: peaked T waves,

decreased P waves, short QT, widened

QRS, sine wave Hypocalcemia: prolonged QT, flat or

inverted T waves

Hypercalcemia: short or absent ST,

decreased QTc interval

Hypomagnesemia: prolonged QT,

flat T waves, prolonged PR, aFib, torsade

Hypermagnesemia: short PR, heartblock, peaked T waves, widened QRS0

Digitalis toxicity: ST depression

(scoop), flat T waves

Quinidine: prolonged QT, widened

QRS

Pericarditis: diffuse ST elevation withPR interval depression

Hypomagnesemia: prolonged QT, flat T waves,

prolonged PR, aFib, torsade Hypermagnesemia: short PR, heart block,

peaked T waves, widened QRS0

Digitalis toxicity: ST depression (scoop), flat T

waves

Appendix:


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Appendix:A Med-Surg Nurses description of cardiac carethings 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 thetherapeutic 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 ofthese 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 thetherapeutic range.


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During therapy, reduce

your patient's cardiac

workload by restricting his

activity. Provide oxygen

through a face mask ornasal cannula, as

prescribed, to support his

heart's oxygen demands

After therapy, your patient may

be referred to an occupationaltherapist to learn how to

conserve oxygen and energy

while performing daily activities.

The therapist also may help your

patient modify his environmentto reduce cardiac workload. For

example, the therapist may

suggest moving bedroom

furniture to the first floor and

obtaining a bedside commode.


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Teach your patient and hisfamily about his prescribed

drug therapy. If a digitalis

glycoside has been

prescribed, instruct him totake his pulse before taking

the drug. Tell your patient

that he may need

potassium supplements

with diuretic and digitalisglycoside therapy.

Tell him to withhold the dose andcall 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 muscletenderness, 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.


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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 acomplete assessment of his

cardiac and respiratory status.

And the nurse will answer

questions about his drug

regimen and monitor hiscompliance with the drug

regimen and dietary restrictions.

The home health nurse will

also instruct him and his

family about using home

oxygen therapy, ifprescribed.

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