pyramid points chapter 60: cardiovascular medications

PYRAMID POINTSPYRAMID POINTS

CHAPTER 60:CHAPTER 60:

CARDIOVASCULAR CARDIOVASCULAR MEDICATIONSMEDICATIONS

Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

ADULT HEALTH:Cardiovascular Medications

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I. AnticoagulantsI. Anticoagulants DescriptionDescription

• Prevent extension and formation of clots by inhibiting factors in Prevent extension and formation of clots by inhibiting factors in clotting cascade and decreasing blood coagulabilityclotting cascade and decreasing blood coagulability

Side effectsSide effects• BleedingBleeding

Heparin sodiumHeparin sodium• Normal activated partial thromboplastin time (aPTT) Normal activated partial thromboplastin time (aPTT)

20 to 30 seconds20 to 30 seconds• Antidote is protamine sulfateAntidote is protamine sulfate

Enoxaprin (Lovenox)Enoxaprin (Lovenox) Warfarin sodium (Coumadin)Warfarin sodium (Coumadin)

• Normal PT is 11 to 12.5 secondsNormal PT is 11 to 12.5 seconds• Normal INR is 0.7 to 1.8Normal INR is 0.7 to 1.8• Antidote is vitamin K (phytonadione [AquaMEPHYTON])Antidote is vitamin K (phytonadione [AquaMEPHYTON])



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II. Thrombolytic MedicationsII. Thrombolytic Medications DescriptionDescription

• Dissolve clotsDissolve clots ContraindicationsContraindications

• Active bleeding, stroke or other intracranial problems, surgical Active bleeding, stroke or other intracranial problems, surgical client, hepatic or renal disease, uncontrolled hypertension, client, hepatic or renal disease, uncontrolled hypertension, recent cardiopulmonary resuscitation, or hypersensitivityrecent cardiopulmonary resuscitation, or hypersensitivity


InterventionsInterventions• Monitor for bleedingMonitor for bleeding• Implement bleeding precautionsImplement bleeding precautions

AntidoteAntidote• Aminocaproic acid (Amicar) is antidote for streptokinaseAminocaproic acid (Amicar) is antidote for streptokinase



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III. Antiplatelet MedicationsIII. Antiplatelet Medications DescriptionDescription

• Inhibit aggregation of platelets and prolong bleeding timeInhibit aggregation of platelets and prolong bleeding time


InterventionsInterventions• Monitor for bleedingMonitor for bleeding

• Implement bleeding precautionsImplement bleeding precautions



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IV. Positive Inotropic-Cardiotonic MedicationsIV. Positive Inotropic-Cardiotonic Medications DescriptionDescription

• Stimulate myocardial contractilityStimulate myocardial contractility Side effectsSide effects

• Dysrythmias, hypotension, thrombocytopeniaDysrythmias, hypotension, thrombocytopenia Toxic, adverse reactionsToxic, adverse reactions

• Hepatotoxocity, hypersensitivityHepatotoxocity, hypersensitivity InterventionsInterventions

• Monitor for side effects and adverse effectsMonitor for side effects and adverse effects• Monitor pulse and blood pressure closelyMonitor pulse and blood pressure closely



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V. Cardiac GlycosidesV. Cardiac Glycosides DescriptionDescription

• Increases the force of myocardial contraction and slows the Increases the force of myocardial contraction and slows the heart rateheart rate

Side effects, toxic effectsSide effects, toxic effects• Gastrointestinal disturbances (anorexia, nausea, vomiting, Gastrointestinal disturbances (anorexia, nausea, vomiting,

diarrhea)diarrhea)• Visual disturbancesVisual disturbances• BradycardiaBradycardia

InterventionsInterventions• Monitor for toxicity; digoxin level above 2 ng/mLMonitor for toxicity; digoxin level above 2 ng/mL• Monitor potassium level for hypokalemiaMonitor potassium level for hypokalemia• Monitor apical pulse; if less than 60/min, hold medication, notify Monitor apical pulse; if less than 60/min, hold medication, notify

physicianphysician



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VI. Antihypertensive MedicationsVI. Antihypertensive Medications Thiazide diureticsThiazide diuretics

• Side effects include hypercalcemia, hyperglycemia, Side effects include hypercalcemia, hyperglycemia, hyperuricemia, hypokalemia, hyponatremia, hypovolemiahyperuricemia, hypokalemia, hyponatremia, hypovolemia

• Interventions include monitoring vital signs, appropriate Interventions include monitoring vital signs, appropriate laboratory values, intake and output (I&O); intake of potassium-laboratory values, intake and output (I&O); intake of potassium-containing foodscontaining foods

Loop diureticsLoop diuretics• Side effects include hypokalemia, hyponatremia, hypocalcemia, Side effects include hypokalemia, hyponatremia, hypocalcemia,

hypomagnesemia, orthostatic hypotensionhypomagnesemia, orthostatic hypotension

• Interventions include monitoring vital signs, appropriate Interventions include monitoring vital signs, appropriate laboratory values, I&O; intake of potassium-containing foodslaboratory values, I&O; intake of potassium-containing foods



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VI. Antihypertensive Medications (continued) VI. Antihypertensive Medications (continued) Osmotic diureticsOsmotic diuretics Carbonic anhydrase inhibitorsCarbonic anhydrase inhibitors Potassium-sparing diureticsPotassium-sparing diuretics

• Side effects include hyperkalemiaSide effects include hyperkalemia

• Interventions include monitoring potassium blood levelInterventions include monitoring potassium blood level



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VII. Peripherally Acting VII. Peripherally Acting -Adrenergic Blockers-Adrenergic Blockers DescriptionDescription

• Cause vasodilation and decrease the blood pressureCause vasodilation and decrease the blood pressure

• Used to treat hypertension and maintain renal blood flowUsed to treat hypertension and maintain renal blood flow Side effectsSide effects

• HypotensionHypotension

• TachycardiaTachycardia

• Sodium and water retentionSodium and water retention

• Gastrointestinal disturbancesGastrointestinal disturbances InterventionsInterventions

• Monitor blood pressure and apical heart rateMonitor blood pressure and apical heart rate

• Monitor for fluid retention and edemaMonitor for fluid retention and edema



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VIII. Centrally Acting Sympatholytics (Adrenergic VIII. Centrally Acting Sympatholytics (Adrenergic Blockers)Blockers) DescriptionDescription

• Inhibit vasoconstriction and reduce peripheral resistanceInhibit vasoconstriction and reduce peripheral resistance• Used to treat hypertensionUsed to treat hypertension

Side effectsSide effects• Sodium and water retentionSodium and water retention• BradycardiaBradycardia• HypotensionHypotension

InterventionsInterventions• Monitor blood pressure and apical heart rateMonitor blood pressure and apical heart rate• Monitor for fluid retention and edemaMonitor for fluid retention and edema• Instruct client that abrupt withdrawal can cause rebound Instruct client that abrupt withdrawal can cause rebound

hypertensionhypertension



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IX. Angiotensin-Converting Enzyme (ACE) IX. Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotension II Receptor Inhibitors and Angiotension II Receptor Blockers (ARB)Blockers (ARB) DescriptionDescription

• Prevent peripheral vasoconstrictionPrevent peripheral vasoconstriction• Used to treat hypertension and heart failureUsed to treat hypertension and heart failure

Side effectsSide effects• Persistent dry coughPersistent dry cough• HypotensionHypotension• TachycardiaTachycardia• HyperkalemiaHyperkalemia• Hypoglycemia in diabetic clientHypoglycemia in diabetic client



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continued …continued …

InterventionsInterventions• Avoid use with potassium supplements and potassium-Avoid use with potassium supplements and potassium-

sparing diureticssparing diuretics

• Monitor vital signs and for signs of hyperkalemiaMonitor vital signs and for signs of hyperkalemia

• Instruct diabetic client about the risk for hypoglycemiaInstruct diabetic client about the risk for hypoglycemia

• Instruct client to report persistent dry coughInstruct client to report persistent dry cough



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X. Antianginal MedicationsX. Antianginal Medications NitratesNitrates

• Side effectsSide effects

• Sublingual medicationsSublingual medications

• Translingual medications (spray)Translingual medications (spray)

• Sustained-release medicationsSustained-release medications

• Transmucosal-buccal medicationsTransmucosal-buccal medications

• Transdermal patchTransdermal patch

• Topical ointmentsTopical ointments

• Client educationClient education



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XI. XI. -Adrenergic Blockers-Adrenergic Blockers DescriptionDescription

• Decrease the workload of the heart and decrease myocardial Decrease the workload of the heart and decrease myocardial oxygen demandsoxygen demands

• Decrease heart rate and blood pressureDecrease heart rate and blood pressure• May mask symptoms of hypoglycemia in diabetic clientMay mask symptoms of hypoglycemia in diabetic client

Side effectsSide effects• BradycardiaBradycardia• HypotensionHypotension• BronchospasmBronchospasm

InterventionsInterventions• Monitor apical pulse rate and blood pressureMonitor apical pulse rate and blood pressure• Monitor for respiratory distress Monitor for respiratory distress • Instruct the diabetic client to monitor for signs of hypoglycemiaInstruct the diabetic client to monitor for signs of hypoglycemia



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XII. Calcium Channel BlockersXII. Calcium Channel Blockers DescriptionDescription

• Decrease the workload of the heart and decrease Decrease the workload of the heart and decrease myocardial oxygen demandsmyocardial oxygen demands

• Promote vasodilation of coronary and peripheral vesselsPromote vasodilation of coronary and peripheral vessels• Used to treat angina, dysrythmias, and hypertensionUsed to treat angina, dysrythmias, and hypertension• Used with caution in heart failure, bradycardia, or Used with caution in heart failure, bradycardia, or

atrioventricular blockatrioventricular block Side effectsSide effects

• BradycardiaBradycardia• HypotensionHypotension• Reflex tachycardiaReflex tachycardia



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InterventionsInterventions• Monitor apical heart rate and blood pressureMonitor apical heart rate and blood pressure

• Monitor for signs of heart failureMonitor for signs of heart failure

• Instruct the client to report dizziness or faintingInstruct the client to report dizziness or fainting



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XIII. Peripheral VasodilatorsXIII. Peripheral Vasodilators DescriptionDescription

• Decrease peripheral resistance Decrease peripheral resistance • Increase blood flow to extremitiesIncrease blood flow to extremities• Used to treat peripheral vascular disorders and cerebral Used to treat peripheral vascular disorders and cerebral

vascular insufficiencyvascular insufficiency Side effectsSide effects

• HypotensionHypotension• TachycardiaTachycardia• FlushingFlushing

InterventionsInterventions• Monitor apical heart rate and blood pressureMonitor apical heart rate and blood pressure• Monitor for signs of inadequate blood flow to extremitiesMonitor for signs of inadequate blood flow to extremities• Instruct client to change positions slowlyInstruct client to change positions slowly



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XIV. Direct-Acting Arteriolar VasodilatorsXIV. Direct-Acting Arteriolar Vasodilators DescriptionDescription

• Relax smooth muscles of blood vessels, resulting in Relax smooth muscles of blood vessels, resulting in vasodilationvasodilation

• Promote an increase in blood flow to the brain and Promote an increase in blood flow to the brain and kidneyskidneys

• Used to treat hypertensionUsed to treat hypertension

Side effectsSide effects• HypotensionHypotension

• Reflex tachycardiaReflex tachycardia

• EdemaEdema



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InterventionsInterventions• Monitor apical heart rate and blood pressureMonitor apical heart rate and blood pressure

• Monitor for fluid retention and edemaMonitor for fluid retention and edema

• Sodium nitroprussideSodium nitroprusside Monitor cyanide and thiocyanide for signs of toxicityMonitor cyanide and thiocyanide for signs of toxicity



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XV. Miscellaneous VasodilatorsXV. Miscellaneous Vasodilators DescriptionDescription

• Nesiritide (Natrecor) dilates arteries and veins and is Nesiritide (Natrecor) dilates arteries and veins and is used to treat decompensated heart failureused to treat decompensated heart failure

Side effectsSide effects• HypotensionHypotension

• DysrhythmiasDysrhythmias

InterventionsInterventions• Monitor apical heart rate and blood pressure, urine Monitor apical heart rate and blood pressure, urine

output, and body weightoutput, and body weight

• Monitor for signs of resolving heart failureMonitor for signs of resolving heart failure



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XVI. Antidysrhythmic MedicationsXVI. Antidysrhythmic Medications DescriptionDescription

• Suppress dysrhythmias by inhibiting abnormal pathways of Suppress dysrhythmias by inhibiting abnormal pathways of electrical conduction through the heartelectrical conduction through the heart

• Classifications Classifications Class I: sodium channel blockersClass I: sodium channel blockers Class II: beta blockersClass II: beta blockers Class III: potassium channel blockersClass III: potassium channel blockers Class IV: calcium channel blockersClass IV: calcium channel blockers

Interventions for antidysrhythmicsInterventions for antidysrhythmics• Monitor heart rate, respiratory rate, and blood pressureMonitor heart rate, respiratory rate, and blood pressure• Provide continuous cardiac monitoring Provide continuous cardiac monitoring • Administer intravenous antidysrhythmics via an infusion pumpAdminister intravenous antidysrhythmics via an infusion pump• Monitor for signs of fluid retentionMonitor for signs of fluid retention• Monitor for effective responseMonitor for effective response



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XVII. Adrenergic AgonistsXVII. Adrenergic Agonists Dobutamine hydrochlorideDobutamine hydrochloride

• Increases myocardial force and cardiac output Increases myocardial force and cardiac output Dopamine hydrochlorideDopamine hydrochloride

• Increases blood pressure (BP), cardiac output, and renal blood Increases blood pressure (BP), cardiac output, and renal blood flowflow

EpinephrineEpinephrine• Used for cardiac stimulation in cardiac arrestUsed for cardiac stimulation in cardiac arrest

Isoproterenol hydrochloride (Isuprel)Isoproterenol hydrochloride (Isuprel)• Used for cardiac stimulation and bronchodilationUsed for cardiac stimulation and bronchodilation

Norepinephrine bitartrate (Levophed)Norepinephrine bitartrate (Levophed)• Stimulates the heart in cardiac arrest and vasoconstricts and Stimulates the heart in cardiac arrest and vasoconstricts and

increases the BP in hypotension and shockincreases the BP in hypotension and shock



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XVII. Adrenergic Agonists (continued)XVII. Adrenergic Agonists (continued) Side effectsSide effects

• DysrhythmiasDysrhythmias

• AnginaAngina

• RestlessnessRestlessness

• Urgency or urinary incontinenceUrgency or urinary incontinence

InterventionsInterventions• Monitor vital signsMonitor vital signs

• Monitor urinary outputMonitor urinary output

• Monitor electrocardiogramMonitor electrocardiogram



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XVIII. Antilipemic MedicationsXVIII. Antilipemic Medications DescriptionDescription

• Reduce cholesterol, triglyceride, or low-density Reduce cholesterol, triglyceride, or low-density lipoprotein levelslipoprotein levels

Bile sequestrantsBile sequestrants• Side effectsSide effects

ConstipationConstipation

• InterventionsInterventions Increase fluid intake and high fiber dietIncrease fluid intake and high fiber diet

HMG-CoA reductase inhibitorsHMG-CoA reductase inhibitors• Side effectsSide effects

Gastrointestinal disturbances, visual disturbances, Gastrointestinal disturbances, visual disturbances, elevated serum liver enzyme levelselevated serum liver enzyme levels



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• InterventionsInterventions Instruct client to report visual problems or gastrointestinal Instruct client to report visual problems or gastrointestinal

disturbancesdisturbances



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XVIII. Antilipemic Medications (continued)XVIII. Antilipemic Medications (continued) General interventionsGeneral interventions

• Monitor serum cholesterol and triglyceride levelsMonitor serum cholesterol and triglyceride levels

• Instruct client about foods low in fat and cholesterolInstruct client about foods low in fat and cholesterol

• Instruct client to follow an exercise programInstruct client to follow an exercise program



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The nurse has reinforced discharge instructions to a client being The nurse has reinforced discharge instructions to a client being placed on long-term anticoagulant therapy with warfarin sodium placed on long-term anticoagulant therapy with warfarin sodium (Coumadin). The nurse reminds the client to do which of the (Coumadin). The nurse reminds the client to do which of the following?following?

1.1. Avoid taking products containing acetylsalicylic acid (aspirin).Avoid taking products containing acetylsalicylic acid (aspirin).2.2. Reduce alcohol intake to 12 oz daily. Reduce alcohol intake to 12 oz daily. 3.3. Take any over-the-counter medications as needed.Take any over-the-counter medications as needed.4.4. Alternate the timing of the daily dose.Alternate the timing of the daily dose.



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The nurse has an order to give a client a scheduled dose of The nurse has an order to give a client a scheduled dose of digoxin (Lanoxin). Prior to administering the medication, the digoxin (Lanoxin). Prior to administering the medication, the nurse routinely screens for which of the following manifestations nurse routinely screens for which of the following manifestations that could indicate digoxin toxicity?that could indicate digoxin toxicity?

1.1. Dyspnea, edema, and palpitations Dyspnea, edema, and palpitations

2.2. Chest pain, hypotension, and paresthesias Chest pain, hypotension, and paresthesias

3.3. Constipation, dry mouth, and sleep disorder Constipation, dry mouth, and sleep disorder

4.4. Double vision, loss of appetite, and nausea Double vision, loss of appetite, and nausea

pyramid points chapter 60: cardiovascular medications

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