Docstoc

cardiacmeds COMMON USED CARDIAC MEDICATIONS

Document Sample
cardiacmeds COMMON USED CARDIAC MEDICATIONS Powered By Docstoc
					COMMON USED
CARDIAC MEDICATIONS


       By: Lisa Nie
    RN, MSN, CMSRN
 Clinical Nurse Specialist
        in Cardiology


                             1
2
3
Preload
  Preload is the volume of
   blood present in a ventricle of
   the heart, after passive filling
   and atrial contraction.
  most accurately described as
   the initial stretching of a single
   cardiac myocyte prior to
   contraction
  Preload is affected by venous
   blood pressure and the rate of
   venous return. These are
   affected by venous tone and
   volume of circulating blood.

                                        4
Afterload (Ventricular systole. Red arrow is
path from left ventricle to aorta. Afterload is largely

dependent upon aortic pressure.

   Afterload is used to mean the
    tension produced by a chamber
    of the heart in order to contract.
   Afterload can also be described
    as the pressure that the
    chamber of the heart has to
    generate in order to eject blood
    out of the chamber. Everything
    else held equal, as afterload
    increases, cardiac output
    decreases
                                                          5
Cardiac Medications
Overview
  Drug therapy for
   CAD




                      6
Antiplatelet aggregation
therapy
  The 1st line of
   pharmacologic
   intervention in the
   treatment of angina.
  Common meds:
    Aspirin
    Plavix



                           7
Indications

  Reduces atherosclerotic events in
   patients with documented atherosclerosis
   by recent CVA, MI or Peripheral artery
   disease (PAD).
  Reduces atherosclerotic events in
   patients with ACS (acute coronary
   syndrome) such as PTCA with or without
   stent placement or CABG
                                          8
Nursing Intervention

  Use in caution in patients at risk for
   bleeding
  Platelet aggregation will not return to
   normal for at least 5 days once drug in
   stopped




                                             9
              Nitrates

 Vasodilators
 2nd line of
  pharmacologic
  intervention
 Decrease O2
  demand and allow
  more blood to
  coronary arteries
 Nitroglycerin

                         10
11
Indications

  Prophylaxis to prevent or
   decrease anginal attacks
   from stressful events or
   against chronic anginal
   attacks.
  Heart failure after an MI

                               12
Nursing Interventions
  Use with caution with patients with volume
   depletion or hypotension
  Monitor VS closely
  For the ointment, measure the prescribed
   amount on the application paper, place on a
   hairless area, don’t rub in, and cover. Remove
   all excess ointment from previous site before
   applying the next dose.
  Remove patch before defibrillation

                                                13
Beta-adrenergic Blockers

  Direct decrease in myocardial
   contractility, HR, BP all of which
   reduce the myocardial O2 demand
  Decrease morbidity and mortality
   rates in pts with CAD (e.g. AMI)
  Atenolol, Coreg, Toprol XL, Inderal




                                         14
15
Indications
  Hypertension
  Angina secondary to
   atherosclerosis
  Cardiac arrhythmias,
   especially: SVT, VT
   (induced by digitalis)
  Prevention of another
   MI
                            16
Nursing Intervention
  Monitor BP, HR
  Monitor activity tolerance
  Monitor liver enzymes, renal function studies
  Instruct patient to change positions slowly to
   avoid syncope episodes
  Monitor for S/S of respiratory distress
  Monitor for hyper and hypoglycemia
  Take with foods to decrease GI side effect
   (nausea, diarrhea).
                                                    17
Calcium Channel Blocking
Agents
  Systemic vasodilation
  Decreased myoardial contractility
  Coronary vasodilation
  Depressant effect on the SA node rate of
   discharge, and the condution velocity
   through the AV node, thus slowing the
   HR.
  Carizem, Norvasc, Verapamil, plendil
                                          18
Indications

  Hypertension
  Prinzmetal’s angina:
       Chest pain caused by vasospasm of the coronary
        arteries usually occurring at rest rather than
        during exercise.
  Chronic stable angina
  A-fib or flutter; Paroxysmal
   supraventricular tachycardia
                                                    19
Nursing Interventions

  Monitor BP, HR, heart rhythm
  Monitor liver enzymes, renal function
  Do not chew or divide, sustained-release
   tabs (SR or XL tabs)
  Take with food to increase absorption
  Assure stool softener is ordered to
   prevent constipation
                                          20
Positive Inotropics Drugs

  Increase the heart’s pumping
   action (contractility) and slow
   down the electrical
   conduction of the heart.
  Slowing of HR
  Decrease velocity through
   AV node
  Digitalis

                                     21
Indications

  Heart failure
  Atrial fibrillation & Flutter
  Paroxysmal
   Supraventricular
   Tachycardia (PSVT)



                                   22
Nursing Interventions

  Monitor renal function studies:
    Renal impairment leads to decrease excretion of
     Digoxin: Dig toxicity (altered color perception, see
     yellow-green halos around visual images, or feel
     weak or dizzy. Notify MD immediately if you notice
     any of these changes)
  Monitor electrolyte levels:
    K+ predisposes the patient to Dig toxicity
    Mg++ predisposes the patient to Dig toxicity

                                                            23
Con. Nursing Interventions

  Monitor rhythm
    Prolonging of PR
    ST wave depression from baseline
    AV block
  Assess apical pulse before administration, hold
   & call MD for HR < 60.
  Call monitor tech immediately before beginning
   IV push, administer IV Dig slowly over 5 min or
   longer.

                                                 24
Angiotensin-Converting
Enzyme (ACE) Inhibitors
  Decrease high BP and prevent or treat
   CHF
  Improve blood flow in blood vessels
   throughout the body
  ACEIs block the body’s production of
   angiotensin, a chemical that causes the
   blood vessels to constrict.

                                             25
26
27
28
29
Prinzmetal's angina
(variant angina)
  What can you tell
   about Prinzmetal’s
   angina?
  How is it different
   from typical angina?




                          30
 Prinzmetal’s angina, also called variant
  angina, is chest pain (angina) that occurs
  at rest for no apparent reason – unlike
  typical angina which usually follows
  physical exertion. Attacks of Prinzmetal’s
  angina are brief but painful and occur
  most often at night

                                           31
 The cause of Prinzmetal’s angina is a coronary
  artery spasm, in which the walls of the artery
  briefly narrow (constrict). This temporarily
  reduces or obstructs blood flow to the heart
  muscle, resulting in chest pain. Coronary artery
  spasms can be associated with
  atherosclerosis.
 Treatment of Prinzmetal’s angina is directed at
  the underlying cause, such as atherosclerosis.
                                                32
33
QEUSTIONS??????




                  34

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:58
posted:3/23/2011
language:English
pages:34