Professional Documents
Culture Documents
Presented by
Marcia Cornell RN, BSN, EMT-P
Teresa Peck BSN, RN
Cardiac Anatomy
Coronary arteries
Nitrates / Vasodilators
Examples
Nitroglycerin (NTG)
Isosorbide (long-acting) (iso-Bid, Isordil, Sorbide, Srbitrate)
Nitrates / Vasodilators
Purpose / Causes
Reduce peripheral resistance
Reduce workload on heart
Provide a better balance of oxygen supply and demand
Angina attacks
MI
Nitrates / Vasodilators
Adverse Effects
Decrease in BP
Dizziness
Headache
Syncope (fainting)
Flushed face
Nitrates / Vasodilators
Nursing Interventions
Sit quietly after taking
Assess B/P
If not effective after 3 doses, seek help
Beta-Blockers
Examples
Metoprolol (Toprolol) (Lopressor)
Atenolol
Propranolol (Inderal)
Meliletine HCL (Mexitil)
Propafenone HCL (Rythmol)
Tocainide HCL (Tonocard)
Sotalol HCL (Betapace)
Acebutolol HCL (Sectral)
Esmolol HCL (Brevibloc)
Carvedilol (Coreg)
Beta-Blockers
Purpose / Causes
Tx angina, HTN, arrhythmias (SVT, VT, ST)
Block beta-adrenergic receptors
Prevent SNS from increasing heart activity
Decreases excitability of cardiac muscle
Slows HR, decreases BP
Decreases myocardial O2 demand
Beta-Blockers
Adverse Effects
Low HR
Low BP
Dizziness, fainting, headache
Beta-Blockers
Nursing Interventions
Monitor HR, BP
Monitor for diarrhea, visual disturbances, respiratory distress.
Use with caution w/ pt w/ lung dx.
Monitor for dysrhythmias, dizziness, sleep disturbances
Calcium Channel Blockers
Examples
Diltiazem (Cardizem)
Verapamil (Calan, Isoptin)
Nifedipine (Adalat)
Calcium Channel Blockers
Purpose / Causes
Block movement of calcium ions into cardiac and smooth muscle fiber.
Decrease cardiac contractility
Anti-arrhythmic excessive atrial activity
Anti-hypertensive
Vasodilator coronary arteries
Angina
Peripheral edema
Nausea/ vomiting
Tachycardia
Use caution w/ CHF
Increase toxicity of digoxin
Calcium Channel Blockers
Nursing Interventions
Monitor apical pulse and BP
Watch for dizziness
Cardioglycoside
Examples
Digoxin (Lanoxin)
Cardioglycoside
Purpose / Causes
Tx heart failure
Anti-arrhythmic atrial dysrhythmias
A-fib w/ RVR, PSVT
Slows conduction of impulses / HR
Increases contractility
Increases Cardiac Output (CO)
Cardioglycoside
Adverse Effects
Toxic S/S
Nausea / vomiting
Fatigue
Headache
Weakness
Cardioglycoside
Nursing Interventions
Observe for signs of toxicity
N/V, anorexia, dysrhythmias, bradycardia, tachycardia, HA, fatigue,
visual disturbance.
Blood levels checked
Monitor apical pulse and BP
Antihypertensives
Examples
Adrenergic blocking agents
Sympathetic blocking agents
Calcium channel blockers
Diuretics
ACE inhibitors
Antihypertensive
Purpose / Causes
Used to lower BP with minimal side effects
Inhibit SNS
Decrease sympathetic tone
Activate alpha receptors in medulla to decrease HR, BP, CO.
Antihypertensive
Adverse Effects
Decreased HR
Low BP
Nasal congestion
Reflex tachycardia
Dry mouth
Fluid retention
Depression
drowsiness
Antihypertensive
Nursing Interventions
Monitor HR, BP
Monitor Diet, Wt.
Monitor Electrolytes.
Angiotension Converting Enzyme Inhibitor / ACE Inhibitors
Examples
Enalapril (Vasotec)
Ramipril (Altace)
Captopril (Capoten)
Losartan (Cozaar)
ACE Inhibitors
Purpose / Causes
Tx HTN, CHF
Block conversion of angiotension I to angiotensin II
Reduce peripheral resistance
Reduce aldosterone secretion
Decreases preload and afterload
ACE Inhibitors
Adverse Effects
Headache
Dizziness
Hypotension
Angioedema*
COUGH
ACE Inhibitors
Nursing Interventions
Monitor HR,BP
Wt, diet
Monitor for swelling of the face
Diuretics (Water pill)
Examples
Hydrochlorothiazide (HCTZ)
Furosemide (Lasix)
Spironolactone (Aldactone)
Diuretics
Purpose / Causes
Remove excess sodium and water
Block reabsorption of sodium and water
Tx HTN, CHF
Diuretics
Adverse Effects
May remove excessive potassium
Nausea / vomiting
Diarrhea
Dizziness
Diuretics
Nursing Interventions
Monitor potassium levels
Monitor fluid intake
Monitor Wt.
Monitor urinary output
Cholesterol / Lipid lowering-STATINS
Examples
Simvastatin (Zocor)
Lipitor
Lovastatin (Mevacor)
Crestor
All of these are statins
Take on empty stomach
Anti-platelets / Anti-coagulants
Purpose / Causes
Reduce risk of blood clot formation
Block coagulation process
Coumadin interferes with vitamin K synthisis of clotting factors
ASA prevents platelet adhesion
Anti-platelets / Anti-coagulants
Adverse Effects
Bleeding
Avoid Trauma
Gastric irritation
Anti-platelets / Anti-coagulants
Nursing Interventions
Monitor clotting ability
PT / APTT
Observe for bleeding
Monitor diet for foods high in vitamin K.
Rotate injection sites if SQ
Anti-dysrhythmics
Examples
Procainamide (Pronestyl, Procan SR)
Lidocaine
Disopyramide (Norpace CR)
Quinidine sulfate (Quinidex Extentabs)
Adenosine (Adonocard)
Antidysrythmics-Oral
Norpace
Procanbid
Quinidine
Tambocor
Cordarone
Anti-dysrhythmics
Purpose / Causes
IV for severe ventricular dysrhythmias
Suppress impulse triggering dysrhythmias.
Long term tx of V-tach, a-fib
Slows conduction thru AV
Anti-dysrhythmics
Adverse Effects
Dry mouth
Blurred vision
Low BP
Nausea/vomiting
Dizziness
Visual disturbances
HA
GI discomfort
dysrythmias
Anti-dysrhythmics
Nursing Interventions
Monitor HR (apical) and BP
No caffeine within 4-6 hrs of adenocard inhibits effects
Inotropics
Examples
Dobutamine (Dobutrex) (IV)
Dopaminie (Intropin) (IV)
Inotropics
Purpose / Causes
Increases myocardial contractility
Increases cardiac output
Increases BP
Improves renal blood flow
Used w/ severe CHF/ Pulmonary Edema
Inotropics
Adverse Effects
Elevated BP, HR
Decreased peripheral circulation
Inotropics
Nursing Interventions
Monitor BP, HR, Urinary output
Palpate peripheral pulses
Notify physician if extremities are cold/mottled.
Vasopressors
Examples
NTG (IV)
Nipride (IV)
Dopamine
Levophed
Vasopressors
Purpose / Causes
Increase BP, CO
Vasopressors
Adverse Effects
HA, elevated BP
N/ V
dizziness
Vasopressors
Nursing Interventions
Monitor Vital signs
Tranquilizers / Anti - anxiety
Examples
Diazepam (valium)
Ativan
Tranquilizers
Purpose / Causes
Decrease restlessness and anxiety
Tranquilizers
Adverse Effects
Sedation
Dizziness
Tranquilizers
Nursing Interventions
Use safety precautions
Thrombolytic Agents
Examples
Streptokinase (Streptase)
Alteplase
Recombinant Activase
Tissue plasminogen activator (TPA)
Thrombolytic Agents
Purpose / Causes
Dissolves blood clots when MI S/S less then 6 hr old.
Prefer within 30 -60 min.
Restores blood flow
Limits size of infarction
Thrombolytic Agents
Adverse Effects
Bleeding
Stroke
Thrombolytic Agents
Nursing Interventions
Monitor VS, telemetry
Monitor for signs of stroke
Stool Softeners
Examples
Surfak
Colace
Stool Softeners
Purpose / Causes
Reduce straining
Prevent constipation
Stool Softeners
Adverse Effects
diarrhea
Stool Softeners
Nursing Interventions
Monitor stools
Electrolytes
Examples
Potassium
Magnesium
Calcium
Electrolytes
Purpose / Causes
Restore electrolyte balance
Electrolytes
Adverse Effects
Electrolytes
Nursing Interventions
Monitor electrolyte levels
Analgesics
Examples
Morphine
Analgesics
Purpose / Causes
Control pain
Decrease myocardial oxygen demand
Analgesics
- Adverse effects
- Low BP
- N/V
- Sedation
Analgesics
Nursing Interventions
Acute MI
M-Morphine
O- Oxygen
A-Aspirin
N-Nitroglycerin
Peripheral Vascular Medications
Trental-decreases blood viscosity, improves flow