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CARDIAC SYSTEM MEDICATIONS

CARDIAC
MEDICATIONS

COMMON USES

WHAT I NEED TO KNOW AS A BRAND NEW


NURSE

Cardiac Glycosides

Indicated for the treatment of


heart failure and dysrhythmias

* Monitor Digoxin levels, therapeutic levels should be between 0.52ng/ml.


* Monitor K+, low serum potassium levels can increase the potential
for toxicity.
* Monitor pulse and teach patient to take their pulse. Hold for pulse
< 60 BPM in adults.
* Administer IV doses slowly over 5 minutes
* A loading or Digitalizing dose may be given to get the serum
levels within therapeutic range.
*Common adverse effects include fatigue, anorexia and bradycardia.
Monitor for signs of toxicity which include: HA, vertigo,
photophobia, yellow-green halos, tachycardia and AV heart block
* Antidote: Digibind

Indicated for the short-term


management of heart failure.

* Adverse effects include ventricular arrhythmias, hypotension,


chest pain, HA, hypokalemia, tremors and thrombocytopenia.
* Due to risk of toxicity theses are generally reserved for patients
who do not respond to cardiac glycosides ore ACE inhibitors

Indicated for acute treatment


of heart failure in patients with
dyspnea at rest and/or minimal
activity.

* Common adverse effects include cardiac arrhythmias,


hypotension, HA, fainting, and anxiety.
* Reduce dose or stop administration with hypotension
* Obtain a baseline creatinine level and continue to monitor, can be
nephrotoxic with acutely decompensated heart failure.

Common Examples:
Digoxin (Lanoxin, Digitek)

Phosphodiesterase
Inhibitors
Common Examples:
Milrinone (Primacor)
Inamrinone (Inocor)

Direct Vasodilators
Nesiritide (Natrecor)

CARDIAC
MEDICATIONS

COMMON USES

WHAT I NEED TO KNOW AS A BRAND NEW


NURSE

Organic Nitrate/Vasodilator

Indicated for the treatment of


stable and unstable angina.
Rapid acting forms are
indicated for the management
of acute angina episodes and
long acting forms are used for
the prevention of angina
attacks.

* HA is the most commonly reported adverse effect, others


include hypotension, tachycardia and contact dermatitis with
topical forms.
*Contraindicated with preexisting hypotension, head trauma or
increased intracranial pressure, and pericardial tamponaade.
*Adequate hydration status required for administration
* For IV administration: use IV pump, hold for systolic BP <
100
* For sublingual administration: store in dark, light resistant
container, replace supply every 6 months, may administer up to
3 tabs SL
* For topical administration: apply with gloves, use non-hairy
sites and rotate sites, avoid lower extremities

Indicated for the treatment of


angina, particularly angina
caused by exercise. Mainstay
treatment for the management
of hypertension, cardiac
dysrhythmias and MI.

*Well tolerated at low doses


* Adverse effects include: bradycardia, hypotension, second and
third degree heart block, fatigue, lethargy, depression, wheezing,
dyspnea, impotence and decreased libido, altered glucose and
lipid metabolism.
* Hold for HR < 60
* Withdraw gradually to avoid rebound hypertension, angina and
MI.
* Periodically monitor blood sugar, cholesterol and triglycerides.
* Use with caution in patient with history of asthma or diabetes

Common Examples:
Nitroglycerin (Nitro-Bid), Isosorbide
(Isordi)

Beta-adrenergic Antagonists
(Beta Blockers)
Common Examples:
Atenlol (Tenormin), Metoprolol
(Lopressor), Propanolol (Inderal)

Unlabeled uses include


migraines, and tachycardia
associated with stage fright.

CARDIAC
MEDICATIONS

COMMON USES

WHAT I NEED TO KNOW AS A BRAND NEW


NURSE

Calcium Channel Blockers

Indicated for the management


of angina, hypertension and
dysrhythmias. Also indicated
for migraines and Raynauds
disease.

* Adverse effects include: bradycardia or tachycardia, heart


block, hypotension, dyspnea, wheezing, GI complaints and
dermatitis.
*Reduce dose with known liver disease and use caution
* Taper dose

Antihypertensive.
Management of opiod
withdrawal.

* Orthostatic hypotension is a common adverse effect, other


adverse effects include bradycardia, reflex tachycardia, sedation,
dizziness and HA.
* Do not discontinue abruptly.
* Aldomet often prescribed for pregnancy induced hypertension

Indicated for hypertension MI


and heart failure.

* Adverse effects are generally mild and include dizziness,


fatigue, HA, hypotension, dry nonproductive cough, chest pain,
tachycardia, hyperkalemia, hypermagnesemia.
*Serious but rare adverse effect: Angioedema
* Monitor K+ and Mg levels.
*Enhance the effects of thiazide diuretics

Antihypertensive, adjunctive
therapy for heart failure.

* Adverse effects are generally mild and include HA, upper


respiratory infections, dizziness, GI complaints and fatigue.
* Potent vasodilator.
* Often used in combination therapy for the management of
hypertension

Common Examples:
Amlodipine (Norvasc), Diltiazem
(Cardizem),Ranolazine (Ranexa)

Alpha Adrenergic Agonists


Common Examples:
Clonidine (Catapres)
Methyldopa (Aldomet)

Angiotensin-converting enzyme
(ACE) Inhibitors
Common Examples:
Captopril (Capoten), Enalapril
(Vasotec), Lisinopril (Zestril, Prinivil)
Moexpril (Univasc) Ramipril (Altace)

Angiotensin II Receptor
Blockers (ARBS)
Common Examples:
Losartan (Cozaar), Olmesartan
(Benicar), Valsartan (Diovan)

CARDIAC
MEDICATIONS

COMMON USES

WHAT I NEED TO KNOW AS A BRAND NEW


NURSE

Direct-Acting Vasodilators

Antihypertensive

* Adverse effects include HA, dizziness, reflex tachycardia,


hypotension, rebound hypertension, hyperglycemia, Na+ and
water retention
* Monitor I & O, blood glucose
* Nipride indicated for emergency management of hypertension,
titrated IV infusion. Monitor VS frequently with continuous
cardiac monitoring.
*Adverse effects eliminate use as drugs of first choice.

Common Examples:
Hydralazine (Apresoline), Nitroprusside
(Nipride)

Diuretics
*See Renal System*

Antihypertensive