1 COMMON USED CARDIAC MEDICATIONS By: Lisa Nie RN, MSN, CMSRN Clinical Nurse Specialist in Cardiology

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

5 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. heartcontractheartcontract  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 cardiac outputcardiac output

6 Cardiac Medications Overview  Drug therapy for CAD

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

8 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

9 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

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

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

13 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

14 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

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16 Indications  Hypertension  Angina secondary to atherosclerosis  Cardiac arrhythmias, especially: SVT, VT (induced by digitalis)  Prevention of another MI

17 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).

18 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

19 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

20 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

21 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

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

23 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

24 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.

25 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.

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30 Prinzmetal's angina (variant angina)  What can you tell about Prinzmetal’s angina?  How is it different from typical angina?

31  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

32  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.

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34 QEUSTIONS??????