Thromboembolic
Antiplatelet Meds
Action: Suppress platelet aggregation
Primary Indication: Prevent thrombosis in arteries
Examples from Reading: Aspirin, Clopidogrel
Two types of dysrhthymias
tachydysrhythmias (dysrhythmias in which heart rate is increased)
bradydysrhythmias (dysrhythmias in which heart rate is slowed)
ACE Inhibitors
End in 'pril'
Action: reduce angiotensin II and increase levels of bradykinin (natural vasodilator and mild diuretic)
Indications: Hypertension, heart failure, MI, LV dysfunction, & nephropathy
Adverse effects: First-dose hypotension, cough, hyperkalemia, renal failure, Fetal injury, angioedema.
Anticoagulants
Action: Reduce formation of fibrin
Primary Indication: Prevent thrombosis in veins, hip surgery
Examples from Reading: Heparin (unfractionated), Low-molecular weight heparin (enoxaparin [Lovenox]),Warfarin
Reversal Agents: Heparin-Protamine sulfate
Warfarin-Vitamin K
Atrial Fibrillation
Treatment goals: Improve ventricular pumping and prevent stroke.
Ways to improve pumping: restore normal sinus rhythm (cardioversion) or slow ventricular rate (beta-blocker)
Ways to prevent stroke: warfarin or newer anticoagulants (apixaban [Eliquis], dabigatran [Pradaxa], edoxaban [Savaysa], and rivaroxaban [Xarelto]) and antiplatelet drugs (aspirin alone or aspirin plus clopidogrel).
Angiotensin II Receptor Blockers
Action: decrease influence of angiotensin II
Indications: Hypertension, heart failure, diabetic nephropathy, MI, Stroke prevention (losartan), prevent MI, stroke, & death in CVD pts (telmisartan [micardis] if intolerant to ACEIs)
Adverse effects: angioedema, fetal harm, renal failure
Thrombolytic Drugs
Action: Break down clots
Primary indications: Acute MI, pulmonary embolus, & ischemic stroke.
Examples from Reading: Alteplase (tPA), Streptokinase
Atrial Flutter
Treatment of choice is DC cardioversion
Two alternatives to cardioversion: (1) RF ablation of the dysrhythmia focus and (2) control of ventricular rate with drugs. As with atrial fibrillation, ventricular rate is controlled with drugs that suppress AV conduction: verapamil, diltiazem, or a beta blocker
Beta-Blockers
End in 'lol'
Action: blockade of cardiac beta1 receptors-decrease heart rate and contractility, decrease AV conduction
Adverse effects: bradycardia, bronchoconstriction, mask signs of hypoglycemia, orthostatic hypotension
Black box warning - abrupt withdrawal can lead to angina, MI, ischemia, dysrhythmias
Direct thrombin inhibitors
Action: Binds with and inhibits thrombin that is free in the blood, as well as thrombin that is bound to clots.
Indications:AFib, Knee or hip replacement (prevent VTE), DVT/PE treatment
Examples from reading: dabigatran
Reversal agent: Idarucizumab
Owing to bleeding risk, dabigatran should be stopped before elective surgery. For patients with normal renal function (CrCl 50 mL/min or higher), dosing should stop 1 or 2 days before surgery. For patients with renal impairment (CrCl below 50 mL/min), dosing should stop 3 to 5 days before surgery.
Sustained VT
Immediate cardioversion is the treatment of choice. If cardioversion fails to normalize rhythm, IV procainamide should be administered; lidocaine and amiodarone are alternatives
Calcium channel blockers
Agents That Affect the Heart and Blood Vessels
Verapamil and diltiazem act on arterioles and the heart
Indications: angina pectoris, essential hypertension, and cardiac dysrhythmias
Examples: Verapamil, Nifedipine
Adverse effects/SE: Constipation, dizziness, facial flushing, headache, and edema of the ankles and feet
Ischemic Therapy consists of:
Anti-ischemic therapy: Nitroglycerin, Beta blocker, O2, IV morphine, ACE inhibitor
Antiplatelet therapy: Aspirin, clopidogrel (or alternate antiplatelet)
Supraventricular Tachycardia (SVT)
Carotid sinus massage or the Valsalva maneuver
If ineffective, an IV beta blocker or calcium channel blocker can be tried.
Amiodarone as a last resort
Direct Renin Inhibitor
Action:
Indications: Reduction of blood pressure in patients with hypertension
Examples: Aliskiren
Adverse Reactions/Side Effects: Hyperkalemia, fetal injury, angioedema