Antidysrhythmic Drugs
Sodium Channel Blocker
Adverse effect: Lupus effect
Administer in the supine position due to severe hypotension *DO NOT give in pts with AV block, heart failure, or renal impariment
Monitor ECG, hypotension, and changes in consciousness
Avoid alcohol
Procainamide
IV Anticoagulant
Inactivates several clotting factors
Low doses prevent thromboembolic events, high doses treat conditions
Adverse effects: heparin-induced thrombocytopenia (HIT) causes an increase in thromboembolic events in 30% of patients
No active bleeding can be present when giving
Herparin
silent killer; most people dont know they have hypertension
Cardiac output: medications that effect CO, stroke volume, or heart rate will affect BP
Peripheral resistance: autonomic nervous system plays a role in regulating peripheral resistance
uncontrolled diabetes = increased blood viscosity
high BP hurts little vessels; 1 lane roads in heart, brain, kidneys, and retinas
Hypertension
Inability of ventricles to pump enough blood
Weakening of muscles due to aging or disease
No cure, only prevention or slowing of progression
Left-side = lungs *more common
Right-side = veins
Antidysrhythmic Drug
Decreases automaticity and slows conduction
Used for atrial dysrhythmia
Adverse effects: visual distrubances = digoxin toxicity
Monitor HR and BP
Assess CO and ECG
Digoxin (Lanoxin)
Slow HR and reduces contractility
If HR is less than 60, CALL TO VERIFY
Abrupt discontinuation can cause MI, severe hypertension, and ventricular dysrhythmias
Contraindications: no pt with heart failure, bradycardia, hypotension or asthma
Oral Anticoagulant
Used for prevention of stroke, MI, DVT and pulmonary embolism
Routine labs (PT and INR)
Takes several days to take effect; can overlap with Heparin
Pregnancy Category - X
Extenisve protein binding; multiple drug interactions DOES NOT PLAY NICE pt should not take any other drugs unless approved
Internal bleeding may cause lumbar pain or abdominal bulging
Warfarom (Coumadin)
Calcium channel blocker
used for hypertension and angina
No pt with heart block or heart failure; can cause or worsen heart failure
Check ECG, HR, and BP
Administer whole
No grapefruit juice
Nifedipine
Myocardial fiber stretching prior to contracting
Frank-Starlin law: the more fibers are stretched, the more forceful contraction
Drugs that increase preload will increase cardiac output
Preload
ACE inhibitor (golden child)
Takes 2 to 3 weeks for maximum effectiveness
Assess BP before giving
*BLACK BOX: discontinue as soon as you find out about pregnancy
Avoid excessive intake of potassium rich foods due to hyperkalemia risk
Lisinopril (prinivil, zestril)
Potassium Channel Blocker
Adverse effects: potentially fatal pneumonia like syndrome, can create new or worsening dysrhythmias
Hypokalemia should be corrected before taking drugs
Amiodarone (Cordarone, Pacerone)
Antiplatelet drug;makes platelets less sticky
Discontinue drug 5 days prior to surgery
Do not give to pt with active bleeding
GARLIC, if not eaten regularly, make increase risk of bleeding
Clopidogrel (Plavix)
Angiotensin II receptor blocker -ARB
blocks vasoconstriction
may cause orthostatic hypotension
Pregnancy category X
Losartan (cozaar)
Affects CO
Pressure in aorta that must be overcome before blood is ejected from left ventricle
Lowering BP creates less afterload = less cardiac workload
Afterload
Cardiac glycosides
increases contractility and improves cardiac output
Adverse effects: digitalis toxicity
Less than 60 hold does and call provider
Check serum digoxin levels for toxicity
Adverse effects: hypotension, bradycardia
NO pt with heart block or heart failure; can cause or worsen heart failure
no grapefruit juice
Calcium Channel Blocker (safest)
Thrombolytic; dissolves life-threatening clots
Used to treat acute MI, DVT
Contraindications: pt. with bleeding disorders, recent surgery, active bleeding, history of stroke or head injury within 3 months, severe hypertension
Whole checklist to ensure pt can have this drug
Pt must be observed overnight for reperfusion dysrhythmia
Alteplase (Activase)
Alpha I adrenergic blockers
Not used as 1st line
First dose phenomena: monitor for hypotension and syncope 2-6 hours after administration
Hold medication for pulse below 60 or BP below 90/60
Doxazosin (Cardura)
Phosphodiesterase Inhibitor
decreases afterload
Short term - only used for stabilization before heart transplant
Milrinone (primacor)
descreses automaticity and slows conduction
Monitor HR and BP
Assess CO and ECG
Adenosine (Adenocard)
Hemostatic; promotes formation and stabilization of clots
Can be given IV to reduce bleeding in 1 to 2 hours
Most used for postoperative bleeding
Hypercoagulation may occur with use of estrogenic oral contraceptives
Aminocaproic Acid (amicar)
Direct acting vasodilator
Only used for severe hypertension
Abrupt withdrawal can cause rebound hypertension and anxiety
hypertension drugs can cause sexual dysfunction related to side effects
Hydralazine (apresoline)
Beta blocker
Slows HR and BP; reduces cardiac workload
Not used much in HF due to risk of worsening
NO asthma due to bronchospasm
BLACK BOX: do not discontinue abruptly
Metoprolol (Lopressor, Troprol)