PYRAMID POINTS CHAPTER 60 CARDIOVASCULAR MEDICATIONS PYRAMID POINTS

PYRAMID POINTS CHAPTER 60: CARDIOVASCULAR MEDICATIONS

PYRAMID POINTS I. Anticoagulants Ø Description • Prevent extension and formation of clots by inhibiting factors in clotting cascade and decreasing blood coagulability Ø Side effects Ø Heparin sodium • Bleeding • Normal activated partial thromboplastin time (a. PTT) 20 to 30 seconds • Antidote is protamine sulfate Ø Ø Enoxaprin (Lovenox) Warfarin sodium (Coumadin) • • • Normal PT is 11 to 12. 5 seconds Normal INR is 0. 7 to 1. 8 Antidote is vitamin K (phytonadione [Aqua. MEPHYTON]) ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 2

PYRAMID POINTS II. Thrombolytic Medications Ø Description • Dissolve clots Ø Contraindications • Active bleeding, stroke or other intracranial problems, surgical client, hepatic or renal disease, uncontrolled hypertension, recent cardiopulmonary resuscitation, or hypersensitivity Ø Side effects • Bleeding Ø Interventions • Monitor for bleeding • Implement bleeding precautions Ø Antidote • Aminocaproic acid (Amicar) is antidote for streptokinase ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 3

PYRAMID POINTS III. Antiplatelet Medications Description • Inhibit aggregation of platelets and prolong bleeding time Ø Side effects • Bleeding Ø Interventions • Monitor for bleeding • Implement bleeding precautions Ø ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 4

PYRAMID POINTS IV. Positive Inotropic-Cardiotonic Medications Description • Stimulate myocardial contractility Ø Side effects • Dysrythmias, hypotension, thrombocytopenia Ø Toxic, adverse reactions • Hepatotoxocity, hypersensitivity Ø Interventions • Monitor for side effects and adverse effects • Monitor pulse and blood pressure closely Ø ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 5

PYRAMID POINTS V. Cardiac Glycosides Ø Description • Increases the force of myocardial contraction and slows the heart rate Ø Side effects, toxic effects • Gastrointestinal disturbances (anorexia, nausea, vomiting, diarrhea) • Visual disturbances • Bradycardia Ø Interventions • • • Monitor for toxicity; digoxin level above 2 ng/m. L Monitor potassium level for hypokalemia Monitor apical pulse; if less than 60/min, hold medication, notify physician ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 6

PYRAMID POINTS VI. Antihypertensive Medications Ø Thiazide diuretics • Side effects include hypercalcemia, hyperglycemia, hyperuricemia, hypokalemia, hyponatremia, hypovolemia • Interventions include monitoring vital signs, appropriate laboratory values, intake and output (I&O); intake of potassiumcontaining foods Ø Loop diuretics • Side effects include hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, orthostatic hypotension • Interventions include monitoring vital signs, appropriate laboratory values, I&O; intake of potassium-containing foods ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 7

PYRAMID POINTS VI. Antihypertensive Medications (continued) Osmotic diuretics Ø Carbonic anhydrase inhibitors Ø Potassium-sparing diuretics • Side effects include hyperkalemia • Interventions include monitoring potassium blood level Ø ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 8

PYRAMID POINTS VII. Peripherally Acting -Adrenergic Blockers Ø Description • Cause vasodilation and decrease the blood pressure • Used to treat hypertension and maintain renal blood flow Ø Side effects • • Ø Hypotension Tachycardia Sodium and water retention Gastrointestinal disturbances Interventions • Monitor blood pressure and apical heart rate • Monitor fluid retention and edema ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 9

PYRAMID POINTS VIII. Centrally Acting Sympatholytics (Adrenergic Blockers) Ø Description • Inhibit vasoconstriction and reduce peripheral resistance • Used to treat hypertension Ø Side effects • Sodium and water retention • Bradycardia • Hypotension Ø Interventions • Monitor blood pressure and apical heart rate • Monitor fluid retention and edema • Instruct client that abrupt withdrawal can cause rebound hypertension ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 10

PYRAMID POINTS IX. Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotension II Receptor Blockers (ARB) Description • Prevent peripheral vasoconstriction • Used to treat hypertension and heart failure Ø Side effects • Persistent dry cough • Hypotension • Tachycardia • Hyperkalemia • Hypoglycemia in diabetic client Ø ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 11

PYRAMID POINTS continued … Ø Interventions • Avoid use with potassium supplements and potassium • • • sparing diuretics Monitor vital signs and for signs of hyperkalemia Instruct diabetic client about the risk for hypoglycemia Instruct client to report persistent dry cough ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 12

PYRAMID POINTS X. Antianginal Medications Ø Nitrates • Side effects • Sublingual medications • Translingual medications (spray) • Sustained-release medications • Transmucosal-buccal medications • Transdermal patch • Topical ointments • Client education ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 13

PYRAMID POINTS XI. -Adrenergic Blockers Ø Description • Decrease the workload of the heart and decrease myocardial oxygen demands • Decrease heart rate and blood pressure • May mask symptoms of hypoglycemia in diabetic client Ø Ø Side effects • • • Bradycardia Hypotension Bronchospasm Interventions • Monitor apical pulse rate and blood pressure • Monitor for respiratory distress • Instruct the diabetic client to monitor for signs of hypoglycemia ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 14

PYRAMID POINTS XII. Calcium Channel Blockers Ø Description • Decrease the workload of the heart and decrease • • • Ø myocardial oxygen demands Promote vasodilation of coronary and peripheral vessels Used to treat angina, dysrythmias, and hypertension Used with caution in heart failure, bradycardia, or atrioventricular block Side effects • Bradycardia • Hypotension • Reflex tachycardia ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 15

PYRAMID POINTS continued … Ø Interventions • Monitor apical heart rate and blood pressure • Monitor for signs of heart failure • Instruct the client to report dizziness or fainting ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 16

PYRAMID POINTS XIII. Peripheral Vasodilators Ø Description • Decrease peripheral resistance • Increase blood flow to extremities • Used to treat peripheral vascular disorders and cerebral vascular insufficiency Ø Side effects • Hypotension • Tachycardia • Flushing Ø Interventions • • • Monitor apical heart rate and blood pressure Monitor for signs of inadequate blood flow to extremities Instruct client to change positions slowly ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 17

PYRAMID POINTS XIV. Direct-Acting Arteriolar Vasodilators Ø Description • Relax smooth muscles of blood vessels, resulting in vasodilation • Promote an increase in blood flow to the brain and kidneys • Used to treat hypertension Ø Side effects • Hypotension • Reflex tachycardia • Edema ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 18

PYRAMID POINTS continued … Ø Interventions • Monitor apical heart rate and blood pressure • Monitor fluid retention and edema • Sodium nitroprusside Monitor cyanide and thiocyanide for signs of toxicity ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 19

PYRAMID POINTS XV. Miscellaneous Vasodilators Ø Description • Nesiritide (Natrecor) dilates arteries and veins and is used to treat decompensated heart failure Side effects • Hypotension • Dysrhythmias Ø Interventions • Monitor apical heart rate and blood pressure, urine Ø output, and body weight • Monitor for signs of resolving heart failure ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 20

PYRAMID POINTS XVI. Antidysrhythmic Medications Ø Description • Suppress dysrhythmias by inhibiting abnormal pathways of electrical conduction through the heart • Classifications Ø Class I: sodium channel blockers Class II: beta blockers Class III: potassium channel blockers Class IV: calcium channel blockers Interventions for antidysrhythmics • • • Monitor heart rate, respiratory rate, and blood pressure Provide continuous cardiac monitoring Administer intravenous antidysrhythmics via an infusion pump Monitor for signs of fluid retention Monitor for effective response ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 21

PYRAMID POINTS XVII. Adrenergic Agonists Ø Dobutamine hydrochloride • Increases myocardial force and cardiac output Ø Dopamine hydrochloride • Increases blood pressure (BP), cardiac output, and renal blood flow Ø Epinephrine • Used for cardiac stimulation in cardiac arrest Ø Isoproterenol hydrochloride (Isuprel) • Used for cardiac stimulation and bronchodilation Ø Norepinephrine bitartrate (Levophed) • Stimulates the heart in cardiac arrest and vasoconstricts and increases the BP in hypotension and shock ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 22

PYRAMID POINTS XVII. Adrenergic Agonists (continued) Side effects • Dysrhythmias • Angina • Restlessness • Urgency or urinary incontinence Ø Interventions • Monitor vital signs • Monitor urinary output • Monitor electrocardiogram Ø ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 23

PYRAMID POINTS XVIII. Antilipemic Medications Ø Description • Reduce cholesterol, triglyceride, or low-density lipoprotein levels Ø Bile sequestrants • Side effects Constipation • Interventions Ø Increase fluid intake and high fiber diet HMG-Co. A reductase inhibitors • Side effects Gastrointestinal disturbances, visual disturbances, elevated serum liver enzyme levels ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 24

PYRAMID POINTS continued … • Interventions Instruct client to report visual problems or gastrointestinal disturbances ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 25

PYRAMID POINTS XVIII. Antilipemic Medications (continued) Ø General interventions • Monitor serum cholesterol and triglyceride levels • Instruct client about foods low in fat and cholesterol • Instruct client to follow an exercise program ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 26

The nurse has reinforced discharge instructions to a client being placed on long-term anticoagulant therapy with warfarin sodium (Coumadin). The nurse reminds the client to do which of the following? 1. 2. 3. 4. Avoid taking products containing acetylsalicylic acid (aspirin). Reduce alcohol intake to 12 oz daily. Take any over-the-counter medications as needed. Alternate the timing of the daily dose. ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 27

The nurse has an order to give a client a scheduled dose of digoxin (Lanoxin). Prior to administering the medication, the nurse routinely screens for which of the following manifestations that could indicate digoxin toxicity? 1. 2. 3. 4. Dyspnea, edema, and palpitations Chest pain, hypotension, and paresthesias Constipation, dry mouth, and sleep disorder Double vision, loss of appetite, and nausea ADULT HEALTH: Cardiovascular Medications Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 28