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COMMON USED COMMON USED CARDIAC MEDICATIONSCARDIAC MEDICATIONS

By: Lisa NieBy: Lisa Nie

RN, MSN, CMSRNRN, MSN, CMSRN

Clinical Nurse Specialist Clinical Nurse Specialist

in Cardiology in Cardiology

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Preload Preload

PreloadPreload is the volume of is the volume of blood present in a blood present in a ventricle of of the the heart, after passive filling , after passive filling and and atrial contraction. contraction.

most accurately described as most accurately described as the initial stretching of a single the initial stretching of a single cardiac myocyte prior to prior to contraction contraction

Preload is affected by venous Preload is affected by venous blood pressure and the rate of blood pressure and the rate of venous return. These are venous return. These are affected by venous tone and affected by venous tone and volume of circulating blood.volume of circulating blood.

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Afterload (Afterload (Ventricular systole. Red arrow is Ventricular systole. Red arrow is path from left ventricle to aorta. Afterload is largely path from left ventricle to aorta. Afterload is largely

dependent upon aortic pressure.dependent upon aortic pressure. AfterloadAfterload is used to mean the is used to mean the

tension produced by a chamber tension produced by a chamber of the of the heart in order to in order to contract. .

Afterload can also be described Afterload can also be described as the pressure that the as the pressure that the chamber of the heart has to chamber of the heart has to generate in order to eject blood generate in order to eject blood out of the chamber. Everything out of the chamber. Everything else held equal, as afterload else held equal, as afterload increases, increases, cardiac output decreases decreases

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Cardiac Medications Cardiac Medications OverviewOverview

Drug therapy for Drug therapy for CAD CAD

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Antiplatelet aggregation Antiplatelet aggregation therapy therapy

The 1The 1stst line of line of pharmacologic pharmacologic intervention in the intervention in the treatment of angina. treatment of angina.

Common meds:Common meds: AspirinAspirin Plavix Plavix

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Indications Indications

Reduces atherosclerotic events in Reduces atherosclerotic events in patients with documented atherosclerosis patients with documented atherosclerosis by recent CVA, MI or Peripheral artery by recent CVA, MI or Peripheral artery disease (PAD). disease (PAD).

Reduces atherosclerotic events in Reduces atherosclerotic events in patients with ACS (acute coronary patients with ACS (acute coronary syndrome) such as PTCA with or without syndrome) such as PTCA with or without stent placement or CABGstent placement or CABG

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Nursing Intervention Nursing Intervention

Use in caution in patients at risk for Use in caution in patients at risk for bleeding bleeding

Platelet aggregation will not return to Platelet aggregation will not return to normal for at least 5 days once drug in normal for at least 5 days once drug in stoppedstopped

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Nitrates Nitrates

VasodilatorsVasodilators 22ndnd line of line of

pharmacologic pharmacologic interventionintervention

Decrease O2 Decrease O2 demand and allow demand and allow more blood to more blood to coronary arteries coronary arteries

Nitroglycerin Nitroglycerin

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Indications Indications

Prophylaxis to prevent or Prophylaxis to prevent or decrease anginal attacks decrease anginal attacks from stressful events or from stressful events or against chronic anginal against chronic anginal attacks. attacks.

Heart failure after an MIHeart failure after an MI

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Nursing InterventionsNursing Interventions

Use with caution with patients with volume Use with caution with patients with volume depletion or hypotensiondepletion or hypotension

Monitor VS closelyMonitor VS closely For the ointment, measure the prescribed For the ointment, measure the prescribed

amount on the application paper, place on a amount on the application paper, place on a hairless area, don’t rub in, and cover. Remove hairless area, don’t rub in, and cover. Remove all excess ointment from previous site before all excess ointment from previous site before applying the next dose. applying the next dose.

Remove patch before defibrillation Remove patch before defibrillation

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Beta-adrenergic Blockers Beta-adrenergic Blockers

Direct decrease in myocardial Direct decrease in myocardial contractility, HR, BP all of which contractility, HR, BP all of which reduce the myocardial O2 demandreduce the myocardial O2 demand

Decrease morbidity and mortality Decrease morbidity and mortality rates in pts with CAD (e.g. AMI)rates in pts with CAD (e.g. AMI)

Atenolol, Coreg, Toprol XL, Inderal Atenolol, Coreg, Toprol XL, Inderal

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Indications Indications

HypertensionHypertension Angina secondary to Angina secondary to

atherosclerosisatherosclerosis Cardiac arrhythmias, Cardiac arrhythmias,

especially: SVT, VT especially: SVT, VT (induced by digitalis)(induced by digitalis)

Prevention of another Prevention of another MIMI

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Nursing Intervention Nursing Intervention

Monitor BP, HRMonitor BP, HR Monitor activity toleranceMonitor activity tolerance Monitor liver enzymes, renal function studiesMonitor liver enzymes, renal function studies Instruct patient to change positions slowly to Instruct patient to change positions slowly to

avoid syncope episodesavoid syncope episodes Monitor for S/S of respiratory distressMonitor for S/S of respiratory distress Monitor for hyper and hypoglycemiaMonitor for hyper and hypoglycemia Take with foods to decrease GI side effect Take with foods to decrease GI side effect

(nausea, diarrhea). (nausea, diarrhea).

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Calcium Channel Blocking Calcium Channel Blocking AgentsAgents

Systemic vasodilationSystemic vasodilation Decreased myoardial contractilityDecreased myoardial contractility Coronary vasodilationCoronary vasodilation Depressant effect on the SA node rate of Depressant effect on the SA node rate of

discharge, and the condution velocity discharge, and the condution velocity through the AV node, thus slowing the through the AV node, thus slowing the HR. HR.

Carizem, Norvasc, Verapamil, plendil Carizem, Norvasc, Verapamil, plendil

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Indications Indications

HypertensionHypertension Prinzmetal’s angina: Prinzmetal’s angina:

Chest pain caused by vasospasm of the coronary Chest pain caused by vasospasm of the coronary arteries usually occurring at rest rather than arteries usually occurring at rest rather than during exercise.during exercise.

Chronic stable anginaChronic stable angina A-fib or flutter; Paroxysmal A-fib or flutter; Paroxysmal

supraventricular tachycardiasupraventricular tachycardia

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Nursing InterventionsNursing Interventions

Monitor BP, HR, heart rhythmMonitor BP, HR, heart rhythm Monitor liver enzymes, renal functionMonitor liver enzymes, renal function Do not chew or divide, sustained-release Do not chew or divide, sustained-release

tabs (SR or XL tabs)tabs (SR or XL tabs) Take with food to increase absorptionTake with food to increase absorption Assure stool softener is ordered to Assure stool softener is ordered to

prevent constipation prevent constipation

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Positive Inotropics DrugsPositive Inotropics Drugs

Increase the heart’s pumping Increase the heart’s pumping action (contractility) and slow action (contractility) and slow down the electrical down the electrical conduction of the heart.conduction of the heart.

Slowing of HRSlowing of HR Decrease velocity through Decrease velocity through

AV nodeAV node DigitalisDigitalis

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IndicationsIndications

Heart failureHeart failure Atrial fibrillation & FlutterAtrial fibrillation & Flutter Paroxysmal Paroxysmal

Supraventricular Supraventricular Tachycardia (PSVTTachycardia (PSVT))

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Nursing InterventionsNursing Interventions

Monitor renal function studies: Monitor renal function studies: Renal impairment leads to decrease excretion of Renal impairment leads to decrease excretion of

Digoxin: Dig toxicity (altered color perception, see Digoxin: Dig toxicity (altered color perception, see yellow-green halos around visual images, or feel yellow-green halos around visual images, or feel weak or dizzy. Notify MD immediately if you notice weak or dizzy. Notify MD immediately if you notice any of these changes)any of these changes)

Monitor electrolyte levels:Monitor electrolyte levels: K+ predisposes the patient to Dig toxicityK+ predisposes the patient to Dig toxicity Mg++ predisposes the patient to Dig toxicityMg++ predisposes the patient to Dig toxicity

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Con. Nursing Con. Nursing InterventionsInterventions

Monitor rhythmMonitor rhythm Prolonging of PRProlonging of PR ST wave depression from baselineST wave depression from baseline AV blockAV block

Assess apical pulse before administration, hold Assess apical pulse before administration, hold & call MD for HR < 60. & call MD for HR < 60.

Call monitor tech immediately before beginning Call monitor tech immediately before beginning IV push, administer IV Dig slowly over 5 min or IV push, administer IV Dig slowly over 5 min or longer. longer.

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Angiotensin-Converting Angiotensin-Converting Enzyme (ACE) Inhibitors Enzyme (ACE) Inhibitors

Decrease high BP and prevent or treat Decrease high BP and prevent or treat CHFCHF

Improve blood flow in blood vessels Improve blood flow in blood vessels throughout the bodythroughout the body

ACEIs block the body’s production of ACEIs block the body’s production of angiotensin, a chemical that causes the angiotensin, a chemical that causes the blood vessels to constrict. blood vessels to constrict.

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Prinzmetal's angina Prinzmetal's angina (variant angina) (variant angina)

What can you tell What can you tell about Prinzmetal’s about Prinzmetal’s angina?angina?

How is it different How is it different from typical angina? from typical angina?

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Prinzmetal’s angina, also called variant Prinzmetal’s angina, also called variant angina, is chest pain (angina) that occurs angina, is chest pain (angina) that occurs at rest for no apparent reason – unlike at rest for no apparent reason – unlike typical angina which usually follows typical angina which usually follows physical exertion. Attacks of Prinzmetal’s physical exertion. Attacks of Prinzmetal’s angina are brief but painful and occur angina are brief but painful and occur most often at night most often at night

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The cause of Prinzmetal’s angina is a coronary The cause of Prinzmetal’s angina is a coronary artery spasm, in which the walls of the artery artery spasm, in which the walls of the artery briefly narrow (constrict). This temporarily briefly narrow (constrict). This temporarily reduces or obstructs blood flow to the heart reduces or obstructs blood flow to the heart muscle, resulting in chest pain. Coronary artery muscle, resulting in chest pain. Coronary artery spasms can be associated with spasms can be associated with atherosclerosis.atherosclerosis.

Treatment of Prinzmetal’s angina is directed at Treatment of Prinzmetal’s angina is directed at the underlying cause, such as atherosclerosis. the underlying cause, such as atherosclerosis.

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