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Cardiac Interventional Meds
Terms in this set (76)
Indications: angina, MI pain
Complications: respiratory depression, and urinary retention
Reversal Agent: Narcan
Indications: Acute angina, chronic angina; HF associated with AMI
Dosage: SL, PO, IV, spray, paste: repeat q 5 min 3 times and call 911
NI and teaching:
Subling: potency fizzles/burns"
same bottle, cool and dark- change after 6ms - 1 yr. (check with Pharmacy)
Contraindications: phosphodiesterase inhibitor within last 24-28 hrs can cause profound hypotension.
Complications: HEADACHE, Hypotension
CNS effects, skin reactions.
When giving this IV pt. can become hypotensive- in rare cases it could be used in ICU for hypertension
Statins and Niacin
Indications: with diet and exercise to treat increased cholesterol and LDL, CAD, MI
NI and teaching:
Do not drink grapefruit juice.
Take at night. Monitor hepatic labs. Peak effect 2-4 weeks
Adverse Effects: GI disturbance [abd pain, N/v]
Liver failure—LABS, Muscle pain, RHABDOMYOLYSIS
Niacin—water soluble vitamin: required as coenzyme for lipid metabolism—reduces LDL, increases HDL
indications: used in combo with statins when not getting therapeutic effect
adverse effects: flushing of face and neck, rash, pruritus, nause
Meperidine Hydrochloride (Demerol)
Dosage: IV .5-1 mg/kg
Contraindications: MAOIs, asthma or respiratory issues, head injuries/trauma, SVT, glaucoma, or those with liver/kidney compromise
Complications: tachycardia, respiratory distress, seizure, increase rise in biliary pressure (though lower than morphine), and urinary retention
Reversal Agent: Narcan
Indications: used to cause amnesia during certain medical procedures
Contraindications: narrow angle glaucoma, intoxication, COPD, CHF, renal failure, or pregnancy/breast feeding
Complications: amnesia, confusion, hypotension, arrhythmias, headache, and respiratory depression
Reversal Agent: Romazicon (flumazenil)
Lorazepam (Ativan), Diazepam
Indications: relieve anxiety, muscle relaxant
Complications: drowsiness, cardiac/respiratory depression, and hypotension
Reversal Agent: flumazenil (Romazicon)
Indication: V-tach to calm heart & stabilize the rhythm
Dosage: bolus: 50-100 mg; infusion: 1-2 mg/min
Contraindications: allergy or inflammation/sepsis at injection site
Complications: hypotension, bradycardia, decreased cardiac output
Indication: V-tach, Vfib, Afib, paroxysmal supraventricular tachycardia
Dosage: IV 150 mg over 10 mins
Contraindications: other antiarrhythmic drugs, antihypertensives, Beta blocks, calcium channel blockers
Complications: bradycardia, hypotension, arrhythmias, and edema
Indications: cardiac arrest due to hypomagnesemia or Torsades de pointes
Indications: atrial fib, ventricular tachy, ventricular fib
ACLS DOC [drug of choice] for VFib, pulseless VTach
Complications: malaise, fatigue, liver toxicity, ocular abnormalities, arrhythmias
Complications: decreased salivation, decreased secretions, dilated pupils
given to AMI pt ASAP
prevent CV occlusion, prevention of reinfarction and used in MI
NI and teaching: Caution in recent surgery pts, risk of bleeding from injured vessels,
Adverse Effects: bleeding, increases bruising, bleeding while brushing teeth, nausea, GI distress, skin rash
Clopidogrel (Plavix) and Ticagrelor (Brilinta)
Indications: Used to treat CV disease that produces occluded vessels (graft maintenance); stents
NI and teaching: stop 7 days before procedure that can cause problems. Some people are Clopidogrel resistant.
If used with omeprazole may decrease antiplatelet effects
Adverse Effects: increased risk for bleeding
anticoagulant: different strengths—heparin lock , heparin inj [1000-5000]
Indications: prevent and treat venous thrombosis, PE, prevents clotting [afib], treat MI and CVA
NI and teaching: Heparin injected subcut. or IV. Immediate onset.
therapeutic range is 1.5-2.5 x control.
Adverse Effects: Bleeding, heparin-induced thrombocytopenia [HIT]
Antidote: Protamine Sulfate—given IV, strong base forms complex with heparin [quick onset]
Indications: atrial fibrillation
NI and teaching: PO onset 3 days. Lasts for 3-5 days.
Eat same amt. green leafy vegetables. If moving from heparin -> warfarin, remain on heparin while starting.
therapeutic range is 1.3-1.5 x control or INR of 2-3.5
Adverse Effects: bleeding, contraindicated in pregnancy, many drug-drug interactions. problems in hospitals related to interactions, and drug effects
Antidote: Vitamin K—given SQ or IM, promotes liver synthesis of clotting factors [delay in action for 24 hrs]
low molecular weight heparin
Indications: prevent and treatment of DVT and prevention of pulmonary embolisms from surgeries [hip, knee, abd] prevention of thrombosis in unstable angina and NSTEMI
NI and teaching: binds and increases effect of antithrombin III on factor Xa, little effect on thrombin, no labs needed, SQ in "love handles"
Adverse Effects: bleeding, fever, swelling of legs
ACE inhibitor drugs
-pril: prevents vasoconstriction and aldosterone release, decreases BP
Indications: 1st line in HF with other drugs; HTN
NI and teaching: PO—empty stomach: 1h bf or 2h a.c.
Allergy causes angioedema esp. in African Americans, Decrease dose in renal failure and teach patients to be careful about salt substitutes due to increase in serum K+
Adverse Effects: vasodilation, hypotension, dizziness,
increase K, loss sodium; causes cough, pancytopenia
-art: binds with receptors of angiotensin II in vascular smooth muscle to decrease BP
Indications: HTN in HF, if ACE contraindicated
NI and teaching: PO, caution with renal and hepatic dysfunction, hypovolemia
Adverse Effects: hypotension, headache, dizziness, cough [not as severe]
Calcium Channel Blockers
-diltiazem, verapamil: inhibits movement of Ca ions, decreases cardiac contractility, decreases BP, can help with HTN or angina
Indications: angina, HTN, atrial fibrillation
NI and teaching: Immediate, sustained release; calcium channel blockers
interact with grapefruit juice
[causes toxic levels]
Adverse Effects: CNS effects, hypotension, bradycardia
direct vasodilator: decreases BP
Indications: severe HTN, emergencies, pulmonary HTN
NI and teaching: PO, IV, IM; contraindicated in cerebral insufficiency
Adverse Effects: hypotension, reflex tachy
cardiac glycoside: increases force of heart contraction; increases cardiac output; reduces heart rate
Indications: HF, atrial arrhythmias
NI and teaching: administer IV dose slowly over 5 minutes. Check labs for dig levels,
therapeutic range is 0.5-2 ng/mL
. Take apical pulse ONE full minute before giving, contraindicated in many arrhythmias.
Adverse Effects: Dig toxicity: headache, anorexia,
n/v, weakness, vision changes halo, arrhythmias.
Antidote: DigiFab [bind to digoxin to correct toxicity]
phosphodiesterase inhibitor: increases cardiac contraction
Indications: used in short term treatment of HF, in patient unresponsive to digoxin and diuretics
NI and teaching: IV, contraindicated in MI, caution in elderly
Adverse Effects: hypotension, arrhythmias, chest pain, burning at IV site
correct underlying cause
for low cardiac output or BP, dizziness, weakness, altered LOC: ACLS protocol:
temporary or permanent pacemaker
if SEVERE: catecholamines: dopamine [intropin] or epinephrine
- underlying cause
- with beta-adrenergic blockers or calcium channel blockers
Paroxysmal supraventricular tachycardia
- immediate cardioversion
- vagal stimulation [Valsalva's maneuver]
once rhythm converts:
- calcium channel blockers or beta-adrenergic blockers
Supraventricular Tachycardia (SVT)
- calcium channel blockers
Atrial Flutter Treatment
- w/ ventricular rate > 150 bets/min, immediate cardioversion
- rate control through Calcium channel blockers or beta-adrenergic blockers
amiodarone, or digoxin.
- Anticoagulation therapy may also be necessary.
- Radio frequency ablation to control rhythm
- ventricular rate >150 beats/min, immediate cardioversion
- ACLS protocol and drug therapy, which may include calcium channel blockers, beta-adrenergic blockers, amiodarone, or digoxin.
- Anticoagulation therapy may also be necessary.
- some patients with refractory atrial fibrillation uncontrolled by drugs, radio frequency catheter ablation
- Correction of underlying cause
- Atropine for symptomatic slow rate
- Pacemaker insertion if patient doesn't respond to drugs
- Discontinuation of digoxin if appropriate
First degree AV block
- Correction of underlying cause
- Possibly atropine if severe symptomatic bradycardia develops
- Cautious use of digoxin, calcium channel blockers, and beta-adrenergic blockers
premature ventricular contraction (PVC)
- If warranted, procainamide, amiodarone, or lidocaine I.V.
- Treatment of underlying cause
- Discontinuation of drug causing toxicity
- Potassium chloride I.V. if PVC induced by hypokalemia
- Magnesium sulfate I.V. if PVC induced by hypomagnesemia
Treatment: Lidocaine & amniodarone
, initiate CPR; follow ACLS protocol for defibrillation, administration of epinephrine or vasopressin followed by amiodarone (lidocaine may be considered if amiodarone isn't available), and advanced airway placement
- If regular wide-complex QRS rhythm (monomorphic) present, administer adenosine (follow ACLS protocol); if drug is unsuccessful, cardioversion
- If polymorphic (irregular) ventricular tachycardia present, immediate defibrillation
- Implantable cardioverter defibrillator if recurrent ventricular tachycardia
Torsades De Pointes Treatment
Ventricular Fibrillation (VF)
- Continue CPR and
- follow ACLS protocol for ET intubation and administration of epinephrine or vasopressin.
Treatment: Epinephrine First, Then Atropine
(Think Heart Stimulants)
What are the medical interventions to relieve pain and decrease myocardial oxygen requirements?
How is this done?
Done through preload
and afterload reduction
o Preload reduction:
- cautiously attempted with
o Pain relief:
promotes COMFORT, helps to increase the oxygen supply and decrease
myocardial oxygen demand,
What helps to treat episodic anginal pain?
What would you monitor patients receiving thrombolytics and anticoagulants for?
What is often prescribed for those with a primary angioplasty after an
A long-term nitrate
When and why (3 reasons) are
- usually within first few hours after
patient is stable as a way to
(1) decrease the size of the infarct
(2) decrease the occurrence of ventricular dysrhythmias
(3) decrease mortality rates
When are ACE inhibitors or ARBs prescribed
What is prescribed if ejection fraction is less than or equal to 40% to prevent in order to prevent ventricular remodeling and the development of heart failure? When is it prescribed?
- ACE inhibitors or ARBs prescribed
- within 48 hours of ACS
- both increase survival after an MI
What is prescribed for patients who continue to have angina despite being on therapy with beta-blockers (unstable angina)?
calcium channel blockers
- promote vasodilation and myocardial perfusion
what is prescribed for variant angina or/and hypertension?
Calcium channel blockers promote vasodilation and myocardial PERFUSION
What can be prescribed for chronic stable angina?
- calcium channel blockers
- when ^ unsuccessful, ranolazine may also be given—with anti-anginal and anti-ischemic properties, it is often effective in relieving pain associated with CSA
What medication is prescribed to be taken daily to prevent clots that can further block coronary arteries?
Lidocaine, Epinephrine, Atropine, Narcan
Emergency drugs to LEAN on
What are anticoagulants used for? What are they contraindicated with?
Used for thrombosis, pulmonary embolism and myocardial infarction
- active bleeding except for DIC
- bleeding disorders
- ulcers, liver and kidney disease
- spinal cord or brain injuries
What does heparin sodium do?
Prevents thrombin from converting fibrinogen to fibrin,
Antidote: Protamine sulfate
What does warfarin do? what drugs should not be administered with warfarin?
Decreases prothrombin activity and prevents the use of vitamin K by the liver
Avoid the administration of salicylates
Use soft toothbrush and electric razor
Antidote: Vitamin K
What is monitored during warfarin therapy?
Monitor PT and INR
What do thrombolytics do?
Activates plasminogen, leading to conversion to plasma, a substance that degrades clots and dissolves formed blood clots
Why are thrombolytics used for MIs?
restore blood flow
limit myocardial damage
preserve LV function and prevent death
When and what are thrombolytics used?
used early in course of MI
within 4-6 hours of onset of infarct
why are thrombolytic agents given for an MI?
thrombolytic agents are given to lyse the clot that is obstructing the coronary artery
When can thrombolytics be dangerous?
if patient has:
- active bleeding
- history of CVA,
- trauma within previous 2 months
- history of thoracic, pelvic or abdominal surgery in previous 10 days
- history of hepatic or renal disease
- uncontrolled HTN
- recently required, prolonged CPR
Side effects of thrombolytic medications
Bleeding, dysrhythmias, fever, allergic reaction
Nursing Implications for thrombolytics
- aPTT, PT, fibrinogen level,
- Hct and platelet count
Monitor for signs of:
- neuro status changes
Avoid injections or puncture sites
What is the antidote for thrombolytics?
aminocaproic acid (Amicar)
What are antiplatelets?
Drugs that reduce the adhesion and aggregation of platelets
What are cardiac glycosides?
Drugs used to stimulate the heart in cases of heart failure and also used to help control ventricular response to atrial fibrillation.
In what patients are cardiac glycosides cautioned in?
Use with caution in patients with:
- renal disease
What is the therapeutic range for digoxin?
Nursing Implications for digoxin
Monitor K+ levels:
- if <3.5mEq/L, notify HCP
Monitor serum levels, electrolyte levels and renal function tests
- If apical pulse rate < 60 bpm, hold medication and notify HCP
what are contraindications for antianginals use? Side effects?
CI: marked hypotension, increased ICP or severe anemia
SE: orthostatic hypotension, HA, flushing or pallor
Nursing interventions and teaching for transdermal nitroglycerin patch:
- apply to hairless area
- use new patch and different site each day
- remove patch after 12-14 hours each day to prevent tolerance
What are contraindications and side effects of beta-adrenergic blockers?
severe renal or hepatic disease
What is cautioned to diabetic patients about beta-adrenergic blockers?
can cause blood sugar to rise or hide symptoms of hypoglycemia
Nursing Implications for Beta-Adrenergic blockers:
hold medication if:
- pulse or BP not within prescribed parameters
- signs of CHF
Change positions slowly to prevent orthostatic hypotension
What are antiarrhythmic drugs?
They suppress abnormal heart rhythm
Increase water/sodium loss-corrects edema
Nursing Implications for antiarrhythmics:
- assess vital signs before meds
- decreased breath sounds
- cough with rales
what are the side effects of antiarrhythmics?
Thiazide diuretics implications
Contraindicated in patients with allergy to sulfonamides
Calcium channel blockers side effects:
may precipitate AV block
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