Cardiac Drugs: HTN, angina; fluid overload and HF: Pharm Exam 2

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Cardiac Drugs: HTN, angina; fluid overload and HF: Pharm Exam 2 by Mind Map: Cardiac Drugs: HTN, angina; fluid overload and HF: Pharm Exam 2

1. Category

1.1. adrenergic

1.1.1. alpha agonist (alpha 2) decrease sympathetic nervous activity, norepinephrine production, and renin activity clonidine methyldopa

1.1.2. alpha blocker (alpha 1) dilates arteries and veins; increase urinary flow rate; decrease bladder neck and urethral obstruction doxazOSIN prazOSIN terazOSIN tamsulOSIN

1.1.3. beta blocker reduces HR and BP by blocking SNS; reduces renin secretion; metoproLOL carvediLOL propanoLOL side effects cardiac metabolic CNS Other contraindications acute HF; dysrhythmias; asthma; DM; vascular disease DON'T use labetaLOL (HTN) or carvediLOL (HF) dually with ASTHMA nursing implications monitor HR <60; report dizzy/fainting; not for long term angina

1.1.4. Side Effects of adrenergic antagonist and blockers orthostatic hypotension; palpitations; sexual dysfunction; vertigo; dry mouth; constipation; n/v

1.1.5. Nursing Implications thorough Hx; v/s; allergy; drug interaction; contraindications; OTC drugs; limit CAFFEINE; orthostasis; ETOH; hot water/conditions

1.2. ACE inhibitors

1.2.1. uses renin-angiotensin aldosterone (RAA) system to treat HTN and HF Why this lowers BP prevents breakdown of bradykinin (vasodilator) prevents angiotensin II from causing vasoconstriciton prevents Na and H2O resorption to reduce preload/BP thus afterload of LV


1.2.3. drug of choice for early HF; Second-line tx for HTN (1st-diuretic); CCB added for uncontrolled HTN lisinoPRIL NOT a prodrug captoPRIL NOT a produg enalaPRIL prodrug ramiPRIL prodrug

1.2.4. Cardioprotective/Renal protective BUT do NOT give with renal damage

1.2.5. SIDE EFFECTS fatigue; dizzy; headache; mood change; impaired taste; possible hyperkalemia dry, unproductive ACE COUGH use ARBs if cough occurs angioedema

1.2.6. RN implications Cr and K+ labs

1.3. ARBs

1.3.1. Tx for HTN and HF when ACE inhibitor causes cough loSARTAN valSARTAN irbeSARTAN candeSARTAN

1.3.2. Blocks A-II receptors; stops vasoconstriction and release of aldosterone


1.3.4. used alone or with diuretics

1.3.5. SIDE EFFECTS Dizzy; fatigue; hypoglycemia; diarrhea; UTI; anemia; weakness

1.4. Calcium channel blockers

1.4.1. angina; HTN; dysrhythmias; migraines, Raynaud's amloDIPINE nicarDIPINE nifeDIPINE verapamil not used often diltiazem dysrhythmias

1.4.2. CONTRAINDICATIONS allergies; acute MI; hypotension; bradycardia

1.4.3. SIDE EFFECTS overexpression of therapeutic effects hypotension; palpitations; bradycardia; constipation; n/v; dyspnea

1.5. direct renin inhibitors

1.5.1. CONTRAINDICATIONS in combo with ACE/ARBs in pts with DM or renal impairment can cause renal impairment, hyperkalemia; severe hypoTN

1.5.2. treat HTN by vasodilation aliskiREN

1.6. diuretics

1.6.1. accelerate rate of urine formation causing removal of Na and H2O

1.6.2. Tx for HTN and HF

1.6.3. RN implications for diuretics fluid volume; I&Os; daily wt; v/s assess contraindications and toxicities (digoxin) take in morning to avoid sleep disturbances monitor K+ hypo with most hyper with K+ sparing Teach nutrition (K+) Ortho hypoTN notify PCP Increased HR or syncope monitor side effects and therapeutic effects

1.6.4. Types of diuretics loop diuretics used for HF edema to control HTN causes potent diuresis and fluid loss SIDE EFFECTS Interactions potassium sparing diuretics/aldosterone antagonist block aldosterone receptors and inhibit action; block resorption of Na and H2O; prevent K+ from being pumped into tubule Tx HTN and HF SIDE EFFECTS Interactions thiazide diuretics first-line for HTN; edema; kidney stones; diabetes insipidus; HF inhibits tubular resorption of Na+, Cl-, K+ resulting in ion loss with water loss; dilate arterioles by direct relaxation SIDE EFFECTS osmotic diuretics carbonic anhydrase inhibitors

1.7. vasodilators

1.7.1. Tx HTN by vasodilation and decreased afterload (SVR) to decrease BP diazoxide HTN emergency Tx nitroprusside HTN emergency Tx SIDE EFFECTS minoxidil also hair growth SIDE EFFECTS hydralazine SIDE EFFECTS

1.7.2. Tx pulmonary HTN bosentan blocks endothelin receptors most common and only for pulmonary HTN epoprostenol continuous IV infusion treprostinil also antiplatelet sildenafil viagra tadalafil

1.8. nitrates

1.8.1. for angina; causes vasodilation in coronary arteries; increased O2 to myocardial tissue nitroglycerin prototypical nitrate for angina sublingual, IV, transdermal, and ointments isosorbide dinitrate/mononitrate organic nitrate for angina immediate release tablets and long acting oral dosage forms

1.8.2. CONTRAINDICATIONS allergy; anemia; glaucoma; hypoTN; head injury; use of Erectile Dysfunction (ED) drugs (sildenAFIL, tadalAFIL, and vardedAFIL)

1.8.3. SIDE EFFECTS headaches (usually decrease with continued use) reflex tachycardia; postural hypoTN

1.8.4. Pt Education proper technique (5 min for sublingual before swallow/take off topical at night) store in airtight, dark glass bottle with metal cap and no cotton filler take at first hint of angina monitor v/s frequently lie down to prevent dizzy