Spotlight on Cardiac Drugs Spotlight on Cardiac Drugs

Drug Class Effect Nursing Considerations

Platelet Inhibitors
Aspirin
Ticlopidine (Ticlid)
Clopidogrel (Plavix)
Glycoprotein IIb/IIa inhibitors
(abciximab, tirofiban, eptifibatide)
nfractionated heparin
!o"#molec$lar#"eight heparin
(enoxaparin %!ovenox&)
Inhibit factors necessary
for platelets to aggregate
on r$pt$red arterial
pla'$e
Ticlodipine can ca$se thrombocytopenia and agran$locytosis, so
fre'$ently monitor platelet co$nts
nfractionated heparin has limited and changeable bioavailability,
so the patient needs fre'$ent activated partial thromboplastin
times to monitor for therape$tic levels
!o" molec$lar heparin has greater bioavailability and more
predictable effects, so it doesn(t re'$ire coag$lation assays
Beta-blockers
Cardioselective types (metoprolol
%Toprol, !opressor&) ) bloc* beta +
receptors in the heart
Noncardioselective types
(propanolol %Inderal&, labetalol
% ,ormodyne, Trandate,&,
Carvedilol %Coreg&) ) bloc* both
the beta + receptors in the heart
and beta - receptors in the l$ngs
and blood vessels
.ed$ce heart rate,
contractility, and speed of
imp$lse cond$ction
thro$gh the A/ node
0eta#bloc*ers are $sed to treat hypertension, angina, cardiac
arrhythmias, myocardial infarction, hyperthyroidism, migraines,
stage fright, and gla$coma1
,oncardioselective beta#bloc*ers aren(t appropriate for someone
"ith a history of constrictive air"ay disease beca$se they can
ca$se bronchoconstriction1 They can also mas* signs of
hypoglycemia1
Carvedilol may be $sed "ith AC2 inhibitors, digitalis, and di$retics
to manage heart fail$re, b$t the combination can slo" A/
cond$ction, so closely monitor the patient for cardiac rhythm
dist$rbances
Peripheral alpha 1-adrenergic blockers
Pra3osin (4inipress)
Tera3osin (5ytrin)
6oxa3osin (Card$ra)
6ilate blood vessels and
decrease blood press$re
The first dose can ca$se severe orthostatic hypotension, ca$sing
the patient to feel light#headed or to faint1
7ho$ld not be $sed alone to treat hypertension beca$se
monotherapy increases the ris* of heart fail$re, stro*e, and chest
pain1
Central alpha 2- agonists
Clonidine (Catapres)
4ethyldopa (Aldomet)
7tim$late receptors in
the brain to decrease 5.
and C8, dilate 0/ and
decrease 0P
Clonidine and methyldopa are approved for hypertension
Clonidine is also being investigated as treatment for menopa$sal
fl$shing,, migraines, and "ithdra"al from opioids, alcohol and
tobacco1
ACE Inhibitors
!osartan (Co3aar)
/alsartan (6iovan)
Irbesartan (Avapro)
Candesartan (Atacand)
Telmisartan (4icardis)
6ecrease p$lmonary
congestion and
peripheral edema9
promote sodi$m and
"ater excretion, and
dilate 0/9 decrease
ventric$lar remodeling
related to 4I or 5:1
4onitor for first dose hypotension
The most common reason to d/c is a dry, irritating co$gh
4onitor the patient for hyper*alemia and avoid potassi$m#sparing
di$retics and potassi$m s$pplements1
6iscontin$e immediately if angioedema develops1
Ta*ing ,7AI6s may increase 0P
Calcium Channel Blockers
Affecting peripheral blood vessels
,ifedipine (Adalat, Procardia)
Amlodipine (,orvasc)
:elodipine (Plendil)
Isradipine (6ynaCirc)
,icardipine (Cardene)
Affecting the heart
/erapamil (Calan, Isoptin)
6iltia3em (Cardi3em, 6ilacor)
4anage coronary
vasospasm and decrease
the heart(s "or*load by
dilating blood vessels
(nondihydropyridines also
decrease contractions)
After 4I, $se only if beta bloc*ers are contraindicated or the
patient can(t tolerate them,
sef$l in patients "ith diabetes, asthma, or migraines
Positie Inotropic Agent
6igoxin Increases force of
ventric$lar contraction9
decreases a$tomaticity of
7A node to maintain an
acceptable heart rhythm
Tell the patient to report irreg$lar heartbeat, vis$al dist$rbances
(bl$rred vision, yello" halo aro$nd ob;ects), fatig$e, anorexia,
na$sea and vomiting1
!asodilators
,itroglycerin (,itrostat)
Isosorbide (Isordil)
6ilate blood vessels to
decrease ventric$lar
filling, preload, and
myocardial oxygen
demand
If the patient develops a tolerance to nitroglycerin, the physician
may prescribe a <nitro#free= period each day (s$ch as removing
the dr$g patch at bedtime)
Diuretics
!oop di$retic (:$rosemide)
Thia3ide di$retic (5CT>)
8smotic di$retic (4annitol)
?#7paring di$retic (7pironolactone)
0loc* reabsorption of
sodi$m and chloride to
decrease intravasc$lar
vol$me
4onitor for dehydration, hypo*alemia ($nless the patient is ta*ing
a potassi$m#sparing di$retic), and hypotension
Teach the patient to ta*e the di$retic in the morning beca$se it "ill
increase the need to $rinate for @ to A ho$rs1 Tell her to "eigh
herself daily and to report any "eight gain of more than B po$nds
(+1C *g) to her health care provider1
Teach her the signs of orthostatic hypotension1 Tell her to get $p
slo"ly and to sit or lie do"n if she feels di33y or faint1
Lifted from: How Cardiac Drugs Do What They Do by Anne Marie Palatnik !" C#C M#" "ursing $%%& '&:( ()*+%