NUR 393 Fall 2015 Cardiac Drug List Digitalis (digoxin)Desired action increase the force of myocardial contractionProlongs refractory period of the AV nodeDecreases conduction through SA and AV nodeTherapeutic effect- increase cardiac output, slow heart rate Indications- heart failure, a fib/a flutter (slow ventricular rate), paroxysmal a. tach ( inc filling time and CO)Side effects dizzy, n/v/d, headache, rash, weak, anxiety Adverse effects- change in heart rhythm, blurry vision, halos Lab values (V/S, electrolytes) therapeutic range 0.5 -2.0Drug Drug interaction avoid antacid and laxative, bb, anticholinergics EKG changes shortens QR and down slope ST segment Patient teaching take pulse hold < 60 < bp 100Diet k+ rich foods Antidote- digibind digifabNursing care: take apical pulse 1 min , monitor labs / patient /

Furosemide (Lasix)Action inhibits reabsorption of sodium and chloride from LOH and distal renal tubulesTherapeutic effect : diuresis and lowers bpIndications :edema from heart failure , renal disease, high bps/e: dizzy lighthead, a/v/nadverse: skin rash , ear ringing muscle weakness crampslab values (v/s , electrolytes) losing k+ less than 3.5, low bpinteractions: dig. Lithium inc their toxicity, nsaids decrease actionpatient teaching/ diet: change position slowly (OH) potass rich diet (banana, oj, avocado). Take in the am. report weight gain,nursing care : monitor I& Os daily take bp and pulse listen to lungs outcome: decrease in edema, weight, bp, increase urine

Spironolactone (Aldactone)Therapeutic effect- same as Lasix but potassium sparing Indications- edema chf patient on dig Side effects Fluid or electrolyte imbalance, gynecomastia, GI upset, drowsiness, headache, hyponatremia; tachycardia, hypotension, oliguria, hyperkalemia; confusion, weakness, paresthesia, hirsutism, mental disturbances, menstrual irregularities, loss of libido and impotence.Adverse effects- Lab values (V/S, electrolytes) k+ levels bun serum,.,EKG changes Patient teaching Diet less k+ foods Antidote- Nursing care: check bp. Hr prior and after. report weight gain weakness cramps ios

Metoprolol (Lopressor) same as carvedilol (coreg)Desired action block beta receptor stimulationTherapeutic effect- decrease hr , bp , frequency of angina Indications- hypertension, angina , mi prevention, manage stable heart failureSide effects bronchospasm , hyper/hypoglycemia fatigue weakness anxiety dizzy nervous nightmares c/n/v, dec libido Adverse effects- bradycardia , hf, p. edema Lab values (V/S, electrolytes) Drug int: dec eff dopamine and dobutamine EKG changes Patient teaching pulseDiet Antidote- Nursing care: Monitor BP, ECG, and pulse frequently. Monitor vital signs and ECG Monitor intake and output ratios and daily weights. Assess routinely for signs and symptoms of HF (dyspnea, rales/crackles, weight gain, peripheral edema, jugular venous distention).

Coumadin (Warfarin sodium)Desired action anticoagulant, long term use takes few days to workTherapeutic effect- prevent thromboembolismIndications- preventative DVT, MI, valve replacement, PE, a fibSide effects cramps nausea red orange urine Adverse effects- bleeding Lab values (V/S, electrolytes) monitor PT . INR (2-3)Drug no Tylenol EKG changes Patient teaching s/s bleeding soft bristle brush Diet no high vit k foods dark green veg Antidote- vit k.. serious plasma whole bloodNursing care: Assess for signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; tarry, black stools; hematuria; fall in hematocrit or BP; guaiac-positive stools, urine, or nasogastric aspirate).Assess for evidence of additional or increased thrombosis. Symptoms depend on area of involvement.

NitroglycerinDesired action direct vasodilator Therapeutic effect- incr blood flow more oxygen less painIndications- angina , CHF,MISide effects headache, dizzy, hypotension, tachycardia Adverse effects-Lab values (V/S, electrolytes) bp/ hr Drug EKG changes may be tachyPatient teaching 1t q5 for 3 doses still pain emergency call Take before activity, rest before you take in, keep in containerDiet Antidote- Nursing care: hr/bp

Enoxaprin (Lovenox)Desired action anticoag. Low mole hep, predictable response

Therapeutic effect- prevent thrombiIndications- dvt ,pe, unstable angina no q wave miSide effects same as warfarin Adverse effects-Lab values (V/S, electrolytes) cbc platelet occult blood no PTTDrug asa, nsaids othrr anticoagEKG changes Patient teaching same as warf blood dark urine DietAntidote- prot,sulfateNursing care:same as warf

HeparinDesired action inhibits antithrobin factors fibrinogen and platelet Therapeutic effect- prevent clotIndications- dvt, a fib,Side effects fever, chills, n/vAdverse effects- bleedingLab values (V/S, electrolytes) Drug recent surgery dont use EKG changes Patient teaching s/s bleeding DietAntidote- p. sulfateNursing care: frequent testing

Dalteparin (Fragmin)Desired action same as other anticoag

Clopidogrel (Plavix)Desired action prevent clumping Therapeutic effect prevent platelet aggragation Indications- acute coronary disease history of MISide effects h/a dizzy weakness syncope flushing rash edema hpt Adverse effects-Lab values (V/S, electrolytes) Drug nsaids EKG changes Patient teaching Diet with meals Antidote- Nursing care :report s/s

Dopamine (Dobutrex)

Desired action stimulates alpha beta

Therapeutic effect- positive inotropic increase cardiac output inc bp (systolic) and pulse pressure Indications- MI, traua, open heart surgery CHF Side effects hypotension, angina , headache Adverse effects-Lab values (V/S, electrolytes) Drug dont use tach or v fibEKG changes may see widen qrs not good Patient teaching DietAntidote- regitine (phentolamine)Nursing care: get ekg..cont cardiac monitor .foley cath Monitor blood pressure, pulse, peripheral pulses, and urinary output at intervals prescribed by physician. Precise measurements are essential for accurate titration of dosage. Report the following indicators promptly to physician for use in decreasing or temporarily suspending dose: Reduced urine flow rate in absence of hypotension; ascending tachycardia; dysrhythmias; disproportionate rise in diastolic pressure (marked decrease in pulse pressure); signs of peripheral ischemia (pallor, cyanosis, mottling, coldness, complaints of tenderness, pain, numbness, or burning sensation). Monitor therapeutic effectiveness. In addition to improvement in vital signs and urine flow, other indices of adequate dosage and perfusion of vital organs include loss of pallor, increase in toe temperature, adequacy of nail bed capillary filling, and reversal of confusion or comatose state.

Dobutamine Desired action same as dopamine.Renal protective Therapeutic effect- inc HRIndications- Side effects Adverse effects-Lab values (V/S, electrolytes) Drug EKG changes Patient teaching Monitor ECG, HR, BP, Cardiac output, and pulmonary wedge pressure continuously Caution should be used to prevent infiltration at injection site Hypovolemia should be corrected before administrating drug w/ plasma expanders Complete physical assessment and focused cardiac assessment prior to administration Hypersensitivity Rxn: skin rash, fever, eosinophilia, and bronchospasm Digitalis preparation prior to admin in patients with a fib w/ rapid ventricular response d/t AV conductionDietAntidote- Nursing care:

Adenocard (Adenosine) emergency drug

Desired action antidys slows entry av

Therapeutic effect- Indications- SVTSide effects /adverse: chest pain hypotension palp dizzy Lab values (V/S, electrolytes) Contraind 2nd 3rd block asthma EKG changes Patient teaching Diet avoide caffeine alcoholAntidote- Nursing care: ecg . bp.lung sounds,k+, ios

Amiodarone (Cordarone)Desired action antiarrTherapeutic effect- normal RRIndications- v fib pulseless v tach Side effects Adverse effects-Lab values (V/S, electrolytes) EKG changes inc pr intervalPatient teaching same as adenosine Nursing care:

Epinepherine emergency drug Desired action vasoconstricter bronchodilator Therapeutic effect- restore rhythm in cardiac arrest inc bp Indications- cardiac arrest Side effects h/a, tremors insomnia Lab values (V/S, electrolytes) hr bpNursing care: auscultate breath sounds

Amlodipine/Diltiazem (Cardizem) check bp/hr Desired action calcium channel blocker Indications- stable angina . a fib , flutter Side effects headache, dizz, n/v axiety