Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
condition when heart muscle fails to effectively pump blood through the heart & systemic
circulation build-up of blood (congestion).
Causes:
• damaged heart muscle
atherosclerosis / coronary artery dse (CAD)
cardiomyopathy
s/sxs
• pulmonary edema
o tachypnea
o dyspnea
o orthopnea
o hemoptysis
o rales /wheezes
• cardiomegaly, increase HR, S3
• anxiety
• decrease peripheral pulses
s/sxs:
Nonpharmacologic measures:
Pharmacologic measures:
CARDIOTONIC DRUGS
I. Cardiac Glycosides
a. Digoxin ( Lanoxin, Lanoxicaps)
b. Digitoxin
Indications:
1. treat CHF
2. correct atrial fibrillation
3. correct atrial flutter
4. treat paroxysmal atrial tachycardia
Digitalis Toxicity
overdose or accumulation of digoxin
s/sxs
i. confusion & delirium
ii. bradycardia
iii. anorexia, N & V, diarrhea
iv. ventricular dysrhythmias heart block
Drug interactions:
1. verapamil, amiodarone, quinidine, erythromycin, tetracycline
ncrease Tx effect & toxic effects
2. potassium- losing diuretics & cortisone hypokalemia increase risk of cardiac
dysrhythmias.
3. antacids decrease digitalis absorption
4. thyroid hormones, metoclopramide or penicillamine decrease digitalis efficacy
Nursing Responsibilities:
Before
1. Obtain a drug history.
2. Obtain baseline pulse rate.
3. Assess for S/Sxs of digitalis toxicity & report ASAP.
4. Be aware of contraindications:
a. Allergy
b. Ventricular dysrhthmias
c. Heartblock
d. Acute myocardial infarction
e. Renal insufficiency
During
1. Read labels carefully.
2. Check dosage & preparation carefully esp in children & elderly.
3. Check apical pulse rate before administering digoxin.
4. Check serum digoxin level ( 0.5 – 2.0 ng /ml)
5. Check serum potassium level (3.5 – 5.3 mEq/L)
6. Maintain emergency equipment on standby:
a. Potassium salts
b. Lidocaine
c. Phenytoin
d. atropine
After
1. Monitor for SE/ adverse effects.
2. Monitor patients response & effectiveness.
A. Amrinone ( Inocor)
B. Milrinone ( Primacor)
Adverse effects:
1. ventricular arrhythmias
2. hypotension
3. chest pain
4. GI upset
5. thrombocytopenia
Nursing responsibilities:
• protect drug from light.
• Monitor PR & BP.
• Monitor platelet counts.
ANTIANGINAL DRUGS
decrease in O2 to myocardium
anginal pain
tightness
pressure in center of chest
pain radiating to left arm or neck
Types of Angina:
1. Classic (Stable)
• occurs with stress or exertion.
2. Unstable (Preinfarction )
• occurs frequently over the course of the day with progressive severity.
• occurs even at rest.
Myocaridal infarction:
complete occlusion of coronary vessel cells become ischemic necrotic
die.
S/sxs:
excruciating chest pain
nausea
severe sympathethic stress reaction
Nonpharmacologic measures:
Pharmacologic measures:
1. Nitrates
2. Calcium channel blockers effective for variant (vasospastic ) angina pectoris
3. Beta- blockers effective for stable angina
Antianginal Drugs:
I. Nitrates
1. Nitroglycerin (Nitro-Bid, Nitrostat, Transderm- Nitro)
2. Amyl nitrate
3. Isosorbide dinitrate (Isordil)
4. Isosorbide mononitrate (Imdur, Monoket)
II. Beta-blockers
A. Non-selective
1. Propanolol ( Inderal)
2. Nadolol (Corgard)
3. Pindolol (Visken)
B. Selective
1. Metoprolol (Toprol, Lopressor)
2. Atenolol (Tenormin)
I. Nitrates
cause generalized vascular & coronary vasodilation.
1. Nitroglycerin
Nitrate of choice in acute anginal attack
Sublingual (SL) tablet
• MC used
• absorbed rapidly & directly into:
internal jugular vein &
right atrium
• ave. dose 0.4mg or gr 1/150 following cardiac pain
• onset of action: 1-3 min. & effects lasts for 10 minutes
• decompose when exposed to light
2. Amyl nitrate
Inhaled
onset of action: 30 secs.
Drug- interactions:
1. beta-blockers
2. calcium channel blockers enhance hypotensive effect of nitrates
3. vasodilators
4. alcohol
5. IV nitroglycerin antagonize effects of heparin.
6. ergot derivatives risk of hypertension & decrease nitrate efficacy.
Nursing responsibilities:
1. Be aware of contraindications!
a. marked hypotension
b. acute myocardial infarction
c. severe anemia
d. head trauma / cerebral hemorrhage
e. pregnancy & lactation
2. Monitor VS.
3. Have client sit or lie down when taking nitrate for the 1st time.
4. Offer sips of water before giving SL nitrates.
5. Give SL preparations under tongue or in buccal pouch.
6. Rotate sites of topical forms.
7. Nitro-Bid ointment use tongue blade or gloves.
8. translingual spray used under tongue, not inhaled.
9. Break amyl nitrate & wave under nose.
10. Nitrol patch – removed nightly to allow for an 8-12 hr night-free interval.
11. taper dosage gradually over 4-6 wks.
12. Proper storage.
II. Beta-blockers
block release of catecholamines (Epi & Norepi)
decrease HR & BP
decrease myocardial contractility
Indications:
1. antianginal long term mgt of stable angina pectoris
2. anti-dysrhythmic
3. antihypertensive
well-absorbed orally
teratogenic effects in animal studies
SE/ adverse reactions:
o decrease in PR & BP
o dizziness, fatigue, emotional depression
o GI upset
o CHF & arrhythmias
o Bronchospasm & cough
A. Nonselective
decrease PR & cause bronchoconstriction
SE
• bronchospasm
• behavioral/ psychotic response
• impotence
1. Propanolol (Inderal)
onset of action:30 min , half-life 3-6hrs
long-term mgmt of angina
used to prevent reinfarction in stable pxs 1-4 wks after MI.
2. Nadolol (Corgard)
3. Pindolol (Visken)
B. Selective
act more strongly with beta 1 receptor.
decrease PR & avoid bronchoconstriction
2. Atenolol (Tenormin)
• onset of action: 60 min, half-life : 6-7hrs, doa: 24 hrs
Drug- interactions:
1. beta-blockers + clonidine paradoxical hypertension
2. beta-blockers + NSAIDS decrease antihypertensive effect
3. beta- blockers + ergot alkaloids peripheral ischemia
4. beta-blockers + insulin / antidiabetic agents change in blood glucose
Nursing Responsibilities:
1. Beware of CI!
a. bradycardia
b. heartblock & cardiogenic shock
c. asthma & COPD
d. preg & lactation
2. Donot discontinue drug abruptly.
III. Calcium Channel blockers
prevent movement of calcium into cardiac & smooth muscle cells
indications:
1. control of variant (vasopastic) angina
2. control of classic (stable) angina
3. atherosclerosis
SE/adverse effects:
1. dizziness, headache
2. nausea & hepatic injury
3. hypotension & bradycardia
4. flushing
1. Verapamil (Calan)
also used to treat rapid cardiac dysrhythmias
bradycardia
onset of action: 10 min, doa: 3 -7hrs – oral, 2hrs - IV
2. Nifedipine (Adalat,Procardia)
most potent
hypotension onset of action: 30 min., doa: 6- 8 hrs
3. Diltiazem (Cardizem)
Others:
4. Nicardipine (Cardene)
5. Amlodipine (Norvasc)
6. Bepridil (Vascor)
7. Felodipine (Plendil)
Drug Interactions:
1. Diltiazem + Cyclosporine increase toxicity
2. Verapamil + Digoxin increase risk of digoxin toxicity & heartblock
3. Verapamil + general anesthetics respiratory depression
Nursing responsibilities:
1. Beware of contraindications:
a. Allergy
b. Heartblock
c. Renal/hepatic dysfunction
d. Preg & lactation
2. Monitor BP & heart rhythm carefully.