this is Professor Hoffman and we're continuing our discussion of cardiovascular drugs this is topic 6D so we're going to be looking at vasodilators nitrates anti ormic and cardiac glycoside classes um as we continue looking at cardiovascular related uh drug and uh situations so as you look at your study guide uh we're looking at again these categories the vasil dilators theight rates anti rythmics cardiac glycosides and um the related reading uh sections are listed there with the hyperlinks so first we want to look at vasodilators uh some example drugs are going to be minoxidil hydrazine nitropress um the nitrates are going as they going be looked at as a separate class they're also active vasod dilators so the vasod dilators we're looking at act directly on the vascular smooth muscle to cause vasod dilation so again if I relax those arterial walls and particular I'm going to lower the blood pressure I'm lowering the resistance so our use is going to be primarily hypertension there are some secondary uses when we look at few of those here in a little bit as we look at reactions um big reaction then is we can lower it too quickly a few of these drugs are extremely potent so we want monitor blood pressure closely that we don't move from hypertension down into a hypotensive crisis um can cause U palpitations the heart is going to respond to this lowering of blood pressure with some little bit harder beating um we may lose pressure of blood flow to the heart muscle itself so we may get some chest pain uh some indiv individuals do develop symptoms of systemic lupus rosis um some other reactions can be neurological with tremors some numbness tingling disorientation can have some impact on uh our sinuses as well as on um GI tract and headache our nursing considerations are to monitor that blood pressure make sure it doesn't drop too quickly or too far we're going to monitor for those individuals who may develop the lupus the SLE the lupus osmosis our teaching is going to be on drug compliance make sure they're taking the doses appropriately at the right time right schedule and they're consistent with it also teaching the patients and their families to watch for signs of a hypotension particularly changes with posture their orthostatic hypotension so again we're going to move the these uh fairly quickly just some key things that we want you to really focus on now the nitrates are specific grouping of vasod dilators U and their names are you going to have nitrate in the end of them um in some part of their generic name they focus again on vascular smooth muscle um direct quick acting vasod dilation and particularly on the cardiac um circulation the cardiac vascular um Network they're going to open up V cardia cardia blood vessels very quickly that are feeding the cardiac muscle and so they're going to be a primary drug for Angina prevention or chest pain uh treatment and prevention so again they're going to drop the blood pressure they're going to drop it very quickly so hypotension is going to be our major concern that we don't drop the blood pressure too quickly we're watching for that we're positioning the patients appropriately to compensate for that again they may experience palpitation ations headache is a very common particular with the fast acting sublingual nitroglycerin or the IV administered nitroglycerin uh nitrates uh headache is very common and uh will be treated with acetominophen to just help relieve the issue if someone's taking sublingual nitroglycerin at home uh we really should expect them to report that they had a headache with it that is a good sign that the drug is still potent um may have some issues of from the hypotension of weakness sweating the dizziness some of our considerations uh want we want to monitor their blood pressure and make them aware of signs and symptoms of hypotension uh we want to discourage them from eating or smoking when they're using them sublingual that's going to affect the absorption rate should not take it with the S denil that is also a vasodilator it's one of the vasodilators commonly known as Viagra was have initially developed as an anti-hypertensive particularly for pulmonary hypertension it was very selective to the pulmonary arteries and it decreased blood pressure there was found to have um the secondary effects that were more common with his Viagra but it is a vasodilator so if we take a nitrate along with individual taking Viagra we're going to get a very significant decrease in blood pressure uh when they're taking sublingual use for emergency use they need to know their dosing schedules how often can they take one what's their maximum level at what point do they call um activate the EMS system and you'll cover a lot of that material in your clinical classes as you're dealing with chest pain protocols the next class we want to look at are anti- rhythmics and these these are drugs that are going to change the cardiac conduction system normally to slow it down to stabilize it is going to be the main effect uh with each of these so we're usually looking at using them for tacky or rapid heart rate dysrhythmias what I want you to know with these is with the class what is it blocking that's the main thing to focus on so when we look at class one anti- rythmic we're looking at drugs that block the flow of sodium across the membranes so you have some example drugs there by decreasing the sodium they're going to decrease cell respons it's the stimulus it's going to again slow heart rate down um going to help stabilize um the conduction and the Rhythm it's another drug that um needs to be metabolized uh by the enzyme in the kidney so a grape fruit juice will block that enzyme a class one drug uh taken with grapefruit juice has a higher risk of toxicity so we want to watch that we also want to watch sodium levels to make sure that um as sodium levels change in the body if they get out of normal that's going to impact the sodium channels as well so that's a secondary thing we have to be aware of the class two drugs are beta blockers so these are the O laws again we've already talked about them how they work what they do um but again this is where they're being used as an anti- arhythmic not as an anti-hypertensive or as an yeah an anti-hypertensive U so being used specifically for this so just a few different considerations to be aware of class three drugs amiodarone would be a common one that you will see as you go into your clinical experiences are going to block potassium so again we see with class one and class three where in interfering with a sodium potassium pump class 3 particularly focusing on blocking pottassium movement when an Impulse uh is generated it's going to slow conduction it's going to decrease um responsiveness so again slowing the heart rate um is our primary goal we can get into toxicities really easily with it that's the blackbox warning and those can be fatal uh has multiple drug interactions so we have to watch that CU we're really tight into that potassium levels so we need to be really monitoring cardiac very closely as well as electrolyte levels and our fourth class are the calcium channel blockers so again when we talked about using them as anti-hypertensive we talked about the fact that they slowed the heart rate down and slowed the contractility this is where it's that's happening we're blocking the movement we're decreasing the responses it's the stimulus we slow conduction so we're going to have have that decreased heart rate also a decreased strength and contraction considerations get vital science monitoring next class we want to look at is cardiac glycosides dejin is the example drug for this class they also work on the sodium potassium pump so they're going to decrease um decrease heart rate but as opposed to the calcium channel blockers and the beta blockers they actually this this class of drug actually increases contractility so it's going to help decrease workload by slowing the heart rate down but it's still going to make it beat as effectively as it possibly can at that slower rate so it becomes a drug for um um for heart failure in the later stages when other D drugs are not being effective as support drugs so again it's going to increase contractility but slow the rate down it's also used useful for atrial fibrillation as a dis anti-ar rythmic um that's why it's falling in following the other classes it's not one of the four classes but just be aware with atrial fibrillation we may see it because it's going to slow or block that conduction system in with the use of sodium and potassium uh issues want to be where we can get develop toxic levels very easily so we have to monitor the dosing and it's going to be GI related type symptoms we're going to be monitoring for um we are slowing the heart rate down so we can look into Brady braic cardia and we also may move into some Brady dysrhythmias or arrhythmias we want to assess apical heart rate and not give it if it's below the parameters that are given by the provider uh if it's being taken on a long-term basis we want to monitor the dexin and potassium levels in particular and we're going to watch out for those GI symptoms of dexin tox icity um so that concludes this section of the cardiac drugs and we will move on to the next topic with the next video