Cardiac Medications Overview

Anticoagulants

• Purpose: Prevent clot growth and formation, not dissolve existing clots.
• Common Medications: Heparin, Low Molecular Weight Heparin (e.g., Enoxaparin), Warfarin, Rivaroxaban.
• Used For:
  • Pulmonary embolism
  • Deep vein thrombosis
  • Atrial fibrillation
  • Post-surgery clot prevention
  • Myocardial infarction
  • Unstable angina
• Mechanism: Slow down the coagulation process by interrupting the clotting cascade.
• Side Effects: Bleeding, bruising, GI upset, osteoporosis (Warfarin), hair loss.
• Nursing Role:
  • Monitor for bleeding (CBC, hemoglobin, hematocrit, platelet levels).
  • Monitor PTT for heparin and PT/INR for warfarin.
  • Assess for signs of internal bleeding.

Anti-platelets

• Purpose: Prevent platelet aggregation.
• Common Medications: Aspirin, Clopidogrel, Cilostazole.
• Used For:
  • Myocardial infarction prevention
  • Stroke prevention
  • Post-stent placement
• Mechanism: Prevent platelets from clumping.
• Side Effects: Bleeding, GI upset, rash, headache.
• Nursing Role:
  • Monitor platelet count, hemoglobin, hematocrit.
  • Assess for bleeding signs (urine, stool, gums).
  • Note: Aspirin is not for children (risk of Reye’s syndrome).

Angiotensin II Receptor Blockers (ARBs)

• Purpose: Cause vasodilation by blocking angiotensin II receptors.
• Common Medications: Olmesartan, Valsartan, Losartan.
• Used For:
  • Hypertension
  • Diabetic nephropathy
  • Heart failure
  • Peripheral arterial disease
• Mechanism: Prevent angiotensin II from binding to receptor sites.
• Side Effects: Dizziness, hypotension, hyperkalemia, GI upset.
• Nursing Role:
  • Monitor potassium levels, renal function.
  • Assess for hypotension and signs of angioedema.

Antiarrhythmics

• Purpose: Treat abnormal heart rhythms.
• Common Medications: Flecainide, Procainamide, Amiodarone, Quinidine.
• Used For:
  • Atrial fibrillation
  • Atrial flutter
  • Ventricular tachycardia
  • Supraventricular tachycardia
• Mechanism: Slow down electrical activity in the heart.
• Side Effects: Bradycardia, hypotension, new arrhythmias, QT prolongation.
• Nursing Role:
  • Monitor rhythm, electrolyte levels.
  • Check for lung toxicity (Amiodarone).

ACE Inhibitors

• Purpose: Inhibit renin-angiotensin-aldosterone system.
• Common Medications: Captopril, Lisinopril, Ramipril.
• Used For:
  • Heart failure
  • Hypertension
  • Post-myocardial infarction
  • Diabetic nephropathy
• Mechanism: Prevent conversion of angiotensin I to angiotensin II.
• Side Effects: Dry cough, dizziness, hyperkalemia, angioedema.
• Nursing Role:
  • Monitor potassium levels.
  • Assess BUN, creatinine.
  • Watch for signs of angioedema.

Beta Blockers

• Purpose: Block beta receptors to inhibit sympathetic nervous system activity.
• Common Medications: Atenolol, Esmolol, Metoprolol.
• Used For:
  • Hypertension
  • Stable angina
  • Arrhythmias
  • Heart failure
  • Other: Migraines, glaucoma, tremors
• Mechanism: Prevent norepinephrine and epinephrine binding.
• Side Effects: Bradycardia, heart block, worsening asthma/COPD, orthostatic hypotension.
• Nursing Role:
  • Monitor ECG, heart rate, blood pressure.
  • Educate patients about gradual tapering off medication.

Calcium Channel Blockers

• Purpose: Block calcium channels, leading to vessel dilation.
• Common Medications: Amlodipine, Felodipine, Nifedipine.
• Used For:
  • Hypertension
  • Angina
  • SVT
  • Raynaud's disease
  • Atrial fibrillation
• Mechanism: Block L-type calcium channels.
• Side Effects: Bradycardia, hypotension, orthostatic hypotension, GI issues.
• Nursing Role:
  • Monitor heart rate, blood pressure.
  • Advise against grapefruit juice.
  • Promote high-fiber diet.

Cardiac Glycosides (e.g., Digoxin)

• Purpose: Strengthen heart contractions, control heart rate.
• Used For:
  • Heart failure
  • Atrial fibrillation/flutter
• Mechanism: Positive inotropic, negative chronotropic and dromotropic effects.
• Side Effects: Toxicity (nausea, vision changes, dysrhythmias), bradycardia.
• Nursing Role:
  • Measure apical pulse before administration.
  • Monitor potassium levels, ECG.
  • Educate on potassium-rich diet.

Statins

• Purpose: Lower cholesterol levels.
• Common Medications: Simvastatin, Lovastatin, Pravastatin.
• Used For:
  • High cholesterol
  • Stabilizing fatty plaques
• Mechanism: Inhibit HMG-CoA reductase.
• Side Effects: Muscle soreness, liver enzyme increase, GI upset, glucose levels.
• Nursing Role:
  • Monitor for rhabdomyolysis.
  • Avoid grapefruit juice.
  • Check liver enzymes.

Diuretics

• Purpose: Increase urination to rid body of excess fluid.
• Types:
  • Loop (e.g., Furosemide)
  • Thiazides (e.g., Hydrochlorothiazide)
  • Potassium-sparing (e.g., Spironolactone)
  • Carbonic anhydrase inhibitors (e.g., Acetazolamide)
• Used For:
  • Heart failure
  • Hypertension
  • Glaucoma
• Mechanism: Act on various parts of the nephron.
• Side Effects: Electrolyte imbalances, dehydration, renal impairment.
• Nursing Role:
  • Monitor fluid and electrolyte status.
  • Check renal function, hearing.

Vasodilators

• Purpose: Dilate blood vessels.
• Common Medications: Nitroglycerin, Minoxidil, Hydralazine.
• Used For:
  • Angina
  • Heart failure
  • Hypertension
  • Pulmonary hypertension
• Mechanism: Dilate blood vessels to drop blood pressure.
• Side Effects: Hypotension, flushing, headache, edema.
• Nursing Role:
  • Monitor blood pressure, heart rate.
  • Educate on position changes.

Angiotensin Receptor Neprolysin Inhibitors

• Purpose: Treat heart failure with reduced ejection fraction.
• Common Medication: Entresto (Sacubitril/Valsartan).
• Mechanism: Inhibit angiotensin II and neprilysin.
• Side Effects: Hypotension, hyperkalemia, renal insufficiency.
• Nursing Role:
  • Do not administer with ACE inhibitors within 36 hours.
  • Monitor electrolytes, renal function, heart failure signs.