Cardiac Medications Overview

Anticoagulants

• Function: Prevent coagulation (clot formation), do not dissolve existing clots.
• Medications: Heparin, Low molecular weight heparin (e.g., enoxaparin), Warfarin, Rivaroxaban.
• Uses: Pulmonary embolism, Deep vein thrombosis, Atrial fibrillation, Post-surgery, Myocardial infarction, Unstable angina.
• Side Effects: Bleeding, bruising, stomach upset, osteoporosis (warfarin), hair loss.
• Nurse's Role:
  • Monitor for bleeding, CBC (hemoglobin, hematocrit), platelet levels.
  • Monitor PTT (heparin) and PT/INR (warfarin) levels.
  • Check urine, stool for blood, and assess for signs of internal bleeding (e.g., low BP and high HR indicating possible bleeding).

Antiplatelets

• Function: Prevent platelet aggregation, stopping clot formation.
• Medications: Aspirin, Clopidogrel, Cilostazol.
• Uses: Myocardial infarction, strokes, coronary artery disease, stent placement.
• Side Effects: Bleeding, bruising, GI upset (especially aspirin), rash, headache.
• Nurse's Role:
  • Monitor platelet count, hemoglobin, hematocrit.
  • Watch for bleeding signs like in urine, stool, gums.
  • Note: Aspirin not for children (Risk of Reye's syndrome).

Angiotensin II Receptor Blockers (ARBs)

• Function: Block angiotensin 2 receptors, causing vasodilation.
• Medications: Olmesartan, Valsartan, Losartan.
• Uses: Hypertension, diabetic nephropathy, heart failure, peripheral arterial disease.
• Side Effects: Dizziness, hypotension, hyperkalemia, GI upset, rare angioedema.
• Nurse's Role:
  • Monitor potassium levels, renal function, blood pressure.
  • Be aware of signs of angioedema (swelling that can affect airway).

Antiarrhythmics

• Function: Treat fast arrhythmias by slowing heart's electrical activity.
• Medications: Flecainide, Procainamide, Amiodarone, Quinidine.
• Uses: Atrial fibrillation, atrial flutter, ventricular tachycardia, supraventricular tachycardia.
• Side Effects: Bradycardia, hypotension, new arrhythmias, heart block, QT interval prolongation, lung toxicity (amiodarone).
• Nurse's Role:
  • Monitor heart rhythm, blood pressure, electrolyte levels.
  • Watch for IV phlebitis and get chest x-rays as needed (amiodarone).

ACE Inhibitors

• Function: Inhibit the RAS system, preventing angiotensin 1 conversion to angiotensin 2, causing vasodilation.
• Medications: Captopril, Lisinopril, Ramipril.
• Uses: Heart failure, hypertension, post-MI, diabetic nephropathy.
• Side Effects: Dry cough, dizziness, hypotension, hyperkalemia, angioedema.
• Nurse's Role:
  • Monitor potassium, renal function, urinary output.
  • Assess for persistent cough, angioedema.

Beta Blockers

• Function: Block beta receptors, reducing sympathetic nervous system effects.
• Medications: Atenolol, Esmolol, Metoprolol.
• Uses: Hypertension, angina, arrhythmias, heart failure, migraines, glaucoma.
• Side Effects: Bradycardia, heart block, heart failure exacerbation, hypotension.
• Nurse's Role:
  • Monitor heart rate, blood pressure, ECG.
  • Educate on tapering off medication, effects of non-selective beta blockers on hypoglycemia awareness.

Calcium Channel Blockers

• Function: Block L-type calcium channels, relaxing blood vessels.
• Medications: Amlodipine, Felodipine, Nifedipine.
• Uses: Hypertension, angina, SVT, Raynaud's disease, atrial fibrillation, migraines.
• Side Effects: Bradycardia, hypotension, reflex tachycardia, GI issues, gum hyperplasia.
• Nurse's Role:
  • Monitor heart rate, blood pressure, ECG.
  • Avoid grapefruit juice, advise high fiber diet for constipation, good oral hygiene.

Cardiac Glycosides

• Medication: Digoxin.
• Uses: Heart failure, cardiogenic shock, atrial fibrillation, flutter.
• Mechanism: Positive inotropic (stronger contraction), negative chronotropic (lower rate), negative dromotropic (slower impulse).
• Toxicity: Narrow therapeutic range (0.5-2 ng/mL), signs include nausea, vision changes, ECG changes.
• Nurse's Role:
  • Monitor apical pulse, potassium levels, ECG.
  • Educate on potassium-rich diet, recognize signs of toxicity.

Statins

• Medications: Simvastatin, Lovastatin, Pravastatin.
• Uses: High cholesterol, stabilize fatty plaques.
• Mechanism: Inhibit HMG-CoA reductase, reducing cholesterol synthesis.
• Side Effects: Muscle soreness, liver enzyme increase, GI upset, glucose level effects.
• Nurse's Role:
  • Monitor for rhabdomyolysis, liver enzymes.
  • Avoid grapefruit juice.

Diuretics

• Types: Loop, Thiazides, Potassium-sparing, Carbonic anhydrase inhibitors.
• Uses: Fluid overload, hypertension, electrolyte imbalances, glaucoma.
• Medications:
  • Loop: Furosemide, Torsemide.
  • Thiazides: Hydrochlorothiazide.
  • Potassium-sparing: Spironolactone.
  • Carbonic anhydrase inhibitors: Acetazolamide.
• Side Effects: Electrolyte imbalances, dehydration, renal impairment, ototoxicity (loops), photosensitivity (thiazides).
• Nurse's Role:
  • Monitor fluid and electrolyte status, renal function, lung sounds.

Vasodilators

• Medications: Nitroglycerin, Minoxidil, Hydralazine.
• Uses: Angina, heart failure, hypertension, coronary artery disease.
• Mechanism: Vasodilation lowers blood pressure and decreases heart workload.
• Side Effects: Hypotension, flushing, headaches, reflex tachycardia, edema.
• Nurse's Role:
  • Monitor blood pressure, heart rate, ECG.
  • Educate on position change safety.

Angiotensin Receptor Neprilysin Inhibitors

• Combination Drug: Sacubitril/valsartan (Entresto).
• Uses: Heart failure with reduced ejection fraction.
• Mechanism: Inhibit angiotensin 2 and neprilysin, prevent ANP and BNP breakdown causing vasodilation and diuresis.
• Side Effects: Hypotension, hyperkalemia, angioedema, renal insufficiency.
• Nurse's Role:
  • Monitor electrolytes, renal function, intake/output, daily weight.
  • Avoid ACE inhibitor use within 36 hours.