Overview of Cardiac Medications

In this video, I'm going to summarize all the cardiac medications that you need to know. So let's get started. First up is the medication class known as the anticoagulants. The prefix anti means against. So we're working against coagulation and that's just a fancy way of talking about the body's ability to form a clot. We're going to affect that process. Now medications in this medication class include heparin, low molecular weight heparin, which is a noxaprin. Warfarin and Rivaroxaban. So what are these medications going to treat? Well they're going to treat conditions that have issues with clots. For instance like pulmonary embolism, deep vein thrombosis, atrial fibrillation or after surgery to prevent clots from forming like those surgeries where you unfortunately have the risk of clots developing like hip and knee surgery and whenever our patients had a myocardial infarction or they're experiencing unstable angina. And how these medications work is that they're going to stop, hence really slow down, the coagulation process, the body's ability to clot. by interrupting the clotting cascade process. Now one important thing to remember about this class of medications is that they do not dissolve or bust up existing clots. They're just going to really prevent those existing clots from growing and getting bigger or new ones from forming. Now there are side effects to these medications and it's because we are affecting that coagulation process. So big side effects come from bleeding and bruising. They can also upset the stomach causing nausea and vomiting. Clots Plus, warfarin, for instance, can affect the bones, leading to osteoporosis. So if your patient's on warfarin, you want to monitor their bone health. And these medications can lead to hair loss. Now, what is the nurse's role with this medication class? Well, one big thing is that you want to be monitoring for bleeding. And there's various tests that you can look at that will tell you, hey, your patient may have bleeding or certain signs and symptoms that tells you we got bleeding. So one thing is that you want to monitor that complete blood count that will be ordered by the health care provider. And you want to be looking at certain parts. parts of that CBC. One thing is the hemoglobin and hematocrit. Look at the patient's levels over time and if they're trending downward that tells you hey you may have some bleeding somewhere even though you don't see some outward bleeding there may be some bleeding inside. In addition if your patient is taking heparin you want to also look at the platelet level on that CBC and make sure that those platelets aren't just trending downward because it could mean that your patient has heparin induced thrombosis. cytopenia which could lead to them actually having an increase in coagulation plus you want to monitor the PTT level as well and then on the flip side with warfarin you wanted to monitor the PT INR level so heparin is PTT level and warfarin is PT INR level also you just want to assess your patient for bleeding so you looked at all those results then you want to take a look at your patients so some places that that blood can be can be in the urine and it can cause the urine just to turn this very light pink. Severe bleeding would be like just full-on red urine. You also want to look at their stool. Is it getting dark and sticky? And look at their gum. See if they have any oozing in their mouth. and assess them for pain particularly in the head or the stomach that could mean that we have some bleeding there and look at their vital signs a decreasing blood pressure hypotension with an increasing heart rate tachycardia that is a big sign that your patient may be bleeding out somewhere. And then if your patient still has menstruation, assess if their periods are heavy. Next up are the anti-platelets. And this medication class works against platelet aggregation, hence the clumping of the platelets. up of those platelets so we don't get a clot formed. And some medications that fall within this medication class include aspirin, clopidogrel, and cilostazole. So what are these medications used to treat? Well, think of conditions where we don't want those platelets forming together. So we could use them to help prevent a myocardial infarction. strokes, or let's say a patient has a stent place. We don't want a clot forming in that stent within that coronary artery because then we're just going to get them a cardiomyofarction, so they can be used for that. And then with patients who have known coronary artery disease or peripheral vascular disease. So again, how these medications work is that they prevent those platelets from sticking, hence clumping together, so we don't get the formation of a clot. Therefore some side effects that can happen because we're affecting that whole clotting process again will be a little similar to the anticoagulants You're going to have some bleeding Bruising GI upset particularly with aspirin. It can be very hard on the stomach leading to nausea vomiting heartburn and These medications can also lead to a rash and headache So the nurse's role is going to be really again looking for bleeding. So you particularly want to pay attention to a decreasing platelet count because we're affecting the platelet levels along with a decreasing hemoglobin hematocrit again points to bleeding. Plus look at sites where there could be bleeding like in the urine, the stool, look at their gums. Are they having excessive bruising or even stomach pain? Because again some of these medications are very hard on the stomach like aspirin. And then with aspirin, just remember as a side note, that aspirin is not for the pediatric population because it can lead to Rice syndrome. Next up are angiotensin II receptor blockers, also known as ARBs. So whenever you see the name of this medication class, pay attention to that angiotensin II. We know from our previous lectures, like with the RAS system, angiotensin 2 is a substance when it's activated. It causes vasoconstriction all through your body. Well, if we're blocking its receptors, we're going to get the opposite of that, vasodilation. So just remember that. So medications in this class include like omasartan, valsartan, losartan. And notice at the end of these generic names, we have the word sartan. So when you see sartan, connect it with ARBs. Now because these medications affect the activation of angiotensin 2, they're really great at treating patients who have hypertension, high blood pressure. Diabetic nephropathy, this is a chronic kidney disease that happens in patients who have diabetes and ARBs can actually help protect. their kidney function. So it can lower the blood pressure to the kidneys, which can decrease inflammation. We get decreased damage to the kidneys over time and the scarring and things that can happen. So it actually has a protective mechanism in it. These medications are also helpful with patients who have heart failure because they can lower the workload on the heart and patients who have peripheral arterial disease. So again, how ARBs work are that they are going to block the activation of angiotensin 2 receptor type 1. sites. This is going to prevent angiotensin 2 from binding to receptor sites. Now this is going to do a lot of things but two things I want you to remember is that that's going to dilate the vessels instead of constrict them and it's going to actually decrease the secretion of aldosterone. And aldosterone is a substance that helps really regulate your blood volume. It normally causes your body to keep water and sodium which helps build up your blood volume and excrete potassium. But if we're decreasing aldosterone secretion, what we're going to do is we're going to rid the body. So excrete our extra water and sodium help decrease the blood volume, but we're going to keep potassium. So because of how these medications work, they can cause the following side effects, dizziness, hypotension, dropping that blood pressure too low, particularly if they have too much medication in their system, it can do this. It can also increase the potassium level and that's because of how how it affects aldosterone and it can cause GI upset. And by the way, it seems like every medication can cause GI upset. So just always remember GI upset because most of that is going to fall in these medication classes. And the nurse's role involves monitoring the potassium level because it can increase too high. So you really want to watch that in patients who. you know are at risk for having kidney disease like patients who have diabetes you want to look at that renal function the bun and creatinine and you want to assess their blood pressure making sure that they're not having hypotension now one thing that can happen with this class which is rare but it could is called angioedema and this is where you get swelling in the face and in the lips and in the mouth and the throat now just thinking about that you got swelling going up in this part of the body what do we need to protect? The airway because we can cut off airflow. Next up are antiarrhythmics. This medication class works against arrhythmias. So we're talking about some abnormal heart rhythms and some medications that are in this class include flecainide, procainamide, amiodarone, and quinidine. So these medications are really good at treating those fast arrhythmias. So some fast arrhythmias include atrial fibrillation, atrial flutter, ventricular tachycardia, and superventricular tachycardia. Now how these medications work is that they slow down the electrical activity in the heart by altering various ion channels in the heart. So that's actually a great thing whenever you're having these fast arrhythmias like SVT, VTAC. We're going to slow things down and make that heart chill out a little bit. However, because we're slowing things down, we can slow down things a little too slow and it can lead to the the following side effects. We could cause bradycardia, hypotension, or we could cause a development of a new arrhythmia. We could cause some type of heart block. We can prolong that, you know, PR interval, which leads to our heart block, or we can prolong the QT interval. And you do not want to prolong that. QT interval. Whenever you start doing that, it can lead to like torsades, which is extremely dangerous. Also, these medications can alter potassium and magnesium levels, and particularly with amiodarone, it can affect the lungs. It can cause lung toxicity. So you definitely want to monitor the lung function. And this medication class can affect the skin and cause rash. Therefore, because of those side effects, a nurse's role includes monitoring the rhythm, making sure they're not entering into those rhythms that we were talking about, assessing the blood pressure, the heart rate, looking at those electrolyte levels, and then with IV, let's say your patient's getting this IV route, making sure they're not getting phlebitis. Now, Some protocols, depending on where you work, like with amiodarone, they may require that that's just given through a central line. But if you do have to give it IV, know that there is a high risk of phlebitis. Plus, a lot of protocols recommend that a patient has a chest x-ray whenever they are getting amiodarone. So you want to make sure you're looking at the results of that. Next are angiotensin converting enzyme inhibitors, so ACE inhibitors. This group is a little bit similar to ARBs in that they are affecting angiotensin 2 in some way, but they do it in different ways. Medications in this class include captopril, lisinopril, ramipril, and notice with these generic names, the endings end in pril. So you see pril, think of ACE inhibitors. These medications are used to treat patients who've had heart failure, hypertension, a post-MI, so after myocardial infarction, they're helpful in decreasing the workload on the heart, which it desperately needs after it just went through trauma. And it can also protect the renal function in patients who have diabetic nephropathy. Now, how these medications work is that they are going to inhibit the RAS system. So the renin-angiotensin-aldosterone system, which is going to prevent the conversion of angiotensin 1 into angiotensin 2. And if we're preventing that process, we're not going to get vasoconstriction. Instead, we're going to get vasodilation. So you can see why it's great for patients with heart failure, with hypertension, and helping protect the renal system. renal function in patients who have diabetes. Now because of that we can get some you know side effects. So some side effects include a persistent dry cough. I have seen patients get this it's typically harmless but it's completely annoying to them and they hate it and if that develops they can get on like an ARB or something else. Now the reason for this they think is because since we are affecting this conversion of angiotensin 1 and angiotensin 2 we also affect a substance called called bradyconin which increases and leads to this cough. It can also cause dizziness because you know we're affecting blood pressure, hypotension. It can increase potassium levels and lead to angioedema. Therefore the nurse's role includes monitoring the potassium level because it can increase. Plus you want to look at the labs like the BUN and creatinine making sure we're not having renal failure going on, looking at their urinary output, making sure it's within normal limits, and then assessing how your patient's tolerating the medication and that they're not developing that persistent dry cough and just checking to make sure that they don't have angioedema which can develop just like with ARBs. Next are beta blockers and this medication class blocks certain beta receptors in the body which is actually beneficial for your cardiovascular system and some medications in this class can include atenolol, esmolol, metoprol and notice at the end of these generic names we have OLL that is totally classic of a beta blocker So remember that those two go together this class can be used to treat a variety of things not really just cardiovascular issues like it can treat hypertension, stable angina, certain arrhythmias, heart failure, but it can also be used with migraines, glaucoma, and tremors. So how this medication class works is that it blocks beta receptor sites. So we don't get norepinephrine and epinephrine binding to these receptor sites. So when we can prevent that, we don't elicit the sympathetic nervous system. So we can help things chill out a little bit, which is beneficial, you know, when you have hypertension, some angina and tremors and things like that going on. But some side effects that can happen is that unfortunately we can slow the heart rate down way too low leading to bradycardia. We can cause a heart block like a second or third degree. We can exacerbate heart failure or we can even worsen a patient's heart rate. asthma or COPD and this really happens with those non-selective beta blockers. So keep that in mind if your patient has that and it can lead to orthostatic hypotension. The nurse's role would include monitoring the ECG, the heart rate, the blood pressure, and making sure the patient If they are at risk for heart failure that they're not experiencing heart failure exacerbation So what that would look like is that they start to have jugular venous distension They're experiencing weight gain they having swelling or they're having difficulty breathing that points to hey we got some heart failure going on and Educate patients. They just cannot quit taking beta blockers They have to be tapered off and if your patient has diabetes or they're at risk for hypoglycemia and and they're on the non-selective kind, they are at risk for their signs and symptoms of hypoglycemia being masked. Because a lot of patients sometimes, they know that their sugar has dropped whenever they become tachycardic. But beta blockers, they prevent your heart rate from climbing up. So educate patients about that. Next we have calcium channel blockers. And this class of medications is going to help block certain types of calcium channels. And some medications that are included in this class include amlodipine, filodipine, and nifedipine. And notice with some of these endings on their generic name, it ends in like dipine, D-I-P-I-N-E. These medications can be used to treat patients who have high blood pressure, so hypertension, angina, SVT, Raynaud's disease, atrial fibrillation, and migraines. Now how these calcium channel blockers work is that they block the L-type calcium channels in the body. So when we... do this we help dilate and relax our vessels. Now because we're affecting this whole process it can lead to the following side effects like bradycardia, hypotension, reflex tachycardia, or orthostatic hypotension. It can even cause a first-degree heart block so it can really affect our cardiovascular system. In addition it can cause some GI problems like constipation and affect the mouth especially the gums leading to a gingival hyperplasia. So as the nurse speaks because we got some cardiac problems that can go on, we definitely want to make sure we're focusing on monitoring their heart rate, their blood pressure, their ECG. And whenever we give this to the patient or they go home to take this, make sure that they know not to take this with grapefruit juice because it can affect how the medication works. Plus, because this medication can cause constipation, they need to make sure that they're eating a high-fiber diet and that they're practicing good oral hygiene to protect their gums. And to prevent injury to themselves. due to the orthostatic hypotension, they want to make sure that whenever they get up and change positions that they do this slowly. Then we have cardiac glycosides. One medication included in this group is sojoxin. And this medication can be used to treat heart failure, cardiogenic shock, atrial fibrillation, or atrial flutter. So how does this medication work? Well, there's three things I want you to remember because chances are you may see it on a farm exam again. The first thing is that it's going to have positive Inotropic effect on the heart where we're talking about inotropic We're talking about the force of contraction and because it's positive it means that the hearts contractions are going to be stronger Which is something we definitely need if our patient has heart failure or cardiogenic shock because the heart it's almost done and if we can get it to pump better that would be great another thing is that it's going to have a negative chronotropic effect so when we're talking about chronotropic we're talking about time hence the rate rate. So because it's negative, it's going to have a slower rate. So the heart is going to be slower. Then thirdly, we're going to have a negative dromatropic effect. So when we're talking about dromatropic, we're talking about like how the electrical signal is running or the conduction. So it's negative. Therefore, we're going to have a slower impulse through the AV node. So we have a heart that's going to be stronger. It's going to be slower. slower and the impulse is going to be slower, which is great when you have a fib, a flutter, or heart failure or cardiogenic shock. Now for side effects that are associated with digoxin, I really want to concentrate on toxicity because digoxin has a very narrow therapeutic range of 0.5 to 2 nanograms per milliliter. Therefore, you want to make sure you are aware of these signs and symptoms of toxicity. So early on, the patient can have nausea and vomiting. Then as it keeps going on they can have vision changes where they start to see yellowish green halos and as we start getting late the ecg will start to have dysrhythmia so you'll notice ecg changes so if your patient's on dig and that stuff's happening definitely want to get help so there are some things that increase your patient's risk of developing digoxin toxicity one thing electrolyte imbalances. A big one is potassium. If that potassium drops too low it can increase the toxin toxicity. Also, low magnesium can do this and a high calcium. Plus patients who are elderly are at risk for this or if they're taking calcium channel blockers. Now other side effects that can happen with the Didoxin of course is bradycardia that's why we always measure the heart rate before we give this medication and headache so going over to nurses role big thing you want to do is you want to count that apical pulse before you administer every Didoxin medication so follow your hospital's guidelines protocols on the ranges and when they want to administer this so this is just typically what it could be like for an adult you don't want to give it you will hold the medication if the heart rate is less than 60 that apical pulse the child less than 70 and an infant less than 90 to 100 again what was that therapeutic range it was 0.5 to 2 nanograms per milliliter and you want to make sure your patient is consuming foods that are rich in potassium if they're not supplementing a lot of times patients are going to be on a supplementation of potassium while they're taking this and monitor that potassium level when it's ordered and the ECG for any changes and make sure that their electrolytes are within range. Then we have the statins. So medications in this class include simvastatin, lovastatin, pravastatin and notice with those generic names what do we end with? Statin. So that makes it so easy whenever you're trying to identify these medications. This class of medications is very helpful in treating patients who have high cholesterol because what they can do is they can help lower the LDL, which is the bad cholesterol. They can help increase the HDL, which is the good cholesterol, and they can help lower the triglyceride levels. Plus, if a patient has some fatty plaques in their heart, because we do not want those to rupture, if they do, it can lead to a myocardial infarction. So statins can actually help in some cases stabilize those fatty plaques. And how this class of medications work is that they inhibit an enzyme known as HMG-CoA reductase. And by doing this we cannot convert mevalonic acid and activate the mevalonate pathway. So cholesterol is not really synthesized and whenever we can't do this we help lower our cholesterol levels. Now some side effects of these medications include sore muscles, but you want to make sure it's not progressing to a condition known as statin-induced rhabdomyolysis, which I'll talk about here in a moment under nurse's role. It can increase liver enzymes, it can cause GI upset, and increase glucose levels in patients who have type 2 diabetes. So the nurse's role includes monitoring for that statin-induced rhabdomyolysis, and that can present with an increase creatinine kinase, dark urine and kidney damage because what happens is as those muscles start to deteriorate and break down inside your muscles is a substance called myoglobin when that goes into the bloodstream eventually everything in your blood has to go to your kidneys to be filtered well your kidneys don't like myoglobin and it stresses them out so what happens is that it damages the kidneys and that's why you get the dark urine so you want to be monitoring for that in addition make sure the patient doesn't take this with grapefruit juice it can lead to increased toxicity and monitor those liver enzymes like the ALT and the AST. Next are diuretics. This class of medication, their whole goal is to increase urination because it's going to rid the body of extra fluid. Now there's four groups I want to go over. We have loop diuretics, thiazides, potassium sparing, and carbonic anhydrase inhibitors. So some medications that fall in each of those categories are the following. For lube diuretics, this could include furosemide, torsemide. For thiazides, we have hydrochlorothiazide or chlorothiazide. Potassium sparing could include spironolactone or amelioride. And then lastly, carbonic anhydrase inhibitors could include acetazolamide. Now, whenever you're trying to think about conditions that diuretics can treat, think about conditions where we have too much fluid buildup, or maybe we have some electrolyte problems, because those diuretics can go in and help correct that. For instance, like heart failure. Your heart's too weak, fluid builds up, and it accumulates in the body, which is not good, especially for your respiratory system. Or hypertension, when we can lower that blood pressure, blood volume, rid the body of a little bit of fluid, we can ease the pressure within those vessels, which will lower our blood pressure. Or if we have electrolyte disturbances where we have too high of electrolytes, some of these diuretics, depending on the group, will act on certain parts of the nephron and can help either keep certain ions, electrolytes, or they can help excrete those. And then even glaucoma, particularly the carbonic and hydrates inhibitors, they can help decrease the amount of fluid in the eye, which lowers the pressure. And again, how these medications work is that they are going to act on specific parts of the nephron within your kidney. For example, loop diuretics. What part do you think it works on within the nephron? The loop of Henle. So based on what... The type of diuretic we're talking about, it will affect that particular part of the nephron and it's going to remove extra fluid from the blood into your urine so it can be excreted out. Now because we're doing this, there are some side effects we have to watch out for. Particularly a big one are those electrolyte imbalances. So each group will... cause certain types of imbalances. So like with loops and thiazides, it can drop the potassium and sodium levels. So we really got to monitor those. With potassium sparing, what do you think it's going to do with that? Based on its name, it's going to spare potassium so you can get hyper clean. increase your potassium with that. Plus because we're ridding the body of fluid we could cause a patient to experience dehydration, we could stress the kidneys out too much and cause renal impairment, and one thing I want you to remember about loops is that it can affect the hearing, cause ototoxicity, and thiazides can cause photosensitivity. So remember that. The nurse's role is really going to revolve around fluid status and electrolyte status of the patient. So we want to monitor their I's and O's, intake and output, daily weights, because that's a good indicator of your fluid status, electrolyte levels, renal function by looking at that BUN. creatinine, making sure we're not dehydrating them too much by watching that blood pressure, assessing lung sounds, you know if your patients getting let's say these for heart failure, well are they actually working? Are those crackles that you heard when they were first admitted decreasing? since they've been getting all this IV furosemide. So checking that out and making sure that you're assessing their hearing because again, those loops can hurt the hearing. Next is vasodilators. And just as its name says, it's going to cause vasodilation. So we're gonna open up those vessels. So medications in this class include nitroglycerin, minoxidil, and hydralazine. Now, Based on how these medications work, they're going to be great at treating conditions where we have angina. Angina a lot of times is occurring because your coronary arteries are not getting good blood flow through them. So they can't feed the myocardial. So we can dilate, let's say that vessel that's got narrowed, we can increase the blood flow. Also, it's helpful in heart failure, which will help decrease the workload on the heart, hypertension, coronary artery disease, pulmonary. hypertension and peripheral vascular disease. And how these medications work is that they dilate the vessels. So whenever you're dilating a vessel what this does is that that's going to drop the overall blood pressure and this can help decrease the workload on your heart and your vascular system. Now this is a good thing if you need it to happen, however it can lead to side effects. So when you dilate what's going to happen? It can cause side effects of hypotension. It can also lead to flushing. big thing like with nitroglycerin, if you ever give it a sublingual, you can see that the patient starts to get flushing in their face, their face becomes red, and they feel really hot. Also, it can lead to those wonderful headaches like those nitroglycerin headaches, orthostatic hypotension, nausea, vomiting, reflex tachycardia, and edema. The nurse's role includes, of course, monitoring their blood pressure, their heart rate, and their ECG, and assessing their status of their flushing, and if they've developed any swelling. A lot of times we give these medications because the patient is having chest pain. So whenever a patient has chest pain and you give these, you want to stay with your patient and you want to assess how their chest pain is doing. You want to look at where the location is. Is the location changing? The onset, the quality of the pain, and the frequency. Plus, while your patient's on these, whenever they go to change positions, you want to make sure you educate them on to do this very slowly because they could pass out. And then last... Firstly we have angiotensin receptor neprolicin inhibitors. And this class of medication includes a combination drug which includes cecubitril and valsartan. And the brand name of this medication is Entresto. And this class of medication is used to treat heart failure that has a reduced ejection fraction. And how these medications work is that they are going to inhibit angiotensin 2 and neprilysin which is going to prevent the breakdown of the substances ANP and BNP and these are natriureic peptides. So whenever we prevent their breakdown we're going to get vasodilation and diuresis which is really beneficial for patients who have heart failure. Now because of this we have side effects that can happen of course. We can get hypotension, high potassium levels, angioedema, renal insufficiency, coughing, and dizziness. Nurses role with this medication would include that you do not administer this medication with an ACE inhibitor for at least 36 hours before or after that ACE inhibitor has been given. Plus you want to make sure you're monitoring the patient's electrolytes, their renal function by looking at that VUN and creatinine and looking at their blood pressure and heart rate. Monitor their intake and output, assessing for any swelling, and their daily weights. Because all that goes along with monitoring a patient for heart failure. And that you want to make sure that this medication is working and that your patient's signs and symptoms of heart failure wasn't worsening. So what would that be if it was? Well, the patient starts to have crackles or their crackles are getting worse. They're having a cough, especially a productive cough. That's a super bad sign. They're having chest pain. They're having weight gain or difficulty breathing. Okay, so that wraps up this video. over cardiac medications. If you'd like to watch more videos in this pharmacology series you can access the link below.

We're going to affect that process. Now medications in this medication class include heparin, low molecular weight heparin, which is a noxaprin. Warfarin and Rivaroxaban.

So what are these medications going to treat? Well they're going to treat conditions that have issues with clots. For instance like pulmonary embolism, deep vein thrombosis, atrial fibrillation or after surgery to prevent clots from forming like those surgeries where you unfortunately have the risk of clots developing like hip and knee surgery and whenever our patients had a myocardial infarction or they're experiencing unstable angina.

And how these medications work is that they're going to stop, hence really slow down, the coagulation process, the body's ability to clot. by interrupting the clotting cascade process. Now one important thing to remember about this class of medications is that they do not dissolve or bust up existing clots.

They're just going to really prevent those existing clots from growing and getting bigger or new ones from forming. Now there are side effects to these medications and it's because we are affecting that coagulation process. So big side effects come from bleeding and bruising.

They can also upset the stomach causing nausea and vomiting. Clots Plus, warfarin, for instance, can affect the bones, leading to osteoporosis. So if your patient's on warfarin, you want to monitor their bone health. And these medications can lead to hair loss.

Now, what is the nurse's role with this medication class? Well, one big thing is that you want to be monitoring for bleeding. And there's various tests that you can look at that will tell you, hey, your patient may have bleeding or certain signs and symptoms that tells you we got bleeding. So one thing is that you want to monitor that complete blood count that will be ordered by the health care provider. And you want to be looking at certain parts.

parts of that CBC. One thing is the hemoglobin and hematocrit. Look at the patient's levels over time and if they're trending downward that tells you hey you may have some bleeding somewhere even though you don't see some outward bleeding there may be some bleeding inside.

In addition if your patient is taking heparin you want to also look at the platelet level on that CBC and make sure that those platelets aren't just trending downward because it could mean that your patient has heparin induced thrombosis. cytopenia which could lead to them actually having an increase in coagulation plus you want to monitor the PTT level as well and then on the flip side with warfarin you wanted to monitor the PT INR level so heparin is PTT level and warfarin is PT INR level also you just want to assess your patient for bleeding so you looked at all those results then you want to take a look at your patients so some places that that blood can be can be in the urine and it can cause the urine just to turn this very light pink. Severe bleeding would be like just full-on red urine.

You also want to look at their stool. Is it getting dark and sticky? And look at their gum. See if they have any oozing in their mouth. and assess them for pain particularly in the head or the stomach that could mean that we have some bleeding there and look at their vital signs a decreasing blood pressure hypotension with an increasing heart rate tachycardia that is a big sign that your patient may be bleeding out somewhere.

And then if your patient still has menstruation, assess if their periods are heavy. Next up are the anti-platelets. And this medication class works against platelet aggregation, hence the clumping of the platelets. up of those platelets so we don't get a clot formed. And some medications that fall within this medication class include aspirin, clopidogrel, and cilostazole.

So what are these medications used to treat? Well, think of conditions where we don't want those platelets forming together. So we could use them to help prevent a myocardial infarction. strokes, or let's say a patient has a stent place. We don't want a clot forming in that stent within that coronary artery because then we're just going to get them a cardiomyofarction, so they can be used for that.

And then with patients who have known coronary artery disease or peripheral vascular disease. So again, how these medications work is that they prevent those platelets from sticking, hence clumping together, so we don't get the formation of a clot. Therefore some side effects that can happen because we're affecting that whole clotting process again will be a little similar to the anticoagulants You're going to have some bleeding Bruising GI upset particularly with aspirin.

It can be very hard on the stomach leading to nausea vomiting heartburn and These medications can also lead to a rash and headache So the nurse's role is going to be really again looking for bleeding. So you particularly want to pay attention to a decreasing platelet count because we're affecting the platelet levels along with a decreasing hemoglobin hematocrit again points to bleeding. Plus look at sites where there could be bleeding like in the urine, the stool, look at their gums.

Are they having excessive bruising or even stomach pain? Because again some of these medications are very hard on the stomach like aspirin. And then with aspirin, just remember as a side note, that aspirin is not for the pediatric population because it can lead to Rice syndrome.

Next up are angiotensin II receptor blockers, also known as ARBs. So whenever you see the name of this medication class, pay attention to that angiotensin II. We know from our previous lectures, like with the RAS system, angiotensin 2 is a substance when it's activated.

It causes vasoconstriction all through your body. Well, if we're blocking its receptors, we're going to get the opposite of that, vasodilation. So just remember that.

So medications in this class include like omasartan, valsartan, losartan. And notice at the end of these generic names, we have the word sartan. So when you see sartan, connect it with ARBs.

Now because these medications affect the activation of angiotensin 2, they're really great at treating patients who have hypertension, high blood pressure. Diabetic nephropathy, this is a chronic kidney disease that happens in patients who have diabetes and ARBs can actually help protect. their kidney function.

So it can lower the blood pressure to the kidneys, which can decrease inflammation. We get decreased damage to the kidneys over time and the scarring and things that can happen. So it actually has a protective mechanism in it.

These medications are also helpful with patients who have heart failure because they can lower the workload on the heart and patients who have peripheral arterial disease. So again, how ARBs work are that they are going to block the activation of angiotensin 2 receptor type 1. sites. This is going to prevent angiotensin 2 from binding to receptor sites. Now this is going to do a lot of things but two things I want you to remember is that that's going to dilate the vessels instead of constrict them and it's going to actually decrease the secretion of aldosterone.

And aldosterone is a substance that helps really regulate your blood volume. It normally causes your body to keep water and sodium which helps build up your blood volume and excrete potassium. But if we're decreasing aldosterone secretion, what we're going to do is we're going to rid the body. So excrete our extra water and sodium help decrease the blood volume, but we're going to keep potassium.

So because of how these medications work, they can cause the following side effects, dizziness, hypotension, dropping that blood pressure too low, particularly if they have too much medication in their system, it can do this. It can also increase the potassium level and that's because of how how it affects aldosterone and it can cause GI upset. And by the way, it seems like every medication can cause GI upset. So just always remember GI upset because most of that is going to fall in these medication classes. And the nurse's role involves monitoring the potassium level because it can increase too high.

So you really want to watch that in patients who. you know are at risk for having kidney disease like patients who have diabetes you want to look at that renal function the bun and creatinine and you want to assess their blood pressure making sure that they're not having hypotension now one thing that can happen with this class which is rare but it could is called angioedema and this is where you get swelling in the face and in the lips and in the mouth and the throat now just thinking about that you got swelling going up in this part of the body what do we need to protect? The airway because we can cut off airflow.

Next up are antiarrhythmics. This medication class works against arrhythmias. So we're talking about some abnormal heart rhythms and some medications that are in this class include flecainide, procainamide, amiodarone, and quinidine.

So these medications are really good at treating those fast arrhythmias. So some fast arrhythmias include atrial fibrillation, atrial flutter, ventricular tachycardia, and superventricular tachycardia. Now how these medications work is that they slow down the electrical activity in the heart by altering various ion channels in the heart. So that's actually a great thing whenever you're having these fast arrhythmias like SVT, VTAC. We're going to slow things down and make that heart chill out a little bit.

However, because we're slowing things down, we can slow down things a little too slow and it can lead to the the following side effects. We could cause bradycardia, hypotension, or we could cause a development of a new arrhythmia. We could cause some type of heart block.

We can prolong that, you know, PR interval, which leads to our heart block, or we can prolong the QT interval. And you do not want to prolong that. QT interval.

Whenever you start doing that, it can lead to like torsades, which is extremely dangerous. Also, these medications can alter potassium and magnesium levels, and particularly with amiodarone, it can affect the lungs. It can cause lung toxicity.

So you definitely want to monitor the lung function. And this medication class can affect the skin and cause rash. Therefore, because of those side effects, a nurse's role includes monitoring the rhythm, making sure they're not entering into those rhythms that we were talking about, assessing the blood pressure, the heart rate, looking at those electrolyte levels, and then with IV, let's say your patient's getting this IV route, making sure they're not getting phlebitis. Now, Some protocols, depending on where you work, like with amiodarone, they may require that that's just given through a central line.

But if you do have to give it IV, know that there is a high risk of phlebitis. Plus, a lot of protocols recommend that a patient has a chest x-ray whenever they are getting amiodarone. So you want to make sure you're looking at the results of that.

Next are angiotensin converting enzyme inhibitors, so ACE inhibitors. This group is a little bit similar to ARBs in that they are affecting angiotensin 2 in some way, but they do it in different ways. Medications in this class include captopril, lisinopril, ramipril, and notice with these generic names, the endings end in pril.

So you see pril, think of ACE inhibitors. These medications are used to treat patients who've had heart failure, hypertension, a post-MI, so after myocardial infarction, they're helpful in decreasing the workload on the heart, which it desperately needs after it just went through trauma. And it can also protect the renal function in patients who have diabetic nephropathy.

Now, how these medications work is that they are going to inhibit the RAS system. So the renin-angiotensin-aldosterone system, which is going to prevent the conversion of angiotensin 1 into angiotensin 2. And if we're preventing that process, we're not going to get vasoconstriction. Instead, we're going to get vasodilation. So you can see why it's great for patients with heart failure, with hypertension, and helping protect the renal system.

renal function in patients who have diabetes. Now because of that we can get some you know side effects. So some side effects include a persistent dry cough.

I have seen patients get this it's typically harmless but it's completely annoying to them and they hate it and if that develops they can get on like an ARB or something else. Now the reason for this they think is because since we are affecting this conversion of angiotensin 1 and angiotensin 2 we also affect a substance called called bradyconin which increases and leads to this cough. It can also cause dizziness because you know we're affecting blood pressure, hypotension.

It can increase potassium levels and lead to angioedema. Therefore the nurse's role includes monitoring the potassium level because it can increase. Plus you want to look at the labs like the BUN and creatinine making sure we're not having renal failure going on, looking at their urinary output, making sure it's within normal limits, and then assessing how your patient's tolerating the medication and that they're not developing that persistent dry cough and just checking to make sure that they don't have angioedema which can develop just like with ARBs. Next are beta blockers and this medication class blocks certain beta receptors in the body which is actually beneficial for your cardiovascular system and some medications in this class can include atenolol, esmolol, metoprol and notice at the end of these generic names we have OLL that is totally classic of a beta blocker So remember that those two go together this class can be used to treat a variety of things not really just cardiovascular issues like it can treat hypertension, stable angina, certain arrhythmias, heart failure, but it can also be used with migraines, glaucoma, and tremors.

So how this medication class works is that it blocks beta receptor sites. So we don't get norepinephrine and epinephrine binding to these receptor sites. So when we can prevent that, we don't elicit the sympathetic nervous system.

So we can help things chill out a little bit, which is beneficial, you know, when you have hypertension, some angina and tremors and things like that going on. But some side effects that can happen is that unfortunately we can slow the heart rate down way too low leading to bradycardia. We can cause a heart block like a second or third degree. We can exacerbate heart failure or we can even worsen a patient's heart rate. asthma or COPD and this really happens with those non-selective beta blockers.

So keep that in mind if your patient has that and it can lead to orthostatic hypotension. The nurse's role would include monitoring the ECG, the heart rate, the blood pressure, and making sure the patient If they are at risk for heart failure that they're not experiencing heart failure exacerbation So what that would look like is that they start to have jugular venous distension They're experiencing weight gain they having swelling or they're having difficulty breathing that points to hey we got some heart failure going on and Educate patients. They just cannot quit taking beta blockers They have to be tapered off and if your patient has diabetes or they're at risk for hypoglycemia and and they're on the non-selective kind, they are at risk for their signs and symptoms of hypoglycemia being masked. Because a lot of patients sometimes, they know that their sugar has dropped whenever they become tachycardic.

But beta blockers, they prevent your heart rate from climbing up. So educate patients about that. Next we have calcium channel blockers. And this class of medications is going to help block certain types of calcium channels.

And some medications that are included in this class include amlodipine, filodipine, and nifedipine. And notice with some of these endings on their generic name, it ends in like dipine, D-I-P-I-N-E. These medications can be used to treat patients who have high blood pressure, so hypertension, angina, SVT, Raynaud's disease, atrial fibrillation, and migraines. Now how these calcium channel blockers work is that they block the L-type calcium channels in the body. So when we...

do this we help dilate and relax our vessels. Now because we're affecting this whole process it can lead to the following side effects like bradycardia, hypotension, reflex tachycardia, or orthostatic hypotension. It can even cause a first-degree heart block so it can really affect our cardiovascular system. In addition it can cause some GI problems like constipation and affect the mouth especially the gums leading to a gingival hyperplasia.

So as the nurse speaks because we got some cardiac problems that can go on, we definitely want to make sure we're focusing on monitoring their heart rate, their blood pressure, their ECG. And whenever we give this to the patient or they go home to take this, make sure that they know not to take this with grapefruit juice because it can affect how the medication works. Plus, because this medication can cause constipation, they need to make sure that they're eating a high-fiber diet and that they're practicing good oral hygiene to protect their gums.

And to prevent injury to themselves. due to the orthostatic hypotension, they want to make sure that whenever they get up and change positions that they do this slowly. Then we have cardiac glycosides.

One medication included in this group is sojoxin. And this medication can be used to treat heart failure, cardiogenic shock, atrial fibrillation, or atrial flutter. So how does this medication work? Well, there's three things I want you to remember because chances are you may see it on a farm exam again. The first thing is that it's going to have positive Inotropic effect on the heart where we're talking about inotropic We're talking about the force of contraction and because it's positive it means that the hearts contractions are going to be stronger Which is something we definitely need if our patient has heart failure or cardiogenic shock because the heart it's almost done and if we can get it to pump better that would be great another thing is that it's going to have a negative chronotropic effect so when we're talking about chronotropic we're talking about time hence the rate rate.

So because it's negative, it's going to have a slower rate. So the heart is going to be slower. Then thirdly, we're going to have a negative dromatropic effect. So when we're talking about dromatropic, we're talking about like how the electrical signal is running or the conduction.

So it's negative. Therefore, we're going to have a slower impulse through the AV node. So we have a heart that's going to be stronger.

It's going to be slower. slower and the impulse is going to be slower, which is great when you have a fib, a flutter, or heart failure or cardiogenic shock. Now for side effects that are associated with digoxin, I really want to concentrate on toxicity because digoxin has a very narrow therapeutic range of 0.5 to 2 nanograms per milliliter. Therefore, you want to make sure you are aware of these signs and symptoms of toxicity.

So early on, the patient can have nausea and vomiting. Then as it keeps going on they can have vision changes where they start to see yellowish green halos and as we start getting late the ecg will start to have dysrhythmia so you'll notice ecg changes so if your patient's on dig and that stuff's happening definitely want to get help so there are some things that increase your patient's risk of developing digoxin toxicity one thing electrolyte imbalances. A big one is potassium. If that potassium drops too low it can increase the toxin toxicity.

Also, low magnesium can do this and a high calcium. Plus patients who are elderly are at risk for this or if they're taking calcium channel blockers. Now other side effects that can happen with the Didoxin of course is bradycardia that's why we always measure the heart rate before we give this medication and headache so going over to nurses role big thing you want to do is you want to count that apical pulse before you administer every Didoxin medication so follow your hospital's guidelines protocols on the ranges and when they want to administer this so this is just typically what it could be like for an adult you don't want to give it you will hold the medication if the heart rate is less than 60 that apical pulse the child less than 70 and an infant less than 90 to 100 again what was that therapeutic range it was 0.5 to 2 nanograms per milliliter and you want to make sure your patient is consuming foods that are rich in potassium if they're not supplementing a lot of times patients are going to be on a supplementation of potassium while they're taking this and monitor that potassium level when it's ordered and the ECG for any changes and make sure that their electrolytes are within range. Then we have the statins. So medications in this class include simvastatin, lovastatin, pravastatin and notice with those generic names what do we end with?

Statin. So that makes it so easy whenever you're trying to identify these medications. This class of medications is very helpful in treating patients who have high cholesterol because what they can do is they can help lower the LDL, which is the bad cholesterol. They can help increase the HDL, which is the good cholesterol, and they can help lower the triglyceride levels. Plus, if a patient has some fatty plaques in their heart, because we do not want those to rupture, if they do, it can lead to a myocardial infarction.

So statins can actually help in some cases stabilize those fatty plaques. And how this class of medications work is that they inhibit an enzyme known as HMG-CoA reductase. And by doing this we cannot convert mevalonic acid and activate the mevalonate pathway.

So cholesterol is not really synthesized and whenever we can't do this we help lower our cholesterol levels. Now some side effects of these medications include sore muscles, but you want to make sure it's not progressing to a condition known as statin-induced rhabdomyolysis, which I'll talk about here in a moment under nurse's role. It can increase liver enzymes, it can cause GI upset, and increase glucose levels in patients who have type 2 diabetes. So the nurse's role includes monitoring for that statin-induced rhabdomyolysis, and that can present with an increase creatinine kinase, dark urine and kidney damage because what happens is as those muscles start to deteriorate and break down inside your muscles is a substance called myoglobin when that goes into the bloodstream eventually everything in your blood has to go to your kidneys to be filtered well your kidneys don't like myoglobin and it stresses them out so what happens is that it damages the kidneys and that's why you get the dark urine so you want to be monitoring for that in addition make sure the patient doesn't take this with grapefruit juice it can lead to increased toxicity and monitor those liver enzymes like the ALT and the AST. Next are diuretics.

This class of medication, their whole goal is to increase urination because it's going to rid the body of extra fluid. Now there's four groups I want to go over. We have loop diuretics, thiazides, potassium sparing, and carbonic anhydrase inhibitors.

So some medications that fall in each of those categories are the following. For lube diuretics, this could include furosemide, torsemide. For thiazides, we have hydrochlorothiazide or chlorothiazide. Potassium sparing could include spironolactone or amelioride. And then lastly, carbonic anhydrase inhibitors could include acetazolamide.

Now, whenever you're trying to think about conditions that diuretics can treat, think about conditions where we have too much fluid buildup, or maybe we have some electrolyte problems, because those diuretics can go in and help correct that. For instance, like heart failure. Your heart's too weak, fluid builds up, and it accumulates in the body, which is not good, especially for your respiratory system.

Or hypertension, when we can lower that blood pressure, blood volume, rid the body of a little bit of fluid, we can ease the pressure within those vessels, which will lower our blood pressure. Or if we have electrolyte disturbances where we have too high of electrolytes, some of these diuretics, depending on the group, will act on certain parts of the nephron and can help either keep certain ions, electrolytes, or they can help excrete those. And then even glaucoma, particularly the carbonic and hydrates inhibitors, they can help decrease the amount of fluid in the eye, which lowers the pressure. And again, how these medications work is that they are going to act on specific parts of the nephron within your kidney. For example, loop diuretics.

What part do you think it works on within the nephron? The loop of Henle. So based on what... The type of diuretic we're talking about, it will affect that particular part of the nephron and it's going to remove extra fluid from the blood into your urine so it can be excreted out. Now because we're doing this, there are some side effects we have to watch out for.

Particularly a big one are those electrolyte imbalances. So each group will... cause certain types of imbalances. So like with loops and thiazides, it can drop the potassium and sodium levels.

So we really got to monitor those. With potassium sparing, what do you think it's going to do with that? Based on its name, it's going to spare potassium so you can get hyper clean.

increase your potassium with that. Plus because we're ridding the body of fluid we could cause a patient to experience dehydration, we could stress the kidneys out too much and cause renal impairment, and one thing I want you to remember about loops is that it can affect the hearing, cause ototoxicity, and thiazides can cause photosensitivity. So remember that. The nurse's role is really going to revolve around fluid status and electrolyte status of the patient. So we want to monitor their I's and O's, intake and output, daily weights, because that's a good indicator of your fluid status, electrolyte levels, renal function by looking at that BUN.

creatinine, making sure we're not dehydrating them too much by watching that blood pressure, assessing lung sounds, you know if your patients getting let's say these for heart failure, well are they actually working? Are those crackles that you heard when they were first admitted decreasing? since they've been getting all this IV furosemide. So checking that out and making sure that you're assessing their hearing because again, those loops can hurt the hearing.

Next is vasodilators. And just as its name says, it's going to cause vasodilation. So we're gonna open up those vessels. So medications in this class include nitroglycerin, minoxidil, and hydralazine. Now, Based on how these medications work, they're going to be great at treating conditions where we have angina.

Angina a lot of times is occurring because your coronary arteries are not getting good blood flow through them. So they can't feed the myocardial. So we can dilate, let's say that vessel that's got narrowed, we can increase the blood flow. Also, it's helpful in heart failure, which will help decrease the workload on the heart, hypertension, coronary artery disease, pulmonary. hypertension and peripheral vascular disease.

And how these medications work is that they dilate the vessels. So whenever you're dilating a vessel what this does is that that's going to drop the overall blood pressure and this can help decrease the workload on your heart and your vascular system. Now this is a good thing if you need it to happen, however it can lead to side effects.

So when you dilate what's going to happen? It can cause side effects of hypotension. It can also lead to flushing.

big thing like with nitroglycerin, if you ever give it a sublingual, you can see that the patient starts to get flushing in their face, their face becomes red, and they feel really hot. Also, it can lead to those wonderful headaches like those nitroglycerin headaches, orthostatic hypotension, nausea, vomiting, reflex tachycardia, and edema. The nurse's role includes, of course, monitoring their blood pressure, their heart rate, and their ECG, and assessing their status of their flushing, and if they've developed any swelling.

A lot of times we give these medications because the patient is having chest pain. So whenever a patient has chest pain and you give these, you want to stay with your patient and you want to assess how their chest pain is doing. You want to look at where the location is.

Is the location changing? The onset, the quality of the pain, and the frequency. Plus, while your patient's on these, whenever they go to change positions, you want to make sure you educate them on to do this very slowly because they could pass out.

And then last... Firstly we have angiotensin receptor neprolicin inhibitors. And this class of medication includes a combination drug which includes cecubitril and valsartan. And the brand name of this medication is Entresto.

And this class of medication is used to treat heart failure that has a reduced ejection fraction. And how these medications work is that they are going to inhibit angiotensin 2 and neprilysin which is going to prevent the breakdown of the substances ANP and BNP and these are natriureic peptides. So whenever we prevent their breakdown we're going to get vasodilation and diuresis which is really beneficial for patients who have heart failure. Now because of this we have side effects that can happen of course. We can get hypotension, high potassium levels, angioedema, renal insufficiency, coughing, and dizziness.

Nurses role with this medication would include that you do not administer this medication with an ACE inhibitor for at least 36 hours before or after that ACE inhibitor has been given. Plus you want to make sure you're monitoring the patient's electrolytes, their renal function by looking at that VUN and creatinine and looking at their blood pressure and heart rate. Monitor their intake and output, assessing for any swelling, and their daily weights.

Because all that goes along with monitoring a patient for heart failure. And that you want to make sure that this medication is working and that your patient's signs and symptoms of heart failure wasn't worsening. So what would that be if it was?

Well, the patient starts to have crackles or their crackles are getting worse. They're having a cough, especially a productive cough. That's a super bad sign.

They're having chest pain. They're having weight gain or difficulty breathing. Okay, so that wraps up this video.

over cardiac medications. If you'd like to watch more videos in this pharmacology series you can access the link below.

Transcript for:Overview of Cardiac Medications

Transcript for:
Overview of Cardiac Medications