Summary of Cardiac Medications

Anti-Coagulants

• Purpose: Work against coagulation to prevent clot formation.
• Medications: Heparin, Low molecular weight heparin (Enoxaparin), Warfarin, Rivaroxaban.
• Indications: Pulmonary embolism, Deep vein thrombosis, Atrial fibrillation, Post-surgery clot prevention, Myocardial infarction, Unstable angina.
• Mechanism: Slow down the coagulation by interrupting the clotting cascade.
• Side Effects: Bleeding, bruising, stomach upset, osteoporosis (with Warfarin), hair loss.
• Nurse's Role:
  • Monitor for bleeding (CBC, hemoglobin, hematocrit levels).
  • Check platelet levels for Heparin-induced thrombocytopenia.
  • Monitor PTT levels for Heparin and PT/INR for Warfarin.
  • Assess for signs/symptoms of bleeding (urine, stool, gums, hypotension, tachycardia).

Anti-Platelets

• Purpose: Prevent platelet aggregation.
• Medications: Aspirin, Clopidogrel, Cilostazol.
• Indications: Myocardial infarction prevention, Stroke prevention, Post-stent placement, Coronary artery disease.
• Mechanism: Prevent platelet clumping.
• Side Effects: Bleeding, bruising, GI upset, headache.
• Nurse's Role:
  • Monitor platelet count, hemoglobin, hematocrit.
  • Assess for bleeding in urine, stool, gums, bruising, stomach pain.
  • Note: Aspirin not for pediatric use (Reye’s syndrome).

Angiotensin II Receptor Blockers (ARBs)

• Purpose: Block angiotensin II to cause vasodilation.
• Medications: Olmesartan, Valsartan, Losartan.
• Indications: Hypertension, Diabetic nephropathy, Heart failure, Peripheral arterial disease.
• Mechanism: Block angiotensin II receptors to dilate vessels and decrease aldosterone secretion.
• Side Effects: Dizziness, hypotension, increased potassium, GI upset, rare angioedema.
• Nurse's Role:
  • Monitor potassium levels, renal function (BUN, creatinine).
  • Assess blood pressure and signs of angioedema.

Anti-Arrhythmics

• Purpose: Treat abnormal heart rhythms.
• Medications: Flecainide, Procainamide, Amiodarone, Quinidine.
• Indications: Atrial fibrillation, Atrial flutter, Ventricular tachycardia, SVT.
• Mechanism: Slow electrical activity in the heart by altering ion channels.
• Side Effects: Bradycardia, hypotension, new arrhythmias, heart block, QT prolongation, electrolyte imbalances, lung toxicity (amiodarone).
• Nurse's Role:
  • Monitor heart rhythm, blood pressure, heart rate, electrolytes.
  • Check for phlebitis with IV administration.

ACE Inhibitors

• Purpose: Inhibit conversion of angiotensin I to II causing vasodilation.
• Medications: Captopril, Lisinopril, Ramipril.
• Indications: Heart failure, Hypertension, Post-MI, Diabetic nephropathy.
• Mechanism: Inhibit RAS system, prevent vasoconstriction.
• Side Effects: Persistent dry cough, dizziness, hypotension, increased potassium, angioedema.
• Nurse's Role:
  • Monitor potassium, renal function, and assess for dry cough and angioedema.

Beta Blockers

• Purpose: Block beta receptors to reduce cardiovascular strain.
• Medications: Atenolol, Esmolol, Metoprolol.
• Indications: Hypertension, Angina, Arrhythmias, Heart failure, Migraines, Glaucoma, Tremors.
• Mechanism: Block norepinephrine and epinephrine binding, reducing sympathetic activity.
• Side Effects: Bradycardia, heart block, exacerbation of heart failure, worsened asthma/COPD, orthostatic hypotension.
• Nurse's Role:
  • Monitor ECG, heart rate, blood pressure, educate on tapering off.

Calcium Channel Blockers

• Purpose: Block calcium channels to dilate and relax vessels.
• Medications: Amlodipine, Nifedipine, Verapamil.
• Indications: Hypertension, Angina, SVT, Raynaud's disease, Atrial fibrillation, Migraines.
• Mechanism: Block L-type calcium channels.
• Side Effects: Bradycardia, hypotension, reflex tachycardia, heart block, constipation, gingival hyperplasia.
• Nurse's Role:
  • Monitor heart rate, blood pressure, ECG.
  • Educate on avoiding grapefruit juice, high fiber diet, oral hygiene.

Cardiac Glycosides

• Purpose: Strengthen heart contractions.
• Medication: Digoxin.
• Indications: Heart failure, Cardiogenic shock, Atrial fibrillation/flutter.
• Mechanism: Positive inotropic, negative chronotropic and dromotropic effects.
• Side Effects: Digoxin toxicity (nausea, vision changes, arrhythmias).
• Nurse's Role:
  • Monitor apical pulse, therapeutic range (0.5-2 ng/mL), potassium levels.
  • Educate on potassium-rich diet.

Statins

• Purpose: Lower cholesterol levels.
• Medications: Simvastatin, Lovastatin, Pravastatin.
• Indications: High cholesterol, plaque stabilization.
• Mechanism: Inhibit HMG CoA reductase, reducing cholesterol synthesis.
• Side Effects: Muscle soreness, increased liver enzymes, GI upset, increased glucose.
• Nurse's Role:
  • Monitor for rhabdomyolysis, liver enzymes, avoid grapefruit juice.

Diuretics

• Purpose: Increase urination to rid body of excess fluid.
• Types:
  • Loop: Furosemide, Toresemide
  • Thiazide: Hydrochlorothiazide
  • Potassium-sparing: Spironolactone
  • Carbonic anhydrase inhibitors: Acetazolamide
• Indications: Heart failure, Hypertension, Electrolyte imbalances, Glaucoma.
• Mechanism: Act on nephron parts to remove extra fluid.
• Side Effects: Electrolyte imbalances, dehydration, renal impairment, ototoxicity (loop), photosensitivity (thiazides).
• Nurse's Role:
  • Monitor fluid status, electrolytes, renal function, hearing.

Vasodilators

• Purpose: Dilate blood vessels.
• Medications: Nitroglycerin, Minoxidil, Hydralazine.
• Indications: Angina, Heart failure, Hypertension, CAD, Pulmonary hypertension.
• Mechanism: Dilate vessels to reduce blood pressure and workload.
• Side Effects: Hypotension, flushing, headaches, orthostatic hypotension, nausea.
• Nurse's Role:
  • Monitor blood pressure, heart rate, ECG.
  • Assess chest pain details, advise slow position changes.

Angiotensin Receptor Neprilysin Inhibitors

• Purpose: Treat heart failure with reduced ejection fraction.
• Medication: Sacubitril/valsartan (Entresto).
• Mechanism: Inhibit angiotensin II and neprilysin to promote vasodilation and diuresis.
• Side Effects: Hypotension, high potassium, angioedema, renal insufficiency, cough, dizziness.
• Nurse's Role:
  • Avoid with ACE inhibitors within 36 hours.
  • Monitor electrolytes, renal function, blood pressure, heart rate, and heart failure symptoms.