in this video I want to summarize all the cardiac medications that you need to know so let's get started first up is a medication class known as the anti-coagulants the prefix anti means against so we are 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 heprin low molecular weight heprin which is an oxin warrin and in River Rock saan 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 a patients had a mardial infarction or they're experiencing unstable angina and how these medications work is that they're going to stop hence really slow 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 Plus warin for instance can affect the bones leading to osteoprosis so if your patient's on morphine 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 healthcare provider and you want to be looking at certain parts of that CBC one thing is the hemoglobin and homat look at the Patients 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 heprin 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 heprin induced thrombocytopenia 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 warrin you wanted to monitor the PTI R level so Hein is PTT level and warrin is PT R level also you just want to assess your patient for bleeding so you've looked at all those results then you want to take a look at your patient 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 fullon red urine you also want to look at their stool is it getting dark and sticky and look at their gums 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 signs a decreasing blood pressure hypotension with an increasing heart rate Tac cardia that is a big sign that your patient may be bleeding out somewhere and then if your patient still has menstration assess if their periods are heavy next up are the antiplatelets and this medication class works against platelet aggregation hence the clumping up of those platelets so we don't get a clot formed and some medications that fall within this medication class includ include aspirin cigil and costasol 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 mardial infarction Strokes or let's say a patient has a stin place we don't want a clot forming in that stin within that coronary artery because then we're just going to get them my cardial inunction so they can be used for that and then with patients who have known coronary artery disease or periph vascular dis disease so again how these medications work is that they prevent those platelets from sticking hence cluing 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 anti-coagulants 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 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 our Angiotensin 2 receptor blockers also known as arbs so whenever you see the name of this medication class pay attention to that Angiotensin 2 we know from our previous lectures like with the RAS system Angiotensin 2 is a substance when it's activated it causes Vaso constriction all through your body well if we're blocking its receptors we're going to get the opposite of that vasod dilation so just remember that some medications in this class include like omartin Val sartin lartin and notice at the end of these generic names we have the word stin so when you see stin 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 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 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 peripher arterial disease so again how arbs work are that they are going to block the activation of angot two receptor type one 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 deep 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 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 Bu and creatinin 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 angio edema 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 air flow next up are anti-ar rhythmics this medication class works against arhythmia so we're talking about some abnormal heart rhythms and some medication that are in this class include fide procainamide amone and quinidine so these medications are really good at treating those fast arrhythmias so some fast arrhythmias include atrial fibrillation atrial flutter ventricular tachicardia and super ventricular tachicardia SVT 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 arhythmia 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 following side effects we could cause bra cardia hypotension or we could cause the development of a new arhythmia 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 long 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 the 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 fitis now some protocols depending on where you work like with AMI odone 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 fitis plus a lot of protocols recommend that a patient has a chest x-ray when they are getting am odone 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 and that they are affecting Angiotensin too in some way but they do it in different ways medications in this class include captopril lysen Ramil and notice with these generic names the endings end in p so you see p think of a Inhibitors these medications are used to treat patients who've had heart failure hypertension a postm so after my cardial 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 one into Angiotensin 2 and if we're preventing that process we're not going to get Vaso constriction instead we're going to get Vaso dilation so you can see why it's great for patients with heart failure with hypertension and helping protect the 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 one into Angiotensin 2 we also affect a substance called Brady Conan 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 angiodema therefore the nurse's role includes monitoring the pottassium level because it can increase plus you want to look at the labs like The Bu and creatinin 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 angoda 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 a tenolol esmolol mopol and notice at the end of these generic names we have o LOL 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 trimmers 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 trimmers 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 braic cardia 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 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 Venus distension they're experiencing weight gain they're 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 they're on the non-selective kind they are at risk for their signs and symptoms of hypoglycemia being massed because a lot of patients sometimes they know that their sugar has dropped whenever they become tartic 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 pH oine and neopine and notice with some of these endings on their generic name it ends in like deine d i p i n e these medications can be used to treat patients who have high blood pressure so hypertension angina SVT rain no 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 bra cardia hypotension reflex t tacac cardia 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 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 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 orthotic 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 the join 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 when we're talking about inotropic we're talking about the force of contraction and because it's positive it means means that the heart's 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 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 drat effect so whenever we're talking about drat Tropic 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 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 the I really want to concentrate on toxicity because the join has a very narrow therapeutic range of 0.5 to 2 nanog per milliliter therefore you want to make sure you aware of these signs and symptoms of toxicity so early on the patient can have nause 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 drimia so you'll notice ECG changes so if your patients on dig and that stuff's happening definitely want to get help so there's are some things that increase your patient's risk of developing toox and toxicity one thing are electrolyte imbalances a big one is potassium if that pottassium drops too low it can increase dexin toxicity also mag a low magnesium can do this and a high calcium plus patients who are elderly or at risk for this or if they're taking calcium channel blockers now other side effects that can happen with the join of course is BTO cardia 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 appical pulse before you administer every dedo and medication so follow your hospitals guidelines protocols on the ranges of 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's less than 60 that appical 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 nanog per milliliter and uh 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 change 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 mardial infarction so Stans 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 m inate 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 satin induced rabdom myisis 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 rabdom myisis and that can present with an increase creatinin cyas dark urine and kidney damage because what happens is that 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 a 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 thides potassium sparing and Carbonic and hydrates inhibitors so some medications that fall in each of those categories are the following for Lube diuretics this could include feride torside for thides we have hydrochlorizide or chloroiodinane acetazolamide now whenever you're trying to think about conditions that diuretics can treat think about conditions where we have have too much fluid build up or maybe we have some electrolyte problems because those diores 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 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 two high of electrolytes some of these Di depending on the group will act on certain parts of the nefron 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're 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 nefron the loop of Henley So based on what type of DIC we're talking about it will affect that particular part of the nefron 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 thyoides it can drop the pottassium and sodium level so we really got to monitor those with potassium SP in what do you think it's going to do with that based on its same it's going to spare potassium so you can get hyperemia increase your potassium with that plus because we're ridding the body of fluid we could cause the 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 autotoxicity and thyoides can cause photosensitivity so remember that the nurse's role is really going to revolve around fluid status and electroly status of the patient so we want to monitor their eyes and nose intake and output daily weights because that's a good indicator of your fluid status electrolyte levels renal function by looking at that bu and creatinin making sure we're not dehydrating them too much by watching that blood pressure assessing lung sounds you know if your patient's getting let's say these for heart failure well are they actually working are those crackles that you heard when they are first admitted decrease since they've been getting all this IV Frost mid so checking that out and making sure that you're assessing their hearing because again those Loops can hurt the hearing next is Vaso dilators and just as its name says it's going to cause vasod dilation so we're going to open up those vessels some medications in this class include nitroglycerin minoxidil and hydrazine 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 not getting good blood flow through them so they can't feed The myocardium 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 a 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 tachicardia 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 fleshing 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's 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 patients 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 lastly we have Angiotensin receptor nepin Inhibitors and this class of medication includes a combination drug which includes suub trial and Val stin and the brand name of this medication is in tresto 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 nepin which is going to prevent the breakdown of the substances a NP and BNP and these are natric peptides so whenever we prevent their breakdown we're going to get vasod dilation 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 angiodema renal insufficiency coughing and dizziness nurse's 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 the ace inhibitor has been given plus you want to make sure you're monitoring the patient's electrolytes the renal function by looking at that bu and creatinin 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 want to make sure that this medication's working and that your patient 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 productive cough that's a super bad sign um 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