drugs affecting the cardio vascular system and blood pressure

cardiac glycoside

increases force of contraction, increasing cardiac output and renal perfusion; slows HR (goal: slower but more powerful heart)

heart failure

oral, IV

IV push over at least 5 minutes with tele monitor

amiodarone and other antidysrhtmic drugs

heart block, decreased renal function

GI effects, visual disturbances (green/yellow halo), bradycardias

take apical pulse 1 full min prior to admin. Hold if HR less than 60 –notify provider; use same brand consistently-varied bioavailability; narrow therapeutic index -toxicity rare but serious – monitor blood levels q 3 months

antianginal agents

Relaxes vascular smooth muscle; dilates coronary arteries to increase blood flow

acute angina

Sublingual tablet q 5 min up to 3 doses;

onset: 1-3 min;

dur.: 30-60 min

sildenafil within last 24 hours (severe hypotension)

hypotension, headache

sodium channel blockers

Decreases depolarization, decreasing automaticity of the ventricular cells; increases ventricular fibrillation threshold

Treatment of life-threatening ventricular arrhythmias during MI or cardiac surgery

IV (topical lidocaine low risk systemic)

Onset: IV-immediate;

Peak: IV-Immediate;

Duration: IV-20 min

Cardiac arrest, respiratory depression/arrest, anaphylaxis

bradycardia, heart block, arrhythmias, hypotension

Have resuscitation equipment available

potassium channel blockers

Blocks potassium channels, delays repolarization; slows HR

v-tachycardia and v-fibrillation; Atrial fib or flutter

Maintenance: oral;

Acute: IV push/infusion (tele floors/ICU/ACLS)

many! Increase digoxin levels (up to 50-70%); decrease metabolism of warfarin requiring lower doses (50% increase in INR); decrease doses of either drug by 50%

Corneal microdeposits (photophobia, visual halos, dry eyes), fatigue, dizziness, photosensitivity, thyroid dysfunction

Hepatotoxicity, pulmonary toxicity, pro arrhythmias (new/existing)

Teach - no grapefruit juice

use barrier sun block

telemetry monitoring (IV)

ACE-inhibitor

Blocks ACE, the enzyme responsible for converting angiotensin I to angiotensin II in the lungs; decreases vascular resistance, prevents aldosterone secretion, prevents breakdown of bradykinin (potent vasoconstrictor)

oral

ACE-inhibitors, ARB’s, K+ sparing-diuretics, NSAIDs (kidneys)

Common-Persistent dry cough (bradykinin), orthostatic hypotension, hyperkalemia (block aldosterone); Rare-angioedema

monitor K+, renal function, change positions slowly (esp first dose)

A= Angioedema

C= Caution

E= Elevated potassium

angiotensin-receptor blocker (ARB)

Blocks binding of angiotensin II to specific receptors in blood vessels and adrenal gland; used as alternate to ACE-inhibitors

oral

same as ACE-1

hypotension

direct vasodilator

Act directly on vascular smooth muscle (venous and arterial) to cause relaxation/vasodilation

Maintenance: oral or transdermal;

Acute HTN crisis: IV push

PVD, heart failure

significant hypotension

calcium-channel blocker

Inhibits flow of calcium ions into myocardial cells and vascular smooth muscle; slows HR, lowers BP

HTN, A-fib, A-flutter, supraventricular tachycardias

maintenance: oral

acute: IV infusion

Hypotension, bradycardia/heart block, peripheral edema

arrhythmias

teach- avoid grapefruit juice (increase levels)

beta adrenergic blocker

Block beta₁ and beta₂ receptors of the SNS; slows HR and lowers BP

HTN, Heart failure, s/p MI, A-fib/flutter

Maintenance: oral ;

acute HTN or dysrhythmias: IV push

Beta-agonist inhaler (albuterol, salmeterol, etc.)

bradycardia, heart blocks, arrhythmias, and hypotension

bradycardia, hypotension, masks signs of hypoglycemia

Bradycardia, hypotension, bronchospasm, pulmonary edema, weakness, fatigue, decreased exercise intolerance, alterations in blood glucose, heart blocks, arrhythmias

monitor hypoglycemia closely in diabetes mellitus; immediate and extended release (XL, XR) prescribed