Essay on Cardiac Medications (Nurs 5)

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CARDIAC MEDICATION LIST
ANTICOAGULANTS | Warfarin sodium (Coumadin)
Prevent the extension and formation of clots by inhibiting factors in the clotting cascade and decreasing blood coagulability.
Contraindicated with active bleeding (except DIC), bleeding disorders, ulcers, liver and kidney disease, and hemorrhagic brain injuries.
Side effects: Hemorrhage, hematuria, epistaxis, ecchymoses, bleeding gums, thrombocytopenia, and hypotension.
Heparin: prevent thrombin from converting to fibrinogen to fibrin. (Prevents new thrombus formation.)
Blood levels (aPTT):
NORMAL: apt is 20 – 36 seconds.
THERAPUETIC: 1.5 – 2.5 x that. aPTT 80 seconds; lower dose aPTT 60 seconds; increased dose
Enoxaparin (Lovenox) – low molecular weight heparin; Longer half life than heparin.
[SUBQ, monitor aPTT & bleeding]
Warfarin sodium (Coumadin): suppresses coagulation, prolong slotting time (monitored by PT – prothrombin time and INR – international normalized ratio).
Blood levels (PT):
NORMAL: 9.6 seconds to 11.8 seconds
THERAPUETIC: 1.5 to 2x.
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INR: 1.3 – 2.
THROMBOLYTIC MEDICATIONS | alteplase (Actvase, tPA), Streptokinase (Retevase)
Activate plasminogen; plasminogen generates plasmin (the enzyme that dissolves clots).
Used in early MI within 4 – 6 hours: restores blood flow, limit myocardial damage, preserve left ventricular function and prevent death.
Contraindications: active internal bleeding, history of hemorrhagic stroke, intracranial problems, surgery within 10 days, uncontrolled HTN.
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Side effects: bleeding dysrhythmias, allergic reaction.
ANTIPLATELET MEDICATIONS | Aspirin, Clopidogrel (Plavix), Ticlopidine (Ticlid)
Inhibit the aggregation of platelets in he clotting process, thereby prolonging the bleeding time.
Used in the prophylaxis of long-term complications following MY, coronary revascularization, stents and brain attacks (stroke).
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Side effects: GI bleed, bruising, hematuria, tarry stool.
POSITIVE INOTOPIC & CARDIOTONIC MEDS | Dopamine, Dobutamine, Inamrinone Lactate, Milrinone (Primacor)
Stimulate myocardial contractility and produce a positive inotropic effect.
Used for short-term management of advanced HF; the increase in myocardial contractility improves cardiac, peripheral, and kidney function by increasing cardiac output, decreasing preload, improving blood flow to the periphery and kidneys, decreasing edema, and increasing fluid excretion. As a result, fluid retention in the lungs and extremities is decreased.
Side effects: dysrhythmias, hypotention, thrombocytopenia
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Monitor BP & pulse; stop it patient’s BP drops or dysrhythmias occur.
CARDIAC GLYCOSIDES | Digoxin (Lanoxin)
Inhibit the sodium-potassium pump, thus increasing intracellular calcium, which causes the heart muscle fibers to contract more efficiently.
Produce a positive inotropic action, which increases the force of myocardial contractions
Slows heart rate
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Side effects: Anorexia, N/V, diarrhea, bradycardia
ANTIHTN
THIAZIDE DIURETICS | Polythiazide
Increase sodium and water excretion by inhibiting sodium reabsorption in the distal tubule of the kidney.
Used in HTN and peripheral edema.
Side effects: hypercalcemia, hyperglycemia, hyperuricemia, hypokalemia, Hyponatremia
LOOP DIURETICS | Furosemide (Lasix)
Inhibit sodium and chloride reabsorption from the loop of Henle and the distal tubule.
Loop diuretics are more potent than thiazide diuretics, causing rapid diuresis; thus reducing vascular fluid volume.
OSMOTIC | Mannitol (Osmitol)
POTASSIUM SPARING | Spironolactolone (Aldactone)
-------------------------------------------------
Promote sodium and water excretion and potassium retention.
PERIPHERALLY ACTING a-ADRENERGIC BLOCKERS | Doxazosin
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