cardiotonics and coronary vasodilators
DESCRIPTION
CARDIOTONICS AND CORONARY VASODILATORS. NURS 1950: Pharmacology I. Objective 1: describe the relationship of calcium to electrical activity of the heart Resting: Preload: Afterload :. repolarization. Heart dependent upon influx of calcium - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/1.jpg)
1
CARDIOTONICS AND CORONARY VASODILATORS
NURS 1950: Pharmacology I
![Page 2: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/2.jpg)
2
Objective 1: describe the relationship of calcium to electrical activity of the heart
Resting: Preload: Afterload:
![Page 3: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/3.jpg)
3
Heart dependent upon influx of calcium Ca+ enters channels in the cardiac cell
membrane and go into the cell along with Na
K+ comes out Cardiac cells contract
repolarization
![Page 4: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/4.jpg)
4
Objective 2: describe how the ANS affects the heart rate
![Page 5: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/5.jpg)
5
The ANS is the primary controller of heart rate
Cholinergic (parasympathetic) vagal fibers are close to the SA node
Stimulation with acetylcholine slows the heart rate
![Page 6: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/6.jpg)
6
Sympathetic (adrenergic) nerves also innervate the heart
Stimulation causes norepinephrine to be released.
Increases heart rate, slows refractory period
![Page 7: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/7.jpg)
7
![Page 8: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/8.jpg)
8
Objective 3: describe how cardiac drugs affect cardiac action
![Page 9: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/9.jpg)
9
1. Increase or decrease the force of myocardial action
Positive inotropics Negative inotropics
How cardiac drugs work
![Page 10: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/10.jpg)
10
2. Increase or decrease heart rate by altering SA node impulse conduction
Positive chronotropics Negative chronotropics
![Page 11: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/11.jpg)
11
3. Increase or decrease conduction of AV impulses
Positive dromotropics Negative dromotropics
![Page 12: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/12.jpg)
12
Diuretics to decrease blood volume
![Page 13: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/13.jpg)
Figure 24.1 Pathophysiology of heart failure
![Page 14: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/14.jpg)
14
Objective 4: identify the action of cardiac glycosides
![Page 15: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/15.jpg)
15
Digoxin & relatives
Come from Natural sources Helpful in CHF Have a positive inotropic effect
Cardiac glycosides
![Page 16: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/16.jpg)
16
Increases mechanical efficiency of heart This pumps more blood With increased blood to kidneys, diuresis
occurs, edema reduced Cardiac glycosides also have negative
chronotropic effect, Negative dromotropic effect
![Page 17: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/17.jpg)
17
Action◦ Thought that they cause release of free calcium
within the cardiac muscle cell
◦ Also change the electrical activity of myocardium
![Page 18: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/18.jpg)
18
Decrease velocity of electrical conduction, prolong refractory period in AV conduction system
Increase vagal tone
![Page 19: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/19.jpg)
19
Objective 5: relate how the effects of digitalis are beneficial to the client with CHF
Recall the signs/symptoms of CHF
How do you think cardiac glycosides improve this condition?
![Page 20: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/20.jpg)
20
Objective 6: describe the usefulness of digitalis in the treatment of atrial fibrillation
![Page 21: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/21.jpg)
21
What is atrial fibrillation? What activity of the cardiac glycosides
improve this condition?
![Page 22: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/22.jpg)
22
Chronotropic/dromotropic effects◦ Suppress impulse conduction through the AV node◦ This prevents excessive atrial activity from
reaching ventricles
![Page 23: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/23.jpg)
23
Objective 7: list the generic and brand names of the digitalis preparations
Digitalis preparations similar in pharmacological properties, toxic effects
![Page 24: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/24.jpg)
24
Digoxin (Lanoxin, Lanoxicaps): oral or IV Onset 30-120 minutes oral Peaks 2-6 hrs Duration 2-4 days Eliminated by kidney
◦ Used most often as rapid onset, short duration
Prototype
![Page 25: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/25.jpg)
25
Must take apical pulse 1 minute before administration
Hold if under 60, contact MD Blood levels needed
![Page 26: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/26.jpg)
26
Objective 8: define digitalization
![Page 27: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/27.jpg)
27
Digitalization is the administration of digitalis that is more than the maintenance dose
This raises the blood level quickly to therapeutic range◦ May also be called a loading dose
![Page 28: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/28.jpg)
28
Example◦ Oral dose of digoxin 0.5-0.75 mg◦ 0.25-0.5 mg then given every 6-8 hours until
desired blood level reached◦ Then maintenance dose: 0.125-0.5 mg daily
![Page 29: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/29.jpg)
29
Objective 9: list symptoms of digitalis toxicity
![Page 30: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/30.jpg)
30
Digitalis toxicity:◦GI distress: N/V, anorexia, and/or diarrhea (flu like symptoms)
◦May have excessive salivation and abdominal pain
◦Neurological: restless, irritable, lethargy, drowsiness, and/or confusion
![Page 31: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/31.jpg)
31
May have vision changes, changes in color◦May have halos, amblyopia and diplopia
◦Cardiac effects: development of arrhythmias (bradycardia, primary AV block)
![Page 32: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/32.jpg)
32
Objective 10: identify factors which predispose digitalis toxicity
![Page 33: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/33.jpg)
33
Toxicity predisposition: hypokalemia as cardiac muscles more sensitive to the glycosides
Renal impairment as 60-90% excreted by kidney
IV administration: rapid accumulation can occur
Contraindications
![Page 34: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/34.jpg)
34
Treatment◦ Hold the drug◦ Use digoxin immune fab (Digibind) Antigen-binding fragments combine with digoxin to neutralize its action
![Page 35: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/35.jpg)
Lisinopril Animation
Click here to view an animation on the topic of lisinopril.
![Page 36: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/36.jpg)
Diuretics Prototype drug: furosemide (Lasix) Mechanism of action: to increase urine
flow, reducing blood volume and cardiac workload
Primary use: to reduce edema and pulmonary congestion
Adverse effects: dehydration, electrolyte imbalance, hypotension, ototoxicity
![Page 37: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/37.jpg)
![Page 38: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/38.jpg)
Furosemide Animation
Click here to view an animation on the topic of furosemide.
![Page 39: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/39.jpg)
Cardiac Glycosides Prototype drug: digoxin (Lanoxin) Mechanism of action: to cause more
forceful heartbeat, slower heart rate Primary use: to increase contractility or
strength of myocardial contraction Adverse effects: neutropenia,
dysrhythmias, digitalis toxicity
![Page 40: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/40.jpg)
![Page 41: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/41.jpg)
Beta-Adrenergic Blockers Prototype drug: Metoprolol (Lopressor,
Troprol XL) Mechanism of action: block cardiac
action of sympathetic nervous system to slow heart rate and B/P, reducing workload of heart
Primary use: to reduce symptoms of heart failure and slow progression of disease
Adverse effects: fluid retention, worsening of heart failure, fatigue, hypotension, bradycardia, heart block
![Page 42: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/42.jpg)
![Page 43: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/43.jpg)
Vasodilators Drugs: hydralazine (Apresoline);
(isosorbide dinitrate (Isordil) Mechanism of action: to relax blood
vessels Primary use: to lower blood pressure Used for clients who cannot take ACE
inhibitors Adverse reactions: reflex tachycardia,
orthostatic hypotension
![Page 44: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/44.jpg)
Phosphodiesterase Inhibitors Prototype drug: milrinone (Primacor) Mechanism of action: to block enzyme
phosphodiesterase in cardiac and smooth muscle
Primary use: as short-term therapy for heart failure
Adverse effects: hypokalemia, hypotension, ventricular dysrhythmias
![Page 45: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/45.jpg)
![Page 46: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/46.jpg)
46
Objective 11: describe the nursing responsibilities associated with administering cardiac glycosides preparations
![Page 47: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/47.jpg)
47
Take apical pulse 1 full minute Hold if under 60, over 100 in adults Report any evidence of irregular rhythm Observe for toxicity S/S Monitor K+ if on diuretics Encourage K+ rich foods
![Page 48: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/48.jpg)
48
Teach client to take pulse Teach S/S of toxicity If hypothyroid, sensitive to digitalis Draw blood levels periodically
![Page 49: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/49.jpg)
49
Atherosclerosis narrows heart’s vessels Blood flow impeded Demand exceeds supply = anginal pain
Angina
![Page 50: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/50.jpg)
50
Objective 12: describe the actions of the antianginal drugs
![Page 51: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/51.jpg)
51
Drugs are used to dilate coronary arteries This brings in oxygen and nutrients Supply = demand so no pain
Goals
![Page 52: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/52.jpg)
52
Objective 13: identify the drugs used to treat angina pectoris
![Page 53: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/53.jpg)
53
Nitroglycerin Calcium channel blockers Beta blockers ACE inhibitors
![Page 54: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/54.jpg)
54
Nitroglycerin drugs Works by relaxing arterial and venous
smooth muscle Dilate coronary arteries
![Page 55: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/55.jpg)
55
Liquid nitroglycerin unstable, highly volatile Oral tablets stable, non-explosive Can be given sublingual for rapid,
predictable action Can be transmucosal, aerosol translingual
spray, IV, transdermal
![Page 56: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/56.jpg)
56
Transdermal
![Page 57: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/57.jpg)
57
Ointment: placed on paper with inches marked off
Amount prescribed placed on the paper, taped into place
4-8 hours of action (Nitro-bid, Nitrol)
![Page 58: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/58.jpg)
58
Nitroglycerin patches: worn 12-14 hours “Patch-off” period of 6-12 hours Prevents tolerance (Transderm-Nitro, Nitro-Dur)
![Page 59: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/59.jpg)
59
IV nitroglycerin in early treatment, then another form
![Page 60: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/60.jpg)
60
Long acting forms for prophylaxis◦ Erythrityl tetranitrate (Cardilate)◦ Pentaerythritol tetranitrate (PETN)
![Page 61: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/61.jpg)
61
Objective 14: list the side effects of nitroglycerin
![Page 62: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/62.jpg)
62
Tolerance Headache Postural hypotension Dizziness Weakness Syncope
◦ Don’t use alcohol with nitros
![Page 63: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/63.jpg)
63
Nitrates can increase intraocular and/or intracranial pressure
![Page 64: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/64.jpg)
64
Objective 15: identify the nursing responsibilities associated with administering the nitroglycerin preparations
![Page 65: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/65.jpg)
65
Teach: when angina occurs, take 3 tabs in 15 min; if no pain relief, call 911
Keep nitro in original container, cap tightly closed
Store in cool, dry place Rotate sites of topical applications Monitor BP during therapy
![Page 66: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/66.jpg)
66
Shelf-life is 6 months. If burning/stinging sensation under tongue, drug still potent
Replace 3 months after opening bottle
![Page 67: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/67.jpg)
67
Objective 16: identify the beta-adrenergic blocker used to treat angina
![Page 68: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/68.jpg)
68
![Page 69: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/69.jpg)
69
Examples: propranolol, Atenolol Decrease heart rate, contractility
◦ Results in reduction of myocardial oxygen consumption
◦ Better if used with nitrates Can not use in COPD, CHF, heart block,
bradycardia, DM
![Page 70: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/70.jpg)
70
When used with nitrates, hypotensive episodes more likely to occur
Drugs used◦ Atenolol (Tenormin)--prototype◦ Metoprolol (Lopressor)◦ Nadolol (Corgard)◦ Propranolol (Inderal)
![Page 71: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/71.jpg)
71
Objective 17: identify the calcium channel blockers used to treat angina
![Page 72: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/72.jpg)
72
![Page 73: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/73.jpg)
73
Nifedipine (Adalat, Procardia) Diltiazem HCl (Cardizem, Dilacor SR)--
prototype Verapamil (Calan, Isoptin) Bepridil (Vascor) Nicardipine HCl (Cardene)
Examples: calcium channel blockers
![Page 74: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/74.jpg)
74
These drugs create coronary vasodilation, increased coronary blood flow, lowered blood pressure, increased cardiac output, and relax coronary artery spasms
![Page 75: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/75.jpg)
Nitrates Prototype drug: nitroglycerin (Nitrostat) Mechanism of action: relax both arterial
and venous smooth muscle; dilate coronary arteries◦ Short acting-terminate acute angina episode◦ Long-acting-decrease severity and frequency of
episodes
![Page 76: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/76.jpg)
Nitrates (continued) Primary use: for lowering myocardial
oxygen demand Adverse effects: hypotension, dizziness,
headache, flushing of face, rash
![Page 77: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/77.jpg)
![Page 78: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/78.jpg)
Beta-Adrenergic Blockers Prototype drug: atenolol (Tenormin) Mechanism of action: to reduce the
cardiac workload by slowing heart rate and reducing contractility
Primary use: for prophylaxis of stable angina
Adverse effects: fatigue, insomnia, drowsiness, impotence, bradycardia, confusion
![Page 79: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/79.jpg)
![Page 80: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/80.jpg)
Calcium Channel Blockers Prototype drug: diltiazem (Cardizem) Mechanism of action: to reduce cardiac
workload by relaxing arteriolar smooth muscle; dilate coronary arteries
Primary use: for lowering blood pressure; bring more oxygen into myocardium
Adverse effects: hypotension, bradycardia, heart failure, constipation, headaches, dizziness, edema
![Page 81: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/81.jpg)
![Page 82: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/82.jpg)
![Page 83: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/83.jpg)
![Page 84: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/84.jpg)
84
Objective 18: identify the ACE inhibitors used to treat angina
![Page 85: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/85.jpg)
85
![Page 86: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/86.jpg)
86
The angiotensin-converting enzyme inhibitors decrease myocardial oxygen demands
![Page 87: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/87.jpg)
87
Captopril (Capoten) Lisinopril (Prinivil)--prototype Ramipril (Altace)
Examples: ACE inhibitors
![Page 88: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/88.jpg)
ACE Inhibitors Prototype drug: lisinopril (Prinivil, Zestril) Mechanism of action: to enhance
excretion of sodium and water Primary use: to decrease blood pressure
and reduce blood volume; dilate veins Adverse effects: first-dose hypotension,
cough, hyperkalemia, renal failure
![Page 89: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/89.jpg)
![Page 90: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/90.jpg)
90
Objective 19: nursing care
![Page 91: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/91.jpg)
91
Frequency, nature, precipitants of angina attack
Lifestyle changes made Effectiveness of coronary vasodilators in
relief of pain Monitor VS, esp. BP
Assessment
![Page 92: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/92.jpg)
92
Ineffective tissue perfusion, cardiac function RT angina
Risk for injury RT side effects of coronary vasodilators
Deficient knowledge RT health alteration and medication regimen
Nursing diagnoses
![Page 93: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/93.jpg)
93
Client will◦ Verbalize decrease in attacks◦ Not experience injury due to coronary
vasodilitation◦ Verbalize s/s of drug toxicity and report to MD
Goals
![Page 94: CARDIOTONICS AND CORONARY VASODILATORS](https://reader035.vdocuments.us/reader035/viewer/2022062520/56816420550346895dd5e0c0/html5/thumbnails/94.jpg)
94
What teaching is done for clients taking nitroglycerin?
What teaching is done for clients taking calcium channel blockers, ACE inhibitors, beta blockers?
What will the nurse monitor when clients are on these medications?
Implementation