Spotlight on Cardiac DrugsSpotlight on Cardiac DrugsDrug Class Effect Nursing Considerations

Platelet Inhibitors Aspirin Ticlopidine (Ticlid) Clopidogrel (Plavix) Glycoprotein IIb/IIa inhibitors

(abciximab, tirofiban, eptifibatide) Unfractionated heparin Low-molecular-weight heparin

(enoxaparin [Lovenox])

Inhibit factors necessary for platelets to aggregate on ruptured arterial plaque

Ticlodipine can cause thrombocytopenia and agranulocytosis, so frequently monitor platelet counts

Unfractionated heparin has limited and changeable bioavailability, so the patient needs frequent activated partial thromboplastin times to monitor for therapeutic levels

Low molecular heparin has greater bioavailability and more predictable effects, so it doesn’t require coagulation assays

Beta-blockers Cardioselective types (metoprolol

[Toprol, Lopressor]) – block beta 1 receptors in the heart

Noncardioselective types (propanolol [Inderal], labetalol [ Normodyne, Trandate,], Carvedilol [Coreg]) – block both the beta 1 receptors in the heart and beta 2 receptors in the lungs and blood vessels

Reduce heart rate, contractility, and speed of impulse conduction through the AV node

Beta-blockers are used to treat hypertension, angina, cardiac arrhythmias, myocardial infarction, hyperthyroidism, migraines, stage fright, and glaucoma.

Noncardioselective beta-blockers aren’t appropriate for someone with a history of constrictive airway disease because they can cause bronchoconstriction. They can also mask signs of hypoglycemia.

Carvedilol may be used with ACE inhibitors, digitalis, and diuretics to manage heart failure, but the combination can slow AV conduction, so closely monitor the patient for cardiac rhythm disturbances

Peripheral alpha 1-adrenergic blockers Prazosin (Minipress) Terazosin (Hytrin) Doxazosin (Cardura)

Dilate blood vessels and decrease blood pressure

The first dose can cause severe orthostatic hypotension, causing the patient to feel light-headed or to faint.

Should not be used alone to treat hypertension because monotherapy increases the risk of heart failure, stroke, and chest pain.

Central alpha 2- agonists Clonidine (Catapres) Methyldopa (Aldomet)

Stimulate receptors in the brain to decrease HR and CO, dilate BV and decrease BP

Clonidine and methyldopa are approved for hypertension Clonidine is also being investigated as treatment for menopausal

flushing,, migraines, and withdrawal from opioids, alcohol and tobacco.

ACE Inhibitors Losartan (Cozaar) Valsartan (Diovan) Irbesartan (Avapro) Candesartan (Atacand) Telmisartan (Micardis)

Decrease pulmonary congestion and peripheral edema; promote sodium and water excretion, and dilate BV; decrease ventricular remodeling related to MI or HF.

Monitor for first dose hypotension The most common reason to d/c is a dry, irritating cough Monitor the patient for hyperkalemia and avoid potassium-

sparing diuretics and potassium supplements. Discontinue immediately if angioedema develops. Taking NSAIDs may increase BP

Calcium Channel BlockersAffecting peripheral blood vessels Nifedipine (Adalat, Procardia) Amlodipine (Norvasc) Felodipine (Plendil) Isradipine (DynaCirc) Nicardipine (Cardene)Affecting the heart Verapamil (Calan, Isoptin) Diltiazem (Cardizem, Dilacor)

Manage coronary vasospasm and decrease the heart’s workload by dilating blood vessels (nondihydropyridines also decrease contractions)

After MI, use only if beta blockers are contraindicated or the patient can’t tolerate them,

Useful in patients with diabetes, asthma, or migraines

Positive Inotropic Agent Digoxin Increases force of

ventricular contraction; decreases automaticity of SA node to maintain an acceptable heart rhythm

Tell the patient to report irregular heartbeat, visual disturbances (blurred vision, yellow halo around objects), fatigue, anorexia, nausea and vomiting.

Vasodilators Nitroglycerin (Nitrostat) Isosorbide (Isordil)

Dilate blood vessels to decrease ventricular filling, preload, and myocardial oxygen demand

If the patient develops a tolerance to nitroglycerin, the physician may prescribe a “nitro-free” period each day (such as removing the drug patch at bedtime)

Diuretics Loop diuretic (Furosemide) Thiazide diuretic (HCTZ) Osmotic diuretic (Mannitol) K-Sparing diuretic

(Spironolactone)

Block reabsorption of sodium and chloride to decrease intravascular volume

Monitor for dehydration, hypokalemia (unless the patient is taking a potassium-sparing diuretic), and hypotension

Teach the patient to take the diuretic in the morning because it will increase the need to urinate for 6 to 8 hours. Tell her to weigh herself daily and to report any weight gain of more than 3 pounds (1.4 kg) to her health care provider.

Teach her the signs of orthostatic hypotension. Tell her to get up slowly and to sit or lie down if she feels dizzy or faint.

Lifted from: How Cardiac Drugs Do What They Do by Anne Marie Palatnik, RN, CSC, MSN, Nursing 2001 31:5 54-60