Drugs To Improve Cardiovascular Function

1. Drugs To Improve Cardiovascular Function Susan Hench, RN, MSN Assistant Professor of Nursing Nursing 102

2. Drugs To Treat Hyperlipidemia • Hyperlipidemia • An abnormal elevation of cholesterol and triglycerides in the blood which predisposes an individual to developing “atherosclerosis” • Dyslipidemias • Abnormalities with one or more of the blood lipids • Atherosclerosis • The accumulation of fatty deposits on the inner walls of arteries and arterioles

3. TREATMENT OPTIONS • Diet low in cholesterol and fat • Weight reduction • Meds as a last resort

4. Drug Classes Used to Treat Hyperlipidemias • Bile Acid-Binding Resins • Niacin • HMG-CoA Reductase Inhibitors • Fibric Acids • Miscellaneous Antilipemic Agents

5. General Nursing Considerations For All Antilipemic Agents • Contraindicated in pregnancy • Monitor blood cholesterol/lipid levels • Monitor liver function via blood tests • Follow a low fat/ low cholesterol diet

6. Drug Class: Bile Acid Binding Resins • Cholestyramine/ Questran • Colestipol/ Colestid • Colesevelam/ Welchol

7. Bile Acid Binding Resin Administration • Implementation Hints • Check triglyceride and cholesterol levels before starting therapy and periodically thereafter • Assess for any GI alterations before therapy • Drink a full glass of water after administration • Take with meals • Taste may be a reason for noncompliance

8. Bile Acid Binding Resins • Actions, Uses, and Therapeutic Outcomes • Bile acids are used in the liver to make cholesterol. • These resins bind with bile acids in the intestine preventing recirculation of the bile acids to the liver and ultimately leading to the excretion of the bound bile acids in the feces. • Used in conjunction with LFLC diet.

9. Bile Acid Binding Resin Evaluation • Side Effects, Drug Interactions • Constipation • Gas, bloating, a feeling of fullness • Nausea, peptic ulcer • Headache • Decreased absorption of fat soluble vitamins • Increased prothrombin time

11. Drug Class: Niacin • Examples • Niacin, Nicotinic Acid/ Niacor, Niaspan, Nico-400, Nicotinex

12. Niacin • Actions, Uses and Therapeutic Outcomes • Action not completely understood • Inhibits synthesis of VLDL in the liver • Used with diet therapy to decrease elevated cholesterol and to reduce the risk of atherosclerosis • Causes a decrease in BP by vasodilation

13. Niacin Evaluation • Side Effects, Drug Interactions • GI effects • Gout • Flushing • Myopathy

14. Niacin Administration • Implementation Hints • Change position slowly • Administer with food • Do not skip doses • Monitor BP and liver function tests • Do not use with DM or gout • May give ASA 325 mg 30 min prior to decrease s/e of flushing and pruritis

15. Drug Class: HMG-CoA Reductase Inhibitors • Lovastatin/ Mevacor • Fluvastatin/ Lescol • Pravastatin/ Pravachol • Simvastatin/ Zocor • Atorvastatin/ Lipitor • Rosuvastatin Calcium/ Crestor

16. HMG-CoA Reductase Inhibitors • Actions, Uses and Therapeutic Outcomes • Blocks HMG-CoA Reductase which is the enzyme in the liver that is responsible for making cholesterol • Used in conjunction with diet and exercise, when diet and exercise alone are unsuccessful, to lower cholesterol levels in the blood (especially LDL levels)

17. HMG-CoA Reductase Inhibitor • Side Effects • Generally well tolerated and side effects are usually mild and transient • GI effects, headache, pharyngitis • Zocor may cause lens opacities • Serious s/e are impairment of liver function and skeletal muscle breakdown

18. HMG-CoA Reductase Inhibitor Administration • Implementation Hints • Take in evening • Report muscle pain • Get blood tests for liver function regularly

19. Drug Class: Fibric Acids • Clofibrate/ Atromid-s • Gemfibrozel/ Lopid • Fenofibrate/ Tricor

20. Fibric Acids • Actions, Uses, and Therapeutic Outcomes • Mechanism of action is unknown • Used in conjunction with diet therapy to reduce triglycerides • Treats some types of hyperlipidemia with low HDL

21. Fibric Acids • Side Effects, Drug Interactions • Nausea, diarrhea, bloating • Fatigue, anorexia • Jaundice • Malaise, myopathy • Heartburn • Gallstones

22. Fibric Acids Nursing Implications • Do not use with statins • Monitor cholesterol levels • Monitor liver function • Give with food to decrease GI symptoms • Instruct patient to report muscle pain

23. Miscellaneous Antilipemic Agents • Ezetimibe/ Zetia • Side Effects and Drug Interactions • Back pain, diarrhea, abdominal pain • Bile acid resins • Nursing implications • Monitor liver and kidney function lab studies • May give with food

24. Miscellaneous Antilipemic Agents • Omega-3 Fatty Acids • Omacor • Actions, Uses, and Therapeutic Outcomes • Evaluation • Nursing Implementation

26. Treatment Options for Hypertension • Pre-Hypertension • Lifestyle modifications • No medications usually needed • Stage 1 • Lifestyle modifications • Usually thiazide-type diuretics • Usually only one med, may choose different kind • Stage 2 • Lifestyle modifications • Usually requires two-drug combo therapy

27. Antihypertensive Medication • Diuretics • Increases urine output by promoting sodium and water loss • Less blood volume produces lower blood pressure • Decreases edema-peripheral and pulmonary

28. Diuretics • Types • Thiazide and thiazide-like • Potassium sparing • Loop • Osmotic

29. Diuretics • Thiazide and Thiazide-like Diuretics • Acts on the distal tubules • Blocks reabsorption of Na and Cl thereby leading to diuresis • Treats HTN and edema associated with CHF, renal disease, hepatic disease, pregnancy, obesity, PMS • Also act directly on the arterioles causing vasodilation which lowers BP

30. Diuretics • Examples of thiazide and thiazide-like diuretics • Chlorothiazide/ Diuril • Hydrochlorothiazide/ HCTZ/ Hydrodiuril • Chlorthalidone/ Hygroton • Metolazone/ Zaroxolyn

31. Diuretics • Side effects of thiazide and thiazide-like diuretics • Gastric irritation, N/V, constipation • Electrolyte imbalances, especially hypokalemia • Dehydration • Increased blood sugar levels • Increased uric acid levels (gout) • Photosensitivity, headache

32. Diuretics • Hypokalemia • Weakness, loss of appetite, constipation • Irregular heartbeat • Muscle cramps, numbness/tingling in hands, feet, or lips • Breathing problems • Unusual tiredness or weakness • Weak or heavy feeling in the legs • Confusion or nervousness

33. Diuretics • Thiazide and thiazide-like diuretics • Drug interactions • The most serious is with Digoxin • Dig causes hypokalemia which is also caused by these diuretics • When used together-the resulting hypokalemia could be life-threatening • Also enhance the action of lithium

34. Diuretics • Potassium-Sparing Diuretics • Act on the distal renal tubules to promote sodium and water excretion and potassium retention • Weaker than thiazide or loop diuretics • A mild diuretic usually used in combination with other antihypertensive medication

35. Diuretics • Examples of K-sparing diuretics • spironolactone/ Aldactone • triamterene/ Dyrenium • Also used in combination drugs • spironolactone+HCTZ/ Aldactazide • triamterene+HCTZ/ Dyazide or Maxide

36. Diuretics • K-sparing diuretic S/E • Electrolyte imbalances, esp. Hyperkalemia • Dehydration • Anorexia, N/V, flatulence • Headache

37. Diuretics • Loop diuretics • Act on the loop of Henle • Very potent and rapidly absorbed thereby causing rapid diuresis • Marked depletion of water and electrolytes • Used to treat HTN, HF, edema

38. Diuretics • Examples of Loop Diuretics • Furosemide/ Lasix • Bumetanide/ Bumex • Torsemide/ Demadex

39. Diuretics • Loop diuretics side effects • Fluid and electrolyte imbalance • Dehydration • Orthostatic hypotension • Vertigo, dizziness • Nocturia, polyuria • GI upset

40. Diuretics • Osmotic diuretics • Increase the concentration of plasma and fluid in the renal tubules • Used to prevent kidney failure • Used to decrease intracranial pressure • Used to decrease intraocular pressure

41. Diuretics • Nursing intervention for diuretics • Monitor VS • Monitor weight • Monitor I&O • Monitor labs • Monitor EKG

42. Diuretics • Client teaching-Diuretics • Maintain proper nutrition • Follow low Na diet • Change position slowly • Monitor BP and HR • Side effects /what to report to Dr • Maintain dosage schedule

44. Beta Blockers - Review • Beta-adrenergic Blockers • Selective block beta 1 • Nonselective block beta 1 and 2 adrenergic receptors • Block interaction with epinephrine and norepinephrine, ie sympathetic stimulation

45. Beta Blockers • Decrease heart rate and blood pressure • Decrease myocardial contractility • Reduce need for oxygen in the heart muscle

46. Beta Blockers • Examples • Nonselective • Propranolol/Inderal • Nadolol/Corgard • Selective • Atenolol/Tenormin • Metoprolol/Lopressor

47. Beta Blockers • Side Effects • Bradycardia and/or hypotension • Peripheral vasoconstriction • Bronchospasm and/or wheezing (NS) • Drowsiness or unusual tiredness • Anxiety/nervousness • Decreased sexual function

48. Medical contraindications to beta-adrenergic blockers • Use nonselective cautiously in asthma patients • Use all cautiously in persons with heart failure

49. Beta Blockers • Nursing Implications • Monitor vital signs • Hold drug if HR is less than 60 or systolic BP less than 90 • With discontinuation, taper dose

50. Nursing interventions and patient teaching for beta-blockers • Take apical pulse and teach patient how to take • Give with meals • Monitor pt for heart failure, renal dysfunction and fluid retention • Monitor for S/S of depression • Instruct patient not to skip doses, double up doses or D/C abruptly • Instruct patient to change position slowly • Instruct patient to report SOA or weight gain