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Pharmacotherapy for CAD, Angina, ACS, Heart Failure

Pharmacotherapy for CAD, Angina, ACS, Heart Failure. Drugs to Decrease Angina Drugs to Improve Cardiac Output Drugs to Decrease Fluid Volume Drugs to Decrease Clot Formation Drugs to Decrease Cholesterol and Decrease Risk of Cardiac Events Herbals.

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Pharmacotherapy for CAD, Angina, ACS, Heart Failure

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  1. Pharmacotherapy for CAD, Angina, ACS, Heart Failure • Drugs to Decrease Angina • Drugs to Improve Cardiac Output • Drugs to Decrease Fluid Volume • Drugs to Decrease Clot Formation • Drugs to Decrease Cholesterol and Decrease Risk of Cardiac Events • Herbals

  2. Drugs to Decrease Angina and Cardiac Workload • Nitrates-nitroglycerin • Calcium channel blockers-diltiazem • Beta-adrenergic blockers-atenolol • Vasodilators-hydralazine (direct vasodilator), lisinopril, losartan (angiotensin inhibitors)

  3. NitratesPrototype: NTG • Action: dilates coronary arteries, decreases preload and afterload • Indication: treatment of acute and chronic angina and prophylaxis • Side effects: headache, hypotension, dizziness, tachycardia • Nursing considerations: assess pain, monitor blood pressure before, during, and after administration.

  4. Calcium Channel BlockersPrototype: diltiazem • Action: inhibits calcium; dilates coronary and peripheral arteries • Indications: Prinzmetal’s and chronic stable angina, hypertension • Side effects: HA, fatigue, drowsiness, dysrhythmias, CHF, heart block, ARF • Nursing considerations: Monitor VS, hold for SBP<90, Heart rate<60; monitor ECG

  5. Beta-blockersPrototype: atenolol • Note that all generic names end in –lol • Action: blocks beta receptors, slows heart rate, decreases oxygen demand • Indications: chronic angina, MI, hypertension • Side effects: fatigue, dizziness, hypotension, bradycardia, bronchospasm (do not use in obstructive or restrictive respiratory diseases), agranulocytosis, thrombocytopenia • Nursing considerations: apical/radial pulse before adm. Notify prescriber for P<50, I&O, daily wts. Monitor BP. Do not stop suddenly (chest pain).

  6. VasodilatorsPrototype: hydralazine • Action: relaxes arteriolar and venous smooth muscle • Indications: to reduce preload and afterload in cardiac pump failure • Side effects: HA, dizziness, bradycardia • Nursing Considerations: obtain VS before beginning tx; keep pt in supine position when starting or titrating tx

  7. Vasodilators: Angiotension-Converting Enzyme Inhibitors • Prototype: lisinopril (note that all generic names end in –pril) • Action: inhibits ACE; blocks conversion of angiotensin I to angiotensin II. • Indications: manage symptomatic heart failure • Side effects: asthenia; dry, persistent, tickling, non-productive cough; angioedema • Nursing Considerations: monitor BP, K+ level and intake, CBC

  8. Vasodilators: Angiotension Receptor Blockers • Prototype: losartan • Action: inhibits vasoconstrictive and aldosterone-secreting action of angiotensin II by blocking angiotensin II receptor on the suface of vascular smooth muscle • Indication: to reduce risk of stroke in patients with HTN and left ventricular hypertrophy • Side effects: angioedema • Nursing Considerations: monitor BP, BUN, creatinine, acute renal failure (if patient depends on compensatory mechanisms)

  9. Drugs to Increase Cardiac Output • Inotropics: digoxin • Adrenergics (sympathomimetics): dobutamine

  10. Cardiac GlycosidesPrototype: digoxin • Action: increases Ca++ influx, strengthens heart muscle and slows HR • Indications: CHF, atrial arrhythmias • Side effects: HA, nausea, anorexia, visual changes, dysrhythmias, heart block (all indicate toxicity) • Nursing considerations: AP x 1 min. Call MD for P<60. Monitor serum level (0.5-2 ng/dl). Monitor lytes and kidney function.

  11. Adrenergics (sympathomimetics)Prototype: dobutamine • Action: stimulates heart’s beta receptors to increase myocardial contractility and stroke volume • Indications: short-term treatment of cardiac decompensation caused by decreased contractility • Side effects: hypertension, increased HR, asthma attacks, anaphylaxis • Nursing considerations: before beginning tx, give digoxin and volume expander to correct hypovolemia; monitor K+, VS, ECG, PAWP, CO, UOP

  12. Drugs to Decrease Fluid Volume • Diuretics: furosemide

  13. Diuretics Prototype: furosemide • Action: inhibits reabsorption of sodium and chloride at the tubules and in the loop of Henle • Indications: pulmonary edema, edema in CHF, HTN • Side effects: Lyte imbalances, orthostatic hypotension, loss of hearing, renal failure, pancytopenia, rash • Nursing considerations:Monitor lytes and fluid status, do postural BPs, monitor for hearing difficulties.

  14. Drugs to Reduce Blood Clot Formation • Antiplatelet: aspirin

  15. AntiplateletsPrototype: aspirin • Action: makes platelets less sticky • Indication: post-MI, prophylaxis of MI • Side effects: NV, rash, GI bleeding, pancytopenia, anaphylaxis, tinnitus • Nursing considerations: hepatic, renal, and blood studies, monitor for ototoxicity and allergic reactions.

  16. Drugs to Decrease Cholesterol and Decrease Risk of Cardiac Events • Antilipidemics: simvastatin

  17. AntilipidemicsPrototype: simvastatin • Action: inhibits HMG-CoA reductase, an early step in cholesterol biosynthesis • Indication: to reduce risk of death from CVD and CV events in patients at high-risk for coronary events; to reduce total and LDL cholesterol levels • Side effects: nausea, vomiting, myalgia, rhabdomyolysis • Nursing considerations: monitor hepatic studies; may increase CK levels; don’t take with grapefruit; take with evening meal to enhance absorption

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