Pharmacology - The Cardiovascular System

*Furosemide
-Torsemide
-Ethacrynic acid
-Bumetanide

Examples: *Furosemide, torsemide, ethacrynic acid, bumetanide
-Act on the ascending loop of Henle in the renal tubules blocking reabsorption of sodium and chloride, promoting excretion of sodium and chloride, which carry water with them.
-Urine output is increased and potassium is excreted

Examples: *Furosemide, torsemide, ethacrynic acid, bumetanide
-Electrolyte imbalances (hyponatremia, hypochloremia, severe fluid loss or dehydration, and hypokalemia)
-Hypotension and orthostatic hypotension
-Ototoxicity: temporary or permanent ringing of ears, hearing loss or balance problems
-Hyperglycemia *especially in diabetic clients
-Hyperuricemia: increased uric acid levels

Examples: *Furosemide, torsemide, ethacrynic acid, bumetanide
-Monitor serum electrolyte levels periodically
-Watch for signs of electrolyte imbalance, such as confusion, muscle twitching or weakness, irregular pulse, and nausea
-Monitor blood pressure frequently
-Monitor for hearing loss

-Thready, irregular pulse
-Orthostatic hypotension
-Anxiety
-Confusion
-Skeletal muscle weakness
-Hypoactive bowel sounds
-Nausea and vomiting
-Polyuria

Examples: *Furosemide, torsemide, ethacrynic acid, bumetanide
-Available for oral, IM, IV
-Give the oral with food to prevent GI symptoms
-If ordered more than once daily, give the second dose by early afternoon to prevent nocturia and loss of sleep

-Raisins
-Baked potato
-Lima beans
-Tomato sauce
-Spinach
-Banana

Examples: *Furosemide, torsemide, ethacrynic acid, bumetanide
-Report signs of electrolyte imbalance, such as confusion, muscle twitching or weakness, irregular pulse, and nausea
-Monitor blood pressure and report dizziness or syncope to provider
-Report new onset of hearing loss, ringing in ears, or vertigo immediately
-Tell clients to eat foods rich in potassium, such as citrus fruits, potatoes, raisins, and bananas

Examples: *Furosemide, torsemide, ethacrynic acid, bumetanide
-Allergy
-Hepatic coma
-Anuria, electrolyte imbalance, or dehydration
-Used with caution in clients with renal or hepatic disorders or DM

-Clients on digoxin need to carefully watch potassium levels
-NSAIDs may decrease the diuretic effect
-Lithium use may cause lithium toxicity
-Other ototoxic medications, such as amino-glycoside antibiotics, increase risk for ototoxicity

-Pulmonary edema in heart failure
-Edema caused by renal, hepatic, or cardiac failure not affected by other diuretics
-Hypertension

Examples: Metroprolol, atenolol (ends in -ol)
-Hypertension
-Angina pectoris
-Dysrhythmias
-MI
-Heart Failure

-Atenolol
-Metroprolol

Examples: Metroprolol, atenolol
-Primarily affects the heart and kidney
-Decreases heart rate and contractility
-Decreases the release of renin which decreases angiotensin-I-related vasoconstriction and aldosterone-related fluid retention

Examples: Metroprolol, atenolol
-Bradycardia and reduced cardiac output
-Heart failure, due to reduced contractility of the heart can also occur (results in shortness of breath, edema, and coughing, especially when laying flat)

Rebound excitation that causes anginal pain or a myocardial infarction

Examples: Metroprolol, atenolol
-Monitor heart rate and report to provider a low rate
-Monitor for signs of heart failure, such as shortness of breath, peripheral edema, and night cough
-Instruct client not to stop their beta blocker suddenly

Examples: Metroprolol, atenolol
-Oral and IV
-Orally for hypertension and both orally and IV for acute MI
-Atenolol is available in a crushable tablet
-Metroprolol is available as immediate-release tablet or sustained-release dose that needs to be taken whole, not crushed
-Should be taken at the same time every day

Examples: Metroprolol, atenolol
-Check pulse daily before taking medication and notify provider of any abnormal readings
-Warn client not to stop taking medication abruptly
-Clients with history of angina need to report increase in angina, or new onset of chest pain to provider
-Client needs to report manifestations of heart failure

Examples: Metroprolol, atenolol
-Do not give to clients with sinus bradycardia, greater than a first-degree heart block, moderate to severe heart failure, cardiogenic shock, peripheral vascular disease, Raynoud's disease, or to children less than 6 years old
-Used with caution for heart failure that is controlled, asthma, COPD, or other chronic respiratory disorders

Examples: Metroprolol, atenolol
-Other antihypertensive medications
-Caution with digoxin
-Hypoglycemic agents may increase a client's risk for hypoglycemia
-Antimuscarinic and anticholinergic medications may decrease the effects

*short-lasting action
*rapidly absorbable routes
-Sublingual
-Transdermal
-IV
-Oral

Increases coronary blood flow by dilating the coronary arteries, vasodilation, decreases preload, reduces myocardial oxygen consumption

-Ask patient if they take other nitrates (isosorbide) for chest pain or if they take erectioe dysfunction medications (cialis, viagra) to avoid significant hypotension
-May compromise maternal and fetal circulation
-Safety and effectiveness not established in children

-Administer one 0.4 mg tablet sublingually every five minutes for acute angina attacks. Call provider if pain is not relieved by three tablets and an additional 15 minutes

-Administered IV by the RN for chest pain unrelieved by nitroglycerine
-Actions: vasodilation and pain relief
**HIGH ALERT MEDICATION
-Monitor respiratory rate, bp, level of consciousness, bowel pattern
-Can be administered to infants and children; dosages adjusted based on weight

Examples: Captopril, lisinopril
-ends in -pril
-Used for hypertension, heart failure, and recent MI

Examples: -pril, captopril, lisinopril
-Reduces angiotensin II which reduces vasoconstriction and drops BP
-Reduces aldosterone which promotes water and sodium excretion

-Fluid accumulation and angioedema
-Hyperkalemia
-Dizziness
-Constant, dry, irritating cough

Examples: -pril, captopril, lisinopril
-get up slowly
-do not take potassium supplements
-may experience dizziness at beginning of therapy
-do not stop abruptly
-Take any time without regard to meals, except captopril-1hr before or 2hr after meals

Examples: ends with -lol
Selective: atenolol, metroprolol, carvedilol, nebivolol
Non-selective: nadalol, propranolol, pindolol, sotalol

Examples: ends in -lol, metroprolol, atenolol
-Hypertention
-Dysrhythmias
-Acute MI
-Mild heart failure

Examples: ends in -lol, metroprolol, atenolol
-Decreases heart rate and contractility, decreasing cardiac output
-Decreases the release of renin which decreases fluid retention and vasoconstriction

Examples: ends in -lol, metroprolol, atenolol
-bradycardia
-hypotension
-2nd or 3rd degree heart block

Examples: ends in -lol, metroprolol, atenolol
-Dizziness
-Hypotension
-Erectile dysfunction
-Headache

Examples: ends in -pine, nifedipine
-Blocks calcium channels in vascular smooth muscle cells resulting in vasodilation and lowered blood pressure

Examples: ends in -pine, nifedipine
-Hypertension
-Cardiac dysrhythmias
-Angina pectoris

Examples: ends in -pine, nifedipine
-Bradycardia
-Heart failure
-Heart block

Examples: ends in -pine, nifedipine
-Dizziness
-hypotension
-flushing of the skin
-peripheral edema
-inflamed gums
-bradycardia

-Angiotensin II Receptor Blocked (ARB)
-Blocks production of angiotensin II resulting in vasodilation and urinary excretion of sodium and water and retention of potassium

-Hypertension
-Prevention of cerebrovascular accidents, or stroke

-Vasodilators
-Dilates arterioles which decreases peripheral resistance, decreasing arterial blood pressure, increasing heart rate and contractility

-Moderate to severe hypertension
-IV forms treat hypertensive crisis
-Heart failure

-Pericarditis
-Tachycardia
-Pulmonary edema