positive inotrope drugs & their MOA
intropin (dopamine), dobutamine (dobutrex), milrinone (primacor), digitalis (lanoxin) - used for CHF & shock to increase contractility - to increase CO
Dobutamine (dobutrex) side effect
decreased BP bc it vasodilates, but can also increase BP by increasing CO
Intropin (dopamine) MOA
increases force of contraction (squeeze). particularly used for acute exacerbations of CHF where BP has fallen.
Furosemide (lasix) and Bumex side effect
electrolyte imbalances (especially hypokalemia - which makes a person more likely to have digoxin toxicity if on that as well)
ACE inhibitors (pril's) MOA
decreases afterload by preventing vasoconstriction, decreases preload by preventing sodium & water retention (inhibits aldosterone), vasodilator.
ACE inhibitors uses
used for HTN, for all post MI pts indefinitely, CHF. reduces mortality & CHF from AMI. Prevents scarring of LV that leads to HF (LV remodeling).
ACE inhibitors side effects
hypotension (orthostatic hypotension early on) - Monitor BP!, hyperkalemia, persistent cough (have to get off drug)
losartan (cozaar), valsartan (diovan), candesartan (atacand), irbesartan (avapro), telmisartan (micardis)
Beta blockers (lol's) uses
used for angina, MI (standard of care for all post MI pts indefinitely), CHF (only stable, chronic - not early mgmt), tachyarrhythmias.
Beta blockers MOA
they inhibit/block the SNS response - decrease HR, contractility, stroke volume, CO, BP, AV node conduction
Beta blockers side effect
hypotension (don't give if SBP < 100), bradycardia, AV block, extreme fatigue/lethargy, impotence
Beta blockers nursing considerations
monitor BP & HR. contraindicated if HR < 60 bpm, insulin dependent DM (monitor sugar more often), asthma, PVD
Natrecor (natriuretic peptide) MOA and use
causes diuresis - opposes renin so it causes excretion of sodium & water to treat fluid overload. used for ACUTE episodes of CHF.
Natrecor (natriuretic peptide) side effect
hypotension - monitor BP, HR, rhythm closely. may need to reduce dosage.
Calcium channel blockers (Cardizem, Procardia/nifedipine, Norvasc/amlodipine) MOA and uses
slows ventricular rate. decreases afterload. more of an antiarrhythmic. Used for HTN, Afib, Aflutter.
angina, MI, HTN, CHF, shock. consider early admin. in select pts: suspected ischemic chest pain, UA (change in angina pattern), acute pulm. edema (if BP > 90 systolic).
decreases pain of ischemia, venous blood return to heart, preload & cardiac O2 consumption. Increases venous dilation and cardiac collateral flow. Dilates coronary arteries.
Nitro side effect
mainly hypotension (bc it's a dilator). Extreme caution if systolic BP < 90 and w/RV infarction, limit drop to 10% if pt normotensive, limit drop to 30% if pt hypertensive. Watch for HA, syncope, tachycardia.
brings BP down really quickly - monitor BP every minute! drug of choice for hypertensive crisis (malignant HTN)
Aspirin actions will reduce:
overall mortality from AMI, nonfatal reinfarction, nonfatal stroke. will not do anything to clot already there!
CHEW the tablet. standard therapy for pain suggestive of AMI. better to use baby aspirin bc it's flavored. if allergic give plavix.
antiplatelet that PREVENTS clot formation, prevents platelet aggregation and vasoconstriction. used for CAD, post MI (STEMI and NSTEMI).
GP-IIb/IIIa inhibitors - Reopro, Aggrastat, Integrilin
antiplatelet (PREVENTS clot formation & from getting bigger)
GP-IIb/IIIa inhibitors - Reopro, Aggrastat, Integrilin uses
ACS w/NO ST segment elevation (NSTEMI), non-Q wave MI, UA, CA reocclusion post PCI or with fibrinolytics given 24 hrs before balloon/stent.
GP-IIb/IIIa inhibitors - Reopro, Aggrastat, Integrilin - side effect
bleeding from ALL sites - urine, stool, sputum, puncture sites, nosebleeds. Monitor labs - Hb, Hct, platelets
used for DVT, PE, MI (STEMI & NSTEMI), DIC, A-Fib, post PTCA or CABG with some lytics if < 48 hrs. For STEMI with/without reperfusion up to 8 days.
Fibrinolytics (thrombolytics) - end in "ase" MOA and uses
BREAK UP clots already formed. Used in MI (STEMI ONLY: w/chest pain > 20 min & < 12 hrs), CVA, PE. Max age for use - 75.
Fibrinolytics (thrombolytics) side effects
death from brain (intracerebral) hemorhage esp. if over age 75, reprofusion arrhythmias (PVB, PAB, Afib/Aflutter) - has plenty of O2 all of a sudden, go away on their own (means the drug is working!)
aldosterone blockers (end in "one") - spironolactone uses
potassium sparing diuretic used in MI and CHF
morphine sulfate indications
used for STEMI, consider in NSTEMI, evidence of acute pulmonary edema. also if systolic BP > 90 and no hypovolemia.
morphine sulfate actions
drug of choice for acute pain d/t MI. decreases pain of ischemia, decreases anxiety (gives feeling of euphoria), decreases extension of ischemia by decreasing O2 demands.
morphine sulfate dose and administration
give "low & slow." 2 to 4 mg every 5-10 min titrated to effect. no cap on the dose. given IV push over 5 min.
precautions with morphine sulfate
depression of ventilation (consult MD), N/V common (can premed w/zofran), bradycardia, drop in BP (increase fluids, elevate feet, lower head)
with or without lytics for 14 days, with or without reperfusion, NSTEMI - give for 6-9 mos, STEMI - gie for 1 year. ALL STEMIs and NSTEMIs get Plavix.
antiplatelet - inhibits platelet aggregation by selectively preventing binding of ADP to its receptor. Prolongs bleeding time.