Cardiovascular Drugs and classification

CARDIOVASCULAR MEDICATION

1. ANTICOAGULANTS : –

Anticoagulants prevent extension and formation of clot
INDICATION :- * Myocardial infarction, unstable angina, atrial fibrillation, Deep vein thrombois, and pulmonary embolism.
CONTRAINDICATION :- Active bleeding, blood dyscrasias, ulcer , liver and kidney disease.

Examples of Anticoagulants :- oral – warfarin sodium ( coumadin)

parental :- fundaparinux (Arixtra)
Enoxaparin (Lovenox )
Heparin sodium

SIDE EFFECTS OF ANTICOAGULANT :-

Hemorrhage
hematuria
Bleeding gums
Epistaxis
Thrombocytopenia

A. Enoxaparin ( lovenox ) low molecular weight heparin :-

Enoxaparin or lovenox prevents thrombin from converting fibrinogen to fibrin
It prevents thromboembolism
It has longer half life than heparin
Intervention :- * Administer only in recumbent patient by subcutaneus injection into anterolateral posterolateral abdominal wall
Do not expale the air from prefilled syringe during injection
monitor aPTT level
aPTT level longer than 80 sec , dosage should be lowered
aPTT level short than 60 sec, dosage should be increased
***ANTIDOTE ;- PROTAMINE SULPHATE

B. HEPARIN SODIUM :-

Heparin prevents thrombin from converting fibrinogen to fibrin
It prevents thromboembolism
Intervention :- Adminitser Heparin subcutaneously , inject into abdomen with 5/8 inch needle (25 – 28 gauze )
monitor aPTT level
aPTT level longer than 80 sec , dosage should be lowered
aPTT level short than 60 sec, dosage should be increased
***ANTIDOTE ;- PROTAMINE SULPHATE

C . WARFARIN SODIUM ( COUMADIN, JANTOVEN )

It is taken orally
warfarin suppresses coagulation by acting as antagonist to vitamin k
warfarin prolongs prothrombin time (PT)
Normal PT id 9.6 sec to 11.8 sec ,therapeutic range is 1.5 to 2 times control value
The tratment goal of warfarin sodium is to raise INR to an appropriate level
Normal INR is 1.3 to 2
***ANTIDOTE ;- VITAMIN K ( PHYTONADIONE)

D. RIVAROXABAN ( XARELTO)

Rivaroxaban works as inhibition of factor Xa
Used in nonvulvular atrial fibrillation and after knee and heep replacement

2. THROMBOLYTIC MEDICATION :

Thrombolytic medication activates plasminogen , plasminogen activates plamin which dissolves clots
INDICATION :- Used in early course of Myocardial infarction within 4 to6 hours of onset of infarction to restore blood circulation
Also used in atrial thrombosis , DVT, Pulmonary emboli.
CONTRAINDICATION :- Active internal bleeding
hisory of stroke
intracranial or intraspinal surgery within prevoius 2 months
History of thorasic or abdominal surgery in previous 10 yrs
uncontrolled hypertension

Examples of Thrombolytics :- Altepase ( Activase)

Reteplase ( Retavase )
Tenecteplase (TNKase)

SIDE EFFECTS :- Bleeding, Dysrhythemia and allergic reaction

Intervention :- Monitor for bleeding

Monitor vitals
Monitor all excretion for occult blood
Withhold the medication if bleeding develops and notify physician
**ANTIDOTE ;- AMINOCARPOIC ACID

3. ANTIPLATELET MEDICATION :

Antiplatelet medication inhibits aggregation of platelets in the clotting process and prolonging the bleeding time .
INDICATION :- : – Used with anticoagulants
used in prophylaxis of long term complication from Myocardial infarction, stent and brain stroke

Examples of Antiplatelets :- Aspirin ( Acetylsalicyclic acid , ASA )

Clopidogrel ( plavix ) .

SIDE EFFECTS :- Gastrointestinal bleeding

Bruising
hematuria
Tarry stool

*****ANTIDOTE of aspirin is sodabicarbonate

4. POSITIVE INOTROPIC AND CARDIOTONIC MEDICATION :

These medication stimulates myocardial contractibility and produce positive inotropic effect.
INDICATION :- Used in short term mgt of heart failure , peripheral and kidney functionby increasing cardiac output, decreasind preload.
For continues infusion , infusion pump should be used
Stop infusion if Blood pressure drops

SIDE EFFECTS :- Dysrhythemia , Hypotension and Thrombocytopenia

A. DOPAMINE :-

Used as short term mgt for severe and acute heart failure
Increases myocardial contractibility and dilates blood vessels and increases renal blood flow.

B. DOBUTAMINE :-

used for short term mgt for heart failure
Increases myocardial contractibility thereby improving cardiac performance

C. INAMRINONE Lactate ( INOCOR ) :-

used for short term mgt for heart failure in those patient who have not responded adequetly to cardiac glycoside, diuretics
****It should not be mixed with Glucose Containing solution

D. Milrinone Lactate:-

Used for short term mgt for heart failure and given before heart transplantaion.

5. CARDIAC GLYCOSIDES :

CARDIAC glycosides inhibits sodium potassium pump thus thus intracellular calcium, which causes heart muscle to contract more efficiently

A. DIGOXIN ( LANOXIN) :-

INDICATION :- CARDIAC glycocide are used for heart failure and cardiogenic site , atrial tachycardia, atrial fibrillation and atrial flutter
CONTRAINDICATION :- ventricular dysrhythemia and 2nd and 3rd degree heart block.
***Early signs of digoxin toxicity present as gastrointestinal menifestation such as anorexia,nauseA AND VOMITING and diarrhoea.
Therapeutic digoxin range is 0.5 to 2ng/ml
above 2 ng/ml is toxic
Hypokalemia and increases the risk of digoxin toxicity
If the pulse rate is lower than 60 beat/min the medication should be withheld and notify physician
****ANTIDOTE of DIGOXIN IS IMMUNE FAB ( DIGIBIND ).

6. ANTIHYPERTENSIVE MEDICATION :

A. LOOP DIURETICS :-

LOOP Diuretic inhibit sodium and chloride reaborption from the loop of Henle and ditil tubule.
Examples of loop Diuretic :- Furoemide ( lasix )
Toremide ( Demadex )
INDICATION :-
Used for hypertension ,pulmonary edema, hypercalcemia and renal disease
Edema asociated with Heart failure

SIDE EFFECTS :- Hypokalemia, hyponatremia and hypocalcemia

thrombocytopenia
Ototoxicity and deafness
Thiamine deficiency

**Adminiter IV furoemide slowly because hearing loss can occur if injected rapidly.

7. POTASSIUM RETAINING DIURETICS :

Potassium retaining diuretics act on distal tubules to promote sodium and water excretion and potasium retention
INDICATION :- Used for edema and hypertension.
CONTRAINDICATION : In renal and hepatic disease
Examples of potassium retaining diurectics :- Sprirolactone (aldactone )
Amiloride hydrochloride

SIDE EFFECTS :-

Hyperkalemia
Nausea and vomiting,diarrhea
Diziness and weakness

Intervention :- Monitor vitals and urine output

Monitor symptoms of hyperkalemia such as nausea and vomiting , abdominal cramps, tachycardia and Tall peaked T wave on ECG

8. ACE INHIBITORS :

ACE inhibitor prevent peripheral vaoconstrictionby blocking conversion of angiotensin 1 to angiotensin 2nd
INDICATION :- Used in Hypertension and heart failure
Examples of ANgiotensin enzyme inhibitors :- pril in the last name are ace inhibitor 1st
Enalpril (Vasotec )
Ramipril (Altase )
Lisinopril (Prinivil )
Captopril (Capoten )
Angiotensin 2nd receptor Blocker :- Sartan in last name are ace 2nd inhibitors
Losartan ( Cozaar )
Telmisartan ( micardis )
Olmesartan ( benical )

SIDE EFFECTS :- Persistant dry cough with ACE inhibititor like remipril

Nausea vomiting
Diminished taste with ACE inhibititor like remipril
Hypotension

Intervention :- Monitor wbc andprotein

Persistant dry cough if it occurs instruct patient to contact Physician
Instruct pt to take captopril 20 to 60 min before meal.

9. ANTIANGINAL MEDICATIONS :

A. NITRATES :-

NITRATES PRODUCE VAODILATION

SIDE EFFECTS : Headache

orthostatic hypotension
Flushing or pallor
faintness

Sublingual medication :

Instruct patient to take 1 tablet for pain sunlingualy and contact emergency
In hospitilized patient , 1 tablet i administered every 5 min for total 3 doses
Blood pressure should be checked before each tablet
Patient taking nitroglycerine tablet they should be instructed to check expiry date before taking medicine bcz expiration may occur in 6 months

9. β ADRENERGIC BLOCKERS :

β Arenergic blocker inhibits β adrenergic response thus decreaing cardiac output
It decreases heart rate and BP
Examples of β adrenergic blockers:- Labetalol ( Trandate )
Propranolol ( Inderal )
Sotalol ( Betapace )

SIDE EFFECTS : Bradycardia

**Brochospasm
hypotension
Agranulocytosis
Hyperglycemia
Nightmares

Intervention :- Withhold medication if pulse and BP are not in prescribed papmeter

Instruct pt to report dizines lightheadedness and naal congestion
Instruct pt taking insulin to monitor Blood glucose level

9 . CALCIUM CHANNEL BLOCKERS :

It decreases cardiac contractibility and workload of heart thus decreaing need for oxygen
Used in Angina, Dyrhythemia and Hypertension.
Examples of Calcium channel blockers:– Amlodipine (Norvasc )
NIcardipine ( cardene )
Nifedipine ( adalat, procardia )
Diltiazem ( Cardizem, dilacor XR )