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15 Cardio 3-4

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  3.Di !  erentiate the pharmacological interventions and the corresponding nursing considerations used to decrease myocardial oxygen consumption in the patient with coronary artery disease. (beta blockers, Ace inhibitors, Nitrates, ASA, lipid lowering agents). Beta BlockersEnd in “lol”: atenolol, carvedilol (Coreg) propranolol, labetolol,, metoprolol (lopressor))IndicationsCommonly used to treat Angina, protect heart from MI, Atrial arrhythmias, HTN, CHF MOACardio selective beta 1 receptors !  myocardial stimulation, which in turn !  HR, slows conduction through the AV node, prolongs the SA node recovery, and !  myocardial oxygen demand by !  myocardial contractile force. When HR is slower gives more time for coronary arteries to fill.  Adverse EffectsMost serious undesirable effects caused by acute withdrawal. May exacerbate angina and precipitate MI. Bronchospasm, !  HR, Heart blocks, Hypotension, CHF, insomnia, depression, fatigue, muscle weakness, hypoglycemia, NV, impotence.Nsg ConsiderationsPromote Na retention. Give with care to diabetic because mask signs of hypoglycemia such as tachycardia, nervousness. May exacerbate bronchospasm.  Abrupt discontinuation can lead to HA, malaise, sweating, palpitations, rebound tachy and be life threatening. Less effective in male smokers.  Ace InhibitorsEnd in ‘pril”: Captopril, Lisinopril, Accupril IndicationsCHF, HTN, AMI MOAPrevents conversion of angiotensin I into angiotensin II. Angiotensin II is a  potent vasoconstrictor and induces aldosterone secretion by the adrenal glands. Aldosterone stimulates sodium and water resorption, which can raise blood pressure. ACE inhibitors block this RASS system causes diuresis, which decreases preload and work required of the heart. Side EffectsHypotension, Renal failure (pre-existing, BUN, Creatinine), cough, taste disturbances, Angioedema, hyperkalemia.Nsg ConsiderationsACE inhibitors should be started and continued indefinitely in patients recovering from STEMI and an EF <40. Monitor renal function. May cause increase in BUN and serum creatinine. Motrin ( prostaglandin decrease effect), Don’t give with K sparing diuretics ( aldactone) , start low, Contraindicated : aortic stenosis, renal failure, renal artery stenosis.  NitratesNitroglycerin (SL, IV, Topical. Spray)IndicationsIschemic chest pain, angina, AMI, HTN associated with MI, CHF, pulmonary edemaMOANitrates dilate all blood vessels. Vasodilatory effects are the result of relaxation of smooth muscle cells part of wall structure of veins and arteries. By causing venous dilation, the nitrates reduce venous return, resulting in decreased preload, afterload and reduced myocardial oxygen demand.  Adverse Side EffectsMost common is HA, postural hypotension, dizziness. If dilation happens too rapidly, reflex tachycardia occurs.Nsg ConsiderationsMedication should be taken first sign of chest pain. Teach patient to stop, sit down before taking drug to prevent falling and take on sublingual tablet. If discomfort is not relieved in 5 minutes, call 911 and take another tablet while waiting for emergency. Pat can take one more while waiting but no more than 3 total. Protect medication from light. Patient should feel tingling under tongue. If not, drug has lost its potency. Good for 3-6 months. While taking, avoid alcohol, hot environments. Take before stressful activities. ASAAspirin, Acetylsalicylic Acid IndicationsProphylaxis of transient ischemic attacks, and MI Analgesic, anti inflammatory, and antipyretic properties. MOAInhibits platelet aggregation by stopping the production of pro-aggregatory thromboxane. Results in dilation of blood vessels and prevention of  platelets from aggregating or forming a clot.  Adverse Side EffectsGI BLEEDING. Take with food. Use enteric coated Nsg ConsiderationsUsed with coumadin  r/o bleeding, may lessen efficacy of ace inhibitors, enteric coated may decrease efficacy with antacids, increase risk of gout, decrease risk of TIA/MI, half life 15-20 min.  Lipid Lowering agents( Questran) bile acid sequestrants(Zetia)cholesterol absorption inhibitors(Niacin)Nicotinic Acid (Niacin)Statins- (Lipitor)hmg coa reductase inhibitorsMOABind bile acids in the GI tract, forming an insoluble complex. Result is increased clearance of cholesterol.Inhibits absorption of cholesterol in the small intestine.Water soluble B vitamin. Effective in !  synthesis of LDL and inhibits lipolysis in adipose tissueInhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, an enzyme which is responsible for catalyzing an early step in the synthesis of cholesterol. Adverse Reactions/ Side EffectsConstipation, impaction, GI upset, rash, vit ADK deficiency. Prolonged use increases risk of bleeding r/t vit K deficiency. Contraindicated- GI dysfunction,disease, cirrhosis ANGIOEDEMA, cholecystitis, cholelithiasis,  liver enzymes, rash,.Contraindicated- hepatic or sever renal dysfunction, gall bladder GI, severe flushing, abnormal lifer tests,  jaundice, Contraindicated in : sever hypotension, liver disease, peptic ulcer Caution with  pts with gall bladder disease, DM, an gout Rash, hives, itching, fever, muscle pain, cramps, weakness, unusual bleeding, blurred vision, HA, constipation, GI upset. Contraindication- active liver disease,  preg, lactating, caution with sever renal failureNsg ConsiderationsInstruct patient to take medication before meals. Thiazide diuretics decrease absorption. Enhance the effects of oral anticoagulants. Monitor stool for steatorrhea or other bile duct obstructionMonitor liver function tests. If symptoms of serious liver injury, hyperbilirubinemia, or jaundice occurs discontinue atorvastatin. May also cause  alkaline  phosphatase and bilirubin levels.Liver function tests, teach to report for unexplained muscle  pain, tenderness, weakness.  4. Compare and contrast the assessment findings, patient care management and education of patients with stable angina, and unstable angina. Stable AnginaUnstable AnginaEtiologyMyocardial ischemia, usually secondary to atherosclerosisRupture of thickened plaque, exposing thrombogenic surface AssessmentAngina, pressure, or complaint of indigestions are clinical manifestations lasting 5-15 minutes and subsides when exertion is relieved and can be prevented or stopped with nitroglycerin or rest.Chest pain new in onset, occurs at rest, or has worsening pattern  frequency, duration, intensity. Represents emergency. For women, fatigue may be most  prominent symptom, along with SOB, indigestion and anxiety.Patient CareAimed at !  O2 demand and  O2 supply; first line treatment for angina is nitrate therapy to promote  peripheral vasodilation. A - ASA, antianginal therapy B - beta blocker, blood pressureC - Cigarette smoking, Ca channel blockers, cholesterol D - diet, diabetes management E - Exercise , educationHospitalization, EKG monitoring,  ASA, systemic anticoagulation with heparin, angioplasty, beta blockers, calcium channel blockers, nitrates.Education  !  cholesterol in diet  !  Salt, ETOH Stop smoking Take ASA, antianginal, beta-blocker,Control diabetesExercise Eat healthy  !  HTN, !  lipids, no smoking, routine physical activity, !  stress, !  obesity, maintain DM 
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