Cardiac

• Check BP/P prior - notify dr systolic >90-100
• Give sip H2O
• Under Tongue
• Check BP/P q 5 Min administer another if needed up to 3
• give no more than 3X
• DO NOT LEAVE patient
• 1 - 2 min for relief
• Spray is more rapid 30 sec - 1 min
• drink H2O before and 5 - 15 min after last

• Ointment - special paper
• Apply to non hairy surface - don't shave
• DO NOT rub
• rotate sites
• wear gloves
• transdermal patch - aplly same time each day

• Nitro-Bid
• Isordil-pro

isorbide (generic)

generic for Nitroglycerin topical (prevention)

Nitroglycerin transdermal

Nitroglycerin transdermal

• HA
• Hypotension
• Dizziness
• Tachycardia - compensatory for hypotension
• Dry mouth

Inderal (propranolol); Tenormin (atenolol)-  “olol”

Check BP & P before giving- hold if BP < 90; pulse < 60

Used when nitrates alone to not prevent angina- NOT for acute angina

Blocks SNS stimulation- decreased HR, decreased myocardial contraction, decreased BP = decreased myocardial O2 demand

Decrease frequency & severity of angina

Decrease need for SL Nitro

Increase exercise tolerance

SE: hypotension, bradycardia, CHF, bronchoconstriction, impotence

SE: hypotension, bradycardia, CHF, bronchoconstriction, impotence

Procardia (nifedipine); Calan, Isoptin (verapamil)

If angina, improves blood supply to myocardium by dilating coronary arteries; decreased workload of heart by dilating peripheral arteries

Prevents movement of extracellular Ca++ into cells: coronary & peripheral arteries to be dilated, decreased myocardial contractility; slows AV node conduction

SE: hypotension, dizziness, lightheadedness, weakness   HA, edema, CHF

Minimize precipitating events

Smoking cessation

Engage in regular exercise

Wt reduction

• Avoid caffeine
• Regular medical followup

Morphine

24-48 hours in CCU to telemetry


Promote healing through rest & decreased O2 demands of myocardium

Morphine

Reperfusion of occluded coronary artery

Aspirin given in ER or ambulance- chew for buccal absorption; antiplatelet effect

Given within 3-5 hours after onset of MI

"clot buster”

Dissolve clot- thrombi

Acts by stimulating conversion of plasminogen to plasmin. Plasmin is a proteolytic enzyme that breaks down the fibrin framework of the thrombus

Goal: re-establish blood flow & prevent or limit tissue damage

Streptase (streptokinase); t-PA (tissue plasminogen activator (alteplase)

SE: Bleeding- internal or external

Must be given by specially trained personnel

Streptase (streptokinase)

t-PA (tissue plasminogen activator (alteplase)

SE: Bleeding- internal or external

 Heparin

Coumadin (warfarin)

given IV or subq: inactivates clotting factors & thrombin so that thrombus formation is prevented.

Does NOT dissolve existing thrombus. Prevents it from getting larger until body can absorb.

Check PTT daily.

Antidote: Protamine Sulfate

Protamine Sulfate

Antidote: Vitamin K

given po: acts in liver to prevent synthesis of Vit K dependent clotting facts.

Inhibits blood clotting mechanism.

Protects against clot formation. Long term anticoagulation.

Check PT/INR.

Antidote: Vitamin K

Bleeding!!

Soft toothbrush, electric razors, medic alert bracelet.

Don’t give ASA & Coumadin/Heparin until specifically ordered by DR.

 Aspirin

Ticlid (ticlopidine); Plavix (clopidogrel)- decreases platelet aggregation

Antiplatelet

decreases platelet aggregation, prevents MI & CVA

Usually once/day dosing if not on other antiplatelet or anticoagulant

Do NOT crush enteric coating; give with food if not enteric coated

Monitor for GI bleeding

Monitor CBC for leukopenia; liver function

Nursing Care & Teaching for client post MI

Antiplatelet

decreases platelet aggregation, prevents MI & CVA

Usually once/day dosing if not on other antiplatelet or anticoagulant

Do NOT crush enteric coating; give with food if not enteric coated

Monitor for GI bleeding

Monitor CBC for leukopenia; liver function

Nursing Care & Teaching for client post MI

• Cardiotonic- Inotropic Cardiac Glycoside
•        - Digoxin (Lanoxin)

• Cardiotonic- Inotropic Cardiac Glycoside
•       for CHF

Slows and Strengthens heart

Increases myocardial contractility

Exchange of Ca and Na into myocardial cells

Improve CO quickly

Loading dose

Digitalis Toxicity

• Dig Level: 0.5-2.0 Therapeutic
•        Toxic: > 2.5

Hypokalemia: Potentiates Digitalis

Elderly

Symptoms: Bradycardia, Anorexia, N/V, Confusion, Irritability, Vision changes

Bradycardia

Anorexia

N/V

Confusion

Irritability

Vision changes

Bradycardia

Dysrhythmias

Anorexia

N/V

Check AP before giving

Hold if < or = 60, call Dr

Check Dig level, K+ level

Monitor for SE

Don’t give with antacids/laxatives

Thiazides (chlorothiazide, hydrothiazide)

Loop diuretics (furosemide, bumetanide)

CHF  Diuretics

Used for CHF to decrease Cardiac Workload by decreasing circulating blood volume

Severe CHF or other Tx not effective

Monitor for hypokalemia- dig toxicity, dysrhythmias

Increased Na & H2O excretion- dehydration

Hypokalemia- muscle weakness, confusion, irritability, anorexia, bradycardia, dig tox

Volume depletion- orthostatic hypotension

Glucose intolerance

I&O, Daily Wt

Monitor postural BPs

Monitor K+ levels

Hyperkalemia- confusion, muscle cramps, dysrhythmias, arrest

K+ rich foods- bananas, potatoes, OJ, tomatoes, raisins

Serum Electrolytes- Na, K

BUN

Blood glucose levels

Hct- fluid balance

Enalapril (Vasotec)

Lisinopril (Prinivil, Zestril)

Captopril (Capoten)

ACE Inhibitors

Blocks effects of renin-angiotensin-aldosterone system

Reduces vasoconstriction

Reduces Na and H2O retention

Decreases cardiac workload & edema

Don’t DC abruptly•

Monitor BP before and after giving

Monitor K+ levels

Safety! Change positions slowly

• Monitor for
• orthostatic hypotension