Classification
ACE Inhibitors
Beta Blockers
Ca+ Channel Blockers
K+ Channel Blockers
Cardiotonics
MOA
↓ conversion of A-I to A-II; vasodilator
decreases HR
decreases conduction
slos action !otential "fibrillation#
decreasses conduction of electrical i$!ulses
*atenolol *carvedilol *metoprolol *sotalol
(vera!a$il (diltia)e$ *amlodipine *nifedipine *felodipine *nicardipine
*amiodarone
%ru& 'a$es
*captopril *enalapril *lisinopril *ramipril *trandolapril *fosinapril
*adenosine *digoxin
*Alpha's dine & sin *clonidine, *prazosin
* effects of di&oin *propafenone *procainamide *ibutilide *sotalol
HTN, A" bloc, !"T,
",. - / n&0$1#
*digitoxin "23 - /4 n&0$1#
!"T, A#fib, !"T, CH+$H+
HTN, a#fib$flutter, !"T,, %unctional !"T dsththmia, peripherial circulation, %unctional chronic stable stable angina dsrhthmia, chronic CA65IO' ( in asthma pt's ( angina stable angina
A#fib$-"- !"T, "T$"+
7ide Effects
hpoT, dizziness, fatigue, A" bloc 5prolonged 3 N$",, brad N$" brad,, 3 hpoT, hpoT, headache, A-+, ./0, interval6, bradcard bradcardia, ia, fatigue, bronchospasms, angioedema, sin rash, hpoT, pulmonar edema, hperglcemia, head$dizz, cough, loss of taste, CH+, headache, dizziness, drosiness, CH+, 4 N$"$C, 12 irritation flushing, rash, fever,chills
H+, A" bloc, pulmonar toxicit, painful breathing, cough, !78, eaness in arms$legs, trouble aling, dizziness, lightheadedness
'ursin& Mana&e$ent
*ortho 83, ?+T's, *2$7, s$s of CH+, *assess 83, H-, sin, eight 5dail or eel6 pulm#edema$lungs, facial edema, /0 * hold if apical : >< dail eight, pain level serum, renal tests *hold if !83 : ;<< *83 & H- @=(h *hold !83 :;<< * avoid 4t7H, 7TC's, *hold if apical : >< *A!A$N!A2s ma & hazardous tass if *hold if !83 : ;<< reduce effectivness dizz) rise slol *ma cause ;B H8 *full effect on 83 * do not stop abruptl *tae ith meals ma not be seen (caution use ith *pines are for 83) varapimil for =(> s & diltiazem for dsrhthmias* African A$ericans
*assess 83, --, apical & sounds, E", eight, radial pulses, renal & ?+T sputum, extremit *hold H-;D< or :>< edema, renal & ?+T's *safet$safet$safet *eep all aptmts(, labs, *teach pt's s$s of etc# & follo diet plan digoxin toxicit *avoid 4t7H, smoing, *no herbal drugs 7TC's, sallo hole, */0 rich diet) monitor ax ma be found in stool
Cardiac 5reat$ent
HTN, CA, !"T, A#fib$flutter, bradcardia, impaired A#fib$flutter,
bronchospasms) & pts ( can mas s$s of hpoglcemia
CA65IO' ( in H+
CO'5RAI'%ICA5E% heart bloc, "#tach$fib, pregnanc
CA65IO' advanced H+ & renal insuffieienc
digoxin toxicit9 KC1 - I8 or 9O earl s$s ( N$"$, brad$tach brad$tach , 3"C's, bi$trigemin bi$trigemin late s$s ( visual changes
*assess 83, A3, lung
/0 levels
Classification
%irect 8asodilators
7tatin %ru&s
Anti!latelet
Anticoa&ulation
Anticholiner&enic
MOA
rela arteriolar s$ooth $uscle: causin& blood vessel dilation
inhibit snthesis of cholesterol in liver
decrease !latelet a&&re&ation < inhibit thro$bus for$ation
!rolon& the for$ation of blood clottin&
anti!aras$!athetic; transient !hase of sti$ulation
*atorvastain *lovastatin *simvastatin *fluvastatin
*A!A *clopidogrel bisulfate
%ru& 'a$es
Cardiac 5reat$ent
7ide Effects
*hdrazaline *nitroglcerin 5sublingual, patch, & paste6 *isosorbide mononitrate *sodium nitroprusside
HTN, chronic stable angina, H+ after 2
H? CA
*arfarin Antidote = 8ita$in K
3T( F#>(;;#Gseconds 2N-( D(=x norm 5;#(D#<6
*heparin, *enoxaprin
*atropine
Antidote = 9rota$ine 7ulfate
a3TT therapeutic ( ><(G<
2 or re(infarction, CA, stroe CO'5RAI'%ICA5E% pregnanc 5=rd trimester6, bleeding disorders or thromboctopenia CA65IO' 3I, hepatic$renal disease
A#fib$flutter, 2, "T, 34, stroe CO'5RAI'%ICA5E% thromboctopenia CA65IO' 3I, severe HTN, hemophelia
bradcardia, obitz 22
H-, 83, bruising, headache, dizziness, N"C, elevated liver hematuria, bruising, can't see, can't pee petechiae, blac$tarr palpitations$tach, enzmes, mopath, epistaxis, confusion, 12 can't spit, can't sh*t stools, bleeding in N$", hpoT, flushing rhabdomlosis, ulcers or upset, tachcardia, agitation,
Classification
%irect 8asodilators
7tatin %ru&s
Anti!latelet
Anticoa&ulation
Anticholiner&enic
MOA
rela arteriolar s$ooth $uscle: causin& blood vessel dilation
inhibit snthesis of cholesterol in liver
decrease !latelet a&&re&ation < inhibit thro$bus for$ation
!rolon& the for$ation of blood clottin&
anti!aras$!athetic; transient !hase of sti$ulation
*atorvastain *lovastatin *simvastatin *fluvastatin
*A!A *clopidogrel bisulfate
%ru& 'a$es
*hdrazaline *nitroglcerin 5sublingual, patch, & paste6 *isosorbide mononitrate *sodium nitroprusside
*arfarin Antidote = 8ita$in K
3T( F#>(;;#Gseconds 2N-( D(=x norm 5;#(D#<6
*heparin, *enoxaprin
*atropine
Antidote = 9rota$ine 7ulfate
a3TT therapeutic ( ><(G<
2 or re(infarction, CA, stroe
A#fib$flutter, 2, "T, 34, stroe
Cardiac 5reat$ent
HTN, chronic stable angina, H+ after 2
7ide Effects
H-, 83, bruising, headache, dizziness, N"C, elevated liver hematuria, bruising, can't see, can't pee petechiae, blac$tarr palpitations$tach, enzmes, mopath, epistaxis, confusion, 12 can't spit, can't sh*t stools, bleeding in N$", hpoT, flushing rhabdomlosis, ulcers or upset, tachcardia, agitation, urine$gums, vasculitis, *reactions lessen ith 12 disturbances, rash hemorrhage delirium, N"C, 4 prolonged use$dose ad%ust hemorrhage
H? CA
CO'5RAI'%ICA5E% pregnanc 5=rd trimester6, bleeding disorders or thromboctopenia CA65IO' 3I, hepatic$renal disease
CO'5RAI'%ICA5E% thromboctopenia CA65IO' 3I, severe HTN, hemophelia
*tae on an empt stomach *tae ith food$mil *monitor ?+T's prior to *avoid all 2 in%ections *if headache develops treat *advise patient of & @>(;Ds after *inspect & teach for $A!A or acetaminpohen prolonged bleeding time) start of therap abnormal bleeding *advise patient to tae an notif HC3 of unusual *use in ad%unction ith *teach a diet consistent in additional dose prior to bleeding 'ursin& diet therap) restrictions of vitamin / is essential Mana&e- anticipated stress & have *ma cause dizziness or saturated fat & cholesterol *med 2 bracelet, electric $ent drug accessible at all times drosiness *revie dietar habits, razor, soft toothbrush *eep record of attacs *inform HC3 before eight, & exercise patterns *contact HC3 prior to *assess pregnanc status undergoing an procedures *C/ ( if muscle pain or taing an 7TC or *avoid 4t7H or ne drug therap eaness occurs herbal therap *do not mix $other drugs * N7 A!A or N!A2s
Dysrhythmia #inus Bra$ycar$ia #inus Tachycar$ia Premature Atrial Contraction %PAC& #u'raventric ular Tachycar$ia %#VT& A.!lutter A.!i"
bradcardia, obitz 22
(assess for tachcardia) ma lead to "#fib (monitor 2$7) ma cause urinar retention (give 2" over ; minute
EKG Characteristics
Causative Agents
Treatments
< 60 bpm & regular
bb, CCB, MI, ICP/IOP, hypothermia, hypoglycemia,
O2, atropie, pacema!er, "rug "o#age a"$u#te" or "i#cotiue"
101 - 200 bpm & regular 60 - 100 bpm & irregular+ P-a'e may be hi""e i the prece"ig (-a'e 10 - 220 bpm & regular+ P-a'e ote hi""e i the (a'e A( 200 - 600 bpm+ V( 3 or < 100 bmp )a.*utter + ! ,aves- a." + irregular)
, , , , pai, hypo(, hypo'olemia, O2, bb, treat u"erlyig cau#e, aemia, hypo%ia, atipyretic#-e'er, aalge#ic#hypoglycemia, hyperthyroi", pai , , caeie, .tO), tobacco, remo'e cau#e, bb, electrolyte balace#, ob#er'atio hyperthyroi", hypo%ia, COP, O2, remo'e cau#e, I a"eo#ie, amio"aroe, bb, CCB, car"io'er#io, ob#er'atio )(4, C, car"iomyopathy, O2, "igo%i, bb, CCB, arari, "igo%i, epiephrie, )*, .tO) car"io'er#io, ablatio ito%icatio, caeie, #tre##, 5b /778amio"aroe, propaeoe car"iac #urgery hypo!alemia, "igitali# to%icity, i#chemia, C, cor pulmoale, rheumatic heart "i#ea#e
1° AV Block
prologe" P-7 iter'al+ I / i# ar rom P 9 1st °
"igo%i to%icity, bb, CCB, MI, C
0° AV Block enken"ach
P-a'e 9 loger, loger, loger, D/2P 9 enken"ach
"igo%i to%icity, bb, C
O2, chec! me"#/lab#, call )CP 8i e o#et, cotiue to moitor O2, temp pacema!er, .7(, :, atropie, chec! me"#/lab#, call )CP, permaet pacema!er
Dysrhythmia #inus Bra$ycar$ia #inus Tachycar$ia
EKG Characteristics
Causative Agents
Treatments
< 60 bpm & regular
bb, CCB, MI, ICP/IOP, hypothermia, hypoglycemia,
O2, atropie, pacema!er, "rug "o#age a"$u#te" or "i#cotiue"
101 - 200 bpm & regular
Premature Atrial Contraction %PAC& #u'raventric ular Tachycar$ia %#VT&
60 - 100 bpm & irregular+ P-a'e may be hi""e i the prece"ig (-a'e 10 - 220 bpm & regular+ P-a'e ote hi""e i the (a'e A( 200 - 600 bpm+ V( 3 or < 100 bmp
A.!lutter A.!i"
)a.*utter + ! ,aves- a." + irregular)
, , , , pai, hypo(, hypo'olemia, O2, bb, treat u"erlyig cau#e, aemia, hypo%ia, atipyretic#-e'er, aalge#ic#hypoglycemia, hyperthyroi", pai , , caeie, .tO), tobacco, remo'e cau#e, bb, electrolyte balace#, ob#er'atio hyperthyroi", hypo%ia, COP, O2, remo'e cau#e, I a"eo#ie, amio"aroe, bb, CCB, car"io'er#io, ob#er'atio )(4, C, car"iomyopathy, O2, "igo%i, bb, CCB, arari, "igo%i, epiephrie, )*, .tO) car"io'er#io, ablatio ito%icatio, caeie, #tre##, 5b /778amio"aroe, propaeoe car"iac #urgery hypo!alemia, "igitali# to%icity, i#chemia, C, cor pulmoale, rheumatic heart "i#ea#e
1° AV Block
prologe" P-7 iter'al+ I / i# ar rom P 9 1st °
"igo%i to%icity, bb, CCB, MI, C
0° AV Block enken"ach
P-a'e 9 loger, loger, loger, D/2P 9 enken"ach
"igo%i to%icity, bb, C
0° AV Block3o"it4 55
I #ome 6/#;# "o;t get through 9 3o"it4 55
7° AV Blockcom'lete
I P8s 9 68s "o;t agree 9 7r$ °
PVC
PC;# occur at 'ariable rate#+ uiocal or multiocal, couplet#, bi/tri/ua"rigemiy+ => #euetial PC;# 9 (
ca eie, .tO), icotie, amiophyllie, epiephrie, "igo%i, i#oprotereol, hypo%ia, e'er, emotioal #tre##, e%erci#e, MI, )*, C,, M prolap#e ,
O2, bb, amio"aroe, procaiami"e, li"ocaie
V.TachV.!i"
10 - 20 bpm+ 6/#;# are i"e & "i#torte"+ ot mea#urable i '5b
aci"o#i#, CM, MI, C, M prolap#e, )*,
CP7, "ebrillate, epiephrie
O2, chec! me"#/lab#, call )CP 8i e o#et, cotiue to moitor O2, temp pacema!er, .7(, :, atropie, chec! me"#/lab#, call )CP, permaet pacema!er
"igo%i to%icity, C, O2, temp pacema!er, .7(, :, me"#/lab#, call )CP, aterior MI, rheumatic 8permaet pacema!er heart "i#ea#e , , O2, .7(, :, me"#/lab#, call MI, myocar"iti#, CM, bb, )CP, 8permaet pacema!er CCB, #cleroe"ema, :P
D: Tests
Descri'tion 9 Pur'ose
;ursing Consi$erations
.?@ recor"ig or 2A-A hour# correlatig rhythm chage# /#ymptom# i "iary+ recor"er i# u#e" to #tore, recall, prit & aalye io or rhythm "i#turbace#
ecourage to #timulate co"itio# that pro"uce #ymptom#+ !eep a accurate "iary o acti'itie# & #ymptom#+ o bath or #hoer
Echocar$iogr am
ultra#ou" o che#t & heart+ mea#ure# .*D - I cotra#t may be u#e" to ehace image#+ al#o recor"# "irectio o bloo" Eo acro## 'al'e#
a##e## or allergy to #hell#h+ #upie po#itio o let #i"e o euipmet+ o cotrai"icatio# to proce"ure ule## cotra#t i# beig u#e"
#u#e" a# #ub#titute or e%erci#e #tre## te#t i people uable to e%erci#e+ Pharmacologi "obutamie or "ipyri"amole iu#e" c Echo 'ia I & "o#e icrea#e" i mi iter'al# to "etect abormalatie#
#tart I iu#io+ moitor : beore/"urig/ater util ba#elie achie'e"+ amiophyllie gi'e to pre'et or re'er#e #i"e eect# o "ipyri"amole
Transeso'hag probe /ultra#ou" tra#"ucer i# eal #alloe" & pa##e# "o e#ophagu#+
throat ae#thetie"+ "e#igate" "ri'er ee"e"+
D: Tests
Descri'tion 9 Pur'ose
;ursing Consi$erations
.?@ recor"ig or 2A-A hour# correlatig rhythm chage# /#ymptom# i "iary+ recor"er i# u#e" to #tore, recall, prit & aalye io or rhythm "i#turbace#
ecourage to #timulate co"itio# that pro"uce #ymptom#+ !eep a accurate "iary o acti'itie# & #ymptom#+ o bath or #hoer
Echocar$iogr am
ultra#ou" o che#t & heart+ mea#ure# .*D - I cotra#t may be u#e" to ehace image#+ al#o recor"# "irectio o bloo" Eo acro## 'al'e#
a##e## or allergy to #hell#h+ #upie po#itio o let #i"e o euipmet+ o cotrai"icatio# to proce"ure ule## cotra#t i# beig u#e"
#u#e" a# #ub#titute or e%erci#e #tre## te#t i people uable to e%erci#e+ Pharmacologi "obutamie or "ipyri"amole iu#e" c Echo 'ia I & "o#e icrea#e" i mi iter'al# to "etect abormalatie#
#tart I iu#io+ moitor : beore/"urig/ater util ba#elie achie'e"+ amiophyllie gi'e to pre'et or re'er#e #i"e eect# o "ipyri"amole
Transeso'hag probe /ultra#ou" tra#"ucer i# eal #alloe" & pa##e# "o e#ophagu#+ cotra#t may be i$ecte" I or Echocar$iogr e'aluatig bloo" Eo i atrial or am 'etricular #epta "eect i# #u#pecte" %TEE&
throat ae#thetie"+ "e#igate" "ri'er ee"e"+ bite bloc! place"-#uctioig a# ee"e"+ o eatig/"ri!ig util gag reEe%
E:ercise #tress Test
E:ercise ;uclear 5maging
Pharmacologi c ;uclear 5maging
;uclear Car$iology
pt to ear comortable clothe#/#hoe# e%erci#e tolerace, F;#, & al! a# uic!ly a# po##ible+ hol" bb rhythm "i#turbace#, .?@ & caeie chage#+ cotrai"icatio# 2A hr# prior to proce"ure+ o #mo!ig acute C "i#ea#e, recet MI G2 = hr# prior+ te#t i# termiate" or ee!#H, agia che#t "i#comort uc ear mage# are a e a re# a er e%plai to eat oly a light meal e%erci#e+ i$ectio gi'e at ma% )7 o betee #ca#+ certai bicycle/trea"mill & cotiue or 1 mi to circulate+ #caig "oe me"icatio# may ee" to be 1-60mi ater e%erci#e+ re#tig #ca 60hel" or 1-2 "ay# beore the 0mi #ca ater iitial iu#io or 2A hour# later
"ipyri"amole or a"eo#ie to promote 'a#o"ilatio he uable to e%erci#e
hol" all caeie pro"uct# 12 hour# prior to proce"ure+ hol" bb & CCB 2A hour# prior
I i$ectio o ra"ioi#otope#+ e#tabli#h I lie - pt ill ha'e to lie mea#ure# bloo" Eo to heart at re#t #till o bac! ith arm# e%te"e" or & hile your heart i# or!ig har"er 20 miute#+ a# a re#ult o repeat #ca# are perorme" ithi a e%ertio or me"icatio+ )CP e miute# to hour# ater the #u#pect# C i$ectio
#ingle='hoton Emission Com'ute$ Tomogra'hy %#PECT&
or MI+ #mall amout# o ra"ioacti'e i#otope i$ecte" 'ia I+ "etect# coroary artery bloo" Eo, itracar"iac #hut#, motio o 'etricle#,
e#tabli#h I lie+ .C@ moitorig
D: Tests
Descri'tion 9 Pur'ose
;ursing Consi$erations
Car$iac Catheteri4atio n
co ra# ec e o e%am e #tructure & motio o heart & coroary arterie#+ al#o pro'i"e# iormatio to "etermie
#mall amout o bloo" remo'e", mi%e" /ra"ioacti'e i#otope & rei$ecte"+ 3ultigate$ .?@;# u#e" or timig, image# acuire" Ac?uisition "urig car"iac cycle+ i"icate" or MI, #can %3@GA& )*, 'al'ular ), car"ioto%ic "rug# o the heart
3agnetic /esonance Angiogra'hy %3/A&
u#e" or 'a#cular occlu#i'e "i#ea#e & + #ame a# M7I but ith u#e o ga"oliium a# I cotra#t
ithhol" oo"/Eui"# 6-1 hour#+ gi'e #e"ati'e+ i#truct patiet to "eep breath he "ye i# i$ecte"+ a##e## circulatio, peripherial pul#e#, color, & #e#atio 1mi/1 hour ater
e#tabli#h I lie, .?@ moitorig+ proce"ure i'ol'e# little ri#! cotrai"icate" /allergie# to cotra#t or implate" metal "e'ice#
e'aluate# heart mu#cle, proce"ure i# uic! & i'ol'e# coroary artery circulatio, Car$iac CT little to o ri#!+ a##e## or #can pulmoary 'ei#, thoracic aorta, #hell#h allergie# pericar"ium+ I cotra#t i#cotiue ati y#r yt mic i'a#i'e #tu"y to recor" car"iac me"# #e'eral "ay# prior to Electro= electrical co"uctio u#ig catheter# 'hysiology 'ia emoral & $ugular 'ei# ito right #tu"y+ 4PO 6-h, I #e"atio i #i"e o heart+ "y#rhythmia ca be #tu$y %EP#& ee"e"+ reuet : & i"uce" & termiate" cotiuou# .?@ ater roce"ure i$ectio o cotra#t ito 'ei# chec! or io"ie allergy+ mil" Peri'herial or arterie# olloe" by #erial %#e"ati'e+ chec! e%tremity Arteriogra'hy ray# to "etect athero#clerotic 9 Venogra'hy plaue#, occlu#io#, aeury#m#, pucture, pul#atio, armth, motio, #ellig, blee"ig+ or trauma D: >a"s
Descri'tion 9 Pur'ose
;ursing Consi$erations
Tro'onin = 5
8 earlie#t icrea#e = hours, pea! hour# 1=0 hrs 8 "uratio o icrea#e = $ays 8 #pecicity F+ #e#iti'ity at pea! H
< 05 g/mF - ormal 05 - 25= g/mF - #u#piciou# or MI i$ury 3 25= g/mF - po#iti'e or MI i$ury
Creatine Kinase %CK&
8 earlie# icrea#e =H hrs+ pea! hour# 0=7 hrs 8 "uratio o icrea#e 7=H hours 8 #pecicity F=HH+ #e#iti'ity at pea! 7=1
car"iac biomar!er u#e" to "iago#e MI & ecro#i#
CK=3B
8 earlie#t icrea#e 7= hours+ pea! hr# 1F=0 hrs 8 "uratio o icrea#e 0=7 hours 8 #pecicity 7=1+ #e#iti'ity at pea! =1
3yoglo"in
=1 #e#iti'e or MI+ #erum cocetratio ri#e =0-60mi ater MI maleJ F.0=10. umol/F+ emaleJ 7.=1. umol/F
e%p a
e purpo#e o #er a #amplig Ge5g5 =% 6-hH+ ormal i# 05= mcg/F ; & mo#t "iago#tic i mea#ure" ithi r#t 12 hour# o o#et o che#t
