PHARMFR5

• Beta (β)-blockers:


  reduce angina, monitor pulse
• Calcium Channel blockers


  Prioritize severe bradycardia
• Nitrates


  relax smooth muscle layer of blood vessels, increasing the lumen of the artery or arteriole, increases the amount of blood flowing through the vessels
• Antianginal Drug 


  If client’s heart rate falls below 50 bpm or if the systolic BP is below 90 mm Hg, hold the drug and notify the provider
• Antianginal Drug


  Teach clients proper administration of nitrates that are prescribed via sublingual or buccal route
• Antianginal Drug


  Dose of sublingual nitroglycerin or spray can be repeated every 5 minutes until pain is relieved or until client has received 3 doses in a 15-minute period; contact provider if angina is not relieved
• Antianginal Drug 


  Remove old paper from previous application, fold in half before disposing in trash, and cleanse area, then don gloves, measure proper dose with paper and/or applicator, and apply the ointment in a thin uniform layer over a small area of the paper; do not rub directly on skin; secure the paper with tape
• Antianginal Drug 

  • Be mindful that tolerance can occur
  • Apply the patch in the morning and leave in place for 10 to 12 hours; remove patch and leave off for 10 to 12 hours
• Antianginal Drug


  If orthostatic hypotension occurs, teach client to rise slowly from laying to sitting to standing (1 to 2 minutes in each position)
• Anticoagulants:


  prevent the formation and extension of a thrombus; used prophylactically in clients at risk for clot formation (“blood thinners”) Prevention and treatment of DVT (deep vein thrombosis)
• Anticoagulants

  • Low–molecular-weight heparins (LMWHs) or fractionated heparins
  • Interfere with the clotting mechanism of the blood preventing the formation and extension of a thrombus 
• Cardiotonic Drug

  Palpate for pedal pulses and peripheral edema
• Antiarrhythmic Cardiovascular System Reactions

  Bradycardia
• Antiarrhythmic Drugs

  • Quinidine 

     Ringing in the ears

     Hearing loss

     Nausea/vomiting

     dizziness
• Antiarrhythmic

  Depresses myocardial excitability or the ability of the myocardium to respond to an electrical stimulus.
• Antiarrhythmic

  Inhibit the movement of calcium through channels across the myocardial cell membranes and vascular smooth muscle
• Antiarrhythmic


  1 adverse reactionconstipation
• Antiarrhythmic


  Rarely – agranulocytosis Pt may present with fever, chills & sore throat and have LOW white blood cell count
• Class III Potassium Channel Blockers: 


  Prolongs the refractory period and repolarization and increasing the ventricular fibrillation threshold
• Class II Beta-Adrenergic (β-adrenergic) Blockers

  Block β-adrenergic receptors of the heart and kidney, decreasing the excitability of the heart and the release of renin (lowering heart rate and blood pressure).
• Class IC – Sodium channel blocker


  Depresses fast sodium channels, decreases the height and rate of rise of action potentials, and slows conduction of all areas of the heart
• Class IB – Sodium channel blocker: selectively depress cardiac conduction


  Decreases diastolic depolarization,decreases automaticity of ventricular cells, and raises the threshold of the ventricular myocardium
• Cardiotonics AR


  Visual disturbances (blurring or yellow halo with digoxin; increased brightness with ivabradine
• Cardiotonics

  • improve the myocardial contraction
  • treats heart failure
• Cardiotonics


  Increases cardiac output through positive inotropic activity (an increase in the force of the contraction).
• Cardiotonics


  When a cardiotonic is used, the pulse rate is monitored and the drug held if the client’s heart rate is less than 60 bpm
• Anticoagulant antagonist


  Otherwise known as Vitamin K - antidote for warfarin
• Protamine is antidote for heparin


  Perform blood coagulation tests every 4 hours.
• Withhold the drug and notify the provider if

  • The PT exceeds 1.5 times the control value
  • There is evidence of bleeding
  • The INR is greater than 3
• Warfarin

  • Prioritize assessing PT/INR
  • Optimal therapeutic results—PT is 1.2 to 1.5 times the control value. INR less than 3.0
• Thrombolytic Drugs


  break down fibrin clots by converting plasminogen to plasmin
• Antiplatelet Drugs


  work by decreasing the platelets' ability to stick together (aggregate
• Antiplatelet drugs decrease the platelets’ ability to aggregate (or stick together). This reduces the chance of thrombus formation in the arterial circulation for conditions such as acute coronary syndrome, MI, and stroke
• Oral and Parenteral Anticoagulants


  bowel – monitor for blood in the stool (black tarry stools)
• Oral and Parenteral Anticoagulants

  Low–molecular-weight heparins (LMWHs) or fractionated heparins
• Oral and Parenteral Anticoagulants


  Interfere with the clotting mechanism of the blood preventing the formation and extension of a thrombus
• Oral and Parenteral Anticoagulants


  ●Anticoagulants: prevent the formation and extension of a thrombus; used prophylactically in clients at risk for clot formation (“blood thinners”) Prevention and treatment of DVT (deep vein thrombosis
• What does Metoprolol do

  Blocks beta-adrenergic receptors
• What does Propranolol do

  Decreases the heart rate and dilates the blood vessels.
• What does digoxin cause

  Slow heart conduction, increases cardiac output and force of contractions