Cardiac Drugs Part II

1. Cardiac Drugs Part II Diuretic Drugs Coagulation Modifier Drugs Antilipemic Drugs

2. The Kidney

3. Nephron • The microscopic filtration unit of the kidney, consisting the glomerulus, proximal convoluted tubule, loop of Henle, distal convoluted tubule, collecting duct, which empties urine into the ureters.

4. Glomerular Filtration Rate • GFR • Is a laboratory value the serves as a gauge of how well the kidneys are functioning as filters. • 180 liters of blood filtered through kidneys per day.

5. Diuretic Drugs • All major classifications developed between 1950 and 1970 and are the most commonly prescribed drugs in the world.

6. Diuretic Drugs • Classified according to site of action

7. Carbonic Anhydrase Inhibitors • Action: inhibit the action of the enzyme carbonic anhydrase. • Site of action: nephrons • Indications: glaucoma, edema, epilepsy, and high altitude sickness.

8. Carbonic Anhyrase Inhibitors • Contraindications: • Drug allergy • Severe renal or hepatic dysfunction • Adrenal gland insufficiency

9. Adverse effects • Drowsiness • Anorexia • Paresthesias • Hematuria (blood in urine) • Melena (blood in stool)

10. Interactions • Increase in digoxin toxicity in clients taking digoxin. • Corticosteroids may cause hypokalemia. • Use with hypoglycemic drugs in diabetic type II

11. acetazolamine • Trade name: Diamox • Caution: check with patient regarding drug allergy to sulfonamides or significant liver or renal dysfuction.

12. Dosing • Oral dosage for adults is 250 to 375 mg / day. • Oral dosing for pediatric patient is 5 mg / kg /day.

13. Loop Diuretics • Potent diuretics • The drugs act primarily along the thick ascending limb of the loop of Henle, blocking chloride and sodium resorption. • Also activate renal prostaglandins which results in dilation of blood vessels in kidneys and lungs and rest of body.

14. Loop Diuretics • Used when rapid diuresis is needed. • Onset of action is1 hour and duration is 1-2 hours. • Usually given in a single daily dose

15. Major Side Effect • Electrolyte imbalance • Especially sodium and potassium • Nurse alert: always check serum potassium and sodium levels before administering.

16. Good Effects of Loop Diuretics • Reduces blood pressure • Reduces pulmonary vascular resistance • Reduces systemic vascular resistance • Reduces central venous pressure • Reduces left ventricular end-diastolic pressure.

17. Contraindications • Drug allergy • Allergy to sulfonamides

18. furosemide • Trade name: Lasix • Therapeutic classification: diuretic • Pharmacologic classification: loop diuretic • Primary use: pulmonary edema and edema associated with heart failure, liver disease and nephrotic syndrome. • Used in treatment of hypertension caused by heart failure.

19. Lasix Dosing • Adult: IV 0.5 to 1 mg / kg / dose (maximum 200 mg / day.

20. Drug calculation problem • Client weighs 170 pounds • Convert pounds to kilograms _________ • Safe range of drug _______ to _______ • Physician order: 56 mg of Lasix IV STAT

21. Drug calculation problem • Lasix is provided as 10 mg / mL • How much would you need to draw up to give the 56 mg?

22. Osmotic Diuretics • Action: increases the osmotic pressure of the glomerular filtrate inhibiting the reabsorption of water and electrolytes.

23. When Used? • Oliguric phase of acute renal failure. • Increased intracranial or intraocular pressure.

24. mannitol • Trade name: Osmitrol, Resectisol • Therapeutic classification: diuretic • Pharmacologic classification: osmotic diuretic

25. mannitol adverse effects • CNS: confusion and headaches • EENT: blurred vision • Cardiovascular: transient fluid expansion, chest pain, CHF, pulmonary edema, tachycardia • GI: Nausea, vomiting and thirst • GU: urinary retention

26. Dosing • Adult dosing: 500 mg / kg (Given in intravenous solution) • Onset 30 to 60 minutes • Peak 1 hour • Duration 6-8 hours

27. Nursing Assessment • Monitor vital signs • Urine output • Signs and symptoms of dehydration • Decreased skin turgor • Fever • Dry skin and mucous membranes • Low urine output

28. Potassium Sparing Diuretics • Also called aldosterone-inhibiting diuretics because they block the aldosterone receptors. • This causes sodium and water to be excreted and potassium to be retained.

29. Potassium Sparing Diuretics • Action: drugs work in the collecting ducts and distal convoluted tubules, where they interfere with sodium-potassium exchange.

30. Indications • Used with other agents to treat edema or hypertension

31. Contraindications and Precautions • Use with caution in geriatric or debilitated patients or patients with diabetes mellitus (increased risk of hyperkalemia). • Renal insufficiency (BUN >30 • History of gout or kidney stones

32. Adverse Reactions / Side Effects • CNS: dizziness, clumsiness, headache • Gastrointestinal: cramps, nausea, vomiting, diarrhea • Other: urinary frequency, weakness, hyperkalemia.

33. spironolactone • Trade name: Aldactone • Therapeutic classification: diuretic • Pharmacological classification: potassium-sparing diuretic

34. Aldactone • Onset: unknown • Peak: 2-3 days • Duration: 2-3 days

35. Dosing • PO Adults • 25-400 mg per day as a single dose or 2-4 divided doses. • PO Children • 1-3 mg / kg / day. Daily or 2-4 divided doses.

36. Thiazides and Thiazide-Like Diuretics • Action: increases excretion of sodium and water by inhibiting sodium reabsorption in the distal tubule. • Therapeutic effects: Lowering of blood pressure in hypertensive patients and diuresis with mobilization of edema.

37. Contraindications • Allergy to sulfonamides • Used cautiously in clients with renal or severe hepatic impairment.

38. Adverse Reactions and Side Effects • CNS: dizziness, drowsiness, lethargy and weakness • CV: hypotension • GI: anorexia, cramps, hepatitis, • Dermatology: photosensitivity, rashes • Fluid / electrolytes: Hypokalemia, dehydration, hyponatremia • MS: muscle cramps

39. hydrochlorothiazide • Trade name: Esidrix, HydroDIURIL • Therapeutic classification: antihypertensive, diuretic • Indication: • management of mild to moderate hypertension • Treatment of edema associated with CHF, renal dysfunction, cirrhosis, corticosteroid therapy, hormonal therapy

40. Dosing • PO adults: 250 mg – 1 gram / day as a single dose or in divided doses • PO children > 6 months: 10-20 mg/kg/day as a single dose or in divided doses.

41. HydroDIURIL • Onset 2 hours • Peak 3-6 hours • Duration 6-12 hours

42. Laboratory Considerations • Electrolytes especially potassium • Blood glucose • BUN • Serum Creatinine • Uric acid

43. Coagulation Modifier Drugs Chapter 27

44. Anticoagulant • A substances that prevents or delays coagulations of the blood.

45. Antiplatelet Drugs • A substance that prevents platelet plugs from forming, which may be beneficial in defending the body against heart attacks and strokes.

46. Anticoagulants • Prevent the formation of a clot by inhibiting certain clotting factors called anticoagulants. • Only given prophylactically because they have no direct effect on a clot that has already formed.

47. Clots / Embolus • Clot: Insoluble solid elements of blood that have chemically separated from the liquid of plasma component of the blood. • Embolus: a blood clot that has been dislodged from the wall of a blood vessel and is traveling throughout the bloodstream.

48. Anticoagulants • Also called antithrombotic drugs because they all work to prevent the formation of clots or thrombus.

49. Embolus • Stoke or cerebral vascular accident occurs when a blood clot travels to the brain. • Pulmonary embolism occurs when a blood clot travels to the lungs. • Deep vein thrombosis or DVT: clot in the veins of the legs.

50. Anticoagulants • All anticoagulants work in the clotting cascade, but do so at different points.