CARDIAC

MEDICATIONS
 Cardiac Output (CO)

 CO is the product of heart rate (HR) & stroke

volume (SV)

 SV is the amount of blood ejected from the

ventricles with each beat – average is approx
70mls

 SV is affected by preload, contractility & after

load
 Preload
- the stretch of the ventricle at the end of diastole

- the amount of stretch decides the amount of blood

ejected

- volume administration is used to increase preload

- ventricular myocardium responds by contracting

more forcefully

- care must be taken not to overstretch the

myocardium
 Contractility
- the force of the myocardial contraction for a given
preload

- the ability of the ventricles to increase stroke volume

- affected by electrolytes Na+, K+, Mg, Ca2+, Ph, +ve

& -ve inotropes preload & after load

- affected by oxygenation, areas of damage & disease

& ischaemic
 After load
- the resistance of the arteries against
ejection

- increasing after load reduces stroke

volume

- increases cardiac workload

- a reduction in after load will reduce

preload with dilated vessels
 Reasons for using
cardiac medications
 Angina

 Hypertension

 Arrhythmias

 Cardiac failure

 Fluid retention leading to cardiac conditions

 Medication Groups
BETA BLOCKERS
- action on the sinus node
- if conduction is blocked then HR is
decreased leading to a fall in BP
- more reserve to increase HR without
angina on exertion
- caution in asthma and COPD as affects
all smooth muscle
- used for relief from angina, HT,
arrhythmia
 Medication Groups cont’d

CALCIUM CHANNEL BLOCKERS

- action on Ca2+ transfer in cell function
affecting muscle contraction
- if blocked, contraction slows & strengthens

- Nifedipine/Felodipine acts on blood vessels

- Verapamil/Diltiazem acts on the heart muscle
- used for relief from angina, HT, arrhythmia
 Medication Groups cont’d

NITRATES

- action has direct effect on veins

- dilates veins so less blood is returning to the heart,
therefore, the heart does not have to pump so hard
and fast (systole)
- resting phase is longer hence allowing more blood
and O2 to the myocardium (diastole)
- used for relief from angina, HT & cardiac failure
 Medication Groups cont’d

ACE INHIBITORS
[Angiotensin Converting Enzyme]

- action affects both the heart and kidneys

- kidneys detect changes in BP, releasing renin when BP is low

- renin stimulates angiotension I leading to the development of

angiotension II leading to vasoconstriction

- vasoconstriction affects kidney function, hence lowered diuresis,

conserving fluids

- ACE inhibitors block the cycle

- dilation lowers preload, lowers afterload & increases diuresis

- used for relief from HT & cardiac failure

 Medication Groups cont’d

DIURETICS
- action is directly on the kidney

- Thiazides work by inhibiting the re-absorption of Na &

Cl in the distal convoluted tubule

- Loop diuretics inhibit Na & Cl absorption in the

ascending loop of Henley

- K+ sparing diuretics act on the collecting tubule

- used for relief from HT & cardiac failure

 Medication Groups cont’d

DIGOXIN

-action is to inhibit Na/K exchange across the cell membrane

- this augments the Ca influx leading to delayed, stronger
contraction

- consider electrolytes as low K enhances digoxin action and

increased K decreases digoxin effects

- belongs to the Glycoside family

- promote nocte administration

 Medication Groups cont’d

SUMMARY
- usually cardiac medications work in combination

- withholding 1 medication may interrupt the

‘combination action’

- symptomatic patients must be assessed by medical

staff to address the cause

- if apex < 60bpm or BP low & patient is asymptomatic,

continue medications, report to medical staff
 Nursing actions
 Learn the cardiac medication groups

 Record apical beats & document in medication chart

 Consider ‘combination effects’ – avoid with-holding medications

 Evaluate patient symptoms – medical review if required

 Consider patient monitoring – P [apex beat], RR, BP, SaO2, fluid

intake/output, weight

 Consider modifying activity i.e. patient position change, escort

 Nursing actions cont’d

 Teach other staff i.e. HCA - FBC, accurate weighing,

patient position change, escorting

 Consider medication options if NBM or pre-

operatively

 Communication with team

 Documentation – include updated nursing care plan

& risk assessments

 Accurate handover considering risks

 Nursing actions cont’d

Educate
Patient/Family/Caregivers/Whanau

 Medication actions & benefits

 Diet (low Na, alcohol, weight reduction)
 Smoking cessation
 Cholesterol/BP/weight monitoring
 Reporting of oedema, SOB, dyspnoea
 Exercise program
 Cardiac rehab/educator/dietician/case
manager/support groups
 References
 MIMS online
 Pirret, A. (2005). Acute care nursing. A physiological approach to
clinical assessment and patient care. Pirret: Auckland.