 Welcome to Nursing School Explained. Today we'll go over cardiac medications that are specific for acute coronary syndrome and heart failure. This by no means is an all-inclusive list, but these are the most important medications that you'll be encountering for these two specific diseases or problems that the patient might have. Now, if you haven't already done so, please also watch the videos about acute coronary syndrome and heart failure to get a little bit of a better understanding of these two disease processes. Now, to just recap real quick, when we're talking about acute coronary syndrome, we're talking about an artery that has a plaque there that is mostly caused by cholesterol deposit. And then we have the platelets that are kind of flowing through this artery and they wanna aggregate. They wanna kind of make this a complete clot, which is why sometimes the artery becomes partially or completely obstructed. And then we have an acute coronary syndrome or an acute myocardial infarction. So just to kind of get this back to the forefront of your memory. So now I'll be looking at a few different medications here. So let's start out with nitroglycerin. I talk in the acute coronary syndrome video, I talk about the medication acronym MONA, which is morphine, oxygen, nitroglycerin and aspirin. So that is specific for acute coronary syndrome. I'm not gonna cover oxygen here because I talk in the other video a little bit about that. So nitroglycerin. Nitroglycerin is a very, very important medication to administer to the patient when they are experiencing chest pain because it is a vasodilator. So now if you look at the drawing here, if these platelets aggregate and want to basically completely obstruct this artery, if we dilate the blood vessel, it'll give the blood more room to flow through and therefore the confusion, the blood flow to the artery distal to this plaque will be restored or at least temporarily, there will be better blood flow. So it's a potent vasodilator, specifically for the coronary arteries, but we can just give the patient a sublingual nitroglycerin and tell this medicine only work in the patient's coronary arteries. It's going to work systemically. So the patient might also have overall vasodilation. So if all the blood vessels dilate, then the patient can have hypertension. So we need to be very careful as to monitoring the patient's blood pressure when we're about to or giving the nitroglycerin. The benefit of nitroglycerin is it increases coronary perfusion and it is available in sublingual, transdermal, PO, and IV versions. So most likely sublingual and IV will be given in the acute phase. Sometimes patients, they start home with sublingual nitroglycerin that they can take if they have stable angina and they'll have chest pain with activity. They'll be instructed to rest, take one nitroglycerin and see how they do. And then IV is only administered at the hospital if there's an acute phase. And then it's also available transdermal, mostly again given when the patient is admitted, but it can also be given PO to patients with stable angina. And that's just a little bit more of a longer acting medication. So side effects, we know it causes vasodilation. So most definitely hypotension is a possible side effect. And it can also cause a pretty significant headache that the patients will be complaining of. So for our nursing care, most certainly we'll have to assess vital signs, specifically blood pressure because we know it can lead to hypotension. Assess the patient's pain if they're complaining of chest pain with a complete PQRST pain assessment and then monitoring to see how the patient responds to the administration. And then sublingual, we can give it times three. So three times is the maximum. And patient education for that, if they're discharged home for stable angina includes, if you have a chest pain, take a nitroglycerin, wait three minutes, take it again, take a second one. Sorry, wait five minutes, take a second one. If the pain does not improve after the second one, wait five minutes, call 911, and then take the third one. Because if the patient hasn't responded twice, there is a chance that something else is going on that's completely clogged in this artery and no matter how much we dilate this flood vessel, the patient is still complaining of pain and then they certainly need to go to the closest emergency department to further figure out what might be going on with their heart. And for IV, it is available in a glass bottle only because otherwise it binds with the plastic of a bag and it needs to go through special filter tubing. So that's an important consideration. One more thing we need to write in here, careful with erectile dysfunction medications. So that would be your Viagra, Cialis, any of those ED medications, because what they really do is also they basal dilate. So if the patient has taken an erectile dysfunction medication in the last 24 hours, nitroglycerin is contraindicated because the patients might still be vasodilated. Now we're adding this vasodilator on top of it. It's gonna bottom out their blood pressure and then we have a whole lot of other things to deal with. So medication number two is morphine. You probably have encountered morphine in the past, which is an opioid pain medication, binds to opioid receptors, but the benefit is it also decreases anxiety, decreases respiratory rate and blood pressure and decreases the preload that we just discussed. And so for side effects, we have hypotension, respiratory depression. It might cause nausea and vomiting. So patients might be complaining of some stomach upset and then dizziness and drowsiness. So if we can maybe educate the patient about these possible side effects ahead of time, then they'll be aware of it. Definitely respiratory depression. You probably know that you should not be administering any opioid pain medications if the respiratory rate is less than 12. And that gets into our nursing care. So we'll be assessing vital signs, specifically blood pressure and respiratory rate, as well as their pain level with the full PQRST pain assessment and then monitoring their response to the administration of the morphine. And certainly we need to assess the level of consciousness because it can cause respiratory depression and dizziness and drowsiness. And sometimes the patient will be very almost somnolent because of the administration of the morphine. So aspirin, aspirin is the next medication. It inhibits platelet aggregation. So it's an anti platelet drug. So basically it changes the mechanism or the way that the platelets work with this aggregation and it makes them less sticky. So aspirin plays a very important role in acute coronary syndrome because we don't want them to aggregate. We want them to be kind of sliding through here and not causing this occlusion of this coronary artery. And another anti platelet agent is Plavix, also called probritogrel. You also sometimes see that used. Sometimes they use both anti platelets depending on the cardiologist, the problem, whatever the patient's history is. So don't be surprised if the orders are for aspirin and Plavix, but always question the orders because now we have two anti platelets that we're gonna give the patient. Within the anti platelet, if we inhibit the platelet aggregation, we're gonna have to monitor the patient for bleeding. Certainly that can be a complication. And then for nursing considerations, we're going to have to assess the platelet counts ahead of time because if they already have thrombocytopenia or a low platelet count, we don't wanna give them this anti platelet which is gonna impair the few functioning platelets that they have and then certainly they can bleed because they're not able to clot efficiently. And we also wanna assess the patient for bleeding and I wrote here, ask for GI and gums because this is something that we as nurses a lot of times cannot assess. So we need to ask the patients, have you had any blood in the stool, blood in the urine or when you brush your teeth, do your gums bleed easily? That might be an indication that the platelets are low. So keep that in mind. So now we're getting more into the medications for heart failure except beta blockers. So ACE inhibitors, those are the medications that end in pril. So keep in mind, this will be your lysine or pril, your capital pril, any of these medications ending in pril. So when you see a medication ending in pril, you know it's going to be an ACE inhibitor. Now what they do, there is the inhibiting conversion of angiotensin one to angiotensin two in the renin angiotensin aldosterone system. If it's been a while that you've looked at the RAS system, please go back to the video that goes into the details about the RAS system and explains how all this relates together and how ACE inhibitors play an important role of inhibiting the system. ACE inhibitors are the first line treatment for patients with heart failure. The patients have very good outcomes because of these medications. So this is the first medication that they'll be put on. Now most common side effect, anything that inhibits that works on the RAS system might lead to hypotension. It's also used as an anti-hypertensive agent. So we certainly have to watch their blood pressure and very common side effects are dry cough and angiotema. So swelling of the tongue that the patient most likely will be complaining fairly soon after they start taking this medication. So for nursing interventions, we want to assess vital signs specifically blood pressure because we know it can lower that. And then we have to assess their electrolytes because it is such an important factor in the RAS system and it also affects the kidney. So we have to assess their electrolytes and their kidney functions. Specifically, we're looking at sodium and potassium because we know that potassium can impair the heart's ability to contract if it's too high or too low. Again, go back to the basic electrolyte discussion if you need a review of that. Then we have the medication Dijoxin, which is a cardiac glycoside. To my knowledge, that Dijoxin is the only cardiac glycoside that there is. And it's a positive inotrope. And what that means, it increases the force of contraction. And so the medication slows down the conduction through the AV node and therefore decreases the patient's heart rate. And the way that this is beneficial when the patient's heart is not pumping efficiently, we need to increase the ability of it to contract. And by slowing down the contraction, the heart muscle has a little bit more time to fill and then contract more forcefully, producing a nice cardiac output and blood pressure and then certainly profusing all the important organs that are being profused by the cardiac output. So side effects, and these can be very significant because Dijoxin is also, patients can become toxic from Dijoxin. And so the first sign and symptom that they'll be having is nausea or vomiting. Then they'll have some visual disturbances. So they'll report seeing halos around lights or maybe having some yellowish green discoloration of their vision. So be very careful. This is what's happening. That could be some Dijoxin problem or toxicity. And then bradycardia. So if the medication, if the patient is Dijoxin toxic and now they have too much medication in their system, it might have slowed down that conduction through the AV node too far. So now they become bradycardic and then it can also lead to dysrhythmias. For nursing assessment, because the medication affects the patient's conduction system, we have to assess their apical heart rate. So we have to make sure we get the setterscope on the chest and listen at the apical point for a full minute and count the beats. And typically we do not give Dijoxin if the heart rate is less than 60 in adults. Now check your specific orders because sometimes they might vary depending on what the patients need, but a general guideline is do not give it if the heart rate in adults is less than 60. And then certainly we wanna have the patient on telemetry monitoring to watch out for bradycardia and dysrhythmias. And then we also want to monitor their electrolytes specifically their potassium level because hypo and hyperkalemia can make the patients the Dijoxin level go up or down and then they can have these very significant side effects. And also the Dijoxin is a kind of an old-fashioned method or an old-fashioned medication, but mostly it's used for heart failure. Now beta blockers, those medications in LOL. And I always tell my students it's not funny, they are no joke, LOL. So beta blockers are LOL medications. They block the beta one adrenergic receptor sites. Which basically means, so I draw another little diagram here that you can use to kind of remember on where beta one and beta two and alpha receptors are located. So remember you have one heart, so that's where the beta one receptors are. You have two lungs, that's where the beta two receptors are. And then you have all this vascular smooth muscle, this is where the alpha receptors are. So a little memory jogger here as well. So beta blockers block the sympathetic nervous system response, which means they also have to decrease anxiety. And they have a very good effect in lowering mortality in patients with angina. So patients with acute coronary syndrome respond really well to beta blockers and studies have shown that it decreased this mortality. Now because we are blocking these beta one receptors in the heart, it will the beta blockers will slow down heart rate and also lower down blood pressure, but they will increase the cardiac output and decrease ischemia in acute coronary syndrome. Side effects because they are blocking the beta one receptor sites, hypotension and bradycardia. So low heart rate and low blood pressure, which is why we need to assess apical heart rate and blood pressure before we give the medications. Now I wrote here, check order parameters because in the joxen for the most part, it's a set 60 apical heart rate limit where sometimes with beta blockers, the cardiologist or the physician in charge might still say that you can give it if the heart rate is around 55 or so, depending on the circumstances. So check your order parameters, but definitely we'll have to assess heart rate and blood pressure before we administer beta blockers. We also have to monitor intake and output very carefully. And caution if the patient has COPD because some beta blockers might be beta one adrenergic receptor blockers or some they might not be very specific whether on the target beta one or beta two receptors. So now for the general population, it doesn't have any underlying lung conditions. It might not be a big problem. But if the patient has COPD, we don't wanna block their beta two receptor sites that are located in the lungs because then they might have some significant shortness of breath and not be able to have the appropriate gaseous change. So COPD patients careful with beta blockers. I hope this review has helped you to get a better understanding of the medications that we use for treatment of acute coronary syndrome and heart failure. Thank you for watching Nursing School Explained. Please subscribe, leave comments below and I'll be happy to review those. See you next time.