Nursing Skills Archives - Page 17 of 18

Cardiovascular System – Cardiac Tissue, Valves and Circulation

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The Cardiovascular System, also known as the Circulatory System, is an organ system that aims to circulate blood to and from cells in the body, transporting nutrients and removing waste.

Systemic Circuit: The heart pumps blood to the body through arteries that branch off into smaller blood vessels called arterioles.

The capillaries network allow oxygen and other nutrients to diffuse from the blood and into the cells, while metabolic waste diffuses into the venous capillaries from the cells.

Pulmonary Circuit: Blood then returns to the heart through the veins, and the cycle is repeated.

The heart wall consists of 3 layers:

EPICARDIUM (a.k.a. visceral pericardium) – outer layer of the heart
MYOCARDIUM – made up of cardiac muscle
ENDOCARDIUM – lines the chambers of the heart and the heart valves

The boundaries of the 4 heart chambers are marked by 3 grooves known as sulci:

Coronary Sulcus a.k.a. Atrioventricular Sulcus
Anterior Interventricular Sulcus
Posterior Interventricular Sulcus

The atria are separated by a wall-like structure called interatrial septum. The ventricles are separated by the interventricular septum, with both ventricles having internal ridges called trabeculae carnae.

The heart valves ensure a one-way flow:

ATRIOVENTRICULAR VALVES: Right AV (Tricuspid) Valve which has 3 cusps, and Left AV (Bicuspid) Valve a.k.a. Mitral Valve. Chordae Tendinae connect the valve cusps to the conical papillary muscles on the ventricle floor.

The heart has a beat of its own thanks to the electro-chemical circuit system and its 4 relay stations:

SA Node
AV Node
Bundle of HIS
Purjinke Fibres

When the aorta leaves the left ventricle, it gives off to the Right Coronary Artery (RCA) and the Left Coronary Artery (LCA).

The RIGHT CORONARY ARTERY supplies the right atrium and the SA Node and gives off to the Right Marginal Branch and the Posterior Interventricular Branch, as well as a small branch to the AV Node.

The LEFT CORONARY ARTERY travels to the coronary sulcus and divides into the Anterior Interventricular Branch/Left Anterior Descending Branch (LAD), and the Circumflex Branch.

Below you can find a collection of videos that can help provide a more visual approach to the Cardiovascular System.

Cardiac Muscle Tissue

Introduction to the Cardiovascular System – Animation

The 3 Heart Wall Layers

The Pericardium

The Epicardium

The Myocardium

The Heart Valves

Coronary Circulation

branches of the aortic arch

Special thanks to the creators of the featured videos on this post, specifically Youtube Channels Registered Nurse RN, Lecturio Medical, The Noted Anatomist, KenHub, CTE Skills, Dr.G Bhanu Prakash Animated Medical Videos and Catalyst University.

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Hypertension – The Silent Killer

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Hypertension is the amount of resistance of blood pumping through the arteries. Organs are susceptible to high blood pressure especially the brain and the kidneys. Cholesterol restricts blood vessels thus affects blood pressure.

Most hypertension cases can be without any visible bodily symptoms, going undiagnosed for a long time.

Hypertension can be classified as Primary (Essential) – originating from an unknown disorder affecting BP regulation mechanisms; or Secondary to other diseases processes. Secondary hypertension could be caused by Renal disease (polycystic kidneys, renal artery stenosis or pyelonephritis), drug-induced (eg. by oral contraceptives or corticosteroids), pregnancy (pre-eclampsia) or hormonal (cushing’s syndrome, phaeochromocytoma, hyper or hypothyroidism, or acromegaly – bone size increase).

Hypertension Risk Factors

Modifiable:

excessive salt diet
obesity
lack of physical exercise
excessive consumption of alcohol
deprivation and socio-economic status
mental health and stress

Non-modifiable:

age
ethnicity
genetics
gender

NICE guidelines suggest that the blood pressure is measured in both arms. In the case of a consistent high blood pressure of 140/90 mmHg or higher, a patient should seek hypertension diagnosis.

Hypertension affects:

cardiovascular system (CHF)
brain (causing a stroke)
kidneys (renal failure)
eyes (retina)

Always assume possible lack of compliance with correct medication intake.

Postural hypotension can be noted as a 20mmHg fall in the systolic reading at a standing position, after another reading in a sitting position.

As for athletic patients, note that athletics have a slower heart rate which is still considered to be healthy.

hypertension nonpharmacologic interventions

Hypertension Pharmacology as listed within the NICE guidelines suggest the following pharmacological steps in the treatment of hypertension:

First line agents for hypertension:

ACEi
ARB
Calcium Channel Blocker

Add-on agents:

Beta Blockers
Alpha Blockers
Thiazide Diuretics
Aldosterone Antagonists / Spironolactone

ACE inhibitors are at times not tolerated by black African or African-Caribbean patients.

If a patient presents with hypertension, check for heart failure and current medication list and review.

Chronic Hypertension Drug Treatment During Pregnancy

Methyldopa: traditionally used drug based on long term data supporting safety
Beta Blockers: although considered generally safe, fetal growth retardation has been reported in the past, especially with the use of Atenolol
Labetalol: contains less side effects than Methyldopa
Clondine: mainly used in the third trimester (limited data)
Calcium Channel Blockers: Nifedipine is used as long acting medication (limited data)
Diuretics: probably safe in low doses if started prior to conception for essential hypertension (still controversial evidence)
ACEi, ARBs, Direct Renin Inhibitors: CONTRAINDICATED.

Ideally, women planning to conceive should be encouraged to discontinue these medications under medical supervision.

Hypertensive Crisis is defined as severely elevated blood pressure associated with new or progressive target organ dysfunction. Although the absolute value of the blood pressure is not as important as the presence of end-organ damage, the systolic blood pressure is usually >180 mmHg and/or the diastolic BP is >120 mmHg. In such crisis, Sodium Nitroprusside is one of the most commonly recommended treatments (contraindicated in patients with chronic kidney disease)

Assessed from https://www.slideshare.net/ParasuramanParasuraman/antihypertensive-drugs-79369508 on 27th January 2021

Hypertension Pathophysiology, Treatment, Nursing Interventions and Pharmacology

Special thanks to the creator of the featured video on this post, specifically Youtube Channel Registered Nurse RN

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Heart Failure Treatment, Management, Nursing Interventions & Drugs

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Heart failure happens when the heart is too weak to pump efficiently. This restricts it from providing proper cardiac output to maintain the body’s metabolic needs.

Complex clinical syndrome that results from any structural or functional impairment of ventricular filling (diastole) or ejection of blood (systole)
2013 ACC/AHA

Systolic Heart Failure is attributed to a pumping problem experienced by the heart where it is unable to contract enough to pump blood to supply to the body, thus resulting in contraction and ejection fraction problems. In this case the patient presents with left ventricular failure with reduced ejection fraction of <40% and marked cardiomegaly (where the ventricle becomes enlarged in size).

Diastolic Heart Failure is attributed to a filling problem experienced by the heart where it is unable to relax the left ventricle, leading to a build-up in the lungs, resulting in relaxation and blood filling problems. In this scenario the patient presents with pulmonary congestion and at times with slightly enlarged ventricles, both due to an increased resistance to filling due to increased ejection fraction of >50%.

The ejection fraction is a comparison between the amount of blood in the heart and the amount of blood pumped out of the heart.

Cardiac output is the amount of blood pumped out of each ventricle per minute. Factors affecting cardiac output include the heart rate, blood volume, contractility and venous return.

Stroke volume is the volume of blood pumped out of each ventricle with every beat.

Cardiac Output = Heart Rate X Stroke Volume

Causes of HF include:

Coronary Artery Disease
Hypertension
Cardiomyopathy
Arrhythmias
Valvular and Congenital Heart Disease
Alcohol and Drugs

HF risk factors

Age
Obesity
Smoking
African Descent
Hypertension
High Cholesterol
Diabetes Mellitus
Coronary Artery Disease

Signs and symptoms of heart failure include shortness of breath, coughing, sleep disturbance, feeling overtired, loss of appetite, dizziness, swollen ankles and abdominal bloating.

HF can be classified in relation to:

CARDIAC OUTPUT: an issue with the ejection fraction (amount of pumped blood to the body). This can be subdivided into High Output Failure and Low Output Failure. High Output Failure occurs due to obesity, anaemia, hyperthyroidism and pregnancy. Usually presents as right sided heart failure followed by left sided heart failure. Low Output Failure happens when the heart fails to generate enough output due to left ventricular systolic or diastolic dysfunction, right ventricular dysfunction caused by changes in the heart rate, preload, afterload and heart contraction.

ANATOMY: issue or defect within the heart muscle

ONSET: acute or chronic

Left Sided HF is characterised by pulmonary oedema. Signs and symptoms include tachypnoea, tachycardia, third heart sound and cardiomegaly.

Right Sided HF is characterised by peripheral oedema, raised jugular venous pressure, hypotension and congestive hepatomegaly (enlarged liver which usually causes an enlarged abdomen).

Accessed from https://www.slideshare.net/raghukishoregalla/inotropic-therapy-for-heart-failure

Below you can find a collection of videos that can help provide a more visual approach to Heart Failure Treatment, Management, Nursing Interventions & Drugs.

Heart Anatomy and Physiology

Congestive Heart Failure (CHF) Treatment, Management, Nursing Interventions & Medications Part 1

Congestive Heart Failure (CHF) Treatment, Management, Nursing Interventions & Medications Part 2

Stroke Volume and Cardiac Output – Preload & Afterload

Special thanks to the creator of the featured videos on this post, specifically Youtube Channel Registered Nurse RN

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Anti Hyperlipidaemic Drugs

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Here you can find videos related to anti hyperlipidaemic drugs covered within cardiovascular pharmacology that help lower LDL cholesterol…

Cardiovascular pharmacology deals with the study of the effects of drugs upon the heart or circulatory system. Cardiovascular medicines help to prevent and treat cardiovascular disease, slow the progression of it as well as treat its symptoms whilst providing a better quality of life and increasing life expectancy.

Types of Cardiovascular Drugs include:

Anti-Hypertensive Drugs
Anti-Angina Drugs
Anti-Arrhythmic Drugs
Anti-Coagulants
Anti-Hyperlipidaemic Drugs

Below you can find a collection of videos that can help provide a more visual approach to cardiovascular pharmacology, specifically on the AntiHyperlipidaemic Drugs.

Anti Hyperlipidaemic Drugs include:

HMG-CoA Inhibitors – Simvastatin, Atrovastatin and Rosuvastatin

Lower elevated LCD Cholesterol.
Causes a large reduction in coronary events and death from heart disease.
Considered as 1st line treatment for patients with elevated coronary artery syndromes and ischaemic heart disease.
Simvastatin is highly effective at night; others may be taken during the day as well.
ADVERSE EFFECTS: liver damage, myopathy, rhambdomyolysis.
CONTRAINDICATIONS: chronic liver disease, pregnancy and lactation.
MONITOR: liver function tests (4-6wks initially, then yearly); muscle enzyme levels if patient complains of muscle pain.

Lipoprotein Lipase Activators – Fenofibrate, Gemfibrozil, Clofibrate and Bezofibrate

Lowers serum TGs and increase HDL cholesterol levels.
ADVERSE EFFECTS: GI disturbances, gall stone formation, myositis, myopathy and rhambdomyolysis.

Bile Acid Sequestrans

Sequestrants bind to bile acids in the intestine, preventing them from being reabsorbed into the blood.
SIDE EFFECTS: constipation, diarrhoea, bloating, flatulence.
PATIENT EDUCATION: take before a meal or at bedtime. Leave at least 1 hour before or 4 hours after taking cholestyramine since it interferes with their absorption.

Hyperlipidaemic Drugs

HMG-CoA Inhibitors a.k.a. Statins

Special thanks to the creators of the featured videos on this post, specifically Youtube Channels Speed Pharmacology and Registered Nurse RN

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Drugs Affecting Coagulation: Anti Platelets, Anti Coagulants, Thrombolytics

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Here you can find videos related to drugs affecting coagulation, including anti-coagulants, anti-platelets and thrombolytics…

Types of Cardiovascular Drugs include:

Anti-Hypertensive Drugs
Anti-Angina Drugs
Anti-Arrhythmic Drugs
Anti-Coagulants
Anti-Hyperlipidaemic Drugs

Below you can find a collection of videos that can help provide a more visual approach to cardiovascular pharmacology, specifically on the Anti-Platelet drugs, Anti-Coagulant Drugs and Thrombolytic Drugs.

Drugs affecting coagulation include:

Anti Platelet Drugs – alter formation of platelet plug

Aspirin:

Effect lasts for up to 10 days, which is approximately the platelets lifespan.
INDICATED FOR: transient ischaemic attack, prevention of ischaemic stroke and MI, acute MI, Angina (chronic stable and unstable).
ADVERSE EFFECTS: GI bleeding, haemorrhagic stroke.
DOSE: 75mg-150mg daily.
MAJOR DRAWBACKS: allergic reactions, lack of effectiveness as an anti-thrombotic drug, lack of response in some patients, irreversible platelet inhibition.

Clopidogrel:

INDICATIONS: prevents blocakage of coronary artery stents, reduces thrombotic events in patients with acute coronary syndrome, prevents stenosis of coronary stents.
ADVERSE EFFECTS: easy bruising, dyspepsia, increased risk of bleeding.
MAJOR DRAWBACKS: increased risk of bleeding (attention when used in combination to other drugs that promote bleeding), limited bioavailability, must be broken down to be activated, patients respond differently to it due to metabolic differences.

Abciximab / Eptifibatide (Glycoprotein IIb/IIIa receptor antagonists):

Most effective anti platelet drugs which can be reversed.
INDICATIONS: acute coronary syndrome, percutaneous coronary interventions.
ADVERSE EFFECTS: bleeding.

Anti Coagulant Drugs – interfere in the clotting cascade and thrombin formation

Warfarin & Coumarins – Vitamin K Antagonists (reduce blood clotting by reducing Vitamin K).

Warfarin:

Stops coagulation by decreasing the production of 4 clotting factors that are dependent on Vitamin K.
Administered orally at the same time each day with or without food.
Initial onset 6-12 hours, with the peak effect developing after several days.
Effect persists for 2-5 days after discontinuation.
INDICATION: long term prophylaxis of thrombosis, prevention of thromboembolism and venous thrombosis, prevention of thrombosis in atrial fibrillation, reduction of recurrent ischaemic attacks and MI.
CONTRAINDICATED: in pregnant and lactating women as it passes through the placenta and breast milk.
ADVERSE EFFECTS: bleeding signs & symptoms, haemorrhage.
DOSE: 2-5mg depending on INR results.
PATIENT EDUCATION: will need ongoing monitoring through INR testing (International Normalised Ratio). Normal INR is usually less or equal to 1, but for patients on Warfarin, INR should range between 2-3, and rechecked every 4 weeks after stabilisation. Should be stopped 5 days before elective surgery. Check for food interactions. Must inform all healthcare providers of Warfarin use. Wear medication bracelet at all times.

Dabigatran, Rivaroxaban, Apixaban: NOAC (Novel Oral Anticoagulants)

Dabigatran:

Directly inhibits thrombin production which then prevents formation of fibrin and clots.
DOSE: 150BD orally every 12hrs at the same time each day.
INDICATION: atrial fibrillation, hip replacement, knee replacement.
ADVERSE EFFECTS: bleeding which could be fatal, GI disturbance, dyspepsia.
ANTIDOTE: Idarucizumab countaracts bleeding caused by Dabigatran.
CONTRAINDICATION: not to be used in patients being administered medications with increased bleeding risk.
PATIENT EDUCATION: should not be discontinued prematurely as it causes increased risk of thrombolitic events; must be stopped 2-5 days before elective surgery.

Rivarobaxan and Apixaban:

Reduce thrombin production by inhibiting selectively factor Xa and prothrombinase activity.
Does not require ongoing lab testing.
INDICATION: prevention of DVT and PE after hip and knee surgery, treatment of DVT and PE unrelated to surgery, prevention of stroke in patients with atrial fibrillation.
DOSE: same time each day once or twice daily.
ADVERSE EFFECTS: dyspepsia, increase risk of bleeding which could be fatal.
CONTRAINDICATION: not to be used in patients being administered medications with increased bleeding risk.
PATIENT EDUCATION: should not be discontinued prematurely as it causes increased risk of thrombolitic events; must be stopped 2-5 days before elective surgery.

Heparin:

Used when rapid anticoagulation is required or quick reversal due to its rapid onset.
May be used in pregnant or lactating women.
DOSE: in units, administered IV or SC, with preferred administration site being the abdominal area 2″ away from the umbilical cord, thighs or buttocks. Rotate injection site to avoid skin damage. Stop 6-12 hours prior to elective surgery.
INDICATIONS: DVT (deep vein thrombosis), Pulmonary Embolism, Arterial Thromboembolism, MI, unstable Angina.
ADVERSE EFFECTS: haemorrhage, heparin-induced thrombocytopenia, hypersensitivity reactions.
CONTRAINDICATIONS: Thrombocytopenia (low platelet level), uncontrollable bleeding. DO NOT ADMINISTER during or immediately after eye, brain or spinal cord surgery.
UNFRACTIONED HEPARIN: APTT monitoring essential, higher risk, antidote Protamine Sulphate used to reverse effects.
LOW MOLECULAR WEIGHT HEPARIN: no APTT monitoring needed, lowers risk of bleeding, osteoporosis and Heparin-induced Thrombocytopenia, no antidote.

Thrombolytic Drugs – stimulate the plasmin system to break down the formed clot

Streptokinase, Anistreplase and Urokinase (Non-Fibrin Specific)

Alteplase, Reteplase and Tenecteplase (Fibrin Specific Tissue Plasminogen)

CONTRAINDICATIONS OF THROMBOLYTICS: active internal bleeding, intracranial trauma, cerebral haemorrhagic stroke, cerebrovascular disease, major surgery in the past 2 weeks, active peptic ulcer, diabetic retinopathy, pregnancy.

Drugs Affecting Coagulation: Blood Thinners

Heparin

Warfarin

PT/INR vs aPTT

Thrombolytics

Special thanks to the creators of the featured videos on this post, specifically Youtube Channels Simple Nursing and Registered Nurse RN

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Direct Vasodilators – Anti-Hypertensives in Cardiovascular Pharmacology

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Here you can find videos related to direct vasodilators which are anti-hypertensive drugs covered within cardiovascular pharmacology…

Types of Cardiovascular Drugs include:

Anti-Hypertensive Drugs
Anti-Angina Drugs
Anti-Arrhythmic Drugs
Anti-Coagulants
Anti-Hyperlipidaemic Drugs

Anti-Hypertensive Drugs are further sub-divided into 4 categories, namely:

Renin-Angiotensin Aldosterone Inhibitors

Adrenergic System Inhibitors

Diuretics

Direct Vasodilators

Below you can find a collection of videos that can help provide a more visual approach to cardiovascular pharmacology, specifically on the Anti-Hypertensive Drugs – Direct Vasodilators.

Nitrates

Available as sublingual spray, oral tablets, transdermal patch, and IV preparation.
Oral medication can be taken up to 3 times within 5 minute intervals; burning sensation may be experienced (harmless).
Sustained release formulas: do not crush and swallow whole; Injection sites should be switched continuously; taper dose over 4-6 weeks to prevent MI.
Transdermal patches can lead to patient tolerance. To avoid, remove patch for 4-8 hours, ideally during the night.
Nitrates are sensitive to light. Protect from sunlight.
INDICATIONS: angina, acute coronary syndrome, for reduction of chest pain and infarct size in MI.
ADVERSE EFFECTS: CNS – throbbing headache, dizziness, weakness; CV – hypotension, reflex tachycardia, syncope; GI – nausea, vomiting, incontinence; EENT – pallor, flushing, sweating; methemoglobinemia and cyanosis if administered in high doses.

Calcium Channel Blockers

Nifedipine, Amiodipine, Nicardipine – Dihyropyridines (Anti Hypertensive properties).

Diltaziem, Verapamil – Non-Dihydropyridines (Anti-Arrhythmic properties).

Causes a decrease in peripheral resistance, blood pressure and cardiac workload, as well as vasodilation.
INDICATIONS: angina pectoris, effort-associated angina, chronic stable angina, unstable crescendo preinfarction angina, essential hypertension.
Parenteral administration for treatment of supraventricular tachyarrhythmia, and temporary control of rapid ventricular rate in atrial flutter or atrial fibrillation.
ADVERSE EFFECTS: dizziness, light-headedness, headache, fatigue, hypotension, heart block, peripheral oedema, bradycardia, nausea, skin flushing, rash.

Direct Vasodilators: Nitroglycerin and Angina

Direct Vasodilators: Administering Nitroglycerin Sublingual Tablets and Translingual Spray

Calcium Channel Blockers

Special thanks to the creators of the featured videos on this post, specifically Youtube Channels Simple Nursing and Registered Nurse RN

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Diuretics – Anti-Hypertensives in Cardiovascular Pharmacology

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Here you can find videos featuring Diuretics through a visual approach to anti-hypertensive drugs for Cardiovascular Pharmacology use

Types of Cardiovascular Drugs include:

Anti-Hypertensive Drugs
Anti-Angina Drugs
Anti-Arrhythmic Drugs
Anti-Coagulants
Anti-Hyperlipidaemic Drugs

Anti-Hypertensive Drugs are further sub-divided into 4 categories, namely:

Renin-Angiotensin Aldosterone Inhibitors

Adrenergic System Inhibitors

Diuretics

Direct Vasodilators

Below you can find a collection of videos that can help provide a more visual approach to cardiovascular pharmacology, specifically on the Anti-Hypertensive Drugs – Diuretics

Diuretics: Promote the production of urine, thus increasing urine volume and the excretion of water from the body.

Before starting patient on diuretics, take baseline data of fluid and electrolyte disturbances, hepatorenal diseases, glucose tolerance abnormalities; Assess skin for oedema and skin tugor status; Assess cardiopulmonary status (blood pressure, pulse, heart and lung sounds); Measure body weight to monitor fluid loss or retention.

Monitor intake and output of voiding; monitor lab tests especially K+, Ca+ uric acid and glucose levels; monitor LFTs and renal function.

ADVERSE EFFECTS: electrolyte imbalance, hyperglycaemia, hyperuricemia, acid base disturbances.

Thiazide Diuretics: Bendroflumethazide, Hydrochlorthiazide, Indapamide

Most commonly used diuretic.
Milder effect when compared to loop diuretics.
Causes lower peripheral vascular resistance as well as the excretion of sodium, water, chloride and potassium.
INDICATIONS: pulmonary oedema, forced diuresis.

Loop: Bumetanide, Furosemide

Causes greatest possible amount of diuresis.
Bumetanide is 40% more potent in producing rapid diuresis.
Available in oral, IV and IM formulation.
INDICATIONS: hypertension, heart failure, oedema.

Potassium Sparing: Spironolactone, Amiloride.

Stops sodium reabsorption by interfering with the sodium potassium pump in the distal convoluted tubule.
Used along with Thiazides or Loops when increased diuretic effect is desired.
INDICATIONS: ideal for patients with low potassium level (hypokalaemia).

Thiazide Diuretics

Loop Diuretics

Potassium Sparing Diuretics

Special thanks to the creator of the featured videos on this post, specifically Youtube Channel Registered Nurse RN

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Adrenergic System Inhibitors – Anti-Hypertensives in CV Pharmacology

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Adrenergic System Inhibitors features videos that provide a visual approach to alpha and beta blockers in cardiovascular pharmacology.

Types of Cardiovascular Drugs include:

Anti-Hypertensive Drugs
Anti-Angina Drugs
Anti-Arrhythmic Drugs
Anti-Coagulants
Anti-Hyperlipidaemic Drugs

Anti-Hypertensive Drugs are further sub-divided into 4 categories, namely:

Renin-Angiotensin Aldosterone Inhibitors

Adrenergic System Inhibitors

Diuretics

Direct Vasodilators

The Adrenergic System:

The main neurotransmitter of the Adrenergic system is Nonepinephrine. Nonepinephrine acts on all adrenergic receptors to generate a response.

When the sympathetic system is stimulated, there is an increase in heart rate and contractility, and blood vessels constrict. When the sympathetic system is blocked, the heart rate slows down and the blood vessels dilate.

Drugs that STIMULATE the adrenergic system = alpha or beta agonists (sympathomimetics).

Drugs that BLOCK the adrenergic system = alpha or beta blockers (sympatholytics).

Beta Blockers:

Beta Blockers block action of Epinephrine and Nonepinephrine and act as antagonists, blocking beta1 (heart) and beta2 (lungs) adrenergic receptors.

First Generation Nonselective Beta Blockers – Act on B1 (Heart) & B2 (Lungs) eg. Nadolol, Oxprenolol, Penbotalol, Pindolol, Propanolol, Sotalol, Timolol.

Second Generation B1 Selective Beta Blockers – Act on B1 (Heart) eg. Acebutolol, Atenolol, Bisoprolol, Esmolol, Metoprolol. Ideal for asthmatics!

Third Generation Vasodilatory: Nonselective eg. Carteolol, Carvedilol, Labetalol; B1 Selective eg. Betaxolol, Nebivolol.

INDICATIONS: angina, arrhythmias, heart failure, hypertension, MI.
ADVERSE EFFECTS: bradycardia, hypotension, increase in lipidemia, decrease in libido, bronchospasm causing shortness of breath, chronic heart failure due to abnormalities in conductivity, kinks peripheral vessels, exhaustion, emotional depression, masks hyperglycaemia.
CONTRAINDICATIONS: bradycardia, heart block, asthma (do not administer 1st Gen Beta Blockers especially Propanolol), CHF, diabetes, COPD. Avoid concurrent administration of BB with CCBs and Diuretics.
NURSING INTERVENTION: check pulse and do not administer if patient is bradycardic. Be extremely careful with HF patients. Monitor side effects.
PATIENT EDUCATION: advise not to stop medication abruptly. Take with food to reduce or prevent GI disturbances. Whilst body adjusts to medication, side effects such as dizziness, light headedness, drowsiness and blurred vision may occur. Cold extremities may be due to the reduction of blood circulation to the extremities.

Alpha Blockers:

Alpha Blockers eg. Doxasozin, Prasozin.

Alpha 1 causes blood vessels to dilate = reduction in the peripheral resistance = fall in BP = postural hypotension. Decreases contraction force of the heart.

Alpha 2 causes vascular smooth muscles to dilate = decrease in BP.

The Sympathetic vs Parasympathetic Nervous System: Inhibiting and Stimulating Drugs

Beta Blockers

Alpha Blockers

Special thanks to the creators of the featured videos on this post, specifically Youtube Channels Registered Nurse RN and Drugs in Motion.

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RAAS Renin-Angiotensin Aldosterone System: CV Drugs Affecting RAAS

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This post features a collection of videos that provide a visual approach on cardiovascular pharmacology for student nurses, specifically on anti-hypertensives affecting RAAS.

Types of Cardiovascular Drugs include:

Anti-Hypertensive Drugs
Anti-Angina Drugs
Anti-Arrhythmic Drugs
Anti-Coagulants
Anti-Hyperlipidaemic Drugs

Anti-Hypertensive Drugs are further sub-divided into 4 categories, namely:

Renin-Angiotensin Aldosterone Inhibitors

Adregenic System Inhibitors

Diuretics

Direct Vasodilators

RAAS – Renin-Angiotensin Aldosterone System

The RAAS system regulates the blood volume and the systemic vascular resistance, affecting the cardiac output (bloodflow) and arterial pressure, and impacting Renin, Angiotensin and Aldosterone.

ACE Inhibitors:

ACE inhibitors end with _pril eg. Enalapril, Lisinopril, Perindopril.

Block the conversion of Angiotensin 1 to Angiotensin 2 = decrease in BP, peripheral volume, heart workload, blood volume, aldosterone secretion.
INDICATIONS: hypertension, heart failure, left ventricular hypertrophy.
SIDE EFFECTS: headache, dizziness, tiredness, hypotension (especially after 1st dose; ideally administer before going to bed at night), reflex tachycardia, arrhythmias, decreased renal function, dry persistent non-productive cough, angioedema (breathing problems), rash, taste disturbances, hyperkalaemia.
NURSING INTERVENTION: avoid abrupt stopping of medication, take 1hr before or 2hrs after a meal, monitor patients with risk of dehydration, check blood profile for electrolytes and creatinine, monitor BP, avoid NSAIDs to minimise renal damage risk, stop additional K+ sparing diuretics and K+ supplements as they would increase the risk for hyperkalaemia.

ARBs – Angiotensin II Receptor Blockers:

ARBs end with _sartans eg. Candesartan, Losartan, Eprosartan.

Block Angiotensin II from binding with receptors in the smooth muscles of the heart and blood vessels = reduction in vasoconstriction, aldosterone secretion, catecholamine release, cell growth and BP.
No effect on bradykinin thus no non-productive cough is experienced as a side effect.
INDICATIONS: hypertension, HF, LVF (left ventricular failure), patients unable to take ACE inhibitors eg. those experiencing dry cough.
ADVERSE EFFECTS: headache, dizziness, weakness, orthostatic hypotension, URTI (upper respiratory tract infections), mild cough, diarrhoea, abdominal pain, nausea, dry mouth, tooth pain, rash, alopecia, dry skin.

Renin Angiotensin Aldosterone System (RAAS)

ACE Inhibitors

Angiotensin II Receptor Blockers ARBs

Special thanks to the creator of the featured videos on this post, specifically Youtube Channel Registered Nurse RN.

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Cardiovascular Disease – Heart Disease Simplified For Nursing Students

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Cardiovascular disease is the main cause of death both globally and in Malta.

Cardiovascular disease risk factors

Non-Modifiable risk factors: age, gender and family history.

Modifiable risk factors: high cholesterol, high BP, diabetes, smoking, being overweight or obese, living an inactive lifestyle, excessive alcohol and excessive stress.

Cardiovascular diseases can be managed through lifestyle changes, which include incorporating a healthy diet as well as exercise routines, smoking cessation, alcohol reduction or cessation, as well as medication used to prevent and treat CV disease, slow the progression of disease and treat its symptoms, and increase life expectancy whilst improving the patients’ quality of life.

Cardiovascular Diseases:

HEART DISEASE: most usual through atherosclerosis, which is the build up of fats, cholesterol and other substances in and on the artery walls (plaque), which can restrict blood flow. The plaque can burst, triggering a blood clot. Although atherosclerosis is often considered a heart problem, it can affect arteries anywhere in your body.
HEART ATTACK /MI: occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck or jaw.
STROKE: Ischaemic stroke is caused by a blockage in an artery that supplies blood to the brain. The blockage reduces the blood flow and oxygen to the brain, leading to damage or death of brain cells. Haemorrhagic stroke, also known as brain haemorrhage or brain bleed, happens due to bleeding in or around the brain.
HEART FAILURE: also known as congestive heart failure, occurs when the heart muscle doesn’t pump blood as well as it should.
ARRHYTHMIA: a problem with the rate or rhythm of the heartbeat where the heart can beat too fast, too slowly, or with an irregular rhythm.
HEART VALVE ISSUES: issues include regurgitation, stenosis, and atresia.

Below you can find a collection of videos that can help provide a more visual approach to cardiovascular disease.

Atherosclerosis and Cardiovascular Disease

Ischaemic Stroke Animation

Haemorrhagic Stroke Animation

Congestive Heart Failure

Cardiac Arrhythmias

Hypertension Overview, Symptoms and Risk Factors

More information about anti-hypertensives can be found here…

Special thanks to the creators of the featured videos on this post, specifically Youtube Channels Biolution, Cook Children’s Health Care System, Scientific Animations, Bupa Health UK, and Registered Nurse RN.

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