634
Unit VI Promoting Health in Patients With Circulatory or Perfusion Disorders
Table 30.2 Medications Used in the Treatment of Coronary Artery Disease—cont’d
Medication Classification Anticoagulants
Mechanism of Action
Exemplars
Nursing Implications
Inhibit clot formation through interaction in different stages of the coagulation cascade.
Apixaban (Eliquis) Dabigatran (Pradaxa) Enoxaparin (Lovenox) Heparin Rivaroxaban (Xarelto) Warfarin (Coumadin) Aspirin (Bayer aspirin, Ecotrin) Clopidogrel (Plavix) Ticagrelor (Brilinta) Ticlopidine (Ticlid) Prasugrel (Effient) Abciximab (ReoPro)
Monitor coagulation studies (not necessary with Xarelto and Eliquis). Initiate bleeding precautions.
Antiplatelet agents
Inhibit platelet aggregation to prevent clot development through:
Monitor for excessive bleeding. Aspirin can be combined with one of the P2Y 12 inhibitors or glycoprotein IIb/IIIa inhib- itor for optimal clot risk reduction in some patients.
COX-1 inhibition P2Y 12 inhibition
Abciximab is given IV only
Glycoprotein IIb/IIIa receptor inhibition Inhibit the sympathetic nervous system response to physical activity, which decreases cardiac workload and oxygen consumption. Reduce blood pressure through inhibiting the RAAS, which decreases workload and oxygen demands. Lower blood pressure by preventing calcium from entering the cells of the heart and arteries. Allow the blood vessels to relax and dilate and increase blood flow through the coronaries. Also prevent coronary artery spasms in Prinzmetals’s/variant angina Reduce heart rate. Dilate coronary arteries when converted to nitric oxide. Nitric oxide produces enzymatic activity that causes vasodi- lation. This action improves blood flow and oxygen supply to the myocardial cells.
Beta blockers
Metoprolol (Lopressor, Toprol XL)
Monitor heart rate and blood pressure.
ACE inhibitors and ARBs
Lisinopril (Zestril) Losartan (Cozaar)
Monitor blood pressure, renal function, and electrolytes.
Calcium channel blockers
Nifedipine (Adalat, Procardia) Amlodipine (Norvasc)
Used when patients cannot tolerate beta blockers or in patients with HF Monitor blood pressure and heart rate.
Vasodilators
Nitroglycerin (Tridil, Nitrostat) Isorsobide dinitrate (Isordil)
Monitor blood pressure and chest pain. Assess for headache. See medication Safety Alert for additional information on administration of nitroglyc- erin for chest pain and contraindications.
ACE, Angiotensin-converting enzyme; ACS, acute coronary syndrome; ARB, angiotensin II receptor blocker; HDL, high-density lipoprotein; HF, heart failure; HTN, hypertension; LDL, low-density lipoprotein; VLDL, very-low-density lipoprotein.
Powered by FlippingBook