Cardiac Simulation Pre-Work
Review the following medication classes:
1. ACE inhibitors: (medications ending in -pril)
Treats: HTN, heart failure, MI, diabetic/non-diabetic nephropathy
Action: inhibits action of ACE, leading to vasodilation and excretion of Na+ and H2O and retention of
K+
Side effects: orthostatic hypotension, cough, hyperkalemia, angioedema
Contraindicated in: history of allergy/angioedema with ACE inhibitor use, bilateral renal artery
stenosis, salt or volume depletion
2. Cardiac glycosides:
Treats: a-fib, a-flutter, CHF
Action: inhibits Na+ K+ ATPase enzyme
Side effects: unusual tiredness/fatigue, anxiety, hallucinations
Contraindicated in: ventricular rhythms (v-fib, v-tach) and 2nd/3rd degree heart blocks
1st Line Medications (Heart Failure): ACE inhibitors, ARBs, beta-blockers
3. Loop diuretics:
Treats: HTN, pulmonary edema caused by HF, seizures, glaucoma, renal diseases not responsive to
other diuretics
Action: inhibit reabsorption of Na+Cl- in proximal and distal convoluted tubules and Loop of Henle
Side effects: orthostatic hypotension, hypokalemia, ototoxicity, hyponatremia, dehydration
Contraindicated in: patients with anuria, electrolyte imbalances, severe kidney/liver dysfunction
4. Beta blockers: (medications end in -lol)
Treats: HTN, heart failure, tachydysrhythmias, angina, MI, hyperthyroidism, glaucoma
Action: blocks beta receptors in heart to decrease cardiac workload, decrease HR, vasodilate
Side effects: bradycardia, orthostatic hypotension, pulmonary edema
Contraindicated in: AV block, sinus bradycardia, heart failure (non-selective beta-blockers),
hypotension, asthma (cardioselective beta-blockers)
Give two examples of medications from the ACE inhibitor class and two examples of medications from
the beta blocker class.
ACE Inhibitors: Captopril, Lisinopril
Beta-blockers: Propranolol, Metoprolol
When administering medications from the classes listed above, what information do you need prior to
administering a medication from that class?
ACE Inhibitors: serum K+ levels, BP, pulse, weight, I&O ratios,
Cardiac Glycosides: serum K+ levels, BP, pulse, apical pulse x 1 min (<60 bpm, hold dose/notify
provider), digoxin levels (if medication being administered), I&O ratios
Loop Diuretics: serum K+ levels, baseline data (orthostatic BP, pulse, weight, serum electrolytes,
location/extent of edema), I&O ratios, ECG rhythm
Beta-blockers: apical pulse x 1 min (<50 bpm or arrhythmias occur, hold dose/notify provider), BP, HR,
ECG rhythm, serum glucose levels, I&O ratios
Review the following medication classes:
1. ACE inhibitors: (medications ending in -pril)
Treats: HTN, heart failure, MI, diabetic/non-diabetic nephropathy
Action: inhibits action of ACE, leading to vasodilation and excretion of Na+ and H2O and retention of
K+
Side effects: orthostatic hypotension, cough, hyperkalemia, angioedema
Contraindicated in: history of allergy/angioedema with ACE inhibitor use, bilateral renal artery
stenosis, salt or volume depletion
2. Cardiac glycosides:
Treats: a-fib, a-flutter, CHF
Action: inhibits Na+ K+ ATPase enzyme
Side effects: unusual tiredness/fatigue, anxiety, hallucinations
Contraindicated in: ventricular rhythms (v-fib, v-tach) and 2nd/3rd degree heart blocks
1st Line Medications (Heart Failure): ACE inhibitors, ARBs, beta-blockers
3. Loop diuretics:
Treats: HTN, pulmonary edema caused by HF, seizures, glaucoma, renal diseases not responsive to
other diuretics
Action: inhibit reabsorption of Na+Cl- in proximal and distal convoluted tubules and Loop of Henle
Side effects: orthostatic hypotension, hypokalemia, ototoxicity, hyponatremia, dehydration
Contraindicated in: patients with anuria, electrolyte imbalances, severe kidney/liver dysfunction
4. Beta blockers: (medications end in -lol)
Treats: HTN, heart failure, tachydysrhythmias, angina, MI, hyperthyroidism, glaucoma
Action: blocks beta receptors in heart to decrease cardiac workload, decrease HR, vasodilate
Side effects: bradycardia, orthostatic hypotension, pulmonary edema
Contraindicated in: AV block, sinus bradycardia, heart failure (non-selective beta-blockers),
hypotension, asthma (cardioselective beta-blockers)
Give two examples of medications from the ACE inhibitor class and two examples of medications from
the beta blocker class.
ACE Inhibitors: Captopril, Lisinopril
Beta-blockers: Propranolol, Metoprolol
When administering medications from the classes listed above, what information do you need prior to
administering a medication from that class?
ACE Inhibitors: serum K+ levels, BP, pulse, weight, I&O ratios,
Cardiac Glycosides: serum K+ levels, BP, pulse, apical pulse x 1 min (<60 bpm, hold dose/notify
provider), digoxin levels (if medication being administered), I&O ratios
Loop Diuretics: serum K+ levels, baseline data (orthostatic BP, pulse, weight, serum electrolytes,
location/extent of edema), I&O ratios, ECG rhythm
Beta-blockers: apical pulse x 1 min (<50 bpm or arrhythmias occur, hold dose/notify provider), BP, HR,
ECG rhythm, serum glucose levels, I&O ratios
