Top Banner
Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College
158

Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Dec 20, 2015

Download

Documents

Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Drugs that affect the Cardiovascular system

Peggy Andrews, Instructor

Chemeketa Community College

Page 2: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

What

abou

t ‘em

?

Page 3: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

LEAD Drugs

• Lidocaine– Interferes with sodium channels to block conduction

abnormalities

• Epinephrine– Increases heart rate, blood pressure and stimulates liver

• Atropine– Blocks actylcholine, speeds heart

• Dopamine– Increases contractile force

Page 4: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Let’s Review First

• Most drugs treat dysrhythmias• Most prevalent

– Tachycardia

– Bradycardia

• Generated through abnormal impulse formation (automaticity)

• OR abnormal conductivity

Page 5: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Dysrhythmias - Most often caused by imbalance between sympathetic and parasympathetic nervous systems

Page 6: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Bradycardia

• Excessive parasympathetic stimulation through muscarinic receptors

Page 7: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Tachycardia

• Variety of causes

• Ischemia, mycoardial infarction, excessive sympathetic stimulation

Page 8: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Develop phase 4 depolarization, generate abnormal impulse– Ectopic foci

• Abnormal conduction;– One-way valve

Page 9: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Antidysrhythmics

• SODIUM CHANNEL BLOCKERS

Page 10: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

What do they do, anyway?

• -amide, ester forms of local anesthetics elevate the threshold of electric excitation of the nerve– Enter open, inactive sodium channels– Anesthetic closes the channel, blocking sodium

influx• Delays impulse• Decreases action potential• Blocks conduction

Page 11: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Procainamide

• Class: antiarrhythmic

• Indications

• Treatment of ventricular and arial arrhythmias– PACs, PVCs, VT, PAT, post conversion from

Af or AF

Page 12: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Decreases myocardial excitability– Slows conduction velocity– Suppresses arrhythmias

Page 13: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Contraindications– Hypersensitivity– Poisonings from tricyclic antidepressants

• Caution– MI– CHF– geriatrics

Page 14: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Adverse reactions– Seizures– Asystole– Heart block– Ventricular arrhythmias– Diarrhea

Page 15: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Route & dose– IV, 20-30 mg/min IV until

• Dysrhythmia converted• Hypotension• QRS widens > 50%• 17 mg/kg administered

– Cardiac Arrest: 100 mg IVP q 5 min.– Infusion: 1 – 4 mg/min (1 gm in 250

ml NS)

• How supplied• 10 mg/ml in 100 mg preload

Page 16: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Lidocaine

• Class– Antidysrhythmic

• Indications– VT, Vf, malignant PVC’s

• Action– Decreases ventricular automaticity & excitability

– Raises fibrillation threshold

– Decreases conduction in ischemic cardiac tissue without affecting normal conduction

Page 17: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Contraindications– Advanced AV block (Mobitz II , 3rd degree

blocks– Torsades de pointes– Stokes-Adams syndrome

• Precaution: – Heart rate less than 60– Hepatic disease - reduce by 50%– >70 y/o – reduce by 50%

Page 18: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Side effects– Drowsiness– Dizziness– Confusion– Hypotension– Nausea, vomiting– Dysrhythmias– Respiratory depression– Cardiac arrest

Page 19: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Route & Dosage:– Loading dose of 1 – 1.5 mg/kg

IVP q 5 min. Max dose of 3 mg/kg– After perfusion is reestablished,

admin. Lidocaine gtt at 2-4 mg/min (start gtt at 1 mg/min if pt > 70 y/o

• How supplied– 10 mg/ml in 100 mg preload

Page 20: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Lidocaine is drug of choice for

• Most types of drug-induced monomorphic VT or Vf, and for VT, Vf associated with cocaine-induced myocardial ischemia

Page 21: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Antidysrhythmics

• Potassium Channel Blockers

Page 22: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Bretylium Tosylate (Bretylol)

• Class; antiadysrhythmic– Different from all other antidysrhythmics– Does not suppress automaticity– Has no effect on conduction velocity

Page 23: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Indications– VT, Vf refractory to lidocaine and defibrillation– Recurrent Vf – VT with a pulse that fails to respond to

lidocaine or procainamide– Wide complex tachycardias not controlled by

lidocaine and adenosine

Page 24: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Causes an initial but transient release of

norepinephrine; effect lasts ~ 20 min. – Then inhibits release of norepinephrine and

blocks reuptake of norepinehprine, resulting in depletion of norepinephrine. Results in:

• Increased fibrillation threshold

• Prolonged effective refractory period

• Suppression of reentry dysrhythmias

Page 25: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Contraindication and precautions– No contraindications when used for Tx of life-threatening

dysrhythmias– Contraindicated in Torsades– Can result in prolonged hypotension in postresuscitation

phase

• Side effects– Initial transient elevated BP followed by hypotension– Dizziness, syncope– Angina– Bradycardia– If administered by rapid IVP, N/V

Page 26: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Dosage– Vf, pulseless VT: 5 mg/kg IVP

• Repeat with 10 mg/kg q 15 min to max dose of 30-35 mg/kg

– If conversion, administer bretylium drip at 1-2 mg/min.

• How supplied– 50 mg/ml in 10 ml preload

Page 27: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

amiodarone (Amrinone, Cordarone)

• Class– antiarrhythmic

• Indications– recurrent VF, unstable VT– When other therapies are ineffective

Page 28: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Prolongs action potential and refractory period

– Slows sinus rate, increases PR, QT intervals

• Contraindications– Severe sinus node dysfunction

– 2nd and 3rd degree AV block

• Precautions– CHF, severe pulmonary or liver disease

Page 29: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Adverse reactions– ARDS, pulmonary fibrosis, CHF, worsening

of arrhythmias– Liver function abnormalities– Anorexia, constipation, N/V, ataxia,

involuntary movement, paresthesia, periphreal neuropathy, tremors

– Bradycardia, hypotension– Dizziness, fatigue, malaise, corneal

microdeposits

Page 30: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Route & dosage– Requires large initial loading dose

(IV route) to prevent delay in onset action

– Must use filter needle

– Draw up slowly – Foams!

Page 31: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• For VT hemodynamically stable (SBP> 85)– 150 mg IV over 10-30 minutes– 900 mg IV over 24 hrs by infusion– Repeat 150 mg IV bolus for VT

• For VT/VF unstable or no BP– 150-300 mg IV bolus– IV infusion (1mg/min)– May repeat bolus

Page 32: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Not water soluble – must use solventPolysorbate 80

• Polysorbate 80 clinical effects:– Decrease heart rate – Depress AV node conduction– Increase atria and ventricular

refractory periods– Available only in glass ampules

Page 33: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• How supplied– 50mg/ml in 3-ml ampules

Page 34: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.
Page 35: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Antidysrhythmics

• Calcium Channel Blockers

Page 36: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Verapamil (Isoptin, Calan)

• Class– Antianginal, Antiarrhythmic, antihypertensive agent

• Indications– Hypertension, angina, Prinzmetal’s angina, Af or AF

with rapid ventricular response

• Action– Inhibits transport of calcium into myocardial and

vascular smooth muscle

– Decreases SA and AV conduction

Page 37: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Contraindications– Hypersensitivity

• Precautions– Severe hepatic impairment

• Adverse reactions, SE– Arrhythmias, CHF

Page 38: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Dosage and route– 5 – 10 mg, IV

• How supplied– 2.5 mg/ml in 2 & 4 ml vials, ampules and

syringes

Page 39: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

diltiazem (Cardizem)

• Class– Antianginal, antiarrhythmic, antihypertensive

• Indication– Hypertension, angina, SVTs and Af & AF with

rapid ventricular response

• Action– Inhibits the transport of calcium into

myocardial and vascular smooth muscle

Page 40: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Contraindications– Hypersensitivity– Sick sinus syndrome – 2nd or 3rd degree AV block

• Precautions– Severe hepatic impairment

Page 41: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Adverse reactions, SE– Arrhythmias

– CHF

– Peripheral edema

• Dosage & route– 0.25 mg/kg

– May repeat in 15 minutes with dose of 0.35 mg/kg

– Follow with gtt at 10 mg/hr

• How supplied– 5 mg/ml in 10 ml vials

– 25 mg preloads

Page 42: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Antidysrhythmics

• Miscellaneous

Page 43: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Adenosine (Adenocard)

• Class– Antiarrhythmic agent

• Indication– Conversion of PSVT– As a diagnostic tool to assess myocardial

perfusion

Page 44: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Restores normal sinus rhythm by interrupting

re-entry pathways in AV node– Slows conduction through AV node

• Contraindications– 2nd or 3rd degree block

• Precautions– Asthma– Unstable angina

Page 45: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Adverse reactions & side effects– SOB– Facial flushing– Transient arrhythmias

• Dosage & route– 6 mg rapid IVP– Repeat in 1 – 2 min. prn at 12 mg rapid IVP– Repeat in 1 – 2 min. prn at 12 mg rapid IVP

Page 46: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• How supplied– 6 mg and 12 mg preload syringes or vials

• Onset is immediate

• Duration is 1 – 2 min

• Note: Proximal IV, RAPID bolus, 20 ml flush with arm raised is critical!!

Page 47: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

digoxin (Lanoxin)

• Class– Antiarrhythmic agent– Cardiotonic and inotropic agent

• Indications– CHF– Tachyarrhythmias– Af & AF– PAT

Page 48: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Increases force of myocardial contractility– Prolongs refractory period of AV node– Decreases conductiion through SA and AV

nodes

• Contraindications– Hypersensitivity– Uncontrolled ventricular arrhythmias– AV block– IHSS

Page 49: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Precautions– Electrolyte abnormalities

• Adverse reactions, SE– Dysrhythmias – Fatigue– Blurred, yellow vision– Anorexia, N/V

Page 50: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Dosage & route– 0.6 – 1.0 mg (10-15 mcg/kg) initially– Give additional fractions at 4 – 8 h intervals– Total dose 200 mg

• How supplied– 0.25 mg/ml in 1 ml preload

Page 51: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Magnesium Sulfate

• Class: CNS depressant, anticonvulsant.

• Indications– Refractory Vf/pulseless VT– Torsades de Pointes– Digoxin-induced VT/Vf– Seizures 2ndary to eclampsia

Page 52: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Contraindications and precautions– None in refractory Vf, VT, Torsades– Renal disease– Heart block– Hypermagnesemia

Page 53: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Side effects– Hypotension– Asystole– Cardiac arrest– Respiratory and CNS depression– Flushing– Sweating

Page 54: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Dosage & Route– Refractory VT: 1-2 gm IVP over 1-2 min.– Refractory Vf: 1-2 gm IVP over 1-2 min.– Digoxin-induced VT/Vf: 2 gm IVP– Seizures 2ndary to eclampsia: 1-4 gm slow IVP

Page 55: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.
Page 56: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Anticholingergics

Page 57: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Atropine Sulfate

• Class– Anticholinergic (parasympatholytic)– Muscarinic antagonist

• Indications– Symptomatic bradycardia– Asystole– PEA if bradycardia– Insecticide poisoning

Page 58: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Blocks the effects of acetylcholine at

muscarinic receptors which would cause a decrease in heart rate.

• Contraindications and precautions– Glaucoma or myasthenia gravis– Can cause tachycardia– Administer cautiously in pt. With MI or

myocardial ischemia

Page 59: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Side effects– Dry mouth– Blurred vision– Urinary retention– Constipation– Tachycardia; possibly VT, Vf

Page 60: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Dosage & Route– Symptomatic bradycardia; 0.5 mg IVP q 5 min.

Max dose 0.04 mg/kg– Asystole; 1.0 mg IVP q 5 min. Max dose 0.04

mg/kg– PEA; 1.0 mg IVP q 5 min. Max dose 0.04

mg/kg– Pesticide poisoning; 2-5 mg IV q 15-30 min.

Page 61: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Antihypertensives

• Diuretics

Page 62: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Furosemide (Lasix)

• Class– Loop diuretic agent– Antihypertensive agent

• Indication– Edema 2ndary to CHF– hypertension

Page 63: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Inhibits reabsorption of sodium and chloride

from the loop of Henle and distal renal tubule

• Contraindictions– Hypersensitivity; cross-sensitivity with

thiazides and sulfonamides may occur

• Precautions– Severe liver disease with cirrhosis or ascites

Page 64: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Adverse reactions, SE– Dehydration, hypochloremia, hypokalemia,

hypomagnesemia, hyponatremia, hypovolemia, metabolic acidosis

• Dosage & route– 20 – 80 mg/day (prehospital setting: generally

double the patient’s home dose up to 80 mg IVP)

• How supplied– 10 mg/ml in 4 or 8 ml preloads

Page 65: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Bumetanide (Bumex)

• Class– Loop diuretic agent– Antihypertensive agent

• Indication– Edema 2ndary to CHF– Hepatic or renal disease– Hypertension

Page 66: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Inhibits reabsorption of sodium and chloride

from the loop of Henle and distal renal tubule– Increases renal excretion of water, sodium,

chloride, magnesium, hydrogen, calcium

• Contraindication– Hypersensitivity; cross sensitivity with

thiazides and sulfonamides

Page 67: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Precautions, – Pre-existing liver disease with cirrhosis or

ascites

• Adverse reactions, SE– Dehydration, hypochloremia, hypokalemia,

hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis

Page 68: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Dosage & Route– 0.5 – 1.0 mg/day IV– May be repeated q 2-3 h prn up to 10 mg/day

• How supplied– 0.25 mg/ml in 10 ml syringes or preloads

Page 69: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Aldactone (spironolactone)

• Class– Potassium sparing diuretic

• Indications– Counteract potassium loss caused by other

diuretics– Commonly used with other agents ( diazides) to

treat edema or hypertension

Page 70: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Causes loss of sodium bicarbonate and calcium

while saving potassium and hydrogen ions.– Weak diuretic and antihypertensive agent when

compared with other diuretics

• Contraindication– Hypersensitivity– hyperkalemia

Page 71: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Precautions– Hepatic dysfunction– Geriatrics– Diabetics

• Adverse reactions & SE– Hyperkalemia– Dizziness

Page 72: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Route & dosage– PO 25 – 400 mg/d as a single dose or 2-4

divided doses. CHF – 12.5 – 25 mg day

• How supplied– 25, 50 or 100 mg tablets

Page 73: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Antihypertensives

• ACE Inhibitors - Angiotension converting enzyme

Page 74: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

enalapril (Enalaprilat, Vasotec)• Class

– Antihypertensive

• Indication– Hypertension– CHF

• Action– ACE inhibitors block conversion of

angiotension I to vasoconstrictor angiotension II.

– Causes systemic vasodilation

Page 75: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Contraindications– Hypersensitivity

• Precautions– Renal impairment– Hepatic impairment– Hypovolemia– Geriatrics– Concurrent diuretic therapy

Page 76: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Adverse reactions, SE– Angioedema– Cough– Hypotension– Taste disturbances– Proteinuria

Page 77: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Dosage & route– 0.625 – 1.25 mg q 6 h IV

• How supplied– 1.25 mg in 1 mg preload or vial

Page 78: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Antihypertensives

• Calcium Channel Blocking Agents

Page 79: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Nifedipine (Procardia)

• Class– Antianginal agent– Antihypertensive agent– Calcium channel blocker

• Indication– Hypertension– Angina– Prinzmetal’s angina

Page 80: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Inhibits transport of calcium into myocardial

and vascular smooth muscle cells– Systemic vasodilation, resulting in decreased

BP

• Contraindication– Hypersensitivity– Sick sinus syndrome– 2nd or 3rd degree block

Page 81: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Precautions– Severe hepatic impairment

• Adverse reactions, SE– Arrhythmias, CHF – Headache– Peripheral edema– flushing

Page 82: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Dosage & route– 10 mg SL – May be repeated in 10 minutes

• How supplied– 10 mg capsules

Page 83: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.
Page 84: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Antihypertensive

• Beta Blocking agent

Page 85: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Labetalol

• Class– Antianginal agent– Antihypertensive agent– Nonselective beta-adrenergic blocking agent

• Indication– Management of hypertension

Page 86: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Blocks stimulation of beta1 and beta2 adrenergic

receptor sites

• Contraindications– Uncompensated CHF– Pulmonary edema– Cardiogenic shock– Bradycardia or heart block

Page 87: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Precautions– Renal impairment

– Hepatic impairment

– Geriatrics

• Adverse reactions, SE– Arrhythmias

– Bradycardias

– CHF

– Pulmonary edema

– Orthostatic hypotension

– Fatigue, weakness

– impotence

Page 88: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Dosage & route– 20 mg (0.25 mg/kg) initially– Additional doses of 40-80 mg q 10 min prn– Max dose 300 mg– Gtt 2 mg/min

• How supplied– 5 mg/ml in 4 mg preload syringe

Page 89: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Direct Vasodilators

Page 90: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Sodium Nitroprusside (Nitroprusside, Nitropress

• Class– Antihypertensive agent

• Indications– Hypertensive crisis– Cardiogenic shock

• Action– Produces peripheral vasodilation by direct

action on venous and arteriolar smooth muscle

Page 91: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Contraindications– Hypersensitivity– Decreased cerebral perfusion

• Precautions– Renal disease– Hepatic disease– Geriatrics

Page 92: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Adverse reactions, SE– Cyanide toxicity– Dizziness, H/A– Abdominal pain, N/V

• Route & dosage– 0.3 mcg/kg/min initially– May be increased prn up to 10 mcg/kg/min not

to exceed 10 min. of therapy

• How supplied– Powder for injection: 50 mg/vial– Reconstitute in 500 cc D5W– Concentration is 100 mcg/ml

Page 93: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Other Vasodilators and Antianginals

Page 94: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Nitroglycerin

• Class: Antianginal agent; Nitrate• Indications:

– Relief of acute anginal pain– Hypertension– CHF with APE

• Action:– Relaxes vascular smooth muscle; decreases

myocardial workload and oxygen demand

Page 95: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Contraindications– Hypotension– Hypovolemia– Intracranial bleed – Aortic stenosis– Recent Viagra use

Page 96: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Side effects– H/A 2ndary to vasodilation– Hypotension– N/V– Tachycardia– Flushing

Page 97: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Dosage & Route– Tablets

• 0.3 - 0.4 mg SL q 3-5 min. • Max 3 doses

– Paste• 1 – 2 cm (6-12 mg) topically

– Spray• 1 - 2 sprays (0.4 - 0.8 mg) SL

– IV• Mix 25 mg in 250 ml D5W (100 mcg/ml);

infuse at 5 mcg/min, titrated to effect

Page 98: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Atenolol (Tenormin)

• Class– Antianginal agent– Antihypertensive agent– Selective beta-adrenergic blocking agent

• Indication– Hypertension– Angina

Page 99: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Blocks stimulation of beta1 receptors. Does not

usually affect beta2 receptors.

– Decreases BP and heart rate

• Contraindications – Uncompensated CHF– Pulmonary edema– Cardiogenic shock – Bradycardia or heart block

Page 100: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Precautions– Renal impairment– Hepatic impairment– Geriatrics– Pulmonary disease (beta selectivity may be

lost)– Diabetes (may mask signs of hypoglycemia)

Page 101: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Adverse reactions, SE– Bradycardia, CHF, pulmonary edema– Fatigue, weakness– Impotence

• Dosage & route– 5 mg IV – Repeat in 10 min

• How supplied– 0.5 mg/ml in 10 ml preload or vial

Page 102: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Hemostatic Agents

Antiplatelets

Page 103: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Aspirin (Salicylate)

• Class– Antiplatelet agent

• Indication– Inflammatory disorders– Fever– TIA– MI

Page 104: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Produces analgesia – Reduces inflammation and fever by inhibiting

the production of prostoglandins– Decreases platelet aggregation

Page 105: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Contraindications– Hypersensitivity – Bleeding disorders or thrombocytopenia

• Precautions– GI bleeds or ulcers– Chronic alcohol use/abuse– Severe renal disease– Viral infections – Pregnancy

Page 106: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Adverse reactions, SE– GI bleeding– Anaphylaxis– Laryngeal edema– Dyspepsia, epigastric distress– Heartburn, nausea

Page 107: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Dosage & route• Pain, Fever

– PO, Rectal• 325 – 500 mg q 3 h OR• 325 – 650 mg q 4 h• Not to exceed 4 g/day

• Cardiac chest pain– PO– 81 mg x 3 chewable childrens aspirin (243 mg)

• (UNLESS TAKING COUMADIN)

• How supplied• Childrens aspirin, 81 mg tablets• Aspirin 325 - 500 mg tablets

Page 108: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Anticoagulants

Page 109: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Heparin

• Class – Anticoagulant

• Indication– Venous thromboembolism– Pulmonary emboli– Af with embolization

Page 110: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Potentiates inhibitory effect of antithrombin on

factor Xa and thrombin– Prevents conversion of fibrinogen to fibrin

• Contraindications– Hypesensitivity– Uncontrolled bleeding– Severe thrombocytopenia

Page 111: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Precautions– Severe liver or kidney disease– Untreated hypertension– Ulcers– Spinal cord or brain injury– Women > 60 y/o

Page 112: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Adverse reactions, SE– Bleeding– Anemia– Thrombocytopenia

• Route & dosage– 10,000 units, followed by 5,000 – 10,000 units

q 4-6 h IV– Gtt: 15 – 18 units/kg/hr

• How supplied– 1,000 – 5,000 units/ml in 10 ml tubex or

preload syringes

Page 113: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.
Page 114: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Thrombolytics

Page 115: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Alteplase (Activase, t-PA)

• Class– Thrombolytic agents (plasminogen activators)

• Indications– Coronary thrombosis– Acute ischemic stroke

• Action– Converts plasminogen to plasmin, which is then

able to degrade fibrin in clots.

Page 116: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Contraindications– Active internal bleeding– Hx of CVA– Recent CNS trauma or surgery– Severe uncontrolled hypertension– Known bleeding tendencies

Page 117: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Precautions– Recent (10 days) major surgery

– GI or GU bleeding

• Adverse reactions, SE– Intracranial hemorrhage

– GI bleeding, retroperitoneal bleeding

– GU tract bleeding

– Anaphylaxis

– Reperfusion arrhythmias

Page 118: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Dosage & route– MI

• 60 mg over first hour, 20 mg over 2nd hour, 20 mg over 3rd hour for total dose of 100 mg.

• How suppliedpowder for injection, packaged with sterile water for injection20 mg vial or 50 mg vial

Reconstitute with 20 mg or 50 mg using 18-ga needle

Avoid excess agitation; solution may foam• Start two IV lines first

Page 119: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Other Cardiac Medications

Page 120: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Calcium Chloride & Calcium Gluconate

• Class– Mineral, electrolyte

• Indications– Hyperkalemia– Hypermagnesemia– Cardiac arrest

Page 121: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Acts as an activator in transmission of nerve

impulses and contraction of cardiac, skeletal, smooth muscles

• Contraindications– Hypercalcemia– Vf

Page 122: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Adverse reactions,SE– Cardiac arrest– Arrhythmias– Constipation, nausea– Phlebitis

• Route & dosage: cardiac arrest– 7 – 14 mEq IVP

Page 123: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• How supplied

• Calcium chloride 10%– 1.36 mEq/ml in 20 ml preloads

• Calcium gluconate 10%– 0.45 mEq/ml in 20 ml preloads

Page 124: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Dopamine (intropin)

• Class– Cardiotonic and inotropic agent– Vasopressor

• Indications– Improve BP– Improve cardiac output

Page 125: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Small doses stimulate dopaminergic receptors,

producing renal vasodilation– Large doses stimulate dopaminergic and beta-

adrenergic receptors, producing cardiac stimulation and renal vasodilation

– Larger doses stimulate alpha-adrenergic receptors and may cause renal vasoconstriction

Page 126: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Contraindications– Tachyarrhythmias– Pheochromoctoma– Hypersensitivity to bisulfites

• Precautions– Hypovolemia– MI

Page 127: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Adverse reactions, SE– Arrhythmias, hypotension

• Route & dosage– Renal vasodilation – 0.5 – 3 mcg/kg/min IV– Cardiac stimulation – 2.0 – 10.0 mcg/kg/min IV– Increased peripheral vascular resistance – 10

mcg/kg/min; titrate to effect

Page 128: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• How supplied– 40 mg/ml or 80 mg/ml in preload or vial– Premixed injection: 1600 mcg/ml in 250 and

500 ml D5W

Page 129: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Dobutamine

• Class– Cardiotonic and inotropic agent

• Indications– Short-term management of heart failure caused

by depressed contractility

• Action– Stimulates beta1 receptors with minor effect on

heart rate or peripheral vessels

Page 130: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Contraindications– Hypersensitivity– IHSS

• Precautions– History of hypertension– MI– Af– Ventricular ectopic beats– hypovolemia

Page 131: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Adverse reactions, SE– Hypertension, increased heart rate– PVCs

• Route & dosage– 0.5 – 1.0 mcg/kg/min, titrated to effect (range 2

- 20 mcg/kg/min

• How supplied– 12.5 mg/ml in 20 ml vial

Page 132: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Epinephrine 1:10,000

• Class– Direct-acting catecholamine secreted by the

adrenal medulla in response to sympathetic stimulation.

Page 133: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Indications– Asystole– Vf– Pulseless VT– PEA– Acute bronchospasm associated with asthma or

COPD– Anaphylaxis

Page 134: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Stimulates beta1, beta2 and alpha1 receptors. – Effect on beta receptors significantly more profound

than on alpha receptors.– Beta1 stimulation results in increased contractility,

increased heart rate, increased AV conduction– Can cause spontaneous myocardial contraction in

asystole.– Increases likelihood of successful defibrillation– Beta2 stimulation results in bronchodilation,

vasodilation in skeletal muscle– Stimulation of alpha1 receptors causes vasoconstriction

Page 135: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Note: Vascular effects are dose-related.– At low doses, beta2 receptors predominate with

decreased total peripheral resistance and decreased BP

– With larger doses, alpha effects predominate with increased peripheral vascular resistance and increased BP.

Page 136: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Contraindications and precautions– No contraindications in cardiac arrest

– Protect Epi from light

– Unstable in alkaline solutions I.e., Sodium Bicarbonate

• Side effects– CNS stimulation

– H/A, dizziness, pallor

– N/V

– Palpitations

Page 137: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Dosage– Cardiac Arrest: 1 mg IVP q 3-5 min.– Endotracheal admin. 2 – 2.5 x IV dose– Acute bronchospasm assoc. with asthma,

COPD: 0.3 mg – 0.5 mg 1:1,000 solution SC q 5-20 min.

• How supplied– 1 mg/ml in 10 ml preload

Page 138: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.
Page 139: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Isoproterenol (Isuprel)

• Class– Beta-adrenergic agonist

• Indications– Refractory torsade de pointes– Immediate temporary control of

hemodynamically significant bradycardia of heart transplant patients

Page 140: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Causes an increase in rate and force of heart

contractions

• Contraindications– Ischemic heart disease– Hypotension– Cardiac arrest

Page 141: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Adverse reactions, SE– Arrhythmias– VT, Vf– NOTE: increases cardiac oxygen demand

• Dosage & route– 2 – 10 mcg/min IV; titrate to HR and rhythm– Mix 1 mg in 250 ml of D5W; gtt at 2 mcg/min

• How supplied– 1 mg in 1 ml preload

Page 142: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Metaprolol (Lopressor)

• Class– Antianginal agent– Antiarrhythmic

• Indications– Hypertension– angina

Page 143: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Blocks stimulation of beta1 adrenergic

receptors.

• Contraindications– Uncompensated CHF– Pulmonary edema– Cardiogenic shock– Bradycardia or heartblock

Page 144: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Precautions– Renal impairment– Hepatic impairment– Geriatrics

• Adverse reactions, SE– Bradycardia, CHF, pulmonary edema– Fatigue, weakness

Page 145: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Dosage & route– MI: 5 mg q 2 min for for total of 15 mg. Then

50 mg orally bid for at least 24 hours; then increase to 100 mg bid

• How supplied– 1 mg/ml in 5 mg preload or vial

Page 146: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Propranolol (Inderal)• Class

– Antianginal agent– Arrhythmic agent– Antihypertensive agent

• Indication– VT, Vf, Af, AF, PSVT– Hypertension– Angina– Anterior MI w/ HTN, tachycardia

Page 147: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Blocks stimulation of beta1 and beta2 adrenergic

receptor sites

• Contraindication– Uncompensated CHF– Pulmonary edema– Cardiogenic shock– Bradycardia or heart block

Page 148: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Adverse reaction, SE– Arrhythmias, bradycardia, CHF, pulmonary edema

– Fatigue, weakness

• Dosage & route– 1 – 3 mg; repeat after 2 min and again in 4 hours prn

• How supplied– 1 mg/ml in 3 ml preload

Page 149: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Norepinephrine (Levophed)• Class

– Adrenergic

– Vasopressor

• Indications– Hemodynamically significant hypotension

– Septic or neurogenic shock

• Action– Beta1 adrenergic effect increases myocardial

contractility and potent alpha adrenergic effect causes arterial and venous vasoconstriction

Page 150: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Contraindications– Hypotension 2ndary to hypovolemia– Myocardial ischemia or infarction

• Precautions– Hypertension– Cardiac disease– Increases cardiac oxygen demand but does not

increase coronary blood flow

Page 151: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Adverse reactions, SE– Bradycardia, hypertension, arrhythmias,

chest pain– Dyspnea– Necrosis at IV site

• Route & dosage– 0.5 – 30 mcg/min titrate to effect– Mix 4 mg in 250 ml D5W (16 mcg/ml)

Page 152: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Sodium Bicarbonate

• Class: Alkalinizing agent

• Indications:– Metabolic acidosis 2ndary to cardiac arrest– Cyclic antidepressants

• Action:– Neutralizes excess acid

Page 153: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Contraindications and precautions– None in confirmed metabolic acidosis– Precaution: Tissue necrosis if infiltrates

• Side effects:– Metabolic alkalosis– Decreased potassium– Fluid overload

Page 154: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Dosage:– 1 mEq/kg IVP followed by 0.5 mEq/kg q 10

min.

• How supplied– 1 mEq/ml in 50 ml preload

Page 155: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

Vasopressin

• Class – Antidiuretic hormone– Non-adrenergic peripheral vasoconstrictor

• Indications– Alternative to Epinephrine in refractory Vf– May be effective with asystole, PEA

Page 156: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Action– Directly stimulates smooth muscle receptors– Increases coronary perfusion pressure

• Contraindications, precautions– None in cardiac arrest

• Adverse reactions, SE– unknown

Page 157: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.

• Dosage & route– 40 units, IVP, one time only

• How supplied– unknown

Page 158: Drugs that affect the Cardiovascular system Peggy Andrews, Instructor Chemeketa Community College.