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Cardiac Drugs

Cardiac Drugs. Daymar College Lisa H. Young, RN, BSN, MA Ed. How to Use a Drug Book. Classifications and Prototype Drugs ( Pr ) Pregnancy Category Controlled Substances Availability Uses and Unlabeled Uses Action and Therapeutic Effect Contraindications and Cautious Use

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Cardiac Drugs

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  1. Cardiac Drugs Daymar College Lisa H. Young, RN, BSN, MA Ed

  2. How to Use a Drug Book • Classifications and Prototype Drugs (Pr) • Pregnancy Category • Controlled Substances • Availability • Uses and Unlabeled Uses • Action and Therapeutic Effect • Contraindications and Cautious Use • Route and Dosage • Administration • Intravenous Drug Administration • Adverse Effects • Diagnostic Test Interference • Interactions • Pharmacokinetics • Clinical Implications • Therapeutic Effectiveness http://www.youtube.com/watch?v=Jh_U8V9-Htw http://www.youtube.com/watch?v=9mcqPJFB3UE

  3. Pharmacologic Principles • Drug Names Generic name Brand name/Proprietary name Chemical name • Indications and Usage • Contraindications

  4. Pharmacologic Principles • Drug Interactions • “Red Flag” Drugs: Warfarin Aspirin Cimetinde Theophylline • Drug Reactions Adverse reaction Side effects

  5. Pharmacologic Principles • Drug Administration • Enteral Routes • Parenteral Routes • Topicals & Transdermal

  6. Pharmacologic Principles • Pharmacokinetics • Absorption • Bioavailability • Therapeutic range • Distribution

  7. Pharmacologic Priniciples • Metabolism • Elimination • Pharmacodynamics • Tolerance

  8. Pharmacologic Principles • Half-Life • Digoxin 30-60 hours • Warfarin 0.5 – 3 days • Heparin 1 – 2 days • Poisonings/Toxicity

  9. Legal Classifications of Drugs • Prescription Drugs • Nonprescription Drugs • Controlled Substances Drug Abuse Drub dependency

  10. Pharmacologic Principles • Prescription Orders • Patient Name (superscription) • Address • Drug name (inscription) • Drug dose • Route (subscription) • Frequency of administration • Number to be dispensed • Number of refills allowed • DEA # • MD Name/signature • MD address • MD Phone number http://www.youtube.com/watch?v=Mhqe12Aj1dE

  11. Reading & Writing a Prescription

  12. Reading Prescription Label • http://www.youtube.com/watch?v=S0oqYJp9t2o • http://www.youtube.com/watch?v=hRdGLzylovM

  13. Medication Administration • Ten Rights • Right patient name • Right drug • Right dosage • Right route & technique • Right time • Right documentation • Right client education • Right to refuse • Right assessment • Right evaluation http://www.youtube.com/watch?v=cm7GexPKNOc&list=PLxdOP8vuQhz9SNJLTWjTGzh3yOTsEsd6l http://www.youtube.com/watch?v=kdB0PmsX2ng

  14. Pharmacology Abbreviations

  15. “Do Not Use” Abbreviations

  16. Charting Medication Administration Examples of charting: A. 9/1/12 9:00 a.m. nitroglycerin, 1 tab, sublingually. Written instructions given to pt. Precautions explained. Told to call office at 1:00p.m. today to report progress of his condition….M. Richards, CMA (AAMA) B. 1/19/12 11:00 a.m. B 12 vitamin, 10000mcg given IM to left deltoid muscle without complications and band aid applied to injection site. Pt tolerated injection well. Pt. given written instructions for possible side effects and considerations. Pt to return in one monthly to receive monthly B 12 injections as ordered……L.Young, CCT. C. 10/10/2012 1:00 p.m. Mantoux test, 0.01 ml. Tuberculin Purified Protein Derivative, Left forearm, subcutaneous, small wheal noted. Pt. instructed not to rub or cover the are and to return for reading on 10/12/12…..M. Richards, CMA (AAMA)

  17. Six Cs of Charting • Client’s own words • Clarity • Completeness • Conciseness • Chronological • Confidentiality http://www.youtube.com/watch?v=mYGf0AdhhI4 http://www.youtube.com/watch?v=SDcmXqSvP7A

  18. Guidelines for Charting • Date/time of entry • Legible handwriting • Permanent black ink • Proper terminology, correct spelling and correct grammar • Document in sequence • Be concise • Correct errors • Sign every entry http://www.youtube.com/watch?v=pe2TQJKXZIs http://www.youtube.com/watch?v=GMVwoR0YU-I http://www.youtube.com/watch?v=Bkoic2dLFmY

  19. Apothecary System • gr = grain gal = gallon • dr = dram qt iii = 3 quarts • oz = ounce ix = 9 • lb = pound qt i = 1 quart • m = minims gr ½ = ½ grain • fl dr = fluid drams pt iiiss = 3 ½ pints • fl oz = fluid ounce 1 grain = 60 mg • pt = pint • qt - quart

  20. Metric System Metric Conversion Value Chart Kilo – Hecto-Deka-Base-Deci-Centi-Milli-X-X-Micro Gram Liter Meter 45.2 grams = 45200.0 milligrams 1cubic centimeter (cc) = 1 milliliters (ml) http://www.youtube.com/watch?v=2QR9yCkAEpE

  21. Dosage Definitions • Dosage unit • Dosage strength • Dosage ordered • Desired dose • Dose on hand • Amount to administer

  22. Drug Dosage Calculations Drug Calculation: Formula Method Ordered Dose X Available Amount Available Dose Amount to give Ordered dose: 500 mg Available dose: 1000 mg Available amount: 1 ml http://www.youtube.com/watch?v=b69Wr008dzM http://www.youtube.com/watch?v=BMDOk3RAHC4 http://www.youtube.com/watch?v=Wa9Zi64_HJk

  23. Rules of Conversion

  24. Calculating Pediatric Dosages • Clark’s Rule • Fried’s Rule • Young’s Law • West’s nomogram • Body Weight method http://www.youtube.com/watch?v=AQaeAON4GUM

  25. Patient Education • Assessment • Plan • Implementing • Document • Evaluate • Special Needs • Noncompliance http://www.youtube.com/watch?v=1HQHdpAov-I

  26. Professionalism • Cultural Considerations • The Life Span • Understanding and knowledgeable about medication • In the Workplace • The Law

  27. Inotropic, Chronotropic and Dromotropic Drugs • http://www.youtube.com/watch?v=eboZYnTF6vs

  28. http://www.youtube.com/watch?v=mQirK5RxhFo

  29. Neurological Control of the Heart and Blood Pressure • Sympathetic Nervous System • Adrenergic Response _ Catecholamines _ Adrenaline _ Beta 1-Adrenergic Receptors _ Alpha 1-Adrenergic Receptors http://www.youtube.com/watch?v=lw1Ag86SvlY

  30. Neurological Control of the Heart and Blood Pressure • Baroreceptors _ Pressure receptors _Mechanoreceptors _Efferent pathways

  31. Neurological Control of the Heart and Blood Pressure • Chemoreceptors _ carotid artery _ Elevated arterial carbon dioxide level _ Heart rate increases _ Vasoconstriction

  32. Neurological Control of the Heart and Blood Pressure • Parasympathetic Nervous System • Vagal Response _ Cholinergic Response _ Acetylcholine _ Nicotinic Cholinergic Receptors _ Muscarinic Cholinergic Receptors

  33. Neurological Control of the Heart and Blood Pressure • Renin-Angiotensin-Aldosterone System _ Release of Renin _ Angiotensin I → Angiotensin II _ Angiotensin-converting enzyme (ACE) http://www.youtube.com/watch?v=M0vpn6YVwiI

  34. Cardiovascular Pharmacology • Preload The stretching of the ventricle at the end of diastole. _ Increasing Preload Administer extracellular fluid expander Decrease dose of stop drugs that cause venous vasodilation _ Decreasing Preload Stop or decrease fluid Diuretics ACE inhibitors Aldosterone antagonists Venous vasodilators http://www.youtube.com/watch?v=FjdJdoZcbyA http://www.youtube.com/watch?v=lPK017oR3bw http://www.youtube.com/watch?v=mQirK5RxhFo

  35. Cardiovascular Pharmacology • Afterload The resistance that the ventricle must overcome to eject its contents. _ Increasing Afterload Sympathomimetics (stimulate alpha receptors) ADH _ Decreasing Afterload Smooth muscle relaxants Calcium channel blockers Alpha receptor blockers ACE inhibitors ARBs & PDE http://www.youtube.com/watch?v=NFcg62I54w8

  36. Cardiovascular Pharmacology • Contractility _Increasing Contractility Sympathomimetics (stimulate B1 receptors) PDE inhibitors Cardiac glycosides _Decreasing Contractility Beta-blockers Calcium channel blockers http://www.youtube.com/watch?v=_sxiloNshfE

  37. Cardiovascular Pharmacology • Heart Rate Cardiac output = heart rate X stroke volume Increasing heart rate Parasympatholytics Sympathomimetics (stimulate B1 receptors) Decreasing heart rate Beta-blockers (block B1 receptors) Calcium channel blockers Cardiac glycosides Other antiarrhythmics http://www.youtube.com/watch?v=PJ8WsZOywgo http://www.youtube.com/watch?v=OVVwyCCyH8E

  38. Sympathomimetics/Adrenergics • Stimulate the sympathetic nervous system • Increase heart rate • Increase contractility • Increase afterload http://www.youtube.com/watch?v=HklZH5QdOeE

  39. Epinephrine • Stimulates: B1 & B2 (low dose) & Alpha receptors (high doses) • Results: increased contractility, automaticity, bronchodilation and selective vasoconstriction • Uses: advanced cardiac life support, anaphylactic shock, hypotension/profound bradycardia • Considerations: instant onset, peak 20 minutes and given IV every 3 – 5 minutes for cardiac standstill http://www.youtube.com/watch?v=9cpD8lG6DvY

  40. Dobutamine • Stimulates: primarily B1, some alpha receptors and modest B2 • Results: increased contractility, increased AV node conduction, modest vasoconstriction • Uses: as an inotrope with modest afterload reduction • Considerations: onset 1 – 2 minutes, peak 10 minutes, blood pressure is variable: B2 causes vasodilation, increased cardiac output increases blood pressure

  41. Dopamine • Stimulates: dopaminergic and some B1 at low doses, B1 at moderate doses, pure alpha stimulation at high doses (>10 mcg/kg/min) • Results: increased contractility at small and moderate doses, increased conduction, vasoconstriction at high doses, does not treat or prevent renal failure at low doses • Uses: refractory hypotension and shock • Considerations: IV onset 1 – 2 minutes & peak 10 minutes http://www.youtube.com/watch?v=YrEn_1FBBsw

  42. Norepinephrine • Stimulates: primarily alpha stimulation, some B1 • Results: potent vasoconstriction (vasopressor) and some increased contractility (positive inotrope) • Uses: refractory hypotension, shock, used as vsopressor but with inotrope properties • Considerations: Rapid IV onset, duration 1-2 minutes

  43. Phenylephrine(synthetic compound) • Stimulates: direct effect is dominant alpha stimulation, no substantial B1 effect at therapeutic doses, indirect effect; causes release of norepinephrine • Results: potent vasoconstriction (vasopressor) • Uses: refractory hypotension • Considerations: rapid IV onset, duration of action 10 – 15 minutes

  44. Non-Sympathomimetic Medications • Arginine vasopressin used as vasopressor • Milrinone (phosphodiesterase inhibitor) used as an inotrope • Side effects: ventricular dysrhythmias exacerbation of accelerated ventricular rate with atrial dysrhythmias

  45. Medications Affect Renin-Angiotensin-Aldosterone System Angiotensin-Converting Enzymes (ACE) Inhibitors • prevent conversion of angiotensin I to angiotensin II • inhibits angiotensin-converting enzyme • promotes arterial vasodilation • reduces afterload Benazepril Captopril Enalapril Fosinopril Lisinopril QuinaprilRamipril

  46. Angiotensin II Receptor Blockers • Blocks angiotensin II • Similar hemodynamic effects as ACE inhibitors • Used in place of ACE inhibitors if they are not tolerated due to intractable cough or angioedema • ARBs end with “sartan” • Candesartan, first drug approved by FDA for heart failure CandesartanIrbesartanTelmisartan EprosartanLosartanValsartan

  47. Aldosterone Antagonists • mineralocorticoid hormone • hold sodium and water and excrete potassium • potassium-sparing diuretics • decrease in preload • minimized release of catecholamines • improved endothelial function • antithrombotic effects • decreased vascular inflammation and myocardial fibrosis SpironolactoneEplerenone http://www.youtube.com/watch?v=OAkbKN6AuWE

  48. Beta-Blockers • block B1 or B2 receptors • decrease heart rate and contractility • bronchial and peripheral vasoconstriction • management of heart failure • management of stable angina • management of acute coronary syndromes • decrease myocardial oxygen demand • increase coronary perfusion • management of hypertension Atenolol Metoprolol Propranolol Esmolol

  49. Calcium Channel Blockers • decrease the flux of calcium • decrease heart rate, contractility and afterload • degree of negative inotropic effect • reduce coronary and systemic vascular resistance • decreasing myocardial oxygen demand • not indicated in the treatment of heart failure • adverse effects: peripheral edema, worsening heart failure, hypotension and constipation Verapamil Dihydropyridine CCB Diltiazem

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