Pharmacological Interventions in Cardiovascular Care

Pharmacological Interventions

• Vasopressors:
  • Used to increase blood pressure in hypotensive patients
  • Examples: dopamine, norepinephrine, vasopressin
  • Side effects: tachycardia, arrhythmias, vasoconstriction
• Inotropes:
  • Used to increase cardiac contractility in patients with cardiogenic shock
  • Examples: dobutamine, milrinone
  • Side effects: tachycardia, arrhythmias, increased myocardial oxygen demand
• Anti-arrhythmics:
  • Used to treat cardiac arrhythmias
  • Examples: amiodarone, lidocaine, procainamide
  • Side effects: pro-arrhythmic effects, QT prolongation, bradycardia

Pain Management

• Assessment:
  • Use pain scales (e.g. numerical rating scale, visual analog scale)
  • Monitor for signs of pain (e.g. tachycardia, hypertension, agitation)
• Pharmacological interventions:
  • Opioids (e.g. morphine, fentanyl)
  • Non-opioids (e.g. acetaminophen, NSAIDs)
  • Adjuvants (e.g. gabapentin, ketamine)
• Non-pharmacological interventions:
  • Comfort measures (e.g. positioning, relaxation techniques)
  • Alternative therapies (e.g. acupuncture, massage)

Cardiovascular Instability

• Hypotension:
  • Defined as systolic blood pressure < 90 mmHg
  • Causes: sepsis, hypovolemia, cardiogenic shock
  • Management: fluid resuscitation, vasopressors
• Hypertension:
  • Defined as systolic blood pressure > 180 mmHg
  • Causes: pain, anxiety, hypertension
  • Management: antihypertensives, sedation
• Cardiac arrhythmias:
  • Causes: electrolyte imbalance, cardiac disease, medication side effects
  • Management: anti-arrhythmics, cardioversion, defibrillation

Respiratory Failure

• Types:
  • Hypoxemic respiratory failure (e.g. pneumonia, ARDS)
  • Hypercapnic respiratory failure (e.g. COPD, respiratory muscle weakness)
• Management:
  • Oxygen therapy
  • Mechanical ventilation
  • Non-invasive ventilation (e.g. CPAP, BiPAP)
  • Respiratory medications (e.g. bronchodilators, mucolytics)

Sedation and Analgesia

• Sedation:
  • Goals: anxiety reduction, comfort, amnesia
  • Medications: benzodiazepines (e.g. midazolam), propofol, dexmedetomidine
  • Side effects: respiratory depression, hypotension, delirium
• Analgesia:
  • Goals: pain relief, comfort
  • Medications: opioids (e.g. fentanyl, morphine), non-opioids (e.g. acetaminophen, NSAIDs)
  • Side effects: respiratory depression, constipation, nausea
• Sedation and analgesia protocols:
  • Used to guide medication administration and titration
  • Examples: Richmond Agitation-Sedation Scale (RASS), Sedation-Agitation Scale (SAS)

Pharmacological Interventions

• Vasopressors increase blood pressure in hypotensive patients, examples include dopamine, norepinephrine, and vasopressin, and can cause tachycardia, arrhythmias, and vasoconstriction.
• Inotropes increase cardiac contractility in patients with cardiogenic shock, examples include dobutamine and milrinone, and can cause tachycardia, arrhythmias, and increased myocardial oxygen demand.
• Anti-arrhythmics treat cardiac arrhythmias, examples include amiodarone, lidocaine, and procainamide, and can cause pro-arrhythmic effects, QT prolongation, and bradycardia.

Pain Management

• Assess pain using numerical rating scales and visual analog scales, and monitor for signs of pain such as tachycardia, hypertension, and agitation.
• Pharmacological interventions for pain management include opioids like morphine and fentanyl, non-opioids like acetaminophen and NSAIDs, and adjuvants like gabapentin and ketamine.
• Non-pharmacological interventions include comfort measures like positioning and relaxation techniques, and alternative therapies like acupuncture and massage.

Cardiovascular Instability

• Hypotension is defined as systolic blood pressure < 90 mmHg, causes include sepsis, hypovolemia, and cardiogenic shock, and is managed with fluid resuscitation and vasopressors.
• Hypertension is defined as systolic blood pressure > 180 mmHg, causes include pain, anxiety, and hypertension, and is managed with antihypertensives and sedation.
• Cardiac arrhythmias are caused by electrolyte imbalance, cardiac disease, and medication side effects, and are managed with anti-arrhythmics, cardioversion, and defibrillation.

Respiratory Failure

• Respiratory failure can be hypoxemic (e.g. pneumonia, ARDS) or hypercapnic (e.g. COPD, respiratory muscle weakness), and is managed with oxygen therapy, mechanical ventilation, non-invasive ventilation, and respiratory medications like bronchodilators and mucolytics.

Sedation and Analgesia

• Sedation goals include anxiety reduction, comfort, and amnesia, and is achieved with medications like benzodiazepines, propofol, and dexmedetomidine, which can cause respiratory depression, hypotension, and delirium.
• Analgesia goals include pain relief and comfort, and is achieved with medications like opioids and non-opioids, which can cause respiratory depression, constipation, and nausea.
• Sedation and analgesia protocols, such as the Richmond Agitation-Sedation Scale (RASS) and Sedation-Agitation Scale (SAS), guide medication administration and titration.

This quiz covers pharmacological interventions used to manage cardiovascular conditions, including vasopressors, inotropes, and anti-arrhythmics. Learn about their uses, examples, and side effects.