Cardiovascular Drugs PDF

Cardiovascular Drugs Module 7  Introduc5on Heart medicines include those to manage arrhythmias, angina (chest pain), blood pressure, cholesterol, and blood clots.  Acute Coronary Syndrome Acute coronary syndrome (ACS) refers to a spectrum of clinical manifesta...

Cardiovascular Drugs Module 7  Introduc5on Heart medicines include those to manage arrhythmias, angina (chest pain), blood pressure, cholesterol, and blood clots.  Acute Coronary Syndrome Acute coronary syndrome (ACS) refers to a spectrum of clinical manifesta=ons associated with acute myocardial infarc=on (NSTEMI & STEMI) and angina (stable & unstable non [UA]). stelevation Eti n elevation.it In ACS, a plaque in a coronary artery ruptures or becomes eroded, triggering the cloIng cascade. A blood clot forms, occluding the artery and interrup=ng blood and oxygen flow to cardiac muscle. Plaque forma,on within an artery  ACS Drugs Many healthcare providers use the acronym MONA to help them remember the ini=al medical treatment op=ons for a pa=ent with ACS. M: morphine O: oxygen N: nitroglycerin A: aspirin. But keep in mind that while MONA might be easy to remember, the drugs aren’t given in the MONA sequence. They’re given in the or- der of OANM.  Oxygen Oxygen (O2) is given if the pa=ent’s O2 satura=on level level is below 94%.  Aspirin The standard recommended aspirin dosage to treat ACS is 160 to 325 oral mg, given as chewable “baby” aspirin to speed absorp=on. Aspirin slows platelet aggrega=on, reducing the risk of further occlusion or re-occlusion of the coronary artery or a recurrent ischemic event.  Nitroglycerin Er To help resolve chest pain from ACS, nitroglycerin 0.4 mg is given sublingually via a spray or rapidly dissolving tablet. If the first dose doesn’t reduce chest pain, the dose can be repeated every 5 minutes W No maximum dose. Émf f A potent vasodilator, nitroglycerin relaxes vascular smooth- muscle beds. It works well on coronary arteries, improving blood flow to 7 ischemic areas. It also decreases myocardial oxygen consump=on, allowing the heart to work with a lower oxygen demand.  mechanism ofaction aanen IE i decreasicardia Nitroglycerin output INTG GTN In peripheral vascular beds, nitroglycerin causes vasodila=on and reduces preload and a^erload, resul=ng in decreased cardiac workload. If chest pain recurs once the ini=al pain resolves or decreases, the pa=ent may be placed on a con=nuous I.V. infusion of nitroglycerin. Because of the drug’s vasodilatory effects, be sure to ins=tute con=nuous blood-pressure monitoring. It is contraindicated when systolic blood pressure of less than 90 mm/Hg. They improve the flow of blood and oxygen to the heart muscle.  Morphine If chest pain doesn’t resolve with sublingual or I.V. nitroglycerin, morphine 2.5 mg may be repeated every 5 minutes via I.V. push. Total maximum dose 10 mg. I An opioid ac=ng primarily on receptors that perceive pain, morphine also acts as a venodilator, reducing ventricular preload and cardiac oxygen requirements. As with nitroglycerin, the pa=ent’s blood pressure needs to be monitored con=nuously. If hypotension occurs, elevate the pa=ent’s legs, give I.V. fluids as ordered, and monitor for signs and symptoms of pulmonary conges=on.  s I tiyo 99,1 An5hypertensive Drugs Different types of blood pressure control drugs: 1. Alpha1 blockers. alpha antagonist 2. Beta blockers. The names o^en end in ‘lol’. Betaantagonists 3. Angiotensin-conver=ng enzyme inhibitors (or ACE inhibitors): The names o^en end in ‘pril’. 4. Angiotensin receptor blockers (or ARBs). The names o^en end in ‘sartan’. 5. Calcium channel blockers (CCB). The names o^en end in ‘pine’. 6. Diure=cs. ftp.iiiiiiiiijnnertena 7. Vasodilators. hydralazine (Apresoline®), sodium Nitroprusside [Nipride®]. Zeralolol ACEIPRI EEB.IE is iiimn when antidysythmic o  Eiiiieiatition gm pgiinta.ir viii no 3 vasoconstrations its Iii  resistanced systemicvascular Nat tho  aiiiiiiii.si Angiotensin II Receptor Blockers (ARBs) A new class of medica=ons known as angiotensin II receptor blockers (ARBs) are used in pa=ents when they are unable to tolerate an ACE inhibitor medica=on. These medica=ons are not considered a primary treatment for CHF, but they are prescribed as an alterna=ve to ACE inhibitor medica=ons. ARB medica=ons are also used outside of CHF to treat hypertension and kidney dysfunc=on. ummm  Diure5cs A diure=c helps reduce the amount of excess fluid in the body by increasing the amount of urine (pee) you produce. People with heart failure may occasionally be prescribed these drugs to prevent fluid building up in the lungs, abdomen, legs, ankles and feet. A buildup of fluid can make heart failure symptoms worse. 2 ed  a nausea bdiarrhea  An5hyperlipidemic Drugs These medicines help manage cholesterol and prevent faky plaques building up in blood vessels (arteries). Cholesterol medicines stabilize faky plaques in the arteries, helping to stop them from breaking up. When this happens, a blood clot can form which can block arteries and cause a heart akack or stroke. HMG Coenzyme A Reductase Inhibitors (Sta=ns) reduce the in incidence of re-infarc=on, recurrent angina, re- hospitaliza=on, and stroke when ini=ated ASAP. Although these medica=ons are not typically ini=ated in the prehospital environment, they are part of the AHA algorithm for UA/NSTEMI. Eyeliner Eimiver Tadcholesterol Todcholestero  An5platelets The development of platelet plugs within the coronary arteries resul=ng in decreased blood flow to the oxygen- hungry cardiac muscle is the underlying mechanism for ACS. Aspirin is rapid and effec=ve in reducing aggrega=on. Clopidogrel (Plavix) is a medica=on that is categorized as an an=platelet and an=coagulant medica=on. Clopidogrel inhibits a specific site on the platelet, rendering it incapable of binding to other platelets. This medica=on alters the platelet for the remainder of its life span, which makes it a powerful an=coagulant. It is o^en used in conjunc=on with aspirin, as well as other an=coagulants, in the treatment of UA/NSTEMI. EEE.EE ni n.E i thrompocytopina  2D 3a Glycoprotein IIb/IIIa Inhibitors The mechanism of ac=on of these medica=ons is that they inhibit platelet aggrega=on by inhibi=ng the integrin glycoprotein IIb/IIIa receptor, as well as the final common pathway of platelet aggrega=on. These medica=ons are very potent platelet inhibitors. mostcommon There are three medica=ons in this class: Abciximab (ReoPro) Ep=fiba=de (Integrilin) Tirofiban (Aggrastat). The use of this class has shown definite reduc=on in death, MI, and the need for revasculariza=on. These medica=ons are used in the emergency department and extensively by cardiology. Currently they are not used in the prehospital environment.  An5coagulants Unfrac=onated heparin and low- molecular-weight heparin (LMWH) are an=coagulants that inhibit thrombin. Heparin acts at mul=ple sites in the normal coagula=on system. Heparin prevents fibrin forma=on and inhibits the ac=va=on of platelets. Enoxaparin (Lovenox) is an LMWH that works by inhibi=ng two proteins in the cloIng cascade. It also inhibits the forma=on of clots.  An5coagulants The only detriment to LMWH is that there is no way to completely reverse its an=coagulant effects. Both medica=ons are considered “blood thinners,” but they do not dissolve exis=ng clots. They are both used in ACS. They are typically ini=ated in the emergency department; however, prehospital providers may transport pa=ents who are receiving these medica=ons. Paramedics performing interfacility transports may also encounter bivalirudin (Angiomax), administered as an IV infusion for pa=ents with STEMI or being transported for a cardiac catheteriza=on. Pete t.IE i 2 7 9 10  41 Fibrinoly5cs me Reperfusion therapy is the gold standard for the treatment of STEMI. The two methods for reperfusion are pharmacologic reperfusion (fibrinoly=cs) and percutaneous coronary interven=on (PCI). Fibrinoly=cs (eg, Ac=vase) dissolve blood clots in arteries and veins. These medica=ons are administered for the emergency treatment of acute myocardial infarc=on and stroke. Fibrinoly=cs have the serious poten=al to cause life- threatening hemorrhage. Careful pa=ent selec=on and exclusion are essen=al. m iiiiiii.ie The End