Cardiac Medications PDF

Cardiac Medications Vanessa Evens RN,BSN,MN Fall 2024 These medications all affect the Cardiovascular System and often have more than 1 pharmacologic/ therapeutic class and can be us...

Cardiac Medications Vanessa Evens RN,BSN,MN Fall 2024 These medications all affect the Cardiovascular System and often have more than 1 pharmacologic/ therapeutic class and can be used for different things!  Part 1- Drugs that Affect the ANS Types Anticholinergic Will include agonists and antagonists affectsCholinergic Adrenergic Adrenergic blocking  Important Cardiac Pharmacology Terms Inotrope- Strength of Contraction Chronotropic – Heart Rate This Photo by Unknown Author This Photo by is licensed under Unknown Author CC BY-SA is licensed under CC BY-SA Dromotropic – Conduction through AV node This Photo by Unknown Author is licensed under CC BY-SA Cholinergic: Cholinergic Agonists parasympathomimetic effect Acetylcholine and Pilocarpine Administered by a variety of routes Pharmacotherapeutics: Atonic bladder conditions, GI disorders, Glaucoma, Salivary gland hypofunction Drug interactions: Any other drugs that affects parasympathetic NS Adverse/Side Effects: GI issues, blurred vision, bradycardia, hypotension, SOB  Cholinergic : Anticholinesterase Drugs to stop breakdown of acetylcholine Reversible: Short duration of action; examples—donepezil, neostigmine Irreversible: Long-lasting effects; examples—insecticides, nerve gas for warfare Pharmacodynamics Produce a stimulant or depressant effect on cholinergic receptors based on site, dose, and duration of action Pharmacotherapeutics: Glaucoma, GI disorders, bladder disorders, antidote for cholinergic blocking agents, dementia, Myasthenia gravis Drug interactions: other cholergic drugs, anti seizure and antibiotic meds Adverse/ Side Effects : Cardiac arrhythmias, preterm labor, GI issues, breathing problems  Given by many routes Belladonna alkaloids (atropine, scopolamine, also ipratropium) Synthetic: Glycopyrrolate Pharmacodynamics -excitatory response, Anticholinergic This Photo by Unknown except intestinal relaxation. Effects depend on dosage and administration route Author is Drugs: Stops licensed under CC BY-SA Positive inotropes: Make the heart beat harder ACTH from Positive chronotropic: Cause the heart to beat faster stimulating Pharmacotherapeutics dry up respiratory cholinergic secretions, sympathetic bradycardia, relax GI muscle, bladder relaxation and incontinence, receptors Dilates pupils for eye exams or surgery, Antidote to cholinergic and anticholinesterase drugs Drug Interactions: any cardiac drugs, antiemetics, tricyclic antidepressants Adverse Reactions: dry mouth, blurred vision tachycardia, depends on dose and closely related to therapeutic effect! Adrenergic Drugs: Catecholamine type, Sympathomimetic effect Dopamine, Epinephrine, Norepinephrine often give parenterally Pharmacodynamics: excitatory response -except intestinal This Photo by Unknown Author is licensed under CC BY relaxation, effects depend on dosage and administration route Positive inotrope: Make the heart beat harder Positive chronotropic: Cause the heart to beat faster Pharmacotherepeutics: Depend on receptor that’s activated Alpha, Beta 1 Beta 2 (for example ) Adrenergic Drugs: Catecholamine type - Sympathomimetic effect Drug interactions Alpha- and beta-adrenergic blockers, Other adrenergic meds, Tricyclic antidepressants Adverse reactions- Restlessness, anxiety, Dizziness, headache, Angina, Hypotension or hypertension, Cardiac arrhythmias, Tissue necrosis or sloughing (with infiltration), Stroke This Photo by Unknown Author is licensed under CC BY-SA Adrenergic Phenylephrine Given by many routes drugs: Non- Pharmacodynamics: Can be direct-acting, catecholamine indirect-acting, or dual-acting; stimulate alpha receptors and selective beta2 receptors type to Pharmacotherapeutics: Bronchodilation and vasoconstriction vasoconstrict Drug interactions: anesthetics, antidepressants vessels all Adverse Reactions: arrhythmias, hypotension, hypertension, headache, insomnia over the body! This Photo by Unknown Author is licensed under CC BY-SA  Alpha-adrenergic blockers prazosin, doxazosin, terazosin “sin” Clonidine -central acting alpha blocker Adrenergic Relaxation/ dilation of smooth muscle in blood vessels…decreased blocking drugs: blood pressure Disrupt Pharmacodynamics Interfere /block the synthesis, storage, Sympathetic NS release, and reuptake of norepinephrine by neurons. Antagonize epinephrine, norepinephrine, or adrenergic drugs at alpha – sympatholytic receptor sites Named by site Pharmacotherapeutics Hypertension, Peripheral vascular of action – disorders, Vascular headaches. Clonidine is also used for pain, opioid withdrawal, and mild sedative Alpha/ Beta Drug interactions Caffeine, antibiotics, cardiac medications, CNS depressants Adverse Reactions – edema, angina, orthostatic hypotension, arrhythmias  Adrenergic blocking drugs: Disrupt Sympathetic NS – sympatholytic Named by site of action – Alpha/ Beta/ Central Beta-adrenergic Blockers Most widely used adrenergic blockers; prevent stimulation of the sympathetic nervous system Can be selective or nonselective Important Nursing Process piece- Ensure patients heart rate is above 60 or per Drs orders before giving- Often a BP parameter will be given also Nonselective: Carvedilol, labetalol, sotalol, timolol Selective: Atenolol, esmolol, metoprolol  Adrenergic blocking drugs: Disrupt Sympathetic NS – sympatholytic Named by site of action – Alpha/ Beta Beta-adrenergic Blockers Pharmacodynamics Increased peripheral vascular resistance, Decreased blood pressure and negative inotropic, chromotropic and dromotropic, Bronchiole constriction Pharmacotherapeutics Angina, Hypertension, Hypertrophic cardiomyopathy, Supraventricular arrhythmias, A-flutter, A- fib, Anxiety, Migraine headaches, Open-angle glaucoma Drug Interactions Cardiac meds, Insulin, oral antidiabetic meds Adverse Reactions Hypotension, bradycardia, AV block, heart failure, fatigue, bronchospasm, GI effects Antidote: Glucagon Part 2: Control of HR, Rhythm, BP, Chest Pain, and cholesterol Inotropic drugs Antiarrhythmic drugs Antianginal drugs Antihypertensive drugs Diuretics (see chap 8) Antilipemic This Photo by Unknown Author is licensed under CC BY-NC  Glycoside- Digoxin Inotropic: Monitor for adverse effects, monitor serum potassium and digoxin Increasing the levels, monitor renal function because digoxin is excreted by the kidneys. Withhold if apical pulse is less than 60! force of the Pharmacokinetics Absorption varies according to route and drug hearts preparation, low protein binding long half life so a loading dose must be given to patients who require immediate drug effects- like a patient with contractions for a rapid SVT better cardiac Pharmacodynamics Boost intracellular calcium at the cell membrane, enabling stronger heart contractions. Positive inotrope, negative output chronotropic and dromotropic Pharmacotherapeutics Heart failure, SVT, Atrial fibrillation or flutter Drug Interactions: many, many drugs, drugs that promote Low potassium can cause dig toxicity! Cardiac meds, St Johns Wort,Ginsing Adverse Reactions: narrow therapeutic index, blurred vison, nausea and Vomiting, abdominal discomfort, cardiac dysrhythmias ANTIDODE! DIGOXIN IMMUNE FAB  Antiarrhythmics: Class I Class I: Sodium channel blockers (largest group); subcategorized into IA, IB, IC Examples: IA—procainamide hydrochloride; IB—lidocaine; IC— flecainide acetate, propafenone hydrochloride Antiarrhythmics: Ensure pulse is >60 before giving four classes I, II, Pharmacodynamics Slow conduction of hearts conduct through blocking sodium channels III, IV + Adenosine Pharmacotherapeutics For treating ventricular and (the lone wolf) supraventricular dysrhythmias- class 1C are used to treat resistant arrhythmias Drug interactions Antibiotics, other blood pressure lowering medications and antiarrhythmics Adverse effects Bradycardia, worsening arrhythmias, confusion , hypotension, seizures, GI discomfort Antiarrhythmics: Class II Beta-adrenergic antagonists/ blockers - See slides in Part 1  Antiarrhythmics: Class III Amiodarone Pharmacokinetics Absorption varies- oral amiodarone very slow to absorb, and highly protein bound. Often given IV as a loading dose Pharmacodynamics Antiarrhythmics: Thought to suppress arrhythmias by delay four classes I, II, repolarization and lengthen refractory period before heart has a chance to beat again III, IV + Adenosine Pharmacotherapeutics (the lone wolf) Usually used for life-threatening ventricular arrhythmias and SVT Drug interactions- blood thinners, anti seizure and cardiac meds Also grapefruit juice! Adverse reactions arrhythmias, Hypotension, Nausea/vomiting, Severe pulmonary toxicity, bronchospasm- black box warning  Antiarrhythmics: Class IV Calcium-channel blockers Examples: Verapamil, diltiazem, amplodipine Antiarrhythmics: Pharmacokinetics- Highly protein bound four classes I, II, Pharmacodynamics Inhibit influx of calcium ions across III, IV + cardiac and smooth muscle cells, decreasing myocardial contractility and oxygen demand, and dilating coronary Adenosine (the arteries and arterioles (negative inotropic effect ) lone wolf) Pharmacotherapeutics- Angina, Lower BP, Restore NSR Drug Interactions: Cardiac meds, lithium, alcohol- enhances effects!, blood thinners, antibiotics Anesthetics Adverse reactions Dizziness, headache, hypotension, GI issues , Bradycardia, AV block, ventricular fibrillation, ventricular asystole, Heart failure, Pulmonary edema The lone wolf: Pharmacokinetics Metabolized inside RBCs and vascular endothelial cells Adenosine is Pharmacodynamics Depresses the pacemaker activity of the SA node- stops the heart! choice for Pharmacotherapeutics Acute treatment of persistent PSVT, Wolff-Parkinson-White syndrome reentry Drug interactions- Methylxanthines, any sympathetic stimulant tachycardias Adverse reactions-Facial flushing, Shortness of breath, angina, dyspnea This Photo by Unknown Author is licensed under CC BY-NC This Photo by Unknown Author is licensed under CC BY This Antianginal drugs to Reduce myocardial demand: Three classes: 1)Nitrates (2) beta- adrenergic blockers 3) calcium channel blockers already covered) Nitrates: Administered through many routes- po, sl, buccal,transdermal, IV Nitrates: Nitroglycerine Pharmacodynamics- dilation of the veins and Nitro Nursing Considerations: arteries, reducing preload and afterload transdermal patches- rotate sites Drug interactions- Sildenafil, and remove after 12-14 hrs to have a anticholinergics, calcium-channel “patch free” interval of 10-12 hr/day blockers, alcohol (keep sensitivity to Nitrates) Adverse effects - Hypotension, tachycardia, headache Sublingual – spray, VS q5 minutes, up to 3 doses -When do you hold a dose? Variable per prescriber but usually HR