Week 6 Cardiac Drugs PDF

EHS 202 Pharmacology in EMS Cardiac Drugs Part 1 10/2/2024 1 Cardiac Drugs Learning Objectives By the end of this lesson you will be able to: Discuss and understand the pharmacological management of pati...

EHS 202 Pharmacology in EMS Cardiac Drugs Part 1 10/2/2024 1 Cardiac Drugs Learning Objectives By the end of this lesson you will be able to: Discuss and understand the pharmacological management of patients with acute coronary syndromes Differentiate between antiplatelets, anticoagulants and fibrinolytics Discuss and understand the pharmacological management of patients with cardiac arrythmias Discuss and understand hypertension and associated complications 10/2/2024 ACUTE CORONARY SYNDROME 2 Learning Objectives By the end of this lesson you will be able to: Differentiate between Percutaneous Coronary Intervention (PCI) and fibrinolytics. Discuss the pharmacological management of hypertension with seizures 10/2/2024 Cardiac Drugs 3 Functional Components of the Heart Myocardium: cardiac muscle fibers are arranged into four chambers, 2 atria and 2 ventricles Conduction system: specialized tissue that conducts nerve impulses throughout the heart, SA and AV node, bundle of His, bundle branches, and Purkinje fibers Nerve supply: nerve branches from both the sympathetic and parasympathetic divisions of the autonomic nervous system, regulate heart rate and force of contraction Cardiac Drugs Main Diseases of the Cardiovascular System Acute Coronary Syndrome ACS) Congestive heart failure Cardiac arrhythmias Hypertension emergencies Cardiac Drugs Drug Review for Cardiac Emergencies Oxygen Beta Blockers Nitroglycerin (not paramedic) Aspirin ACE Inhibitors Morphine Sulfate (not paramedic) Fentanyl Tenecteplase Acetyl Salicylic Acid (Fibrinolytic) Clopidogrel Heparin Epinepherine Nifedipine Atropine (not paramedic) Amioderone 10/2/2024 Cardiac Drugs 6 Acute Coronary Syndrome ACS defines a progression of ischemic heart disease from Angina to Acute Myocardial Infarction Begins with early plaque formation in artery Inflammatory response caused by cholesterol. Plaque rupture can obstruct artery by thrombus formation and interfere with blood delivery Stable angina pectoris occurs when heart’s oxygen demand exceeds its supply Pain may be relieved with rest, oxygen supplementation Unstable angina pectoris (UA; or sometimes USA) occurs when partially occluding thrombus produces ischemia UA pain is longer in duration, may not be relieved by rest, medication. Requires immediate attention! 10/2/2024 Cardiac Drugs 7 Acute Coronary Syndrome Non-ST-segment elevation myocardial infarction (NSTEMI) The acute process in which ischemia effects myocardium with no elevation of ST segment on ECG NSTEMI has elevated cardiac enzymes than UA Indicates necrosis of cardiac tissue ST-segment elevation myocardial infarction (STEMI) The actual infarction of the cardiac tissue secondary to oxygen deprivation Cell death occurs with permanent damage to heart cells Has elevation of ST segments on ECGs 10/2/2024 Cardiac Drugs 8 Unstable Angina and NSTEMI Management Aspirin Morphine Sulphate To be discussed further in subsequent slides © Jones & Bartlett Learning. [Guy, Jeffrey S.. Pharamacology for the Prehospital Professional] 10/2/2024 ACUTE CORONARY SYNDROME 9 Unstable Angina and NSTEMI Managment Nitroglycerin has many benefits Easy to administer, effective, safe Reduces blood pressure Sublingual nitroglycerin is considered gold standard of drugs used to treat angina Before administering nitroglycerin, determine if patient is taking phosphodiesterase inhibitor medications (Viagra, Cialis) May cause intractable hypotension with nitroglycerin Assess for ECG evidence of right ventricular infarction Patients dependent on adequate preload and may decompensate 10/2/2024 Cardiac Drugs 10 Glyceryl Trinitrate (Nitroglycerin) Produces vasodilation and dilates veins, produces a reduction in cardiac preload Reduces cardiac workload congestive heart disease Improves blood flow to ischemic myocardium Decreases myocardial oxygen demand Sue Heaton/Alamy Stock Photo. [Guy, Jeffrey S.. Pharamacology for the Prehospital Professional] 10/2/2024 Cardiac Drugs 11 Morphine Sulfate Commonly used for the treatment of pain Relieve pulmonary congestion by vasodilation Lowers myocardial oxygen demand and reduces anxiety A respiratory depressant 10/2/2024 Cardiac Drugs 12 ST-Segment Myocardial Infarction (STEMI) Pathophysiology of STEMI Complete blockage of an artery by a ruptured plaque and thrombus formation Occasionally, decreased blood flow can occur secondary to vasospasm Can be caused by cocaine abuse https://medlineplus.gov/ency/imagepages/9377.htm If not reversed, infarction will occur and result in cell death 10/2/2024 Cardiac Drugs 13 STEMI Management Appropriate prehospital care includes: Starting patient on oxygen when indicated Initiating IV Placing patient on cardiac monitor Administering Oxygen (if appropriate), Aspirin, Nitroglycerin (GTN), Morphine Sulphate Remember MONA – Morphine, Oxygen, Nitrates, Aspirin Reperfusion therapy is also indicated in STEMI treatment 10/2/2024 ACUTE CORONARY SYNDROME 14 STEMI Management Reperfusion therapy is the gold standard for STEMI treatment Two methods: Pharmacologic reperfusion (fibrinolytics) Indicated in patients with onset of symptoms of less than 6 hours (JRCALC), ST-segment elevation > 1mm in 2+ contiguous leads PPCI – Primary Percutaneous Coronary Intervention Preferred when available and when can be completed within 90 min of symptom onset, also when there is increased bleeding risk 10/2/2024 Cardiac Drugs 15 https://www.dicardiology.com/content/study-concludes-very-early- percutaneous-coronary-intervention-following-fibrinolysis-safe STEMI Management Antiplatelets, such as aspirin and clopidogrel, prevent blood cells called platelets from clumping together to form a clot. Anticoagulants, such as heparin or warfarin, slow down your body's process of making clots and affect fibrin formation Fibrinolytics (Clot busters): fibrin is de-graded and the foundation of the clot is disrupted in a process called Fibrinolysis eg Streptokinase, Tenecteplase, Alteplase 10/2/2024 Cardiac Drugs 16 https://www.dicardiology.com/content/study-concludes-very-early- percutaneous-coronary-intervention-following-fibrinolysis-safe Antiplatelets Aspirin is antiplatelet medication Prohibits platelets from adhering to each other Used for analgesic, anti-inflammatory, antipyretic effects Prevents clots from forming Clopidogrel Inhibits platelet aggregation – addition of Clopidogrel alongside Aspirin reduces the risk of major ischeamic events by 1/3 in patients undergoing PPCI or thrombolysis. 10/2/2024 Cardiac Drugs 17 Anticoagulants Heparin prevents fibrin formation and inhibits activation of platelets. Administered when Tenecteplase is to be given – Clot busting drug. Thrombolysis checklist 10/2/2024 Cardiac Drugs 18 Fibrinolytics Used in acute STEMI within 6 hours of symptom onset where PCI is NOT readily available. Tenecteplase activates the fibrinolytic system, including the breaking up intravascular thrombi and emboli. Thrombolysis checklist is required to assess the patient prior to administration of Tenecteplase. 10/2/2024 ACUTE CORONARY SYNDROME 19 Sample checklist for Thrombolysis 10/2/2024 Cardiac Drugs 20  Congestive Heart Failure 10/2/2024 https://sinahealthtour.com/heart-failure/ 21 Cardiac Drugs Introduction Congestive heart failure (CHF) A cardiovascular disorder Continues to increase in prevalence, especially among the older adults 6% to 10% of all people older than 65 years having symptoms consistent with the disease CHF patients often take multiple medications Providers must be familiar with medications used for Long-term therapy of CHF Short-term drug therapy for exacerbations of CHF Pulmonary edema 10/2/2024 Cardiac Drugs 22 Congestive Heart Failure (CHF) Heart failure may be Onset of heart failure the result of may be rather acute ischemic heart after a myocardial disease infarction (MI), or diabetes mellitus may take years to hypertension develop in conditions such as hypertension, disease of the heart or diabetes mellitus valves 10/2/2024 Cardiac Drugs 23 Congestive Heart Failure (CHF) Symptoms Accumulation of excess fluid or poor peripheral perfusion (shortness of breath from pulmonary edema, edema of the extremities) Inadequate oxygen delivery to the tissues https://www.google.com/imgres?imgurl=https%3A%2F%2Flookaside.fbsbx.com%2Flookaside%2Fcrawler%2Fmedia%2F%3Fmedia_id%3D10158074538481834&imgrefurl=https%3A%2F%2Fw ww.facebook.com%2FUTHealthEastTexas%2Fposts%2Fcongestive-heart-failure-chf-occurs-when-your-heart-cannot-pump-enough-blood-to- %2F10158074538481834%2F&tbnid=abNoqc2PIK_tOM&vet=12ahUKEwjTwYfW0p_sAhVFlxoKHWegCvEQMygMegUIARDeAQ..i&docid=FXdmxL2kc3q8bM&w=9 60&h=545&q=heart%20failure %20symptoms&hl=en&client=safari&ved=2ahUKEwjTwYfW0p_sAhVFlxoKHWegCvEQMygMegUIARDeAQ 10/2/2024 Cardiac Drugs 24 Pulmonary Edema An accumulation or “backing up” of fluid in the lungs that causes heart failure and poor output of the heart. Other patients with heart failure may report only fatigue and weakness. FIGURE 10-1 congestive heart failure Guy, Jeffrey S.. Pharamacology for the Prehospital Professional] 10/2/2024 Cardiac Drugs 25 Diagnosis of CHF Often suspected in patients with shortness of breath and peripheral edema The same is also seen in chronic obstructive pulmonary disease (COPD) CHF can produce peripheral edema Not easily diagnosed by physical examination Children with heart disease can also have heart failure and resultant pulmonary edema 10/2/2024 Cardiac Drugs 26 CHF Management Follow International Liaison Committee on Resuscitation guidelines (i.e. AHA or ERC) Patients take the following medications for: Long-term control of systolic and diastolic hypertension The treatment of lipid disorders Control heart rate and treat thyroid disorders Angiotensin-converting enzyme (ACE) inhibitors 10/2/2024 Cardiac Drugs 27  CHF Management Oxygen: Patients present in significant respiratory distress or evidence of hypoxemia (oxygen saturation level