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CARDIOVASCULAR MEDICATIONS

FIRST DO NO HARM . 5/28/2012. 2. There are 5 rights to patient medication administration:Right patient Right drug Right dose Right route Right time . 5/28/2012. 3. Once you have given the Drug, you can't get it back, so do it right the first time!. Autonomic Nervous System. 5/28/2012. 4. Sympa

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CARDIOVASCULAR MEDICATIONS

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    1. 5/31/2012 1 CARDIOVASCULAR MEDICATIONS

    2. FIRST DO NO HARM 5/31/2012 2 There are 5 rights to patient medication administration: Right patient Right drug Right dose Right route Right time

    3. 5/31/2012 3 Once you have given the Drug, you can’t get it back, so do it right the first time!

    4. Autonomic Nervous System 5/31/2012 4 Sympathetic system ("fight or flight") Parasympathetic system ("rest and digest" or "feed and breed")

    5. 5/31/2012 5 Sympathetic system Adrenal medulla Epinephrine and Norepinephrine Adrenergic Receptors (alpha or beta receptors

    6. Drugs Affecting the Autonomic Nervous System 5/31/2012 6 Drugs stimulate sympathetic nervous system = Agonists = Sympathomimetics Drugs inhibit sympathetic nervous system = Antagonists = sympatholytics = Blockers (alpha and beta)

    7. Drugs Affecting the Autonomic Nervous System 5/31/2012 7 Drugs stimulate parasympathetic nervous system = Parasympathomimetics (?ACH) Drugs inhibit parasympathetic nervous system = Parasympatholytics (?ACH)

    8. Beta blockers 5/31/2012 8 Reduce the rate and force of contraction of the heart Bronchoconstriction Given for hypertension and angina Not for asthma E.g. Inderal

    9. Beta agonists 5/31/2012 9 Bronchodilation Tachycardia and elevation of blood pressure Used in anaphylactic shock and cardiac arrest E.g. Adrenalin

    10. Beta-2 agonists 5/31/2012 10 Bronchodilation May also cause tachycardia and palpitations in high dose E.g. Ventolin

    11. Parasympathomimetics 5/31/2012 11 Mimic the effects of acetylcholine, e.g. bethanechol (Urecholine), Or mimic acetylcholine by blocking acetylcholinesterase (e.g. Physostigmine)

    12. Parasympathetic blockers (Parasympatholytics) block effect of acetylcholine. Common example is Atropine 5/31/2012 12

    13. Medications Affecting the Cardiovascular System 5/31/2012 13 Medications Used for Cardiovascular Conditions Medications by Therapeutic classifications

    14. Medications Used for Cardiovascular Conditions 5/31/2012 14 Antihypertensives: Diuretics Alpha Blockers Beta Blockers Calcium Channel Blockers Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors) Angiotensin Receptor Blockers Vasodilators Centrally Acting Agents

    15. Medications Used for Cardiovascular Conditions 5/31/2012 15 Antianginals: Beta Blockers Calcium Channel Blockers Coronary Vasodilators including Nitrates

    16. Medications Used for Cardiovascular Conditions 5/31/2012 16 Antidysrythmics: Cardiac Glycosides including Digoxin Beta Blockers Calcium Channel Blockers Various – Adenosine, Procainamide, Quinidine, Lidocaine, Bretylium

    17. Medications Used for Cardiovascular Conditions 5/31/2012 17 Cardiac Sympathomimetics: Dobutamine Dopamine Epinephrine Norepinephrine Isoproterenol Phenylephrine

    18. Medications Used for Cardiovascular Conditions 5/31/2012 18 Congestive Heart Failure Therapy: Angiotensin Converting Enzyme (ACE) Inhibitors Cardiac Glycosides (Digoxin) Diuretics Sympathomimetics/Inotropes

    19. Medications by Therapeutic Classifications 5/31/2012 19 Diuretics: Loop Diuretics – Furosemide Osmotic Diuretics – Mannitol Potassium Sparing Diuretics – Amiloride, Spironolactone, Triamterene Thiazide Diuretics – Hydrochlorothiazide

    20. Medications by Therapeutic Classifications 5/31/2012 20 Beta Adrenergic Blocking Agents Propranolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor) Labetolol (Trandate) Esmolol (Brevibloc

    21. Medications by Therapeutic Classifications 5/31/2012 21 Calcium Channel Blocking Agents Nifedipine (Adalat) Diltiazem (Cardizem) Verapamil (Isoptin) Amlodipine (Norvasc) Felodipine (Renedil)

    22. Medications by Therapeutic Classifications 5/31/2012 22 Angiotensin converting enzyme inhibitors Captopril (Capoten) Enalapril (Vasotec) Enalaprilat (Vasotec IV) Fosinopril (Monopril) Ramipiril (Altace)

    23. Medications by Therapeutic Classifications 5/31/2012 23 Angiotensin II receptor antagonists losartan (Cozaar) valsartan (Diovan)

    24. Medications by Therapeutic Classifications 5/31/2012 24 Vasodilators Hydralazine (Apresoline) Nitroglycerin Sodium Nitroprusside

    25. Medications by Therapeutic Classifications 5/31/2012 25 Sympathomimetics: Dobutamine Dopamine Epinephrine Norepinephrine Isoproterenol Phenylephrine

    26. Medications by Therapeutic Classifications 5/31/2012 26 Antidysrythmics: Cardiac glycosides including Digoxin Beta Blockers Calcium Channel Blockers Various – Adenosine, Procainamide, Quinidine, Lidocaine, Bretylium

    27. Drugs Actions 5/31/2012 27 Beta Adrenergic Blocking Agents Calcium Channel Blocking Agents Angiotensin Converting Enzyme Inhibitors Angiotensin II Receptor Blockers Diuretics Cardiac Sympathomimetics and Antidysrythmics

    28. Beta Adrenergic Blocking Agents 5/31/2012 28 These drugs block the beta-receptors in the sympathetic nervous system can be useful in situations where sympathetic activity is excessive or inappropriate. E.g. hypertension, angina, dysrythmias

    29. Calcium Channel Blocking Agents 5/31/2012 29 Contractions of cardiac and smooth muscle cells are dependent on the movement of calcium ions into the cells through specific channels. If calcium reduced, there will be changes in cardiac electrical activity and vasodilation Used in dysrythmias, angina, and hypertension

    30. Angiotensin Converting Enzyme Inhibitors 5/31/2012 30 Acts on renin-angiotensin-aldosterone system If the conversion of angiotensin I to angiotensin II by enzymes is blocked, there will be reduction in blood pressure by vasodilation

    31. Angiotensin II Receptor Blockers 5/31/2012 31 They block angiotensin II effect at the angiotensin type 1 receptors. Thus there is vasodilation and blood pressure lowering.

    32. Diuretics 5/31/2012 32 Most diuretics act by increasing sodium excretion by the kidney Where sodium goes, so does water, so that when the sodium remains in the kidney filtrate (urine), more water will be held, and thus urine volume or fluid excretion goes up.

    33. Diuretics 5/31/2012 33 As sodium is excreted, so is potassium, so these drugs can considerably upset potassium levels in the blood, leading to cardiac abnormalities. Potassium supplements like Slow K

    34. Cardiac Sympathomimetics and Antidysrythmics 5/31/2012 34 Most are used within the context of resuscitation from cardiac arrest.

    35. Medications in the Context of Cardiac Arrest 5/31/2012 35 Inotropes (Sympathomimetics) Antidysrythmics Vasodilators Beta Blockers Diuretics Analgesics Thrombolytics

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