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  1. COMMON EMERGECY DRUGS 1.ANTICOAGULANTSAnticoagulants prevents the extension and formation of clots by inhibiting factors in the clotting cascade and decreasing blood coagulability.Anticoagulants are administered when there is evidence of clot formation, MI, unstable angina, atrialfbirillationdeep vein thrombosis, pulmonary embolism.Anticoagulants are contraindicated with active bleeding disorder or blood dyscrasias, ulcers, liver and kidney disease, and hemorrhagic brain injuries.

  2. Common AnticoagulantsHeparin sodiumWarfarin sodium (Coumadin)SallicylatesSulfonamidesGingko and ginseng (herbs)Phinyltoin (Dilantin)Cimetidine(Tagament)Allopurinol (Zyloprim)

  3. Heparin sodium – prevents thrombin form converting fibrigen to fibrin. Heparin prevents thromboembolism. The therapeutic dose does not dissolve clots but prevents new thrombus formation.Blood levels. The normal activated partial thromboplastin time (aPTT) is 20 TO 36 seconds is most laboratory. To maintain a therapeutic level of anticoagulantion when the client is receiving a continuous infusion of heparin, the aPTT should be 1.5 to 2.5 times the normal value.

  4. Warfarin sodium (Coumadin)Warfarin sodium suppresses coagulation by acting as an antogonist of vitamin K by inhibiting four dependent clotting factors (X, IX, VII, and II). Warfarin sodium prolongs clotting time and is monitored by the prothrombin time (PT). It is used for long-term antcoagulation and is used mainly to prevent thromboembolic conditions such as thrombophlebitis, pulmonary edema, embolism formation caused by atrial fibrillation and MI.Blood levels. The normal PT is 9.6 to 11.8 seconds. The therapeutic range is 1.5 to 2 times the normal value.The normal INR is 1.3 to 2.0

  5. 2. THROMBOLYTIC MEDICATIONSThrombolytic medications activate plasminogen; plasminogen generates plasmin (the enzyme that dissolve clots). Thrombolytic medications are used earlly in the course of myocardial infarction (within 4 to 6 hours of the onset of the infarct) to restore blood flow, limit myocardial damage, preserve left ventricular function, and prevent death.Common Thrombolytic medicationsAlteplase (Activase, Tpa)Reteplase (Retavase)Streptokinase (Streptase) (common use)Urokinase (Abbokinase)

  6. 3. POSITIVE INOTROPIC AND CARDIOTONIC MEDICATIONSThese medications stimulate myocardial contractility and produce a positive effect.Dopamine – used as short-term rescue measure for clients with sever, acute cardiac failure.Increase myocardial contractility, thereby improving cardiac performance. Dilate renal blood vessel and increases renal blood flow and urine output.Dobutamine- used for short-term management of heart failure. Increases myocardial contractility, thereby improving cardiac performance.

  7. 4.CARDIAC GLYCOSIDES Cardiac glycosides - inhibit the sodium-patassium pump, thus increasing intracellular calcium, which causes the heart muscle fibers to contract more efficiently. Cardiac glycosides produce a positive inotropic action, which increases the force of myocardial contractions. Cardiac glycosides produce a negative chronotropic action, which slow the heart rate. Cardiac glycosides produce a negative dromotropic action that slows conduction velocity through the atrioventricular (AV) node. It is used for heart failure and cardiogenic shock, atrial tachycardia, atrial fibrillation, and atrial flutter.0Common Cardiac glycosidesDigoxin (Lanoxicaps, Lanoxin, Digitek)

  8. 5.ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITOR AND ANGIOTENSIN II RECEPTOR BLOCKERS (ARBs).ACE inhibitors prevent peripheral vasoconstriction by blocking conversion of angiotensin 1 to angiotensin II. ARBs prevent periphiral vasoconstriction and secretion of aldosterone and block the binding af A11 to type 1 A11 receptors.These medications are used as emergecy drugs for hypertension and heart failure.COMMON ACE INHIBITORCaptopril (Capoten)Enalapril (Vasotec)

  9. 6.B-ADRENERGIC BLOCKERSB-Adrenergic blockers –inhibit response to B-adrenergic stimulation, thus decreasing cardiac output. B-adrenergic blockers block the release of catecholamines, epinephrine, and norepinephrine, thus decreasing the heart rate and BP.B-adrenergic blockers decrease the workload of the heart and decrease oxygen demands. Use for angina, dysrthymias, hypertension, migraine headache, prevention of MI and glaucoma.COMMON B-ADRENERGIC BLOCKERS (end with olol)Popanolol (corgard)Atenolol (tenormin)Metoprolol (lopressor)Timolol (blocarden)Atenolol (tenormin)

  10. 7. CALCIUM CHANNEL BLOCKERSCalcium channel blockersdecrease cardiac contractility (negative inotropic effect by relaxing smooth muscle) and the workload of the heart, thus decreasing the need of oxygen. Calcium channel blockers promote vasodilation of the coronary and peripheral vessels. Use for angina, dysrhythmias, or hypertension.COMMON CALCIUM CHANNEL BLOCKERSDiltiazem (cardizem) (common emergency drug)Nicardipine (dynacirc)Nifedipine (carden)Verapamil (calan) (common emergency drug)

  11. 8. ADRENERGIC AGONIST1. Dopamine (intropine) – increase BP and cardiac output through positive inotropic action and increase renal blool flow through its action on alpha and beta receptors.2. Dobutamine–increasemyocardial force and cardiac output through stimulation of beta receptors.3. Epinephrine (adrenalin) – used for cardiac stimulation in cardiac arrest. Used for bronchodilator in asthma or allergic reactions.4. Norepinephrine (levophed) – stimulates the heart in cardiac arrest. Vasoconsticts and increases BP in hypotension and shock.

  12. ANTIDYSRHYTHMIC MEDICATIONSAntidysrhythmicmedications suppress dysrhythmias by inhibiting abnormal pathways of electrical conduction through the heart.Class 1 antidysrhythmic are sodium channel blockersClass 11 antidysrhythmic are B-blockersClass 111 antidysrhyrthmic are potassium channel blockersClass lVantidysrhythmic are calcium channel blockers

  13. CLASS 1 ANTIDYSRHYTHMIC DRUGS SODIUM CHANNEL BLOCKERSClass 1A antidysrhythmic SODIUM CHANNEL BLOCKERS1. Disopyramide (norplace)2. Procainamide (procanbid)3. Quinidine sulfateClass 1B antidysrhythmic SODIUM CHANNEL BLOCKERS1. Lidocaine (xylocaine)2. Mexiletine hydrochloride (mexitil)3. Phenytoin (dilantin)Class 1C antidysrhythmic SODIUM CHANNEL BLOCKERS1.Flecainide acetate (tambocor)2. Propafenone hydrochloride (rythmol)

  14. CLASS 11 ANTIDYSRHYMIC DRUGS B-BLOCKERS1. Propanolol (inderal)2. Esmolol (brevibloc)CLASS 111 ANTIDYSRHYMIC DRUGS POTASSIUM CHANNEL BLOCKERS1. Amiodarone (cordarone)2. BretyliumCLASS IV ANTIDYSRHYTHMIC DRUGS CALCIUM CHANNEL BLOCKERS1. Verapami (calan)2. Diltiazem (cardizem)

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