Drug Classifications
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Cardiac Drug Classifications

Cardiac Drug Classifications

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Drug Classifications Drug Classifications Presentation Transcript

  • Cardiac Drug Sherry L. Knowles, RN, CCRN, CRNI Classifications
  • Cardiac Drugs
    • ACE Inhibitors Anti-Coagulants
    • Nitrates Calcium Channel
    • Blockers
    • Vasopressors Anti-Dysrhythmiias
    • GPII b III a Inhibitors
    • Diuretics
    • Angiotensin II Anti-Inflammatory
    • Antagonists
    • Inotropics Beta Blockers
    • Alpha Blockers Anti-Lipidemics
    • Thrombolytics
    • Inotropic
    Cardiac Drugs Drug actions Chronotropic Dromotropic
    • Inotropic
      • Affects Contractility
    Cardiac Drugs
        • Positive Inotropics  the force
        • of myocardial contraction.
        • Negative Inotropics  the force
        • of myocardial contraction.
    • CHRONOTROPIC
      • Affects Heart Rate
    Cardiac Drugs
        • Beta Adrenergic and Blocking Agents
        • Slowing rates can  filling time
        • Antiarrhythmics
        • Beta Blockers
        • Calcium Channel Blockers
    Cardiac Drugs
    • Dromotropic
      • Affects Conductivity
    • Alpha receptors
    Cardiac Drugs D opa receptors Beta receptors
    • Alpha receptors
      • On Blood Vessels
    Cardiac Drugs
        • Stimulation causes vasoconstriction
        • Blocking cause vasodilation
    • Beta receptors
      • On Heart and Lungs
    Cardiac Drugs
        • Beta 1 and Beta 2
        • Cardioselective vs Non-Selective
    • Beta receptors
      • Beta 1
    Cardiac Drugs
        • Stimulation causes positive
        • inotropic effects
        • Blocking causes negative
        • inotropic effect
    • Beta receptors
      • Beta 2
    Cardiac Drugs
        • Stimulation causes bronchodilation
        • Blocking causes bronchoconstriction
    • Dopa receptors
      • On Renal (Mesenteric) Vessels
    Cardiac Drugs
        • Stimulation causes vasodilation
        • Blocking causes vasoconstriction
    • ALPHA BLOCKERS
    Cardiac Drugs
    • Used for hypertension,
    • BETA BLOCKERS
    Cardiac Drugs
    • Slow Heart Rate
      • Negative Chronotropic
    • Lower BP
    • Slow Conduction
      • Negative Dromotropic
    • Encourage Electrical Stability
    • CALCIUM CHANNEL BLOCKERS
    Cardiac Drugs
    • Slows Heart Rate
      • Negative Chronotropic
    • Vasodilator
    • Prevents Arterial Vasospasm
    • Beta Blockers : Adverse Effects
    Cardiac Drugs
    • Fatigue
    • Bronchospasm
    • Impotence
    • Depression
    • Aggravation of heart failure
    • VASODILATORS
    Cardiac Drugs
    • ACE INHIBITORS
    Cardiac Drugs
    • Causes Vasodilation
    • Reduces Afterload
        • Reduces work of heart
    •  Remodeling Effects
    • ANGIOTENSIN II ANTAGONISTS
    Cardiac Drugs
    • Vasodilator
    • Reduces Afterload
    • May be used in place of ace inhibitors
    • NITRATES
    Cardiac Drugs
    • Arterial & Venous Vasodilator
    • Reduces Preload & Afterload
    • Reduces Work of the Heart
    • Improves Cardiac Output
    • Ca 2+ Channel Blockers : Adverse Effects
    Cardiac Drugs
    • Less severe with oral than intravenous application
    • Hypotension
    • Severe sinus bradycardia or heart block (especially with  -blockers)
    • Ca 2+ Channel Blockers : Adverse Effects
    Cardiac Drugs
    • Less severe with oral than intravenous application
    • Hypotension
    • Severe sinus bradycardia or heart block (especially with  -blockers)
    • DIURETICS
    Cardiac Drugs
    • Reduce Preload
    • Reverse Fluid Overload
    • Reduces Pulmonary Congestion
    • VASOPRESSORS
    Cardiac Drugs
    • Vasoconstrictors
      • Alpha Adrenergic
    •  Blood Pressure
    •  Heart Rate
      • Positive Chronotropic
    • ANTIDYSRHYTHMICS
    Cardiac Drugs
    •  Heart Rate
      • Negative Chronotropic
    • Slow Conduction
      • Negative Dromotropic
    • Also Includes:
      • Beta Blockers
      • Calcium Channel Blockers
    • ANTI-HYPERTENSIVES
    Cardiac Drugs
      • Presynaptic agents: centrally acting, peripherally acting
      • Dieuretics
      • Beta Blockers
      • Alpha Blockers
      • Vasodilators
      • Calcium Entry Blockers
      • Angiotensin Converting Enzyme (ACE) Inhibitors
    • GpIIbIIIa Inhibitors
    Cardiac Drugs
    • ReoPro
        • Long Half-life
    • Integrilin
    • Aggrastat
    • GpIIbIIIa Inhibitors
    Cardiac Drugs
    • ReoPro, Integrilin, Aggrastat
    • Monitor Platelet Levels
      • Check within 4-6 hours after initiation
      • Monitor daily and prn any bleeding
    • ANTICOAGULANTS
    Cardiac Drugs
    • Heparin – administered by injection
    Low Molecular Weight Heparin Can be given on fix-dosed schedule and do not require APTT monitoring Less likely to cause thrombocytopenia Warfarin – Coumadin Rat poison Antagonist of vitamin K – blocks synthesis of vitamin K dependent factors in coagulation cascade Peak effects take several days Antiplatelet drugs
    • THROMBOLYTICS
    Cardiac Drugs Streptokinase tPA
    • ANTI-SEPSIS / ANTI-INFLAMMATORY
    Cardiac Drugs
    • Activated Protein C (Xygris)
        • May cause bleeding
    • ANTI-LIPIDEMICS
    Cardiac Drugs
    • HDL
      • High Density Lipoprotein
      • Associated with  risk
    • LDL
      • Low Density Lipoprotein
      • Associated with  risk
    • Look at Ratio HDL  LDL
    • ADENOSINE
    Cardiac Drugs Stops supraventricular tachycardia Extremely short half-life
    • AMIODARONE
    Cardiac Drugs Amiodarone – Class III potassium channel blockers – delays repolarization – prolongs refractory period Reduced automaticity SA node, reduced conduction thru AV node
    • DIGOXIN
    Cardiac Drugs
    • Positive Inotropic
      • Increases force of contraction
    • Negative Dromotropic
      • Slows conduction
    • Negative Chronotropic
      • Slows heart rate
    • DOPAMINE
    Cardiac Drugs
    • Positive Inotropic
      • Increases contractility
    • Alpha, Beta, & Dopa Adrenergic
      • Dose dependent
    • Positive Chronotropic
      • May increase heart rate
    • DOBUTAMINE
    Cardiac Drugs
    • Positive Inotropic
      • Increases contractility (Beta 1 stimulation)
    • Beta 1 and Beta 2 Adrenergic
    • Vasodilator
    • Positive Chronotropic
      • May increases heart rate
    • PRIMACOR
    Cardiac Drugs
    • Positive Inotropic
      • Increases contractility
    • Vasodilator
      • Acts similar to Dobutamine
    • EPINEPHRINE
    Cardiac Drugs
    • Alpha Adrenergic
      • Potent Vasoconstrictor
    • Beta 1 and Beta 2 Adrenergic
      • Positive Inotrope
      • Bronchodilator
    • LEVOPHED (Norepinephrine)
    Cardiac Drugs
    • Alpha Adrenergic
      • Potent Vasoconstrictor
    • Beta 1 Adrenergic
      • Positive Inotrope
    • NEO-SYNEPHRINE
    Cardiac Drugs
    • Alpha Adrenergic
      • Vasoconstrictor
    • Used for Severe Hypotension
    • Used for Drug Induced Hypotension
    • NITROGLYCERIN
    Cardiac Drugs
    • Venous & Arterial Vasodilator
    • Dilates Coronary Arteries
    • Nitrate
      • Vasodilator
        •  Preload (primarily)
        •  Venous Capitance
        •  SVR (slightly)
        •  Work of Heart
    • MORPHINE
    Cardiac Drugs
    • Vasodilator (venous)
      •  Pulmonary Congestion
      •  Work of Heart
    • Analgesic
    • Sedative Properties
      • Reduces Anxiety
    • REFLUDIN
    Cardiac Drugs
    • CLASSIFICATION
    • Anticoagulant
    • Anti-thrombin
    • USES
    • AMI
    • HIT
    • Venous thrombosis
    • DVT prophylaxis
    • ADVERSE EFFECTS
    • Bleeding
    • Anemia
    • References
    • Hudak, B., Gallo, B., & Morton, P. (1998). Critical Care Nursing (7th ed.). Philadelphia, PA: Lippincott.
    • Clochesy, J., Breu, C., Cardin, S., Whittaker, A., & Rudy, E. (1996). Critical Care Nursing (2nd ed.). Philadelphia, PA: Saunders.
    • American Association of Critical-Care Nurses. (1991). Core Curriculum for Critical Care Nursing (4th ed.). Philadelphia, PA: Saunders.
    • Knowles, Sherry. (2002-2004). Inservice Handout.
    Cardiac Drugs