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Drug Classifications
 

Drug Classifications

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Cardiac Drug Classifications.

Cardiac Drug Classifications.

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  • DRUG CLASSIFICATION : In the Critical Care Unit 2004
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 Anti-thrombin Anti-platelet
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 INOTROPIC Positive Inotropes Dopamine Digoxin Dobutamine Primacor Negative Inotropes Beta Blockers: Lopressor Calcium Channel Blockers: Verapamil
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 ALPHA BETA DOPA AGONISTS VS ANTAGONISTS ADRENERGIC VS BLOCKER
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 ACE INHIBITORS Enalapril (Vasotec) 2.5-20 mg bid Captopril (Capoten) 6.25-100 mg tid Lisinopril (Prinivil, Zestril) 5-40 mg qd Quinapril (Accupril) 5-20 mg bid Ramipril (Altace) 2.5-5 mg bid Fasinopril (Monopril) 20-40 mg qd SIDE EFFECTS: Dry Cough Hypotension Dizziness Headache Hyperkalemia Nausea Neutropenia Angioedema Cough, first-dose hypotension, hyperkalemia, renal failure, fetal injury, angioedema, rash, neutropenia, impaired taste WARNING: Do not give NSAIDS with Ace Inhibitors MUST REACH THERAPEAUTIC DOSAGE FOR BENEFITS. PRIL
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 ANGIOTENSIN II ANTAGONISTS Losartan Potassium (Cozar) 25-100 mg qd-bid Valsartan (Diovan) 160-320 mg qd SIDE EFFECTS: Better tolerated than ace inhibitors. Hypotension Dizziness Bradycardia Cramps Diarrhea Hyperkalemia Nausea Losartan (Cozaar) – does not cause angioedema or cough NO COUGH COMPARED TO ACE INHIBITORS
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 Propranalol non-selective Esmolol 9 min. half-life (red cell esterases) Sotalol non-selective blocks K channels more effective for some arrhythmias BETA BLOCKERS Metoprolol (Lopressor, Toprol) Carvedilol (Coreg) 3.125-25 mg bid. Patients > 85 kg up to 50 mg bid Labetalol (Normodyne, Trandate) 200-400 mg bid Propranolol (Inderal) Esmolol (Brevibloc) Sotalol (Betapace) Naldolol (Corgard) Cardioselective: Atenolol (Tenormin) SIDE EFFECTS: Hypotension Dizziness AV Block Bradycardia Thrombocytopenia Elevated Liver Enzymes OLOL
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 Propranalol non-selective Esmolol 9 min. half-life (red cell esterases) Sotalol non-selective blocks K channels more effective for some arrhythmias BETA BLOCKERS Metoprolol (Lopressor, Toprol) Carvedilol (Coreg) 3.125-25 mg bid. Patients > 85 kg up to 50 mg bid Labetalol (Normodyne, Trandate) 200-400 mg bid Propranolol (Inderal) Esmolol (Brevibloc) Sotalol (Betapace) Naldolol (Corgard) Cardioselective: Atenolol (Tenormin) SIDE EFFECTS: Hypotension Dizziness AV Block Bradycardia Thrombocytopenia Elevated Liver Enzymes OLOL
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 NITRATES Nitroglycerin Isosorbide (Ismo, Imdur) SIDE EFFECTS: Hypotension Headache OTHER VASODILATORS: Nitroprusside (Nipride) Potent venous and arterial vasodilator. Used for hypertensive crisis. Hydralazine (Apresoline) 50-600 mg qd in divided doses bid-qid PERIPHERAL VASODILATORS: Nipride Hyperstat Apresoline Minoxidil CORONARY VASODILATORS: Imdur Isordil Nitro Persantine Do not combine with other drugs causing vasodilation (Viagra) or hypotensive drugs
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 CALCIUM CHANNEL BLOCKERS Nifedipine (Procardia) Verapamil (Calan) Norvasc (Amlodipine)) Diltiazem (Cardizem) Prevent calcium from entering cells Used for hypertension, angina, cardiac dysrhythmias Calcium channels in vascular smooth muscle – when blocked – prevents contraction and therefore, vasodilation
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 CALCIUM CHANNEL BLOCKERS Nifedipine (Procardia) Verapamil (Calan) Norvasc (Amlodipine)) Diltiazem (Cardizem)
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 CALCIUM CHANNEL BLOCKERS Nifedipine (Procardia) Verapamil (Calan) Norvasc (Amlodipine)) Diltiazem (Cardizem)
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 DIURETICS Furosemide (Lasix) 40-320 mg qd-bid Bumetanide (Bumex) 0.5 -10 mg qd, bid, tid, qod Ethacrynic Acid (Edecrin) 50-400 mg qd-bid Metolazone (Zaroxolyn) Torsemide (Demodex) HCTZ (Hydrochlorothiazide, HydroDIURIL) 50-200 mg qd May cause glucose intolerance and lipid abnormalities. POTASSIUM SPARING DIUTETICS: Spironolactone (Aldactone) 25-200 mg qd-tid Triamterene (Dyrenium 100-300 mg qd-bid Amiloride (Midamor) 5-20 mg qd SIDE EFFECTS: Hyponatremia Hypokalemia Ototoxicity Leukopenia Metabolic alkalosis Metabolic acidosis Mental confusion Nausea
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 VASOPRESSORS Dopamine (10-20 mcg/kg/min Norepinephrine (Levophed) Epinephrine (Adrenalin) SYMPATHOMIMETICS
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 ANTIDYSRHYTHMICS Lidocaine Procainamide Amiodarone SIDE EFFECTS: AV Block Bradycardia QT Elongation
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 ANTIDYSRHYTHMICS Lidocaine Procainamide Amiodarone SIDE EFFECTS: AV Block Bradycardia QT Elongation
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 Inhibits Platelet Activation ReoPro Integrilin Aggrastat Inhibits Platelet Receptor Sites Stops clotting activity at the site of the clot Can stop an MI
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 ADVERSE EFFECTS: Bleeding Thrombocytopenia – heparin induced Hypersensitivity Protamine sulfate for OD Monitoring of – APTT Given in units Low Molecular Heoparin: Enoxaparin - Lovenox Dalteparin Ardeparin COUMADIN: Long-term prophylaxis of thrombosis Prosthetic heart valves Atrial fibrillation Must monitor PT (prothrombin time) – INR (contains a correction factor for PT) PT/INR needs to be monitored frequently Vitamin K can be given in case of overdose Antiplatelet drugs: ASA – suppresses platelet aggregation Adenosine diphosphate receptor antagonists: Block ADP receptors preventing ADP-stimulated aggregation Ticlopidin – prevent stroke Clopidogrel – prevent stroke and MI ANTIDYSRHYTHMICS Lidocaine Procainamide Amiodarone SIDE EFFECTS: AV Block Bradycardia QT Elongation
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 Heparin Induced Throbocytopenia
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 ANTIDYSRHYTHMICS Lidocaine Procainamide Amiodarone SIDE EFFECTS: AV Block Bradycardia QT Elongation
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 ANTIDYSRHYTHMICS Lidocaine Procainamide Amiodarone SIDE EFFECTS: AV Block Bradycardia QT Elongation
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 “ Statins” – HMG CoA inhibitors – most widely used – also increase number of LDL receptors on liver cells Lovastatin, Fluvastatin, Pravastatin, Simvastatin, Atorvastatin, Cerivastatin Adverse Effects: Hepatotoxicity, GI disturbances, myopathy ANTI-LIPIDEMICS Lopid (Gemfibrozil) Mevacor (Lovastatin) Zocor (Simvastatin) Provachol (Pravastatin) Questran (Cholestyramine)
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 Long half-life Bad side effects – pulmonary toxicity Bluish discoloration of skin GI side effects Liver dysfunction Thyroid dysfunction
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 DIGOXIN USES: CHF ATRIAL FIB/FLUTTER PAT DOSAGE:  0.125-0.5 mg qd  May be diluted in 5-10 cc NS or D 5 W  Given slowly IV (over 5 minutes) diluted in 5-10 cc. NURSING IMPLICATIONS:  Maintain potassium in normal range.  Monitor digoxin and electrolyte levels.  Use cautiously with the elderly, acute MI’s, severe pulmonary disease, advanced heart failure, hypothyroidism, and renal insufficiency.  Monitor for Adverse Effects: (ST depression, PVC’s, bradycardia, blocks, or other dysrhythmias, headache, weakness, agitation, apathy, nausea, yellow-green halos around images, or blurred vision)  May hold for low heart rate. Digoxin Inhibit Na/K ATPase Not SR Ca pump Decreased Na gradient less Ca extrusion across plasma membrane more Ca pumped into SR Positive inotropic effects Digitalis Glycosides: Adverse Effects: Digitalis intoxication is a common clinical problem Digitalis intoxication arrhythmias Nausea Disturbances of cognitive function Competes with potassium for binding – when potassium is low, Digoxin is high Therapeutic Range: Important to know - .5-2.0ng/ml But patient may be “toxic” even if within the normal range Measures to treat toxicity – pacemaker, antidysrhythmics, digibind Adverse Effects: DYSRHYTHMIAS TOXICITY – very narrow therapeutic index – hypokalemia makes it easier for toxicity to occur GI – disturbances Fatigue Visual disturbances
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 DOPAMINE USES:  Hypotension (without Hypovolemia)  Cardiogenic Shock  Severe CHF  To improve renal perfusion (low dose) ACTIONS:  Renal. mesenteric, and cerebral vasodilation (low dose).   cardiac output (moderate dose).  Potent vasoconstrictor (high dose). NURSING IMPLICATIONS:  Titrate to effect/Assess VS frequently.  Watch for Adverse Effects: (Tachycardia, hypertension, vasoconstriction (loss of renal or mesenteric perfusion), extension of an MI, tissue necrosis, etc.).  May cause ectopy
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 DODUTAMINE USES: CHF Pulmonary Congestion Low Cardiac Output ACTIONS:   Contractility   Afterload (  SVR)   Preload DOSE: 3-5 mcg/kg/min  May cause ectopy
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 PRIMACOR (Milrinone) USES: CHF ACTIONS: *  Contractility *  Afterload *  Preload NURSING IMPLICATIONS: * Incompatible with Lasix * Contraindicated in IHSS * Must use cautiously with Renal Insufficiency. * Monitor for Adverse Effects (Dysrhythmias, Hypotension, etc.) LOADING DOSE: 50 mcg/kg over 10 minutes MAINTENANCE DOSE: 0.375-0.75 mcg/kg/min INOCOR (Amrinone)
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 EPINEPHRINE USES: Asystole/-fib Severe Hypotension Anaphylaxis Acute Bronchospasm ACTIONS: Peripheral Vasoconstriction NURSING IMPLICATIONS:  Available in two concentrations (1:1000 and 1:10,000)  Contraindicated in hypovolemia.  Monitor for Adverse Effects (V-tach, V-Fib, Tachycardia, Vasoconstrictor.)
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 LEVOPHED
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 NEO-SYNEPHRINE USES: Severe Hypotension Shock Drug Induced Hypotension PSVT ACTIONS: Vasoconstriction NURSING IMPLICATIONS:  Enhances effects of Isuprel, Aminophylline, and Atropine.  Monitor for Adverse Effects (Tachycardia, Bradycardia, Ectopy, Angina, Respiratory Depression, Tissue Necrosis, etc.)
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 NITROGLYCERIN USES: Angina AMI Myocardial Ischemia CHF HTN Heart Failure ACTIONS:   Preload (Primarily dilates venous system)   Myocardial Ischemia (dilates coronary arteries)   SVR  Helps Prevent Coronary Artery Vasospasm. NURSING IMPLICATIONS:  Assess for desired effects.  Monitor for Adverse Effects (Hypotension, Headache, Dizziness, Flushing)
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 MORPHINE USES: Pain Dyspnea (due to pulmonary congestion) ACTIONS:   Preload   Pulmonary Congestion  Cough Suppressant NURSING IMPLICATIONS:  Assess for desired effects  Have Narcan Available  Monitor for Adverse Effects (Hypotension, Respiratory Depression, N/V, etc.)
  • DRUG CLASSIFICATION : In the Critical Care Unit 2004 OTHER CARDIAC DRUGS ANTI COAGULANTS Heparin Lovenox Coumadin TPA Eminase Strepto Urokinase Amicar ANTI PLATELET ASA Ticlid Persantine ReoPro Aggrastat Integrin

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
    • Anti-Dysrhythmics
    • GPII b III a Diuretics
    • Angiotensin II Inhibitors
    • Antagonists Beta Blockers
    • Inotropics
    • Anti-Inflammatory Anti-platelet
    • Thrombolytics
    • Anti-Lipidemics
    • Vasopressors Anti-thrombin
    • 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 vasodilatation
        • Blocking causes vasoconstriction
    • 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
    • BETA BLOCKERS
    Cardiac Drugs
    • Slow Heart Rate
      • Negative Chronotropic
    • Lower BP
    • Slow Conduction
      • Negative Dromotropic
    • Promote Electrical Stability
    • BETA BLOCKERS : Adverse Effects
    Cardiac Drugs
    • Fatigue
    • Bronchospasm
    • Impotence
    • Depression
    • Aggravation of heart failure
    • NITRATES
    Cardiac Drugs
    • Arterial & Venous Vasodilator
    • Reduces Preload & Afterload
    • Reduces Work of the Heart
    • Improves Cardiac Output
    • CALCIUM CHANNEL BLOCKERS
    Cardiac Drugs
    • Slows Heart Rate
      • Negative Chronotropic
    • Vasodilator
    • Prevents Arterial Vasospasm
    • Ca 2+ Channel Blockers : Adverse Effects
    Cardiac Drugs
    • Less severe with oral than IV application
    • May cause Hypotension
    • May cause sinus bradycardia or heart block (especially with  -blockers)
    • Ca 2+ Channel Blockers : Adverse Effects
    Cardiac Drugs
    • Less severe with oral than with 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
    • 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 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 Antiplatelets
    • REFLUDIN
    Cardiac Drugs
    • CLASSIFICATION
    • Anticoagulant
    • Anti-thrombin
    • USES
    • AMI
    • HIT
    • Venous thrombosis
    • DVT prophylaxis
    • ADVERSE EFFECTS
    • Bleeding
    • Anemia
    • 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 Supra-Ventricular Tachycardia
    • Extremely short half-life
    • AMIODARONE
    Cardiac Drugs
    • Antiarrhythmic
    • Negative Chronotropic
    • Negative Dromotropic
      • Delays Repolarization
      • Prolongs Refractory Period
      • Reduces automaticity of SA node
      • Reduces 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
    • 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