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Cardiac Drug Sherry L. Knowles, RN, CCRN, CRNI Classifications
Cardiac Drugs <ul><li>  ACE Inhibitors    Anti-Coagulants </li></ul><ul><li>  </li></ul><ul><li>  Nitrates      Calcium Ch...
<ul><li>Inotropic </li></ul>Cardiac Drugs Drug actions   Chronotropic     Dromotropic
<ul><li>Inotropic </li></ul><ul><ul><li>Affects Contractility </li></ul></ul>Cardiac Drugs <ul><ul><ul><li>Positive Inotro...
<ul><li>CHRONOTROPIC </li></ul><ul><ul><li>Affects Heart Rate </li></ul></ul>Cardiac Drugs <ul><ul><ul><li>Beta Adrenergic...
<ul><ul><ul><li>Antiarrhythmics </li></ul></ul></ul><ul><ul><ul><li>Beta Blockers </li></ul></ul></ul><ul><ul><ul><li>Calc...
<ul><li>Alpha   receptors </li></ul>Cardiac Drugs D opa   receptors     Beta   receptors
<ul><li>Alpha receptors </li></ul><ul><ul><li>On Blood Vessels </li></ul></ul>Cardiac Drugs <ul><ul><ul><li>Stimulation ca...
<ul><li>Beta receptors   </li></ul><ul><ul><li>On Heart and Lungs </li></ul></ul>Cardiac Drugs <ul><ul><ul><li>Beta 1  and...
<ul><li>Beta receptors </li></ul><ul><ul><li>Beta 1 </li></ul></ul>Cardiac Drugs <ul><ul><ul><li>Stimulation causes positi...
<ul><li>Beta receptors </li></ul><ul><ul><li>Beta 2 </li></ul></ul>Cardiac Drugs <ul><ul><ul><li>Stimulation causes bronch...
<ul><li>Dopa receptors </li></ul><ul><ul><li>On Renal (Mesenteric) Vessels </li></ul></ul>Cardiac Drugs <ul><ul><ul><li>St...
<ul><li>ALPHA BLOCKERS </li></ul>Cardiac Drugs <ul><li>Used for hypertension,  </li></ul>
<ul><li>BETA BLOCKERS </li></ul>Cardiac Drugs <ul><li>Slow Heart Rate </li></ul><ul><ul><li>Negative Chronotropic </li></u...
<ul><li>CALCIUM CHANNEL BLOCKERS </li></ul>Cardiac Drugs <ul><li>Slows Heart Rate </li></ul><ul><ul><li>Negative Chronotro...
<ul><li>Beta Blockers :   Adverse Effects </li></ul>Cardiac Drugs <ul><li>Fatigue </li></ul><ul><li>Bronchospasm </li></ul...
<ul><li>VASODILATORS </li></ul>Cardiac Drugs
<ul><li>ACE INHIBITORS </li></ul>Cardiac Drugs <ul><li>Causes Vasodilation </li></ul><ul><li>Reduces Afterload </li></ul><...
<ul><li>ANGIOTENSIN II ANTAGONISTS   </li></ul>Cardiac Drugs <ul><li>Vasodilator </li></ul><ul><li>Reduces Afterload </li>...
<ul><li>NITRATES </li></ul>Cardiac Drugs <ul><li>Arterial & Venous Vasodilator </li></ul><ul><li>Reduces Preload & Afterlo...
<ul><li>Ca 2+  Channel Blockers : Adverse Effects </li></ul>Cardiac Drugs <ul><li>Less severe with oral than intravenous a...
<ul><li>Ca 2+  Channel Blockers : Adverse Effects </li></ul>Cardiac Drugs <ul><li>Less severe with oral than intravenous a...
<ul><li>DIURETICS </li></ul>Cardiac Drugs <ul><li>Reduce Preload </li></ul><ul><li>Reverse Fluid Overload </li></ul><ul><l...
<ul><li>VASOPRESSORS </li></ul>Cardiac Drugs <ul><li>Vasoconstrictors </li></ul><ul><ul><li>Alpha Adrenergic </li></ul></u...
<ul><li>ANTIDYSRHYTHMICS </li></ul>Cardiac Drugs <ul><li>   Heart Rate </li></ul><ul><ul><li>Negative Chronotropic  </li>...
<ul><li>ANTI-HYPERTENSIVES </li></ul>Cardiac Drugs <ul><ul><li>Presynaptic agents: centrally acting,  peripherally acting ...
<ul><li>GpIIbIIIa Inhibitors </li></ul>Cardiac Drugs <ul><li>ReoPro </li></ul><ul><ul><ul><li>Long Half-life   </li></ul><...
<ul><li>GpIIbIIIa Inhibitors </li></ul>Cardiac Drugs <ul><li>ReoPro, Integrilin, Aggrastat </li></ul><ul><li>Monitor Plate...
<ul><li>ANTICOAGULANTS </li></ul>Cardiac Drugs <ul><li>Heparin – administered by injection </li></ul>Low Molecular Weight ...
<ul><li>THROMBOLYTICS </li></ul>Cardiac Drugs Streptokinase tPA
<ul><li>ANTI-SEPSIS / ANTI-INFLAMMATORY </li></ul>Cardiac Drugs <ul><li>Activated Protein C (Xygris) </li></ul><ul><ul><ul...
<ul><li>ANTI-LIPIDEMICS </li></ul>Cardiac Drugs <ul><li>HDL </li></ul><ul><ul><li>High Density Lipoprotein </li></ul></ul>...
<ul><li>ADENOSINE </li></ul>Cardiac Drugs Stops supraventricular tachycardia Extremely short half-life
<ul><li>AMIODARONE </li></ul>Cardiac Drugs Amiodarone – Class III potassium channel blockers – delays repolarization – pro...
<ul><li>DIGOXIN </li></ul>Cardiac Drugs <ul><li>Positive Inotropic </li></ul><ul><ul><li>Increases force of contraction </...
<ul><li>DOPAMINE </li></ul>Cardiac Drugs <ul><li>Positive Inotropic </li></ul><ul><ul><li>Increases contractility </li></u...
<ul><li>DOBUTAMINE </li></ul>Cardiac Drugs <ul><li>Positive Inotropic </li></ul><ul><ul><li>Increases contractility (Beta ...
<ul><li>PRIMACOR </li></ul>Cardiac Drugs <ul><li>Positive Inotropic </li></ul><ul><ul><li>Increases contractility </li></u...
<ul><li>EPINEPHRINE </li></ul>Cardiac Drugs <ul><li>Alpha Adrenergic </li></ul><ul><ul><li>Potent Vasoconstrictor </li></u...
<ul><li>LEVOPHED (Norepinephrine) </li></ul>Cardiac Drugs <ul><li>Alpha Adrenergic </li></ul><ul><ul><li>Potent Vasoconstr...
<ul><li>NEO-SYNEPHRINE </li></ul>Cardiac Drugs <ul><li>Alpha Adrenergic </li></ul><ul><ul><li>Vasoconstrictor </li></ul></...
<ul><li>NITROGLYCERIN </li></ul>Cardiac Drugs <ul><li>Venous & Arterial Vasodilator </li></ul><ul><li>Dilates Coronary Art...
<ul><li>MORPHINE </li></ul>Cardiac Drugs <ul><li>Vasodilator (venous) </li></ul><ul><ul><li>   Pulmonary Congestion </li>...
<ul><li>REFLUDIN </li></ul>Cardiac Drugs <ul><li>CLASSIFICATION </li></ul><ul><li>Anticoagulant </li></ul><ul><li>Anti-thr...
<ul><li>References </li></ul><ul><li>Hudak, B., Gallo, B., & Morton, P. (1998).  Critical Care Nursing   (7th ed.). Philad...
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Drug Classifications

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Cardiac Drug Classifications

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Drug Classifications

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

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