Downloaded 31 times
More Related Content
.pptx](https://cdn.slidesharecdn.com/ss_thumbnails/4-240618060737-02835d31-thumbnail.jpg?width=640&height=640&fit=bounds)
Similar to Cardiovascular Drugs
Cardiovascular Drugs
- 1. Unit 10 CardiovascularDrugs 5 Hrs. Mr. Dipti Y. Sorte, Associate Professor Himalayan College of Nursing, SRHU. Dehradun.
- 2. INC Syllabus • Haematinics. •Cardiotonics. • Anti anginals. • Antihypertensives & Vasodilators. • Anti – arrhythmic. • Plasma expanders. • Coagulants & Anticoagulants. • Antiplatelets & thrombolytics. • Hypolipidemics. Composition, Action, Dosage, Route, Indications, Contraindications, Drug Interactions, Side effects, Adverse effects, Toxicity & Role of nurse
- 3. Haematinics •Haematinics are thedrugs which used to stimulate the formation of RBC’s These are used primarily in the treatment of Anemia. Eg. Iron.
- 4. Mechanism of action •Theyact as supplement and replace depleted iron stores in the bone marrow to assist in the erythropoiesis (RBC production)
- 5. Drug example anddoses S. No. Drugs Doses 1 Ferrous Fumarate Up to 600 mg daily. 2 Ferrous Sulphate 200mg TDS 3 Ferrous Gluconate 300mg as per requirement. 4 Iron Dextran 50mg/ml IM or IV
- 6. Indications / Uses •Toprevent and treat iron deficiency anemia. •In children during rapid growth period. •In pregnant and lactating mother. •As dietary supplement of iron. •Patient with post gastrectomy.
- 7. Contraindication / Precautions •Patientwith hemochromatosis. •Hemolytic anemia. •Patient with hemosiderosis. •Hypersensitivity to the drug.
- 8. Adverse effects •Nausea /vomiting. •Constipation. •GI distress. •Dark stool. •Local pain at I.V. site. •Parental iron may causes, headache, Vomiting nausea and anaphylaxis. •Temporarily stain teeth with liquid iron. •Bronchospasm with parenteral iron.
- 9. Drug interactions •Antacids, Tetracyclines,Cimetidine decrease absorption of oral iron preparations. •Vit C (ascorbic acid) and chloramphenicol increases absorption of oral iron prepartions.
- 10. Nursing Responsibilities • Nurseshould administer drugs according to prescribed routes. • Should check for constipation. • Monitor patient CBC count, HB and plasma iron levels. • Nurse should teach the patient to: Continue regular dosing schedule after missing dose. Drink at least 2 liters of liquid daily. Avoids antacids, caffeine products, dairy products, egg, whole grain breads for 1hour after taking oral iron preparations. Be aware that oral iron preparations may turn stool dark green or black.
- 11.
- 12. Introduction •These are thedrugs which have a positive inotropic effect on heart. They increase the force of myocardial contraction without corresponding increase in O2 consumption. They are used for the treatment of congestive heart failure.
- 13. Mechanism of Action •Cardiacglycosides inhibit the enzyme Na-K-ATPase present in cardiac muscle. This cause an increase intracellular Na & Ca in heart muscle cells that leads to increase in force of contraction.
- 14. Drug examples &Doses: S No. Drugs Doses 1 Digoxin 0.125- 0.75 mg PO per day 2 Digitoxin 125-500 mcg once daily.
- 15. Indication / uses •Totreat congestive heart failure (commonly given with diuretics) •To control the ventricular rate in arterial fibrillation, paroxysmal arterial tachycardia.
- 16. Contraindication/precautions • Contraindicated inuncontrolled ventricular arrythmias, constrictive pericarditis, complete heart block. • Risk of Digoxin toxicity is increases with hypercalcemia. • Hypokalemia, Hypomagnesemia, renal failure. • Elderly patients have more risk of toxicity because they are more sensitive to drug’s effects, anorexia may be an early warning sign of toxicity.
- 17. Adverse Effects • Bradycardia. •Weakness. • Fatigue. • Nausea, vomiting. • May cause digoxin toxicity such as anorexia, nausea, vomiting, visual disturbance, confusion, bradycardia, heart block, premature ventricular contractions.
- 18. Drug interactions. •With potassiumwasting diuretics because they may cause potassium loss increase the risk of digoxin toxicity. •Antacids, aminoglycosides metoclopramide decrease GI absorption of digoxin.
- 19. Nursing Responsibilities •Before givingdigoxin, assess apical pulse, sr. drug and electrolyte level of patient with hold drug and notify physician if pulse rate is bellow 60 beat per min or minimum. •The nurse should keep a watch a sign and symptoms of toxicity. (eg. Anorexia, nausea, vomiting, palpitation ) and if occurs further administration of drugs should stop if pulse rate increases to more than 120 it may indicate toxicity. •Nurse should know that dose must be reduced in patients with renal failure.
- 20. Teach patient to: •Take prescribed drug properly. • Consult physician before discontinuing drug. • Count his pulse before taking each dose. • Assess signs and symptoms of digoxin toxicity and heart failure.
- 21. Anti anginals (Drugused in Angina) •Angina pectoris is the chest pain due to anoxia of heart muscles generally due to obstruction or spasm in coronary artery. The drugs used in angina pectoris prevent terminate attacks of angina pectoris are called antianginal drugs. •These drugs are mainly classified as: 1. Nitrates. 2. Beta – Blockers. (already described) 3. Calcium channel blockers. (already described)
- 22. Nitrates •Nitrates are thedrugs which are vasodilator effects thus used in angina pectoris.
- 23. Mechanism of action •Nitratesrelease NO (Free radical nitric oxide) which is powerful muscle relaxant. So they produce vasodilation, decreased preload and afterload, reduce myocardial oxygen consumption.
- 24. Drug example anddoses S. No. Drugs Doses 1 Isosorbide Mononitrate 10-20mg orally twice daily. 2 Isosorbide dinitrate 30-480mg orally in divided dose (5-10mg sublingually) 3 Nitroglycerine 0.3mg sublingually.
- 25. Indications / Uses •Acuteangina. •Prevention of expected and chronic anginal attacks. •Long term prevention of angina. •Nitroglycerine is also administer I.V to treat surgical hypertension.
- 26. Adverse effects •Headache ismost common. •Orthostatic hypertension. •Flushing. •Nausea, vomiting. •Dizziness. •Tachycardia. •Palpitations.
- 27. Contraindication / Precautions •Hypersensitivityto nitrates. •Severe anemia. •Orthostatic hypertension. •Early MI. •Increased ICP. •Use cautiously in patients with hypotension.
- 28. Drug interactions •Antihypertensives, andsildenafil, tadalafil may increase hypotension effects.
- 29. Nursing Responsibilities • Nurseshould teach the patient about proper use and storage of nitroglycerine sublingual tablets. • Instruct the patient to sit down and take the drug at the first sign of an acute angina attack. • Teach the patient to repeat the dose if no relief occurs in 5minutes and take emergency medical help if no relief occurs after taking 3tablets in 15mins. • Inform patient that headache is common side effect of nitrates and typically subsides with continued therapy. • Advise patient to avoid beverages. • Advise the patient that sublingual tablets may be taken at the onset of activities known to cause angina such as sexual activity.
- 30. Antihypertensives •Hypertension is adisease characterized by abnormally high blood pressure.
- 31. Classification of Antihypertensivedrugs • Beta blockers. Eg. Atenolol, timolol, metoprolol, propanol. • Calcium channel blockers. Eg. Nifedipine, Amlodipine, verapamil, diltiazem. • ACE inhibitors. Eg. Captopril, Ramipril, lisinopril, enalpril. • Diuretics. Eg. Furosemide, Amiloride, Spironolactone. • Vasodilators. Eg. Hydralazine, minoxidil, diazoxide. • Angiotensin antagonist. Eg. Losartan.
- 32. Mechanism of action(Beta – Adrenergic Blockers). •Beta adrenergic receptors causes vasoconstriction in blood vessels. Thus these drugs prevents stimulation of beta – adrenergic receptors of sympathetic nervous system, thereby decreasing cardiac output.
- 33. Drug example anddoses S. No. Drugs Doses 1 Atenolol 50-100mgBD orally 2 Timolol 10-20mg orally twice a day. 3 Propranolol 20-80 mg orally. 4 Betaxolol 10mg orally BD. 5 Metoprolol 50mg every 4-6hrly.
- 34. Indications / Uses •Totreat mild hypertension. •Angina pectoris.
- 35. Contraindication / Precautions •Contraindicatedin patients with asthma, sinus bradycardia, cardiogenic shock, second or third degree heart block. •Use these drugs with cautiously in pregnant and breast feeding women and in those with impaired hepatic function.
- 36.
- 37. Drug interactions •These drugscause additive hypotension when used concurrently with alcohol and antihypertensives or calcium channel blockers.
- 38. Nursing Responsibilities •Do notdiscontinue drug abruptly. •Administer propranolol constituently with food, food may increase absorption.
- 39. Mechanism of action(Calcium channel blockers). •They are chemically different but pharmacologically similar drugs. They have commen mechanism of action. They block the entry of Ca⁺⁺ ions into the smooth and cardiac muscle cells that leads to decreased intracellular Ca⁺⁺ ions there by smooth muscle relaxation leads to vasodilation.
- 40. Graphically: •They block theentry of Ca⁺⁺ ions into the smooth and cardiac muscle cells. •Decrease intracellular Ca⁺⁺ ions. •Smooth muscle relaxation. • Vasodilation.
- 41. Drug example anddoses S. No. Drugs Doses 1 Amlodipine 5-10mg OD 2 Verapamil. 80mg TDS orally. 3 Nifedipine 30-60mg orally OD 4 Diltiazem 80-100 mg orally. 5 Perhexiline. 200-400 mg orally in divided dose.
- 42. Indications / Uses •Totreat the mild hypertension. •Angina pectoris.
- 43. Contraindication / Precautions •Contraindicatedin patient with asthma, sinus bradycardia, cardiogenic shock, second and third heart block. •Use these drugs cautiously pregnant and breast feeding women and in those with impaired hepatic function.
- 44.
- 45. Drug interactions •They mayincrease risk digoxin toxicity when used with digoxin. •May cause heart block when used with other calcium channel blocker.
- 46. Nursing Responsibilities •Nurse shouldknow that nifedipine may be given sublingually. •Warn patient not to stop drug abruptly.
- 47. Mechanism of action(ACE inhibitors). •These drugs are also used in the treatment of hypertension, It acts by inhibiting angiotensin converting enzyme and prevents the conservation of angiotensin – I & angiotensin – II and preventing peripheral vasoconstriction.
- 48. Drug example anddoses S. No. Drugs Doses 1 Captopril 25mg TDS 2 Enalapril 2.5 mg daily, 40 mg daily in divided dose. 3 Lisinopril 5-10mg daily 4 Ramipril 2.5mg – 5mg daily.
- 49. Indications / Uses •Totreat mild hypertension. •Ramipril also used to treat heart failure after myocardial infarction. •To reduce the risk of MI and death from cardiovascular causes.
- 50.
- 51. Contraindication / Precautions •Contraindicatedin patient with asthma, sinus bradycardia, cardiogenic shock, second and third heart block. •Use these drugs cautiously pregnant and lactating mother and in those with impaired hepatic function.
- 52. Drug interactions •Antihypertensives, diureticsmay increase hypertensive effects. •NSAID’S may decrease it effects. •They may increase hypoglycemic effects if used with insulin and oral antidiabetics. •ACE inhibiters may increase diuretic effects and increase the risk of hyperkalemia with concurrent use with potassium sparing diuretics.
- 53. Nursing Responsibilities •Antihypertensives captoprilon empty stomach. •Teach patient to report light headedness and avoid sudden position changes to minimize orthostatic hypertension.
- 54. Vasodilators (Peripheral vasodilator) •Theseare the drugs which are also vasodilator effects thus reduce blood pressure.
- 55. Mechanism of action •Theyare potent direct relaxant of vascular smooth muscle and reduce both systolic and diastolic B.P.
- 56. Drug example anddoses S. No. Drugs Doses 1 Hydralazine 10-20mg slowly I.V. injection. 25-200mg daily orally divided doses. 2 Minoxidil 5-50 mg daily orally.
- 57. Indications / Uses •Usedin moderate to severe hypertension. •To treat severe and essential hypertension.
- 58. Contraindication / Precautions •Contraindicatedin patient with asthma, sinus bradycardia, Cardiac failure. •Use these drugs cautiously pregnant and breast feeding women and in those with impaired hepatic function.
- 59. Adverse effects •Fluid retention. •Orthostatichypertension. •Tachycardia. •Severe hypertension. (with IV doses) •Minoxidil also can causes excessive hair growth.
- 60. Drug interactions •Sildenafil, hypertensivedrugs may potentiate antihypertensive effects of nitroprusside sodium.
- 61. Nursing Responsibilities •Nurse shouldclosely monitor patient for fluid volume excess, monitor patients blood pressure every 5 mins at start of infusion and at least every 15mins during infusion. •Assess weight of patient daily and record intake and output. •Advise the patient taking minioxidil that excessive hair growth is likely to occur 3to6 months after therapy begins. Reassure the patient that extra growth should be disappear 1to 6 month after therapy ends.
- 62. Antiarrhythmics •Arrhythmias means abnormalcardiac rhythm. It occur due to an abnormal excitability of a part of cardiac muscle or due to an abnormality in conduction system of heart. So these drugs are used for arrhythmia.
- 63. Mechanism of action •These drugs block Na⁺ (Sodium) channel of cell membranes and reduces excitability of cardiac muscle and slows the conduction in heart. • Verapamil drug block Ca⁺ channels and prevents accumulation of Ca⁺⁺ ion in myocardial cells and shows the conduction of AV node. • Beta blockers also blockage beta adrenoreceptor at heart and reduced excitability of the heart.
- 64. Drug example anddoses S. No Drugs Doses 1 Quinidine 200-300 mg 3-4 times daily orally. 2 Lidocaine 1mg/kg IV/2% injection 3 Lignocaine 100mg IV 4 Verapamil 80mg thrice daily 5 Propranolol 20-80 mg daily 6 Atenolol 50-100 mg twice daily. 7 Bretylium 5-10mg/kg loading dose. 8 Ibutilide 1mg I.V. given over 10minutes
- 65. Indications / Uses •Ventriculararrhythmias. •Ventricular tachycardia. •Lidocaine used to treat life threatening ventricular arrhythmias. •To treat sinus tachycardia (Propranol). •Also used to treat hypertension.
- 66. Contraindication / Precautions •Persistentsevere bradycardia. •Cardiac failure. •Hypersensitivity to these drugs. Cardiogenic shock. •Complete atrioventricular block. •2nd & 3rd degree heart block.
- 67.
- 68. Drug interactions •Simultaneously usewith antihypertensives causes additive hypotension. •Propranolol may increases hypotensive effects when used with NSAID’s indomethacin, Ca⁺ channel blockers. •Concurrent use with digoxin may increased digoxin levels and worsen arrhythmias.
- 69. Nursing Responsibilities •Before administeringlidocaine always check label to prevent administering from containing epinephrine, or preservatives. •After administering Bretylium keep patient supine and observe for hypotension. •Teach patient to change position slowly if taking Bretylium. •Administer IV bolus for ventricular arrhythmias followed by continuous IV infusion as ordered.
- 70. Assignment: Plasma Expanders &Coagulants
- 71. Anticoagulants •These are theagents which inhibit the process of clotting, thus they are used to prevent unwanted thrombosis.
- 72. Mechanism of action •Theyprevent extension and formation of clots by inhibiting factors in the clotting cascade.
- 73. Drug example anddoses S. No. Drugs Doses 1 Heparin 5,000-10,000 unit by I.V. 2 Warfarin 20-30mg PO 3 Phenindione 200-300mg PO
- 74. Indications / Uses •Thrombosisin deep veins. •Unstable angina in PTCA. •Open heart surgery. •To treat and prevent thromboembolic disorders and ischemic complications.
- 75. Contraindication / Precautions •Bleedingincluding thrombocytopenia. •Peptic ulcer disease. •Recent surgery. •Coagulation disorders.
- 76. Adverse effects •Hyperlipidemia. •Hemorrhages. •Nausea. •Insomnia. •Thrombocytopenia. •Pain atinjection site. •Constipation.
- 77. Drug interactions •Chloramphenicol, metronidazole,androgens, quinidine, thrombolytics increase the risk of bleeding and may increase effects the risk of warfarin. •Alcohol, barbiturates, estrogen containing hormonal contraceptives and some food rich in vit. K increase the risk of clotting and may decrease the effects of warfarin. •Prolonged or regular use with other drugs that effect platelet function such as aspirin, NSAID’s may increase the risk bleeding.
- 78. Nursing Responsibilities • Don’tgive heparin by IM route. • Asses the early signs of unusual bleeding. • Nurse should minimize venipunctures and injections, apply pressure to all puncture sites. • Monitor hemoglobin and clotting factor and platelet level. • Nurse should teach the patient to: 1. Not to take drugs or vitamins, including over the counter or herbal products, without medical approval. 2. Inform physician and dentist of therapy regimens before undergoing any medical treatment.
- 79. Antiplatelets •These are thedrugs which interfere with platelet function and are useful in the prophylaxis of thrombosis disorders.
- 80. Mechanism of action •Theyinterfere with platelets function and inhibits platelets clumping.
- 81. Drug example anddoses S. No. Drugs Doses 1 Aspirin 2 Clopidogrel 3 Dipyridamole 4 Ticlopidine.
- 82. Indications / Uses •Usedas prophylaxis for thromboembolic events. •Aspirin used in patients with previous MI or unstable angina to reduce the risk of death from these conditions and in men to reduce the risk of transient ischemic stroke. •Clopidogrel is use to reduce a cardiovascular events. •Myocardial infarction.
- 83. Contraindication / Precautions •Activebleeding. •Coagulation disorder. •Ulcer disorder. •Recent surgery. •Cancer. •Thrombocytopenia.
- 84. Adverse effects •Bleeding/Hemorrhage. •Neutropenia. •Abnormal stool. •Rash. •Painin injection site. •Pancytopenia. •Dizziness. •Headache. •Nausea.
- 85. Drug interactions •Prolonged orregular use with other drugs that effect platelet function such as aspirin, NSAID’s may increase the risk of bleeding.
- 86. Nursing Responsibilities •Monitor patientfor bruising or bleeding. •Assess the early signs of unusual bleeding. •Nurse should minimize venipuncture and injections, apply pressure to all puncture sites. •Monitor hemoglobin and clotting factor and platelets level.
- 87. Thrombolytics (Fibrinolytics) •These drugsare used to lyse (Dissolve) thrombus or clot.
- 88. Mechanism of action •Theseagents activate plasminogen to form plasmin thus dissolve clot or thrombosis. (Plasminogen Plasma Clot dissolution).
- 89. Drug example anddoses S. No. Drugs Doses 1 Streptokinase 5,00,000 units IV. 2 Urokinase 5,000 units 3 Alteplase 100mg IV in divided doses.
- 90. Indications / Uses •Myocardialinfarction. •Deep vein thrombosis. •Pulmonary embolism. •Stroke.
- 91. Contraindication / Precautions •Recentstreptococcal infection. •Recent stroke. •Ulcer disease. •Cancer. •Active internal bleeding. •Coagulation disorders. •Recent surgery.
- 92.
- 93. Drug interactions •Prolong orregular use with other drugs that effect platelet function such as aspirin, NSAID’s may increase the risk of bleeding.
- 94. Nursing Responsibilities •Assess theearly signs of unusual bleeding. •Nurses should minimize venipunctures and injections, apply pressure to all puncture sites. •Monitor hemoglobin and clotting factor and platelets level. •Avoid IM injections. •Avoid subclavian catheters for central venous lines.
- 95. Hypolipidemics •These drugs areused in the treatment of atherosclerosis and hyperlipidemia.
- 96. Mechanism of action •Theyinhibit the synthesis of cholesterol in liver also they inhibit the transfer of triglycerides from liver to plasma and block HMG- COA reductase in the liver preventing cholesterol synthesis.
- 97. Drug example anddoses S. No. Drugs Doses 1 Atorvastatin 10-20mg daily 2 Simvastatin 10-40mg at night daily. 3 Lovastatin 10-20mg daily at night. 4 Clofibrate 1-2gm daily PO individual doses. 5 Colestipol 15-30gm daily.
- 98. Indications / Uses •CAD •Hyperlipidemia. •Hypertriglyceridemia. •Secondaryprevention of cardiovascular events. •Atherosclerosis. •Hypercholesterolemia. •Increase in Sr. level of HDLs.
- 99. Contraindication / Precautions •Hypersensitivityto these drugs. •Elevated liver function test results. •Hepatic and severe renal dysfunctions. •Cautiously in pregnancy and breast feeding women.
- 100. Adverse effects •Headache. •Photosensitivity. •Progression ofcataracts. •Insomnia. •Blurred vision. •Nausea / vomiting. •Diarrhea. •Constipation. •Dyspepsia. •Rhabdomyolysis. •Abdominal cramps. •Flatulence. •Hypersensitivity reaction. •Myopathies.
- 101. Drug interactions •Use witherythromycin, cyclosporin, nicotinic acid may increase the risk of Rhabdomyolysis and myopathy. •May increase digoxin levels. •Concurrent use of simvastatin, atorvastatin with warfarin sodium may increase the effects of warfarin.
- 102. Nursing Responsibilities •These drugsshould start only after diet therapy has provan ineffective. •Advise patient to avoid alcohol consumption. •Give lovastatin with evening meal because absorption is enhanced and cholesterol biosynthesis is greater in evening. •Monitor liver function test periodically. •Monitor blood level of fat soluble vitamin, serum cholesterol, and triglyceride levels and liver function tests during therapy.
- 103. References 1. Dr. P.K.Panwar, Essentials of pharmacology for nurses, AITBS pub. 2017, India, Pg no. 118 – 134. 2. Dr. Suresh k sharma, Textbook of pharmacology, pathology & genetics for nurses, Jaypee pub. 2016 India Pg no 362 – 452. 3. Tara v. Shanbhag, Smita shenoy, Pharmacology preparation manual for undergraduate, Elsevier pub. 2014. Pg no. 101 – 147. 4. Marilyn Herbert – Ashton, Nancy Clarkson, Pharmacology, Jones & Barllet pub 2010 India, Pg no 303 – 391. 5. Govind s. mittal, Pharmacology at a glance, Paras medical book pub. 2009 India 31 – 34. 6. Madhuri Inamdar, Pharmacology in nursing, Vora medical pub. 2006 India 1st edition, Pg no 61 – 91.