This document categorizes and describes various cardiac drugs used to treat heart conditions. It lists drug classes including ACE inhibitors, calcium channel blockers, beta blockers, diuretics, vasopressors, and antidysrhythmics. For each drug class, it provides a brief description of the drug's actions, such as its effects on contractility, heart rate, and blood pressure. Side effects are also noted for some classes. The document serves as a reference for nurses on the classifications, uses, and adverse effects of common cardiac medications.

1. Cardiac Drug Sherry L. Knowles, RN, CCRN, CRNI Classifications

2. 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

3. Inotropic Cardiac Drugs Drug actions Chronotropic Dromotropic

4. Inotropic Affects Contractility Cardiac Drugs Positive Inotropics  the force of myocardial contraction. Negative Inotropics  the force of myocardial contraction.

5. CHRONOTROPIC Affects Heart Rate Cardiac Drugs Beta Adrenergic and Blocking Agents Slowing rates can  filling time

6. Antiarrhythmics Beta Blockers Calcium Channel Blockers Cardiac Drugs Dromotropic Affects Conductivity

7. Alpha receptors Cardiac Drugs D opa receptors Beta receptors

8. Alpha receptors On Blood Vessels Cardiac Drugs Stimulation causes vasoconstriction Blocking cause vasodilation

9. Beta receptors On Heart and Lungs Cardiac Drugs Beta 1 and Beta 2 Cardioselective vs Non-Selective

10. Beta receptors Beta 1 Cardiac Drugs Stimulation causes positive inotropic effects Blocking causes negative inotropic effect

11. Beta receptors Beta 2 Cardiac Drugs Stimulation causes bronchodilation Blocking causes bronchoconstriction

12. Dopa receptors On Renal (Mesenteric) Vessels Cardiac Drugs Stimulation causes vasodilation Blocking causes vasoconstriction

13. ALPHA BLOCKERS Cardiac Drugs Used for hypertension,

14. BETA BLOCKERS Cardiac Drugs Slow Heart Rate Negative Chronotropic Lower BP Slow Conduction Negative Dromotropic Encourage Electrical Stability

15. CALCIUM CHANNEL BLOCKERS Cardiac Drugs Slows Heart Rate Negative Chronotropic Vasodilator Prevents Arterial Vasospasm

16. Beta Blockers : Adverse Effects Cardiac Drugs Fatigue Bronchospasm Impotence Depression Aggravation of heart failure

17. VASODILATORS Cardiac Drugs

18. ACE INHIBITORS Cardiac Drugs Causes Vasodilation Reduces Afterload Reduces work of heart  Remodeling Effects

19. ANGIOTENSIN II ANTAGONISTS Cardiac Drugs Vasodilator Reduces Afterload May be used in place of ace inhibitors

20. NITRATES Cardiac Drugs Arterial & Venous Vasodilator Reduces Preload & Afterload Reduces Work of the Heart Improves Cardiac Output

21. 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)

22. 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)

23. DIURETICS Cardiac Drugs Reduce Preload Reverse Fluid Overload Reduces Pulmonary Congestion

24. VASOPRESSORS Cardiac Drugs Vasoconstrictors Alpha Adrenergic  Blood Pressure  Heart Rate Positive Chronotropic

25. ANTIDYSRHYTHMICS Cardiac Drugs  Heart Rate Negative Chronotropic Slow Conduction Negative Dromotropic Also Includes: Beta Blockers Calcium Channel Blockers

26. ANTI-HYPERTENSIVES Cardiac Drugs Presynaptic agents: centrally acting, peripherally acting Dieuretics Beta Blockers Alpha Blockers Vasodilators Calcium Entry Blockers Angiotensin Converting Enzyme (ACE) Inhibitors

27. GpIIbIIIa Inhibitors Cardiac Drugs ReoPro Long Half-life Integrilin Aggrastat

28. GpIIbIIIa Inhibitors Cardiac Drugs ReoPro, Integrilin, Aggrastat Monitor Platelet Levels Check within 4-6 hours after initiation Monitor daily and prn any bleeding

29. 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

30. THROMBOLYTICS Cardiac Drugs Streptokinase tPA

31. ANTI-SEPSIS / ANTI-INFLAMMATORY Cardiac Drugs Activated Protein C (Xygris) May cause bleeding

32. ANTI-LIPIDEMICS Cardiac Drugs HDL High Density Lipoprotein Associated with  risk LDL Low Density Lipoprotein Associated with  risk Look at Ratio HDL  LDL

33. ADENOSINE Cardiac Drugs Stops supraventricular tachycardia Extremely short half-life

34. AMIODARONE Cardiac Drugs Amiodarone – Class III potassium channel blockers – delays repolarization – prolongs refractory period Reduced automaticity SA node, reduced conduction thru AV node

35. DIGOXIN Cardiac Drugs Positive Inotropic Increases force of contraction Negative Dromotropic Slows conduction Negative Chronotropic Slows heart rate

36. DOPAMINE Cardiac Drugs Positive Inotropic Increases contractility Alpha, Beta, & Dopa Adrenergic Dose dependent Positive Chronotropic May increase heart rate

37. DOBUTAMINE Cardiac Drugs Positive Inotropic Increases contractility (Beta 1 stimulation) Beta 1 and Beta 2 Adrenergic Vasodilator Positive Chronotropic May increases heart rate

38. PRIMACOR Cardiac Drugs Positive Inotropic Increases contractility Vasodilator Acts similar to Dobutamine

39. EPINEPHRINE Cardiac Drugs Alpha Adrenergic Potent Vasoconstrictor Beta 1 and Beta 2 Adrenergic Positive Inotrope Bronchodilator

40. LEVOPHED (Norepinephrine) Cardiac Drugs Alpha Adrenergic Potent Vasoconstrictor Beta 1 Adrenergic Positive Inotrope

41. NEO-SYNEPHRINE Cardiac Drugs Alpha Adrenergic Vasoconstrictor Used for Severe Hypotension Used for Drug Induced Hypotension

42. NITROGLYCERIN Cardiac Drugs Venous & Arterial Vasodilator Dilates Coronary Arteries Nitrate Vasodilator  Preload (primarily)  Venous Capitance  SVR (slightly)  Work of Heart

43. MORPHINE Cardiac Drugs Vasodilator (venous)  Pulmonary Congestion  Work of Heart Analgesic Sedative Properties Reduces Anxiety

44. REFLUDIN Cardiac Drugs CLASSIFICATION Anticoagulant Anti-thrombin USES AMI HIT Venous thrombosis DVT prophylaxis ADVERSE EFFECTS Bleeding Anemia

45. 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