emergency drugs for masters cardiovascular students

1. St. Paul’s Hospital Millennium Medical
College

Cardiovascular Drugs
Prepared by : SrTigist Tsegaye (MSc,CvPN)
Department of Medical Surgical Nursing
Postgraduates Cardiovascular Nursing 1

2. LEARNING OBJECTIVES
At the end of this lesson the students will
be:
-Discuss the major categories of drugs related to
cardiovascular disease treatment
-Describe the major drug effects of various drugs on
cardiovascular functions
-Discuss Nursing implications while administrating the drugs
2
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3. OUTLINES
 Inotropes, chronotropes, dromotrope
 antianginal drugs
 Antihypertensive drugs
 Antiarrhythmic drugs
 Anticoagulant
 Drugs of hyperlipidemia
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4. DRUGS ACTING ON CARDIOVASCULAR
SYSTEM
 Inotropes is an agent which increases or
decreases the force or energy of contraction
 Increase myocardial contractility
 Slowing heart rate (negative chronotropic effect)
 Decrease conduction velocity through AV node
 Arrhythmias,Tachycardia,Hypotension,Anxiety,Feve
r,Myocardial Ischemia,Pulmonary Embolism
4

5. CON....
 Cardiac glycoside-digitalis derivatives –Digoxin
 Increase force of contraction with out increasing
oxygen consumption
 Treatment for congestive heart failure, septic
shock, cardiogenic shock, pulmonary hypertension
 Inhibit Na-K Atpase
 Sympathomimetics-Epinephrine,Dopamine,
Doubtamine,Norepinephrine 5

6. CON...
 Cardiac glycoside
-Indirect effect on cardiovascular system regulated
by autonomic nervous system that has effect on
sino -atria node (SA) and atrioventricular (AV)node.
-Has direct effect on cardiac muscle and the
conduction system
Digoxin :Initial therapy 0.125 to 0.325 mg/day
Side effect –anorexia,nausea,vomiting,diarrhea
rare,headache,blurred vision.....
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7. CON...
 Phosphodiesterase Inhibitors- are medications that cause
blood vessels to relax and widen, improving circulation and
lowering blood pressure –Milirinone-inotrope vasodialtor
 Sympathomimetics-Drugs having potent effect by
stimulating beta 1 &2 ,and alpha 1 & 2
 Negative inotropes include beta-blockers, calcium channel
blockers, and antiarrhythmic medicines
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8. CON...
 Alpha (α) adrenoceptors mediate smooth muscle
contraction and vasoconstriction, while beta (β) receptors
mediate vasodilation, smooth muscle relaxation,
bronchodilation, and excitatory cardiac function
 beta-adrenergic receptor antagonists (beta-blockers) are a
family of agents that are widely used to treat hypertension,
angina pectoris and cardiac arrhythmias
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9. CON...
 Dopamine
 Constrict blood vessel
 Used in Heart Failure
 200mg/5ml ampoule
 Infusion:200mg in 200ml Normal saline
 Syringe pump :200mg in 50 ml Normal saline
 Intermediate dose 2 to 10mcg/kg/min
 Low dose 0.5 to 2mcg/kg/min
 Indication-occulsive vascular disease
Tachyarrhythmia 9

10. CON...
 Nursing implication
-monitor cardiac out put,ECG,hypertension
chest pain,and premature ventricular tachycardia
-React with Phenytoin ,Haloperidol
Doubtamine
Treatment for Congestive Heart Failure
- 250mg/20 ml Or 250mg/5ml
usual dose 2.5 to 10mcg/kg/min
initial dose 2to 3mcg/kg/min
Infusion pump :500mg in 250 normal saline
Syringe pump :250 mg in 50cc normal saline
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11. CON...
Max dose 20 mcg/kg/min
Interact with beta blockers ,Nitropruside,diuretics
 Doubtamine –atrial fibrillation-digitalize the patient before
use it to prevent ventricular tachycardia
 rehydrate the patient
 Adverse effect-
hypokalemia,tremors,nausea,headacheMI,arrythemia,Tachy
cardia
Adrenaline-smooth muscle relaxation in the air way
-smooth muscle contraction in the arterioles
-increase cardiac muscle contractility
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12. CON...
 Indication :
-Anaphylaxis reaction, hypotension, bronchospasm
cardiac arrest, asystole
infusion:0.05-0.1mcg/kg/min
max dose 1-1.5mcg/kg/min
For arrest 1ml every 2min
Interact with digoxin,diuretics,oxytocin
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13. CON ...
 Dilution
4ml of adrenalin in 46 ml of NS
Drug concentration 4mg/50 NS=0.08mg
0.8mgx1000=80mcg/ml
Rate of infusion = desired dosex60
80 mcg/ml
Interacts with beta blocking agents,glycosides,antidepressants
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14. CON...
 Adverse effect
:hypertension,tachycardia,tremor,dizziness,palpitation
 Nursing consideration
-administer in central line
- cautious patient with atherosclerosis ,occlusive vascular
disease, peripheral thrombosis
- protect from direct light
-dispose dilution after 24 hrs
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15. CON...
-ECG, Cardiac output
-Using syringe pump ,lable the loaded drug
-monitor urine out put
Noradrenalin similar to adrenaline
Treatment of low blood pressure
React with Amitriptyline,Halotne,Isoflueren,diabetes
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16. CON...
 Chronotropic – affects heart rate (increase or decrease
by affecting electrical conduction system of the heart.
 Positive chronotropes
 Most Adrenergic agonists.
 Atropine-Anti cholinergic,rx of nerve effect, pesticide
poisoning, slow heart rate, saliva production
 Dopamine.
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17. CON...
-Epinephrine.
-Isoproterenol-treat bradycardia conditions
-Milrinone -inotrope and vasodilator.
-Theophylline- relaxing the muscles around the airways
 Negative chronotropes
Betablocks ,Digoxin
A dromotropic agent is one which affects the conduction
speed (in fact the magnitude of delay) in the AV node, and
subsequently the rate of electrical impulses in the heart
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18. CON...
 Positive dromotropy –Increase conduction velocity
epinephrine-phenytoin
 Negative dromotropy-vagal stimulation-Verapamil
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19. CON...
 Antiangina drugs
 Against pain of angina pectoris
 This mainly
 Nitrates- vasodilators, release NO muscle relaxant
 reduce preload and after load
 - nausea, vomiting ,tachycardia,palpitation
 -adverse reaction severe anemia,early MI,
 Inceased ICP.Hypotension
 Beta –blockers
 Calcium channel blockers
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20. CON...
 Active antianginal agent
 Nitroglycerine is used to treat surgical hypertension
 Drug interactions with ,sildenafil
 Nursing intervention
-proper storage of the drug
-take in 5 minute and take emergency medical check up -if
no relief 3 tablets
-Teach the patient to sit down while taking this medication
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21. CON...
 Adverse effect-
-Headache ,orthostatic hypertension,flushing,nausea vomiting
 Contraindicated
-Hypertensive to nitrates, orthostatic hypertension,
MI,Increased intra cranial pressure.Caution patient with
hypotension
-Interact with antihypertensive drugs
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22. Con...
 Antihypertensive Drugs
-Hypertension –abnormal increased blood pressure
class of antihypertensive drugs
 Nitrates-
 Beta –blockers- Metoporolol
 Calcium chanel blockers-NIFDIPINE
 ACEI-Captopril-inhibit conversion angiotensin I to
angiotensin II
 Vasodilators –hydralazine
 Diuretics-Furosemide,spironolactone
 Angiotensin antagonist-Losartan
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23. CON...
 Beta-blockers prevent stimulation of beta-aderengic
receptors of sympathetic nervous system
 Not to be given with bradycardiya,third degree heart
block,cardiogenic shock
Calcium channel blockers
 Block entry of calcium ion into smooth muscle and cardiac
cell that decrease intercellular ca ions there is smooth
muscle relaxation leads to vasodilations
 Digoxin toxocity,interaction with other calcium channel
blocker
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24. CON...
 Adverse effect
-Orthostatic hypertension,Fatigue,bradycardia,nausea ,
Vomiting
Drug interactions
-Other Calcium channel blockers,alcohol
Nursing Intervention
-Do not stop the drug abruptly
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25. CON...
 Antiarrhythmic drugs
 Antiarrhythmic medications prevent and treat
abnormal heartbeats (arrhythmias)
 There are four main groups of antiarrhythmic
medications: class I, sodium-channel blockers;
 class II, beta-blockers;
 class III, potassium-channel blockers; -prolong
action potential
 class IV, calcium-channel blockers; and
miscellaneous antiarrhythmics, or unclassified
antiarrhythmics.
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26. CON...
 Class I, sodium channel blockers: These drugs prevent
sodium from getting through cell membranes. This can slow
electrical impulses in the heart muscle. Examples include
disopyramide, flecainide, mexiletine, propafenone and
quinidine
 Class Ia: Fast sodium (Na) channel blockers
 Ib -Lidocaine, phenytoin, mexiletine (depress phase 0
selectively in abnormal/ischemic tissue, shorten
repolarization)
 Ic -Flecainide, propafenone, moricizine (markedly depress
phase 0, minimal effect on repolarization) 26

27. CON...
 Class II, beta blockers: These drugs slow down the heart
rate, often by blocking hormones such as adrenaline.
Examples include acebutolol, atenolol, bisoprolol,
metoprolol, nadolol and propranolol.
 increasing action potential duration and the effective
refractory period
27

28. CON...
 Class III, potassium channel blockers: These drugs
prevent potassium from getting through cell membranes.
This can slow down electrical impulses in all of the heart’s
cells.
 prolongs repolarization without affecting conduction velocity
by blocking one or more time-dependent potassium
currents.
 Examples include amiodarone
28

29. CON...
 Class IV, non dihydropyridine calcium channel
blockers : These drugs block calcium channels in
heart muscle. This can decrease heart rate and
contractions.
 decrease conduction through the AV node, and shorten
phase two (the plateau) of the cardiac action potential
 Examples include diltiazem and verapamil.
 Other antiarrhythmic drugs :
 Adenosine: This medication can block or slow down
electrical impulses at the atrioventricular node, between
the upper and lower chambers of the heart.
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30. CON...
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31. CON...
 Anticoagulants
- prevent clot formation-to prevent thrombosis
- Heparin,warfarin
- Indication
- -PCI
- -Open heart surgery
- -thromboemolic disorder
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32. CON...
 Contraindicated
-Peptic ulcer
-Recurrent surgery
Coagulation disorder
 Adverse effect
Hyperlipidemia,Heamorrhage,thrombocytopiena,constipation,p
ain at injection site
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33. CON...
 Do not give heparin IM
Antiplatelates
-asprin
-clopidegrol
contraindication
-similar to anticoagulant
 Thrombolytic-to dissolve clot
 Example streptokinase , Alteplase
33

34. CON...
Indication
 MI
 DVT
 PE
 Stroke
Drugs of Hyperlipidemia
-to treat atherosclerosis
 Prevent synthesis of cholestrol in liver
 Eg atrovastatin
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35. DRUG CALCULATION
Drop rate
 Drip Rate (dpm) =Volume of IV fluid (mL) x drops/ml(drop
factor)
Time to run (h) 60 min/h
 Drip rate (mL/hour) = Total volume (mL) / Infusion time
 Situation: The patient is ordered an IV of 1000ml of Normal Saline
over 12 hours with drop factor of 15 drops/ml
 Calculate
rate(ml/hr)=1000/12=83.3ml/hr
drip rate =1000 x 15= 20.83drip/min
 12x60 35

36. CON....
Heparin Infusion Rate: Total Units (in IV bag) =units/hr
Total volume (ml) x
eg .Heparin infusion is to start rate of 1350 units/hour at
per the practitioner’s order. The heparin infusion comes
in a 500ml bag with 25,000 units. Calculate the starting
rate of the infusion (ml/hour).
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37. CON...
 25000 Units= 1350 units /hr
500ml x
50x=1350ml/hr
x=27ml/hr
An IV with nitroglycerin is infusing at 8 mL/hr. The
concentration of the IV is 50 mg in 250 mL of D5W. How
many mg/hr is the patient receiving?
50mg divided by 250 ml = 0.2 mg x 8ml/hr = 1.6mg/hr
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38. CON
 RATIO AND PROPORTION METHOD
 D= Desired dose or dose ordered by the primary care
provider.
 H = dose on hand or dose on the label of bottle, vial,
ampule.
 V = vehicle or the form in which the drug comes (i.e.,
tablet or liquid).
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39. CON....
 STANDARD FORMULA
Desired dose(D)XVehicle (V)
 dose on hand(H )
 Order: Amoxacilline 500 mg
On hand: Amoxacilline 250 mg in 5 mL
Desired (D) = 500 mg
On hand (H) = 250 mg
Vehicle (V) = 5 mL
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40. CON...
 Rate of Infusion
 Ml/hr =desired dose x pt weight x60
drug concentration
 For Noradernaline 4/50mglml =80mcq/ml
 For dopamine concentration 200mg/5ml=4000mcq
 For doubtamine concentration 250mg/5ml=5000mcq
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41. REFERENCE
 https://app.lecturio.com/#/article/2907
 https://www.google.com/search?q=antiarrhyt
hmic+drugs&rlz
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