This document discusses various inotropic agents and diuretics. It describes different types of inotropic agents including positive inotropes like digitalis glycosides, dobutamine, and phosphodiesterase inhibitors, as well as negative inotropes. Common diuretics are also summarized such as high efficacy loop diuretics, thiazide diuretics, carbonic anhydrase inhibitors, and osmotic diuretics. Their mechanisms of action, therapeutic uses, and potential adverse effects are highlighted.
This document discusses various inotropic drugs used to increase the contractility of the heart. It describes the mechanisms and indications for commonly used inotropes like dobutamine, dopamine, epinephrine, milrinone and digoxin. Precise dosing guidelines and dilution methods are provided for each drug. Potential side effects and nursing considerations are also summarized for safe administration of inotropic therapy.
This document discusses inotropic agents, which are drugs that affect the strength of contraction of the heart muscle. It describes positive inotropes that increase contraction and negative inotropes that decrease contraction. The choice of inotrope depends on its pharmacological effects and the specific cardiovascular condition. Positive inotropes discussed include calcium, calcium sensitizers like levosimendan, catecholamines, cardiac glycosides, and others. Negative inotropes include beta blockers, calcium channel blockers, and antiarrhythmics. The mechanisms and effects of various catecholamines like dopamine, dobutamine, epinephrine, and dopexamine are also outlined.
This document provides an overview of inotropes and vasopressors used to support cardiac function. It reviews the physiology of cardiac contraction and classifies drugs by their mechanisms of action on beta-adrenergic, alpha-adrenergic, or phosphodiesterase receptors. Common agents like dopamine, norepinephrine, and vasopressin are described in terms of their hemodynamic effects. The document notes the limited evidence to guide clinical use and suggests choice depends on individual patient factors. Novel approaches combining inotropes with beta-blockers are also mentioned.
The term inotropic state is most commonly used in reference to various drugs that affect the strength of contraction of heart muscle (myocardial contractility). However, it can also refer to pathological conditions. For example, enlarged heart muscle (ventricular hypertrophy) can increase inotropic state, whereas dead heart muscle (myocardial infarction) can decrease it.
This document discusses inotropes, which are drugs that increase the force of myocardial contraction. It defines inotropes and discusses their physiological effects and classification. Various endogenous and exogenous inotropic agents are described in detail, including their mechanisms of action, indications, dosages, pharmacokinetics and side effects. Sympathomimetic drugs like epinephrine, norepinephrine and dopamine are discussed as conventional positive inotropic agents.
1. Clinical examination alone is not sufficient to assess hemodynamic status in critically ill patients as individual vital signs do not reflect overall status.
2. Arterial lines can be used to monitor blood pressure, heart rate, and derive parameters like cardiac output but waveforms require interpretation and may be affected by various artifacts.
3. Pulmonary artery catheters can measure central venous and pulmonary artery pressures as well as cardiac output but have potential complications and their use remains controversial with no proven benefits shown in large trials.
1) An arterial line allows continuous monitoring of a patient's blood pressure by connecting an arterial catheter to a pressure transducer. The transducer converts pressure oscillations into an electrical waveform displayed on a monitor.
2) The arterial waveform provides information about cardiovascular physiology and hemodynamics. An accurate waveform depends on proper catheter placement, monitoring equipment setup, and avoiding issues like dampening or resonance.
3) Key portions of the arterial waveform include the anacrotic limb, anacrotic notch, dicrotic limb, and dicrotic notch, which reflect events in the cardiac cycle and can be affected by conditions like vascular resistance.
This document discusses dilated cardiomyopathy (DCM), the most common type of cardiomyopathy. It provides details on:
1) The causes, symptoms, signs, diagnostic tests and goals of treatment for DCM. The mainstay of therapy includes vasodilators, digoxin and diuretics.
2) The morphological and microscopic features of DCM which involve enlargement and spherical dilation of the heart chambers.
3) Disease progression can lead to marked left ventricular dilatation and circulatory failure if left untreated. Management aims to relieve symptoms and slow progression.
This document discusses various inotropic drugs used to increase the contractility of the heart. It describes the mechanisms and indications for commonly used inotropes like dobutamine, dopamine, epinephrine, milrinone and digoxin. Precise dosing guidelines and dilution methods are provided for each drug. Potential side effects and nursing considerations are also summarized for safe administration of inotropic therapy.
This document discusses inotropic agents, which are drugs that affect the strength of contraction of the heart muscle. It describes positive inotropes that increase contraction and negative inotropes that decrease contraction. The choice of inotrope depends on its pharmacological effects and the specific cardiovascular condition. Positive inotropes discussed include calcium, calcium sensitizers like levosimendan, catecholamines, cardiac glycosides, and others. Negative inotropes include beta blockers, calcium channel blockers, and antiarrhythmics. The mechanisms and effects of various catecholamines like dopamine, dobutamine, epinephrine, and dopexamine are also outlined.
This document provides an overview of inotropes and vasopressors used to support cardiac function. It reviews the physiology of cardiac contraction and classifies drugs by their mechanisms of action on beta-adrenergic, alpha-adrenergic, or phosphodiesterase receptors. Common agents like dopamine, norepinephrine, and vasopressin are described in terms of their hemodynamic effects. The document notes the limited evidence to guide clinical use and suggests choice depends on individual patient factors. Novel approaches combining inotropes with beta-blockers are also mentioned.
The term inotropic state is most commonly used in reference to various drugs that affect the strength of contraction of heart muscle (myocardial contractility). However, it can also refer to pathological conditions. For example, enlarged heart muscle (ventricular hypertrophy) can increase inotropic state, whereas dead heart muscle (myocardial infarction) can decrease it.
This document discusses inotropes, which are drugs that increase the force of myocardial contraction. It defines inotropes and discusses their physiological effects and classification. Various endogenous and exogenous inotropic agents are described in detail, including their mechanisms of action, indications, dosages, pharmacokinetics and side effects. Sympathomimetic drugs like epinephrine, norepinephrine and dopamine are discussed as conventional positive inotropic agents.
1. Clinical examination alone is not sufficient to assess hemodynamic status in critically ill patients as individual vital signs do not reflect overall status.
2. Arterial lines can be used to monitor blood pressure, heart rate, and derive parameters like cardiac output but waveforms require interpretation and may be affected by various artifacts.
3. Pulmonary artery catheters can measure central venous and pulmonary artery pressures as well as cardiac output but have potential complications and their use remains controversial with no proven benefits shown in large trials.
1) An arterial line allows continuous monitoring of a patient's blood pressure by connecting an arterial catheter to a pressure transducer. The transducer converts pressure oscillations into an electrical waveform displayed on a monitor.
2) The arterial waveform provides information about cardiovascular physiology and hemodynamics. An accurate waveform depends on proper catheter placement, monitoring equipment setup, and avoiding issues like dampening or resonance.
3) Key portions of the arterial waveform include the anacrotic limb, anacrotic notch, dicrotic limb, and dicrotic notch, which reflect events in the cardiac cycle and can be affected by conditions like vascular resistance.
This document discusses dilated cardiomyopathy (DCM), the most common type of cardiomyopathy. It provides details on:
1) The causes, symptoms, signs, diagnostic tests and goals of treatment for DCM. The mainstay of therapy includes vasodilators, digoxin and diuretics.
2) The morphological and microscopic features of DCM which involve enlargement and spherical dilation of the heart chambers.
3) Disease progression can lead to marked left ventricular dilatation and circulatory failure if left untreated. Management aims to relieve symptoms and slow progression.
This document discusses the determinants of ventricular performance, including systolic and diastolic function. Systolic function depends on cardiac output, which equals stroke volume multiplied by heart rate. Stroke volume is determined by preload, afterload, contractility, and other factors. Diastolic function relates to ventricular filling and compliance. Mechanical ventilation can reduce ventricular performance by decreasing preload. Inhalational anesthetics vary in their effects, with isoflurane causing minimal depression. Succinylcholine and ketamine can increase heart rate and contractility while benzodiazepines and propofol cause little cardiovascular effect.
Inotropic agents work by increasing the force and velocity of cardiac muscle contraction. They are used to improve myocardial function and support circulation in heart failure. Common inotropic agents include cardiac glycosides like digoxin which inhibit Na+-K+-ATPase, beta-adrenergic agonists like dobutamine which stimulate beta-1 receptors, and phosphodiesterase inhibitors like milrinone which increase cAMP levels. While inotropes can provide short-term hemodynamic support, long-term use does not improve survival and may increase mortality in heart failure patients.
This document discusses hemodynamic pressure monitoring, including indirect and invasive arterial pressure monitoring, central venous pressure monitoring, and pulmonary artery catheter placement and measurements. It provides details on:
- Methods for continuously monitoring arterial blood pressure, heart rate, and circulatory function during anesthesia
- Techniques for indirect and direct arterial pressure measurement
- Components, calibration, and placement of arterial pressure monitoring catheters
- Measurements obtained from central venous and pulmonary artery catheters like cardiac output, pressures, and oxygen saturation
- Potential complications of pulmonary artery catheter placement
This document discusses inotropes and vasopressors used to support the failing heart or peripheral vasculature. It defines inotropes as drugs that increase cardiac contractility and vasopressors as drugs that induce vasoconstriction. Common inotropes and vasopressors discussed include epinephrine, norepinephrine, dopamine, and dopexamine. It provides details on the physiology and pharmacology of these drugs, including their effects on different adrenergic receptors and cardiovascular functions.
This document discusses various vasoactive drugs used to treat low blood pressure and cardiac issues in critically ill patients. It begins by explaining the immature heart's limited responsiveness to medications and calcium regulation. It then describes different types of effects that agents can have including increasing blood pressure, contractility, heart rate, and relaxation. The remainder of the document delves into specific drugs, outlining their mechanisms, indications, dosages, and side effects. These include catecholamines like epinephrine, norepinephrine, and dopamine, as well as dobutamine, milrinone, vasopressin, nitroprusside, and nesiritide.
GP IIb/ IIIa inhibitors are the select group of antiplatelet agents which are used in injectable forms only. They block the final step of platelet activation and cross-linking by Fibrinogen and vonWilbrand Factor.
Hemodynamics of cardiac tamponade, constrictive pericarditis & restrictive ca...Dr. Rajesh Das
The document provides information on the anatomy, physiology, and pathophysiology of the pericardium and pericardial diseases. It discusses the layers of the pericardium, functions of restraining cardiac volume and lubricating the heart. In pathophysiology, it describes cardiac tamponade, constrictive pericarditis, and their differences from restrictive cardiomyopathy. Diagnostic tools including echocardiography and cardiac catheterization are outlined for evaluating pericardial diseases and distinguishing constrictive pericarditis from restrictive cardiomyopathy.
This document discusses various inotropes and vasoactive agents used to support hemodynamics. It describes the classification of agents as inotropes, chronotropes, vasopressors, or vasodilators. Key agents covered include dopamine, dobutamine, adrenaline, noradrenaline, milrinone, vasopressin, nitroglycerine, and sodium nitroprusside. For each agent, the document discusses receptor physiology, hemodynamic effects, indications, dosing, side effects, and monitoring considerations. It concludes with describing a vasoactive inotrope score used to quantify cardiovascular support.
1) The document provides information on inotropes and vasopressors including their classification, sites of action, clinical effects, indications, and doses. It discusses catecholamines like adrenaline, noradrenaline, dopamine, and dobutamine. It also covers phosphodiesterase inhibitors, vasopressin, ephedrine, metaraminol, phenylephrine, methoxamine, and digoxin.
2) The document concludes with recommendations on first and second line vasopressor/inotropic agents for different clinical situations like septic shock, heart failure, cardiogenic shock, anaphylactic shock, and anesthesia-induced hypotension.
This document discusses ranolazine, a drug used to treat chronic angina. It begins by introducing chronic angina as a condition affecting many Americans. It then reviews the history of anti-anginal drugs and discusses why newer treatments are needed. The document focuses on the mechanism of action and clinical trial results of ranolazine. Ranolazine is a unique anti-anginal that acts by inhibiting fatty acid oxidation and blocking late sodium channels. Clinical trials such as MARISA, CARISA and ERICA demonstrated ranolazine's ability to reduce angina symptoms and improve exercise tolerance when added to standard anti-anginal therapies.
Trans-esophageal echocardiography (TEE) uses ultrasound to obtain high-quality images of the heart and surrounding structures. It involves inserting a probe with an ultrasound transducer at the tip through the mouth and esophagus. TEE provides clearer images than transthoracic echocardiography as the esophagus is directly behind the heart. A TEE exam involves systematically imaging the heart in various planes as the transducer is advanced and manipulated. Standard views include the mid-esophageal four-chamber, two-chamber, aortic, and RV inflow-outflow views. Real-time 3D TEE can provide en face views of structures.
ventricular premature complexes and idioventricular rhythm identification is important in the ICU ..they may run into arryhthmias..look over my seminar...
any queries...
Ionotropes and vasopressor use in the EDSCGH ED CME
This document discusses the use of inotropes and vasopressors in the emergency department for management of shock. It provides an overview of different drug classes including their mechanisms of action, dosages, and side effects. Case studies are presented to demonstrate how these drugs may be used in scenarios involving hypotension, shock, and heart block. Key drugs discussed include norepinephrine, dopamine, adrenaline, metaraminol, and isoprenaline. The document emphasizes the importance of determining the type of shock and selecting an appropriate drug to increase cardiac output, systemic vascular resistance, or both depending on the clinical situation.
This document summarizes different vasopressors and inotropes used to treat hypotension. It describes the receptor activities, physiological effects, indications, and complications of various drugs including phenylephrine, norepinephrine, epinephrine, dopamine, dobutamine, vasopressin, and phosphodiesterase inhibitors. It provides guidance on selecting agents and titrating doses based on the underlying cause of hypotension and the patient's clinical status.
The document discusses various types of cardiac arrhythmias including their definitions, causes, clinical manifestations and management. It describes normal sinus rhythm and defines arrhythmias as any change from the normal heart rhythm. Common arrhythmias discussed include sinus tachycardia, sinus bradycardia, premature atrial complexes, premature ventricular complexes, atrial flutter, atrial fibrillation and ventricular tachycardia. It provides EKG images to demonstrate the different arrhythmias and compares characteristics of supraventricular and ventricular arrhythmias. Causes, clinical significance and treatment approaches for different arrhythmias are also summarized.
This document provides information on levosimendan, a calcium sensitizer used in the management of congestive heart failure. It discusses levosimendan's mechanism of action of enhancing cardiac contractility without increasing intracellular calcium levels. This reduces the drug's potential for arrhythmias compared to other inotropes. The document summarizes levosimendan's pharmacokinetics, dosing, efficacy demonstrated in clinical trials compared to dobutamine and placebo, and side effect profile. It positions levosimendan as an ideal agent for increasing cardiac output while minimizing oxygen demand, tachyphylaxis and arrhythmogenic potential.
PERIOPERATIVE RENAL PROTECTION : WHAT IS THE EVIDENCE?Dr Jayashree Patki
PERIOPERATIVE RENAL PROTECTION : WHAT IS THE EVIDENCE?-
Dr. JAYASHREE PATKI
MBBS, MD, PGDHHM
Sr. Consultant
Krishna Institute of Medical Sciences
Hyderabad
Digoxin & Nitroglycerin by Dr. Sanaullah Aslam (Complete)Sanaullah Aslam
Digoxin is a drug derived from foxglove that increases the strength of heart contractions and regulates heart rhythm. It is used to treat heart failure and abnormal heart rhythms. Digoxin works by increasing the amount of calcium available to heart muscles to improve contraction. Common side effects include nausea, vomiting, and heart palpitations. In cases of toxicity, treatment includes administering digoxin immune fab to remove digoxin from the bloodstream.
Nitroglycerin is a vasodilator that relaxes blood vessels. It is used to treat angina by dilating coronary arteries and reducing the workload on the heart. Nitroglycerin is administered sublingually as a tablet or spray for
This document provides an overview of various classes of antihypertensive drugs, including their mechanisms of action and side effects. It discusses ACE inhibitors, ARBs, beta blockers, calcium channel blockers, alpha blockers, central sympatholytics, vasodilators, and combination drugs. The classes are described along with examples of common drugs within each class. Mechanisms involve inhibiting the renin-angiotensin-aldosterone system, blocking adrenoreceptors, or relaxing smooth muscle. Side effects include cough, hypotension, fatigue, sexual dysfunction, and fluid retention depending on the specific drug. Factors like comorbidities and costs help determine which antihypertensive is suitable for an individual patient.
This document summarizes various inotropic drugs used to increase cardiac contractility including cardiac glycosides like digoxin, catecholamines like dopamine and dobutamine, phosphodiesterase inhibitors like milrinone, and calcium sensitizers like levosimendan. It provides details on their mechanisms of action, pharmacokinetics, uses, dosages, and side effects. The document focuses on the inotropic and hemodynamic effects of these drugs and their roles in treating low cardiac output states and heart failure.
This document discusses the determinants of ventricular performance, including systolic and diastolic function. Systolic function depends on cardiac output, which equals stroke volume multiplied by heart rate. Stroke volume is determined by preload, afterload, contractility, and other factors. Diastolic function relates to ventricular filling and compliance. Mechanical ventilation can reduce ventricular performance by decreasing preload. Inhalational anesthetics vary in their effects, with isoflurane causing minimal depression. Succinylcholine and ketamine can increase heart rate and contractility while benzodiazepines and propofol cause little cardiovascular effect.
Inotropic agents work by increasing the force and velocity of cardiac muscle contraction. They are used to improve myocardial function and support circulation in heart failure. Common inotropic agents include cardiac glycosides like digoxin which inhibit Na+-K+-ATPase, beta-adrenergic agonists like dobutamine which stimulate beta-1 receptors, and phosphodiesterase inhibitors like milrinone which increase cAMP levels. While inotropes can provide short-term hemodynamic support, long-term use does not improve survival and may increase mortality in heart failure patients.
This document discusses hemodynamic pressure monitoring, including indirect and invasive arterial pressure monitoring, central venous pressure monitoring, and pulmonary artery catheter placement and measurements. It provides details on:
- Methods for continuously monitoring arterial blood pressure, heart rate, and circulatory function during anesthesia
- Techniques for indirect and direct arterial pressure measurement
- Components, calibration, and placement of arterial pressure monitoring catheters
- Measurements obtained from central venous and pulmonary artery catheters like cardiac output, pressures, and oxygen saturation
- Potential complications of pulmonary artery catheter placement
This document discusses inotropes and vasopressors used to support the failing heart or peripheral vasculature. It defines inotropes as drugs that increase cardiac contractility and vasopressors as drugs that induce vasoconstriction. Common inotropes and vasopressors discussed include epinephrine, norepinephrine, dopamine, and dopexamine. It provides details on the physiology and pharmacology of these drugs, including their effects on different adrenergic receptors and cardiovascular functions.
This document discusses various vasoactive drugs used to treat low blood pressure and cardiac issues in critically ill patients. It begins by explaining the immature heart's limited responsiveness to medications and calcium regulation. It then describes different types of effects that agents can have including increasing blood pressure, contractility, heart rate, and relaxation. The remainder of the document delves into specific drugs, outlining their mechanisms, indications, dosages, and side effects. These include catecholamines like epinephrine, norepinephrine, and dopamine, as well as dobutamine, milrinone, vasopressin, nitroprusside, and nesiritide.
GP IIb/ IIIa inhibitors are the select group of antiplatelet agents which are used in injectable forms only. They block the final step of platelet activation and cross-linking by Fibrinogen and vonWilbrand Factor.
Hemodynamics of cardiac tamponade, constrictive pericarditis & restrictive ca...Dr. Rajesh Das
The document provides information on the anatomy, physiology, and pathophysiology of the pericardium and pericardial diseases. It discusses the layers of the pericardium, functions of restraining cardiac volume and lubricating the heart. In pathophysiology, it describes cardiac tamponade, constrictive pericarditis, and their differences from restrictive cardiomyopathy. Diagnostic tools including echocardiography and cardiac catheterization are outlined for evaluating pericardial diseases and distinguishing constrictive pericarditis from restrictive cardiomyopathy.
This document discusses various inotropes and vasoactive agents used to support hemodynamics. It describes the classification of agents as inotropes, chronotropes, vasopressors, or vasodilators. Key agents covered include dopamine, dobutamine, adrenaline, noradrenaline, milrinone, vasopressin, nitroglycerine, and sodium nitroprusside. For each agent, the document discusses receptor physiology, hemodynamic effects, indications, dosing, side effects, and monitoring considerations. It concludes with describing a vasoactive inotrope score used to quantify cardiovascular support.
1) The document provides information on inotropes and vasopressors including their classification, sites of action, clinical effects, indications, and doses. It discusses catecholamines like adrenaline, noradrenaline, dopamine, and dobutamine. It also covers phosphodiesterase inhibitors, vasopressin, ephedrine, metaraminol, phenylephrine, methoxamine, and digoxin.
2) The document concludes with recommendations on first and second line vasopressor/inotropic agents for different clinical situations like septic shock, heart failure, cardiogenic shock, anaphylactic shock, and anesthesia-induced hypotension.
This document discusses ranolazine, a drug used to treat chronic angina. It begins by introducing chronic angina as a condition affecting many Americans. It then reviews the history of anti-anginal drugs and discusses why newer treatments are needed. The document focuses on the mechanism of action and clinical trial results of ranolazine. Ranolazine is a unique anti-anginal that acts by inhibiting fatty acid oxidation and blocking late sodium channels. Clinical trials such as MARISA, CARISA and ERICA demonstrated ranolazine's ability to reduce angina symptoms and improve exercise tolerance when added to standard anti-anginal therapies.
Trans-esophageal echocardiography (TEE) uses ultrasound to obtain high-quality images of the heart and surrounding structures. It involves inserting a probe with an ultrasound transducer at the tip through the mouth and esophagus. TEE provides clearer images than transthoracic echocardiography as the esophagus is directly behind the heart. A TEE exam involves systematically imaging the heart in various planes as the transducer is advanced and manipulated. Standard views include the mid-esophageal four-chamber, two-chamber, aortic, and RV inflow-outflow views. Real-time 3D TEE can provide en face views of structures.
ventricular premature complexes and idioventricular rhythm identification is important in the ICU ..they may run into arryhthmias..look over my seminar...
any queries...
Ionotropes and vasopressor use in the EDSCGH ED CME
This document discusses the use of inotropes and vasopressors in the emergency department for management of shock. It provides an overview of different drug classes including their mechanisms of action, dosages, and side effects. Case studies are presented to demonstrate how these drugs may be used in scenarios involving hypotension, shock, and heart block. Key drugs discussed include norepinephrine, dopamine, adrenaline, metaraminol, and isoprenaline. The document emphasizes the importance of determining the type of shock and selecting an appropriate drug to increase cardiac output, systemic vascular resistance, or both depending on the clinical situation.
This document summarizes different vasopressors and inotropes used to treat hypotension. It describes the receptor activities, physiological effects, indications, and complications of various drugs including phenylephrine, norepinephrine, epinephrine, dopamine, dobutamine, vasopressin, and phosphodiesterase inhibitors. It provides guidance on selecting agents and titrating doses based on the underlying cause of hypotension and the patient's clinical status.
The document discusses various types of cardiac arrhythmias including their definitions, causes, clinical manifestations and management. It describes normal sinus rhythm and defines arrhythmias as any change from the normal heart rhythm. Common arrhythmias discussed include sinus tachycardia, sinus bradycardia, premature atrial complexes, premature ventricular complexes, atrial flutter, atrial fibrillation and ventricular tachycardia. It provides EKG images to demonstrate the different arrhythmias and compares characteristics of supraventricular and ventricular arrhythmias. Causes, clinical significance and treatment approaches for different arrhythmias are also summarized.
This document provides information on levosimendan, a calcium sensitizer used in the management of congestive heart failure. It discusses levosimendan's mechanism of action of enhancing cardiac contractility without increasing intracellular calcium levels. This reduces the drug's potential for arrhythmias compared to other inotropes. The document summarizes levosimendan's pharmacokinetics, dosing, efficacy demonstrated in clinical trials compared to dobutamine and placebo, and side effect profile. It positions levosimendan as an ideal agent for increasing cardiac output while minimizing oxygen demand, tachyphylaxis and arrhythmogenic potential.
PERIOPERATIVE RENAL PROTECTION : WHAT IS THE EVIDENCE?Dr Jayashree Patki
PERIOPERATIVE RENAL PROTECTION : WHAT IS THE EVIDENCE?-
Dr. JAYASHREE PATKI
MBBS, MD, PGDHHM
Sr. Consultant
Krishna Institute of Medical Sciences
Hyderabad
Digoxin & Nitroglycerin by Dr. Sanaullah Aslam (Complete)Sanaullah Aslam
Digoxin is a drug derived from foxglove that increases the strength of heart contractions and regulates heart rhythm. It is used to treat heart failure and abnormal heart rhythms. Digoxin works by increasing the amount of calcium available to heart muscles to improve contraction. Common side effects include nausea, vomiting, and heart palpitations. In cases of toxicity, treatment includes administering digoxin immune fab to remove digoxin from the bloodstream.
Nitroglycerin is a vasodilator that relaxes blood vessels. It is used to treat angina by dilating coronary arteries and reducing the workload on the heart. Nitroglycerin is administered sublingually as a tablet or spray for
This document provides an overview of various classes of antihypertensive drugs, including their mechanisms of action and side effects. It discusses ACE inhibitors, ARBs, beta blockers, calcium channel blockers, alpha blockers, central sympatholytics, vasodilators, and combination drugs. The classes are described along with examples of common drugs within each class. Mechanisms involve inhibiting the renin-angiotensin-aldosterone system, blocking adrenoreceptors, or relaxing smooth muscle. Side effects include cough, hypotension, fatigue, sexual dysfunction, and fluid retention depending on the specific drug. Factors like comorbidities and costs help determine which antihypertensive is suitable for an individual patient.
This document summarizes various inotropic drugs used to increase cardiac contractility including cardiac glycosides like digoxin, catecholamines like dopamine and dobutamine, phosphodiesterase inhibitors like milrinone, and calcium sensitizers like levosimendan. It provides details on their mechanisms of action, pharmacokinetics, uses, dosages, and side effects. The document focuses on the inotropic and hemodynamic effects of these drugs and their roles in treating low cardiac output states and heart failure.
This document discusses antiarrhythmic drugs, which are used to treat abnormal heart rhythms known as cardiac arrhythmias. It defines arrhythmias and describes their causes and mechanisms. It then classifies antiarrhythmic drugs into four main classes based on their effects on ion channels in the heart muscle. For each class, it provides examples of drugs, their mechanisms of action, uses, and common side effects. The classes are sodium channel blockers, beta blockers, potassium channel blockers, and calcium channel blockers.
Here are the key points of management:
1. Hospital admission and IV access is needed given the hypertensive emergency presentation with severe hypertension and papilledema.
2. Sodium nitroprusside infusion is started at a low dose and titrated up slowly to reach the target BP of 160/100-110 mmHg, with no more than a 25% reduction within 2 hours.
3. Alternatively, enalaprilat can be given in divided doses not exceeding 5mg total over several hours to gradually lower the BP within the target range.
Close monitoring is required given the emergency presentation until BP is stabilized. The goal is to lower BP gradually to avoid rebound hypertension but do so promptly given the
This document discusses cardiovascular drugs, including inotropes, vasodilators, and vasopressors. It lists various drug types for each category and describes their modes of action, uses, side effects, and dosages. The objectives are to describe cardiovascular drugs, list the types, explain their uses and side effects, and discuss dosage. Examples of inotropes discussed are catecholamines, phosphodiesterase inhibitors, and cardiac glycosides. Nitrates, ACE inhibitors, and calcium channel blockers are some vasodilators covered. The vasopressors section outlines alpha-adrenergic drugs and vasopressin analogs.
This document discusses various classes of antihypertensive drugs including diuretics, ACE inhibitors, angiotensin receptor blockers, and calcium channel blockers. It provides details on their mechanisms of action, pharmacokinetics, therapeutic uses, side effects, and contraindications. Diuretics are first-line treatment for mild to moderate hypertension and work by increasing sodium excretion. ACE inhibitors and ARBs block the renin-angiotensin-aldosterone system to lower blood pressure. Calcium channel blockers inhibit calcium channels to cause vasodilation and lower blood pressure.
This document discusses various classes of antihypertensive agents used to treat hypertension. It defines hypertension and describes the renin-angiotensin-aldosterone system which is important in regulating blood pressure. Common classes of antihypertensive agents discussed include diuretics, ACE inhibitors, ARBs, calcium channel blockers, beta-blockers, alpha blockers, and central sympatholytics. Lifestyle modifications including weight loss, exercise, diet changes, and avoiding tobacco are also recommended for managing hypertension.
This document discusses vasoactive agents and their receptor physiology and clinical applications. It begins by outlining the objectives of understanding vasopressor and inotropic receptor physiology and appropriate clinical use. It then provides background on vasopressors, inotropes, and drugs that have both effects. The majority of the document then discusses the receptor physiology and mechanisms of action of various adrenergic, dopaminergic, and vasopressin receptors. It also covers individual drug classifications, effects, indications, and considerations for agents like epinephrine, norepinephrine, dopamine, dobutamine, milrinone, vasopressin, levosimendan, and vasodilators. Studies comparing agents
This document discusses drugs used for congestive heart failure (CHF). It defines heart failure and lists its common causes. It then describes the classes of drugs used to relieve CHF symptoms and improve cardiac function, such as diuretics, vasodilators, ACE inhibitors, and beta-blockers. It provides details on cardiac glycosides like digoxin, including its pharmacology, mechanisms of action, effects, interactions, and precautions. Finally, it briefly discusses other drugs used in CHF treatment like phosphodiesterase inhibitors amrinone and milrinone, and the inotropic drug dobutamine.
This document discusses heart failure and its treatment. Heart failure results from reduced cardiac output and activation of the sympathetic nervous system and renin-angiotensin-aldosterone system, leading to sodium and water retention. Beta-blockers are beneficial for treating heart failure despite initially reducing cardiac function, as they prevent ischemia, induce remodeling, reduce toxicity, and apoptosis. Inotropic drugs like cardiac glycosides and beta-adrenergic agonists increase contractility but their long term use increases mortality.
Congestive cardiac failure is defined as a chronic condition where the heart is unable to pump enough blood to meet the body's needs. It can be classified as systolic, diastolic, acute or chronic. Common causes include arrhythmias, myocardial infarction, hypertension, and obesity. Symptoms include fatigue, shortness of breath, and edema while signs include tachycardia and edema. Diagnosis involves tests such as ECG, echocardiogram, and blood tests. Management consists of medications like ACE inhibitors, diuretics, beta-blockers and lifestyle modifications like diet, exercise and smoking cessation.
This document summarizes several classes of antihypertensive drugs. It discusses diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, alpha blockers, direct vasodilators, and their mechanisms of action, indications, side effects and monitoring. The document provides tables with examples of drugs within each class and details regarding administration and patient education.
This document summarizes different types of antianginal drugs used to treat angina pectoris. The main types discussed are nitrates, calcium channel blockers, beta adrenergic antagonists, and potassium channel openers. Nitrates work by dilating veins and relaxing coronary arteries to redistribute blood flow. Calcium channel blockers inhibit calcium entry into cardiac and smooth muscle cells to reduce peripheral resistance. Beta blockers block adrenergic receptors in the heart and kidney to decrease cardiac output and release of renin. Potassium channel openers open potassium channels in smooth muscles to cause relaxation.
Scope: This subject is intended to impart the fundamental knowledge on various aspects
(classification, mechanism of action, therapeutic effects, clinical uses, side effects and
contraindications) of drugs acting on different systems of body and in addition,emphasis
on the basic concepts of bioassay. Objectives: Upon completion of this course the student should be able to
1. Understand the mechanism of drug action and its relevance in the treatment of
different diseases
2. Demonstrate isolation of different organs/tissues from the laboratory animals by
simulated experiments
3. Demonstrate the various receptor actions using isolated tissue preparation
Hypertension is defined as a systolic blood pressure over 140 mmHg or a diastolic blood pressure over 90 mmHg. It can be caused by environmental factors like stress, high sodium intake, smoking, and obesity. Antihypertensive drugs work through various mechanisms like diuretics which increase sodium excretion, ACE inhibitors which inhibit angiotensin II synthesis, and calcium channel blockers which relax smooth muscles. Lifestyle modifications and medication are important to control blood pressure and prevent complications of hypertension like heart disease and stroke.
Emergency medications are used to treat life-threatening conditions and save patients' lives. They work quickly to control symptoms and stabilize vital functions. This document outlines several emergency drugs including adrenaline, noradrenaline, dopamine, dobutamine, nitroglycerin, and others. It describes their mechanisms of action, indications, side effects, and important nursing considerations for safe administration. Understanding these critical care medications is important for emergency treatment of patients.
Hypertension and its update in treatmentAhmed Elberry
This document discusses hypertension (HTN), including its definition, causes, risk factors, complications, classification, manifestations, and treatment options. Some key points:
- HTN is defined as a sustained blood pressure ≥140/90 mmHg. It has no symptoms but can lead to serious complications without treatment.
- Causes include primary (essential) HTN in 90-95% of cases and secondary HTN in 5% of cases related to underlying diseases or drugs.
- Treatment involves non-pharmacological options like diet, exercise, weight control as well as pharmacological options including diuretics, ACE inhibitors, calcium channel blockers, and beta-blockers.
- HTN
Pharmacological Management of Congestive Heart Failure.pptxSanjayChandrasekar2
This document discusses pharmacological management of congestive heart failure. It describes various compensatory responses during heart failure and drugs used to treat it including diuretics to reduce fluid overload, beta blockers to limit heart rate and energy use, ACE inhibitors and vasodilators to increase efficiency by reducing afterload and preload, and inotropic drugs like cardiac glycosides to increase contractility when used as a carrot on a stick. The mainstay of treatment involves diuretics along with ACE inhibitors, aldosterone antagonists, and other vasodilators or beta blockers depending on the situation.
This document discusses treatment options for congestive heart failure. It describes several classes of drugs used including inotropic drugs like digoxin to increase heart contraction; diuretics like furosemide and thiazide to reduce fluid overload; ACE inhibitors like captopril and enalapril to reduce afterload and preload; vasodilators to reduce preload and afterload; beta blockers like bisoprolol and carvedilol which are preferred to improve ventricular function; and aldosterone antagonists like spironolactone to prevent sodium reabsorption. The mechanisms of action and side effects of each drug class are explained in detail. Non-drug treatments like reducing salt intake and exercise
Pulmonary edema is fluid accumulation in the lungs that impairs gas exchange and can cause respiratory failure. Cardiac failure occurs when the heart cannot maintain adequate cardiac output or can only do so with elevated filling pressure. Left ventricular failure can be systolic, with reduced contractility, or diastolic, with impaired relaxation. Common causes include coronary artery disease, myocardial infarction, cardiomyopathy, and valvular heart disease. Treatment involves oxygen, diuretics, ACE inhibitors, beta blockers, and management of triggers like infections, arrhythmias, and electrolyte imbalances.
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...Donc Test
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Study Guide Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Course Hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Answers Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Course hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Study Guide Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Ebook Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Questions Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Stuvia
3. INTRO..
▪ A Drug that alters the force or energy of contraction
▪ Greek origin – ino = fiber , tropic = related to
2 Types
Positive inotropes
Negative inotropes
• Agent's strength of muscular
contraction
• Agents weaken the force of
muscular contractions
3
4. POSITIVE INOTROPES
▪ Enhances the myocardial contractility Increases the ejection
fraction of the heart
▪ Used to support cardiac function in conditions such as :
a) Decompensated CHF
b) Cardiogenic shock
c) Septic shock
d) Myocardial infarction
e) Cardiomyopathy , etc.
4
6. Cardiac glycosides
▪ Often called Digitalis or digitalis glycosides
▪ Source : medical plants (digital purpurea)
▪ Chemically similar compounds increasing cardiac
contractility
▪ Have been widely used in treating HF
▪ Pharmacodynamics: - Na+/K+ ATPase inhibition + Vagal
stimulation
▪ Agents : - Digoxin , Digitoxin
6
7. Digoxin
▪ Digoxin is a medication used to treat various heart conditions.
Most frequently it is used for atrial fibrillation, atrial flutter, and
heart failure.
▪ Pharmacological class : Cardiac glycoside
▪ Therapeutic class : Inotropes , antiarrhythmic
▪ In a normal heart
▪ Increases the force of contraction
▪ Constriction of blood vessel
▪ HR and CO unchanged
CARDIAC EFFECTS
7
8. ▪ In heart failure
▪ Increases the contractility and CO
▪ Systole is shortened so that there is more time for ventricular
filling
▪ HR is reduced
▪ Decreases conduction velocity of AV node and his-purkinje
system and prolongs their ERP (protection of ventricle from
AF)
▪ Prolongation of PR interval (delayed Av conduction)
▪ Shortening of QT interval (shorter ventricular systole)
▪ Depression of ST segment
▪ Inversion or disappearance of T wave
ECG changes
8
9. 1. Cardiac arrhythmias
2. GI side effects – anorexia , nausea, vomiting, diarrhoea,
abdominal cramps
3. CNS – headache, fatigue, neuralgia, blurred vision, loss of
color perception
4. Endocranial – gynecomastia
▪ Hypokalemia ,
▪ children < 10 years and elderly,
▪ myocardial infarction ,
▪ hypothyroidism ,
▪ myocarditis ,
▪ WPW syndrome
CONTRAINDICATION
A/E and Toxicity
9
10. Dopamine
▪ 3,4-dihydroxyphenylethylamine
▪ Endogenous catecholamine and immediate precursor of
norepinephrine and epinephrine
▪ It differs from NE and E by absence of –OH group at β carbon
atom side chain
▪ Important neurotransmitter, doesn’t cross BBB
10
11. 11
▪ At low therapeutic dose (2-5 μg/kg/min IV), it reacts with vascular
D1 receptor , especially in renal, mesenteric and coronary
vasculature and produce increase in GRF, renal blood flow and Na
excretion
▪ At 5 μg/kg/min, it also stimulates β1 receptors causing
increasing Cardiac output, but PVR and MAP are unchanged due to
simultaneous dilatation of renal and splanchnic vessels
▪ At still higher doses (>10μg/kg/min) it can cause vasoconstriction
by α1 receptors
▪ Conditions with low CO with compromised renal function
Cardiovascular effect
Therapeutic uses
12. Dobutamine
▪ Used clinically as a racemic mixture of 2 enantiomers
▪ I form – potent agonist at α1
d form – potent α1 antagonist , agonist β1
▪ Net effect is β1 agonist action
▪ Structurally similar to dopamine, but doesn’t have actions on
dopamine receptors
12
13. 13
▪ Inactive when given orally, usually given IV
▪ T1/2 is 2 minutes and steady state plasma concentration is achieved in
10 – 12 minutes
▪ Conjugates of dobutamine and its major metabolized compounds are
excreted primarily in urine and small amounts in faces
▪ Short term management of cardiac failure following surgery or MI
▪ Cardiac stress testing
▪ Sharp rise in BP and heart rate in some patients, especially in those
with history of HTN
▪ Increase in oxygen demand and precipitation of angina or aggravation
of MI
▪ Ventricular ectopic activity
Adverse effects
Therapeutic uses
Pharmacokinetics
14. Adrenaline (epinephrine)
▪ Pharmacological class: sympathomimetic (direct acting)
▪ Action : Adrenaline acts on β1,β2 and α1 receptors
▪ CVS: Increased heart rate and force of contraction produce an
increase in cardiac output. Systolic blood pressure rises
▪ RES: bronchial smooth muscle is relaxed resulting in
bronchodilatation through effect of β2
▪ Metabolic: Adrenaline mobilizes glucose from glycogen and
rises blood sugar. Pupillary dilatation (mydriasis) occurs.
14
15. ▪ Low cardiac output states
▪ During cardiac arrest
▪ Allergic reactions (anaphylactic shock)
▪ Local anesthetic
▪ Bronchodilator for acute severe asthma attack
▪ Septic shock
▪ DCM
▪ High blood pressure
▪ Sinus tachycardia
▪ Abnormal heart rhythm
▪ Parkinson symptoms
▪ Closed angle glaucoma
INDICATION
CONTRAINDICATION
15
16. Noradrenaline (nor epinephrine)
▪ Noradrenaline (norepinephrine) is a substance released naturally
by the nerve cells
▪ Vasopressor (a drug that rises the BP because of its ability to
constrict blood vessels)
▪ Pharmacologic class: sympathomimetic
▪ Actions : potent vasoconstrictor
▪ Increases BP by vasoconstriction. Less likely to cause tachycardia
than adrenaline
16
17. ▪ Acute hypotension states such as septic shock where peripheral
vasodilatation occurs
▪ Severe cardiogenic shock
▪ Neurogenic shock
▪ Spinal anesthesia , blood transfusion.
▪ MI
▪ Hemodynamically significant hypotension(SBP < 70 mmHg )
with low total peripheral resistance
▪ High blood pressure
▪ Blood clot , blockage of blood vessels
▪ Excess amount of carbon dioxide in the blood
▪ Decreased oxygen saturation
▪ Decreased blood volume
INDICATION
CONTRAINDICATION
17
18. Phosphodiesterase inhibitors
▪ Drugs that block subtype of enzyme phosphodiesterase (PDE),
therefore preventing the inactivation of the intercellular second
messenger's cAMP and cGMP by respective PDE subtypes.
▪ They are classified into non-selective PDE inhibitors and selective
PDE
▪ Non-selective: caffeine, aminophylline, IBMX, paraxanthine,
pentoxifylline, theobromine, theophylline.
▪ Selective : PDE1 to PDE 11
18
20. NEGATIVE INOTROPES
▪ Decreases myocardial contractility , and are used to decrease
cardiac workload in conditions such as angina
▪ While negative inotropism may precipitate or exacerbate heart
failure
▪ Certain beta-blockers ( carvedilol, bisoprolol, and metoprolol) have
been believed to reduce morbidity and mortality in congestive
heart failure.
20
21. NEGATIVE INOTROPES
1. Beta blockers
2. Calcium channel blockers:
▪ Diltiazem
▪ Verapamil
▪ Clevidipine
3. Class 1a antiarrhythmics such as :
▪ Quinidine
▪ Procainamide
▪ Disopyramide
4. Class 1c antiarrhythmic such as :
▪ Flecainide
21
22. Note..
▪ Although inotropic agents improve functional status of CHF,
long term benefit on mortality is questionable
▪ In fact, some drugs have shown to increase mortality
▪ At present digoxin remains the only oral inotropic agent available
for management of CHF
22
24. DIURETICS
▪ These are drugs which cause a net loss of Na+ and water in urine
▪ Diuretics are among the most widely prescribed drugs
▪ Application of diuretics to the management of hypertension and in
edema
24
29. Osmotic diuretics
▪ Mannitol
▪ Freely filtered at the glomerulus
▪ Not reabsorbed at the renal tubules
▪ Relatively inert pharmacologically
▪ Non – metabolizable
▪ Increases the plasma osmolarity
▪ Decreases sodium reabsorption
▪ Dilute tubular fluid and increase water excreation
29
30. 30
▪ Head injury or stroke
▪ Glaucoma
▪ In case of poisoning
▪ To maintain GRF and urine flow in patients with impaired renal
function
▪ Headache, nausea , vomiting, pulmonary edema
Therapeutic uses
Adverse effects
31. High efficacy (loop) diuretics
▪ Site of action : Thick ascending limb of loop of Henle
▪ Inhibits the luminal Na+ - k+ - 2Cl transporter – reduce
reabsorption of NaCl
▪ Prevent reabsorption of Ca2+ and Mg2+
▪ Acute pulmonary edema (IV-Furosemide)
▪ Renal edema
▪ Hypertension associated with renal failure and CHF
▪ Hypercalcemia and renal calcium stones
▪ Hyperkalemia
▪ Forced diuresis – in case of poisoning
Therapeutic uses of loop diuretics
31
37. Contraindications
▪ Contraindicated in patients:
• With known hypersensitivity to the drugs, electrolyte
imbalances, severe liver or kidney dysfunction, anuria,
hypokalemia and hyponatremia
Mannitol : contraindicated in patient with active intracranial
bleeding
potassium – sparing diuretics : Contraindicated in patients with
hyperkalaemia ; Not recommended for children
37