Cardiovascular drugs

Cardiac Drugs
Used in Hypertension
Used in Angina Pectoris and M
Used in Shock
Used in Arrhythmias
Used in CHF
Antihypertensive drugs
The Drugs employed to control hypertension
can be classified as:
Diuretics
Beta-blockers
Alpha adrenergic blockers
Calcium channel blockers
Angiotensin-converting enzyme inhibitors
Angiotensin II receptor blockers
Peripheral vasodilators
Common Drugs in HPN
N Evaluating the effectiveness of these
drugs is simply to monitor the BP if it
becomes NORMAL
%he "olols
The Beta-BIockers (B1)
%hese agents are antagonist of the beta-
receptors of the sympathetic nervous
system.
%hey reduce cardiac output by diminishing
the sympathetic nervous system response
and sympathetic tone.
%he "olols
The Beta-BIockers
Vascular resistance and heart rate
decrease causing reduced blood pressure.
Beta-blockers can either block the beta-
receptor, beta 2 receptor or BO%H.
%he selective beta-blockers (B1) are
specific to one type of receptor only.
%he "olols
%he following are the common beta-blockers- the '-OLOL'
Non-selective (B1 and B2)
Propranolol
Carteolol
Nadolol
Penbutolol
Pindolol
%imolol
Selective and Specific (B1)
Acebutolol
Atenolol
Betaxolol
Bisoprolol
Metoprolol
%he "olols
Pharmacodynamics: the mechanism of
action of the beta-blockers
%hese agents block the beta-adrenergic
receptors in the body, thereby decreasing
the heart rate and in turn, the blood
pressure.
%he "olols
Pharmacodynamics: the mechanism of
action of the beta-blockers.
%he non-selective agents block both Beta1
and 2 receptors causing bronchial
constriction.
%he onset of action is 30 minutes and the
duration may range from 6-12 hours.
%he "olols
Clinical ndications of the beta-blockers
Hypertension
Angina pectoris
Myocardial infarction
%he "olols
Contraindications and precautions
%hese agents are not given to patients with:
Heart blocks
Bradycardia
Congestive heart failure
Chronic obstructive pulmonary disease
Diabetes
%he "olols
Pharmacodynamics- Side effects and
adverse effects
CVS- Bradycardia, Hypotension, rebound
hypertension when abruptly stopped
Respi- Bronchoconstriction,
bronchospasms
Others- insomnia, depression, nightmares,
constipation
Impaired ability of the liver to convert
glycogen to glucose causing
HYPOGLYCEMIA!
%he "olols
mplementation
Monitor patient's vital signs. %ake the heart rate
before giving the drug
nstruct the patient to take the drug as
prescribed. Warn not to abruptly stop the
medication
Suggest to avoid over-the-counter medications
Give health teaching as to name of drug,
dosages and side effects.
%he "olols
mplementation
Remind client NO% to change position
abruptly as to avoid orthostatic
Hypotension
Alert diabetic clients of the possible
hypoglycemic effect
nform that this can cause sexual
dysfunction
%he "olols
mplementation
Advise client to utilize other means to
control blood pressure such as diet
modification, exercise, lifestyle changes,
etc
Advise to eat high fiber foods to counter-
act constipation
%he !rils
The Angiotensin Converting Enzyme Inhibitors
%hese are commonly called ACE inhibitors
because the agents BLOCK the conversion of A
to A in the LUNGS.
%hese agents alter one of the mechanisms of
blood pressure control- the RAAS or renin-
angiotensin-aldosterone system.
Angiotensin is a very powerful vasoconstrictor
and stimulus for the release of aldosterone.
%he !rils
The Angiotensin Converting Enzyme Inhibitors
"Pril
Benazepril
Captopril- prototype
Enalapril
Enalaprilat
Fosinopril
Lisinopril
Moexipril
Quinapril
Ramipril
%randorapril
%he !rils
Pharmacodynamics: %he mechanism of
action of the ACE inhibitors
%hese agents prevent the conversion of
angiotensin to angiotensin by inhibiting
the enzyme in the lungs- the angiotensin
converting enzyme.
%he action leads to decreased A and
decreased aldosterone level leading to a
decrease in blood pressure.
%he !rils
Pharmacodynamics: %he mechanism of
action of the ACE inhibitors
The effect of Iowering the bIood
pressure is attributed to the decrease
in cardiac workIoad and decrease
peripheraI resistance and bIood
voIume.
%he !rils
CIinicaI indications of the ACE
inhibitors
Hypertension, either aIone or in
combination with other agents.
Congestive heart faiIure, Ieft
ventricuIar dysfunction
Diabetes
%he !rils
Contraindications and Precautions in the Use
of ACE inhibitors
Presence of aIIergy is a cIear
contraindication.
The ACE inhibitors are NOT given to patients
with renaI dysfunction because these drugs
may cause further decrease in renaI bIood
fIow.
If given to pregnant women, the drugs cross
the placenta and produce renal abnormalities
in the fetus.
ACE inhibitors
Pharmacodynamics: the adverse effects
CVS- reflex tachycardia, chest pain, angina,
cardiac arrhythmias
CNS- dizziness, drowsiness, and
lightheadedness
G%- G irritation, nausea, vomiting, peptic ulcer,
constipation and liver damage
Renal- renal insufficiency, proteinuria
Others- rash, photosensitivity, dermatitis and
alopecia, sodium excretion and potassium
retention, fatal pancytopenia.
COUGH- this cough is really unrelenting and
bothersome.
ACE inhibitors
mplementation
%he nurse should encourage the patient to
implement lifestyle changes such as weight
reduction, smoking cessation, decreased intake
of alcohol, dietary restriction of salt/fats and
increased exercise.
Give the drug on an empty stomach, either 1
hour before or 2 hours after meals to ensure
proper drug absorption
ACE inhibitors
mplementation
Monitor the patient who is at risk of
developing fluid volume alteration
Provide comfort measures like safety
Precaution, environmental control, skin
care, oral care and symptomatic relief of
cough.
ACE inhibitors
mplementation
Provide patient teaching including the
name of drug, dosage, measure to handle
adverse effects and the warning signs to
report. Stress the importance of NO%
abruptly stopping the medication if
symptoms are improving.
Caution the patient to change position
slowly and to avoid hazardous or delicate
tasks and driving if drowsiness is a
problem
%he sartans"
The Angiotensin II Receptor BIockers
%hese are SELEC%VE agents that
specifically bind to the angiotensin
receptors in the blood vessels and adrenal
cortex to prevent the release of
aldosterone and to prevent
vasoconstriction.
%he sartans"
Prototype: Losartan
Candesartan
rbesartan
Losartan
%elmisartan
Valsartan
%he sartans"
Pharmacodynamics- %he mechanism of
action of the A-R-B
%hese agents work by attaching to the
Angiotensin receptors in the vascular
smooth muscles and in the adrenal gland.
%he action results in 'ASODILATION
because A action (constriction) is
inhibited and BLOCKAGE of aldosterone
release
%he sartans"
Clinical Use of the A-R-B
Hypertension, either alone or in
combination.
%hese agents are also used if the patient
cannot tolerate the unrelenting cough
associated with ACE inhibitors.
%he sartans"
Contraindications and precautions
associated with the A-R-B
%hese agents are contraindicated in the
presence of allergy.
t is NOT GI'EN to pregnant mothers
because of the associated FETAL DEATH
and severe fetal abnormalities. Lactating
women should also avoid these drugs
because they can affect the neonate.
%he sartans"
Pharmacodynamics: the adverse effects
CNS- headache, dizziness, weakness,
syncope and orthostatic Hypotension
G%- Diarrhea, abdominal pain, nausea,
dry mouth and tooth pain
Respiratory- mild cough
Skin- rash, dry skin and alopecia.
%he sartans"
mplementation
Encourage the patient to implement
lifestyle changes, including weight loss,
smoking cessation, decrease in alcohol
and salt in the diet, and increased
exercise, to increase the effectiveness of
anti-hypertensive therapy.
Administer without regard to meals;
give with food to decrease GI distress if
needed.
%he sartans"
mplementation
Alert the surgeon and mark the patient's
chart prominently if the patient is to
undergo surgery to alert medical
personnel that the blockage of
compensatory angiotensin could result in
hypotension following surgery that needs
to be reversed with volume expansion.
%he sartans"
mplementation
Ensure that the patient is not pregnant
before beginning therapy and suggest the
use of barrier contraceptives while on this
drug to avert potential fetal death or
abnormalities that have been associated
the these drugs.
Find an alternative method of feeding the
baby if patient is nursing to prevent the
potentially danger- block of the renin-
angiotensin system in the neonate.
%he sartans"
mplementation
Monitor the patient carefully in any situation that
might lead to a drop in fluid volume (e. g.,
excessive eating, and vomiting diarrhea,
dehydration) to detect treat excessive
hypotension that may occur.
Provide comfort measures to help the patient
tolerate drug effects (e.g., small, frequent meals;
access to bathroom facilities; safety precautions
if CNS effects occur environmental control;
appropriate skin care needed; analgesics as
needed).
Calcium channel blockers
%hese agents prevent the movement
of calcium into the cardiac and
smooth muscle cells when the cells
are stimulated.
Calcium channel blockers
This bIocking of caIcium wiII interfere with the
muscIe ceII's abiIity to contract, leading to a loss
of smooth muscle tone, vasodilation, and a
decrease in peripheral resistance.
These effects wiII decrease blood pressure,
cardiac workload, and myocardial oxygen
consumption.
Calcium channel blockers
CaIcium channeI bIockers are very effective in
the treatment of angina because they decrease
the cardiac workIoad.
Calcium channel blockers
Pharmacodynamics: Mechanism of action
Calcium channel blockers inhibit the
movement of calcium ions across the
membranes of myocardial and arterial
muscle cells, altering the action potential and
blocking muscle cell contraction.
%his effect will depress myocardial contractility,
slow cardiac impulse formation in the conductive
tissues, and relax and dilate arteries, causing a
fall in blood pressure and a decrease in venous
return.
Calcium channel blockers
%he calcium channel blockers that are used in the
treatment of hypertension include the following:
%he "-dipine and others
Diltiazem (Cardizem, Tiamate)
'erapamil
Amlodipine (Norvasc)
Felodipine (Plendil)
sredipine (DynaCirc)
Nicardipine(Cardene)
Nifedipine (CALCIBLOC, Procardia XL)-
prototype!
Nisoldipine (Sular)
Calcium channel blockers
CON%RANDCA%ON and PRECAU%ONS
%hese drugs are contraindicated in the presence
of allergy to any of these drugs
With heart block or sick sinus syndrome
because these could be exacerbated by the
conduction-slowing effects of these drugs
With renal and hepatic dysfunction, which could
alter the metabolism and excretion of these
drugs; and with pregnancy and lactation
because of the potential for adverse effects on
the fetus and neonate.
Calcium channel blockers
Pharmacodynamics: the ADVERSE EFFEC%S
%he adverse effects associated with these drugs
are related to their effects on cardiac output and
on smooth muscle.
CNS effects include dizziness, lightheadedness,
headache, and fatigue.
G problems can include nausea and hepatic injury
related to direct toxic effects hepatic cells.
Cardiovascular effects include hypotension,
bradycardia, peripheral edema, and heart block.
Skin flushing and rash may also occur
Calcium channel blockers
Pharmacodynamics:
%he main use of calcium channel blockers is
the treatment of angina
Also in hypertension
Also in vascular spasm= Raynauds
Calcium channel blockers
MPLEMEN%A%ON
Monitor blood pressure carefully while
patient is on therapy because of increased
hypotensive episodes
f possible, obtain serial ECG tracing
Provide comfort measures to help patient
tolerate drug effects- includes serving
small frequent feedings and safety
precaution due to hypotension and
dizziness
Calcium channel blockers
MPLEMEN%A%ON
Provide health teaching as to drug name,
dosage, administration, side effects and
warning manifestations to report
%he Vasodilators
Vasodilators produce relaxation of the
vascular smooth muscle, decreasing
peripheral resistance and reducing blood
pressure.
%hey cause the reflex tachycardia that
occurs when blood pressure drops
%he Vasodilators
%he vasodilators are used to treat severe
hypertension
Vasodilators
Diazoxide (Hyperstat)
Hydralazine (Apresoline)
Minoxidil (Loniten)
Sodium Nitroprusside (Nitropress)
%olazoline (Priscoline)
Vasodilators
Pharmacodynamics: mechanism of action of
the vasodilators
The vasodilators act directly on
vascular smooth muscle to cause
muscle relaxation, leading to
vasodilation and drop in blood
pressure.
%hey are indicated for the treatment of
severe hypertension that has not
responded to other therapy.
Vasodilators
Contraindications and Precautions
%he vasodilators are contraindicated in the
presence of known allergy to the drug;
with pregnancy and lactation because of
the potential for adverse effects on the
fetus and neonate; and with any condition
that could be exacerbated by a sudden fall
in blood pressure, such as cerebral
insufficiency.
Vasodilators
Pharmacodynamics: the adverse effects of
the vasodilators
CNS- dizziness, anxiety, headache
CVS- reflex tachycardia, CHF, chest
pain, edema; skin rash, lesions (abnormal
hair growth with minoxidil), hypotension
G upset, nausea, and vomiting
Vasodilators
Pharmacodynamics: the adverse effects of
the vasodilators
Cyanide toxicity (dyspnea, headache,
vomiting, dizziness, ataxia, loss of
consciousness, imperceptible pulse,
absent reflexes, dilated pupils, pink color,
distant heart sounds, shallow breathing)
may occur with nitroprusside, which is
metabolized to cyanide and which also
suppresses iodine uptake and can cause
hypothyroidism.
Vasodilators
MPLEMEN%A%ON
Encourage the patient to implement lifestyle
changes, including weight loss, smoking
cessation, decrease in alcohol and salt in the
diet, and increased exercise, to increase the
effectiveness of antihypertensive therapy.
Monitor blood pressure closely during
administration to evaluate for effectiveness and
to ensure quick response if blood pressure falls
rapidly or too much.
Vasodilators
MPLEMEN%A%ON
Monitor blood glucose and serum
electrolytes to avoid potentially serious
adverse effects.
Monitor the patient carefully in any
situation that might lead to a drop in fluid
volume (e.g., excessive sweating,
vomiting, diarrhea, dehydration) to detect
and treat excessive hypotension that may
occur.
Vasodilators
MPLEMEN%A%ON
Provide comfort measures to help the
patient tolerate drug effects (e.g., small,
frequent meals, access to bathroom
facilities safety precaution if CNS effects
occur, environmental control, appropriate
skin care as needed, analgesic as
needed).
Provide thorough patient teaching
Offer support and encouragement to deal
with the diagnosis drug regimen.
Drugs for the Treatment of Congestive
Heart FaiIure
Vasodilators- Nitrates that act to directly relax vascular
muscle tone and cause decrease in blood pressure with
pooling of blood in the veins. %he preload and afterload
will be decreased
ACE inhibitors- are agents that block the conversion of
angiotensin to angiotensin . %he result is blockage of
the vasoconstriction and decreased blood volume. %he
afterload will be decreased.
Diuretics are employed to decrease the blood volume,
which decreases the venous return and the blood
pressure. %he results are decreased preload and
decreased afterload.
Drugs for the Treatment of Congestive
Heart FaiIure
Beta stimulators will stimulate the beta receptors
in the sympathetic nervous system, increasing
the myocardial contraction- called positive
inotropic effect.
ardiotonic drugs- these agents affect the
INTRA&AR calcium levels in the heart
muscles leading to increased contractility . The
result is increased cardiac output, increased
renal blood flow, increased perfusion and
increased urine formation. The cardiotonic
drugs are: the cardiac glycosides and the
phosphodiesterase inhibitors.
%he cardiac glycosides
%hese are agents extracted from the
foxglove plant. %hey are available in
oral and parenteral preparations. %he
following are the cardiac glycosides:
igoxin (anoxin)
igitoxin (rystodigin)
Ouabain
%he cardiac glycosides
Pharmacodynamics: the Mechanism of
action
%hey increase the level of CALCIUM
inside the cell by inhibiting the
Sodium-Potassium pump.
More calcium will accumulate inside
the cell during cellular depolarization.
%he cardiac glycosides
Positive inotropic Effect- the myocardium
will contract forcefully
ncreased cardiac output
ncreased blood flow to the body organs like
the kidney and liver
Negative chronotropic effect- the heart
rate is slowed due to decreased rate of
cellular repolarization
Bradycardia
Decreased conduction velocity through
the AV node
%he cardiac glycosides
Clinical Use of the cardiac glycosides
%reatment of congestive heart failure
%reatment of dysrhythmias like atrial
flutter, atrial fibrillation and
paroxysmal atrial tachycardia
%he cardiac glycosides
Contraindications and Precautions
Contraindicated in the presence of allergy
to any cardiac glycoside.
%hey are NOT given to patients with
ventricular dysrhythmias, heart block or
sick sinus syndrome, aortic stenosis, acute
M, electrolyte imbalances
(HYPOKALEMIA, HYPOMAGNESEMIA
and HYPERCALCEMIA) and renal failure
(may cause accumulation of drug)
%he cardiac glycosides
Pharmacodynamics: the Adverse Effects of the
Cardiac glycosides
CNS- Headache, weakness , seizures and
drowsiness
CVS- arrhythmias
f digitalis toxicity is developing- the nurse must
assess the following adverse effects: Anorexia,
nausea and vomiting, visual changes-
YELLOW halo around an object, and
palpitations or very slow heart rate
%he cardiac glycosides
Drug-Drug nteractions
f taken with Verapamil, Amniodarone, quinidine,
quinine, erythromycin and tetracyclines- can
increase the risk of NCREASED effects of
digitalis.
If taken with potassium-losing diuretics like
furosemide- can INCREASE the risk of
toxicity and arrhythmias. Potassium
replacement must be given.
f given with cholestyramine, charcoal and
colestipol- can cause impaired absorption of
digitalis
%he cardiac glycosides
mplementation
Administer the initial rapid digitalization
and loading dose as ordered intravenously
Monitor the APICAL pulse rate for ONE
full minute before administering the drug.
Withhold the drug if
Less than 60 in adults
Less than 90 in infants
More than 110 in adults
Retake pulse in one hour, if pulses remain
abnormal, refer!
%he cardiac glycosides
mplementation
Check the spelling of the drug- DGOXN
is different from DG%OXN!
Check the dosage preparation and the
level of digitalis in the blood. (Therapeutic
level is 0.5 to 2.0 nanograms/m)
Administer intravenous drug VERY slow V
over 5 minutes to avoid arrhythmias. Do
NO% administer intramuscularly because it
can cause severe pain
%he cardiac glycosides
mplementation
Administer the drug without food if possible to
avoid delayed absorption. Weight patient daily
to determine fluid retention
Maintain emergency equipment and drugs=
Potassium salts, Lidocaine for arrhythmias,
phenytoin for seizures, atropine for bradycardia.
Provide comfort measures- small, frequent
meals, adequate lighting, comfortable position,
rest periods and safety precautions
%he cardiac glycosides
mplementation
Provide health teaching- drug name, action,
dosage and side effects. Advise the patient to
report any of the following: 'isual changes,
rapid weight gain, unusually low heart
rate, persistent nausea, vomiting and
anorexia
Monitor serum potassium level
%he cardiac glycosides
Evaluation
Evaluate effectiveness of the drug:
Increased urine output
Normal heart rate in arrhythmia
The AntianginaI drugs
n the treatment of angina, three agents
are commonly employed-
Organic nitrates
Beta-blockers and
Calcium-channel blockers.
%he benefits of the drugs lie in their
different mode of action.
The AntianginaI drugs
%he nitrates can cause vasodilatation
of the veins and to some extent,
coronary artery
The AntianginaI drugs
Beta-blockers will decrease the heart
rate
The AntianginaI drugs
Calcium-channel blockers will
decrease force of contraction leading
to a decreased myocardial workload
and demand.
%hey can also produce vasodilation
The AntianginaI drugs
Anti anginaI drugs are effective if
the chest pain is reIieved
%he Organic nitrates
%hese agents are simple nitric and nitrous
acid esters of alcohols. Being alcohol, they
differ in their volatility. %he following are
the nitrates commonly used:
Nitroglycerin- A moderately volatile
nitrate
sosorbide Dinitrate (sordil) or mononitrate
Amyl nitrate- an extremely volatile nitrate
%he Organic nitrates
NitrogIycerin
%his agent is supplied in oral, spray,
transdermal and ointment preparations.
%he Organic nitrates
Pharmacodynamics: the mechanism of
action
Nitroglycerin relaxes the smooth
muscles in the vascular system by
its conversion to nitric oxide, a
chemical mediator in the body that
relaxes smooth muscles.
%he Organic nitrates
Administered nitrates
ncreased nitrates in the blood
increased formation of nitric oxide
increased cGMP formation
increased dephosphorylation of myosin
Vascular smooth muscle relaxation
vasodilatation
%he Organic nitrates
Pharmacokinetics- absorption to excretion
t can be given orally, parenterally and
topically.
%he onset of action of nitroglycerin is
more than 1 hour.
Because significant first-pass hepatic
effect, Nitroglycerin is given
SUBLNGUALY.
%he Organic nitrates
Pharmacodynamics: Side effects and
adverse effects
HEADACHE is the most common effect
of nitroglycerin.
CVS- postural Hypotension, facial flushing,
tachycardia
%OLERANCE- the tolerance to the
actions of nitrates develop rapidly. %his
can be managed by providing a day of
abstinence.
%he Nitrates
mplementation
Monitor vital signs, especially watchful for
hypotensive episodes
Advise patient to remain supine or sit on a
chair when taking the nitroglycerin for the
first time. Emphasize that he should
change his position slowly or rise from bed
slowly to avoid orthostatic Hypotension
Offer sips of water before giving sublingual
nitroglycerin because dryness may inhibit
drug absorption
%he Nitrates
mplementation
Apply nitroglycerin ointment to the
designated mark on paper.
%he nurse should remove any excess
ointment on the skin from the previous
dose.
She should NE'ER USE her bare fingers
because the drug can be absorbed, utilize
gloves or tongue blades instead.
%he Nitrates
mplementation
Apply nitroglycerin patch to an area with
few hairs. Never touch the medication
portion.
%he patch and the ointment should NO%
be applied near the area for defibrillation
because explosion and skin burns may
result
%he Nitrates
MPLEMEN%A%ON
Emphasize that tolerance to the
nitroglycerin can occur.
f the medication cannot relieve the pain,
report to the hospital immediately.
%he Nitrates
MPLEMEN%A%ON
Provide client health teaching- the sublingual
nitroglycerin tablet is USED if chest pain occurs
The dose may be repeated if pain is
unreIieved within 5 minutes.
Repeat the medication administration if the
pain has not yet subsided.
DO NOT give more than 3 tablets! If chest
pain persists for more than 15 minutes,
hospitaI consuIt shouId be done
immediateIy.
%he Nitrates
MPLEMEN%A%ON
nstruct the client to avoid alcohol while
taking nitroglycerin to avoid potentiating
the hypotensive effect of the medication
f beta blockers and calcium-channel
blockers are given, instruct the patients to
consult the physician before discontinuing
the medication
%he Nitrates
MPLEMEN%A%ON
Other components of health teaching for
home self-administration:
f taking Sublingual Nitroglycerin, the patient
should be instructed to place the tablet under
the tongue for quick absorption.
A burning sensation/biting/stinging sensation
may indicate that the tablet is FRESH!
Store the tablet in a dark container, keep it
away from heat and direct sunlight to avoid
lessening the potency
%he Nitrates
MPLEMEN%A%ON
Other components of health teaching for home
self-administration:
HEADACHES are common in the initial period
of nitroglycerin therapy. Advise patient to take
PARACE%AMOL for relief
%he nitroglycerin patch is applied once a day,
usually in the morning. %he sites should be
rotated, in the chest, arms and thighs avoiding
hairy areas.
%he Nitrates
MPLEMEN%A%ON
Other components of health teaching for
home self-administration:
Position supine with elevated legs to manage
Hypotension.
Nitroglycerin tablet can be taken
prophylactically in situations where chest
pain is anticipated- Sex, exercise, etc..
f patient is taking beta blockers, instruct how to
obtain heart rate in a minute
Drugs for Shock
Dopamine
%his is a sympathomimetic drug often
used to treat Hypotension in shock states
that are not caused by Hypovolemia.
%his drug is an immediate precursor of
nor-epinephrine, occurs naturally in the
CNS basal ganglia where it functions as a
neurotransmitter.
Drugs for Shock
Dopamine
Pharmacodynamics: t can activate the
alpha and beta adrenergic receptor
depending upon the concentration. t
stimulates receptors to cause cardiac
stimulation and renal vasodilation.
%he dose range is 1-20 micrograms/kg/min
Drugs for Shock
Dopamine
Pharmacokinetics: Dopamine is
administered V, excreted in the urine.
At low dose (1-2 micrograms), dopamine
DLA%ES the renal and mesenteric blood
vessels producing an increase output
(dopaminergic effect)
Drugs for Shock
Dopamine
At moderate dose of 2-10 micrograms,
dopamine enhance cardiac output by
increasing heart rate (beta 1-adrenergic
effect) and elevates blood pressure
through peripheral vasoconstriction (alpha
adrenergic effect)
Drugs for Shock
Dopamine
At higher doses of more than 10
micrograms- vasoconstriction of all
vessels will predominate that can lead to
diminished tissue perfusion
Drugs for Shock
Dopamine
Dopamine is indicated to treat Hypotension, to
increase heart rate and to increase urine output
(given less than 5 mg/kg/min)
%he nurse typically prepares the dopamine drip-
dopamine (at a concentration of 400-800 mg) is
mixed in 250 mL D5W and administered as drip
via an infusion pump for precise dosage
administration.
Sodium bicarbonate will inactivate the dopamine
Drugs for Shock
Dopamine
Pharmacodynamics: side effects-
%achycardia
hypertension
ectopic beats, angina
dysrhythmias, myocardial ischemia,
nausea and vomiting.
Drugs for Shock
Dopamine: Nursing consideration
Check the IV site hourIy for signs of drug
infiItration of dopamine, which can cause
severe tissue necrosis.
PhentoIamine shouId be infiItrated in
muItipIe areas to reduce tissue damage.
Drug is effective if Urine output
is increased and BP is increased
Anti-Arrhythmias
Arrhythmias (sometimes called
Dysrhythmias) are conduction
dysfunctions caused by abnormalities in
impulse generation or impaired
transmission of the impulses.
%hey are simply deviations from the
normal rate or pattern of the heartbeat.
Anti-Arrhythmias
Four things may happen during arrhythmias:
%he heart will beat too FAS% (tachycardia,
either the atrium or the ventricle)
%he heart will beat too slow (bradycardia)
%he heart will respond to other impulses
generated by the cardiac cells (other than
the SA node)
%he heat will respond to impulses traveling
along extra pathways
Anti-Arrhythmias
Anti-arrhythmic agents are given to modify
impulse generation and conduction.
%he desired action of these
antidysrhythmics is to restore the cardiac
rhythm to normal.
%hey affect the action potential of the
cardiac cells, altering their automaticity,
conductivity, or BO%H
Anti-Arrhythmias
Because the anti-arrhythmic drugs
affect the conduction system, they aIso
can produce ARRHYTHMIAS
They are aIso Pro-Arrhythmics
Anti-Arrhythmias
The cIasses of anti-arrhythmic agents:
CIass 1 agents - are fast SODIUM channeI bIockers
that affects the depoIarization phase.
CIass 2 agents- are BETA bIockers that affect the
depoIarization.
CIass 3 agents- are POTASSIUM channeI bIockers
that diminish the outward potassium current during
repoIarization of cardiac ceIIs.
CIass 4 agents- are caIcium channeI bIockers that
decrease the caIcium infIux into the speciaIized
cardiac muscIe ceIIs causing sIowed conduction
Anti-Arrhythmias
The cIasses of anti-arrhythmic agents:
CIass 1 agents -
CIass 1 A- Quinidine, Procainamide,
Disopyramide, Moricizine
CIass 1 B- Lidocaine, MexiIetine, Tocainide
CIass 1 C- Encainide, FIecainide,
propafenone
Anti-Arrhythmias
The cIasses of anti-arrhythmic agents:
CIass 2 agents- are BETA bIockers that
affect the depoIarization. They
decrease the conduction veIocity,
automaticity and recovery time.
ExampIes are: PropranoIoI, MetoproIoI,
pindoIoI, acebutoI and esmoIoI
Anti-Arrhythmias
The cIasses of anti-arrhythmic agents:
CIass 3 agents- are POTASSIUM
channeI bIockers that diminish the
outward potassium current during
repoIarization of cardiac ceIIs.
They increase the refractory period and
proIong the action potentiaI. ExampIes
are: sotaIoI, bretyIium, amniodarone
Anti-Arrhythmias
CIass 4 agents- are caIcium channeI
bIockers that decrease the caIcium
infIux into the speciaIized cardiac
muscIe ceIIs causing sIowed
conduction. They increase the
refractory period of the AV node, which
decreases the ventricuIar response.
The exampIes of caIcium channeI
bIockers are diItiazem and verapamiI
Anti-Arrhythmias
MisceIIaneous- digoxin and adenosine
Anti-Arrhythmias
eneraI Nursing Process for Anti-arrhythmics
Assessment
Patient History- the nurse obtains health and drug
histories. She should elicit symptoms of shortness of
breath, heart palpitations, coughing, chest pain, previous
angina or dysrhythmias, and the current medications.
Physical Examination- the nurse performs assessment
and baseline monitoring
Laboratory exams- the nurse obtains ECG results and
cardiac markers- CK-MB, AS% and LDH)
Anti-Arrhythmias
Nursing Diagnoses
Alteration on perfusion: decreased cardiac
output
Alteration in thought processes and sensory-
perceptual alteration
Anxiety related to irregular heartbeat
Risk for activity intolerance
Risk for injury related to CNS effects
Knowledge deficit regarding drug therapy
Anti-Arrhythmias
Planning
%he client will no longer experience
abnormal cardiac rhythm
%he client will comply with the drug
regimen
Anti-Arrhythmias
mplementation
Monitor Vital signs especially BP and HR.
Patient can develop Hypotension
Administer the parenteral drugs slow V for a
period of 2-3 minutes
Monitor ECG for abnormal patterns and report
findings.
nstruct to report palpitations and abnormal
cardiac rate
Maintain life support equipment on stand by to
treat severe adverse reactions that might occur
Anti-Arrhythmias
mplementation
Establish safety precautions- side rails,
lighting, and noise control.
Provide client teaching. nstruct the client to
take the prescribed drug as ordered.
Emphasize the client to avoid alcohol, caffeine
and tobacco.
Alcohol can intensify the hypotensive effects,
caffeine increases the cathecolamine levels
and tobacco can promote vasoconstriction.
nstruct the client to report side effects
including dizziness, faintness, and nausea and
vomiting.
Anti-Arrhythmias
Evaluation
Evaluate the effectiveness of the prescribed
anti-dysrhythmic by comparing heart rates with
baseline heart rate.
Assess the client's response to the drug.
Monitor for adverse effect- sedation,
Hypotension, cardiac arrhythmias, respiratory
depression, CNS effect.
Evaluate the effectiveness of the teaching
plan. Monitor the effectiveness of comfort
measures and compliance to regimen.