6/3/ CARDIOVASCULAR MEDICATIONS

FIRST DO NO HARM 6/3/ There are 5 rights to patient medication administration: 1. Right patient 2. Right drug 3. Right dose 4. Right route 5. Right time

6/3/ Once you have given the Drug, you can’t get it back, so do it right the first time!

Autonomic Nervous System 6/3/ Sympathetic system ("fight or flight") Parasympathetic system ("rest and digest" or "feed and breed")

6/3/ Sympathetic system Adrenal medulla Epinephrine and Norepinephrine Adrenergic Receptors (alpha or beta receptors Stimulates

Drugs Affecting the Autonomic Nervous System 6/3/ Drugs stimulate sympathetic nervous system = Agonists = Sympathomimetics Drugs inhibit sympathetic nervous system = Antagonists = sympatholytics = Blockers (alpha and beta)

Drugs Affecting the Autonomic Nervous System 6/3/ Drugs stimulate parasympathetic nervous system = Parasympathomimetics ( ↑ ACH) Drugs inhibit parasympathetic nervous system = Parasympatholytics ( ↓ ACH)

Beta blockers 6/3/ Reduce the rate and force of contraction of the heart Bronchoconstriction Given for hypertension and angina Not for asthma E.g. Inderal

Beta agonists 6/3/ Bronchodilation Tachycardia and elevation of blood pressure Used in anaphylactic shock and cardiac arrest E.g. Adrenalin

Beta-2 agonists 6/3/ Bronchodilation May also cause tachycardia and palpitations in high dose E.g. Ventolin

Parasympathomimetics 6/3/ Mimic the effects of acetylcholine, e.g. bethanechol (Urecholine), Or mimic acetylcholine by blocking acetylcholinesterase (e.g. Physostigmine)

Parasympathetic blockers (Parasympatholytics) block effect of acetylcholine. Common example is Atropine 6/3/

Medications Affecting the Cardiovascular System 6/3/ Medications Used for Cardiovascular Conditions Medications by Therapeutic classifications

Medications Used for Cardiovascular Conditions 6/3/ Antihypertensives: Diuretics Alpha Blockers Beta Blockers Calcium Channel Blockers Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors) Angiotensin Receptor Blockers Vasodilators Centrally Acting Agents

Medications Used for Cardiovascular Conditions 6/3/ Antianginals: Beta Blockers Calcium Channel Blockers Coronary Vasodilators including Nitrates

Medications Used for Cardiovascular Conditions 6/3/ Antidysrythmics: Cardiac Glycosides including Digoxin Beta Blockers Calcium Channel Blockers Various – Adenosine, Procainamide, Quinidine, Lidocaine, Bretylium

Medications Used for Cardiovascular Conditions 6/3/ Cardiac Sympathomimetics: Dobutamine Dopamine Epinephrine Norepinephrine Isoproterenol Phenylephrine

Medications Used for Cardiovascular Conditions 6/3/ Congestive Heart Failure Therapy: Angiotensin Converting Enzyme (ACE) Inhibitors Cardiac Glycosides (Digoxin) Diuretics Sympathomimetics/Inotropes

Medications by Therapeutic Classifications 6/3/ Diuretics: Loop Diuretics – Furosemide Osmotic Diuretics – Mannitol Potassium Sparing Diuretics – Amiloride, Spironolactone, Triamterene Thiazide Diuretics – Hydrochlorothiazide

Medications by Therapeutic Classifications 6/3/ Beta Adrenergic Blocking Agents Propranolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor) Labetolol (Trandate) Esmolol (Brevibloc

Medications by Therapeutic Classifications 6/3/ Calcium Channel Blocking Agents Nifedipine (Adalat) Diltiazem (Cardizem) Verapamil (Isoptin) Amlodipine (Norvasc) Felodipine (Renedil)

Medications by Therapeutic Classifications 6/3/ Angiotensin converting enzyme inhibitors Captopril (Capoten) Enalapril (Vasotec) Enalaprilat (Vasotec IV) Fosinopril (Monopril) Ramipiril (Altace)

Medications by Therapeutic Classifications 6/3/ Angiotensin II receptor antagonists losartan (Cozaar) valsartan (Diovan)

Medications by Therapeutic Classifications 6/3/ Vasodilators Hydralazine (Apresoline) Nitroglycerin Sodium Nitroprusside

Medications by Therapeutic Classifications 6/3/ Sympathomimetics: Dobutamine Dopamine Epinephrine Norepinephrine Isoproterenol Phenylephrine

Medications by Therapeutic Classifications 6/3/ Antidysrythmics: Cardiac glycosides including Digoxin Beta Blockers Calcium Channel Blockers Various – Adenosine, Procainamide, Quinidine, Lidocaine, Bretylium

Drugs Actions 6/3/ Beta Adrenergic Blocking Agents Calcium Channel Blocking Agents Angiotensin Converting Enzyme Inhibitors Angiotensin II Receptor Blockers Diuretics Cardiac Sympathomimetics and Antidysrythmics

Beta Adrenergic Blocking Agents 6/3/ These drugs block the beta-receptors in the sympathetic nervous system can be useful in situations where sympathetic activity is excessive or inappropriate. E.g. hypertension, angina, dysrythmias

Calcium Channel Blocking Agents 6/3/ Contractions of cardiac and smooth muscle cells are dependent on the movement of calcium ions into the cells through specific channels. If calcium reduced, there will be changes in cardiac electrical activity and vasodilation Used in dysrythmias, angina, and hypertension

Angiotensin Converting Enzyme Inhibitors 6/3/ Acts on renin-angiotensin-aldosterone system If the conversion of angiotensin I to angiotensin II by enzymes is blocked, there will be reduction in blood pressure by vasodilation

Angiotensin II Receptor Blockers 6/3/ They block angiotensin II effect at the angiotensin type 1 receptors. Thus there is vasodilation and blood pressure lowering.

Diuretics 6/3/ Most diuretics act by increasing sodium excretion by the kidney Where sodium goes, so does water, so that when the sodium remains in the kidney filtrate (urine), more water will be held, and thus urine volume or fluid excretion goes up.

Diuretics 6/3/ As sodium is excreted, so is potassium, so these drugs can considerably upset potassium levels in the blood, leading to cardiac abnormalities. Potassium supplements like Slow K

Cardiac Sympathomimetics and Antidysrythmics 6/3/ Most are used within the context of resuscitation from cardiac arrest.

Medications in the Context of Cardiac Arrest 6/3/ Inotropes (Sympathomimetics) Antidysrythmics Vasodilators Beta Blockers Diuretics Analgesics Thrombolytics