1. Common Medications and Laboratory test for Post-op Open Heart Patients
Always remember….

2. Objectives
Understand use of specific class of medications and their impact upon the cardiac system.
Identify one indication and one contraindication for medications based upon patient needs.
Identify laboratory testing and one corrective measure for specific abnormality.
Understand the variants between POCT versus direct laboratory values and the impact upon the bedside treatment

3. Dilators, Constrictors, et al in between
Medications
Dilators, Constrictors, et al in between

4. Inotropes Used to alter force of energy creation
Can be either ‘negative’ or ‘positive’ in nature
Tend to like the ‘positive’ effects seen
Always deliver centrally due to adverse effects to tissue
May alter laboratory levels, i.e.
Calcium
Glucose
diabetics

5. Inotropes - Drugs Dopamine Dobutamine Epinepherine Norepinepherine
Milrinone
Calcium
Prostaglandins

6. Inotropes – effects (good)
Increase cardiac output
Increase systolic blood pressure
Increase urinary output
Improvement in contractility will augment cardiac output
Rates calculated in microgram/kilogram/minute or micrograms/minute (usually first one is done)

7. Side effects of inotropic support
Tachyarrhythmias
Elevated glucose levels
Anxiety
Small vessel ischemia
Kidney insufficiency

8. Phosphodiesterase inhibitors
Isolated in rats brain in 1972
Further studies into 1977 brought them to light for use in humans
Non-selective and selective
PDE-3 or Milrinone
places effect upon cAMP and calcium activation
increase in CO
decrease in SVR/PVR
half-life longer than straight inotropic cousins

9. PDE inhibitor S/E Kidney dysfunction Considered proarrhythmic
Bronchospasms
Metabolic derangements
potassium

10. Vasopressors Help with augmenting SVR and supporting blood pressure
Majority are considered alpha-agonist with neosynepherine considered a pure alpha
Some medications that are inotropes are used in the vasopressor avenue also, Levophed which has both properties
Caution with use, may impact small vessel ischemia so patient assessment and evaluation key points

11. Hormone peptide - Vasopressin
Increase vascular resistance, hence increasing arterial blood pressure
Compensatory mechanism in shock states
Does not increase myocardial oxygen demand as do the other inotropic agents
Usually last line drug

12. Prostoglandins - Flolan
Help to control vascular tone
Influence sodium excretion
Influence upon RAAS system
Usually given in nebulized therapy
In the presentation of right sided dysfunction 2/2 to pulmonary resistance issues (pulmonary HTN, ARDS, etc)
costly

13. Antiarrhythmics Amiodarone
Primarily seen for control and alleviation of atrial fibrillation
Very long half life, to some extent indeterminate
Can act as ‘chemical’ defibrillation agent so must be used cautiously
Long term side effects – lungs, eyes, thyroid, GI

14. Antiarrhythmics - continued
Digoxin
Atrial fib impact
Rate control predominantly
Does have inotropic effects, positive to LV
Requires loading dosage
Levels should be monitored to avoid side effects

15. Antiarrhythmics - continued
Cardizem
Atrial fib rate control
Will have some degree impact upon blood pressure
Titrated to attainable heart rate, usually <110
Can quickly cause bradycardia

16. Antiarrhythmic medication side effects
Proarrhythmic potential
Bradycardia
Hypotension
Mentation alterations
n/v
Visual disturbances

17. Factor VIIa (recombinant)
Used in face of coagulopathy not responsive to other means
Direct action on reducing fibrinolysis
Usually given in conjunction with cryoprecipitate factors
Costly

18. Protamine sulfate Reversal for heparin
Primarily given after completion of cardiopulmonary bypass
Due to potential rebound heparin effects, can be given at bedside
Allergy to fish contraindication, effects can be very dramatic
1 mg for every 100 units normal dosage regimen

19. Blood Products Platelets Fresh frozen plasma Cryoprecipitate
Bleeding issues
Low counts
Fresh frozen plasma
volume
Cryoprecipitate
Factor deficiencies

20. Labs commonly seen Hemoglobin/hematocrit Platelet count
Basic metabolic profile
Arterial blood gas
Ionized calcium level
Magnesium
Lactic acid level
Heparin antibody

21. Common labs – continued
Coagulation profile
Blood glucose
ACT