1. 6/3/2016 1 CARDIOVASCULAR MEDICATIONS

2. FIRST DO NO HARM 6/3/2016 2 There are 5 rights to patient medication administration: 1. Right patient 2. Right drug 3. Right dose 4. Right route 5. Right time

3. 6/3/2016 3 Once you have given the Drug, you can’t get it back, so do it right the first time!

4. Autonomic Nervous System 6/3/2016 4 Sympathetic system ("fight or flight") Parasympathetic system ("rest and digest" or "feed and breed")

5. 6/3/2016 5 Sympathetic system Adrenal medulla Epinephrine and Norepinephrine Adrenergic Receptors (alpha or beta receptors Stimulates

6. Drugs Affecting the Autonomic Nervous System 6/3/2016 6 Drugs stimulate sympathetic nervous system = Agonists = Sympathomimetics Drugs inhibit sympathetic nervous system = Antagonists = sympatholytics = Blockers (alpha and beta)

7. Drugs Affecting the Autonomic Nervous System 6/3/2016 7 Drugs stimulate parasympathetic nervous system = Parasympathomimetics ( ↑ ACH) Drugs inhibit parasympathetic nervous system = Parasympatholytics ( ↓ ACH)

8. Beta blockers 6/3/2016 8 Reduce the rate and force of contraction of the heart Bronchoconstriction Given for hypertension and angina Not for asthma E.g. Inderal

9. Beta agonists 6/3/2016 9 Bronchodilation Tachycardia and elevation of blood pressure Used in anaphylactic shock and cardiac arrest E.g. Adrenalin

10. Beta-2 agonists 6/3/2016 10 Bronchodilation May also cause tachycardia and palpitations in high dose E.g. Ventolin

11. Parasympathomimetics 6/3/2016 11 Mimic the effects of acetylcholine, e.g. bethanechol (Urecholine), Or mimic acetylcholine by blocking acetylcholinesterase (e.g. Physostigmine)

12. Parasympathetic blockers (Parasympatholytics) block effect of acetylcholine. Common example is Atropine 6/3/2016 12

13. Medications Affecting the Cardiovascular System 6/3/2016 13 Medications Used for Cardiovascular Conditions Medications by Therapeutic classifications

14. Medications Used for Cardiovascular Conditions 6/3/2016 14 Antihypertensives: Diuretics Alpha Blockers Beta Blockers Calcium Channel Blockers Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors) Angiotensin Receptor Blockers Vasodilators Centrally Acting Agents

15. Medications Used for Cardiovascular Conditions 6/3/2016 15 Antianginals: Beta Blockers Calcium Channel Blockers Coronary Vasodilators including Nitrates

16. Medications Used for Cardiovascular Conditions 6/3/2016 16 Antidysrythmics: Cardiac Glycosides including Digoxin Beta Blockers Calcium Channel Blockers Various – Adenosine, Procainamide, Quinidine, Lidocaine, Bretylium

17. Medications Used for Cardiovascular Conditions 6/3/2016 17 Cardiac Sympathomimetics: Dobutamine Dopamine Epinephrine Norepinephrine Isoproterenol Phenylephrine

18. Medications Used for Cardiovascular Conditions 6/3/2016 18 Congestive Heart Failure Therapy: Angiotensin Converting Enzyme (ACE) Inhibitors Cardiac Glycosides (Digoxin) Diuretics Sympathomimetics/Inotropes

19. Medications by Therapeutic Classifications 6/3/2016 19 Diuretics: Loop Diuretics – Furosemide Osmotic Diuretics – Mannitol Potassium Sparing Diuretics – Amiloride, Spironolactone, Triamterene Thiazide Diuretics – Hydrochlorothiazide

20. Medications by Therapeutic Classifications 6/3/2016 20 Beta Adrenergic Blocking Agents Propranolol (Inderal) Atenolol (Tenormin) Metoprolol (Lopressor) Labetolol (Trandate) Esmolol (Brevibloc

21. Medications by Therapeutic Classifications 6/3/2016 21 Calcium Channel Blocking Agents Nifedipine (Adalat) Diltiazem (Cardizem) Verapamil (Isoptin) Amlodipine (Norvasc) Felodipine (Renedil)

22. Medications by Therapeutic Classifications 6/3/2016 22 Angiotensin converting enzyme inhibitors Captopril (Capoten) Enalapril (Vasotec) Enalaprilat (Vasotec IV) Fosinopril (Monopril) Ramipiril (Altace)

23. Medications by Therapeutic Classifications 6/3/2016 23 Angiotensin II receptor antagonists losartan (Cozaar) valsartan (Diovan)

24. Medications by Therapeutic Classifications 6/3/2016 24 Vasodilators Hydralazine (Apresoline) Nitroglycerin Sodium Nitroprusside

25. Medications by Therapeutic Classifications 6/3/2016 25 Sympathomimetics: Dobutamine Dopamine Epinephrine Norepinephrine Isoproterenol Phenylephrine

26. Medications by Therapeutic Classifications 6/3/2016 26 Antidysrythmics: Cardiac glycosides including Digoxin Beta Blockers Calcium Channel Blockers Various – Adenosine, Procainamide, Quinidine, Lidocaine, Bretylium

27. Drugs Actions 6/3/2016 27 Beta Adrenergic Blocking Agents Calcium Channel Blocking Agents Angiotensin Converting Enzyme Inhibitors Angiotensin II Receptor Blockers Diuretics Cardiac Sympathomimetics and Antidysrythmics

28. Beta Adrenergic Blocking Agents 6/3/2016 28 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

29. Calcium Channel Blocking Agents 6/3/2016 29 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

30. Angiotensin Converting Enzyme Inhibitors 6/3/2016 30 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

31. Angiotensin II Receptor Blockers 6/3/2016 31 They block angiotensin II effect at the angiotensin type 1 receptors. Thus there is vasodilation and blood pressure lowering.

32. Diuretics 6/3/2016 32 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.

33. Diuretics 6/3/2016 33 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

34. Cardiac Sympathomimetics and Antidysrythmics 6/3/2016 34 Most are used within the context of resuscitation from cardiac arrest.

35. Medications in the Context of Cardiac Arrest 6/3/2016 35 Inotropes (Sympathomimetics) Antidysrythmics Vasodilators Beta Blockers Diuretics Analgesics Thrombolytics