drug classifications
DESCRIPTION
Cardiac Drug Classifications.TRANSCRIPT
Sherry L. Knowles, RN, CCRN, CRNI
Cardiac DrugsCardiac Drugs ACE Inhibitors ACE Inhibitors Anti-Coagulants Anti-Coagulants
Nitrates Nitrates Calcium Channel Blockers Calcium Channel Blockers
Anti-DysrhythmicsAnti-DysrhythmicsGPIIGPIIbbIIIIIIaa Diuretics Diuretics
Angiotensin II Angiotensin II Inhibitors Inhibitors Antagonists Antagonists
Beta Blockers Beta Blockers InotropicsInotropics
Anti-InflammatoryAnti-Inflammatory Anti-plateletAnti-platelet
ThrombolyticsThrombolytics Anti-LipidemicsAnti-Lipidemics
Vasopressors Vasopressors Anti-thrombin Anti-thrombin
InotropicInotropic
Drug actions
ChronotropicChronotropic
Dromotropic Dromotropic
Cardiac DrugsCardiac Drugs
InotropicInotropic Affects ContractilityAffects Contractility
Cardiac DrugsCardiac Drugs
Positive Inotropics Positive Inotropics the force the force
of myocardial contraction.of myocardial contraction. Negative Inotropics Negative Inotropics the force the force
of myocardial contraction.of myocardial contraction.
CHRONOTROPICCHRONOTROPIC Affects Heart RateAffects Heart Rate
Cardiac DrugsCardiac Drugs
Beta Adrenergic and Blocking AgentsBeta Adrenergic and Blocking Agents Slowing rates can Slowing rates can filling time filling time
AntiarrhythmicsAntiarrhythmics Beta BlockersBeta Blockers Calcium Channel Blockers Calcium Channel Blockers
Cardiac DrugsCardiac Drugs DromotropicDromotropic
Affects ConductivityAffects Conductivity
AlphaAlpha receptorsreceptors
DDopaopa receptorsreceptors
BetaBeta receptorsreceptors
Cardiac DrugsCardiac Drugs
Alpha receptorsAlpha receptors On Blood VesselsOn Blood Vessels
Stimulation causes vasoconstrictionStimulation causes vasoconstriction Blocking cause vasodilationBlocking cause vasodilation
Cardiac DrugsCardiac Drugs
Beta receptorsBeta receptors On Heart and LungsOn Heart and Lungs
BetaBeta11 and Beta and Beta22
Cardioselective vs Non-SelectiveCardioselective vs Non-Selective
Cardiac DrugsCardiac Drugs
Beta receptorsBeta receptors BetaBeta11
Stimulation causes Stimulation causes positivepositive
inotropic effectsinotropic effects Blocking causes Blocking causes negative negative
inotropic effectinotropic effect
Cardiac DrugsCardiac Drugs
Beta receptorsBeta receptors BetaBeta22
Stimulation causes bronchodilationStimulation causes bronchodilation Blocking causes bronchoconstrictionBlocking causes bronchoconstriction
Cardiac DrugsCardiac Drugs
Dopa receptorsDopa receptors On Renal (Mesenteric) VesselsOn Renal (Mesenteric) Vessels
Stimulation causes vasodilatationStimulation causes vasodilatation Blocking causes vasoconstriction Blocking causes vasoconstriction
Cardiac DrugsCardiac Drugs
ACE INHIBITORSACE INHIBITORS
Cardiac DrugsCardiac Drugs
o Causes VasodilationCauses Vasodilation
o Reduces AfterloadReduces Afterloado Reduces work of heartReduces work of heart
o Remodeling EffectsRemodeling Effects
ANGIOTENSIN II ANTAGONISTSANGIOTENSIN II ANTAGONISTS
Cardiac DrugsCardiac Drugs
o VasodilatorVasodilator
o Reduces AfterloadReduces Afterload
o May be used in place of May be used in place of ace inhibitorsace inhibitors
BETA BLOCKERSBETA BLOCKERS
Cardiac DrugsCardiac Drugs
o Slow Heart RateSlow Heart Rateo Negative ChronotropicNegative Chronotropic
o Lower BPLower BPo Slow ConductionSlow Conduction
o Negative DromotropicNegative Dromotropic
o Promote Electrical StabilityPromote Electrical Stability
BETA BLOCKERSBETA BLOCKERS :: Adverse EffectsAdverse Effects
Cardiac DrugsCardiac Drugs
o FatigueFatigue
o BronchospasmBronchospasm
o ImpotenceImpotence
o DepressionDepression
o Aggravation of heart failureAggravation of heart failure
NITRATESNITRATES
Cardiac DrugsCardiac Drugs
o Arterial & Venous VasodilatorArterial & Venous Vasodilator
o Reduces Preload & AfterloadReduces Preload & Afterload
o Reduces Work of the HeartReduces Work of the Heart
o Improves Cardiac OutputImproves Cardiac Output
CALCIUM CHANNEL BLOCKERSCALCIUM CHANNEL BLOCKERS
Cardiac DrugsCardiac Drugs
o Slows Heart RateSlows Heart Rateo Negative ChronotropicNegative Chronotropic
o VasodilatorVasodilator
o Prevents Arterial VasospasmPrevents Arterial Vasospasm
CaCa2+2+ Channel Blockers Channel Blockers: Adverse Effects: Adverse Effects
Cardiac DrugsCardiac Drugs
o Less severe with oral than IV applicationLess severe with oral than IV application
o May cause HypotensionMay cause Hypotension
o May cause sinus bradycardia or heart block May cause sinus bradycardia or heart block
(especially with (especially with -blockers)-blockers)
CaCa2+2+ Channel Blockers Channel Blockers: Adverse Effects: Adverse Effects
Cardiac DrugsCardiac Drugs
o Less severe with oral than with intravenous Less severe with oral than with intravenous
applicationapplication
o HypotensionHypotension
o Severe sinus bradycardia or heart block Severe sinus bradycardia or heart block
(especially with (especially with -blockers)-blockers)
DIURETICSDIURETICS
Cardiac DrugsCardiac Drugs
o Reduce PreloadReduce Preload
o Reverse Fluid OverloadReverse Fluid Overload
o Reduces Pulmonary CongestionReduces Pulmonary Congestion
VASOPRESSORSVASOPRESSORS
Cardiac DrugsCardiac Drugs
o VasoconstrictorsVasoconstrictorso Alpha AdrenergicAlpha Adrenergic
o Blood PressureBlood Pressure
o Heart RateHeart Rateo Positive ChronotropicPositive Chronotropic
ANTIDYSRHYTHMICSANTIDYSRHYTHMICS
Cardiac DrugsCardiac Drugs
o Heart RateHeart Rateo Negative ChronotropicNegative Chronotropic
o Slow ConductionSlow Conductiono Negative DromotropicNegative Dromotropic
o Also Includes: Also Includes: o Beta Blockers Beta Blockers o Calcium Channel BlockersCalcium Channel Blockers
GpIIbIIIa InhibitorsGpIIbIIIa Inhibitors
Cardiac DrugsCardiac Drugs
o ReoProReoProo Long Half-lifeLong Half-life
o IntegrilinIntegrilin
o Aggrastat Aggrastat
GpIIbIIIa InhibitorsGpIIbIIIa Inhibitors
Cardiac DrugsCardiac Drugs
o ReoPro, Integrilin, AggrastatReoPro, Integrilin, Aggrastat
o Monitor Platelet LevelsMonitor Platelet Levels
o Check within 4-6 hours after initiationCheck within 4-6 hours after initiation
o Monitor daily and prn any bleedingMonitor daily and prn any bleeding
ANTICOAGULANTSANTICOAGULANTS
Cardiac DrugsCardiac Drugs
HeparinLow Molecular Weight Heparin
Can be given on fix-dosed schedule and do not require APTT monitoringLess likely to cause thrombocytopenia
Warfarin – CoumadinRat poisonAntagonist of vitamin K – blocks synthesis of vitamin K dependent factors in coagulation cascadePeak effects take several days
Antiplatelets
REFLUDINREFLUDIN
Cardiac DrugsCardiac Drugs
CLASSIFICATION• Anticoagulant• Anti-thrombin
USES• AMI• HIT• Venous thrombosis• DVT prophylaxis
ADVERSE EFFECTS• Bleeding• Anemia
THROMBOLYTICSTHROMBOLYTICS
Cardiac DrugsCardiac Drugs
Streptokinase
tPA
ANTI-SEPSIS / ANTI-INFLAMMATORYANTI-SEPSIS / ANTI-INFLAMMATORY
Cardiac DrugsCardiac Drugs
o Activated Protein C (Xygris)Activated Protein C (Xygris)
o May cause bleedingMay cause bleeding
ANTI-LIPIDEMICSANTI-LIPIDEMICS
Cardiac DrugsCardiac Drugs
o HDLHDLo High Density LipoproteinHigh Density Lipoproteino Associated with Associated with risk risk
o LDLLDLo Low Density LipoproteinLow Density Lipoproteino Associated with Associated with risk risk
o Look at Ratio Look at Ratio HDL HDL LDLLDL
ADENOSINEADENOSINE
Cardiac DrugsCardiac Drugs
o Stops Supra-Ventricular Tachycardia
o Extremely short half-life
AMIODARONEAMIODARONE
Cardiac DrugsCardiac Drugs
o Antiarrhythmico Negative ChronotropicNegative Chronotropico Negative DromotropicNegative Dromotropic
o Delays RepolarizationDelays Repolarizationo Prolongs Refractory PeriodProlongs Refractory Periodo ReducesReduces automaticity of SA nodeo ReducesReduces conduction thru AV node
DIGOXINDIGOXIN
Cardiac DrugsCardiac Drugs
o Positive InotropicPositive Inotropico Increases force of contractionIncreases force of contraction
o Negative DromotropicNegative Dromotropico Slows conductionSlows conduction
o Negative ChronotropicNegative Chronotropico Slows heart rateSlows heart rate
DOPAMINEDOPAMINE
Cardiac DrugsCardiac Drugs
o Positive InotropicPositive Inotropic
o Increases contractilityIncreases contractility
o Alpha, Beta, & Dopa AdrenergicAlpha, Beta, & Dopa Adrenergic
o Dose dependent Dose dependent
o Positive ChronotropicPositive Chronotropic
o May increase heart rateMay increase heart rate
DOBUTAMINEDOBUTAMINE
Cardiac DrugsCardiac Drugs
o Positive InotropicPositive Inotropic
o Increases contractility (BetaIncreases contractility (Beta1 1 stimulation)stimulation)
o BetaBeta11 and Beta and Beta2 2 AdrenergicAdrenergic
o VasodilatorVasodilator
o Positive ChronotropicPositive Chronotropic
o May increases heart rateMay increases heart rate
PRIMACORPRIMACOR
Cardiac DrugsCardiac Drugs
o Positive InotropicPositive Inotropic
o Increases contractilityIncreases contractility
o VasodilatorVasodilator
o Acts similar to Dobutamine Acts similar to Dobutamine
EPINEPHRINEEPINEPHRINE
Cardiac DrugsCardiac Drugs
o Alpha AdrenergicAlpha Adrenergic
o Potent VasoconstrictorPotent Vasoconstrictor
o BetaBeta11 and Beta and Beta22 Adrenergic Adrenergic
o Positive InotropePositive Inotrope
o BronchodilatorBronchodilator
LEVOPHED LEVOPHED (Norepinephrine)(Norepinephrine)
Cardiac DrugsCardiac Drugs
o Alpha AdrenergicAlpha Adrenergic
o Potent VasoconstrictorPotent Vasoconstrictor
o BetaBeta11 Adrenergic Adrenergic
o Positive InotropePositive Inotrope
NEO-SYNEPHRINENEO-SYNEPHRINE
Cardiac DrugsCardiac Drugs
o Alpha AdrenergicAlpha Adrenergic
o VasoconstrictorVasoconstrictor
o Used for Severe HypotensionUsed for Severe Hypotension
o Used for Drug Induced HypotensionUsed for Drug Induced Hypotension
NITROGLYCERINNITROGLYCERIN
Cardiac DrugsCardiac Drugs
o Venous & Arterial VasodilatorVenous & Arterial Vasodilator
o Dilates Coronary ArteriesDilates Coronary Arteries
o NitrateNitrateo VasodilatorVasodilator
o Preload (primarily)Preload (primarily)o Venous CapitanceVenous Capitanceo SVR (slightly)SVR (slightly)o Work of HeartWork of Heart
MORPHINEMORPHINE
Cardiac DrugsCardiac Drugs
o Vasodilator (venous)Vasodilator (venous)
o Pulmonary CongestionPulmonary Congestion
o Work of HeartWork of Heart
o AnalgesicAnalgesic
o Sedative PropertiesSedative Properties
o Reduces AnxietyReduces Anxiety
ReferencesReferences
Hudak, B., Gallo, B., & Morton, P. (1998). Hudak, B., Gallo, B., & Morton, P. (1998). Critical Care NursingCritical Care Nursing (7th (7th ed.). Philadelphia, PA: Lippincott.ed.). Philadelphia, PA: Lippincott.
Clochesy, J., Breu, C., Cardin, S., Whittaker, A., & Rudy, E. (1996). Clochesy, J., Breu, C., Cardin, S., Whittaker, A., & Rudy, E. (1996). Critical Care Nursing Critical Care Nursing (2nd ed.). Philadelphia, PA: Saunders. (2nd ed.). Philadelphia, PA: Saunders.
American Association of Critical-Care Nurses. (1991). American Association of Critical-Care Nurses. (1991). Core Core Curriculum for Critical Care NursingCurriculum for Critical Care Nursing (4th ed.). Philadelphia, PA: (4th ed.). Philadelphia, PA: Saunders. Saunders.
Knowles, Sherry. (2002-2004). Inservice Handout.Knowles, Sherry. (2002-2004). Inservice Handout.
Cardiac DrugsCardiac Drugs