Cardiac drugs for cardiovascular nurses.pptx

Cardiovascular drugs and drug calculation

1. St. Paul’s Hospital Millennium Medical College   Cardiovascular Drugs Prepared by : SrTigist Tsegaye ( MSc,CvPN ) Department of Medical Surgical Nursing Postgraduates Cardiovascular Nursing Programme June 2024 1

2. Learning objectives At the end of this lesson, the students will be: - Discuss the major categories of drugs related to cardiovascular disease treatment -Describe the major drug effects of various drugs on cardiovascular functions -Discuss Nursing implications while administrating the drugs 2

3. Outlines Inotropes, chronotropes, dromotrope antianginal drugs Antihypertensive drugs Antiarrhythmic drugs Anticoagulant Drugs of hyperlipidemia Analgesics others 3

4. Drugs acting on cardiovascular system Inotropes is an agent which increases or decreases the force or energy of contraction Positive Inotropes Increase myocardial contractility resulting in an increased cardiac output. It includes: -Cardiac glycoside-digitalis -Phosphodiesterase Inhibitors -Sympathomimetic drugs 4

5. Con.... Cardiac glycoside-digitalis derivatives –Digoxin Increase force of contraction with out increasing oxygen consumption Treatment for congestive heart failure, septic shock, cardiogenic shock, pulmonary hypertension Inhibit Na-K Atpase 5

6. Con... - Indirect effect on cardiovascular system regulated by autonomic nervous system that has effect on sino -atria node (SA) and atrioventricular (AV)node. -Has a direct effect on cardiac muscle and the conduction system Digoxin: Initial therapy 0.125 to 0.325 mg/day Side effects –anorexia, nausea, vomiting, diarrhea rare, headache,blurred vision..... 6

7. Con... Phosphodiesterase Inhibitors - are medications that cause blood vessels to relax and widen, improving circulation and lowering blood pressure –Milirinone-inotrope vasodilator Sympathomimetics -Drugs have potent effect by stimulating beta 1 &2 , and alpha 1 & 2 Sympathomimetics -Epinephrine , Dopamine , Dobutamine,Norepinephrine 7

8. Con... Alpha ( α) adrenoceptors mediate smooth muscle contraction and vasoconstriction, while beta ( β) receptors mediate vasodilation, smooth muscle relaxation, bronchodilation, and excitatory cardiac function beta-adrenergic receptor antagonists (beta-blockers) are a family of agents that are widely used to treat hypertension, angina pectoris, and cardiac arrhythmias 8

9. Con... Dopamine Constrict blood vessel Used in Heart Failure 200mg/5ml ampoule Infusion:200mg in 200ml Normal saline Syringe pump :200mg in 50 ml Normal saline Intermediate dose 2 to 10mcg/kg/min 9

10. coN … Low dose 0.5 to 2mcg/kg/min 2-5mcg/kg/min—low dose-Renal vasodilation –increase urine output A larger dose of cardiac stimulation Increase BP, Increase CO Indication-occlusive vascular disease, Tachyarrhythmia contraindicated ; Vfib, Ventricular tachycardia Adverse effect hypotension, nausea, vomiting 10

11. Con… Nursing implication Monitor Blood Pressure Heart rate Pulse Pressure ECG,PCWP(pulmonary capillary wedge pressure),Urine Output chest pain , and premature ventricular tachycardia -React with Phenytoin, Haloperidol Iv infiltration is very serious and can cause vasoconstriction Antidote is phentolamine 11

12. CON... Dobutamine - 250mg/20 ml Or 250mg/5ml usual dose 2.5 to 10mcg/kg/min initial dose 2to 3mcg/kg/min -Infusion pump:500mg in 250 normal saline -Syringe pump:250 mg in 50cc normal saline -Increase contractility of the heart, CO -little use for CHF -Decrease After load 12

13. Con... -atrial fibrillation-digitalize the patient before use it to prevent ventricular tachycardia - rehydrate the patient Adverse effect-hypokalemia, tremors,nausea,headache MI,, Tachycardia Nursing implication Monitor -Blood Pressure -Heart rate Pulse Pressure -ECG,PCWP(pulmonary capillary wedge pressure),Urine Output -chest pain, and premature ventricular tachycardia 13

14. Con… Adrenaline - smooth muscle relaxation in the airway - smooth muscle contraction in the arterioles -increase cardiac muscle contractility Indication : - Anaphylaxis reaction, hypotension, bronchospasm cardiac arrest, asystole -infusion:0.05-0.1mcg/kg/min -max dose 1-1.5mcg/kg/min -For arrest 1ml every 2min -Interact with digoxin,diuretics,oxytocin 14

15. Con ... Dilution 4ml of adrenalin in 46 ml of NS Drug concentration 4mg/50 NS=0.08mg 0.8mgx1000=80mcg/ml Rate of infusion = desired dosex60 80 mcg/ml Interacts with beta-blocking agents, glycosides, antidepressants It can also calculated when the dose is given as mcg/kg/min Ml/ hr = desired dose x pt weight x time drug concentration 15

16. Con... Adverse effect :hypertension,tachycardia,tremor,dizziness,palpitation Nursing consideration -administer in central line - cautious patient with atherosclerosis ,occlusive vascular disease, peripheral thrombosis - protect from direct light -dispose dilution after 24 hrs 16

17. Con... - ECG, Cardiac output -Using a syringe pump ,label the loaded drug -monitor urine output Noradrenalin similar to adrenaline Treatment of low blood pressure React with Amitriptyline, Halotne,Isoflueren , diabetes drugs 17

18. Con… Negative inotropes include - beta-blockers, - calcium channel blockers, and - antiarrhythmic medicines 18

19. Con... Chronotropic – affects heart rate (increase or decrease) by affecting electrical conduction system of the heart. Positive chronotropes -Most Adrenergic agonists. -Atropine-Anti cholinergic,rx of nerve effect, pesticide poisoning, slow heart rate, saliva production -Dopamine. 19

20. Con... -Epinephrine. -Isoproterenol-treat bradycardia conditions -Milrinone -inotrope and vasodilator. -Theophylline- relaxing the muscles around the airways  Negative chronotropes Beta blocks, Digoxin 20

21. Con... A dromotropic agent affects the conduction speed (in fact the magnitude of delay) in the AV node, and subsequently the rate of electrical impulses in the heart Positive dromotrope –Increase conduction velocity -epinephrine -phenytoin Negative dromotrope-vagal stimulation - Verapamil 21

22. CON... Antianginal drugs -Against pain of angina pectoris -This mainly -Nitrates- vasodilators, release NO muscle relaxant reduce preload and after-load - nausea, vomiting, tachycardia, palpitation -adverse reaction severe anemia, early MI, -Increased ICP.Hypotension -Beta-blockers -Calcium channel blockers 22

23. Con... Active antianginal agent -Nitroglycerine is used to treat surgical hypertension -Drug interactions with, sildenafil Nursing intervention -proper storage of the drug -take in 5 minutes and take an emergency medical check -if no relief 3 tablets -Teach the patient to sit down while taking this medication 23

24. Con... Adverse effect- -Headache, orthostatic hypertension, flushing,nausea vomiting Contraindicated -Hypertensive to nitrates, orthostatic hypertension, Increased intracranial pressure. caution Patients with hypotension,Inferior wall MI -Interact with antihypertensive drugs 24

25. Con... Antihypertensive Drugs -Hypertension –abnormally increased blood pressure class of antihypertensive drugs You have to differentiate between hypertensive crisis and emergency Nitrates- Beta-blockers- Metoprolol Calcium channel blockers- Nifdipine ACEI-Captopril-inhibit conversion angiotensin I to angiotensin II Vasodilators – hydralazine Diuretics- Furosemide,spironolactone Angiotensin antagonist- Losartan 25

26. Con... Beta-blockers prevent stimulation of beta- aderengic receptors of sympathetic nervous system -Not to be given with bradycardiya,third degree heart block,cardiogenic shock Calcium channel blockers Block entry of calcium ion into smooth muscle and cardiac cell that decrease intercellular ca ions there is smooth muscle relaxation leads to vasodilation -Digoxin toxocity,interaction with other calcium channel blocker 26

27. Con... Adverse effect -Orthostatic hypertension,Fatigue,bradycardia,nausea , Vomiting Drug interactions - Other Calcium channel blockers,alcohol Nursing Intervention -Do not stop the drug abruptly 27

28. Con... Antiarrhythmic drugs Antiarrhythmic medications prevent and treat abnormal heartbeats (arrhythmias) There are four main groups of antiarrhythmic medications: class I, sodium-channel blockers; class II, beta-blockers; class III, potassium-channel blockers; -prolong action potential class IV, calcium-channel blockers; and miscellaneous antiarrhythmics , or unclassified antiarrhythmics . 28

29. CON... Class I, sodium channel blockers:  These drugs prevent sodium from getting through cell membranes. This can slow electrical impulses in the heart muscle. Examples include disopyramide , flecainide , mexiletine , propafenone and quinidine Class Ia : Fast sodium (Na) channel blockers Ib -Lidocaine, phenytoin , mexiletine (depress phase 0 selectively in abnormal/ischemic tissue, shorten repolarization) Ic - Flecainide , propafenone , moricizine (markedly depress phase 0, minimal effect on repolarization) 29

30. Con... Class II, beta blockers:  These drugs slow down the heart rate, often by blocking hormones such as adrenaline. Examples include acebutolol , atenolol , bisoprolol , metoprolol , nadolol and propranolol . increasing action potential duration and the effective refractory period 30

31. Con... Class III, potassium channel blockers:  These drugs prevent potassium from getting through cell membranes. This can slow down electrical impulses in all of the heart’s cells. prolongs repolarization without affecting conduction velocity by blocking one or more time-dependent potassium currents. Examples include amiodarone 31

32. CON... Class IV, non dihydropyridine calcium channel blockers :  These drugs block calcium channels in heart muscle. This can decrease heart rate and contractions. decrease conduction through the AV node, and shorten phase two (the plateau) of the cardiac action potential Examples include diltiazem and verapamil . Other antiarrhythmic drugs : Adenosine:  This medication can block or slow down electrical impulses at the atrioventricular node, between the upper and lower chambers of the heart. 32

33. Con... 33

34. Con... Anticoagulants prevent clot formation to prevent thrombosis Heparin, warfarin Indication -PCI -Open heart surgery -thromboembolic disorder 34

35. Con... Contraindicated -Peptic ulcer -Recurrent surgery Coagulation disorder Adverse effect Hyperlipidemia,Heamorrhage,thrombocytopiena,constipation,pain at injection site 35

36. Con... Do not give heparin IM Antiplatelates - asprin - clopidegrol contraindication -similar to anticoagu l Thrombolytic-to dissolve clot Example streptokinase , Alteplase 36

37. Con... I ndication - MI - DVT -PE -Stroke Hyperlipidemia -to treat atherosclerosis -Prevent synthesis of C holesterol in the liver - Eg atorvastatin 37

38. Analgesics The effects of analgesics that must be considered: Heart rate- Sinus bradycardia via central vagal stimulation -Occasionally sinus arrest exacerbated by concomitant vagal excitation (e.g. laryngoscopy) -Beta-blockers Mean arterial pressure has no effect or a slight decrease (unless there is significant bradycardia) -Greater decrease if associated with histamine release Vascular system No effect on SVR (unless histamine release ) 38

39. Analgesics Con … Mild vasodilation with a decrease in preload (due to decline of central sympathetic outflow) Myocardium No effect on contractility (except for pethidine which is a depressant ) -No effect on metabolic rate -Possible ischemic preconditioning Excitability Decreased myocardial contractility -Increased refractory period The main opioid antagonist currently used in practice is naloxone. 39

40. con… Morphine 1mg/ml to be diluted in 10 ml normal saline -Each mg one ml. Fentanyl 100mcg/2ml to be diluted with 8ml normal saline to be each 10mcg/ml. Tramadol PO/IV Paracetamol PO 40

41. Drug calculation Drop rate Drip Rate ( dpm ) = Volume of IV fluid ( mL ) x drops/ml(drop factor ) Time to run (h) 60 min/h Drip rate ( mL /hour) = Total volume ( mL ) / Infusion time Situation: The patient is ordered an IV of 1000ml of Normal Saline over 12 hours with drop factor of 15 drops/ml Calculate rate(ml/hr)=1000/12=83.3ml/hr drip rate = 1000 x 15= 20.83 drip/min 12x60 41

42. con.... Heparin Infusion Rate : Total Units (in IV bag ) = units/hr Total volume (ml) x eg . Heparin infusion is to start at 1350 units/hour per the practitioner’s order. The heparin infusion comes in a 250 ml bag with 25,000 units. Calculate the starting rate of the infusion (ml/hour ). 42

43. CON... 25000 Units = 1350 units /hr 250 x 100x=1350ml/hr x=13.5ml/hr An IV with nitroglycerin is infusing at 8 mL /hr. The concentration of the IV is 50 mg in 250 mL of D5W. How many mg/hr is the patient receiving? 50mg divided by 250 ml = 0.2 mg x 8ml/hr = 1.6mg/hr 43

44. Con… When Heparin is ordered as an international unit for example If1000 IU/ hr of heparin to be infused for 24 hrs , you have to follow the following 1.25000IU of heparin to be mixed within 250ml of normal saline 2. To calculate we use the given dose and the drug concentration ml/ hr =1000IU/ hr 25,000IU/250ml of normal saline =10ml/hr if no perfuser you have to change it drop/min 44

45. con Ratio and Proportion Method  D Desired dose or dose ordered by the primary care provider.  H = dose on hand or dose on the bottle, vial, or ampule label. V = vehicle or the drug’s form (i.e., tablet or liquid).  45

46. CON.... STANDARD FORMULA Desired dose(D) XVehicle (V) dose on hand(H ) Order:   Amoxacilline 500 mg On hand:   Amoxacilline 250 mg in 5 mL Desired (D) = 500 mg On hand (H) = 250 mg Vehicle (V) = 5 mL Computation: 500mgx5ml= 10ml 250mg 46

47. CON... Rate of Infusion in cath lab Ml/hr = desired dose x pt weight x60 drug concentration For Noradernaline 4/50mglml =80mcq/ml For dopamine concentration 200mg/5ml=4000mcq For dobutamine concentration 250mg/5ml=5000mcq For ICU drug concentration may vary. Ml/ hr = desired dose x quantity when weight is not given available dose 47

48. Con… Others Read on Lasix infusion Read on potassium chloride infusion Iv antibotics To be discuss in group. 48

49. rEFERENCE https://app.lecturio.com/#/article/2907 https://www.google.com/search?q=antiarrhythmic+drugs&rlz BNF for children 2007 49