SEMINAR on Drugs Used in Cardiac Disease

7/29/2019 SEMINAR on Drugs Used in Cardiac Disease

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Seminar on drugs used in cardiac diseases

Introduction

Cardiovascular drugs encompass a large number of prescription medications that are used to

control heart disease. It is a complicated group of drugs with many being used for multiple heart

conditions. You may also encounter patients who have one or more cardiovascular conditions

such as CHF, hypertension and an arrhythmia. These patients may be taking multiple

medications for each condition. If you look at the list of Top 200 drugs, you will find that 25% of

those drugs are cardiovascular drugs, which is another good reason to become familiar with these

drugs and how they might interact with other medications.

CLASSIFICATION OF CARDIAC USED IN CARDIAC DISEASES

1. Anti-arrhythmic agentThe arrhythmias are conceptually sirnple-dysfunctions cause abnormalities in impulse

formation and conduction in the myocardium. However, in the clinic, arrhythmias present

as a complex family of disorders that show a variety of symptoms. For example, cardiac

arrhythmias may cause the heart

to beat too slowly (sinus bradycardia) to beat too rapidly (sinus or ventricular tachycardia, atrial or ventricular premature

depolarization, atrial flutter) to respond to impulses originating from sites other than the SA node to respond to impulses traveling along accessory (extra) pathways that lead to

deviant depolarizations (A-V reentry, Wolff-Parkinson White syndrome).

In order to make sense of this large group of disorders, it is useful to organize the

arrhythmias into groups according to the anatomic site of the the abnormality-the

atria, AV node, or the ventricles.

Class of anti-arrhythmia drug

Class 1 sodium channel blocker e.g. flecanide, quinidine

Class 2 beta adrenoreceptor blocker e.g. metoprolol, propanololClass 3 sodium channel blocker e.g. amiodarone

Class 4 calcium blocker e.g. diltiazem, verapamil, nifedipine

Other Anti-arrhythmic drug e.g. adenosine, digoxin


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2. Anti-anginal drugAngina pectoris is a characteristic chest pain caused by coronary blood flow that is

insufficient to meet the oxygen demands of the myocardium. The imbalance between

oxygen delivery and utilization may result from a spasm of the vascular smooth muscle

or from obstruction of blood vessels caused by atherosclerotic lesions. Angina is

characterized by a sudden, severe pressing substernal pain radiating to the left arm.

Organic nitrates e.g. isosorbide dinitrate, nitroglycerin Beta blocker e.g. propanolol Calcium channel blocker e.g. diltiazem, verapamil, nifedipine

3. Drugs affecting blood Platelet inhibitor e.g. aspirin, ticlopidine Anticoagulant e.g. enoxaparin, warfarin, heparin. Thrombolytic agent e.g. urokinase, streptokinase Treatment of bleeding e.g. aminocaproic acid, vitamin k, tranexamic acid Treatment of anemia e.g. folic acid, cyanocobalamine, iron

4. Antihypertensive drugHypertension is defined as a sustained diastolic blood pressure greaterthan 90 mm Hg

accompanied by an elevated systolic blood pressure (>I 40 mm Hg). Hypertension results

from increased peripheral vascular smooth muscle tone, which leads to increased

arteriolar resistance and reduced capacitance of the venous system. Elevated blood

pressure is an extremely common disorder, Although hypertension may occur secondary

to other disease processes, more than 90% of patients have essential hypertension, a

disorder of unknown origin affecting the blood pressure-regulating mechanism. A family

history of hypertension increases, the likelihood that an individual will develop

hypertensive disease. Essential hypertension occurs four times more frequently among

blacks than among whites, and it occurs more often aniong middle-aged males than

among middle-aged females. Environmental factors such as a stressful lifestyle, high

dietary intake of sodium, obesity, and smoking all further predispose an individual to the

occurrence of hypertension. Diuretics e.g. hydrochlorothiazide, frusemide, spirolactone Alpha blocker e.g. doxazosin, prazosin Beta blocker e.g. metoprolol, propanolol ACE inhibitor e.g. catopril, analapril, ramipril Angiotensin II antagonist e.g losartan Calcium channel blocker e.g. diltiazem, verapamil, nifedipine, amlodipine


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Vasodilators e.g sodium nitropruside

5. Inotropic agents Positive inotropic agent e.g. dobutamine Negative inotropic agent e.g. dopaamine

6. Cardiac glycosides e.g. digoxin, digitoxin7. Hypolipidemic agents e.g. statin


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FLECANIDE

Group of drugantiarrhythmic agent, sodium channel blocker

Pharmacological name- flecanide

Trade nameAlmarytm, Apocard, Ecrinal, Flcaine

Dose of drug1-2.5mg/kg/body wt

Route of drug - oral

Action - Flecainide is is a class I C antiarrhythmic agent, Flecainide has local anesthetic activity

and belongs to the membrane stabilizing (Class 1) group of antiarrhythmic agents; it has

electrophysiologic effects characteristic of the IC class of antiarrhythmics, ntiarrhythmic actions

are mediated through effects on sodium channels in Purkinje fibers. Flecainide is a sodium

channel blocker, binding to voltage gated sodium channels. It stabilizes the neuronal membraneby inhibiting the ionic fluxes required for the initiation and conduction of impulses. Ventricular

excitability is depressed and the stimulation threshold of the ventricle is increased during

diastole.

Indication: prevention of paroxysmal supraventricular tachycardias (PSVT), including

atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia and other

supraventricular tachycardias of unspecified mechanism associated with disablin

Contraindication: hypersensitivity, cardiogenic shock, CHF, pre-existing sinus node

dysfunction or 2nd

or 3rd

degree heart block (without a pacemaker), renal impairment, pregnancy,

lactation or children.

Adverse effect

Nausea and vomiting, convulsions, hypotension, bradycardia, syncope, extreme wideningof the QRS complex, widening of the QT interval, widening of the PR interval,

ventricular tachycardia, AV nodal block, asystole, bundle branch block, cardiac failure,

and cardiac arrest.

CNSdizziness, anxiety, fatigue, headache, mental depressin. tremor, Blurred vision, Chest pain, CHF

Role and responsibility of nurse

Monitor ECG may cause QRS widening, PR prolongation, QT prolongation Monitor intake and output, daily weigh the patient Asses for signs of CHF Monitor Blood pressure and pulse throughout the therapy


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QUINIDINE

Group of drug - antiarrhythmic agent (class 1 A), sodium channel blocker

Pharmacological nameQuinidine

Dose of drug

PO (Adults): 324972mg q 812 hr. IV (Adults): 200400 mg given at a rate


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METOPROLOL

Group of drug - antiarrhythmic agent, beta adrenoreceptor blocker

Pharmacological name - metoprolol

Trade name - tartarate 25, 50, 100mg

Dose of drug

PO (Adults):

- Antihypertensive/antianginal25100 mg/day as a single dose initially or 2divided doses, 450 mg/day (for angina, give in divided doses)

- MI2550 mg (starting 15 min after last IV dose) q 6 hr for 48 hr, then 100 mgtwice daily for a minimum of 3 month.

- Heartfailure12.525 mg once daily- Migraneprevention50100 mg 24 times dailyIV (Adults):

- MI5 mg q 2 min for 3 doses, followed by oral dosingAction

Blocks stimulation of beta1(myocardial)-adrenzinergic receptors. Does not usually affect beta2

(pulmonary, vascular, uterine) adrenergic receptor sites. decreases blood pressure and heart rate.

De creased frequency of attacks of angina pectoris. Decreased rate of cardiovascular mortalityand hospitalization in patients with heart failure

Indication - Hypertension. Angina pectoris. Prevention of MI, heart failure due to ischemic,

ventricular arrhythmias/tachycardia, Migraine, tremors, drug induced akathesia, anxiety

Contraindication - Uncompensated CHF, Pulmonary edema, Cardiogenic shock, Bradycardia or

heart block

Adverse effect

-

CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness,insomnia,memory loss, mental status changes, nervousness, nightmares.

- EENT: blurred vision, stuffy nose.- Resp: bronchospasm, wheezing- CV: bradycardia, CHF, pulmonary edema, hypotension, peripheral

vasoconstriction.


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- GI: constipation, diarrhea, drug induced hepatitis, drymouth, flatulence,gastricpain, heartburn.

- GU: erectile dysfunction- MS: arthralgia, back pain, joint pain


Monitor vital sign and ECG every after parenteral administration, if HR


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- Monitor intake and output ratios and daily weight. Assess patient routinely forevidence of fluid overload (peripheral edema, dyspnoea, weight gain jugular

venous distension

- Informthe patient abrupt withdrawal can cause life threatening arrhythmias, HT,myocardial ischemia.

- During intravenous administration should be diluted in 50 ml of NaCL 0.9% orD5% and infuse over 10-15 min

AMIODARONE

Group of drug - antiarrhythmic class III

Pharmacological nameAmiodarone

Trade name - cardarone, pacerone

Dose of drug: 1ml contains 50 mg amiodarne

Oral

Adults 800-1600mg/day in 1-2 doses for 1-3 wk, then 600-800mg/day in 1-2 doses for 1month then 400mg maintenance dose

Children 10mg/kg/day for 10 days, then 5 mg/day for several weeks then 2.5 mg/kg/daymaintenance dose.

Intravenous

Adults: 150 mg over 10 min, followed by 360 mg over the next 6 hr and then 540 mgover the next 18 hr. Continuous infusion at 0.5 mg/min until oral therapy is initiated, if

arrhythmia recurs, a small loading infusion of 150 mg over 1 0 min should begiven in

addittion,the rate of the maintenance infusion may be increased. Conversion to initial oral

therapyIfdu ration of IV infusion was 3w k.

oral dose should be 400 mg/ day.

ACLSguidelines for pulseless ventricular fibrillation or ventricular tachycardia 5 mg/kgas bolus.

Supraventricular TachycardiaOral


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Adults 600-800mg/day for 1 wk or until desired response occurs or side effectsdevelop,then decrease to 400 mg/day for 3 wk. then maintenance dose of 200400

mg/day.

Children 10 mg/kg/day for 10 days or until response or side effects occur, then 5mg/kg/day for several weeks, then decreased to 2.5 mg/kg/day lowest effective

maintenance dose.

Action

Prolongs action potential and refractory period. Inhibits adrenergic stimulation. Slows the

sinusrate,increases PR and QT intervals, and decreases peripheral vascular resistance

(vasodilation). Ths suppresses arrhythmia

Indication

Life threatening ventricular arrhythmia, Supraventricular tachycardia, ACLS

Contraindication

Cardiogenic shock, SA node dysfunction, 2nd

and 3rd

degree AV block, syncope,

hypersensitivity.

Adverse effect

CNS: confusional states, disorientation, hallucinations, fatigue, malaise, dizziness,headache, insomnia.

EENT: corneal micro-deposits Resp: adult respiratory distress syndrome (ards), pulmonary fibrosis, pulmonary toxicity. CV: CHF, worsening of arrhythmias, bradvcardia, hypotension. GI: liver function abnormalities, anorexia, constipation, nausea, vomiting, Integumentary : toxic epidermal necrolysis (rare). photosensitivitv , blue discoloration. Endo: hvpothvroidism, Hvperthvroidisrn. Neuro: ataxia, involuntary movement, paraesthesia, peripheral neuropath, poor

coordination, tremor.


Monitor ECG continuously during IV therapy or initiation of oral therapy. Monitor heart rate and rhythm Asses for signs of pulmonary toxicity (rales, crackles, decreased breath sound, pleuritic

friction rub)

Asses for sign and symptoms of ARDS (dyspnoea, tachycardia, rales or crackles) Monitor liver and thyroid function before administration For continuous infusion dilute 900mg in 500ml of D5%


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DILTIAZEM

Group of drugantiarrhythmia class IV, antihypertensive, antianginals, calcium channel

blocker.

Pharmacological name - diltiazem

Trade namecardiazem, taztia XT

Dose of drug

Oral: 30-120 mg 3-4 times daily or 60-120 mg twice daily or 180-240 mg once a day(max 360mg/day)

Intravenous: 0.25 mg/kg repeat in 15 min with 0.35mg/kgContinuous infusion at 10 mg/hr for 24 hr (5-15mg/hr)

Action

Inhibits transport of calcium into myocardial and vascular smooth muscle cells, resulting in

inhibition of excitation contraction coupling and subsequent contraction, results in decreased

blood pressure, coronary vasodilatation and suppresses arrhythmias

Indication

Hypertension, Angina pectoris and vasospastic angina, Supraventricular tachycardia and rapid

ventricular rates in atrial flutter or fibrillation.

Contraindication

Hypersensitvity, 2nd or 3rd degree AV block, recent MI, pulmonary congestion, blood pressure


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Monitor blood pressure arid pulse prior to therapy, during dose titration, and periodicallyduring therapy.

Monitor ECG during prolonged therapy, may cause prolonged PR interval, asses forbradycardia

Monitor intake and output ratios and daily weight Assess for signs of CHF (peripheraledema, rales/crackles, dvspnoea, weight gain, jugular venous distention).

Monitor frequency of Prescription refills to determine adherence. Patients receiving digoxin concurrently with calcium channel blockers should have

routine serum digoxin levels checked and bemonitored for signs of digoxin toxicity.

Do not open, crush, break or chew sustained capsule or tablet

VERAPAMIL

Group of drug: antianginals, antiarrhythmiac agents class IV, antihypertensive, vascular

headache suppressants, calcium channel blocker

Pharmacological name: verapamil

Trade name : apo-verap, isoptin, verelan

Dose of drug

Route/Dosage

P0 (Adults): 80-1 20 mg 3 times daily, increased as needed. Patients with poorventricular function, hepatic impairment, orgeriatric patients 40 mg 3 times daily initially.

Extended-releasepreparations 120-240 mg/day as a single dose; may he increased as

needed (range 240-480 mg/day).

P0 (Children up to 15 yr): 4-8 mg/kg/day in divided doses. IV (Adults): 5-10mg (75-150 mcg/kg); may repeat with 10mg (150 mcg/kg) after 15-30

min.

IV (Children 1-15 yr): 2-5mg (l00-300 mcg/kg); may repeat after 30 min (initial dosenot to exceed 5 mg: repeat dose not to exceed 10mg).

IV (Children


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Inhibits the transport of calcium into myocardial and vascular smooth muscle cells,resulting in inhibition of excitation-contraction coupling and subsequent contraction.

Decreases SA node and AV node conduction and prolongs AV node refractory period in

conduction tissue.

Systemic vasodilatation, resulting in decreased blood pressure. Coronary vasodilatation resulting in decreased frequency and severity of attacks of

angina.

Suppression of ventricular tachycarrhythmias.Indication

Management of hypertension, angina pectoris, vasospastic angina (prinzmetals). Management of Supraventricular arrhythmias, rapid ventricular arrhythmia, rapid

ventricular rates in atrial flutter or fibrillation.

Prevention of migraine, management of cardiomyopathy.Contraindication

Hypersensitivity, sick sinus syndrome, 2nd or 3rd degree AV block, BP


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NIFEDIPINE

Group of drug:- antianginals, antihypertensive, calcium channel blocker.

Pharmacological name:- Nifedipine

Trade name:- adalat XL, procardia

Dose of drug

PO (adults):- 10-30mg 3 times daily (not to exceed 180mg/day) or 30-90 mg once daily as

sustained release form (CC, XL) (not to exceed 90-120 mg/day)

Action

Inhibits the transport of calcium into myocardial and vascular smooth muscle cells,resulting in inhibition of excitation-contraction coupling and subsequent contraction.

Systemic vasodilatation, resulting in decreased blood pressure. Coronary vasodilatation resulting in decreased frequency and severity of attacks of

angina

Indication

Management of hypertension(extended release only), angina pectoris, vasospastic angina. Prevention of migraine headache Management of CHF or cardiomyopathy.

Contraindication

Hypersensitivity, sick sinus syndrome, 2nd or 3rd degree AV block, BP


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Monitor blood pressure and pulse before and after therapy Monitor ECG during prolonged therapy (causes prolonged PR interval and bradycardia) Weigh daily, monitor intake output Asses for signs of CHF (peripheral edema, rales/crackles, dyspnoea, dspnoea, weight

gain, jugular vein distension)

In geriatric patients asses fall risks and institution fall prevention strategies. Do not open, crush, break or chew extended release tablets

ADENOSINE

Group of drug:- antiarrhythmic

Pharmacological name:- adenosine

Trade name:- adenocard, adenoscan

Dose of drug:-

IV (adult and children>50kg):-

Antiarrhythmic- 6mg by rapid bolus; if no result repeat 1-2 min later as 12 mg rapidbolus (dose can be repeated not more than 12mg).

Diagnostic:- 140 mcg/kg/min for 6 min (0.84m/kg) IV (children


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IV children 2-5yr: - 25-35mcg/kg given as 50% of dose initially & 1/4 th of initial dose ineach subsequent dose at 6-12 hrs interval

IV children 1-24month: - 30-50mcg/kg given as 50% of dose initially & 1/4th of initialdose in each subsequent dose at 6-12 hrs interval

IV infant fullterm: - 20-30mcg/kg given as 50% of dose initially & 1/4 th of initial dosein each subsequent dose at 6-12 hrs interval

IV infant premature: - 15-25mcg/kg given as 50% of dose initially & 1/4 th of initialdose in each subsequent dose at 6-12 hrs interval.

PO adults: - 0.75-1.5mg given as 50% of dose initially & 1/4 th of initial dose in eachsubsequent dose at 6-12 hrs interval. Maintenance dose 0.125-0.5mg/day as tablets or

0.35-0.5 mg/day as gelatin capsule, depending on patients lean body weight, renal

function & serum level.

PO children >10yr: - 10-15mcg/kg given as 50% of dose initially & 1/4th of initial dosein each subsequent dose at 6-12 hrs interval. Maintenance dose 2.5-5mcg/kg given as a

single dose.

PO children 5-10yr: - 20-35mcg/kg given as 50% of dose initially & 1/4 th of initial dosein each subsequent dose at 6-12 hrs interval. Maintenance dose 5-10mcg/kg given in

daily 2 divided doses.

PO children 2-5yr: - 30-40mcg/kg given as 50% of dose initially & 1/4th of initial dosein each subsequent dose at 6-12 hrs interval. Maintenance dose 7.5-10mcg/kg given in


PO children 1-24month: - 35-60mcg/kg given as 50% of dose initially & 1/4th

of initialdose in each subsequent dose at 6-12 hrs interval. Maintenance dose 10-15mcg/kg given

in daily 2 divided doses.

PO infant fullterm: - 25-35mcg/kg given as 50% of dose initially & 1/4 th of initial dosein each subsequent dose at 6-12 hrs interval. Maintenance dose 6-10mcg/kg given in


PO infant premature: - 20-30mcg/kg given as 50% of dose initially & 1/4 th of initialdose in each subsequent dose at 6-12 hrs interval. Maintenance dose 5-7.5mcg/kg given

in daily 2 divided doses.

Availability:-

Tablets:- 0.125mg, 0.25mg. Capsule:- 0.05mg, 0.1mg, 0.2mg Injection:- 0.25mg/ml

Action


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Increases the force of myocardial contraction. Prolongs refractory period of the AV node.

Decreases conduction through the SA & AV nodes. Increases cardiac output (positive inotropic

effect) and slowing of heart rate (negative inotrope).

Indication

CHF, tachycardia, Atrial fibrillation and atrial flutter, paraoxysmal atrial tachycardia.

Contraindication

Hypersensitivity, uncontrolled ventricular arrhythmias, AV block Idiopathic hypertrophic subaortic stenosis, constrictive pericarditis, Alcohol intolerance

Adverse effect

CNS:-fatigue, headache, weakness.

CVS:- arrhythmia, bradycardia, ECG changes, AV block, SA block. GI:- anorexia, nausea, vomiting, diarrhea. Endo:- gynecomastia Thrombocytopenia, digoxin toxicity with electrolyte imbalance.


Monitor apical pulse for 1 full minute before administration. Withhold dose and notifyphysician if pulse rate is


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Contraindication

Hypersensitivity Severe anemia Pericardial tamponade Constrictive pericarditis Alcohol intolerance Cerebral hemorrhages

Adverse effect

Dizziness, headache, hypotension, tachycardia, syncope, abdominal pain, alcohol intoxication(in

case of large IV dose)


Assess location, duration, intensity and precipitating factors of angina pain. Monitor blood pressure and pulse during the regimen Sustained release capsules should be swallowed whole, do not crush, break or chew. Avoid drinking, eating or smoking. Doses must be diluted and administered as an infusion. Standard infusion sets made up of

polyvinyl chloride may absorb 80% of nitroglycerin so glass bottles and special tubing

should be used.

In case of lingual spray lift the tongue and spray under the tongue.

TICLOPIDINE

Group of drug:- antiplatelet agent, platelet aggregation factor

Pharmacological name:-ticlopidine

Dose of drug

PO (adult):- 250mg twice a day with food

Availability: - 250mg

Action

Inhibitsplatelet aggregation by altering the function of platelet membranes. Prolongs bleeding

time & decreases incidence of stroke in high risk patients


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It interferes with the hepatic synthesis of vitamin K dependent clotting factors (2, 7, 9 and 10),

and prevents the thrombus formation and thus decreases the density of blood. It decreases risk of

subsequent MI

Indication

Prophylaxis and treatment of venous thrombus, pulmonary thrombus, pulmonaryembolism, atrial fibrillation with embolization.

Prevention of thrombus and embolization after prosthetic valve placement.Contraindication

Uncontrolled bleeding, active ulcer disease, Severe liver or kidney disease, Uncontrolled hpertension

Adverse effect

Uncontrolled bleeding(internal or external), cramps, nausea, dermal necrosis, fever.Role and responsibility of nurse

Asses the patient for signs of bleeding and hemorrhage (gums, nose, tarry black stool,hematuria, hypotension)

Monitor Prothrombin time or INR before the drug therapy and 3-5 days after therapy toevaluate the required dose

Liver function should be monitored before and after therapy.

Instruct the patient to avoid use of sharp metals or articles, protect him from injury toavoid hemorrhage, use of soft bristle tooth brush, use electric razor for shaving

Avoid IM injections Instruct the patient to avoid alcohol, NSAIDs intake during the therapy

LOW MOLECULAR WEIGHT HEPARIN

Group of drug: anticoagulant, antithrombotic, low molecular weight heparin

Pharmacological name: enoxaparin, dalteparin

Trade name: fragmin, lovenox


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Instruct the patient to avoid use of sharp metals or articles, protect him from injury toavoid hemorrhage, use of soft bristle tooth brush, use electric razor for shaving

Avoid IM injections Instruct the patient to avoid alcohol, NSAIDs intake during the therapy Observe subcutenous injection site for hematomas, ecchymosis or inflammation During administering subcutenous injection use alternate sites (ant. Abdominal wall,

upper thigh or buttocks)

UROKINASE STREPTOKINASE

Group of drug: thrombolytic agent, plasminogen activator

Pharmacological name: urokinase, streptokinase

Dose of drug

Streptokinase

IV (adults): 1.5 million units is given as a continous infusion over 60 min. Intracoronary: 20,000 unit bolus followed by 2000-4000 units/ min infusion for 30-90

min

Urokinase

IV (adults): 4400 nits/kg loading dose, followed by 4400 unit/kg/hr for 12 hrAction

Convert plasminogen to plasma, which is then able to degrade fibrin present in clots. Urokinase

directly activates plasminogen, streptokinase combines plasminogento form activator or

complexes, which then converts plasminogen into plasmin. Which results in lysis of thrombi

with preservation or improvement of ventricular function (decreases the rish of CHF or death).

Indication

Urokinase: acute massive pulmonary emboli. Streptokinase: acute arterial thrombi(MI)

Contraindication

Active internal bledding


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PO (adults): 20-40mg q6-8hr until desired response in hypertension In case of CCF max. 2.5mg/day Hypercalcemia: 120mg/day in 2-3 doses

PO (childrens): 2mg/kg/day max. 6mg/kg/day IV (adults): 20-40mg/day and can be repeated, for continous infusion bolus- 0.1mg/kg

followed by 0.1-0.4mg/kg/hr

Action:

Inhibits the absorption of sodium and chloride from loop of henle and distal renal tubule,

increases renal excretion of water,sodium, chloride magnesium, potassium, and calcium. Inturn

causes diuresis and lowers down the blood pressure

Indication

Oedemadue to heart failure, hepatic impairment or renal disease Hypertension

Contraindication

Hypersensitivity with thiazide or sulfonamides may cause hepatic coma or anuria Some products contain alcohol and should be avoided in patient with alcohol intolerance

Adverse effect

Dehydration and Electrolyte imbalance: Hypokalaemia, dehydration, hypercalcemia,hypomagnesia

Thrombocytopenia, hyperuricemia Dizziness, weakness, headache Hypotension, cramping, hepatitis, excessive urination.


Monitor blood pressure, intake output Monitor the fluid stats of the patient Monitor the patient for tinnitus or hearing loss Daily weigh the patient Investigate serum electrolyte and monitor the behavior of the patient (may cause increase

glucose level in diabetic patient, sr. bilirubin)

Administer in morning to prevent disruption of sleep cycle.


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SPIROLACTONE

Group of drug: spatassium sparing diuretic

Pharmacological name: Spirolactone

Trade name: novospartin, aldactone

Dose of drug

PO (Adults):HTN510mg/day (up to 20mg) PO (Adults):Edema25200 mg/day in 12 divided doses Diagnosis of primary hyperaldosteronism- 100400 mg/day in 12 divided dose. CHF: 12.525 mg/day (unlabeled use)

Action

Inhibition of sodium reabsorption in the kidney while saving potassiumand hydrogen ions

(spironolactone achieves this effect by antagonizing aldosterone receptors). Weak diuretic and

antihypertensive response wwhen compared with other diuretics but conserves potassium.

Indication

To counteract potassium loss caused due to other diuretics Primary aldosteronism Management of CCF

Contraindication

Hypersensitivity Hyperkalaemia Anuria, acute renal insufficiency (sr. creat >2.5mg/dl)

Adverse effect

Clumsiness, headache Hperkalemia, hyponatremia

Erectile dysfunction Increases hypotension with ingestion of alcohol


Monitor blood pressure, intake output Daily weigh the patient


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Monitor for signs of hyperkalaemia weakness, fatigue, paraesthesia, dyspnea, cardiacarrhythmias

Monitor sr. potassium level before and after therapy

ACE INHIBITOR

Group of drug: ACE INHIBITOR

Pharmacological name: enalapril, ramipril, captopril

Trade name: vasotec, monopril, altace

Dose of drug

Captopril: PO (Adults): Hypertension12.525mg 2-3 times daily, may be increased at 12

wk intervals up to 150 mg 3 times daily (begin with 6.2512.5 mg 23 times daily in patients

receiving diuretics) (maximum dose = 450 mg/day). CHF25 mg 3 times daily (6.2512.5 mg,

3 times daily. Post-MI6.25-mg test dose, followed by 12.5 mg 3 times daily, may be increased

up to 50 mg 3 times daily.

Enalapril: PO (Adults): Hypertension2.55 mg once daily, increase as required up to 40

mg/day in12 divided doses (initiate therapy at 2.5mgonce daily in patients receiving diuretics).

CHF2.5 mg 12 times daily, titrated up to target dose of 10mg twice daily; begin with 2.5 mg

once daily in patients with hyponatremia (serum sodium


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Hypersensitivity Previous angioedema caused by ACE inhibitors Womans with child bearing

Adverse effect

Cough, taste disturbances, GI disturbances Hypotension Angioedemaproteinuria, renal dysfunction


Monitor blood pressure Asses for signs of angioedema (dyspnea, facial swelling) Monitor weight and resolution of fluid overload Administer empt stomach 1 hr before meal to prevent GI disturbances

DOBUTAMINE

Group of drug: inotropic, adrenergic

Trade name: dobutrex

Dose of drug

IV (Adults and Children): Start with low infusion rates (0.51 mcg/kg/min), titrated at intervals

of a few minutes, guided by the patients response (range 220 mcg/kg/min, up to 40

mcg/kg/min)

Action

Dobutamine (Dobutrex) produces inotropic effects by stimulating myocardial beta receptors,

increasing the strength of myocardial activity and improving cardiac output. Myocardial alpha-

adrenergic receptors are also stimulated, resulting in decreased pulmonary and systemic vascular

resistance (decreased afterload). Dobutamine enhances the strength of cardiac contraction,

improving stroke volume ejection and overall cardiac output without significant increased heartrate.

Indication: cardiac decompensation caused by heart disease or surgical procedures

Contraindication:

Hypersensitivity to dobutamine


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Idiopathic hypertrophic subaortic stenosisAdverse effect

Shortness of breath Hpetension Premature ventricular contracture Angina Palpitations


Monitor blood pressure, heart rate, ECG, cardiac output, urinary output Palpate peripheral pulses and temperature of extremities (vasodilation can cause oedema

and retention)

Vials must be diluted before use Dilute 2501000 mg in 250500 ml of D5W, 0.9%NaCl, 0.45% NaCl, D5/0.45%NaCl, D5/0.9% NaCl.

Monitor electrolytes Monitor for hpokalaemia (weakness, faigue, U wave in ECG)

DOPAMINE

Group of drug: inotropic, vasopressor, adrenergic

Pharmacological name: dopamine

Dose of drug

Small doses (0.53 mcg/kg/min) stimulate dopaminergic receptors, producing renalvasodilation.

Larger doses (210 mcg/kg/min) stimulate dopaminergic and beta1-adrenergicreceptors, producing cardiac stimulation and renal vasodilation.

Doses greater than 10 mcg/kg/min stimulate alpha-adrenergic receptors and may causerenal vasoconstriction.

Action

Dopamine (Intropin) is a sympathomimetic agent that has varying vasoactive effects depending

on the dosage. It increases cardiac otput, increases blood pressure and improves renal blood


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SUMMARY

Till now we have seen about the classification of cardiac drugs and subtypes with examples

Conclusion

Though cardiac drugs are the ones which are extensively used, but as a nurse while administering

and prescribing this drugs one must remember the the action indication side effect and necessary

observations otherwise this life saving drugs can be fatal if not admininstered or monitored at

right time, right place.


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Group of drug

Pharmacological name

Trade name

Dose of drug

Route of drug

Action

Indication

Contraindication

Adverse effect


Documents

SEMINAR on Drugs Used in Cardiac Disease