Nurse Review

NurseReview.Org Pharmacology Cardiovascular
Drugs - Presentation Transcript
1. Cardiovascular drugs
2. Cardiac Drugs
o Used in Hypertension
o Used in Angina Pectoris and MI
o Used in Shock
o Used in Arrhythmias
o Used in CHF
3. Antihypertensive drugs
o The Drugs employed to control hypertension can be classified as:
o Diuretics
o Beta-blockers
o Alpha adrenergic blockers
o Calcium channel blockers
o Angiotensin-converting enzyme inhibitors
o Angiotensin II receptor blockers
o Peripheral vasodilators
4. Common Drugs in HPN
o IN Evaluating the effectiveness of these drugs is simply to monitor the BP
if it becomes NORMAL
5. The “olol”s
o The Beta-Blockers (B1)
o These agents are antagonist of the beta-receptors of the sympathetic
nervous system.
o They reduce cardiac output by diminishing the sympathetic nervous
system response and sympathetic tone.
6. The “olol”s
o The Beta-Blockers
o Vascular resistance and heart rate decrease causing reduced blood
pressure. Beta-blockers can either block the beta- receptor, beta 2 receptor
or BOTH.
o The selective beta-blockers (B1) are specific to one type of receptor only.
7. The “olol”s
o The following are the common beta-blockers- the ‘-OLOL’
o Non-selective (B1 and B2)
 Propranolol
 Carteolol
 Nadolol
 Penbutolol
 Pindolol
 Timolol
o Selective and Specific (B1)
 Acebutolol

 Atenolol
 Betaxolol
 Bisoprolol
 Metoprolol
8. The “olol”s
o Pharmacodynamics: the mechanism of action of the beta-blockers
o These agents block the beta-adrenergic receptors in the body, thereby
decreasing the heart rate and in turn, the blood pressure.
9. The “olol”s
o Pharmacodynamics: the mechanism of action of the beta-blockers.
o The non-selective agents block both Beta1 and 2 receptors causing
bronchial constriction.
o The onset of action is 30 minutes and the duration may range from 6-12
hours.
10. The “olol”s
o Clinical Indications of the beta-blockers
o Hypertension
o Angina pectoris
o Myocardial infarction
11. The “olol”s
o Contraindications and precautions
o These agents are not given to patients with:
o Heart blocks
o Bradycardia
o Congestive heart failure
o Chronic obstructive pulmonary disease
o Diabetes
12. The “olol”s
o Pharmacodynamics- Side effects and adverse effects
o CVS- Bradycardia , Hypotension, rebound hypertension when abruptly
stopped
o Respi- Bronchoconstriction, bronchospasms
o Others- insomnia, depression, nightmares, constipation
o Impaired ability of the liver to convert glycogen to glucose causing
HYPOGLYCEMIA!
13. The “olol”s
o Implementation
o Monitor patient’s vital signs. Take the heart rate before giving the drug
o Instruct the patient to take the drug as prescribed. Warn not to abruptly
stop the medication
o Suggest to avoid over-the-counter medications
o Give health teaching as to name of drug, dosages and side effects.
14. The “olol”s
o Implementation
o Remind client NOT to change position abruptly as to avoid orthostatic
Hypotension

o Alert diabetic clients of the possible hypoglycemic effect
o Inform that this can cause sexual dysfunction
15. The “olol”s
o Implementation
o Advise client to utilize other means to control blood pressure such as diet
modification, exercise, lifestyle changes, etc
o Advise to eat high fiber foods to counter-act constipation
16. The Prils
o The Angiotensin Converting Enzyme Inhibitors
o These are commonly called ACE inhibitors because the agents BLOCK
the conversion of AI to AII in the LUNGS.
o These agents alter one of the mechanisms of blood pressure control- the
RAAS or renin-angiotensin-aldosterone system.
o Angiotensin II is a very powerful vasoconstrictor and stimulus for the
release of aldosterone.
17. The Prils
o The Angiotensin Converting Enzyme Inhibitors
o “— Pril”
o Benazepril
o Captopril- prototype
o Enalapril
o Enalaprilat
o Fosinopril
o Lisinopril
o Moexipril
o Quinapril
o Ramipril
o Trandorapril
18. The Prils
o Pharmacodynamics: The mechanism of action of the ACE inhibitors
o These agents prevent the conversion of angiotensin I to angiotensin II by
inhibiting the enzyme in the lungs- the angiotensin converting enzyme.
o The action leads to decreased AII and decreased aldosterone level leading
to a decrease in blood pressure.
19. The Prils
o Pharmacodynamics: The mechanism of action of the ACE inhibitors
o The effect of lowering the blood pressure is attributed to the decrease in
cardiac workload and decrease peripheral resistance and blood volume .
20. The Prils
o Clinical indications of the ACE inhibitors
o Hypertension, either alone or in combination with other agents.
o Congestive heart failure, left ventricular dysfunction
o Diabetes
21. The Prils
o Contraindications and Precautions in the Use of ACE inhibitors
o Presence of allergy is a clear contraindication.

o The ACE inhibitors are NOT given to patients with renal dysfunction
because these drugs may cause further decrease in renal blood flow.
o If given to pregnant women, the drugs cross the placenta and produce
renal abnormalities in the fetus.
22. ACE inhibitors
o Pharmacodynamics: the adverse effects
o CVS- reflex tachycardia , chest pain, angina, cardiac arrhythmias
o CNS- dizziness, drowsiness, and lightheadedness
o GIT- GI irritation, nausea, vomiting, peptic ulcer, constipation and liver
damage
o Renal- renal insufficiency, proteinuria
o Others- rash, photosensitivity, dermatitis and alopecia, sodium excretion
and potassium retention, fatal pancytopenia.
o COUGH - this cough is really unrelenting and bothersome.
23. ACE inhibitors
o Implementation
o The nurse should encourage the patient to implement lifestyle changes
such as weight reduction, smoking cessation, decreased intake of alcohol,
dietary restriction of salt/fats and increased exercise.
o Give the drug on an empty stomach, either 1 hour before or 2 hours after
meals to ensure proper drug absorption
24. ACE inhibitors
o Implementation
o Monitor the patient who is at risk of developing fluid volume alteration
o Provide comfort measures like safety Precaution, environmental control,
skin care, oral care and symptomatic relief of cough.
25. ACE inhibitors
o Implementation
o Provide patient teaching including the name of drug, dosage, measure to
handle adverse effects and the warning signs to report. Stress the
importance of NOT abruptly stopping the medication if symptoms are
improving .
o Caution the patient to change position slowly and to avoid hazardous or
delicate tasks and driving if drowsiness is a problem
26. The “sartans”
o The Angiotensin II Receptor Blockers
o These are SELECTIVE agents that specifically bind to the angiotensin II
receptors in the blood vessels and adrenal cortex to prevent the release of
aldosterone and to prevent vasoconstriction.
o Prototype: Losartan
o Candesartan
o Irbesartan
o Losartan
o Telmisartan
o Valsartan

o Pharmacodynamics- The mechanism of action of the A-R-B
o These agents work by attaching to the Angiotensin II receptors in the
vascular smooth muscles and in the adrenal gland.
o The action results in VASODILATION because AII action (constriction)
is inhibited and BLOCKAGE of aldosterone release
o Clinical Use of the A-R-B
o Hypertension, either alone or in combination.
o These agents are also used if the patient cannot tolerate the unrelenting
cough associated with ACE inhibitors.
o Contraindications and precautions associated with the A-R-B
o These agents are contraindicated in the presence of allergy.
o It is NOT GIVEN to pregnant mothers because of the associated FETAL
DEATH and severe fetal abnormalities. Lactating women should also
avoid these drugs because they can affect the neonate.
o Pharmacodynamics: the adverse effects
o CNS- headache, dizziness, weakness, syncope and orthostatic
Hypotension
o GIT- Diarrhea, abdominal pain, nausea, dry mouth and tooth pain
o Respiratory- mild cough
o Skin- rash, dry skin and alopecia.
o Implementation
o Encourage the patient to implement lifestyle changes, including weight
loss, smoking cessation, decrease in alcohol and salt in the diet, and
increased exercise, to increase the effectiveness of anti-hypertensive
therapy.
o Administer without regard to meals; give with food to decrease GI distress
if needed .
o Implementation
o Alert the surgeon and mark the patient's chart prominently if the patient is
to undergo surgery to alert medical personnel that the blockage of
compensatory angiotensin II could result in hypotension following surgery
that needs to be reversed with volume expansion.
o Implementation
o Ensure that the patient is not pregnant before beginning therapy and
suggest the use of barrier contraceptives while on this drug to avert
potential fetal death or abnormalities that have been associated the these
drugs.

o Find an alternative method of feeding the baby if patient is nursing to
prevent the potentially danger- block of the renin-angiotensin system in
the neonate.
o Implementation
o Monitor the patient carefully in any situation that might lead to a drop in
fluid volume (e. g., excessive eating, and vomiting diarrhea, dehydration)
to detect treat excessive hypotension that may occur.
o Provide comfort measures to help the patient tolerate drug effects (e.g.,
small, frequent meals; access to bathroom facilities; safety precautions if
CNS effects occur environmental control; appropriate skin care needed;
analgesics as needed).
36. Calcium channel blockers
o These agents prevent the movement of calcium into the cardiac and
smooth muscle cells when the cells are stimulated.
o This blocking of calcium will interfere with the muscle cell's ability to
contract, leading to a loss of smooth muscle tone, vasodilation, and a
decrease in peripheral resistance .
o These effects will decrease blood pressure, cardiac workload, and
myocardial oxygen consumption .
o Calcium channel blockers are very effective in the treatment of angina
because they decrease the cardiac workload.
o Pharmacodynamics: Mechanism of action
o Calcium channel blockers inhibit the movement of calcium ions across the
membranes of myocardial and arterial muscle cells, altering the action
potential and blocking muscle cell contraction.
o This effect will depress myocardial contractility, slow cardiac impulse
formation in the conductive tissues, and relax and dilate arteries, causing a
fall in blood pressure and a decrease in venous return.
o The calcium channel blockers that are used in the treatment of
hypertension include the following:
o The “-dipine” and others
o Diltiazem (Cardizem, Tiamate)
o Verapamil
o Amlodipine (Norvasc)
o Felodipine (Plendil)
o Isredipine (DynaCirc)
o Nicardipine(Cardene)
o Nifedipine (CALCIBLOC, Procardia XL)-prototype!
o Nisoldipine (Sular)
o CONTRAINDICATION and PRECAUTIONS

o These drugs are contraindicated in the presence of allergy to any of these
drugs
o With heart block or sick sinus syndrome because these could be
exacerbated by the conduction-slowing effects of these drugs
o With renal and hepatic dysfunction, which could alter the metabolism and
excretion of these drugs; and with pregnancy and lactation because of the
potential for adverse effects on the fetus and neonate.
o Pharmacodynamics: the ADVERSE EFFECTS
o The adverse effects associated with these drugs are related to their effects
on cardiac output and on smooth muscle.
 CNS effects include dizziness , lightheadedness, headache, and
fatigue.
 GI problems can include nausea and hepatic injury related to direct
toxic effects hepatic cells.
 Cardiovascular effects include hypotension, bradycardia,
peripheral edema, and heart block . Skin flushing and rash may
also occur
o Pharmacodynamics:
o The main use of calcium channel blockers is the treatment of angina
o Also in hypertension
o Also in vascular spasm= Raynauds
o IMPLEMENTATION
o Monitor blood pressure carefully while patient is on therapy because of
increased hypotensive episodes
o If possible, obtain serial ECG tracing
o Provide comfort measures to help patient tolerate drug effects- includes
serving small frequent feedings and safety precaution due to hypotension
and dizziness
o IMPLEMENTATION
o Provide health teaching as to drug name, dosage, administration, side
effects and warning manifestations to report
46. The Vasodilators
o Vasodilators produce relaxation of the vascular smooth muscle, decreasing
peripheral resistance and reducing blood pressure.
o They cause the reflex tachycardia that occurs when blood pressure drops
47. The Vasodilators
o The vasodilators are used to treat severe hypertension
48. Vasodilators
o Diazoxide (Hyperstat)
o Hydralazine (Apresoline)
o Minoxidil (Loniten)
o Sodium Nitroprusside (Nitropress)

o Tolazoline (Priscoline)
49. Vasodilators
o Pharmacodynamics: mechanism of action of the vasodilators
o The vasodilators act directly on vascular smooth muscle to cause muscle
relaxation, leading to vasodilation and drop in blood pressure .
o They are indicated for the treatment of severe hypertension that has not
responded to other therapy.
50. Vasodilators
o Contraindications and Precautions
o The vasodilators are contraindicated in the presence of known allergy to
the drug; with pregnancy and lactation because of the potential for adverse
effects on the fetus and neonate; and with any condition that could be
exacerbated by a sudden fall in blood pressure, such as cerebral
insufficiency.
51. Vasodilators
o Pharmacodynamics: the adverse effects of the vasodilators
o CNS- dizziness , anxiety, headache
o CVS- reflex tachycardia , CHF, chest pain, edema; skin rash, lesions
(abnormal hair growth with minoxidil), hypotension
o GI upset, nausea, and vomiting
52. Vasodilators
o Pharmacodynamics: the adverse effects of the vasodilators
o Cyanide toxicity (dyspnea, headache, vomiting, dizziness, ataxia, loss of
consciousness, imperceptible pulse, absent reflexes, dilated pupils, pink
color, distant heart sounds, shallow breathing) may occur with
nitroprusside , which is metabolized to cyanide and which also suppresses
iodine uptake and can cause hypothyroidism.
53. Vasodilators
o IMPLEMENTATION
o Encourage the patient to implement lifestyle changes, including weight
loss, smoking cessation, decrease in alcohol and salt in the diet, and
increased exercise, to increase the effectiveness of antihypertensive
therapy.
o Monitor blood pressure closely during administration to evaluate for
effectiveness and to ensure quick response if blood pressure falls rapidly
or too much .
54. Vasodilators
o IMPLEMENTATION
o Monitor blood glucose and serum electrolytes to avoid potentially serious
adverse effects.
o Monitor the patient carefully in any situation that might lead to a drop in
fluid volume (e.g., excessive sweating, vomiting, diarrhea, dehydration) to
detect and treat excessive hypotension that may occur.
55. Vasodilators
o IMPLEMENTATION

o Provide comfort measures to help the patient tolerate drug effects (e.g.,
small, frequent meals, access to bathroom facilities safety precaution if
CNS effects occur, environmental control, appropriate skin care as needed,
analgesic as needed).
o Provide thorough patient teaching
o Offer support and encouragement to deal with the diagnosis drug regimen.
56. Drugs for the Treatment of Congestive Heart Failure
o Vasodilators- Nitrates that act to directly relax vascular muscle tone and
cause decrease in blood pressure with pooling of blood in the veins. The
preload and afterload will be decreased
o ACE inhibitors- are agents that block the conversion of angiotensin I to
angiotensin II. The result is blockage of the vasoconstriction and
decreased blood volume. The afterload will be decreased.
o Diuretics are employed to decrease the blood volume, which decreases the
venous return and the blood pressure. The results are decreased preload
and decreased afterload.
57. Drugs for the Treatment of Congestive Heart Failure
o Beta stimulators will stimulate the beta receptors in the sympathetic
nervous system, increasing the myocardial contraction- called positive
inotropic effect.
o Cardiotonic drugs- these agents affect the INTRACELLULAR calcium
levels in the heart muscles leading to increased contractility . The result is
increased cardiac output, increased renal blood flow, increased perfusion
and increased urine formation. The cardiotonic drugs are: the cardiac
glycosides and the phosphodiesterase inhibitors.
58. The cardiac glycosides
o These are agents extracted from the foxglove plant. They are available in
oral and parenteral preparations. The following are the cardiac glycosides:
o Digoxin (Lanoxin)
o Digitoxin (Crystodigin)
o Ouabain
o Pharmacodynamics: the Mechanism of action
o They increase the level of CALCIUM inside the cell by inhibiting the
Sodium-Potassium pump .
o More calcium will accumulate inside the cell during cellular
depolarization.
o Positive inotropic Effect- the myocardium will contract forcefully
 Increased cardiac output
 Increased blood flow to the body organs like the kidney and liver
o Negative chronotropic effect- the heart rate is slowed due to decreased rate
of cellular repolarization
 Bradycardia
o Decreased conduction velocity through the AV node

o Clinical Use of the cardiac glycosides
o Treatment of congestive heart failure
o Treatment of dysrhythmias like atrial flutter, atrial fibrillation and
paroxysmal atrial tachycardia
o Contraindications and Precautions
o Contraindicated in the presence of allergy to any cardiac glycoside.
o They are NOT given to patients with ventricular dysrhythmias, heart block
or sick sinus syndrome, aortic stenosis, acute MI, electrolyte imbalances
( HYPOKALEMIA, HYPOMAGNESEMIA and HYPERCALCEMIA )
and renal failure (may cause accumulation of drug)
o Pharmacodynamics: the Adverse Effects of the Cardiac glycosides
o CNS- Headache, weakness , seizures and drowsiness
o CVS- arrhythmias
o If digitalis toxicity is developing- the nurse must assess the following
adverse effects: Anorexia, nausea and vomiting, visual changes-
YELLOW halo around an object, and palpitations or very slow heart rate
o Drug-Drug Interactions
o If taken with Verapamil, Amniodarone, quinidine, quinine, erythromycin
and tetracyclines- can increase the risk of INCREASED effects of
digitalis.
o If taken with potassium-losing diuretics like furosemide- can INCREASE
the risk of toxicity and arrhythmias. Potassium replacement must be given.
o If given with cholestyramine, charcoal and colestipol- can cause impaired
absorption of digitalis
o Implementation
o Administer the initial rapid digitalization and loading dose as ordered
intravenously
o Monitor the APICAL pulse rate for ONE full minute before administering
the drug. Withhold the drug if
 Less than 60 in adults
 Less than 90 in infants
 More than 110 in adults
o Retake pulse in one hour, if pulses remain abnormal, refer!
o Implementation
o Check the spelling of the drug- DIGOXIN is different from DIGITOXIN!
o Check the dosage preparation and the level of digitalis in the blood.
( Therapeutic level is 0.5 to 2.0 nanograms/mL )
o Administer intravenous drug VERY slow IV over 5 minutes to avoid
arrhythmias. Do NOT administer intramuscularly because it can cause
severe pain

o Implementation
o Administer the drug without food if possible to avoid delayed absorption .
Weight patient daily to determine fluid retention
o Maintain emergency equipment and drugs= Potassium salts, Lidocaine for
arrhythmias, phenytoin for seizures, atropine for bradycardia.
o Provide comfort measures- small, frequent meals, adequate lighting,
comfortable position, rest periods and safety precautions
o Implementation
o Provide health teaching- drug name, action, dosage and side effects.
Advise the patient to report any of the following: Visual changes, rapid
weight gain, unusually low heart rate, persistent nausea, vomiting and
anorexia
o Monitor serum potassium level
o Evaluation
o Evaluate effectiveness of the drug:
o Increased urine output
o Normal heart rate in arrhythmia
70. The Antianginal drugs
o In the treatment of angina, three agents are commonly employed-
 Organic nitrates
 Beta-blockers and
 Calcium-channel blockers.
o The benefits of the drugs lie in their different mode of action.
o The nitrates can cause vasodilatation of the veins and to some extent,
coronary artery
o Beta-blockers will decrease the heart rate
o Calcium-channel blockers will decrease force of contraction leading to a
decreased myocardial workload and demand.
o They can also produce vasodilation
o Anti anginal drugs are effective if the chest pain is relieved
75. The Organic nitrates
o These agents are simple nitric and nitrous acid esters of alcohols. Being
alcohol, they differ in their volatility. The following are the nitrates
commonly used:
o Nitroglycerin- A moderately volatile nitrate
o Isosorbide Dinitrate (Isordil) or mononitrate
o Amyl nitrate- an extremely volatile nitrate
o Nitroglycerin

o This agent is supplied in oral, spray, transdermal and ointment
preparations.
o Pharmacodynamics: the mechanism of action
o Nitroglycerin relaxes the smooth muscles in the vascular system by its
conversion to nitric oxide, a chemical mediator in the body that relaxes
smooth muscles.
o Administered nitrates
o Increased nitrates in the blood
o increased formation of nitric oxide
o increased cGMP formation
o increased dephosphorylation of myosin
o Vascular smooth muscle relaxation
o vasodilatation
o Pharmacokinetics- absorption to excretion
o It can be given orally, parenterally and topically.
o The onset of action of nitroglycerin is more than 1 hour.
o Because significant first-pass hepatic effect, Nitroglycerin is given
SUBLINGUALY.
o Pharmacodynamics: Side effects and adverse effects
o HEADACHE is the most common effect of nitroglycerin.
o CVS- postural Hypotension, facial flushing, tachycardia
o TOLERANCE - the tolerance to the actions of nitrates develop rapidly.
This can be managed by providing a day of abstinence.
81. The Nitrates
o Implementation
o Monitor vital signs, especially watchful for hypotensive episodes
o Advise patient to remain supine or sit on a chair when taking the
nitroglycerin for the first time. Emphasize that he should change his
position slowly or rise from bed slowly to avoid orthostatic Hypotension
o Offer sips of water before giving sublingual nitroglycerin because dryness
may inhibit drug absorption
82. The Nitrates
o Implementation
o Apply nitroglycerin ointment to the designated mark on paper.
o The nurse should remove any excess ointment on the skin from the
previous dose.
o She should NEVER USE her bare fingers because the drug can be
absorbed, utilize gloves or tongue blades instead.
83. The Nitrates
o Implementation
o Apply nitroglycerin patch to an area with few hairs. Never touch the
medication portion.

o The patch and the ointment should NOT be applied near the area for
defibrillation because explosion and skin burns may result
84. The Nitrates
o IMPLEMENTATION
o Emphasize that tolerance to the nitroglycerin can occur.
o If the medication cannot relieve the pain, report to the hospital
immediately.
85. The Nitrates
o IMPLEMENTATION
o Provide client health teaching- the sublingual nitroglycerin tablet is USED
if chest pain occurs
o The dose may be repeated if pain is unrelieved within 5 minutes.
o Repeat the medication administration if the pain has not yet subsided .
o DO NOT give more than 3 tablets! !! If chest pain persists for more than
15 minutes, hospital consult should be done immediately.
86. The Nitrates
o IMPLEMENTATION
o Instruct the client to avoid alcohol while taking nitroglycerin to avoid
potentiating the hypotensive effect of the medication
o If beta blockers and calcium-channel blockers are given, instruct the
patients to consult the physician before discontinuing the medication
87. The Nitrates
o IMPLEMENTATION
o Other components of health teaching for home self-administration:
 If taking Sublingual Nitroglycerin, the patient
should be instructed to place the tablet under the
tongue for quick absorption.
 A burning sensation/biting/stinging sensation may
indicate that the tablet is FRESH !
 Store the tablet in a dark container , keep it away
from heat and direct sunlight to avoid lessening the
potency
88. The Nitrates
o IMPLEMENTATION
 HEADACHES are common in the initial period of
nitroglycerin therapy. Advise patient to take
PARACETAMOL for relief
 The nitroglycerin patch is applied once a day,
usually in the morning. The sites should be rotated,
in the chest, arms and thighs avoiding hairy areas.
89. The Nitrates
o IMPLEMENTATION
 Position supine with elevated legs to manage
Hypotension.

 Nitroglycerin tablet can be taken prophylactically in
situations where chest pain is anticipated- Sex,
exercise, etc..
 If patient is taking beta blockers, instruct how to
obtain heart rate in a minute
90. Drugs for Shock
o Dopamine
o This is a sympathomimetic drug often used to treat Hypotension in shock
states that are not caused by Hypovolemia.
o This drug is an immediate precursor of nor-epinephrine, occurs naturally
in the CNS basal ganglia where it functions as a neurotransmitter.
91. Drugs for Shock
o Dopamine
o Pharmacodynamics: It can activate the alpha and beta adrenergic receptor
depending upon the concentration. It stimulates receptors to cause cardiac
stimulation and renal vasodilation .
o The dose range is 1-20 micrograms/kg/min
92. Drugs for Shock
o Dopamine
o Pharmacokinetics: Dopamine is administered IV, excreted in the urine.
o At low dose ( 1-2 micrograms ), dopamine DILATES the renal and
mesenteric blood vessels producing an increase output (dopaminergic
effect)
93. Drugs for Shock
o Dopamine
o At moderate dose of 2-10 micrograms, dopamine enhance cardiac output
by increasing heart rate ( beta 1-adrenergic effect) and elevates blood
pressure through peripheral vasoconstriction (alpha adrenergic effect)
94. Drugs for Shock
o Dopamine
o At higher doses of more than 10 micrograms- vasoconstriction of all
vessels will predominate that can lead to diminished tissue perfusion
95. Drugs for Shock
o Dopamine
o Dopamine is indicated to treat Hypotension, to increase heart rate and to
increase urine output (given less than 5 mg/kg/min)
o The nurse typically prepares the dopamine drip- dopamine (at a
concentration of 400-800 mg) is mixed in 250 mL D5W and administered
as drip via an infusion pump for precise dosage administration.
o Sodium bicarbonate will inactivate the dopamine
96. Drugs for Shock
o Dopamine
o Pharmacodynamics: side effects- Tachycardia
o hypertension
o ectopic beats, angina
o dysrhythmias, myocardial ischemia, nausea and vomiting.

97. Drugs for Shock
o Dopamine: Nursing consideration
 Check the IV site hourly for signs of drug infiltration of dopamine,
which can cause severe tissue necrosis.
 Phentolamine should be infiltrated in multiple areas to reduce
tissue damage.
 Drug is effective if Urine output is increased and BP is increased
98. Anti-Arrhythmias
o Arrhythmias (sometimes called Dysrhythmias) are conduction
dysfunctions caused by abnormalities in impulse generation or impaired
transmission of the impulses.
o They are simply deviations from the normal rate or pattern of the
heartbeat.
99. Anti-Arrhythmias
o Four things may happen during arrhythmias:
o The heart will beat too FAST (tachycardia, either the atrium or the
ventricle)
o The heart will beat too slow (bradycardia)
o The heart will respond to other impulses generated by the cardiac cells
(other than the SA node)
o The heat will respond to impulses traveling along extra pathways
100.Anti-Arrhythmias
o Anti-arrhythmic agents are given to modify impulse generation and
conduction.
o The desired action of these antidysrhythmics is to restore the cardiac
rhythm to normal.
o They affect the action potential of the cardiac cells, altering their
automaticity, conductivity, or BOTH
o Because the anti-arrhythmic drugs affect the conduction system, they also
can produce ARRHYTHMIAS!
o They are also Pro-Arrhythmics!
o The classes of anti-arrhythmic agents:
o Class 1 agents - are fast SODIUM channel blockers that affects the
depolarization phase.
o Class 2 agents- are BETA blockers that affect the depolarization.
o Class 3 agents- are POTASSIUM channel blockers that diminish the
outward potassium current during repolarization of cardiac cells.
o Class 4 agents- are calcium channel blockers that decrease the calcium
influx into the specialized cardiac muscle cells causing slowed conduction
o Class 1 agents -
 Class 1 A- Quinidine, Procainamide, Disopyramide, Moricizine
 Class 1 B- Lidocaine, Mexiletine, Tocainide

 Class 1 C- Encainide, Flecainide, propafenone
o Class 2 agents- are BETA blockers that affect the depolarization. They
decrease the conduction velocity, automaticity and recovery time.
Examples are: Propranolol, Metoprolol, pindolol, acebutol and esmolol
o Class 3 agents- are POTASSIUM channel blockers that diminish the
outward potassium current during repolarization of cardiac cells.
o They increase the refractory period and prolong the action potential.
Examples are: sotalol, bretylium, amniodarone
o Class 4 agents- are calcium channel blockers that decrease the calcium
influx into the specialized cardiac muscle cells causing slowed conduction.
They increase the refractory period of the AV node, which decreases the
ventricular response.
o The examples of calcium channel blockers are diltiazem and verapamil
o Miscellaneous- digoxin and adenosine
o General Nursing Process for Anti-arrhythmics
o Assessment
o Patient History- the nurse obtains health and drug histories. She should
elicit symptoms of shortness of breath, heart palpitations, coughing, chest
pain, previous angina or dysrhythmias, and the current medications.
o Physical Examination- the nurse performs assessment and baseline
monitoring
o Laboratory exams- the nurse obtains ECG results and cardiac markers-
CK-MB, AST and LDH)
o Nursing Diagnoses
o Alteration on perfusion: decreased cardiac output
o Alteration in thought processes and sensory-perceptual alteration
o Anxiety related to irregular heartbeat

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46 comments
Comments 1 - 10 of 46 next Post a comment

• + mikachan 1 week ago mark as spam

hi,
could you send me a copy of theses slides? Very helpful on my part as a CI.
Thanks
wdrn94@yahoo.com

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o
o Risk for injury related to CNS effects
o Knowledge deficit regarding drug therapy
o Planning
o The client will no longer experience abnormal cardiac rhythm
o The client will comply with the drug regimen
o Implementation
o Monitor Vital signs especially BP and HR. Patient can develop
Hypotension
o Administer the parenteral drugs slow IV for a period of 2-3 minutes
o Monitor ECG for abnormal patterns and report findings.
o Instruct to report palpitations and abnormal cardiac rate
o Maintain life support equipment on stand by to treat severe adverse
reactions that might occur
o Implementation
o Establish safety precautions- side rails, lighting, and noise control.
o Provide client teaching. Instruct the client to take the prescribed drug as
ordered. Emphasize the client to avoid alcohol, caffeine and tobacco.
o Alcohol can intensify the hypotensive effects, caffeine increases the
cathecolamine levels and tobacco can promote vasoconstriction.
o Instruct the client to report side effects including dizziness, faintness, and
nausea and vomiting.
o Evaluation
o Evaluate the effectiveness of the prescribed anti-dysrhythmic by
comparing heart rates with baseline heart rate.
o Assess the client’s response to the drug.

o Monitor for adverse effect- sedation, Hypotension, cardiac arrhythmias,
respiratory depression, CNS effect.
o Evaluate the effectiveness of the teaching plan. Monitor the effectiveness
of comfort measures and compliance to regimen.

Nurse Review

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