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Common Medications and Laboratory test for Post-op Open Heart Patients Always remember…. Objectives • Understand use of specific class of medications and their impact upon the cardiac system. • Identify one indication and one contraindication for medications based upon patient needs. • Identify laboratory testing and one corrective measure for specific abnormality. • Understand the variants between POCT versus direct laboratory values and the impact upon the bedside treatment Medications Dilators, Constrictors, et al in between Inotropes • Used to alter force of energy creation • Can be either ‘negative’ or ‘positive’ in nature • Tend to like the ‘positive’ effects seen • Always deliver centrally due to adverse effects to tissue • May alter laboratory levels, i.e. • Calcium • Glucose diabetics Inotropes - Drugs • • • • • • • Dopamine Dobutamine Epinepherine Norepinepherine Milrinone Calcium Prostaglandins Inotropes – effects (good) • • • • • Increase cardiac output Increase systolic blood pressure Increase urinary output Improvement in contractility will augment cardiac output Rates calculated in microgram/kilogram/minute or micrograms/minute (usually first one is done) Side effects of inotropic support • • • • • Tachyarrhythmias Elevated glucose levels Anxiety Small vessel ischemia Kidney insufficiency Phosphodiesterase inhibitors • • • • Isolated in rats brain in 1972 Further studies into 1977 brought them to light for use in humans Non-selective and selective PDE-3 or Milrinone places effect upon cAMP and calcium activation increase in CO decrease in SVR/PVR half-life longer than straight inotropic cousins PDE inhibitor S/E • • • • Kidney dysfunction Considered proarrhythmic Bronchospasms Metabolic derangements • potassium Vasopressors • Help with augmenting SVR and supporting blood pressure • Majority are considered alpha-agonist with neosynepherine considered a pure alpha • Some medications that are inotropes are used in the vasopressor avenue also, Levophed which has both properties • Caution with use, may impact small vessel ischemia so patient assessment and evaluation key points Hormone peptide - Vasopressin • Increase vascular resistance, hence increasing arterial blood pressure • Compensatory mechanism in shock states • Does not increase myocardial oxygen demand as do the other inotropic agents • Usually last line drug Prostoglandins - Flolan • • • • • Help to control vascular tone Influence sodium excretion Influence upon RAAS system Usually given in nebulized therapy In the presentation of right sided dysfunction 2/2 to pulmonary resistance issues (pulmonary HTN, ARDS, etc) • costly Antiarrhythmics • Amiodarone • Primarily seen for control and alleviation of atrial fibrillation • Very long half life, to some extent indeterminate • Can act as ‘chemical’ defibrillation agent so must be used cautiously • Long term side effects – lungs, eyes, thyroid, GI Antiarrhythmics - continued • Digoxin • Atrial fib impact • Rate control predominantly • Does have inotropic effects, positive to LV • Requires loading dosage • Levels should be monitored to avoid side effects Antiarrhythmics - continued • Cardizem • Atrial fib rate control • Will have some degree impact upon blood pressure • Titrated to attainable heart rate, usually <110 • Can quickly cause bradycardia Antiarrhythmic medication side effects • • • • • • Proarrhythmic potential Bradycardia Hypotension Mentation alterations n/v Visual disturbances Factor VIIa (recombinant) • • • • Used in face of coagulopathy not responsive to other means Direct action on reducing fibrinolysis Usually given in conjunction with cryoprecipitate factors Costly Protamine sulfate • • • • • Reversal for heparin Primarily given after completion of cardiopulmonary bypass Due to potential rebound heparin effects, can be given at bedside Allergy to fish contraindication, effects can be very dramatic 1 mg for every 100 units normal dosage regimen Blood Products • Platelets • Bleeding issues • Low counts • Fresh frozen plasma • Bleeding issues • volume • Cryoprecipitate • Bleeding issues • Factor deficiencies Labs commonly seen • • • • • • • • Hemoglobin/hematocrit Platelet count Basic metabolic profile Arterial blood gas Ionized calcium level Magnesium Lactic acid level Heparin antibody Common labs – continued • Coagulation profile • Blood glucose • ACT
