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N402
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 Angina is caused by insufficient
O2 to part of the myocardium
Therefore, angina is relieved by decreasing O2 to the
myocardium! Accomplished by:
Decrease the heart rate…
Dilate the veins (decrease preload)…
Decrease contractility… or,
Decrease BP (decrease afterload)
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βBlockers
Ca
Channel
Blockers
Organic
Nitrates
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 Requires drugs from 2 classes because each class
relieves angina from a different approach…
 β-Blockers slow heart rate and decrease contractility…
 Ca Channel Blockers decrease afterload…, and
 Organic Nitrates decrease preload
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 Slow the heart rate and decrease contractility
 Therefore, afterload is decreased
 Used to treat both hypertension and angina
 Not effective on Prinzmetal’s angina
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 Relax arteriolar smooth muscle to decrease BP
 Therefore, decrease afterload
 Also dilate coronary smooth muscle
 Useful in treating Prinzmetal’s angina
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 Dilation of veins decreases amount of blood returning
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
to heart
Therefore decreases preload
Also dilates coronary arteries
Useful in treating Prinzmetal’s angina
May be short acting (NTG) or long acting (isosorbide)
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 Sudden blockage of coronary artery by dislodged
plaque
 Causes coagulation cascade
 Results in:
UNSTABLE ANGINA
Incomplete occlusion
by thrombus
Causes chest pain
INFARCTION
Complete occlusion
by thrombus
Causes ischemia and
necrosis
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Goals of treatment:
Unstable angina
Relief of pain
Prevent clot enlargement
Myocardial infarction
Restore blood supply
Prevent thrombus enlargement
Decrease O2 demand
Prevent dysrhythmias
Manage pain
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 Should be given within first 20 minutes to 12 hours
 Risk is excessive bleeding
 Not everyone is a candidate
 Use with caution in the elderly
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Anticoag.
ASA/clopidogrel
↓ O2 demand
Antianginal
Β-Blockers
Nitrates
Pain Mgt
MS
ACEI
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 Occurs when there is insufficient blood supply to vital
organs by cardiovascular system
 Major types of shock:
Hypovolemic
Excessive blood loss
Cardiogenic
Pump failure
Septic
Toxins in blood
Neurogenic
Sudden loss of sympathetic activity
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 Used when fluids alone are ineffective
 Rapid onset, short duration
 Given by continuous IV until patient is stabilized
Dopamine (Dopastat, Intropin
2-5 mcg/kg/min; up to 20-50 mcg/kg/min
Norepinepherine (Levophed)
0.5 mcg/min up to 8-30 mcg/min
Phenyephrine (Neo-Synepherine)
Epinephrine
Watch closely for adverse effects: BP changes,
dysrhythmias, necrosis at infusion/injection site (Regitine)
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Commonly associated drugs:
 Antibiotics—especially PCNs, cephalosporins,
sulfonamides
 NSAIDS—ASA, ibuprofen, naproxen
 ACEIs
 Opioids
 Iodine based contrast media
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 Epinephrine 1:1000 subcu or IM initial drug of choice
 Antihistamines e.g., diphenhydramine
 Bronchodilator by inhalation, e.g., albuterol
 High flow oxygen
(some exceptions)
 Systemic corticosteroids
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Major categories
Atrial
Blocks
Ventricular
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 Supraventricular
 Originate in the atria
 Atrial fibrillation is most common SV dysrhythmia
 Ventricular
 More serious than atrial dysrhythmias
 Complete disorganization of contractions
 Heart block
 Blockage of electrical conduction system
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 Cardioversion
 Disrupts cardiac rhythm to “reset”
 Patient may be awake
 Defibrillation
 Uses more joules of shock
 Patient should not be awake!
 Implantable cardioverter
defibrillators
 Respond to sensing of dysrhythmias
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Block flow through
ion channels
(conduction)
Change autonomic
activity
(automaticity)
I Sodium channel blockers
II β-blockers
III Potassium channel blockers
IV Calcium channel blockers
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 Prevent depolarization
 Action potential slows
 Ectopic pacemaker activity suppressed
 Procainamide
 May produce new dysrhythmias
 Hypotension
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 Decrease conduction through the AV node
 Automaticity is reduced
 Dysrhythmias can be stabilized
 Propanolol (Inderal)
 Watch for laryngospasm
 Bradycardia
 Serious dysrhythmias
 Myocardial ischemia
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 Delay repolarization of the myocardial cells
 Lengthen refractory period
 Used for serious dysrhythmias
 Used for atrial and
ventricular dysrhythmias
 Amiodarone
 May cause new
dysrhythmias
 Hypotension
 Bradycardia
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 Slow conduction velocity through AV node
 Reduced automaticity in the heart
 Slows heart rate
 Prolongs refractory period
 Verapamil
 Myocardial infarction
 Heart failure
 May be given continuous IV for up to 24 hours
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Remember?
 COPD includes:
 Chronic bronchitis
 Emphysema
 And asthma is off in its own category….
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 Ventilation is the process of moving air in and out of
the lungs
 Respiration is the exchange of gases due to diffusion
 Perfusion is the flow of blood through the lungs
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Bronchospasm
Inflammation
Asthma
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Bronchodilators address muscle spasm of the respiratory
tree:
βadrenergic
agonists
Anticholinergics
Methlyxanthines
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 Activate the sympathetic nervous system (sympathetic =
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dilation; parasympathetic = constriction)
Cause vasodilation
Drugs in this category classified as long-acting or shortacting
Short-acting referred to as rescue-drugs
Long-acting cannot relieve acute bronchospasm!
 Albuterol (Proventil)
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Tachycardia
Dysrhythmias
Hypokalemia
Paradoxical bronchospasm
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 Alternative for patients who cannot tolerate β-
adrenergic agonists
 Block the parasympathetic nervous system
 Prevent vasoconstriction
 Ipratropium (Atrovent)
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Headache
Cough
Dry mouth
Paradoxical bronchospasm
Pharyngitis
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 Older drugs
 Long term management
of persistent asthma
 Narrow margin of safety
 Related to caffeine
 Theophylline (Theo-Dur)
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Tremors
Tachycardia
Dysrhythmias
Headache
Respiratory arrest
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Corticosteroids
Lelukotriene
modifiers
Mast cell
stabilizers
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 Potent, naturally occurring
 Allow smooth muscle to become more sensitive to
bronchodilation
 Reduce responsiveness to allergens
 Used for preventing asthma attacks
 Beclomethasone (Qvar)
 Hoarseness
 Cough, sore throat
 Oropharyngeal candidiasis
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 Alternative drugs
 Inhibit release of leukotrienes
 Edema
 Inflammation
 bronchoconstriction
 Zafirkulast (Acolate)
 Headache, nausea
 Throat pain
 Increased suicidal ideation
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 Inhibit release of histamine from mast cells
 Taken daily
 Not effective for acute events
 Cromolyn (Intal)
 Sneezing, nasal stinging
 Throat irritation
 Angioedema
 Bronchospasm
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 Many of the same drugs are used with the COPD
patient
 Medications
are based on COPD
symptoms
Bronchodilators
Corticosteroids
Antibiotics
Mucolytics
Oxygen
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 β-blockers which cause bronchoconstriction
 Respiratory depressants (MS, barbiturates)
 Most importantly…smoking cessation!
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