Download cardiovascular medications

CARDIOVASCULAR
MEDICATIONS
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FIRST DO NO HARM
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There are 5 rights to patient medication administration:
Right patient
Right drug
Right dose
Right route
Right time
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Once you have given the
Drug, you can’t get it back, so do it
right the first time!
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Autonomic Nervous System
 Sympathetic system ("fight or flight")
 Parasympathetic system ("rest and digest"
or "feed and breed")
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Stimulates
Sympathetic system
Adrenal medulla
Stimulates
Epinephrine and Norepinephrine
Stimulates
Adrenergic Receptors (alpha or beta receptors
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Drugs Affecting the Autonomic
Nervous System
 Drugs stimulate sympathetic nervous system = Agonists =
Sympathomimetics
 Drugs inhibit sympathetic nervous system = Antagonists =
sympatholytics = Blockers (alpha and beta)
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Drugs Affecting the Autonomic
Nervous System
 Drugs stimulate parasympathetic nervous system =
Parasympathomimetics (↑ACH)
 Drugs inhibit parasympathetic nervous system =
Parasympatholytics (↓ACH)
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Beta blockers
 Reduce the rate and force
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of contraction of the heart
Bronchoconstriction
Given for hypertension and
angina
Not for asthma
E.g. Inderal
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Beta agonists
 Bronchodilation
 Tachycardia and elevation
of blood pressure
 Used in anaphylactic shock
and cardiac arrest
 E.g. Adrenalin
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Beta-2 agonists
 Bronchodilation
 May also cause
tachycardia and
palpitations in high dose
 E.g. Ventolin
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Parasympathomimetics
 Mimic the effects of acetylcholine, e.g. bethanechol
(Urecholine),
 Or mimic acetylcholine by blocking
acetylcholinesterase (e.g. Physostigmine)
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Parasympathetic blockers
(Parasympatholytics)
 block effect of acetylcholine.
Common example is Atropine
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Medications Affecting the
Cardiovascular System
 Medications Used for Cardiovascular Conditions
 Medications by Therapeutic classifications
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Medications Used for Cardiovascular
Conditions
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Antihypertensives:
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Diuretics
Alpha Blockers
Beta Blockers
Calcium Channel Blockers
Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors)
Angiotensin Receptor Blockers
Vasodilators
Centrally Acting Agents
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Medications Used for Cardiovascular
Conditions
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Antianginals:
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Beta Blockers
Calcium Channel Blockers
Coronary Vasodilators including Nitrates
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Medications Used for Cardiovascular
Conditions
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Antidysrythmics:
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Cardiac Glycosides including Digoxin
Beta Blockers
Calcium Channel Blockers
Various – Adenosine, Procainamide, Quinidine, Lidocaine,
Bretylium
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Medications Used for Cardiovascular
Conditions
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Cardiac Sympathomimetics:
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Dobutamine
Dopamine
Epinephrine
Norepinephrine
Isoproterenol
Phenylephrine
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Medications Used for Cardiovascular
Conditions
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Congestive Heart Failure Therapy:
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Angiotensin Converting Enzyme (ACE)
Inhibitors
Cardiac Glycosides (Digoxin)
Diuretics
Sympathomimetics/Inotropes
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Medications by Therapeutic
Classifications
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Diuretics:
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Loop Diuretics – Furosemide
Osmotic Diuretics – Mannitol
Potassium Sparing Diuretics – Amiloride, Spironolactone,
Triamterene
Thiazide Diuretics – Hydrochlorothiazide
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Medications by Therapeutic
Classifications
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Beta Adrenergic Blocking Agents
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Propranolol (Inderal)
Atenolol (Tenormin)
Metoprolol (Lopressor)
Labetolol (Trandate)
Esmolol (Brevibloc
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Medications by Therapeutic
Classifications
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Calcium Channel Blocking Agents
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Nifedipine (Adalat)
Diltiazem (Cardizem)
Verapamil (Isoptin)
Amlodipine (Norvasc)
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Felodipine (Renedil)
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Medications by Therapeutic
Classifications
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Angiotensin converting enzyme inhibitors
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Captopril (Capoten)
Enalapril (Vasotec)
Enalaprilat (Vasotec IV)
Fosinopril (Monopril)
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Ramipiril (Altace)
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Medications by Therapeutic
Classifications
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Angiotensin II receptor antagonists
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losartan (Cozaar)
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valsartan (Diovan)
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Medications by Therapeutic
Classifications
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Vasodilators
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Hydralazine (Apresoline)
Nitroglycerin
Sodium Nitroprusside
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Medications by Therapeutic
Classifications
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Sympathomimetics:
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Dobutamine
Dopamine
Epinephrine
Norepinephrine
Isoproterenol
Phenylephrine
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Medications by Therapeutic
Classifications
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Antidysrythmics:
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Cardiac glycosides including Digoxin
Beta Blockers
Calcium Channel Blockers
Various – Adenosine, Procainamide, Quinidine, Lidocaine,
Bretylium
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Drugs Actions
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Beta Adrenergic Blocking Agents
Calcium Channel Blocking Agents
Angiotensin Converting Enzyme Inhibitors
Angiotensin II Receptor Blockers
Diuretics
Cardiac Sympathomimetics and Antidysrythmics
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Beta Adrenergic Blocking Agents
 These drugs block the beta-receptors in the
sympathetic nervous system
 can be useful in situations where
sympathetic activity is excessive or
inappropriate. E.g. hypertension, angina,
dysrythmias
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Calcium Channel Blocking
Agents
 Contractions of cardiac and smooth muscle cells are
dependent on the movement of calcium ions into the
cells through specific channels.
 If calcium reduced, there will be changes in cardiac
electrical activity and vasodilation
 Used in dysrythmias, angina, and hypertension
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Angiotensin Converting Enzyme
Inhibitors
 Acts on renin-angiotensin-aldosterone system
 If the conversion of angiotensin I to angiotensin II by
enzymes is blocked, there will be reduction in blood pressure
by vasodilation
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Angiotensin II Receptor Blockers
 They block angiotensin II effect at the angiotensin type 1
receptors. Thus there is vasodilation and blood pressure
lowering.
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Diuretics
 Most diuretics act by increasing sodium excretion by the
kidney
 Where sodium goes, so does water, so that when the sodium
remains in the kidney filtrate (urine), more water will be
held, and thus urine volume or fluid excretion goes up.
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Diuretics
 As sodium is excreted, so is potassium, so these drugs can
considerably upset potassium levels in the blood, leading to
cardiac abnormalities.
 Potassium supplements like Slow K
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Cardiac Sympathomimetics and
Antidysrythmics
 Most are used within the
context of resuscitation
from cardiac arrest.
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Medications in the Context of Cardiac
Arrest
 Inotropes (Sympathomimetics)
 Antidysrythmics
 Vasodilators
 Beta Blockers
 Diuretics
 Analgesics
 Thrombolytics
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