Definition of Terms

 Inotropic drugs- increased myocardial

contractility.
e.g. dopamine
 Chronotropic drugs- influence the cardiac rate by
increasing the impulse generated in the SA node.
e.g. Epinephrine, ATSO4
 Dromotropic drugs- delayed the speed of
conduction of nerve fibers.
e.g. lidocaine, cordarone, verapamil
 Common Drugs

 1. Ace inhibitor
 2. Beta Blockers
 3. Calcium Channel Blockers
 4. Diuretics
 5. Nitrates
 6. antiplatelet/ anticoagulant/ fibronolytics/
thrombolytics
 Cardiovascular Drugs

 Angiotensin-Converting Enzyme (ACE )

Inhibitors
A vasodilator that interfere the
production of angiotensin II. Reduce
afterload &
improve cardiac output & renal blood
flow
 ACE Inhibitors

Examples Indications
 Enalapril -reduce mortality & improve
LV dysfunction in post MI
 Ramipril -delay progression of heart
failure
 Captopril -decrease sudden death &
recurrence of MI
 Lisinopril
 ACE Inhibitors

Precautions/Contraindications
 C.I. in Pregnancy & Angioedema
 Hypersensitivity to Ace Inhibitors
 Reduce dose in renal failure
 ACE Inhibitors

Nursing Responsibilities
 Avoid hypotension esp. following initial dose &
in relative volume depletion
 Generally started w/in first 24 hours after
fibrolytic therapy has been completed & BP has
stabilized
 Monitor BP
 Instruct client to take at the same time every
day to ensure a stable blood level.
 Avoid sudden change of position.
 Take captopril or moexipril 1 hour before meals.
 Cardiovascular Drugs

 BETA BLOCKERS
Decrease myocardial O2 demand by
decreasing HR, Bp, myocardial
contractility & calcium output.
 BETA BLOCKERS

Examples Indication
 Metoprolol -MI & unstable angina in the absence
of complications
 Atenolol -adjunctive agent w/ fibronolytic
therapy
 Propanolol (Inderal) -convert to normal sinus rhythm
or to slow ventricular response
 Esmolol (Brevibloc) (or both) in supraventricular
tachyarrhythmias are 2nd line agent after
adenosine, diltiazem or digitalis derivative
-reduce myocardial ischemia & damage in AMI pts.
w/ elevated HR, BP or both
 BETA BLOCKERS

Precautions/Contraindications
 Concurrent IV administration w/ IV calcium
channel blocking agents like verapamil or
diltiazem can cause severe hypotension
 BETA BLOCKERS

Nursing Responsibilities
 Assess PR before administration of the drug; w/hold if
bradycardia is present
 Administer with food to prevent GI upset
 Do not administer propanolol to clients w/ asthma. It
causes bronchoconstriction
 Do not administer propanolol to clients w/ DM. It causes
hypoglycemia.
 Give w/ extreme caution in clients w/ heart failure
 Observe the side effect which areas follows: nausea,
vomiting, mental depression, mild diarrhea, fatigue &
impotence.
 Check BP & HR (withhold if below 50BPM & normal limit)
 Cardiovascular Drugs

 CALCIUM CHANNEL BLOCKERS

Inhibit calcium ion transportation into
myocardial cells to depress inotropic
w/ chronotropic activity, decrease cardiac
workload. Has vasodilatation effect &
reduces coronary vasospasm.
 CALCIUM CHANNEL
BLOCKERS

Examples Indication
 Diltiazem -to control ventricular rate
in atrial fibrillation & atrial flatter
 Verapamil -use after adenosine to treat

 Nifedipine refractory PSVT in pts. w/

narrow QRS complex &
 Calcibloc adequate BP
 CALCIUM CHANNEL
BLOCKERS

Precautions/Contraindications
 Do not use for wide QRS tachycardia of uncertain origin
or for poison/drug induced tachycardia
 Avoid pts. w/ WPW syndrome plus rapid atrial
fibrillation or flutter, in pts. w/ SSS or AV block w/out a
pacemaker
 Expect BP drop resulting from peripheral vasodilatation
(greater drop with verapamil than with diltiazem)
 Avoid in pts. receiving oral B-blockers
 Concurrent IV administration w/ B-blockers can cause
severe hypotension
 Cardiovascular Drugs

DIURETICS
Examples Indication
 furosemide -adjuvant therapy for
pulmonary edema in pts.
 diamox with systolic BP >90 to 100
mmHg (w/out symptoms of s
 duiril shock)
-hypertensive emergencies
-increase ICP
 DIURETICS

Precautions/Contraindications
 Dehydration
 Hypovolemia
 Hypotension
 Hypokalemia or other electrolyte imbalances
 DIURETICS

Nursing Responsibilities
 Monitor BP, I&O, wt., edema, pulse. Furosemide can
lead to profound water depletion
 Assess volume depletion; dizziness, hypotension,
tachycardia, muscle cramping.
 Take with meals
 Avoid sudden change of position.
 Monitor serum electrolyte as baseline data.
 To prevent nocturia, give thru p.o. or I.M. preparation
in the morning. Give 2nd dose in early afternoon
 Watch out for signs of hypokalemia such as muscle
weakness & cramps.
 Cardiovascular Drugs

NITRATES
Examples Indication
 Nitroglycerin (nitrosts/ -Initial antianginal for suspected
Transderm patch/ ischemic pain
nitro-ointment -For initial 24 to 48 hours in pts.
with AMI & CF, large anterior
 Isordil (Isosorbide infarction, persistent or recurrent
Dinitrate) ischemia or hypertension
 Imdur (Isosorbide
Mononitrate)
 NITRATES

Precautions/Contraindications
 With evidence of AMI, limit SBP drop to 10% if pt. is
normotensive, 30% drop if hypertensive & avoid drop
below 90mmHg
 Do not mix with other drug
 Pt. should sit or lie down when receiving the
medication
 Hypotension
 Severe bradycardia or tachycardia
 RV infarction
 Viagra w/in 24 hours
 NITRATES

Nursing Responsibilities
 Assume sitting or supine position when taking the drug to prevent
orthostatic hypotension
 Take maximum of 3 doses at 5 mins. interval
 If taken sublingual, the medication causes burning or stinging
sensation under the tongue
 Sublingual route produces onset of action w/in 1 to mins., duration of
action is 30 mins.
 Offer sips of water before giving sublingual nitrates; dryness of mouth
may inhibit absorption
 Administration of Intravenous Nitroglycerin infusion requires pump for
accurate control of medication.
 NITRATES

Nursing Responsibilities
 Instruct pt. to always carry 3 tabs. in his pocket
 Store nitroglycerin in cool, dry place, use dark colored air tight
container, maybe destroyed by heat, light or moisture
 Change of stock of nitroglycerin every 6 mos.
 Observe the side effects: headache, flushed face, dizziness, faintness,
tachycardia; these are common during first few doses of the
medication. Do not discontinue the drug
 Transderm patch is applied once a day, usually in the morning.
Retention of the skin site is necessary, usually the chest wall
Common Cardiovascular
Drugs

ANTIPLATELET /
ANTICOAGULANT /
FIBRONOLYTIC /
THROMBOLYTIC
 Antiplatelet

 Aspirin
 Ticlopidine (Ticlid)
 Clopidogrel (Plavix)
 Dyperidamole (Persantin)
 Cilostazol (Pletaal)
 IV Antiplatelet

 Glycoprotein IIb/IIIa Inhibitors

 Abciximab (Reopro)
 Tirofiban (Aggrastat)
 Anticoagulant

 Unfractional or regular heparin

 Low molecular wt. (Fraxiparine)
 Warfarin (Coumadin)
 Fibrolytics / Thrombolytics

 Streptokinase
 Tissue Plasminogen Activators (TPA IV)
 Urokinase
 Antiplatelet

Aspirin
 Blocks formation of thromboxane A2, w/c causes
platelets to aggregate, arteries to constrict. This
reduces overall AMI mortality, reinfarction,
nonfatal stroke. Administer to any person with
symptoms: pressure, heavy weight, squeezing,
particularly reperfusion candidates unless
hypersensitive to aspirin.
 Precautions/Contraindications
 Contraindicated in pts. with active ulcer or
asthma and with known hypersensitivity to
aspirin
 IV Antiplatelet

Glycoprotein IIb/IIIa Inhibitors

 These drugs inhibit the integrin glycoprotein IIb/IIIa receptor
in the membrane of platelets, inhibiting platelet
aggregation.

Precautions/Contraindications
 Active internal bleeding or bleeding disorder in past 30 days
 History of intracranial hemorrhage or other bleeding
 Surgical procedure or trauma w/in 1 mo.
 Platelet count <150,000/mm3
 Hypersensitivity & concomitant of another GP IIb/IIIa
inhibitor.
 Nursing Responsibilities

Platelet Aggregation Inhibitor

 Assess for signs & symptoms of bleeding
 Avoid straining at stool
 Do not give ASA w/ Coumadin
 ASA should be given food
 Observe for toxicity (tinnitus)
 Nursing Responsibilities

Heparin Sodium
 Assess for signs & symptoms of bleeding
 Keep Protamine sulfate available. It is the
antidote of heparin Na
 If administered SQ, do not aspirate, do not
massage to prevent hematoma formation
 Use of maximum of 2 wks.
 Nursing Responsibilities

Coumadin
 Assess for signs & symptoms of bleeding
 Keep vit. K readily available
 Monitor prothrombine time
 Minimize green leafy vegetables in the diet.
These contain vit. K
 Agent Used

in

Full Cardiac Arrest

 Oxygen

 Mechanism of Action
-Elevate arterial O2

 Indication
-chest pain due to cardiac ischemia
-hypoxemia
-cardiac arrest
 Epinephrine

 Mechanism of Action
-Increase HR & myocardial O2 requirements
- Increases automaticity
-Improves coronary & cerebral perfusion pressure
due to its peripheral vasoconstriction effects

 Indication
-Pulse less V-tach -cardiac arrest
-asystole -bronchospasm hypersensitivity
-V-fib -severe hypotension
 Epinephrine

 Dosage
-Bolus: 1 mg q 3-5 mins.
-Drip: 30 mg in 250cc D5W
 Nursing Responsibilities
-Take BP, HR
-Assess signs of shock
-Teach pt. to take pulse
-Difficulty in voiding in male pts.
-Don’t mix w/ bicarbonate
 Atropine Sulfate

 Mechanism of Action
-Parasympatholytic drug
-Enhances both sinus node automaticity &
atrioventricular conduction via its direct
vagolytic action

 Indication
-severe sinus bradycardia
-AV blocks (1st degree AV block or mobitz type)
 Atropine Sulfate

 Dosage:
-0.5 - 1 mg. Maximum of 2 – 3 mg
Nursing Responsibilities Side Effects
-Assess if pt. has - dry mouth
glaucoma, BPH -respiratory
depression
-Severe mouth -dilatation of pupil
dryness
 Anti-arrhythmic Agents
(Lidocaine)

 Mechanism of Action
-Local anesthetic
- Suppresses ventricular arrhythmias by
decreasing automaticity

 Indication
-V-tach
-cardiac arrest -V-
fib
 Anti-arrhythmic Agents
(Lidocaine)

 Dosage
-Bolus: 0.5 – 3 mg/kg.
-Drip: 2 – 4 mg/min

 Nursing Responsibilities
-Watch out for signs of lidocaine induced
neurological toxicity
-Correct K level first to reach its maximum

effect
-Record weight
 Sodium Bicarbonate

 Mechanism of Action
-Clinically widely used buffer agent
-Dissociates to Na and HCO3 ions
-In the presence of hydrogen ions, these are converted to
carbonic acid & hence to CO2 which is transported to &
excreted by the lungs

 Indication
-metabolic acidosis -prolonged cardiac arrest
-hyperkalemia

 Nursing Responsibilities
-Determine ABG esp pH & CO2 content
-Ensure IV line is patent, extravasations of tissue may cause
slouching or necrosis
-Not to be mix w/ Dopamine
 Morphine Sulfate

 Mechanism of Action
-Increases venous capacitance & reduces systemic
vascular resistance, relieving pulmonary congestion
-Reduces intramyocardial wall tension which decreases
myocardial O2 requirements

 Indication
-AMI
-acute cardiogenic pulmonary edema

 Dosage
-Bolus: 1 - 3 mg IVP 1-5 mins.
Inotropic Agents

Norepinephrine
Dopamine
Dobutamine
Lanoxin
 Norepinephrine

 Mechanism of Action
-Naturally occurring catecholamine
-Potent peripheral vasoconstrictor (alpha receptor stimulating
agent)
resulting to increase in BP
-Increases myocardial contractility (beta receptor stimulating
agent)

 Indication
-hypotension
-cardiogenic shock

 Nursing Responsibilities
-Monitor BP closely
-Titrate gradually to avoid abrupt & severe hypotension
-Infuse through a central line to prevent extravasations &
necrosis
 Dopamine

 Mechanism of Action
-Chemical precursor of norepinephrine that stimulates dopaminergic, beta &
alpha adrenergic
-Low dose (1-5) renal vasodilation. Causes renal, mesenteric & cerebrovascular
dilation. Tends to produce an increase in renal output.
-Moderate dose (5-10) cardiac dose. Enhances myocardial contractility,
increased cardiac output & rise in BP
-High dose (10-20) vasopressor dose Produces peripheral arterial & venous
vasoconstriction

 Indication
-hypovolemia -septic shock
-hypotension w/ symptomatic bradycardia

 Nursing Responsibilities
-Monitor HR, BP
-Taper gradually to avoid acute hypotension
-Watch out nausea & vomiting
-Do not mix w/ NaHCO3
 Dobutamine

 Mechanism of Action
-Improves myocardial contractility, increases CO,
decreases ventricular filling pressure, decreases
total systemic & pulmonary vascular resistance
-Increases renal blood flow due to increased CO

 Indication
-tx of CHF -AMI
-Cardiogenic & septic chock

 Nursing Responsibilities
-Monitor for tachycardia & presence of arrhythmia
-Monitor BP
 Lanoxin

 Mechanism of Action
-Increases myocardial contractility
-Controls ventricular response to atrial flutter and fibrillation

 Indication
-CHF, chronic
-SVT, A-fib, A flutter

 Nursing Responsibilities
-Monitor severe bradycardia
-Watch out rhythm & EKG changes, ventricular disrrhythmias
&
AV blocks
-Monitor for renal dysfunction & electrolytes imbalances.
- Seeing yellow spots and colored vision are common
symptoms of digitalis toxicity
 signs of digitalis toxicity

 Visual disturbances such as seeing yellow

spots
 Seeing yellow spots and colored vision are
common symptoms of digitalis toxicity
Thank you!!!!
God Bless!!!!!