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7/29/2019 SEMINAR on Drugs Used in Cardiac Disease
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Seminar on drugs used in cardiac diseases
Introduction
Cardiovascular drugs encompass a large number of prescription medications that are used to
control heart disease. It is a complicated group of drugs with many being used for multiple heart
conditions. You may also encounter patients who have one or more cardiovascular conditions
such as CHF, hypertension and an arrhythmia. These patients may be taking multiple
medications for each condition. If you look at the list of Top 200 drugs, you will find that 25% of
those drugs are cardiovascular drugs, which is another good reason to become familiar with these
drugs and how they might interact with other medications.
CLASSIFICATION OF CARDIAC USED IN CARDIAC DISEASES
1. Anti-arrhythmic agentThe arrhythmias are conceptually sirnple-dysfunctions cause abnormalities in impulse
formation and conduction in the myocardium. However, in the clinic, arrhythmias present
as a complex family of disorders that show a variety of symptoms. For example, cardiac
arrhythmias may cause the heart
to beat too slowly (sinus bradycardia) to beat too rapidly (sinus or ventricular tachycardia, atrial or ventricular premature
depolarization, atrial flutter) to respond to impulses originating from sites other than the SA node to respond to impulses traveling along accessory (extra) pathways that lead to
deviant depolarizations (A-V reentry, Wolff-Parkinson White syndrome).
In order to make sense of this large group of disorders, it is useful to organize the
arrhythmias into groups according to the anatomic site of the the abnormality-the
atria, AV node, or the ventricles.
Class of anti-arrhythmia drug
Class 1 sodium channel blocker e.g. flecanide, quinidine
Class 2 beta adrenoreceptor blocker e.g. metoprolol, propanololClass 3 sodium channel blocker e.g. amiodarone
Class 4 calcium blocker e.g. diltiazem, verapamil, nifedipine
Other Anti-arrhythmic drug e.g. adenosine, digoxin
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2. Anti-anginal drugAngina pectoris is a characteristic chest pain caused by coronary blood flow that is
insufficient to meet the oxygen demands of the myocardium. The imbalance between
oxygen delivery and utilization may result from a spasm of the vascular smooth muscle
or from obstruction of blood vessels caused by atherosclerotic lesions. Angina is
characterized by a sudden, severe pressing substernal pain radiating to the left arm.
Organic nitrates e.g. isosorbide dinitrate, nitroglycerin Beta blocker e.g. propanolol Calcium channel blocker e.g. diltiazem, verapamil, nifedipine
3. Drugs affecting blood Platelet inhibitor e.g. aspirin, ticlopidine Anticoagulant e.g. enoxaparin, warfarin, heparin. Thrombolytic agent e.g. urokinase, streptokinase Treatment of bleeding e.g. aminocaproic acid, vitamin k, tranexamic acid Treatment of anemia e.g. folic acid, cyanocobalamine, iron
4. Antihypertensive drugHypertension is defined as a sustained diastolic blood pressure greaterthan 90 mm Hg
accompanied by an elevated systolic blood pressure (>I 40 mm Hg). Hypertension results
from increased peripheral vascular smooth muscle tone, which leads to increased
arteriolar resistance and reduced capacitance of the venous system. Elevated blood
pressure is an extremely common disorder, Although hypertension may occur secondary
to other disease processes, more than 90% of patients have essential hypertension, a
disorder of unknown origin affecting the blood pressure-regulating mechanism. A family
history of hypertension increases, the likelihood that an individual will develop
hypertensive disease. Essential hypertension occurs four times more frequently among
blacks than among whites, and it occurs more often aniong middle-aged males than
among middle-aged females. Environmental factors such as a stressful lifestyle, high
dietary intake of sodium, obesity, and smoking all further predispose an individual to the
occurrence of hypertension. Diuretics e.g. hydrochlorothiazide, frusemide, spirolactone Alpha blocker e.g. doxazosin, prazosin Beta blocker e.g. metoprolol, propanolol ACE inhibitor e.g. catopril, analapril, ramipril Angiotensin II antagonist e.g losartan Calcium channel blocker e.g. diltiazem, verapamil, nifedipine, amlodipine
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Vasodilators e.g sodium nitropruside
5. Inotropic agents Positive inotropic agent e.g. dobutamine Negative inotropic agent e.g. dopaamine
6. Cardiac glycosides e.g. digoxin, digitoxin7. Hypolipidemic agents e.g. statin
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FLECANIDE
Group of drugantiarrhythmic agent, sodium channel blocker
Pharmacological name- flecanide
Trade nameAlmarytm, Apocard, Ecrinal, Flcaine
Dose of drug1-2.5mg/kg/body wt
Route of drug - oral
Action - Flecainide is is a class I C antiarrhythmic agent, Flecainide has local anesthetic activity
and belongs to the membrane stabilizing (Class 1) group of antiarrhythmic agents; it has
electrophysiologic effects characteristic of the IC class of antiarrhythmics, ntiarrhythmic actions
are mediated through effects on sodium channels in Purkinje fibers. Flecainide is a sodium
channel blocker, binding to voltage gated sodium channels. It stabilizes the neuronal membraneby inhibiting the ionic fluxes required for the initiation and conduction of impulses. Ventricular
excitability is depressed and the stimulation threshold of the ventricle is increased during
diastole.
Indication: prevention of paroxysmal supraventricular tachycardias (PSVT), including
atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia and other
supraventricular tachycardias of unspecified mechanism associated with disablin
Contraindication: hypersensitivity, cardiogenic shock, CHF, pre-existing sinus node
dysfunction or 2nd
or 3rd
degree heart block (without a pacemaker), renal impairment, pregnancy,
lactation or children.
Adverse effect
Nausea and vomiting, convulsions, hypotension, bradycardia, syncope, extreme wideningof the QRS complex, widening of the QT interval, widening of the PR interval,
ventricular tachycardia, AV nodal block, asystole, bundle branch block, cardiac failure,
and cardiac arrest.
CNSdizziness, anxiety, fatigue, headache, mental depressin. tremor, Blurred vision, Chest pain, CHF
Role and responsibility of nurse
Monitor ECG may cause QRS widening, PR prolongation, QT prolongation Monitor intake and output, daily weigh the patient Asses for signs of CHF Monitor Blood pressure and pulse throughout the therapy
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QUINIDINE
Group of drug - antiarrhythmic agent (class 1 A), sodium channel blocker
Pharmacological nameQuinidine
Dose of drug
PO (Adults): 324972mg q 812 hr. IV (Adults): 200400 mg given at a rate
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METOPROLOL
Group of drug - antiarrhythmic agent, beta adrenoreceptor blocker
Pharmacological name - metoprolol
Trade name - tartarate 25, 50, 100mg
Dose of drug
PO (Adults):
- Antihypertensive/antianginal25100 mg/day as a single dose initially or 2divided doses, 450 mg/day (for angina, give in divided doses)
- MI2550 mg (starting 15 min after last IV dose) q 6 hr for 48 hr, then 100 mgtwice daily for a minimum of 3 month.
- Heartfailure12.525 mg once daily- Migraneprevention50100 mg 24 times dailyIV (Adults):
- MI5 mg q 2 min for 3 doses, followed by oral dosingAction
Blocks stimulation of beta1(myocardial)-adrenzinergic receptors. Does not usually affect beta2
(pulmonary, vascular, uterine) adrenergic receptor sites. decreases blood pressure and heart rate.
De creased frequency of attacks of angina pectoris. Decreased rate of cardiovascular mortalityand hospitalization in patients with heart failure
Indication - Hypertension. Angina pectoris. Prevention of MI, heart failure due to ischemic,
ventricular arrhythmias/tachycardia, Migraine, tremors, drug induced akathesia, anxiety
Contraindication - Uncompensated CHF, Pulmonary edema, Cardiogenic shock, Bradycardia or
heart block
Adverse effect
-
CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness,insomnia,memory loss, mental status changes, nervousness, nightmares.
- EENT: blurred vision, stuffy nose.- Resp: bronchospasm, wheezing- CV: bradycardia, CHF, pulmonary edema, hypotension, peripheral
vasoconstriction.
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- GI: constipation, diarrhea, drug induced hepatitis, drymouth, flatulence,gastricpain, heartburn.
- GU: erectile dysfunction- MS: arthralgia, back pain, joint pain
Role and responsibility of nurse
Monitor vital sign and ECG every after parenteral administration, if HR
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- Monitor intake and output ratios and daily weight. Assess patient routinely forevidence of fluid overload (peripheral edema, dyspnoea, weight gain jugular
venous distension
- Informthe patient abrupt withdrawal can cause life threatening arrhythmias, HT,myocardial ischemia.
- During intravenous administration should be diluted in 50 ml of NaCL 0.9% orD5% and infuse over 10-15 min
AMIODARONE
Group of drug - antiarrhythmic class III
Pharmacological nameAmiodarone
Trade name - cardarone, pacerone
Dose of drug: 1ml contains 50 mg amiodarne
Oral
Adults 800-1600mg/day in 1-2 doses for 1-3 wk, then 600-800mg/day in 1-2 doses for 1month then 400mg maintenance dose
Children 10mg/kg/day for 10 days, then 5 mg/day for several weeks then 2.5 mg/kg/daymaintenance dose.
Intravenous
Adults: 150 mg over 10 min, followed by 360 mg over the next 6 hr and then 540 mgover the next 18 hr. Continuous infusion at 0.5 mg/min until oral therapy is initiated, if
arrhythmia recurs, a small loading infusion of 150 mg over 1 0 min should begiven in
addittion,the rate of the maintenance infusion may be increased. Conversion to initial oral
therapyIfdu ration of IV infusion was 3w k.
oral dose should be 400 mg/ day.
ACLSguidelines for pulseless ventricular fibrillation or ventricular tachycardia 5 mg/kgas bolus.
Supraventricular TachycardiaOral
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Adults 600-800mg/day for 1 wk or until desired response occurs or side effectsdevelop,then decrease to 400 mg/day for 3 wk. then maintenance dose of 200400
mg/day.
Children 10 mg/kg/day for 10 days or until response or side effects occur, then 5mg/kg/day for several weeks, then decreased to 2.5 mg/kg/day lowest effective
maintenance dose.
Action
Prolongs action potential and refractory period. Inhibits adrenergic stimulation. Slows the
sinusrate,increases PR and QT intervals, and decreases peripheral vascular resistance
(vasodilation). Ths suppresses arrhythmia
Indication
Life threatening ventricular arrhythmia, Supraventricular tachycardia, ACLS
Contraindication
Cardiogenic shock, SA node dysfunction, 2nd
and 3rd
degree AV block, syncope,
hypersensitivity.
Adverse effect
CNS: confusional states, disorientation, hallucinations, fatigue, malaise, dizziness,headache, insomnia.
EENT: corneal micro-deposits Resp: adult respiratory distress syndrome (ards), pulmonary fibrosis, pulmonary toxicity. CV: CHF, worsening of arrhythmias, bradvcardia, hypotension. GI: liver function abnormalities, anorexia, constipation, nausea, vomiting, Integumentary : toxic epidermal necrolysis (rare). photosensitivitv , blue discoloration. Endo: hvpothvroidism, Hvperthvroidisrn. Neuro: ataxia, involuntary movement, paraesthesia, peripheral neuropath, poor
coordination, tremor.
Role and responsibility of nurse
Monitor ECG continuously during IV therapy or initiation of oral therapy. Monitor heart rate and rhythm Asses for signs of pulmonary toxicity (rales, crackles, decreased breath sound, pleuritic
friction rub)
Asses for sign and symptoms of ARDS (dyspnoea, tachycardia, rales or crackles) Monitor liver and thyroid function before administration For continuous infusion dilute 900mg in 500ml of D5%
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DILTIAZEM
Group of drugantiarrhythmia class IV, antihypertensive, antianginals, calcium channel
blocker.
Pharmacological name - diltiazem
Trade namecardiazem, taztia XT
Dose of drug
Oral: 30-120 mg 3-4 times daily or 60-120 mg twice daily or 180-240 mg once a day(max 360mg/day)
Intravenous: 0.25 mg/kg repeat in 15 min with 0.35mg/kgContinuous infusion at 10 mg/hr for 24 hr (5-15mg/hr)
Action
Inhibits transport of calcium into myocardial and vascular smooth muscle cells, resulting in
inhibition of excitation contraction coupling and subsequent contraction, results in decreased
blood pressure, coronary vasodilatation and suppresses arrhythmias
Indication
Hypertension, Angina pectoris and vasospastic angina, Supraventricular tachycardia and rapid
ventricular rates in atrial flutter or fibrillation.
Contraindication
Hypersensitvity, 2nd or 3rd degree AV block, recent MI, pulmonary congestion, blood pressure
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Monitor blood pressure arid pulse prior to therapy, during dose titration, and periodicallyduring therapy.
Monitor ECG during prolonged therapy, may cause prolonged PR interval, asses forbradycardia
Monitor intake and output ratios and daily weight Assess for signs of CHF (peripheraledema, rales/crackles, dvspnoea, weight gain, jugular venous distention).
Monitor frequency of Prescription refills to determine adherence. Patients receiving digoxin concurrently with calcium channel blockers should have
routine serum digoxin levels checked and bemonitored for signs of digoxin toxicity.
Do not open, crush, break or chew sustained capsule or tablet
VERAPAMIL
Group of drug: antianginals, antiarrhythmiac agents class IV, antihypertensive, vascular
headache suppressants, calcium channel blocker
Pharmacological name: verapamil
Trade name : apo-verap, isoptin, verelan
Dose of drug
Route/Dosage
P0 (Adults): 80-1 20 mg 3 times daily, increased as needed. Patients with poorventricular function, hepatic impairment, orgeriatric patients 40 mg 3 times daily initially.
Extended-releasepreparations 120-240 mg/day as a single dose; may he increased as
needed (range 240-480 mg/day).
P0 (Children up to 15 yr): 4-8 mg/kg/day in divided doses. IV (Adults): 5-10mg (75-150 mcg/kg); may repeat with 10mg (150 mcg/kg) after 15-30
min.
IV (Children 1-15 yr): 2-5mg (l00-300 mcg/kg); may repeat after 30 min (initial dosenot to exceed 5 mg: repeat dose not to exceed 10mg).
IV (Children
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Inhibits the transport of calcium into myocardial and vascular smooth muscle cells,resulting in inhibition of excitation-contraction coupling and subsequent contraction.
Decreases SA node and AV node conduction and prolongs AV node refractory period in
conduction tissue.
Systemic vasodilatation, resulting in decreased blood pressure. Coronary vasodilatation resulting in decreased frequency and severity of attacks of
angina.
Suppression of ventricular tachycarrhythmias.Indication
Management of hypertension, angina pectoris, vasospastic angina (prinzmetals). Management of Supraventricular arrhythmias, rapid ventricular arrhythmia, rapid
ventricular rates in atrial flutter or fibrillation.
Prevention of migraine, management of cardiomyopathy.Contraindication
Hypersensitivity, sick sinus syndrome, 2nd or 3rd degree AV block, BP
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NIFEDIPINE
Group of drug:- antianginals, antihypertensive, calcium channel blocker.
Pharmacological name:- Nifedipine
Trade name:- adalat XL, procardia
Dose of drug
PO (adults):- 10-30mg 3 times daily (not to exceed 180mg/day) or 30-90 mg once daily as
sustained release form (CC, XL) (not to exceed 90-120 mg/day)
Action
Inhibits the transport of calcium into myocardial and vascular smooth muscle cells,resulting in inhibition of excitation-contraction coupling and subsequent contraction.
Systemic vasodilatation, resulting in decreased blood pressure. Coronary vasodilatation resulting in decreased frequency and severity of attacks of
angina
Indication
Management of hypertension(extended release only), angina pectoris, vasospastic angina. Prevention of migraine headache Management of CHF or cardiomyopathy.
Contraindication
Hypersensitivity, sick sinus syndrome, 2nd or 3rd degree AV block, BP
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Role and responsibility of nurse
Monitor blood pressure and pulse before and after therapy Monitor ECG during prolonged therapy (causes prolonged PR interval and bradycardia) Weigh daily, monitor intake output Asses for signs of CHF (peripheral edema, rales/crackles, dyspnoea, dspnoea, weight
gain, jugular vein distension)
In geriatric patients asses fall risks and institution fall prevention strategies. Do not open, crush, break or chew extended release tablets
ADENOSINE
Group of drug:- antiarrhythmic
Pharmacological name:- adenosine
Trade name:- adenocard, adenoscan
Dose of drug:-
IV (adult and children>50kg):-
Antiarrhythmic- 6mg by rapid bolus; if no result repeat 1-2 min later as 12 mg rapidbolus (dose can be repeated not more than 12mg).
Diagnostic:- 140 mcg/kg/min for 6 min (0.84m/kg) IV (children
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IV children 2-5yr: - 25-35mcg/kg given as 50% of dose initially & 1/4 th of initial dose ineach subsequent dose at 6-12 hrs interval
IV children 1-24month: - 30-50mcg/kg given as 50% of dose initially & 1/4th of initialdose in each subsequent dose at 6-12 hrs interval
IV infant fullterm: - 20-30mcg/kg given as 50% of dose initially & 1/4 th of initial dosein each subsequent dose at 6-12 hrs interval
IV infant premature: - 15-25mcg/kg given as 50% of dose initially & 1/4 th of initialdose in each subsequent dose at 6-12 hrs interval.
PO adults: - 0.75-1.5mg given as 50% of dose initially & 1/4 th of initial dose in eachsubsequent dose at 6-12 hrs interval. Maintenance dose 0.125-0.5mg/day as tablets or
0.35-0.5 mg/day as gelatin capsule, depending on patients lean body weight, renal
function & serum level.
PO children >10yr: - 10-15mcg/kg given as 50% of dose initially & 1/4th of initial dosein each subsequent dose at 6-12 hrs interval. Maintenance dose 2.5-5mcg/kg given as a
single dose.
PO children 5-10yr: - 20-35mcg/kg given as 50% of dose initially & 1/4 th of initial dosein each subsequent dose at 6-12 hrs interval. Maintenance dose 5-10mcg/kg given in
daily 2 divided doses.
PO children 2-5yr: - 30-40mcg/kg given as 50% of dose initially & 1/4th of initial dosein each subsequent dose at 6-12 hrs interval. Maintenance dose 7.5-10mcg/kg given in
daily 2 divided doses.
PO children 1-24month: - 35-60mcg/kg given as 50% of dose initially & 1/4th
of initialdose in each subsequent dose at 6-12 hrs interval. Maintenance dose 10-15mcg/kg given
in daily 2 divided doses.
PO infant fullterm: - 25-35mcg/kg given as 50% of dose initially & 1/4 th of initial dosein each subsequent dose at 6-12 hrs interval. Maintenance dose 6-10mcg/kg given in
daily 2 divided doses.
PO infant premature: - 20-30mcg/kg given as 50% of dose initially & 1/4 th of initialdose in each subsequent dose at 6-12 hrs interval. Maintenance dose 5-7.5mcg/kg given
in daily 2 divided doses.
Availability:-
Tablets:- 0.125mg, 0.25mg. Capsule:- 0.05mg, 0.1mg, 0.2mg Injection:- 0.25mg/ml
Action
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Increases the force of myocardial contraction. Prolongs refractory period of the AV node.
Decreases conduction through the SA & AV nodes. Increases cardiac output (positive inotropic
effect) and slowing of heart rate (negative inotrope).
Indication
CHF, tachycardia, Atrial fibrillation and atrial flutter, paraoxysmal atrial tachycardia.
Contraindication
Hypersensitivity, uncontrolled ventricular arrhythmias, AV block Idiopathic hypertrophic subaortic stenosis, constrictive pericarditis, Alcohol intolerance
Adverse effect
CNS:-fatigue, headache, weakness.
CVS:- arrhythmia, bradycardia, ECG changes, AV block, SA block. GI:- anorexia, nausea, vomiting, diarrhea. Endo:- gynecomastia Thrombocytopenia, digoxin toxicity with electrolyte imbalance.
Role and responsibility of nurse
Monitor apical pulse for 1 full minute before administration. Withhold dose and notifyphysician if pulse rate is
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Contraindication
Hypersensitivity Severe anemia Pericardial tamponade Constrictive pericarditis Alcohol intolerance Cerebral hemorrhages
Adverse effect
Dizziness, headache, hypotension, tachycardia, syncope, abdominal pain, alcohol intoxication(in
case of large IV dose)
Role and responsibility of nurse
Assess location, duration, intensity and precipitating factors of angina pain. Monitor blood pressure and pulse during the regimen Sustained release capsules should be swallowed whole, do not crush, break or chew. Avoid drinking, eating or smoking. Doses must be diluted and administered as an infusion. Standard infusion sets made up of
polyvinyl chloride may absorb 80% of nitroglycerin so glass bottles and special tubing
should be used.
In case of lingual spray lift the tongue and spray under the tongue.
TICLOPIDINE
Group of drug:- antiplatelet agent, platelet aggregation factor
Pharmacological name:-ticlopidine
Dose of drug
PO (adult):- 250mg twice a day with food
Availability: - 250mg
Action
Inhibitsplatelet aggregation by altering the function of platelet membranes. Prolongs bleeding
time & decreases incidence of stroke in high risk patients
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It interferes with the hepatic synthesis of vitamin K dependent clotting factors (2, 7, 9 and 10),
and prevents the thrombus formation and thus decreases the density of blood. It decreases risk of
subsequent MI
Indication
Prophylaxis and treatment of venous thrombus, pulmonary thrombus, pulmonaryembolism, atrial fibrillation with embolization.
Prevention of thrombus and embolization after prosthetic valve placement.Contraindication
Uncontrolled bleeding, active ulcer disease, Severe liver or kidney disease, Uncontrolled hpertension
Adverse effect
Uncontrolled bleeding(internal or external), cramps, nausea, dermal necrosis, fever.Role and responsibility of nurse
Asses the patient for signs of bleeding and hemorrhage (gums, nose, tarry black stool,hematuria, hypotension)
Monitor Prothrombin time or INR before the drug therapy and 3-5 days after therapy toevaluate the required dose
Liver function should be monitored before and after therapy.
Instruct the patient to avoid use of sharp metals or articles, protect him from injury toavoid hemorrhage, use of soft bristle tooth brush, use electric razor for shaving
Avoid IM injections Instruct the patient to avoid alcohol, NSAIDs intake during the therapy
LOW MOLECULAR WEIGHT HEPARIN
Group of drug: anticoagulant, antithrombotic, low molecular weight heparin
Pharmacological name: enoxaparin, dalteparin
Trade name: fragmin, lovenox
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Instruct the patient to avoid use of sharp metals or articles, protect him from injury toavoid hemorrhage, use of soft bristle tooth brush, use electric razor for shaving
Avoid IM injections Instruct the patient to avoid alcohol, NSAIDs intake during the therapy Observe subcutenous injection site for hematomas, ecchymosis or inflammation During administering subcutenous injection use alternate sites (ant. Abdominal wall,
upper thigh or buttocks)
UROKINASE STREPTOKINASE
Group of drug: thrombolytic agent, plasminogen activator
Pharmacological name: urokinase, streptokinase
Dose of drug
Streptokinase
IV (adults): 1.5 million units is given as a continous infusion over 60 min. Intracoronary: 20,000 unit bolus followed by 2000-4000 units/ min infusion for 30-90
min
Urokinase
IV (adults): 4400 nits/kg loading dose, followed by 4400 unit/kg/hr for 12 hrAction
Convert plasminogen to plasma, which is then able to degrade fibrin present in clots. Urokinase
directly activates plasminogen, streptokinase combines plasminogento form activator or
complexes, which then converts plasminogen into plasmin. Which results in lysis of thrombi
with preservation or improvement of ventricular function (decreases the rish of CHF or death).
Indication
Urokinase: acute massive pulmonary emboli. Streptokinase: acute arterial thrombi(MI)
Contraindication
Active internal bledding
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PO (adults): 20-40mg q6-8hr until desired response in hypertension In case of CCF max. 2.5mg/day Hypercalcemia: 120mg/day in 2-3 doses
PO (childrens): 2mg/kg/day max. 6mg/kg/day IV (adults): 20-40mg/day and can be repeated, for continous infusion bolus- 0.1mg/kg
followed by 0.1-0.4mg/kg/hr
Action:
Inhibits the absorption of sodium and chloride from loop of henle and distal renal tubule,
increases renal excretion of water,sodium, chloride magnesium, potassium, and calcium. Inturn
causes diuresis and lowers down the blood pressure
Indication
Oedemadue to heart failure, hepatic impairment or renal disease Hypertension
Contraindication
Hypersensitivity with thiazide or sulfonamides may cause hepatic coma or anuria Some products contain alcohol and should be avoided in patient with alcohol intolerance
Adverse effect
Dehydration and Electrolyte imbalance: Hypokalaemia, dehydration, hypercalcemia,hypomagnesia
Thrombocytopenia, hyperuricemia Dizziness, weakness, headache Hypotension, cramping, hepatitis, excessive urination.
Role and responsibility of nurse
Monitor blood pressure, intake output Monitor the fluid stats of the patient Monitor the patient for tinnitus or hearing loss Daily weigh the patient Investigate serum electrolyte and monitor the behavior of the patient (may cause increase
glucose level in diabetic patient, sr. bilirubin)
Administer in morning to prevent disruption of sleep cycle.
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SPIROLACTONE
Group of drug: spatassium sparing diuretic
Pharmacological name: Spirolactone
Trade name: novospartin, aldactone
Dose of drug
PO (Adults):HTN510mg/day (up to 20mg) PO (Adults):Edema25200 mg/day in 12 divided doses Diagnosis of primary hyperaldosteronism- 100400 mg/day in 12 divided dose. CHF: 12.525 mg/day (unlabeled use)
Action
Inhibition of sodium reabsorption in the kidney while saving potassiumand hydrogen ions
(spironolactone achieves this effect by antagonizing aldosterone receptors). Weak diuretic and
antihypertensive response wwhen compared with other diuretics but conserves potassium.
Indication
To counteract potassium loss caused due to other diuretics Primary aldosteronism Management of CCF
Contraindication
Hypersensitivity Hyperkalaemia Anuria, acute renal insufficiency (sr. creat >2.5mg/dl)
Adverse effect
Clumsiness, headache Hperkalemia, hyponatremia
Erectile dysfunction Increases hypotension with ingestion of alcohol
Role and responsibility of nurse
Monitor blood pressure, intake output Daily weigh the patient
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Monitor for signs of hyperkalaemia weakness, fatigue, paraesthesia, dyspnea, cardiacarrhythmias
Monitor sr. potassium level before and after therapy
ACE INHIBITOR
Group of drug: ACE INHIBITOR
Pharmacological name: enalapril, ramipril, captopril
Trade name: vasotec, monopril, altace
Dose of drug
Captopril: PO (Adults): Hypertension12.525mg 2-3 times daily, may be increased at 12
wk intervals up to 150 mg 3 times daily (begin with 6.2512.5 mg 23 times daily in patients
receiving diuretics) (maximum dose = 450 mg/day). CHF25 mg 3 times daily (6.2512.5 mg,
3 times daily. Post-MI6.25-mg test dose, followed by 12.5 mg 3 times daily, may be increased
up to 50 mg 3 times daily.
Enalapril: PO (Adults): Hypertension2.55 mg once daily, increase as required up to 40
mg/day in12 divided doses (initiate therapy at 2.5mgonce daily in patients receiving diuretics).
CHF2.5 mg 12 times daily, titrated up to target dose of 10mg twice daily; begin with 2.5 mg
once daily in patients with hyponatremia (serum sodium
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Hypersensitivity Previous angioedema caused by ACE inhibitors Womans with child bearing
Adverse effect
Cough, taste disturbances, GI disturbances Hypotension Angioedemaproteinuria, renal dysfunction
Role and responsibility of nurse
Monitor blood pressure Asses for signs of angioedema (dyspnea, facial swelling) Monitor weight and resolution of fluid overload Administer empt stomach 1 hr before meal to prevent GI disturbances
DOBUTAMINE
Group of drug: inotropic, adrenergic
Trade name: dobutrex
Dose of drug
IV (Adults and Children): Start with low infusion rates (0.51 mcg/kg/min), titrated at intervals
of a few minutes, guided by the patients response (range 220 mcg/kg/min, up to 40
mcg/kg/min)
Action
Dobutamine (Dobutrex) produces inotropic effects by stimulating myocardial beta receptors,
increasing the strength of myocardial activity and improving cardiac output. Myocardial alpha-
adrenergic receptors are also stimulated, resulting in decreased pulmonary and systemic vascular
resistance (decreased afterload). Dobutamine enhances the strength of cardiac contraction,
improving stroke volume ejection and overall cardiac output without significant increased heartrate.
Indication: cardiac decompensation caused by heart disease or surgical procedures
Contraindication:
Hypersensitivity to dobutamine
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Idiopathic hypertrophic subaortic stenosisAdverse effect
Shortness of breath Hpetension Premature ventricular contracture Angina Palpitations
Role and responsibility of nurse
Monitor blood pressure, heart rate, ECG, cardiac output, urinary output Palpate peripheral pulses and temperature of extremities (vasodilation can cause oedema
and retention)
Vials must be diluted before use Dilute 2501000 mg in 250500 ml of D5W, 0.9%NaCl, 0.45% NaCl, D5/0.45%NaCl, D5/0.9% NaCl.
Monitor electrolytes Monitor for hpokalaemia (weakness, faigue, U wave in ECG)
DOPAMINE
Group of drug: inotropic, vasopressor, adrenergic
Pharmacological name: dopamine
Dose of drug
Small doses (0.53 mcg/kg/min) stimulate dopaminergic receptors, producing renalvasodilation.
Larger doses (210 mcg/kg/min) stimulate dopaminergic and beta1-adrenergicreceptors, producing cardiac stimulation and renal vasodilation.
Doses greater than 10 mcg/kg/min stimulate alpha-adrenergic receptors and may causerenal vasoconstriction.
Action
Dopamine (Intropin) is a sympathomimetic agent that has varying vasoactive effects depending
on the dosage. It increases cardiac otput, increases blood pressure and improves renal blood
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SUMMARY
Till now we have seen about the classification of cardiac drugs and subtypes with examples
Conclusion
Though cardiac drugs are the ones which are extensively used, but as a nurse while administering
and prescribing this drugs one must remember the the action indication side effect and necessary
observations otherwise this life saving drugs can be fatal if not admininstered or monitored at
right time, right place.
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Group of drug
Pharmacological name
Trade name
Dose of drug
Route of drug
Action
Indication
Contraindication
Adverse effect
Role and responsibility of nurse
Recommended