Cardiac Drugs
Cardiac Drugs
Cardiac Drugs
Pharm.
The
heart is a large muscular organ which constantly pushes oxygen-rich blood to the brain and
extremities and transports oxygen-poor blood from the brain and extremities to the lungs to
gain oxygen. Blood comes into the right atrium from the body, moves into the right ventricle
and is pushed into the pulmonary arteries in the lungs. After picking up oxygen, the blood
travels back to the heart through the pulmonary veins into the left atrium, to the left
ventricle and out to the body's tissues through the aorta.
Cardiac drugs
Cardiac glycoside
Cardiac glycosides are the most effective drugs for treatment of C.H.F.
They increase myocardial contractions, which will increase blood supply to all
organs including the kidneys therefore causing diuresis, which will decrease
the edema.
They are used to treat cardiac arrhythmia because they decrease heart rate.
Mechanism of Action:
They increase the force of myocardial contractions (positive inotropic).
It increases the contractility of the heart muscle by minimizing the movement of Na+and K+ions and
increasing the release of Ca++ions in the myocardial cells.
It decreases the heart rate due to increase in parasympathetic nervous system and decrease in the
sympathetic tone.
The initial dose is the larger dose (the loading or digitalizing dose), the subsequent doses are referred
to as (Maintenance doses).
Results:
Coronary dilatation.
Indications:
Contraindication:
1. Hypersensitivity.
3. Given with caution for elderly and people who have kidney failure.
Side effects:
1. They are extremely toxic and may cause death.
2. There is a narrow margin of safety between the therapeutic dose and the toxic dose.
3. Could cause overdose by cumulative effects of the drug, so frequent assessment of the serum level is
essential.
4. May cause cardiac arrhythmia such as bradycardia (below than 60 beat/minute), ventricular
fibrillation (which may lead to cardiac arrest and death), and Bigeminal rhythm.
5. Nausea, vomiting, and diarrhea.
Note:
Patients suffering from digitalis intoxication should be admitted to the ICU for continuous monitoring
of ECG. Administration of digitalis should be halted.
If serum potassium is below normal, administer K+salts and give antiarrhythmic drugs as Lidocain as
ordered by Dr.
Drug interactions:
2. Fursemide (Lasix): it increase K+loss and increase the chance for digitalis toxicity.
1. K+loss (hypokalemia) which results from: diuretics, NPO, gastric suction, and poor K+intake.
2. Pathological conditions;
a. Liver disease: they decrease metabolism and therefore increase digitalis level.
b. Kidney disease: they decrease the excretion of drug and therefore increase digitalis levels.
Nursing considerations:
Check doctor’s order, medication record and bottle label accurately.
Teach client if heart rate is less than 60/minute to hold the medication and see the doctor.
Drugs:
1. Digitoxin: crystodigin
2. Digoxin: Lanoxin
Dose: digitalization dose = 0.4 – 0.6 mg followed by 0.05 – 0.35 mg once or twice daily.
Note: cardiac arrest can be expected if an adult ingests 10 mg or if a child ingests 4 mg.
Coronary vasodilators
Antianginal drugs
Angina pectoris: is a clinical syndrome characterized by paroxysm ofpain in the anterior chest caused
by insufficient coronary blood flow and/or inadequate oxygen supply to the myocardial muscle.
Causes: (1) Atherosclerosis. (2) Vasospasim.
1. Nitrates/nitrites.
Nitrates/nitrites:
- Nitrates/nitrites - Action: direct relaxation of blood vessels and smooth muscles vasodilatation O2
requirements.
- Relaxation of smooth muscles of coronary arteries coronary vasodilatation blood supply to the
myocardium.
Objectives of treatment:
Indications:
Contraindications:
2. Severe anemia.
2. Hypotension.
3. Head trauma.
4. Cerebral hemorrhage.
Side effects:
Nursing considerations:
3. If anginal pain is not relieved in 5 minutes by first sublingual tablet, to take up to 2 more tablets at 5
minutes interval. If pain has not subsided 5 minutes after the 3rd tablet, client should be taken to the
emergency room as this case could be an infarction (MI) and not angina.
4. Take sublingual tablets 5-15 minutes prior to any situation likely to cause anginal pain such as
climbing stairs.
Isosorbide dinitrate:
- Uses:
- Esophageal spasm.
- Dosage:
-Mechanism of Action: for contraction of cardiac and smooth muscle to occur, extracellular calcium
must move into the cell through openings called calcium channels.
These agents inhibit the influx of calcium through the cell membrane resulting in a depression of
automatically and conduction velocity in both smooth and cardiac muscles leading to:
1. Myocardial contractility.
Nifedipine: Adalat
- Side effects: pulmonary and peripheral edema, MI, hypotension, dizziness, lightheadedness,
palpitation, headache, muscle cramps.
- In hypertensive emergencies: 10-20 mg given orally or sublingually by puncturing the capsule and
squeezing contents under the tongue.
Amlodipine besylate
Trade name: Amicore
Dose: Initially, 2.5 to 5 mg P.O. daily. Dosage adjusted according to patient response and tolerance.
Maximum daily dose is 10 mg
Adverse reactions
Respiratory: dyspnea.
Use cautiously in patients receiving other peripheral vasodilators, especially those with severe aortic
stenosis, and in those with heart failure.
Because drug is metabolized by the liver, use cautiously and in reduced dosage in patients with severe
hepatic disease.
Nursing considerations
Monitor blood pressure frequently during initiation of therapy. Because drug-induced vasodilation has a
gradual onset, acute hypotension is rare.
Notify doctor if signs of heart failure occur, such as swelling of hands and feet or shortness of breath.
Teach patient to continue taking drug, even when feeling better. Grapefruit juice may increase drug
level and adverse reactions. Discourage use together.
Verapamil: Ikacor
- Uses:
- P.O:
- angina pectoris.
- Essential hypertension.
- Side effects: AV block, bradycardia, headache, dizziness, abdominal cramps, blurring of vision, and
edema. .
2. Teach them how to take pulse and blood pressure. Hold the medication in case of hypotension or
bradycardia and consult the treating Dr.
- β-adrenergic receptors have been classified as beta 1 (in the cardiac muscle) and beta 2 (in
the bronchi and blood vessels).
- These drugs could be selective (working on one receptor such as β1 selective drugs
(Atenolol) or it could be nonselective (such as Propranolol)
Uses:
1. hypertension,
2. Anginal pectoris.
3. Cardiac arrhythmias.
4. Myocardial infarction.
5. Prophylaxis of migrin.
Peripheral vasodilators:
Isoxsuprine:
Mechanism of Action: Direct relaxation of vascular smooth muscles increasing peripheral blood
flow, the drug also has a cardiac stimulation and uterine relaxation effect “Alpha receptor blocking and
Beta receptor stimulation.
Uses:
2. Buerger’s disease.
3. Raynaud’s disease.
Contraindications: postpartum period, arterial bleeding.
Side effects: tachycardia, hypotension, chest pain, nausea, vomiting, rash, dizziness.
Papverine:
mechanism of Action: direct spasmolytic effect on smooth muscle and vascular system, bronchial
muscle, GI & urinary tract.
Uses:
3. Paraenteral use for: Acute MI and ngina pectoris, Pulmonary embolism, and ureteral, biliary, & GI
colic.
Side effects: Flushing of face, hypertension, tachycardia, constipation, dry mouth and throat,
headache.
Antihypertensive drugs
Hypertension: is a condition in which the mean arterial blood pressure is elevated.
Essential hypertension: could be mild, moderate, or sever and may lead to dangerous changes in
kidneys, eyes and blood vessels.
Secondary hypertension: a certain disease or condition leads to elevation of blood pressure such as
toxemia or pregnancy, acute kidney failure, etc.
Antihypertensive agents: are initiated when diastolic blood pressure is higher that 90mm/Hg.
1. Weight reduction.
2. Sodium restriction.
3. Alcohol restriction.
4. Stop smoking.
5. Exercise.
6. Behavior modification.
1. Diuretics.
2. Beta-blocking agents.
Initial therapy is continued for one month. If there is no response, combination therapy is needed.
Nursing considerations:
2. Evaluate the extent of the client’s understanding of the disease and the therapy.
Captopril:
- Captopril is a highly specific competitive inhibitor of angiotensin I converting enzyme. The enzyme is
responsible for the conversion of angiotensin I to angiotensin II which decrease BP.
Indications:
1. Hypertension.
Side effects:
Skin rash, loss of taste, neutropnea, nausea, vomiting, hypotension, proteinuria, renal failure and
hyperkalemia.
Dosage:
- If there is no response, after 1-2 weeks, increase dose to 25 mg 2-3 time per day.
Nursing considerations:
3. Obtain baseline hematological studies, liver & renal functions tests prior to beginning the treatment.
4. Determine client’s understanding of the therapy and if he/she takes other medications.
5. Observe client closely for hypotension 3 hours after the initial dose.
6. In case of hypotension, place client in supine position and give IV saline infusion.
7. Withhold potassium sparing diuretics and consult with physician (hyperkalemia may occur).
10. Explain to client that he may develop loss of taste for 2-3 months, if it persist, notify the physician.
Enalapril maleate
Class: ACE-inhibitor
Uses: Hypertension
Dose: Initially, 5 mg P.O. once daily; then adjusted based on response. Usual dosage range is 10 to 40 mg
daily as a single dose or two divided doses. Or, 1.25 mg I.V. infusion over 5 minutes q 6 hours.
Adjust-a-dose: If patient is taking diuretics or creatinine clearance is 30 ml/minute or less, initially, 2.5
mg P.O. once daily.
Side effects:
GU: decreased renal function (in patients with bilateral renal artery stenosis or heart failure).
Skin: rash.
Other: angioedema.
Drugs Interactions
Diuretics: May excessively reduce blood pressure. Use together cautiously. Insulin, oral antidiabetics:
May cause hypoglycemia, especially at start of enalapril therapy. Monitor patient closely.
Potassium-sparing diuretics, potassium supplements: May cause hyperkalemia. Avoid using together
unless hypokalemia is confirmed.
Contraindicated in patients hypersensitive to drug and in those with a history of angioedema related to
previous treatment with an ACE inhibitor.
Use cautiously in patients with renal impairment or those with aortic stenosis or hypertrophic
cardiomyopathy.
Nursing considerations
Closely monitor blood pressure response to drug.
Monitor CBC with differential counts before and during therapy. Diabetic patients, those with impaired
renal function or heart failure, and those receiving drugs that can increase potassium level may develop
hyperkalemia. Monitor potassium intake and potassium level.
Instruct patient to report breathing difficulty or swelling of face, eyes, lips, or tongue. Swelling of the
face and throat (including swelling of the larynx) may occur, especially after first dose.
Advise patient to report signs of infection, such as fever and sore throat. Inform patient that light-
headedness can occur, especially during first few days of therapy. Tell him to rise slowly to minimize this
effect and to notify doctor if symptoms develop. If he faints, he should stop taking drug and call
prescriber immediately.
Tell patient to use caution in hot weather and during exercise. Inadequate fluid intake, vomiting,
diarrhea, and excessive perspiration can lead to light-headedness and fainting.
Tell woman of childbearing age to notify doctor if pregnancy occurs. Drug will need to be stopped.
- β-adrenergic receptors have been classified as beta 1 (in the cardiac muscle) and beta 2 (in the bronchi
and blood vessels).
- These drugs could be selective (working on one receptor such as β1 selective drugs (Atenolol) or it
could be nonselective (such as Propranolol)
Uses:
1. hypertension
2. Anginal pectoris.
3. Cardiac arrhythmias.
4. Myocardial infarction.
5. Prophylaxis of migrin.
Contraindications:
Side effects:
Bradycardia, C.H.F., hypotension, cold extremities (due to peripheral vasoconstriction), edema, dyspnia,
shortness of breath, nausea, vomiting, hepatomegaly and bronchospasm.
Treating overdose:
1. Inducing vomiting, gastric lavage.
2. Artificial respiration.
3. Give atropine sulfate 0.6 mg (up to 3 mg) and glycogan for the treatment of bradycardia.
5. I.V fluids.
Nursing considerations:
1. Instruct patient/family to take blood pressure and pulse.
4. Some drugs lead to blurring of vision, so that tell patients not to engage in activities need mental
alertness.
Atenolol:
Dosage:
Initial dose is 50 mg, if there is no response, increase dose to 100 mg daily.IV in case of acute MI: give 5
mg over 5 minutes, and if there is no response, give another 5 mg after 10 minutes.
Specific nursing considerations:
For IV use, the drug may be diluted in sodium chloride, dextrose, on dextrose saline.
Valolol:
Propranolol hydrochloride
Mechanism of Action: manifests both beta1 and beta 2 adrenergic blocking activity.
Indication:
1. Angina pectoris.
2. Hypertension.
3. Cardiac arrhytmias.
4. Prophylaxis of migrin.
5. Prophylaxis of MI.
6. Pheochromocytoma
Dosage:
Tablets: initial dose of 40 mg bid, then 120-240 mg in 2-3 divided doses.
Temolol maleate:
Uses:
Clondine Hydrochloride:-
-Side effects:- Drowsiness, headache, malaise, dry mouth, bradycardia, and constipation.
- -Dosage:- Initially 0.1 mg bid ,then increased to 0.1 - 0.2 mg daily until desired response is obtained.
Methyldopa :-
-Trade name:-(Aldomin)
-Contraindications:-
1. Hypersensitivity,
3. Pregnancy.
4. Pheochromocytoma.
-Side effects:-
-Nursing considerations:-
1. Avoid activities that need mental awareness such as driving.
5. Explain to pt. that urine rarely may be turn into dark / blue color.
-Mechanism of Action:- directly affect smooth muscles vasodilation, cardiac output and finally blood
flow to the brain and kidneys.
- Contraindications:-
- Angina pectoris.
- Chronic glomerulonephritis.
- Side effects:-
-Dosage:-
-I.V, I.M :-50 mg (IV slowly) repeated as necessary. ( may decrease Bp in 5 minutes.)
1) Accurate diagnosis.
Amiodarone hydrochloride:-
Classification:- Antiarrhythmic
Mechanism of Action:- increases the duration of the myocardial cell action potential as well as alpha &
beta antiadrenergic effect.
Indications:
- Should be reserved for life threatening ventricular arrhythmias which don’t respond to other therapy.
Contraindications:
- Sensitivity.
- Sinus bradycardia
- AV block
- Thyroid dysfunction
Side effects:
- Hepatotoxicity.
Dose:
- Tabs 200 mg.
2- Lidocaine Hydrochloride:
Calss: antiarrhrythmic.
Mechanism of Action: shortens the refractory period & suppresses the automatically of ectopic foci
without affecting conduction of impulses through cardiac tissue.
Contraindications:
- Hypersensitivity
- Heart block.
Nursing considerations:
6. Obtain B.P., Pulse, Resp. rate to use as baseline data to evaluate response to treatment.
7. Drug should be given in a monitored environment.
10. If adverse reactions occur, discontinue infusion & prepare for emergency management.
3. Phenytoin
Action: acts in the motor cortex of the brain to reduce the spread of electrical discharges from the
rapidly firing epileptic foci in this area. Also activity of centers in the brain stem responsible for the tonic
phase of grand mal seizures.
Uses:
Chronic epilepsy.
Tachycardia.
Contraindications:
Hypersensitivity.
Side effects:
Drowsiness, ataxia, dizziness, measles-like rash, gingival hyperplasia, Hirsutism (excessive hair growth) ,
hypoglycemia.
3- If a pregnant woman takes this drug, tell her not to breast-feed her baby.
4. Procainamide:
Trade name: procan
Classification : antiarrhythmic
Mechanism of Action: produce a direct cardiac effect to prolong the refractory period of the heart &
depress the conduction of the cardiac impulse.
Uses:
- ventricular tachycardia.
- Atrial fibrillation.
- Digitalis intoxication.
5. Propranolol
6. Verapamil