AKANNI.

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.

 Digitoxins are plant alkaloids.

 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.

 They are primarily excreted through the kidneys.

 The initial dose is the larger dose (the loading or digitalizing dose), the subsequent doses are referred
to as (Maintenance doses).

Results:

Decrease in venous pressure.

Coronary dilatation.

Reduce heart size.

Marked diuresis and decreasing edema.

Indications:

1. Congestive heart failure (C.H.F).

2. Cardiac arrhythmia (atrial fibrillation, atrial flutter and sinus tachycardia).

 Contraindication:

1. Hypersensitivity.

2. Angina pectoris in absence of CHF.

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.

6. Headache, malaise and muscle weakness.

7. Skin rashes, blurring of vision, diplopia and white halos.

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:

1. Antacid (they decrease the effect of digitalis).

2. Fursemide (Lasix): it increase K+loss and increase the chance for digitalis toxicity.

Predisposing factors 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.

 Observe & monitor for evidence of bradycardia or arrhythmia.

 Measure intake and output accurately.

 Weigh the patient in daily basis.

 Pulse should be checked by 2 nurses

 Provide the client with food high in potassium as banana, orange.

 Monitor serum digoxin level.

 Elderly people should be assessed for early signs of toxicity.

Teach patients that bradyacadia, nausea, vomiting, diarrhea, appetite loss, and

visual disturbances could be early signs of toxicity.

Teach client if heart rate is less than 60/minute to hold the medication and see the doctor.

 Have digoxin antidote available (digoxin immune FAB).

Drugs:

1. Digitoxin: crystodigin

Class: cardiac glycoside

Uses: drug of choice for maintenance in CHF.

Dose: Digitalizing dose is 0.6 mg in 4-6 hours.Maintenance: 0.05 – 0.3 mg/day.

2. Digoxin: Lanoxin

Class: cardiac glycoside.

It is the drug of choice for CHF because of:

1. It has rapid onset.

2. It has short duration.

3. It can be administered P.O. or IV.

Dose: digitalization dose = 0.4 – 0.6 mg followed by 0.05 – 0.35 mg once or twice daily.

3. Digoxin Immune FAB: (Ovine)

Class: digoxin antidote.

Action: antibodies bind to digoxin and excreted through the kidneys.

Uses: life threatening digitalis toxicity or overdose.

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.

 There are three groups of drugs used for treatment of angina:

1. Nitrates/nitrites.

2. Beta-adrenergic blocking agents.

3. Calcium channel blocking agents.

 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.

- Relaxation of arteries and veins BP workload in the heart.

 Objectives of treatment:

1.Treatment of anginal attack and thus relief pain.

2.Prophylactic treatment to prevent or delay the occurrence of MI.

3.Prolongs intervals between attacks.

 Indications:

1. Prophylaxis and treatment of acute angina pectoris.

2. Treatment of chronic angina pectoris.

3. Treatment of hypertension associated with MI or CHF.

4. Nitroglycerin ointment for treatment of Raynaud’s disease.

 Contraindications:

1. Sensitivity to nitrates Hypotension.

2. Severe anemia.

2. Hypotension.

3. Head trauma.

4. Cerebral hemorrhage.
 Side effects:

1. Headache, syncope, dizziness.

2. Postural hypotension, transient flushing, and palpitation.

3. Topical application may lead to dermatitis.

 Drug interaction: Antihypertensive agents, Beta-adrenergic blocking agents, and calcium-channel

blocking agent (they may lead to additive hypotension).

 Dosage: there are several forms available:

1.Sublingual: Cordil 5 mg PRN.

2. PO: Isotard 20 – 40 mg twice a day.

3. Topical: available as patches or ointment.

4. Parental (IV infusion).

 Nursing considerations:

1. Medications should be taken on an empty stomach.

2. Carry sublingual tablets in a glass bottle, tightly capped.

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.

5. Take sublingual tablets while sitting to avoid postural hypotension.

 Isosorbide dinitrate:

- Present in the forms of capsules chewable, sublingual, tablets.

- Trade names: Isoral, Cordil, Isotard.

- Class: coronary vasodilator.

- Dosage forms: caps 20-40 mg, tabs 20-40 mg.

- Uses:

- Tabs for only prophylaxis of anginal pain.

- Chewable, sublingual to terminate acute attack and relieve acute pain.

- Esophageal spasm.

- Side effects: Headache, hypotension.

- Dosage:

-Sublingual: acute attack 2.5-5 mg Q 2-3 hrs.

-Oral caps/tabs: 5-20 mg Q 6 hrs.

-Extended release tabs: 20 –80 mg Q 8-12 hrs.

- Note: Isosorbide mononitrate given for patients with liver impairments.

 Calcium channel blocking agents:

-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.

2. Inhibit spasm of coronary arteries dilatation.

3. Peripheral vasodilatation peripheral resistance.

4. S. A. node automatically and conduction heart rate.

Diltazem Hcl: Cardiazem, dilatam.

- Class: calcium channel blocking agent (anti-angina, antihypertensive).

- Uses: vasospastic angina, essential hypertension.

- Contraindications: hypotension, pulmonary congestion, and MI.

- Side effects: AV block, bradycardia, CHF. Hypotension.

- Dosage: 30 mg qid before meals and at bedtime.

Nifedipine: Adalat

- Class: calcium channel blocking agent (anti-angina, antihypertensive).

- Uses: vasospastic angina, essential hypertension.

- Contraindications: hypersensitivity, lactation.

- Side effects: pulmonary and peripheral edema, MI, hypotension, dizziness, lightheadedness,
palpitation, headache, muscle cramps.

- Dosage: 10- 30 mg tid.

- 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

Class: calcium channel blocking agent (anti-angina, antihypertensive).

Use: Angina and hypertension.

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

CNS: headache, fatigue, dizziness, light-headedness, paresthesia.

CV: edema, flushing, palpitations.

GI: nausea, abdominal pain.

Musculoskeletal: muscle pain.

Respiratory: dyspnea.

Skin: rash, pruritus.

Contraindications & cautions

Contraindicated in patients hypersensitive to drug.

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

Class: calcium channel blocking agent (anti-angina, antihypertensive, antiarrhythmia).

- Uses:

- P.O:

- angina pectoris.

- arrhythmia (atrial fibrillation, and flutter).

- Essential hypertension.

- IV: supraventricular tachycardia.

- Contraindications: hypotension, cardiac shock, and MI.

- Side effects: AV block, bradycardia, headache, dizziness, abdominal cramps, blurring of vision, and
edema. .

- Dosage: Initial 80-120 mg tid then 240-480 mg /day.

 Nursing considerations for calcium channel blocking agents:

1. Discuss with the patient/family the goals of therapy.

2. Teach them how to take pulse and blood pressure. Hold the medication in case of hypotension or
bradycardia and consult the treating Dr.

3. Instruct the client to report any untoward sings as dizziness.

4. In case of postural hypotension, advise the client to change position slowly.

5. Advise client to sit down immediately if fainting occurs.

6. Calcium antagonists should be taken with meals to GI irritation.

Beta-adrenargic blocking agents:

Beta-adrenargic blocking agents:

- Action: it combines with beta-adrenargic receptors to block the response to sympathetic

nerve impulses, circulating catecholamines or adrenargic drugs.

- β-adrenergic receptors have been classified as beta 1 (in the cardiac muscle) and beta 2 (in
the bronchi and blood vessels).

- Blocking of β1 receptors HR, myocardial contractility and cardiac output BP.

- Blocking of β2 receptors airway resistance (bronchospasm) , and vasoconstriction.

- 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:

 Trade name: Vasodin.

 Class: peripheral vasodilator.

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:

1. Symptomatic treatment of cardiovascular insufficiency.

2. Buerger’s disease.

3. Raynaud’s disease.
 Contraindications: postpartum period, arterial bleeding.

 Side effects: tachycardia, hypotension, chest pain, nausea, vomiting, rash, dizziness.

 Dosage: 10-20 mg 3-4 time daily.

 Papverine:

 Class: peripheral vasodilator.

 mechanism of Action: direct spasmolytic effect on smooth muscle and vascular system, bronchial
muscle, GI & urinary tract.

 Uses:

1. Cerebral and peripheral ischemia.

2. Smooth muscle relaxant/

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.

 Treatment of hypertension includes:

1. Weight reduction.

2. Sodium restriction.

3. Alcohol restriction.

4. Stop smoking.
5. Exercise.

6. Behavior modification.

 Single drug should be considered from the following classes:

1. Diuretics.

2. Beta-blocking agents.

3. Calcium channel blocking agents.

4. Angiotesin converting enzyme inhibitors.

 Initial therapy is continued for one month. If there is no response, combination therapy is needed.

 Nursing considerations:

1. Determine base line blood pressure before starting antihypertensive treatment.

2. Evaluate the extent of the client’s understanding of the disease and the therapy.

3. Ascertain lifestyle changes.

4. Determine client’s ability to take his BP measurement.

5. Record significant changes in BP readings.

6. Advise client to adhere to low sodium diet.

7. Explain the importance of adhering to treatments plan.

8. Teach the patient/family how to measure intake and output.

1. Angiotensin-converting enzyme inhibitors (ACE-Inhibitor):

 Captopril:

Trade name: Capotin, inhabace.

Class: antihypertensive, inhibitor of angiotensin synthesis.

Mechanism of Action:

- 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.

- Reduce peripheral arterial resistance.

- Decrease aldosterone secretion which works to increase level of serum potassium.

Indications:

1. Hypertension.

2. In combination with diuretics and digitalis in the treatment of CHF.

Contraindication: Hypersensitivity, renovascular disease and pregnancy.

Side effects:

Skin rash, loss of taste, neutropnea, nausea, vomiting, hypotension, proteinuria, renal failure and
hyperkalemia.

Dosage:

Tablets: - 12.5 mg 2-3 time per day.

- If there is no response, after 1-2 weeks, increase dose to 25 mg 2-3 time per day.

 Nursing considerations:

1. In case of overdose, give normal saline to restore BP.

2. Should not be discontinued without Dr. order.

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).

8. Take captopril 1 hour before meal or on an empty stomach.

9. Report skin rash, heartburn, and chest pain to physician.

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:

CNS: headache, dizziness, fatigue, vertigo, syncope.

CV: hypotension, chest pain, angina pectoris.

GI: diarrhea, nausea, abdominal pain, vomiting.

GU: decreased renal function (in patients with bilateral renal artery stenosis or heart failure).

Hematologic: bone marrow depression.

Respiratory: dyspnea, dry, persistent, nonproductive cough.

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.

Lithium: May cause lithium toxicity. Monitor lithium level.

NSAIDs: May reduce antihypertensive effect. Monitor blood pressure.

Potassium-sparing diuretics, potassium supplements: May cause hyperkalemia. Avoid using together
unless hypokalemia is confirmed.

Contraindications & cautions

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.

2. Beta-adrenargic blocking agents:

- Mechanism of Action: it combines with beta-adrenargic receptors to block the response to
sympathetic nerve impulses, circulating catecholamines or adrenargic drugs.

- β-adrenergic receptors have been classified as beta 1 (in the cardiac muscle) and beta 2 (in the bronchi
and blood vessels).

- Blocking of β1 receptors HR, myocardial contractility and cardiac output BP.

- Blocking of β2 receptors airway resistance (bronchospasm) , and vasoconstriction.

- 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:

Bradycardia, C.H.F., cardiogenic shock, diabetes, thyrotoxicosis, chronic bronchitis, asthma,

bronchospasm, emphysema.

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.

4. Treat hypoglycemia and hypokalemia.

5. I.V fluids.

6. Adrenaline or dopamine to increase Blood pressure.

Nursing considerations:
1. Instruct patient/family to take blood pressure and pulse.

2. Provide written instructions as when to call physician (e.g. HR below 50 beat/min).

3. Consult the physician before interrupting the therapy.

4. Some drugs lead to blurring of vision, so that tell patients not to engage in activities need mental
alertness.

5. Instruct patient to dress warmly during cold weather.

6. Diabetic patient should be very careful about symptoms of hypoglycemia.

7. Report any asthma-like symptoms.

Atenolol:

Trade name: Normatin.

Class: Beta-adrenergic blocking agent

Classification: beta 1 –adrenoreceptr blocking drug which is a cardioselective.

Uses: Hypertension angina pectoris.

Dosage:

Tablets: 50 mg or 100 mg daily

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:

 Trade name: Corgard

 Class: Beta-adrenergic blocking agent.

 Action: manifests both beta 1 and beta 2 adrenergic blocking.

 Uses: hypertension, angina pectoris.

 Dose: 40-80 mg daily.

Propranolol hydrochloride

Trade name: Inderal, Deralin

Classification: beta-adrenergic blacking agent, antiarryhthmic.

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

Additional side effects: psoriasis-like eruptions.

Dosage:
Tablets: initial dose of 40 mg bid, then 120-240 mg in 2-3 divided doses.

Temolol maleate:

Trade name: Blocadren, Timpotic.

Classification: Ophthalmic agent, beta-adrenergic agent.

Mechanism of Action: both beta1 and beta 2 receptors blocking activity.

Uses:

Tablets: for hypertension.

Ophthalmic solution: chronic open angle glaucoma.

3. Centrally acting agents:-

Used for treatment of chronic hypertension, since it affects CNS.

Clondine Hydrochloride:-

-Trade name:- (Catapres)

- Classification:-Antihypertensive, centrally antiadrenergic agent.

- Mechanism of Action:- stimulates alpha-adrenergic receptors of CNS nhibition of sympathetic

vasomotor centers & nerve impulses HR & BP.

-Uses:- treatment of mild to moderate hypertension.

-Side effects:- Drowsiness, headache, malaise, dry mouth, bradycardia, and constipation.

- N.B:- If colonidine is D.C abruptly, rebound hypertension may occur.

- -Dosage:- Initially 0.1 mg bid ,then increased to 0.1 - 0.2 mg daily until desired response is obtained.

Methyldopa :-

-Trade name:-(Aldomin)

-Classification:- Antihypertensive, centrally acting antiadrenergic agent.

 -Mechanism of Action:- The active metabolite alphamethylenorepinephrin lowers BP by stimulating
central inhibitory alpha-adrenergic receptors.

-Uses:- Hypertension & hypertension crises (parenteral).

-Contraindications:-

1. Hypersensitivity,

2. Active hepatic diseases.

3. Pregnancy.

4. Pheochromocytoma.

-Side effects:-

- Headache, dizziness, general weakness, depression and sedation.

- Bradycardia, orthostatic hypotension.

- Dry mouth, nausea, vomiting, sore (black) tongue.

- Jaundice, liver disorders.

-Hemolytic anemia, & leukopenea impotence.

-Dosage:- Tabs. :- initially 250 mg bid or tid.

-Nursing considerations:-
1. Avoid activities that need mental awareness such as driving.

2. Note any evidence of jaundice and do liver function test onintervals..

3. Advise pt. to rise from the bed slowly.

4. Instruct pt. about reportable Signs & Symptoms

5. Explain to pt. that urine rarely may be turn into dark / blue color.

6.Advise client to carry a card detailing current medication regimens always.

4. Agents that act directly on vascular smooth muscles:-

-Hydralazine hydrochloride:-

-Trade name:- ( Apresoline )

-Classification:- Antihypertensive, direct action on vascular smooth muscles.

-Mechanism of Action:- directly affect smooth muscles vasodilation, cardiac output and finally blood
flow to the brain and kidneys.

- Uses:- used with combination therapy to treat yhpertension.

Given parenterally in hypertension emergencies.

- Contraindications:-

- Angina pectoris.

- Rheumatic heart disease.

- Chronic glomerulonephritis.

- Systemic lupupus erthrmatosis (S.L.E.)

- Side effects:-

-Orthostatic hypotension, tachycardia, nausea, vomiting.

-Headache, dizziness, constipation and male impotence.

-Dosage:-

-Tabs. : initially 10 mg qid for 2-4 days, then 25 mg bid

-I.V, I.M :-50 mg (IV slowly) repeated as necessary. ( may decrease Bp in 5 minutes.)

*** Antiarrhythmic agents **

Cardiac arrhythmias:- altered patterns of contraction or marked increased or decreased HR reducing

the ability of the heart to pump blood.
Examples:-

Premature ventricular beats, atrial flutter, atrial fibrillation, ventricular fibrillation-----

N.B:- The effective treatment of arrhythmias depends on:

1) Accurate diagnosis.

2) Changing the causative factor.

3) Appropriate selection of an antiarrhythmic drugs.

Amiodarone hydrochloride:-

Trade name:- ( Procor)

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:

- Bradycardia, CHF, Fatigue, tremors.

- Visual disturbances, photophobia, dry eyes.

- Hemolytic or aplastic anemia.

- Hepatotoxicity.

Dose:
- Tabs 200 mg.

- Maintenance dose: 200-400 mg daily.

- IV infusion: 5 mg/kg over 20-120 minutes.

2- Lidocaine Hydrochloride:

Trade name: xylocaine – Esracain

Calss: antiarrhrythmic.

Mechanism of Action: shortens the refractory period & suppresses the automatically of ectopic foci
without affecting conduction of impulses through cardiac tissue.

Indications: acute ventricular arrhythmias as which follow MI or cardiac surgeries.

Contraindications:

- Hypersensitivity

- Heart block.

Side effects: hypotension, bradycardia, dyspnea, dizziness .

Dosage: available in ampules of a concentration of 1% (100mg), 2% (200mg)

Loading dose : IV. Bolus 50-100 mg at rate of 25-50 mg\min

Infusion : 20-50 mg\kg at a rate of 1-4 mg\m.

Nursing considerations:

1. Don’t add lidocain to blood transfusion assembly.

2. Make certain that vials state “for cardiac arrhythmias”.

3. Use 5% dextrose solution to prepare drug (stable for 24 hours).

4. Assess for history of hypersensitivity.

5. Use electronic infusion device to regulate the infusion of the drug.

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.

8. Assess B.P. frequently during administration.

9. Assess for respiratory depression.

10. If adverse reactions occur, discontinue infusion & prepare for emergency management.

3. Phenytoin

Trade name: Dilantin

Class: anticonvulsant , antiarrhythmic.

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.

Premature ventricular contractions.

Tachycardia.

Contraindications:

Hypersensitivity.

Side effects:

Drowsiness, ataxia, dizziness, measles-like rash, gingival hyperplasia, Hirsutism (excessive hair growth) ,
hypoglycemia.

N.B : - rapid I.V. administration Hypotension & arrhythmia.

Dose for arrhythmias:

Tabs 200-400 mg daily.

I.V. 100 mg q 5 minutes up to a maximum of 1g.

Nursing Considerations:
1- I.V. phenytoin may forms precipitate, so flush tubing by saline (not dextrose) before & after
administration.

2- Assess for hypersensitivity.

3- If a pregnant woman takes this drug, tell her not to breast-feed her baby.

4- Obtain liver & kidney function studies.

5- Monitor serum drug levels on a routine basis.

6- During I.V. therapy, monitor B.P. for signs of hypotension .

7- Take e food to minimize GI upset.

8- If the patient is diabetic, monitor for signs of hypoglycemia.

9- Oral hygiene to minimize bleeding from the gum.

10- Report any excessive growth of hair.

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.

Contraindication: Hypersensitivity, complete AV heart block.

Side effects: Hypotension, abdominal pain, bitter taste.

5. Propranolol

6. Verapamil