cardiac medication

5/17/2018 cardiac medication

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Cardiac Medications:Whats With the Mixing & Matching?

Michele B. Collins MSN RN CCRN

September 2!


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Sodium-Potassium Pump

Sodium OUTSIDE cell &Potassium INSIDE cell

before depolarization

Cell has NEGTI!E char"e& must CONT#CT to

become POSITI!E

S node has less ne"ati$it%

so it ser$es as pacemaer


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' With cell stimulation, cell permeabilityallows sodium INTO cell & potassiumOUT of cell

' With sodium, can only hae ST!T"#fast channel$% contraction

' alcium "#fast channel$% also enterscell,leadin' to total controlled contraction


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ardiac (epolari)ation

' Na* - +* pumpuses ener'y "!TP%so SOIU ./!0/S

cell andPOT!SSIU(/TU(NS to cell

' alcium also leaescell at this time


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ardiac (epolari)ation

If the S-! nodedoes not'enerate animpulse, anothercardiac site WI.."#reentry

phenomenon$%


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Statistically, if you take sixdierent drugs, you have an

80% percent chance of at leastone drug-drug interaction.

(a%ne )* nderson+ Dean+

State Uni$ersit% of Ne, -or

School of Pharmac%


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edications iscussed

' Antiarrhythmics

' Beta Blockers Ace Inhibitors

' Calcium Channel Blockers

' ACE Inhibitors

' Angiotensin II Receptor Blockers (ARB)

' Diuretics

' Digitalis' Nitrates

' Amiodarone


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Why so any1

' In atrial 2brillation, used tosuppress arrhythmias

' Often done to reliee the

symptoms associated with loss ofthe atrial component toentricular 2llin' "atrial kick% dueto atrial 2brillationor 3utter4
http://en.wikipedia.org/wiki/Atrial_fibrillationhttp://en.wikipedia.org/wiki/Atrial_flutterhttp://en.wikipedia.org/wiki/Atrial_flutterhttp://en.wikipedia.org/wiki/Atrial_fibrillation


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' In indiiduals with entriculararrhythmias, used to suppress

arrhythmias4 !ntiarrhythmica'ents may be considered the2rst-line therapy in the

preention of sudden deathincertain forms of structural heartdisease
http://en.wikipedia.org/wiki/Cardiac_arresthttp://en.wikipedia.org/wiki/Cardiac_arrest


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Automaticity

' (efers to a cardiac musclecell

2rin' o5 an impulse on its own' !ll cardiac cells can initiate an

action potential, howeer, onlysome of these cells are desi'nedto routinely tri''er heart beats

' 6ound in the 7conduction system7of the heart and include the S!node, !0 node, 8undle of 9ISand Pur:in;e 2bers

' Sinoatrial nodeis a sin'lespeciali)ed location in the atriumwhich has a hi'her automaticity"a faster pacema:er% than therest of the heart, and therefore is

usually responsible for settin'the heart rate, and initiatin'
http://en.wikipedia.org/wiki/Cardiac_musclehttp://en.wikipedia.org/wiki/Action_potentialhttp://en.wikipedia.org/wiki/Sinoatrial_nodehttp://en.wikipedia.org/wiki/Sinoatrial_nodehttp://en.wikipedia.org/wiki/Action_potentialhttp://en.wikipedia.org/wiki/Cardiac_muscle


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Re-entry' Occurs when an electrical

impulse recurrentlytraels in a ti'ht circlewithin the heart, ratherthan moin' from oneend of the heart to theother and then stoppin'

' If conduction isabnormally slow in someareas, part of the impulse

will arrie late andpotentially be treated asa new impulse


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' an produce a sustained abnormalcircuit rhythm4 (e-entry circuits areresponsible for atrial 3utter, most

paro


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' onditions thatincreaseautomaticity

includesympathetic nerous systemstimulation and

hypo


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' (esultin' heart rhythm depends onwhere the 2rst si'nal be'ins

. if in sinoatrial node, the rhythm remains

normal but rapid

. if an ectopic focus, many types ofdysrhythmia may ensue4


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ositi!e Inotropes

' "#E E$$EC"% &$ %"I'A"IN* ADRENER*ICRECE"&R%

' RECE"&R %I"EAC"I&N

' alpha peripheral blood !essels

!asoconstriction o+ peripheral arterioles' beta , myocardium increasedheart rate (chronotropic)

' increased contraction +orce (inotropic)

inc conduction'

' (dromotropic)' beta . peripheral blood !essels !asodilation o+

peripheral arterioles / !eins' bronchioles bronchodilation


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AN"IARR#0"'IC%


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AN"IARR#0"'IC%(1aughan 2illiams

classi3cation)' Class I 4 'embrane-stabili5ing age

' Class II 4 Beta-blocking agents' Class III 4 Increase time +or cell to

repolari5e

' Class I1 4 Calcium Channel blockers


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' lass I a'ents interfere with the sodium"Na*% channel4

' lass II a'ents are anti-sympathetic nerous systema'ents4 osta'ents in this class are beta bloc:ers4

' lass III a'ents a5ect potassium"+*%e=u


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Class I Antidysrhythmics6

' slo7 rate o+ spontaneous depolari5ationo+ cardiac cells8 thus decreasingautomaticity8 increasing re+ractoryperiod8 / decreasing susceptibility to

escape beats' rolong 9" inter!al' 2iden 9R% inter!al> decreased Na* in3u Nitro'lycerin

' 6or acute an'inal attac:s4 S. dosa'e "4Jm'%>R Instruct patient to lie downR (epeat at minute interalsD if pain not

relieed, up to B tablets

R If an'inal pain persists after B doses, 'o to /R Stay with patient and monitor 0S "esp4 8P%R 9eadache & hypotension are ma;or side e5ects

.on' actin' Nitrates>
http://allnurses.com/http://allnurses.com/


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.on'-actin' Nitrates>Isordil, nitro'lycerin ointment, nitro'lycerin

transdermal patch

' Ointment> useappropriateapplication paperD

dont #rub in$

' (otate sites "remoeold patch, ointments%

' !oid contact withs:in

Nitrate3free periods 45 .

67 hrs8 9: hr period; to

pre$ent tolerance

#emo$e patch before

defibrillatin" as patch

ma% e0plode


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Side /5ects

' 9ypotension, diaphoresis, nausea

' Tachy- and bradydysrhythmias

' 9eadacheD re3e< tachycardia


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ru' Interactions

' Sympathomimetics, thyroidhormones, nicotine

' !ll increase cardiac wor:load so

counteract NTH e5ects


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Nitrates

' Drugs in this class include6

' Isosorbide initrate

' Isosorbide ononitrate


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!miodarone

' Principal e5ect on cardiac tissue toincrease time for cell to repolari)e

' ainly bloc: potassium channels, therebyprolon'in' repolari)ation4

' o not a5ect the sodium channel so conductionelocity is not decreased' Used to treat atrial arrhythmias "atrial

2brillation and atrial 3utter% as well asentricular arrhythmias "entricular 2brillation

' Preent re-entrant arrhythmias' results in Echemical anti2brillatoryE action
http://en.wikipedia.org/wiki/Potassium_channel_blockerhttp://en.wikipedia.org/wiki/Potassium_channel_blocker


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Side /5ects

' ulmonary 3brosis

' Abnormal thyroid+unction

' hotophobia8

' Nausea8 !omiting

' Blue-gray skin color

' %eeing halos aroundobects


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' ay ta:e oer B wee:s to wor:Dhalf-life about days

' onitor with patients in 96 and

elderly for decreased 8P and pulse' !ssess for 3uid retention


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' 9ae patient swallow whole

' o not stop abruptly' Ta:e one hour before meals or

hours after meals

' 9i'h fat meals eleate leels

' Use sunscreens and sun'lasses whenoutside
http://images.google.com/imgres?imgurl=http://www.istockphoto.com/file_thumbview_approve/5082066/2/istockphoto_5082066-sunglasses-and-sunscreen.jpg&imgrefurl=http://www.istockphoto.com/file_closeup/illustrations-vectors/vector-icons/5082066-sunglasses-and-sunscreen.php%3Fid%3D5082066&usg=__0YgHPQ-Gla5ACYWF4Ut2b4IfsAI=&h=380&w=380&sz=41&hl=en&start=1&tbnid=CXOCgQFWY-PoVM:&tbnh=123&tbnw=123&prev=/images%3Fq%3Dsunglasses%2Band%2Bsunscreen%26gbv%3D2%26hl%3Den


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ru' Interactions

' !nticoa'ulants increaseanticoa'ulation

' Increased di'o


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Class III otassiumChannel Blockers

' !miodarone "ordarone%

' ofetilide "Ti:osyn%

' Ibutilide "orert%

So 9ow oes This


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So 9ow oes This(elate to y Patients1 9TN

' Hoal. Two primary re'ulatory factors

' 8lood 3ow "olume%

' Peripheral 0ascular (esistance "P0(%

. Primary 'roups of dru's are used>' iuretics

' !drener'ic inhibitors "8eta-bloc:ers%

' 0asodilators' !/ inhibitors

' alcium anta'onists

harmacologic


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harmacologic"reatment

' 6or patients with systolic dysfunction"e;ection fraction J%

. !n'iotensin-conertin' en)yme "!/%

inhibitors for all patients. 8eta bloc:ers for all patients e


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.!ldosterone anta'onist "!/inhibitor or !(8% for those with

' dyspnea at rest or

' symptomatic patients who haesu5ered a recent myocardialinfarction

' !(8 as a substitute for patientsintolerant of !/ inhibitors


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' i'o


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' 96 patients on multiple medicationsare at a ris: of potential dru'interactions and side e5ects

. ris: of hyper:alemia is increased withrenal insuVciency treated with analdosterone anta'onist and an !/inhibitor4

Hoals for 't of 9eart


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Hoals for 't of 9eartisease

' a


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' (educe chances of clot formation

' (educe oerall blood olume ifoerload

' aintain heart rate between -Kbeatsmin to ma


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What ru's 9elp toeet these Hoals1

@ a


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What ru's 9elp toeet these Hoals "contd%1

@ (educe chances of!S! or other anti-platelet

clot formation a'ents

@ (educe 3uid

olume oerload iuretics

@ +eep heart rate btw 8eta bloc:ers &

-Kmin alcium-channel bloc:ers

@ ysrhythmias !ntidysrhytmics

l f


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Treatment Hoals for 96

. (eliee symptoms & improe Cuality of life

. Preent readmission to hospital, andorrecurrent ischemic eents

. (educe mortality. edications used>

' !/ Inhibitors

' 8eta 8loc:ers

' iuretics' 0asodilators

' i'italis

hibi


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!/ Inhibitors

' Increase lifespan ofpatients with heart failure

' /5ects on blood essels

that seem to counteractthe process ofatherosclerosis and haebeen shown to reduce

heart attac:, stro:e, andmortality in !

8 8l :


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8eta-8loc:ers

' .ower blood pressure & slow heartrate "includin' protection a'ainstarrhythmias%

' 9elps lower ris: of stro:e and heartattac:s

Ni


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Nitrates

' Used to treat an'ina

' 0asodilates and

stops chest pain byincreasin'myocardial o


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!ntidysrhythmic ru's

' Used to brin' under control abnormalrhythms of the heart "includin' atrial2brillation%, so the heart can pump

more e5ectiely

! tih t i


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!ntihypertensies

' Used to control 8P & ris: of stro:e &I

' ate'ories

. !/ Inhibitors

. 8eta-8loc:ers

. alcium-hannel 8loc:ers

'anaging the Cost


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'anaging the Cost

' Patients may be ta:in' twoto four dru's to

mana'e cardiac condition

. in addition to meds for otherhealth issues such

as diabetes

. ed treatment for a chronic

condition becomes e


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' /en with worsenin' condition some

people try to limit costs. ay or may not as: which can be

decreased or stopped

' 8est if medication re'imen is :eptsimple so patients without insurancecan purchase 'eneric ersions

without rationin' their doses4

R 3ll R d "


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Re3ll Red "ape

' Patients and 9Ps often face red tapewhen it comes to re2lls and

preapproed status4' If desired med is not on insurance

company7s preferred list. ust complete preauthori)ation form

. !lso must tal: with insurance companyabout why that particular medication isneeded


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' Patients receiin' non-formulary dru's often paymore

. ay only be able to 'et partially2lled prescriptions

. Proiders should see: 'eneric orless e


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%imple %teps6


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% p e % epsi+estyle Changes

' ecreasesodium inta:e

' /


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Preload or !fterload1

!rterial asoconstriction

8P AXAJ

!dministration of hydrala)ine or nitroprusside

!dministration of Nitro'lycerin

iuretic therapy

!rterial asodilation


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' .ist some positie and ne'atieaspects to the administration of betabloc:ers


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' The desired e5ect from the use ofdiuretics in the patient with acute leftentricular failure is to Y


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' .ist some medications that decreasemyocardial contractility


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' What are some of the si'ns &symptoms of left sided heart failure1


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' Zour patient on di'o


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' What are some positie and ne'atieaspects related to Nitro'lycerinadministration1


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! patient with a dysrhythmia isplaced on di'o

cardiac medication

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