Cardio Pharmacology

1. Protamine sulfate: antidote for heparin (use is when patient’s aPTT is very high) Vitamin K: antidote for coumadin (uses PT/INR); both work slowly. 2. Why are Coumadin and Heparin given together? If you have DVT treatment, it can keep existing blood clots from getting larger or prevent new ones from forming. They do this by preventing the production of certain proteins needed for blood to clot. 3. Lipitor Atorvastatin is used along with a proper diet to help lower “bad” cholesterol and fats (such as LDL, triglycerides) and raise “good” cholesterol (HDL) in the blood. It belongs to a group of drugs known as “statins.

” It works by reducing the amount of cholesterol made by the liver. Lowering “bad” cholesterol and triglycerides and raising “good” cholesterol decreases the risk of heart diseases and helps prevent strokes and heart attacks. other lifestyle changes that may help this medication work better include exercising, losing weight if overweight, and stopping smoking. Take this medication by mouth with or without food as directed by your doctor, usually once daily. Example: mevacor 4. Questran Take this medication by mouth as directed by your doctor, usually 1 to 2 times a day.

This medication comes as a powder with doses measured by the scoopful (using the provided scoop) or in individual dose packets. Do not take your dose in the dry powder form. Mix the medication in at least 2 to 6 ounces (60 to 180 milliliters) of liquid (such as water, milk, fruit juice), stir completely, and drink immediately. Rinse your glass with more liquid and drink the rinse liquid to be sure that you have taken the entire dose. You may also mix this medication with watery soups, applesauce, or a pulpy fruit which has a lot of juice (such as crushed pineapple, peaches).

Do not hold the mixture in your mouth for long since doing so can damage your teeth. Practice good dental habits (such as brushing and flossing your teeth regularly). Cholestyramine may decrease your absorption of other medications. Take your other medications at least 1 hour before or 4 to 6 hours after cholestyramine. 5. Anticoagulants 1. Treatment with anticoagulant medications can result in episodes of bleeding, especially after an injury or when there is too much anticoagulant in the bloodstream. Anticoagulant medications, such as coumadine and heparin, prolong the time that it takes for blood to clot.

They do this by interfering with the normal pathway that regulates blood clot formation. Common bleeding from an anticoagulant symptoms include excessive bleeding, nose bleeds, black stools, blood in stool, rectal bleeding, vomiting blood, and vomiting coffee grounds-appearing material. Minor complications of bleeding from anticoagulant include: excessive bruising, gum bleeding, minor nose bleeds, prolonged bleeding from minor wounds. Serious complications of bleeding from anticoagulant include: compartment syndrome, GI bleeding, post op bleeding, severe nose bleeds, intracranial hemorrhage.

6. Thrombolytics Thrombolytic therapy is a treatment used to break up dangerous clots inside your blood vessels. To perform this treatment, your physician injects clot-dissolving medications into a blood vessel. In some cases, the medications flow through your bloodstream to the clot. In other cases, your physician guides a long, thin tube, called a catheter, through your blood vessels to the area of the clot. Depending on the circumstances, the tip of the catheter may carry special attachments that break up clots.

The catheter then delivers medications or mechanically breaks up the clot. Examples: Streptokinase, Urokinase Thrombolytic therapy commonly is used to treat an ischemic stroke, which is another name for a clot in a blood vessel in your brain. It can also be used to treat clots in: A lung artery, called a pulmonary embolism The deep veins of your leg, called deep vein thrombosis (DVT) Your heart, which may cause a heart attack An artery elsewhere in your body, such as in an arm or leg artery A bypass graft or dialysis catheter that has become blocked.

Common adverse effects of all the thrombolytic drugs is bleeding complications related to systemic fibrinogenolysis and lysis of normal hemostatic plugs. The bleeding is often noted at a catheterization site, although gastrointestinal and cerebral hemorrhages may occur. Therefore, patients who have experienced trauma injury or who have a history of cerebral hemorrhagic stroke are not usually administered thrombolytics. Re-thrombosis can occur following thrombolysis, and therefore anticoagulants such as heparin are usually co-administered, and continued after thrombolytic therapy for a period of time. 7.

Digoxin Lanoxin is used to treat heart failure by increasing left ventricular ejection fractions and arrhythmias such as atrial fibrillation by controlling the ventricular response rate. Side effects: fatigue, arrhythmias, bradycardia, anorexia. Route: IV and PO. Digoxin is primarily excreted by the kidneys; therefore, patients with impaired renal function require smaller than usual maintenance doses of digoxin. In patients with hypokalemia or hypomagnesemia, toxicity may occur despite serum digoxin concentrations below 2. 0 ng/mL, because potassium or magnesium depletion sensitizes the myocardium to digoxin.

Hypothyroidism may reduce the requirements for digoxin. Digoxin should be used with caution in patients with acute myocardial infarction. The use of inotropic drugs in some patients in this setting may result in undesirable increases in myocardial oxygen demand and ischemia. Newborn infants display considerable variability in their tolerance to digoxin. Premature and immature infants are particularly sensitive to the effects of digoxin, and the dosage of the drug must not only be reduced but must be individualized according to their degree of maturity.

Digitalis glycosides can cause poisoning in children due to accidental ingestion. 8. Iron Iron is a mineral. Most of the iron in the body is found in the hemoglobin of red blood cells and in the myoglobin of muscle cells. Iron is needed for transporting oxygen and carbon dioxide. It also has other important roles in the body. Try to avoid taking it with foods containing dairy products, coffee, tea, or cereals. Iron poisoning can cause many serious problems including stomach and intestinal distress, liver failure, dangerously low blood pressure, and death.

Iron absorption is affected by the iron status of the individual, the type of food eaten, vitamin C intake and other factors in the diet. People with a low reserve of iron will absorb more iron than those with sufficient stores. This is the body’s way of trying to maintain adequate levels of iron while protecting against iron toxicity. One of these methods is to include foods rich in vitamin C in the diet. Good sources of vitamin C include citrus fruits and juices, tomatoes, strawberries, melons, dark green leafy vegetables and potatoes. To have an effect, these foods must be eaten at the same meal as the iron source.

Another method to improve non-heme iron absorption is to include a source of heme iron (meat) with the meal. Not only will more total iron be eaten, but the percentage of non-heme iron that is absorbed will be greater. 9. Potassium sparing diuretics Adalctone, Dyrenium, Midamor. Potassium-sparing diuretics are commonly used to help reduce the amount of water in the body. Unlike some other diuretics, these medicines do not cause your body to lose potassium. Amiloride and spironolactone are also used to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries.

Potassium-sparing diuretics help to reduce the amount of water in the body by acting on the kidneys to increase the flow of urine. This also helps to lower blood pressure. 10. Lidocaine common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery. Contraindications: Heart block, second or third degree (without pacemaker) Severe sinoatrial block (without pacemaker).

Serious adverse drug reaction to lidocaine or amide local anaesthetics hypotension bradycardia accelerated indioventricular rhythm pacemaker 11. Nitroglycerin protocol Nitroglycerin spray and tablets are used to treat episodes of angina (chest pain) in people who have coronary artery disease (narrowing of the blood vessels that supply blood to the heart). The spray and tablets may also be taken just before activities that may cause episodes of angina in order to prevent the angina from occurring. The extended-release capsules can only be used to prevent angina attacks; they cannot be used to treat an attack once it has begun. Nitroglycerin is in a class of medications called vasodilators.

It works by relaxing the blood vessels so the heart does not need to work as hard and therefore does not need as much oxygen. Common side effects: flushing, lightheadedness, dizziness. Serious side effects to report: blurred vision, dry mouth, chest pain, fainting. 12. Treatment of intermittent claudication The most important are to stop smoking, take regular exercise, lose weight and to have any vascular risk factors treated. It is very important not to put on weight, because the more weight the leg muscles have to carry around the more blood they will need.

There is good evidence that patients with intermittent claudication who take regular exercise can increase their walking distance. It is important that your blood pressure is measured, and if found to be consistently high it should be treated by your doctor. Raised blood pressure can cause further deterioration in hardening of the arteries if left untreated. If you have diabetes it is important that your sugar levels are tightly controlled as this helps to reduce the risk of future problems. 13. Procardia This medication is used to prevent certain types of chest pain (angina).

It may allow you to exercise more and decrease the frequency of angina attacks. Nifedipine belongs to a class of medications known as calcium channel blockers. It works by relaxing blood vessels so blood can flow more easily. This medication must be taken regularly to be effective. It should not be used to treat attacks of chest pain when they occur. Can use other medications (such as sublingual nitroglycerin) to relieve attacks of chest pain. 14. Heparin Anticoagulant (blood thinner) that prevents the formation of blood clots. Treat and prevent blood clots in the veins, arteries, or lung.

Also used before surgery to reduce the risk of blood clots. Heparin is injected under the skin or into a vein through an IV and into a muscle. Subcutaneous administration should be deep, preferably into fatty layers of abdomen. Use a small-gauge needle to minimize tissue trauma. Rotate injection sites frequently. Sites: abdomen, 25-28g, 3/8-5/8 length, 90 degrees or 45 degrees on thin pts, volume is 0. 5-1mL. 15. Why do most patients stop taking antihypertensive medication? Like many people who have been prescribed antihypertensive drugs, you may be tempted to stop taking them or actually do so without going back to your doctor.

It’s all too easy to convince yourself that you don’t really need them because you’re feeling well and have no symptoms. The chances are that, if you do this, you may one day end up in the accident and emergency department of your local hospital, because you have developed one of the complications of hypertension, such as a heart attack or stroke. 16. Beta Blockers end with -olol Beta blockers, also known as beta-adrenergic blocking agents, are drugs that block norepinephrine and epinephrine (adrenaline) from binding to beta receptors on nerves.

There are three types of beta receptors and they control several functions based on their location in the body. Beta 1: receptors in heart, eye, kidney Beta 2: lungs, GI tract, liver, uterus, blood vessels, and skeletal muscle. Beta 3: fat cells. Beta blockers primarily block ? 1 and ? 2 receptors. By blocking the effect of norepinephrine and epinephrine, beta blockers reduce heart rate; reduce blood pressure by dilating blood vessels; and may constrict air passages by stimulating the muscles that surround the air passages to contract. Used for: abnormal heart rhythm, high blood pressure, heart failure, angina.

Patients with bradycardia should not take beta blockers. This is because one of the effects of beta blockers is to decrease the heart rate. So a patient with bradycardia who takes beta blockers is at risk for a dangerously low heart rate. Patients with second or third degree heart block should not take beta blockers because there is a risk that the heart block will worsen and result in abnormal, potentially fatal heart rhythms. The actions of beta blockers is to constrict the airways; patients with asthma already have constricted airways, so the beta blockers make the problem worse.

Patients with diabetes should avoid them as well because beta blockers can mask the symptoms of low blood sugar, making the problem of hypoglycemia unawareness more dangerous than it already is. 17. Oral Iron Prep Administer orally between meals (e. g. , 2 hours before or 1 hour after a meal) For patients who have difficulty tolerating oral iron supplements, administer smaller, more frequent doses; start with a lower dose and increase slowly to the target dose; try a different form or preparation; or take with or after meals or at bedtime.

18. Norpace Contraindications People whose hearts normally rest for long periods between beats cannot take Norpace. Nor can patients whose hearts are too weak to supply blood to all parts of the body. diabetes, glaucoma, kidney disease, liver problems, myasthenia gravis, urinary problems (such as due to enlarged prostate, urinary retention). This drug may cause low blood sugar (hypoglycemia), especially if you have diabetes, heart failure, decreased kidney/liver function, or nutrition problems. 19. Diuretics with or w/o potassium.

For patients taking the kinds of diuretics that rob potassium from the body, physicians may recommend adding potassium-rich foods or drinks, such as citrus fruits and juices, to the diet. Or they may suggest taking a potassium supplement or taking another medicine that keeps the body from losing too much potassium. If the physician recommends any of these measures, be sure to closely follow his or her directions. Do not make other diet changes without checking with the physician. People who are taking potassium-sparing diuretics should not add potassium to their diets, as too much potassium may be harmful.

26/08/2013 Learning Objectives: After completing this chapter you should able to: •Name categories of cardiovascular drugs •Describe the therapeutics effects of drugs •Identify the side effects 2 26/08/2013 Heart & Blood Circulation 3 functional parts: • • • Cardiac muscle …

Introduction : Beta-blockers, also known as beta antagonists, beta-adrenergic blocking agents, or beta-adrenergic antagonists, are drugs that are prescribed to treat several different types of conditions, including hypertension (high blood pressure), angina, some abnormal heart rhythms, heart attack (myocardial infarction), …

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1. 1Identify current legislation, guidelines, policies and protocols relevant to the administration of medication. The Medicines Act 1968 is an Act of Parliament of the United Kingdom. It governs the control of medicines for human use and for veterinary use, …

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