Cardiac Pharmacology Flashcards
Opioids: Morphine
Indications
* acute MI pain, acute and chronic pain
Mechanisms of action
* binds with receptors in brain and dorsal horn of spinal cord
* mimics endogenous opioids such as endorphins and enkephalins (also stimulate opioid receptors)
* peripheral vasodilation
Adverse effects
* CNS depression respiratory depression, cardiac arrest⭢
* dysphoria (restlessness, depression, and anxiety)
* hallucinations, dizziness, constipation, nausea
* itching sensation
Calcium Channel Blockers (Selective for Vessels): Diltiazem
Indications
▪ stable angina, atrial dysrhythmias, HTN
Mechanisms of action
* inhibits transport of calcium into myocardial cells
* decreases HR and force of contraction, decreasing O2 demand of myocardium
* blocks vascular smooth muscle channels
Desired effects
* relaxes both coronary and peripheral blood vessels
Adverse effects
* related to vasodilation
* dizziness, edema of ankles and feet
Calcium Channel Blockers (Selective for Vessels): Amlodipine
Indications
* chronic stable angina, variant angina, HTN
Mechanisms of action
* blocks calcium channels in myocardial and vascular smooth muscle, including the coronary arteries
* inhibits calcium ion influx across cell membranes
Desired effects
* relaxes peripheral vascular smooth muscle
Adverse effects
* dizziness, flushing, hypotension, H/A, peripheral edema, dysrhythmias
Vasodilators: Nitroglycerin
Indications
* taken while acute anginal episode is in progress or just prior to physical activity
Mechanisms of action
* precursor to nitric oxide (forms NO)
* NO relaxes vascular smooth muscle
Adverse effects
* usually cardiovascular in nature and are rarely life-threatening
* H/A is common and may be severe
* reflex tachycardia
β1-Adrenergic
Receptor
Blockers
(“olols”):
Metoprolol
Indications
* used after MI
* target HR between 60 and
90 BPM
* also used for angina, HTN, & MI
Mechanisms of Action
* selectively blocks β1 receptors
* slows conduction velocity
across myocardium
Adverse effects
* bradycardia, hypotension
* bronchospasm is negligible
ACE Inhibitors (“prils”): Enalapril
Indications
* HTN, HF
Mechanisms of Action
* inhibits angiotensin-converting enzyme (ACE)
* angiotensin I cannot be converted to angiotensin II
Adverse effects
* hyperkalemia, orthostatic hypotension, headache, dizziness, persistent cough
* can cause life-threatening angioedema, neutropenia, agranulocytosis
Neprilysin
Inhibitor /ARB:
Sacubitril/Valsartan
(combination drug)
Indications
* reduce mortality and hospitalizations in clients with HF
Mechanisms of action
* sacubitril: inhibits neprilysin →↑ cardioprotective (NPs) by ↓ their
enzymatic breakdown
* valsartan: (ARB) blocks angiotensin II receptors → vasodilation &
↓aldosterone release
Adverse effects
* hyperkalemia, hypotension, dizziness
Cardiac
Glycosides:
Digoxin
Indications
* primarily used for HF
* can stabilize some dysrhythmias
Mechanisms of action
* inhibits Na+/K+ ATPase causing Na+ to accumulate in myocytes
* as Na+ accumulates, calcium ions released from storage areas in cell
* release of calcium ion produces more forceful contraction of
myocardial fibres
* suppresses sinoatrial (SA) node and slows electrical conduction through AV node
Adverse effects
* N/V, anorexia, fatigue, H/A, dizziness
* visual disturbances (halos, blurring, yellow and green tinge)
Antidysrhythmics (Antiarrhythmics): Amiodarone
Indications
* resistant ventricular tachycardia that may prove life-threatening
* atrial dysrhythmias in clients with HF
* recurrent fibrillation
Mechanisms of action
* blocks potassium and sodium ion channels
Adverse effects
* most serious adverse effect occurs in lung
* causes a pneumonia-like syndrome
* also causes blurred vision, rashes, photosensitivity, N & V, anorexia, fatigue, dizziness, and hypotension
Cyclooxygenase
(COX) Inhibitors:
Acetylsalicylic
Acid
Indications
* antiplatelet (unique to this NSAID)
* significant anticoagulant activity
* secondary prevention of vascular events
* mild to moderate pain & inflammation, fever
Mechanisms of Action
* inhibits cyclooxygenase (COX) enzyme pathway preventing production of rostaglandin & synthesis of thromboxane A2
* COX irreversibly inhibited for lifespan of platelet (7-10 days)
Adverse effects
* gastric discomfort
* bleeding
* ↑ clotting time
* salicylism (can occur with high dosing)
* tinnitus, dizziness, headaches, sweating
Thrombolytics:
Tissue
Plasminogen
Activator (tPA):
Alteplase
Indications
* MI and CVA related to clots (thrombotic)
* off-label use: restore IV catheter patency
Mechanisms of action
* identical to human tPA enzyme
* mimics body’s process of clot destruction
Adverse effects
* severe risk of bleeding
* spontaneous ecchymoses, hematomas, epistaxis, intracranial bleeding
