Cardiac Pharmacology Flashcards
Epinephrine
Classification: Alpha and beta adrenergic agent. Vasopressor, intotropic, chronotropic, and dromoatropic
Mechanism of Action: Will increase HR and in turn affect CO and SVR
Indications: Cardiac arrest (will be given as a bolus), pulseless arrythmia, Hypotension, Anaphylaxsis
Norepinephrine
Class of Drug: Inotrope, vasoactive agent. Alpha and beta 1 agonist
Mechanism of Action: Will affect CO and SVR. Is an powerful alpha and beta1 which results in an increase in myocardial contractility
Indications: Hypotension, distributive shock
Dopamine
Class of Drug: Inotrope, vasoactive agent
Mechanism of Action: Precurser to norepinphrine. Stimaultes alpha, beta, and dopmerginic recpetors. Only administered via IV
Indications:
Low Dose (1-5 mg/kg/min): Renal Dose (dilate renal arteries)
Medium Dose (5-10 mg/kg/min): Cardiac Dose (treat bradycardia by increase CO)
High Dose (1-5 mg/kg/min): Vasopressor Dose (treat hypothermia with alpha effects of decreaseing SVR and constrction)
Phenylephrine
Class of Drug: Alpha agonist
Mechanism of Action: Last 20 min (last longer the epinephrine and no disturbances of heart rhythm)
Indications: Hypotension and used in RSI for hypotension
Vasopressin
Class of Drug: Inotrope, vasoactive agent
Generic: Vasopressin
Trade: ADH
Mechanism of Action: Non adrenergic peripheral vasoconstrictor
Indications: PEA, Hypotension,
NO BETA STIMULATION
Dubutamine
Class of Drug: Inotrope, vasoactive agent
Generic: Dubutamine
Mechanism of Action: Syntheteic catecholamine taht produces predominately beta effects (iontrope) and change BP
Indications: Patients with heart pumping problems and a systolic BP of >70mmHg
Isoproterenol
Class of Drug: Inotrope, vasoactive agent
Generic: Isoproterenol
Mechanism of Action: Nearly a pure beta agonists, patent iontrop and chronotrope, will decrease BP and increase SVR
Indications: Rarely used to treat bradycardia or b blocker overdose
Imamrione and Mitrinone
Class of Drug: Inotrope, vasoactive agent
Generic: Imamrione and Mitrinone
Mechanism of Action: Causes iontropic effects in the heart, peripheral vasodilation (does not affect sympathetic NS)
Indications: Severe CHF, Refractory cardiogenic shock
Atropine
Class of Drug: Chronotrope
Generic: Atropine
Mechanism of Action: Parasympathetic (enhance autonomacay of SA node which will increase rate through av conduction)
Indications: Symptomatic bradyarrhythmia but may not work in heart blocks
Lidocaine
Class of Drug: Class I Anti-Arrthymias (Na Channel Blockers)
Generic: Lidocaine
Mechanism of Action: Suppress ventricle arrthymias and decrease myocardial conduction and increase VF threshold
Indications: Refractory Shock, VF (pulseless), and VT management. Manage PVC irritability
Class II Anti-Arrhythmias (B-Blockers)
Names: Mteoprolol, propranolol, labetalol, atenalol, esmalol
Mechanism of Action: Beta Blocker Adrenergic Receptor
Decrease the effect of catecholamines, decrease HR and BP, decrease myocardial contraction and O2 consumption
Avoid in diseases with bronchospasms
Indications: Acute Coronary syndrome, hypertension, actute tachycardia (SVT)
Amiadarone
Category: Class III Anti-Arrhythmias (K Channel Blockers)
Generic Name: Amiarone
Mechanism of Action: Second line in ACLS
Indications: Refractory shock, pulsleless VF, VT, tachycardia,
Can cause amidarone lung or smurf lung
Adenosine
Category: Class IV Anti-Arrhythmias (Ca Channel Blockers)
Generic Name: Adenosine
Trade Name: Adenocard
Mechanism of Action: Endogenous compound that depresses both the SA and AV node
Indications: Treat SVT, warn patients of sensations of heat, chest pain, and flushing
Do not give to asthmatic patients
Digoxin
Category: Class IV Anti-Arrhythmias (Ca Channel Blockers)
Generic Name: Digoxin
Trade Name: Lanoxin
Mechanism of Action: Cardiac glycoside, derivities of digitalis, anti-arrhythmia and inotropic
Indications: Decreased ventricular repsonpe in atrial fibirllation or atrial flutter
Narrow Therapeutic Range
May cause arrhythmias and precitate cardiac arrest
Nitroglycerin
Nitroprusside
Category: Nitric Vasodilator
Generic Name: Nitroglycerin, Nitroprusside
Mechanism of Action: Breaks down nitric oxide to produce vasodilation
Indications: Angina, AMI, CHF, hypertensive crisis
Can result in hypotension
ACE Inhibitors
Category: ACE Inhibitors
Generic Name: Captropril
Mechanism of Action: Prevent sysnthesis of angotensin which will result in vasodilation
Indications: Hypertension, Myocardial infarction
What are drugs with Positive Chronotropic Effects
A positive chronotrope will increase HR and this will be anything that stimulates B1
Ex. Epi, Norepi, Dopamine, Dobutamine, Atropine
What is a drug that is a powerful alpha agent
Levophed, Phenylephrine and dopamine (high/pressor dose).
What are the effects of beta 2 stimulation
Bronchodilation (for receptors in the lungs) and vasodilation (due to the receptors in the periphery)
Cautions with beta 1 stimulation
The increased HR and contractility cause an increase in myocardial demand/oxygen consumption and myocardial irritability. Also decreased time in diastole…may impact filling time at high rates.
Effects of Dopamine
Low Dose (1-5 mcg/kg/min) results in renal and splanchnic vasodilation (due to dopaminergic receptor stimulation)
Moderate Dose (5-10 mcg/kg/min) results in increased HR, contractility and rate of conduction due to B1 stimulation
High Dose (10-20 mcg/kg/min) results in increased SVR and increased BP due to a1 stimulation
When is a bolus of Epinephrine given
In pulsesless states! VT, VFib, PEA and asystole
Vasopressin is also an alternative that can be given and it will have the advantage that there is no B1 stimulation thus doesn’t further stress the heart (beyond the increased afterload it results) with the increased HR and increased irritability
How do “Iondilators” work and Why are they helpful in patients with CHF
Inhibit phosphodiesterase III (an enzyme that breaks down cAMP. Increased levels of cAMP in the heart results in increased inotropism and increased cAMP in peripheral smooth muscles causes vasodilation
Heparin
Coumadin
Category: Anti-Thrombolytic/Coagulation
Generic Name: Heparin, Coumadin
Mechanism of Action: Heparin inhibits clotting pathway, Caumadin will use used post heparin
Indications: Treat thromboemobulism, PE, atrial fib, intravascular coagulation
CAUTION: Bleeding, bruising, hemorrhage
ASA
Abciximab
Clopidagrel
Category: Anti-Thrombolytic/Platlet
Generic Name: ASA, Abciximab, Clopidagrel
Trade Name: Aspirin, Repro, Plavix
Mechanism of Action: prevent thromboxone fomation
Indications: Thrombolus embolism, myocardial infarction
Cation Increased risk of bleeding, relative contraindications when thrombolytics are used
Alteplase
Retephase
Streptokinase
Tenecteplase
Category: Anti-Thrombolytic
Mechanism of Action: Lyse formed thrombi be degrading fibrin
Indications: Acute myocardial infarction, PE,
Inotrope
Affects myocardial contractility
Dromotrope
Affect rate of conduction
Catecholamine
Sympathomimetic Action
Alpha Adrenergic Receptors
Located in peripheral vasculature where they will regulate smooth vascular tone
Agonist Action: Vasoconstriction
Alpha 1- Peripheral blood vessels
Alpha 2- Presynaptic sympathetic neurons and CNS
Beta 1 Receptors
Located in the heart
Agonist: Increase HR, Contraction, and conduction
Dopaminergic Receptors
Located in the smooth muscle in the cerebral, coronary, renal, and splanchnic vascular beds
Agonist stimulation will results in vasodilation and therefore increased blood flow to these areas
Adenosin
Depress both SA and AV node to treat SVT
Anticoagulants
Will prevent the formation of a fibrin clot and prevent further clot formation
Used to preven PE and in DIC
Antiplatletes
Inhibits the stickiness of platlets in the clotting process
Thrombolytics
