pharmocology

Drugs that affect the heart, increase its rate (positive chronotropic), or decrease its rate (negative chronotropic).

Drugs affect the force of contraction (positive or negative)

Drugs alter the rhythm or electrical conduction through the heart muscle.  A positive dromotropic drug enhances the electrical conduction. Negative dromotropic drugs slow conduction.

Related to contraction and relaxation of the heart

cellular level by ions transporting in and out of cells

action potentials that are dependant on sodium, calcium, and Potassium

Potassium moves out of the cell while sodium moves in  which proceeds contraction

Influences actin and myosin, which contron cardia cell length and muscle contraction

• Atrial fibrillation or flutter
• Paroxysmal supraventricular tachycardia
• autonomic atrial tachycardias

• Decrease blood levels of vasoconstrictor angiotensin II.
• No direct positive inotropic effects.
• Decrease aldosterone secretion, salt and water retention, and vascular resistance.
• Decrease afterload and alter structural changes in the congested heart by remodeling.
• Decrease symptoms
• Prolongs life in patients with HF

• Inhibits the sodium/potassium exchange in the heart
• Causes an increase in the contractility of the heart

Increase the cardiac output by lowering blood pressure and decreasing fluid volume

• Treated with early reperfusion therapy with either primarily percutaneous coronary intervention or adminstration of a fibrinolutic agent
• Oxygen
• Aspirin
• Sublingual nitroglycerin

receive additional Clopidogrel (Plavix) or prasugrel (Effient) and/or glycoprotein IIb/IIIa receptor blockers

• Used for fluid retention
• Decrease excess volume and decrease the workload of the heart
• Doses are usually givin early in the day to prevent nocturnal diuresis
• It is important to monitor:
• Weight loss
• Decrease in edema
• Breath sounds

• Occure when ventricles are not able to pump enough blood to supply the body
• The loss of contractile or pump efficiency makes the blood volume increase whithin the heart and the heart eventually enlarges 

An unclassified antiarrhythmic used to convert superventricular tachycardia to a sinus rhythm and at times it aids in the diagnosis of the rhythm disorder

• Pain relief and prevention of recurrent pain
• Decreasing consumption of oxygen by the heart or increasing the delivery of oxygen to the heart
• Nitroglycerin SL used for quick relief

• Precursor of norepinephrine and releases endogenous norepinephrine
• Dose dependent stimulation of dopaminergic, B1, and a adrenergic receptors
• Dopamine infusions should not be abruptly discontinued

Shows ventricular depolarization, which is followed by the mechanical contraction of the right and left ventricles

• Increase cAMP levels by inhibiting cAMP breakdown of the enzyme phosphodieterase
• Results in increased vascular smooth muscle relaxation and increased in heart contractility

Arterioles

Veins regulate preload

Target organ disease (TOD) can result

• Inhibits sympathetic activity
• Decrease the rate and force of contraction, lowering blood pressure
• B-Blockers can decrease HDL cholesterol, raise triglycerides and elevate plasma glucose
• Metoprolol (Lopressor)
• Propranolol (Inderal)
• Atenolol (Tenormin)

• Amiloride
• Spironolactone
• Triamterene
• Eplerenone

• Produce arterial relaxation and vasodilation
• Side effects:
• Peripheral edema
• Dizziness
• Have different effect on heart rate and atrioventricular nodal conduction

• Vasopressor drugs
• Cardiotonic agents

• Bleeding gums
• Nosebleeds
• Petechiae
• Blood in urine or stools

• Anticoagulants
• Lepirudin (Refludan)
• Argatroban
• Bivalirudin (Anginomax)

• Thromboplastin fors in the presence of vitamin K
• Prothrombin in the presence of thromboplastin and calcium forms thrombin

• Reduce spontaneous breathing
• Prevent movement that can dislodge tubes
• Reduce oxygen consumption
• Put patient is sync with ventilator

must take place to bring the muscle back to its resting level so it can again be depolarized.

Can be reversed with cholinesterase inhibitors (neostigmine and pyridostigmine).

Stage 1—“Conscious sedation.” Patient is awake but can not feel pain. Frequently used for scopes and minor procedures.

Stage 2—Loss of consciousness but patient still has reflexes, such as cough.

Surgical anesthesia that progresses to respiratory depression.

Complete loss of respiratory drive, and patient may have loss of cardiovascular tone

could be a good choice for sedation in the ICU.

• Compazine
• promethazine (Phenergan)
• Propofol
• Antiemetic drugs
• Antimuscarinic
• Serotonin antagonist
• Dopamine antagonists

Naloxone (Narcan)

• The most common drug class with sedative, hypnotic, and anxiolytic pharmacologic effects
• Can be used as cocktails for antesia
• work by enhanching the inhibitory effect on the receptor for the neurotransmitter GABA within the brain
• Versed

• used in the intensive care unit for sedation of mechanically ventilated patients and for sedation prior to and/or during surgical procedures in patients without intubation
• It works by stimulating central alpha2 receptors resulting in anesthetic and sedative properties

Is used to make dosage adjustments for heparin

May be 2 to 3 or higher

Effective in treating patients with upper airway obstruction