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.
Cardiac action potential
Related to contraction and relaxation of the heart
The cardiac action potential is controlled at the...
cellular level by ions transporting in and out of cells
The pacemaking and conduction throughout the heart are driven by...
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
ACE inhibitors for Hear failure
- 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
Acute coronary syndrome with elevated ST segement!
- Treated with early reperfusion therapy with either primarily percutaneous coronary intervention or adminstration of a fibrinolutic agent
- Sublingual nitroglycerin
Patients with no ST segement elevation Acute coronary syndrome
receive additional Clopidogrel (Plavix) or prasugrel (Effient) and/or glycoprotein IIb/IIIa receptor blockers
Diruetics for Heart failure
- 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
Treatment of angina
- 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
Dopamine for Heart failure
- 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
Veins regulate preload
If hypertension goes untreated...
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)
Hypertensive agents for hypokelimia
Calcium channel blockers
- Produce arterial relaxation and vasodilation
- Side effects:
- Peripheral edema
- Have different effect on heart rate and atrioventricular nodal conduction
What drugs can increase blood pressure?
- Vasopressor drugs
- Cardiotonic agents
Warfarin (Coumadin) It is important to monitor for!
- Bleeding gums
- Blood in urine or stools
Drugs that inhibit the thrombin release!
- Lepirudin (Refludan)
- Bivalirudin (Anginomax)
- Thromboplastin fors in the presence of vitamin K
- Prothrombin in the presence of thromboplastin and calcium forms thrombin
Why we use neuromuscular blocking agents
- 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.
What drugs can reverse Nondepolarizing Agents
Can be reversed with cholinesterase inhibitors (neostigmine and pyridostigmine).
Stage 1 of antisia
Stage 1—“Conscious sedation.” Patient is awake but can not feel pain. Frequently used for scopes and minor procedures.
Stage 2 of antisia
Stage 2—Loss of consciousness but patient still has reflexes, such as cough.
Stage 3 of antisia
Surgical anesthesia that progresses to respiratory depression.
Stage 4 of antisia
Complete loss of respiratory drive, and patient may have loss of cardiovascular tone
could be a good choice for sedation in the ICU.
Postoperative nausea and vomiting
- promethazine (Phenergan)
- Antiemetic drugs
- Serotonin antagonist
- Dopamine antagonists
How do you reverse operiods?
- 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
- 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
The PTT lab test..
Is used to make dosage adjustments for heparin
May be 2 to 3 or higher
Effective in treating patients with upper airway obstruction