drug classifications

Sherry L. Knowles, RN, CCRN, CRNI

Cardiac DrugsCardiac Drugs ACE Inhibitors ACE Inhibitors Anti- Anti-

CoagulantsCoagulants Nitrates Nitrates Calcium Channel Calcium Channel

Blockers Blockers VasopressorsVasopressors Anti-DysrhythmiiasAnti-Dysrhythmiias

GPIIGPIIbbIIIIIIaa Inhibitors Inhibitors DiureticsDiuretics

Angiotensin II Angiotensin II Anti-Inflammatory Anti-Inflammatory Antagonists Antagonists

InotropicsInotropics Beta Blockers Beta Blockers

Alpha Blockers Alpha Blockers Anti-LipidemicsAnti-Lipidemics

ThrombolyticsThrombolytics

InotropicInotropic

Drug actions

ChronotropicChronotropic

Dromotropic Dromotropic

Cardiac DrugsCardiac Drugs

InotropicInotropic Affects ContractilityAffects Contractility

Cardiac DrugsCardiac Drugs

Positive Inotropics Positive Inotropics the force the force

of myocardial contraction.of myocardial contraction. Negative Inotropics Negative Inotropics the force the force

of myocardial contraction.of myocardial contraction.

CHRONOTROPICCHRONOTROPIC Affects Heart RateAffects Heart Rate

Cardiac DrugsCardiac Drugs

Beta Adrenergic and Blocking AgentsBeta Adrenergic and Blocking Agents Slowing rates can Slowing rates can filling time filling time

AntiarrhythmicsAntiarrhythmics Beta BlockersBeta Blockers Calcium Channel Blockers Calcium Channel Blockers

Cardiac DrugsCardiac Drugs DromotropicDromotropic

Affects ConductivityAffects Conductivity

AlphaAlpha receptorsreceptors

DDopaopa receptorsreceptors

BetaBeta receptorsreceptors

Cardiac DrugsCardiac Drugs

Alpha receptorsAlpha receptors On Blood VesselsOn Blood Vessels

Stimulation causes vasoconstrictionStimulation causes vasoconstriction Blocking cause vasodilationBlocking cause vasodilation

Cardiac DrugsCardiac Drugs

Beta receptorsBeta receptors On Heart and LungsOn Heart and Lungs

BetaBeta11 and Beta and Beta22

Cardioselective vs Non-SelectiveCardioselective vs Non-Selective

Cardiac DrugsCardiac Drugs

Beta receptorsBeta receptors BetaBeta11

Stimulation causes positiveStimulation causes positive

inotropic effectsinotropic effects Blocking causes negative Blocking causes negative

inotropic effectinotropic effect

Cardiac DrugsCardiac Drugs

Beta receptorsBeta receptors BetaBeta22

Stimulation causes bronchodilationStimulation causes bronchodilation Blocking causes Blocking causes

bronchoconstrictionbronchoconstriction

Cardiac DrugsCardiac Drugs

Dopa receptorsDopa receptors On Renal (Mesenteric) VesselsOn Renal (Mesenteric) Vessels

Stimulation causes vasodilationStimulation causes vasodilation Blocking causes vasoconstrictionBlocking causes vasoconstriction

Cardiac DrugsCardiac Drugs

ALPHA BLOCKERSALPHA BLOCKERS

Cardiac DrugsCardiac Drugs

Used for hypertension, Used for hypertension,

BETA BLOCKERSBETA BLOCKERS

Cardiac DrugsCardiac Drugs

Slow Heart RateSlow Heart Rate Negative ChronotropicNegative Chronotropic

Lower BPLower BP

Slow ConductionSlow Conduction Negative DromotropicNegative Dromotropic

Encourage Electrical Encourage Electrical StabilityStability

CALCIUM CHANNEL BLOCKERSCALCIUM CHANNEL BLOCKERS

Cardiac DrugsCardiac Drugs

Slows Heart RateSlows Heart Rate Negative ChronotropicNegative Chronotropic

VasodilatorVasodilator

Prevents Arterial VasospasmPrevents Arterial Vasospasm

Beta BlockersBeta Blockers:: Adverse EffectsAdverse Effects

Cardiac DrugsCardiac Drugs

FatigueFatigue BronchospasmBronchospasm ImpotenceImpotence DepressionDepression Aggravation of heart failureAggravation of heart failure

VASODILATORSVASODILATORS

Cardiac DrugsCardiac Drugs

ACE INHIBITORSACE INHIBITORS

Cardiac DrugsCardiac Drugs

Causes VasodilationCauses Vasodilation

Reduces AfterloadReduces Afterload Reduces work of heartReduces work of heart

Remodeling EffectsRemodeling Effects

ANGIOTENSIN II ANTAGONISTSANGIOTENSIN II ANTAGONISTS

Cardiac DrugsCardiac Drugs

VasodilatorVasodilator

Reduces AfterloadReduces Afterload

May be used in May be used in place of ace place of ace inhibitorsinhibitors

NITRATESNITRATES

Cardiac DrugsCardiac Drugs

Arterial & Venous VasodilatorArterial & Venous Vasodilator

Reduces Preload & AfterloadReduces Preload & Afterload

Reduces Work of the HeartReduces Work of the Heart

Improves Cardiac OutputImproves Cardiac Output

CaCa2+2+ Channel Blockers Channel Blockers: Adverse Effects: Adverse Effects

Cardiac DrugsCardiac Drugs

Less severe with oral than intravenous Less severe with oral than intravenous applicationapplication

HypotensionHypotension Severe sinus bradycardia or heart block Severe sinus bradycardia or heart block

(especially with (especially with -blockers)-blockers)

CaCa2+2+ Channel Blockers Channel Blockers: Adverse Effects: Adverse Effects

Cardiac DrugsCardiac Drugs

Less severe with oral than intravenous Less severe with oral than intravenous applicationapplication

HypotensionHypotension Severe sinus bradycardia or heart block Severe sinus bradycardia or heart block

(especially with (especially with -blockers)-blockers)

DIURETICSDIURETICS

Cardiac DrugsCardiac Drugs

Reduce PreloadReduce Preload

Reverse Fluid OverloadReverse Fluid Overload

Reduces Pulmonary CongestionReduces Pulmonary Congestion

VASOPRESSORSVASOPRESSORS

Cardiac DrugsCardiac Drugs

VasoconstrictorsVasoconstrictors Alpha AdrenergicAlpha Adrenergic

Blood PressureBlood Pressure

Heart RateHeart Rate Positive ChronotropicPositive Chronotropic

ANTIDYSRHYTHMICSANTIDYSRHYTHMICS

Cardiac DrugsCardiac Drugs

Heart RateHeart Rate Negative Chronotropic Negative Chronotropic

Slow ConductionSlow Conduction Negative DromotropicNegative Dromotropic

Also Includes: Also Includes: Beta Blockers Beta Blockers Calcium Channel BlockersCalcium Channel Blockers

ANTI-HYPERTENSIVESANTI-HYPERTENSIVES

Cardiac DrugsCardiac Drugs

Presynaptic agents: centrally acting, Presynaptic agents: centrally acting, peripherally acting peripherally acting

Dieuretics Dieuretics

Beta Blockers Beta Blockers

Alpha Blockers Alpha Blockers

Vasodilators Vasodilators

Calcium Entry Blockers Calcium Entry Blockers

Angiotensin Converting Enzyme (ACE) Angiotensin Converting Enzyme (ACE) Inhibitors Inhibitors

GpIIbIIIa InhibitorsGpIIbIIIa Inhibitors

Cardiac DrugsCardiac Drugs

ReoProReoPro Long Half-lifeLong Half-life

IntegrilinIntegrilin

Aggrastat Aggrastat

GpIIbIIIa InhibitorsGpIIbIIIa Inhibitors

Cardiac DrugsCardiac Drugs

ReoPro, Integrilin, AggrastatReoPro, Integrilin, Aggrastat

Monitor Platelet LevelsMonitor Platelet Levels

Check within 4-6 hours after initiationCheck within 4-6 hours after initiation

Monitor daily and prn any bleedingMonitor daily and prn any bleeding

ANTICOAGULANTSANTICOAGULANTS

Cardiac DrugsCardiac Drugs

Heparin – administered by injection

Low Molecular Weight HeparinCan be given on fix-dosed schedule and do not require APTT monitoringLess likely to cause thrombocytopenia

Warfarin – CoumadinRat poisonAntagonist of vitamin K – blocks synthesis of vitamin K dependent factors in coagulation cascadePeak effects take several days

Antiplatelet drugs

THROMBOLYTICSTHROMBOLYTICS

Cardiac DrugsCardiac Drugs

StreptokinasetPA

ANTI-SEPSIS / ANTI-INFLAMMATORYANTI-SEPSIS / ANTI-INFLAMMATORY

Cardiac DrugsCardiac Drugs

Activated Protein C Activated Protein C (Xygris)(Xygris)

May cause bleedingMay cause bleeding

ANTI-LIPIDEMICSANTI-LIPIDEMICS

Cardiac DrugsCardiac Drugs

HDLHDL High Density LipoproteinHigh Density Lipoprotein Associated with Associated with risk risk

LDLLDL Low Density LipoproteinLow Density Lipoprotein Associated with Associated with risk risk

Look at Ratio Look at Ratio HDL HDL LDLLDL

ADENOSINEADENOSINE

Cardiac DrugsCardiac Drugs

Stops supraventricular tachycardiaExtremely short half-life

AMIODARONEAMIODARONE

Cardiac DrugsCardiac Drugs

Amiodarone – Class III potassium channel blockers – delays repolarization – prolongs refractory periodReduced automaticity SA node, reduced conduction thru AV node

DIGOXINDIGOXIN

Cardiac DrugsCardiac Drugs

Positive InotropicPositive Inotropic Increases force of contractionIncreases force of contraction

Negative DromotropicNegative Dromotropic Slows conductionSlows conduction

Negative ChronotropicNegative Chronotropic Slows heart rateSlows heart rate

DOPAMINEDOPAMINE

Cardiac DrugsCardiac Drugs

Positive InotropicPositive Inotropic

Increases contractilityIncreases contractility

Alpha, Beta, & Dopa AdrenergicAlpha, Beta, & Dopa Adrenergic

Dose dependentDose dependent

Positive ChronotropicPositive Chronotropic

May increase heart rateMay increase heart rate

DOBUTAMINEDOBUTAMINE

Cardiac DrugsCardiac Drugs

Positive InotropicPositive Inotropic

Increases contractility (BetaIncreases contractility (Beta1 1 stimulation)stimulation)

BetaBeta11 and Beta and Beta2 2 AdrenergicAdrenergic

VasodilatorVasodilator

Positive ChronotropicPositive Chronotropic

May increases heart rateMay increases heart rate

PRIMACORPRIMACOR

Cardiac DrugsCardiac Drugs

Positive InotropicPositive Inotropic

Increases contractilityIncreases contractility

VasodilatorVasodilator

Acts similar to Dobutamine Acts similar to Dobutamine

EPINEPHRINEEPINEPHRINE

Cardiac DrugsCardiac Drugs

Alpha AdrenergicAlpha Adrenergic

Potent VasoconstrictorPotent Vasoconstrictor

BetaBeta11 and Beta and Beta22 Adrenergic Adrenergic

Positive InotropePositive Inotrope

BronchodilatorBronchodilator

LEVOPHED LEVOPHED (Norepinephrine)(Norepinephrine)

Cardiac DrugsCardiac Drugs

Alpha AdrenergicAlpha Adrenergic

Potent VasoconstrictorPotent Vasoconstrictor

BetaBeta11 Adrenergic Adrenergic

Positive InotropePositive Inotrope

NEO-SYNEPHRINENEO-SYNEPHRINE

Cardiac DrugsCardiac Drugs

Alpha AdrenergicAlpha Adrenergic VasoconstrictorVasoconstrictor

Used for Severe HypotensionUsed for Severe Hypotension

Used for Drug Induced HypotensionUsed for Drug Induced Hypotension

NITROGLYCERINNITROGLYCERIN

Cardiac DrugsCardiac Drugs

Venous & Arterial VasodilatorVenous & Arterial Vasodilator

Dilates Coronary ArteriesDilates Coronary Arteries

NitrateNitrate VasodilatorVasodilator

Preload (primarily)Preload (primarily) Venous CapitanceVenous Capitance SVR (slightly)SVR (slightly) Work of HeartWork of Heart

MORPHINEMORPHINE

Cardiac DrugsCardiac Drugs

Vasodilator (venous)Vasodilator (venous) Pulmonary CongestionPulmonary Congestion

Work of HeartWork of Heart

AnalgesicAnalgesic

Sedative PropertiesSedative Properties

Reduces AnxietyReduces Anxiety

REFLUDINREFLUDIN

Cardiac DrugsCardiac Drugs

CLASSIFICATION• Anticoagulant• Anti-thrombin

USES• AMI• HIT• Venous thrombosis• DVT prophylaxis

ADVERSE EFFECTS• Bleeding• Anemia

ReferencesReferences

Hudak, B., Gallo, B., & Morton, P. (1998). Hudak, B., Gallo, B., & Morton, P. (1998). Critical Care NursingCritical Care Nursing (7th (7th ed.). Philadelphia, PA: Lippincott.ed.). Philadelphia, PA: Lippincott.

Clochesy, J., Breu, C., Cardin, S., Whittaker, A., & Rudy, E. (1996). Clochesy, J., Breu, C., Cardin, S., Whittaker, A., & Rudy, E. (1996). Critical Care Nursing Critical Care Nursing (2nd ed.). Philadelphia, PA: Saunders. (2nd ed.). Philadelphia, PA: Saunders.

American Association of Critical-Care Nurses. (1991). American Association of Critical-Care Nurses. (1991). Core Core Curriculum for Critical Care NursingCurriculum for Critical Care Nursing (4th ed.). Philadelphia, PA: (4th ed.). Philadelphia, PA: Saunders. Saunders.

Knowles, Sherry. (2002-2004). Inservice Handout.Knowles, Sherry. (2002-2004). Inservice Handout.

Cardiac DrugsCardiac Drugs