Nursing Responsibilities in Administering Cardiovascular Drugs

NURSING
RESPONSIBILITIES IN
ADMINISTERING
CARDIOVASCULAR DRUGS
AND SUPPORTS
1
PHILIPPINE HEART CENTER – DIVISION OF NURSING EDUCATION & RESEARCH
CARDIOVASCULAR DRUGS
Drugs that affect the function of the heart and
blood vessels are among the most widely used
in medicine.
♥ Although these drugs may exert their primary
effect either on the blood vessels or on the heart
itself, the cardiovascular system functions as an
integral unit.
♥ Thus, drugs that affect blood vessels are often
useful in treating conditions in which the primary
disorder lies in the heart.
2
Definition of terms
Preload – refers to pressure exerted on the
ventricular muscle at the end of diastole by
the volume of blood in the chamber. How
far the myocardium is stretched before it
begins contraction.
Afterload – refers to the pressure the
ventricles must overcome to eject its blood
volume. The resistance encountered by
the heart once contraction begins.
3
Definition of terms
Inotropic drugs (Inotropes)
• Agents that alter the force or strength of the
heart’s muscular contractions.
• Calcium plays an important role in the process of
heart muscle contraction.
• Types:
1. Positive inotropic agents – increase myocardial
contractility
2. Negative inotropic agents – decrease myocardial
contractility
4
Definition of terms
Positive inotropes – used to improve
cardiac function (heart failure)
– Beta-agonists
– Cardiac glycosides
– Phosphodiesterase (PDE) inhibitors
– Calcium-sensitizing drugs
(Levosimendan)
– Glucagon
5
Definition of terms
Negative inotropes - used to decrease
cardiac workload in conditions such as
angina
– Beta blockers
– Calcium channel blockers
– Centrally acting symphatolytics (block
symphatetic activity)
– Class IA antiarrhythmic drugs
(Quinidine, Procainamide)
6
Definition of terms
Chronotropic drugs – drugs that influence
the heart rate by increasing the impulse
generation in the SA node.
Eg.,epinephrine, AtSo4
Dromotropic drugs – drug that increase or
delay the speed of conduction of nerve
fibers. Eg., lidocaine, cordarone,
verapamil
7
COMMON CARDIOVASCULAR DRUGS
AND SUPPORTS
1. Ace Inhibitors
2. Angiotensin Receptor Blockers
3. Beta Blockers
4. Calcium Channel Blockers
5. Diuretics
6. Nitrates
7. Antiplatelet/Anticoagulant/
Fibrinolytic/ Thrombolytic
8
ACE INHIBITORS
• Reduce blood pressure by interrupting
the renin-angiotensin-aldosterone
system (RAAS)
– blocks the enzyme that converts angio I to angio II
in the lungs
• reduce mortality and improve LV
dysfunction in post AMI patients
• delay progression of heart failure
• decrease sudden death and recurrent MI
9
10
ACE INHIBITORS
Examples
 Enalapril (Vasotec)
 Captopril (Capoten)
 Quinapril (Accupril)
 Ramipril (Altace)
11
ACE INHIBITORS
Indications Precautions/
• Hypertension contraindications
• Adjunctive therapy • contraindicated in
for CHF pregnancy and
• Type 2 DM angioedema
• hypersensitivity to
• Decrease
ACE inhibitors
mortality in post-
MI clients • reduce dose in
renal failure
12
ACE INHIBITORS
Cardio-Renal effects
• Vasodilation (arterial and Venous)
– reduce arterial & venous pressures
– reduce ventricular afterload & preload
• Decreases blood volume
– natriuretic
– diuretic
• Depress symphathetic activity
• Inhibit cardiac & vascular hypertrophy
13
ACE INHIBITORS
Practice Pointers:
• Avoid hypotension, especially following initial dose
and in relative volume depletion.
• Captopril, Moexipril, Quinapril & Ramipril will have
reduced absorption if given with food.
• Instruct not to use potassium supplements or any
food & substance that contain large amount of K+.
• Observe for dry cough and hyperkalemia.
• Elderly patients may undergo blood or other testing
to determine kidney function before being
prescribed ACE inhibitors.
14
ANGIOTENSIN RECEPTOR
BLOCKERs (ARBs)
• ARBs prevent (or block) angiotensin II
substance from entering receptors in the smooth
muscles of the heart and blood vessels.
• They have no effect on bradykinin.
• Generally more expensive than ACE inhibitors,
but do not cause the coughing that is a common
side effect of ACE inhibitors.
• More effective in some cases when used in
conjunction with a diuretic.
• Currently, ARBs are primarily used in patients
who cannot tolerate the side effects produced by
ACE inhibitors.
15
BLOCKERs (ARBs)
Action:
Blocks Angiotensin II binding to receptor
blocks vasoconstriction & aldosterone release
decrease Blood Pressure
16
BLOCKERs (ARBs)
Example: Indications:
• Candesartan • Hypertension
• Losartan • Heart Failure
• Telmisartan • Type 2 Diabetes
(Micardis) • Left Ventricular
• Olmesartan Hypertrophy
• Valsartan (Diovan)
• Irbesartan
• Eprosartan
17
BLOCKERs (ARBs)
Practice Pointers:
• Check electrolytes, creatinine and blood
pressure before starting AIIRBs.
• Stop potassium-sparing diuretics and
potassium supplements.
• Stop NSAIDs if possible to minimise risk of
renal impairment.
• Warn patients to lie down for 2-4 hours
because of the risk of first-dose hypotension.
18
BETA BLOCKERS
• Also known as Beta antagonists or beta-
adrenergic blocking agents
• Drugs that block norepinephrine &
epinephrine from binding to beta receptors on
nerves.
• Bind to beta 1 (cardiac) and/or beta 2 (lungs)
adrenergic receptor sites that prevents the
release of cathecolamines
• Decrease myocardial oxygen demand by
decreasing HR, BP, myocardial contractility
and cardiac output.
19
BETA BLOCKERS
Examples
1. Cardioselective 2. Non-selective
 Metoprolol • Carvedilol (Coreg)
(Lopressor)
• Propranolol
 Atenolol
(Tenormin) (Inderal)
 Esmolol • Nadolol (Corgard)
(Brevibloc) • Sotalol (Betapace)
 Acebutolol
(Sectral)
20
BETA BLOCKERS
Indications Precautions/Contraindicat
ions
• Hypertension
• concurrent IV
• Myocardial infarction administration with
and unstable angina calcium channel blocking
in the absence of agents like can cause
complications severe hypotension
• Adjunctive agent with • ↑ hypotensive effects
fibrinolytic therapy when given with diuretics
• Arrhythmias • Sinus bradycardia
• Heart blocks
• Heart failure
• Asthma (Propranolol)
• Diabetes Mellitus
21
BETA BLOCKERS
Practice Pointers:
1. Assess pulse rate before administration of the drug;
withhold if bradycardia is present
2. Administer with food to prevent GI upset
3. Do not administer propanolol to clients with asthma. It
causes bronchoconstriction
4. Do not administer propanolol to clients with DM. It
causes hypoglycemia
5. Give with extreme caution in clients with heart failure
1. Observe for side effects which are as follows:
nausea, vomiting, mental depression, mild diarrhea,
fatigue and impotence
7. Avoid sudden discontinuance of the drug.
22
BETA BLOCKERS
8. You may experience dizziness, lightheadedness,
drowsiness, and blurred vision as your body adjusts to the
medication.
9. Because beta-blockers may reduce blood circulation to the
extremities, your hands and feet may be cold. Dress warm.
Undesirable effects:
Bradycardia
Lipidemia ↑, Libido ↓
BrOnchospasm
CHF, conduction abnormalities
Kinks peripheral vessels
Exhaustion, emotional depression
Reduces recognition of hypoglycemia
23
CALCIUM CHANNEL BLOCKERS
• aka Calcium antagonists
• Inhibit calcium ion transportation into
myocardial cells to depress inotropic and
chronotropic activity, decreasing cardiac
workload.
• Has vasodilation effect and reduces coronary
vasospasm
• ↓ arteriolar constriction
• ↓ PVR
• ↓Blood pressure
24
Example
• Diltiazem (Cardizem)
• Verapamil (Isoptin)
• Calcibloc
• Bepridil (Vascor)
• Amlodipine (Norvasc)
• Felodipine (Plendil)
• Nimodipine (Nimotop)
• Nicardipine (Cardene)
• Nifedipine (Procardia) SR
25
Indications
• to control ventricular rate in atrial fibrillation and atrial
flutter
• use after adenosine to treat refractory PSVT in patients
with narrow QRS complex and adequate blood
pressure
• Hypertension
• Classic chronic stable angina
• Pulmonary hypertension
• Migraine headaches
26
Precautions/Contraindications
• Do not use for wide QRS tachycardia of uncertain
origin or for poison/drug-induced tachycardia
• Avoid in patients with WPW syndrome plus rapid atrial
fibrillation or flutter, in patients with SSS or AV block
without a pacemaker.
• Expect blood pressure drop resulting from peripheral
vasodilatation (greater drop with verapamil than with
diltiazem)
• Avoid in patients receiving oral B-blockers
• Concurrent IV administration with B-blockers can
cause severe hypotension
27
Practice Pointers:
• Monitor hepatic and renal function studies.
• Monitor ECG & avoid giving when heart blocks are
present.
• Encourage client to take drug with meals or milk.
• Use very cautiously with heart failure/ left ventricle
impairment.
• Don't take these medications with grapefruit or
grapefruit juice because they can reduce your liver's
ability to eliminate calcium channel blockers from your
body.
• Don’t abruptly stop the medication.
28
DIURETICS
• Refer to any substance that helps to rid the
body of excess body fluids and salts through
urination
• They work by making the kidneys put more
sodium into urine. The sodium, in turn, takes
water with it from the blood.
• That decreases the amount of fluid flowing
through the blood vessels, which reduces
pressure on the walls of the arteries.
29
Types of DIURETICS
1. Loop: Furosemide (Lasix), Bumetanide (Bumex), Torsemide
(Demadex)
– Inhibit Na (25%), Cl, & H2O resorption in the loop of henle thus ↓
blood volume
– Also increase the excretion of potassium; Potent diuretic
– High-ceiling
1. Thiazide: Hydrochlorothiazide (HCTZ)

– Inhibit Na (5%) resorption and increase Cl, H2O, K+, Ca++, Bicarb,
Mg excretion in the urine; Also cause arterial dilatation; Moderate
diuretic
– Low-ceiling
3. K-sparing: Amiloride, Spironolactone (Aldactone)
– Block Na-K exchange in distal tubule causing loss of Na and
water and retention of K+. Weak diuretic mostly added to
preserve K+.
30
Types of DIURETICS
1. Carbonic Anhydrase Inhibitors: Acetazolamide (Diamox)
– Inhibits the enzyme carbonic anhydrase which normally is
responsible for excreting H+ to combine with HCO3 for
elimination of excess acidity, as well as promoting diuresis.
This drug obviously leads to an increase level of H+ in the
blood (M. Acidosis) and an increased excretion of Bicarb
(HCO3)
– These are the weakest of the diuretics and seldom used in
cardiovascular disease. Their main use is in the treatment of
glaucoma.
1. Osmotic: Mannitol (Osmitrol)
– Increases osmotic pressure of glomerular filtrate, thus
preventing reabsorption of water.
– Increases excretion of sodium & chloride.
– Indicated for oliguria, edema, ↑ ICP,
↑ IOP, treat certain drug toxicities.
31
DIURETICS
Indications Precautions/
• adjuvant therapy for Contraindication
pulmonary edema in • Dehydration
patients with systolic BP • Hypovolemia
>90 to 100 mmHg • Hypotension
(without signs and
symptoms of shock) • Hypokalemia or other
electrolyte imbalance
• hypertensive
emergencies
• Heart failure
• increased intracranial
pressure
32
DIURETICS
Practice Pointers:
• It is best to give diuretics early in the
morning and early afternoon.
• Monitor weight, BP, and HR.
Furosemide can lead to profound water
and electrolyte depletion.
• Monitor I and O, and electrolytes.
• Watch out for signs of hypokalemia
such as muscle weakness and cramps.
33
DIURETICS
Practice Pointers:
• Administer IV Lasix slowly because
hearing loss can occur if given rapidly.
• Hypercalcemia is more likely to develop
so never administer Thiazides to patient
with hypercalcemia
• Eat foods rich in potassium, use
sunscreen, and change position
slowly.
34
NITRATES
• Nitrates are used to treat the chest pain
associated with angina and to ease the
symptoms of congestive heart failure (CHF).
• Nitrates are vasodilators. Vasodilators widen
(dilate) the blood vessels, improving blood flow
and allowing more oxygen-rich blood to reach
the heart muscle.
• Nitrates also relax the veins. If less blood is
returning to the heart from the arms and legs, it
eases the workload on the heart.
35
NITRATES
• Examples • Indications
• Nitroglycerine • initial antianginal for
• (Nitrostat/transderm suspected ischemic
patch/nitro ointment) pain
• Isosorbide dinitrate • for initial 24 to 48
(isordil) hours in patients with
• Isosorbide AMI and CHF, large
mononitrate (imdur) anterior wall
infarction, persistent
or recurrent ischemia
or hypertension
36
NITRATES
• Do not mix with other drugs.
• Patient should sit or lie down when receiving
this medication.
• Do not shake aerosol spray because this
affects metered dose.
• Hypotension
• Severe bradycardia or tachycardia
• RV infarction
• Do not mix with Viagra.
37
NITRATES
Practice Pointers:
• Assume sitting or supine position when taking the
drug to prevent orthostatic hypotension.
• Take maximum of three doses at 5 minute interval.
• If taken sublingual, the medication causes burning
or stinging sensation under the tongue.
• Sublingual route produces onset of action within 1
to 2 minutes, duration of action is 30 minutes.
• Offer sips of water before giving sublingual
nitrates; dryness of mouth may inhibit absorption.
• Instruct patient to always carry 3 tablets in his
pocket.
38
NITRATES
Practice Pointers:
• Store nitroglycerine in cool, dry place; use dark
colored air tight container. Change stock of
nitroglycerine every six months.
• Observe for side effects: headache, flushed face,
dizziness, faintness, tachycardia; these are
common during first few doses of the medication.
Do not discontinue the drug.
• Transderm patch is applied once a day,
usually in the morning. Rotation of skin
sites is necessary, usually on the
chest wall.
39
Antiplatelet/ Anticoagulant/
Fibrinolytics/ Thrombolytics
Aspirin IV Antiplatelet drugs
• Ticlopidine(Ticlid) (Gycoprotein IIb/IIa
• Clopidogrel (Plavix) inhibitors)
• Dipyridamole • Abciximab (Reopro)
(Persantin) • Tirofiban (Aggrastat)
• Cilostazol (Pletaal)
Thrombolytics /
Anticoagulants Fibrinolytics
• unfractionated or • Streptokinase
regular heparin • Tissue Plasminogen
• low molecular weight Activator (TPA IV)
(Fraxiparine)
•
• Urokinase IV
warfarin (Coumadin)
40
Aspirin/ASA
Action
 Analgesic
 Antipyretic
 Anti-inflammatory
 Antiplatelet / anti-clotting – Blocks
formation of thromboxane A2,
which causes platelets to
aggregate & arteries to constrict.
aka acetylsalicylic acid (ASA)
41
Aspirin/ASA
Indications
• administer to all patients w/ ACS
particularly reperfusion candidates
unless hypersensitive to aspirin
• blocks formation of thromboxane A2,
which causes platelets to aggregate,
arteries to constrict. This reduces overall
AMI mortality, re-infarction, nonfatal
stroke.
• Any person with symptoms (“pressure,”
“heavy weight,” “squeezing”)
42
Aspirin/ASA
Precautions/Contra- Practice Pointers:
indications • assess for signs and
• Active ulcer disease symptoms of bleeding
• Asthma • avoid straining at stool
• Hypersensitive to • do not give ASA with
aspirin coumadin
• Bleeding disorders • ASA should be given
• Renal and hepatic with food
disorders • Observe for toxicity
• Influenza (tinnitus)
• Pregnancy
• Lactation
43
Glycoprotein IIb/IIIa inhibitors
• These drugs inhibit the integrin glycoprotein
IIb/IIIa receptor in the membrane of platelets,
inhibiting platelet aggregation and thrombus
formation.
• Indicated for ACS without ST segment
elevation
• Frequently used during percutaneous
coronary interventions (angioplasty with or
without intracoronary stent placement).
• They should be given intravenously.
• Potent platelet inhibitors
44
Glycoprotein IIb/IIIa inhibitors
• active internal bleeding or bleeding disorder in past 30
days
• history of intracranial hemorrhage or other bleeding
• surgical procedure or trauma within 1 month
• platelet count <150,000/mm3
• hypersensitivity and concomitant use of another GP
IIb/IIIa inhibitor
Practice Pointers:
• Before, during, and after this medicine is taken,
patients should have blood tests that indicate platelet
count and clotting time of the blood.
• Assess for presence of bleeding.
45
Anticoagulant: Heparin Sodium
• Inhibits the Intrinsic Factors, making
them slower to respond, which makes
clotting more difficult and less extensive.
• Partial Thromboplastin Time (PTT)
measures the speed of collection of
these factors, thereby measuring the
effectiveness of Heparin.
46
Anticoagulant: Heparin Sodium
Practice Pointers:
• Assess for signs and symptoms of bleeding
• Keep protamine sulfate available. It is the
antidote of heparin Na.
• If administered subcutaneously, do not
aspirate, do not massage to prevent
hematoma formation
• Monitor APTT or PTT levels
• Use for a maximum of 2 weeks
47
Anticoagulant: Coumadin
• Interferes with the hepatic synthesis of
Vitamin K-clotting factors (II, VII, IX & X)
• aka Warfarin
Indications
• Deep vein thrombosis prophylaxis
• To prevent complications of heart-valve
replacements
• Atrial arrhythmias
48
Anticoagulant: Coumadin
Practice Pointers:
• Assess for sign and symptoms of
bleeding
• Keep vitamin K readily available. It is the
antidote of Coumadin
• Monitor Prothrombin time
• Minimize green leafy vegetables in the
diet. These contain vitamin K.
49
AGENTS USED IN
FULL
CARDIAC ARREST
50
Agents Used in Full Cardiac Arrest
• Oxygen
• Epinephrine
• Atropine Sulfate
• Anti-arrhythmic Agents
• Sodium Bicarbonate
• Morphine Sulfate
51
Oxygen
 An element, a gas and a drug
Mechanism of Action
 elevates arterial O2 tension including
arterial O2
Indications
 chest pain due to cardiac
ischemia
 hypoxemia
 cardiac arrest
52
Oxygen
Practice Pointers:
• A physician’s order is required.
• Do not change the flow rate of oxygen unless directed
to do so by the physician.
• Periodic assessment and documentation of oxygen
saturation levels is required.
• If the patient is using a mask or a cannula, gauze can
be tucked under the tubing to prevent irritation of the
cheeks or the skin behind the ears.
• Water-based lubricants can be used to relieve dryness
of the lips and nostrils.
53
Atropine Sulfate
Mechanism of Action
• parasympatholytic drug
• enhances both sinus node automaticity and atrioventricular
conduction via its direct vagolytic action
Indication
• severe sinus bradycardia
• AV blocks (1st degree AV block or mobitz type)
Dosage
• 0.5 – 1 mg
• Max of 2 – 3 mg
Nursing Responsibilities
• assess if patient has glaucoma/BPH
• relieve mouth dryness
54
Epinephrine
Mechanism of Action
• increases HR and myocardial oxygen requirements
• increases automaticity
• improves coronary and cerebral perfusion pressure due
to its peripheral vasoconstriction effects
Indications
• Bronchospasm, hypersensitivity reaction
• Cardiac arrest
• Ventricular fibrillation
• Pulse less Ventricular tachycardia
• Asystole
• Severe hypotension
55
Epinephrine
Dosage:
• bolus: 1 mg every 3-5 minutes
• drip: 30 mg in 250 cc D5W
Practice Pointers:
• take BP, HR
• assess signs of shock
• teach patient to take pulse
• difficulty in voiding in male patients
• don’t mix with bicarbonate
56
Antiarrhythmic Agents (Lidocaine)
Mechanism of Action
• local anesthetic
• antiarrhythmic agent
• suppresses ventricular arrhythmias by
decreasing automaticity
Indication
• Vtach, Vfib, Cardiac arrest
Dosage
• bolus: 0.5 -3 mg/kg
• drip: 2 – 4 mg/min
57
Antiarrhythmic Agents (Lidocaine)
Practice Pointers:
 watch out for signs of lidocaine induced
neurological toxicity
 correct K+ level first to reach its maximum
effect
 Do not use if solution is pinkish or darker than
slightly yellow or if it contains a precipitate.
 XYLOCAINE Parenteral Solutions without
preservative are for single use only. Discard
unused portion
 The multidose vials should not be used for more
than three days after the container has been
opened for the first time.
58
Sodium Bicarbonate
Mechanism of Action
• clinically widely used buffer agent
• dissociates to sodium and bicarbonate ions
• in the presence of hydrogen ions, these are
converted to carbonic acid and hence to CO2
which is transported to and excreted by the
lungs
Indications
• metabolic acidosis
• hyperkalemia
• prolonged cardiac arrest
59
Sodium Bicarbonate
Practice Pointers:
 determine ABG especially pH and
CO2 content
 ensure IV line is patent, extravasation
to tissues may cause sloughing and
necrosis
 not to be mixed with dopamine and
calcium elements
 ensure that serums K+ and
Ca++ is adequate
60
Morphine Sulfate
Mechanism of Action
• increases venous capacitance and reduces systemic
vascular resistance, relieving pulmonary congestion
• reduces intramyocardial wall tension which
decreases myocardial myocardial oxygen
requirements
Indications
• AMI
• Acute cardiogenic pulmonary edema
Dosage
• 1 – 3 mg IV push (1 – 5 minutes)
61
Morphine Sulfate
Practice Pointers:
1. Monitor patient’s parameters.
2. Give the drug regularly as ordered to prevent pain
rather than to treat pain after it occurs.
3. Teach patient to turn, cough and breathe deeply every
two hours to prevent atelectasis.
4. Inform patient that drug may cause constipation. Stool
softener, fiber laxative, increased fluid intake and bulk
in diet may help alleviate problem.
5. Caution patient to avoid sudden position changes to
prevent orthostatic hypotension.
6. Instruct patient to avoid intake of alcoholic beverages
and other CNS depressants.
62
Inotropic Agents
▪ Norepinephrine
▪ Dopamine
▪ Dobutamine
▪ Lanoxin
63
Inotropic Agent: NOREPINEPHRINE
Mechanism of Action
• naturally occurring catecholamine
• potent peripheral vasoconstrictor (alpha receptor
stimulating agent) resulting to increase in BP
• powerful inotropic agent (beta receptor
stimulating agent) which increases myocardial
contractility
Indications
• hypotension
• cardiogenic shock
• GI bleeding
64
Inotropic Agent: NOREPINEPHRINE
Practice Pointers:
 Correct hypovolemia prior to infusion
 Monitor BP closely preferably via A-line
 Titrate gradually to avoid abrupt and severe
hypotension
 Infuse through a central line to prevent exravasation
and necrosis
 Don’t mix with other drugs; incompatible with
alkaline solutions.
 Administer continuous drip on infusion pump
 Must be diluted in dextrose containing solutions
prior to infusion
 The infusion site should be checked frequently for
free flow.
65
Inotropic Agent: DOPAMINE
Mechanism of Action
• chemical precursor of norepinephrine that
stimulates dopaminergic, beta adrenergic and
alpha adrenergic receptors.
 Produces positive chronotropic and inotropic
effects on the myocardium, resulting in increased
heart rate, cardiac contractility & blood pressure.
 However, because dopamine cannot cross the
blood-brain barrier, dopamine given as a drug does
not directly affect the central nervous system.
66
Indications: Dopamine is given to correct
hemodynamic imbalances present in:
 Shock syndrome due to AMI
 Hypovolemia
 Trauma
 Hypotension with symptomatic bradycardia
 Endotoxic septicemia
 Open heart surgery
 Renal failure
 Chronic cardiac decompesation (CHF)
67
Low dose (1-5) renal vasodilation.
 Causes renal, mesenteric and
cerebrovascular dilation. Tends to produce
an increase in renal output.
Moderate dose (5-10) cardiac dose.
 Enhances myocardial contractility increased
cardiac output an rise in BP.
High dose (10-20) vasopressor dose.
 Produces peripheral arterial and venous
vasoconstriction.
68
Practice Pointers:
• Correct hypovolemia before treatment.
 Monitor heart rate & rhythm, BP, urine output
 Taper gradually to avoid acute hypotension
 Care should be taken to control the rate of infusion so
as to avoid inadvertent administration of a bolus of
drug.
 Watch out for nausea and vomiting
 Do not mix with alkaline solution; don’t
give through the same line.
 Administer continuous drip on infusion pump.
 Give drug into a large vein to prevent extravasation.
69
Inotropic Agent: DOBUTAMINE
Mechanism of Action
 It is a direct-acting inotropic agent whose
primary activity results from stimulation of the b-
receptors of the heart.
 Improves myocardial contractility, increases
cardiac output, decreases ventricular filling
pressure, decreases total systemic and
pulmonary vascular resistance
 Increases renal blood flow due to increased
cardiac output
 short-term therapy
70
Inotropic Agent: DOBUTAMINE
Indications
 Tx of CHF
 AMI
 Cardiogenic shock
 Septic shock
Practice Pointers:
 monitor for tachycardia and presence of arrhythmia
 monitor BP
 Hypovolemia should be corrected prior to the
initiation of treatment with dobutamine.
 not to be mixed with other drugs in the same
71
Inotropic Agent: LANOXIN
Mechanism of Action
 increases myocardial contractility
 controls ventricular response to atrial flutter and
fibrillation
Preparation
 available as a 0.05 mg/mL oral solution and 0.25
mg/mL or 0.5 mg/mL injectible solution.
Digitalization
 special dosing regimen involving "loading doses"
used to rapidly increase digoxin plasma levels
 the therapeutic plasma concentration range
is 0.5 - 1.5 ng/ml.
72
Therapeutic Uses of Digitalis Compunds
Heart Failure Arrhythmias
• ↑ inotropy • ↓ AV nodal
• ↑ ejection fraction conduction
• ↓ preload • ↓ ventricular rate
• ↓ pulmonary in atrial flutter
congestion/edema
and fibrillation
73
In selecting a dose of digoxin, the following factors
must be considered:
• The body weight of the patient. Doses should be
calculated based upon lean (i.e., ideal) body weight.
• The patient's renal function, preferably evaluated on the
basis of estimated creatinine clearance.
• The patient's age. Infants and children require different
doses of digoxin than adults. Also, advanced age may be
indicative of diminished renal function even in patients
with normal serum creatinine concentration (i.e., below
1.5 mg/dL).
74
Practice Pointers:
 monitor for severe bradycardia
 watch out for rhythm and ECG changes,
ventricular dysrrhythmias and AV blocks
 monitor for renal dysfunction and electrolyte
imbalances
 Lean, elderly patients are more susceptible to
digitalis toxicity because they often have reduced
renal function, and their reduced muscle mass
increases plasma digoxin levels at a given dose
because muscle Na+/K+-ATPase acts as a large
binding reservoir for digitalis.
75
MISSED DOSE?
General principle:
• If you forget to take one or more doses:
take your next dose at the normal time and
in the normal amount. Do not take any
more than your doctor prescribed.
• If you miss one dose, skip it and continue
with your normal schedule.
• Avoid playing “catch-up””
76

Nursing Responsibilities in Administering Cardiovascular Drugs

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Nursing Responsibilities in Administering Cardiovascular Drugs

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NURSING

blocks vasoconstriction & aldosterone release

decrease Blood Pressure

1. Thiazide: Hydrochlorothiazide (HCTZ)

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