Pharmacology Blue Print 2

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inotropic durgs

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drugs that influence the force or energy of muscular contractions, particularly the contraction of the heart muscle

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positive inotropic effect

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an increase in the force and velocity of myocardial contraction without a corresponding increase in oxygen consumption-increased force

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negative inotropic effect

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a reduction in the force of a contraction

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chronotropic drugs

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drugs that influence the rate of the heart beat

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positive chronotropic effect

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increase the rate at which the heart beats

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negative chronotropic effect

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decrease the rate at which the heart beats

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Dromotropic dugs

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drugs that influence the conduction of electrical impulses within tissues

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positive dromotropic effect

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accelerate conduction of electrical impulses

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negative domotropic effect

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a decreased automaticity at the sa node

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conduction system of the heart

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the sinoatrial (SA) node, atrioventricular (AV)node, bundle of His, and the Purkinje fibers

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organophosphate insecticide exposure

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this can be treated with the administration of atropine a cholinergic antagonist drug (anticholinergic)

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Cholinergic blocking drugs/parasympatholytics/antimuscarinics/anticholinergic drugs

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drugs that block or inhibit the actions of acetylcholine at the muscarinic receptors in the parasympathetic nervous system which allows the sympathetic nervous system to dominate. They are largely competitive antagonists, have little effect on the nicotinic receptors except in high doses. The block of acetylcholine causes pupils to dilate, decrease GI motility, secretions, and salivation, and may cause an increase in heart rate. Can cause urinary retention, dry mucous membranes, and cause bronchial dilation.

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Atherosclerosis

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a common form of arteriosclerosis involving deposits of fatty, cholesterol containing material (plaques) within arterial walls

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How do nitrates/nitrites work?

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used in the prophylactic and treatment of angina and other cardiac problems by dilating all blood vessels. Vasodilation occurs as a result of relaxation of the smooth muscle cells that are a part of the wall structure of veins and arteries. venous dilation reduces venous return and in turn the left ventricular end-diastolic volume (pre-load), which results in lower left ventricular pressure, and myocardial oxygen demand. include: amyl nitrite, nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate

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indications for nitrates and nitrites

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used to treat stable, unstable and vasospactic (printzmetal) angina. Long acting are used for prevention of angina, and rapid are for acute attacks.

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Adverse effects of nitrates/nitrites

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include headache, tachycardia and postural hypotension

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hyperkalemia

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an excessive serum potassium level exceeding 5.5 mEq/L and is often symptomless until very high levels are present int eh blood. Eventually you will see muscle weakness, electrocardiographic abnormalities, and intractable cardiac rhythm disturbances leading to cardiac arrest. Can be treated with sodium polystyrene sulfonate, sodium bicarbonate, or insulin and glucose. Hemodialysis is also effective

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Sodium polystyrene sulfonate/Kayexalate
aka
cation exchange resin

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administered orally by NG tube or as an enema to treat hyperkalemia. it works in the intestine where potassium ions from the body are exchanged for sodium ions in the resin

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hypokalemia

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a deficiency of potassium which is normally caused by excessive potassium loss rather than from poor dietary intake. normal potassium levels are 3.5-5 mEq/L. symptoms include anorexia, hypotension, lethargy, mental confusion, muscle weakness, nausea, cardiac dysrhythmias, neuropathy, paralytic ileus, and secondary alkalosis. If diagnosed early may be treated with potassium-rich foods but in clinically significant cases oral or parenteral administration of a potassium supplement is needed.

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hyponatremia

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a condition of sodium loss or deficiency and occurs when teh serum levles decrease below 135 mEq/L. Manifests with lethargy, hypotension, stomach cramps, vomiting, diarrhea and seizures. mild cases are treated with oral administration of soidum chloride tablest and or fluid restictions. More serious cases are treated with NS or lactated Ringer's solution administered IV.

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sodium chloride

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primarily used as a replacement electrolyte for either the prevention or treatment of sodium loss, or as a diluent for the infusion of compatible drugs and in the assessment of kidney function after a fluid challenge. Contraindicated for those who are hypersensitive. Pregnancy category C. Adverse reactions: oral-gastric upset, parenteral- venous phlebitis, and death by cerebral edema if hypertonic saline (3% or 5%) is administered too rapidly.

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hypernatremia

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the condition of sodium excess with serum levels exceeding 145 mEq/L. Symptoms are water retention (edema), and hypertension, red, flushed skin; dry, sticky mucous membranes; increased thirst; temperature elevation; and decreased/absent urination.

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potassium supplements

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supplements are administered either to prevent or to treat potassium depletion. Oral forms include acetate, bicarbonate, chloride, citrate and gluconate salts. Parenteral forms include acetate, chloride, and phosphate. The dose will depend on the requirements of the patient. Potassium is contraindicated in patient with severe renal disease, severe hemolytic disease, Addison's disease, those with hyperkalemia, acute dehydration or extensive tissue breakdown from multiple traumas Preg.C. adverse reactions-orally- gi upset including bleeding and ulceration. IV dose usually painful at site, must be administered slowly or can cause cardiac arrest

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cryoprecipitate

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a blood produce used to manage acute bleeding- over 50% blood loss slowly or 20% rapidly

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Fresh Frozen Plasma- FFP

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a blood product used to increase the clotting factor levels in patients with a demonstrated deficiency. product is obtained by centrifuging whole blood and removing the cellular components. not recommended for routine fluid resuscitation, but may be used as an adjunct to massive blood transfusion for patients with coagulation disorders, has a plasma expanding capacity similar to dextran. Caution it may transmit pathogens.

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Packed Red Blood Cells- PRCBs

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a blood product used to increase oxygen-carrying capacity in patients with anemia, in patients with substantial hemoglobin deficits, and in patients who have lost up to 25% of their total blood volume. are obtained by the centrifugation of whole blood and the separation or RBC from plasma and other cellular elements. oxygen-carrying capacity is better than other blood products and are less likely to cause cardiac fluid overload. Disadvantages-high cost, limited shelf life, and fluctuating availability, as well as ability to transmit viruses, trigger allergic reactions, and cause bleeding abnormalities.

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plasma protein fractions- PPF

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a blood product used to manage acute bleeding- over 50% blood loss slowly or 20% rapidly

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Milrinone/Primacor

Pregnancy category c

IV only

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a phosphodiesterase inhibitor (PDI)-an inotropic dug which inhibits the action of the enzyme phosphodiesterase which results in increase cAMP, which is beneficial for pt with heart failure by providing a positive inotropic effect and vasodilation. Should be a used short-term, in contraindicated in cases of known allergy. main adverse effect is dysrhythmias. Adverse effects-cardiac dysrhythmias, hypotension, angina, hypokalemia, tremor, and thrombocytopenia.

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Inamrinone/amrinon

iv onlyf

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a PDI used for short term therapy for heart failure, causes more calcium to be available to help increase the force of contraction. adverse reactions- thrombocytopenia, dysrhythmias, nausea, and hypotension.

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Nitroprusside/Nipride

Pregnancy C

IV only

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relaxes arteriolar, venous smooth muscle resulting in reduction n cardiac preload/after-load, an decreases BP in hypertensive crisis
Adverse effects- dizziness, headache, twitching, can cause cyanide, thiocyanate toxicity, flushing. Black box- hypotension.
Food interactions-aconite will result in increased toxicity or death, licorice will decrease the hypertensive.
Monitor-BP, ECG, electrolytes, check weight, edema, CHF, dilute, keep away from light, if discolored discard. Teach patient to report headache, dizziness, loss of hearing, blurred vision, dyspnea, faintness

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metolazone/zaroxolyn

PO

Pregnancy B

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a thiazide diuretic that appears to be more potent than the thiazide diuretics, most visible in pt with renal dysfunction. it remains effective to a creatinine clearance as low as 10 mL/min. may be given in combo with other loop diuretics to produce potent diuresis in patients with severe symp. of heart failure. Increases risk of digoxin toxicity if taken together. adverse effects- dizziness, headache, decreased libido, gi issues, impotence, jaundice, agranulocytosis, photosensitivity, hyperglycemia. Electrolyte imbalances most common issue. reduces potassium levels, elevated calcium, lipids, glucose, and uric acid.

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carbonic anhydrase inhibitors

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inhibit the activity of the enzyme carbonic anhydrase which is found in the kidneys,eyes, and other parts of the body. Their action primary takes place in the proximal tubule. Can induce metabolic acidosis which is beneficial in the prevention of certain seizures. Used to treat glaucoma, edema, and high-altitude sickness and rarely used as an antiepleptic. Most common is acetazolamide which can be used short term as a diuretic, for glaucoma, and high-altitude sickness.
Contraindicated for those with hyponatremia, hypokalemia, sever renal, or hepatic dysfunction, adrenal gland insufficiency, and cirrhosis. Adverse effects-metabolic acidosis, hypokalemia, drowsiness, anorexia, paresthesias, hematuria, urticaria, photosensitivity, and melena.