REGINE C.

SULIB BSN-II
Cardiovascular system
Anatomy
-Heart is made of four chambers (atria) that communicate with lower chambers
ventricles) via atrioventricular (AV) valves. Blood vessel (arteries, arterioles, capillaries, venules
and veins). There are various circulations (cardiac, pulmonary, systemic, hepatic and fetal in
pregnant woman)
Physiology
-cardiac cycle is a sequence of events that occur as the heart pumps blood through
vessels to the body. Occurs during of a single systole (contractions) and diastole (relaxation) of
the atria and ventricles. It produces heart sounds and a pulse. Cardiac conduction system sends
impulses and controls the heart beat. The blood pressure refers to the pressure of the blood in
the systemic circulation. The cardiovascular system moves blood throughout the body, helps
maintain proper body pH and electrolyte composition and helps body temperature
Inotropic drugs:
Cardiac glycosides
Mechanism of action of Cardiac glycosides inhibits the sodium-potassium activation of
adenosine trophosphate, which regulate the amount of sodium and potassium inside the cell. It
promotes movement of calcium from extracellular to intracellular cyplasm and strengthens
myocardial contractility (positive inotropic action) and it act on the central nervous system to
enhance vagal tone, slowing contarctility through the SA and AV nodes (negative chonotropic
actions). It is absorbed well from GI tract and is distributed widely throughout body; poorly
protein bound. It metabolized by the liver and GI flora and excreted unchanged in urine. Drug
example digoxin (digitek, lanoxicaps, lanoxin). Cardiac glycosides is indicated for heart failure,
atrial fibrillation, atrial flutter, paroxysmal atrial tachycardia. Contraindications and precautions
of Cardiac glycosides are uncontrolled ventricular arrythmiasis, idiopathic hypertrophic
subaortic stenosis , constrictive pericarditis, complete heart blockand is used cautiously in
patients with acute MI because it increases the risk of arrythmiasis .Adverse reaction of Cardiac
glycosides are bradycardia, nausia, vomiting, diarrhea, digoxin toxicity. Nursing responsibilities
before andministering digoxin, asses patients apical pulse, serum drug and electrolyte levels
and renal function; withhold drug and notify practitioner if pulse rate is below 60 beats/minute
or minimum specified by practitioner. continously monitor serum digoxin level and watch for
signs and symptoms of toxicity and dont alternate dosage forms. know that digoxin immune
fab is an antidote for toxicity and know also that reduced dosage is needed in patients with
renal impairment
Phosphodiesterase inhibitors
Mechanism of action Phosphodiesterase inhibitors, increase myocardial contractility
and decrease systemic vascular resistance and venous return, resulting in improved cardiac
output. It is absorbed administer I.V and is distributed rapidly, metabolized by liver (inamirone)
and excreted primarily in the urine. Drug example of Phosphodiesterase inhibitors are
inamirone (inamirol), milrinone (primacor). Indicated for heart failure, waiting for heart
transplant. Contraindications and precautions Phosphodiesterase inhibitors:hypersensitivity to
these drugs or bisulfates, acute MI, severe obstructive aortic or pulmonic valvular disease.
Adverse reaction Of Phosphodiesterase inhibitors are arrythmiasis (ventricular), hypotension,
thrombocytopenia, headache, nausea, vomiting, anorexia, chest pain. Nursing responsibilities
are, closely monitor patients hemodynamic status, monitor patients heart rate, heart rhythm,
and blood pressure frequently, administer I.V drug using an infusion pump; slow or stop
infusion if patients blood pressure drops .
Antiarrythmics
Class I Antiarrythmics
Mechanism of action of Class I Antiarrythmics all class I drugs and substance: block sodium
channels (local anesthetic effect) and slow conduction of electrical impulses. Class IA drugs:
slow depolarization and prolong repolarization . Class IB drugs: normalize depolarization and
shorten repolarization. Class IC drugs: slow depolarization and normalize repolarization. Usually
well absorbed in GI tract oral administration and distribution of highly protein bound.
Metabolized by the liver And excreted in urine Drug example class IA : disopyramide(norpace),
procainamide(pronestyl), quinidine. Class IB: lidocaine (xylocaine), mexiletine (mexitil),
tocainide. Class IC: flocainide (tambocor), propafenone (rythmol). Indicated for ventricular
arrythmiasis, ventricular ectopy, and ventricular tachycardia. Class I Antiarrythmics
contraindications and precautions: complete atrioventricular block,hypersensitivity to these
drugs. Adverse reaction of Class I Antiarrythmics hypotension, heart failure, nausea, vomiting,
diarrhea, palpitions . Nursing responsibilities before giving lidocaine, always check label to
prevent administering from containing epinephrine or preservations. Administering I.V bolus for
ventricular arrythmiasis, followed by continuous I.V infusion, as ordered. Dont administer Class
IA drugs with food unless prescribed. Administer mexiletine or tocainide with food or antacids.
Be aware that disopyramide has anticholinergic effects and monitor QT interval when
administering procainamide .

Class II Antiarrythmics
Mechanism of action of Class II Antiarrythmics decrease symphathetic activity at the SA and AV
nodes, decreasing automaticity and prolonging the refractory period. Well absorbed after the oral
administration; esmolol only avilable I.V and not widely distributed. It is extensive first-pass metabolize
by the liver, emolol metabolized by red blood cells And excreted in urine and feces .Drug example
acebutol (sectral), esmolol (brevibloc), propranol (inderal). Indicated for sinus tachycardia, atrial
fibrilation or flutter. Class II Antiarrythmics contraindications and precautions persistent severe
bradycardia, second- or third-degree heart block, overt cardiac failure, cardiogenic shock. Adverse
reaction of Class II Antiarrythmics fatigue, hypotension, heart failure, bradycardia, arrhythmias heart
block, bronchospasm, GI distress. Nursing responsibilities to instruct patient to watch for signs and
symptoms of fluid retention, advised patient to limit fluid and salt intake to minimize fluid retention.
Inform patient that drugs should be discontinued gradually: abrupt discontinuation may exacerbate
angina symptoms or precipitate MI and monitor ECG continuously when beginning therapy.
Class III Antiarrythmics
Mechanism of action prolonging the action potential and absolute refractory period. The
absorption slow and variable after oral administration. It is widely distributed in fats tissues and liver
highly protien bound. Metabolized extensively by the liver and excreted in bile, amiodarone has longest
half-life of all antiarrythmics . Drug example amiodarone (cordarone), ibutilide (corvert), sotalol
(beytapace AF) . Indicated for recurrent ventricular fibrillation, unstable ventricular tachycardia, atrial
fibrillation and maintenance of normal sinus rhythm. Class III Antiarrythmics contraindications and
precautions are Breast-feeding, Severe sinus node dysfunction, Bradycardia-induced
syncope,Hypokalemia and Heart block . Adverse reaction of Class III Antiarrythmics hypotension,
bradycardia and Pulmonary fibrosis, corneal microdeposits . Nursing responsibilities to dont administer
sotalol unless patient is unresponsive to other antiarrythmiasis and has a life-threatening ventricular
arrhythmia. Asses lung, thyroid and neurologic function in patients receiving amiodarone to ensure
prompt detection of adverse effect. Teach patient to: use artificial tears and sunscreen and wear
protective clothing if taking amiodarone.
Class IV Antiarrythmics
Mechanism of action blocks slow inwards calcium channels, slowing conduction throughout the
AV node. It absorbed rapidly and completely from GI tract after oral adminisrtation and distribution of
highly protein bound. Metabolized by the liver, goes through first-pass metabolism and excreted in
urine. Drug example diltiazen (cardizem, tiazac), verapamil (calan, covera-HS, isoptin SR, verelin).
Indicated for atrial fibrillation and flutter(except when associated with accessory bypass tracts,
supraventricular tachycardias , prinzmetals or variant angina pectoris and hypertension.
Contraindications and precautions of Class IV Antiarrythmics : atrial fibrillation and flutter(except when
associated with accessory bypass tracts, second- or third-degree heart block, overt cardiac failure,
cardiogenic shock.Adverse reaction are dizziness, hypotension, bradycardia, edema, constipation.
Nursing responsibilities to advised patient to change position slowly, encourage patient to increase fiber
intake and if patients is receiving I.V verapamil, monitor blood pressure and ECG continously.