CARDIOVASCULAR

PHARMACOLOGY
Definition of terms:

PRE-LOAD – How far the myocardium is stretched before it begin

contraction. (DIASTOLE)
Ex. Nitroglycerin

AFTERLOAD – The resistance (LOAD) encountered by the heart one

contraction begins (SYSTOLE).
Ex. Digitalis

INOTROPICS – Drugs that affect or increase myocardial contractility.

DROMOTROPICS – Refers to conduction, positive speed of conduction,

delays conduction.
Ex. Lidocaine, Verapamil, Cordarone
CHRONOTROPICS – Increase impulse generation in the SA node.
Ex. Epiniphrine, AtSO4

ADVERSE EFFECT – Predictable effects of drugs.

SIDE EFFECTS – not known.

TOXIC EFFECT – Unpredictable adverse effect. ( Overdose, liver failure)

*prolonged use of drugs.
 MAJOR CARDIOVASCULAR PHARMACOLOGY

Agents used in full cardiac arrest.

1.OXYGEN
ACTIONS:
A. First drug to use for respiratory compromise.
B. Essential for cellular metabolism and survival.

INDICATIONS:
A. Use in any suspected cardiopulmonary emergency.
B. Use with any complaints of shortness of breath.
C. Use for any patient complaining of chest pain.
D. For any suspected hypoxemia.

SUPPLIED:
* Deliver at 100%concentration from portable tanks, or
from wall-mounted sources through delivery devices.
* Various delivery devices give the ff. percentages of oxygen.
PRECAUTIONS:
A. Do not with hold oxygen from anyone who might need it.
B. Observe closely when using on the rare patient dependent on
hypoxic respiratory drive. (be prepared to ventilate patient’s lungs).

 CONVERSIONS
From O2 to L/min and FIO2
FIO2 to L/min = present FIO2
-20/4
Example: if the doctor ordered for FIO2 of 60%
60%-20 = 10lpm
4
L/min to FIO2% = L/min x 4 + 20
Example: 10L/min X 4 + 20 = 60% FIO2
2. EPINEPHRINE

ACTIONS
 The drug of choice for patients in cardiac arrest.
 Raises blood pressure by constricting the peripheral blood vessel .The
vasoconstrictive actions improves coronary blood. flow and increase
the chance for survival.
 In bradycardic patients, epinephrine increases the heart rate by
increasing electrical activity in the myocardium and the intrinsic
cardiac automaticity ( chronotropic effect); also increases myocardial
O2 consumption.

SUPPLIED
 Glass ampule at 1mg/ml.
 Drip 30mg in 250cc D5W at 100cc / hr.
PRECAUTIONS
.
 Can elevate the BP and induce or exacerbate ventricular ectopy and VT
or VF.
 Patient who are taking digitalis much more likely to have toxic side
effects from epinephrine.
3.ATROPINE SULFATE

ACTIONS
 Acts as para sympatholytic, vagolytic and anti cholinergic drug.
 Benefits conditions with excess vagal activity.
 Increases SA node automaticity and AV conduction when
suppressed by abnormal parasympathetic or vagal discharges .
 Not effective for asystolic conditions that lack a vagal component
.

INDICATIONS
 Symptomatic bradycardia.
 Sinus arrest.
 1st and 2nd degree AV block.
SUPPLIED
DOSE:
 For cardiac arrest patient give 1mg repeat every 3-5 mins to a maximum
dose of 3mg.

PRECAUTIONS

• Do not give doses lower than 0.5mg. Can produce slowing of heart rate
rather than speeding it up .
• Can produce tachycardia.
• Can precipitate VF or VT.
• Can increase angina and chest pain to patient with coronary artery or
ischemic heart disease.
• Can cause anti cholinergic syndrome that occurs in overdosage.
• Avoid in hypothermia.
 ANTI ARRYTHMIC AGENTS
A. LIDOCAINE
ACTIONS
 Increases the amount of current needed to cause fibrillation (raises
fibrillation threshold); decrease the amount of current needed for
defibrillation ( lowers the defibrillation threshold).
 Decreases excitability in ischemic tissue.
 Suppresses ventricular irritability.

RECOMMENDED
1. Cardiac arrest resulting from VF/VT.
 Administer after initial defib shocks, intubation, and epinephrine.
2. Stable perfusing VT.
3. AMI patients with new- onset symptomatic ventricular ectopy.
SUPPLIED
 Preload 5ml syringe with 20mg/ml; total= 100mg.
 Also in 5ml vial of 10mg/ml; total of 50mg.

DOSE: bolus 0.5-3mg/kg

DRIP: 30-50mcg/kg/min or continue if circulation returns at
2-4mg/min.

PRECAUTIONS:
 Watch out for lidocaine toxicity (disorientation, seizures,respiratory
compromise).
 Watch out for lidocaine heart block.
B. VERAPAMIL

ACTIONS
 Slows down conduction and prolong refractoriness therefore causing
coronary vasodilation.

INDICATIONS:
 Use for narrow –complex SVT (PSVT) that have not responded to vagal
maneuvers.
 Use only if the PSVT remains narrow and the patient is not
hypotensive.
 Can convert wide-complex tachycardias that are SVT in origin. Use
verapamil if the blood pressure is normal or elevated.

SUPPLIED
2.5mg/ml
( DO NOT MIX WITH FUROSEMIDE BECAUSE IT WILL LOST ITS
POTECY).
 MISCELLANEOUS DRUGS

SODIUM BICARBONATE

ACTIONS:
 Acts as a buffer agent administered to neutralize hydrogen ions.

INDICATIONS:
 Tissue acidosis
 Pre exsisting hyperkalemia.
 Patient remains in cardiac arrest, despite successful intubation and
effective ventilations and chest compressions.
 Patient achieves return of spontaneous circulation after a long arrest
interval.
SUPPIED:

 50ml pre loaded syringe (8.4% sodium bicarb @ 50meq/50ml).

DOSE
 1mEq/kg IV bolus then depending on ABG result thereafter.

PRECAUTIONS:
 Watch out for respiratory depression.
 Observe for hypotension.
 Sodium bicarbonate can produce a variety of side effects including the
ff:
- Mixed venous intracellular acidosis.
-Hyper osmolality
-hyper natremia
-Metabolic alkalosis
- Acute hypokalemia
 INOTROPICS AGENTS

DOPAMINE

ACTIONS:
 Asympathomimetic, natural catecholamine. Depending on
dose,dopamine stimulates different adrenergic receptors. The different
receptors produce diff effects: increase renal output;increase cardiac
contractility;increse blood pressure.

 works on the “tank” portion (producing vasocontrictions and a smaller

tank) and on the “pump” portion ( leading to stronger cardiac action).
INDICATIONS:

 Post resuscitation hypotension. Use dopamine in vasoppresor doses

(10-20ug/kg/min) to treat (transient hypertension is the goal).
 Cardiogenic shock, cardiac failure. Should be combined with
vasodilators (nitroglycerin and nipride) to reduce preload and improve
cardiac output. The vasodilators antagonize the arterial and venous
constriction caused by the dopamine.

DOSE:
Low dose : 1-2mcg/kg /min - “renal dose”
medium dose: 2-10mcg/kg/min - “cardiac doses”
large dose: 10mcg/kg/min - “vasopressor doses”

PRECAUTIONS:
 Do not mix with NaHCO3 or any alkaline sol’n as this will inactivate
dopamine.
 Taper gradually ( over several hours) to avoid sudden drop of BP.
.
 Watch out for excessive increases in cardiac rate .(may induce SVT or
ventricular arrhythmias).
 May induce angina and ischemic changes in people with severe
coronary artery disease.
 May cause tissue necrosis and sloughing. If local skin infiltration
occurs.
 May aggravate pulmonary congestion in people with heart failure.
 Patient taking dilantin may experience excessive hypotension with
dopamine.
.
 DOBUTAMINE
ACTIONS:
 Increases contractility of the heart.
 Mild peripheral vasodilation ( decreases afterload).

INDICATIONS:
 Use for pump problems such as pulmonary edema and CHF.

SUPPLIED: 250mg /20ml mix it with D5W 250ML or NSS.

DOSE:
 Infusion rate is usually between 2 and 20 mcg/kg /min.
 Titrate so that heart rate does not increase greater than 10% baseline.
 Requires hemodynamic monitoring for optimal use.
NITROGLYCERIN
 ACTIONS:
• Dilates venous capacitance vessels.
• Inhibits venous return to the heart (reduces preload).
• Decreases systemic vascular resistance and facillatates
cardiac emptying (reduces afterload).
• Decreases myocardial O2 consumption.
• Dilates coronary arteries.
INDICATIONS:
 Chest pain or suspected cardiac origin.
 Unstable angina.
 Acute pulmonary edema.
 CHF.
 Hypertensive crisis or urgency with chest pain.
 Elevated BP in setting of AMI.

SUPPLIED
 0.3-0.4mg sublingual tablet (1 tab q 5min x 3tabs).
 Ampules 5mg in 10ml, 8mg in 10ml, 10mg in 10ml.
 Vials: 25mg /5ml 50mg/10ml mix in 250ml of D5W.
PRECAUTIONS:

 Observe for orthostatic hypotension.

 Store tablet in dark container.
 Watch out for headache, excessive drop of BP syncope, and
tachycardia.
 Instruct the patient to sit or lie down.

DIURETICS

ACTIONS:
 Inhibits reabsorption of sodium chloride in the loop of Henle.
 Reduces venous return.
INDICATIONS:

 Pulmonary congestion associated with left ventricular dysfunction.

 Hypertensive emergencies and urgencies.
 Hypercalcemia severe.
 Patients with massive fluid retention or renal insufficiency or both.

PRECAUTIONS:
 Can produce hyponatremia , hypokalemia, hypovolemia,
hyperuricemia, tinnitus.
 Monitor BP, electrolytes, BUN, creatinine and uric acid levels.
 Check the weight daily.
 Standard dose of drug
concentration
 DOPAMINE HCL - 200mg/250cc D5W

 DOBUTAMINE - 250mg/250cc D5W

 LIDOCAINE - 1g/1000mg in 250 D5W

 ISOKET - 10mg in 90cc D5W or NSS

 EPINEPHRINE - 30mg in 250 D5W

REMINDERS:
1.If the patient is intubated, check the ET level. It should be at the
second and third tracheal ring ( 1 to 2 cm above the carina).
2. ET size of 7 – 8 multiplied by 3 = 21 – 24 level
Inflate the balloon 8 – 10 cc of air. For tracheostomy, 5 cc of air.
3.Increase CO2 – Increase RR, PEEP, I/E ratio and TV
4.Decrease HCO3 – give NaHCO3 (alkalosis)
5.Increase HCO3 – check urine
ASSESSING INCREASE ICP
vomiting- pressure from medulla oblongata it maybe projectile.
diplopia- pressure from the CN VI (abducens)which controls lateral
rectus muscles of the eyes.
anisucoria- due to cranial nerve III compression.There is ipselateral
pupil dilation.
pinpoint -indicate pones involvement.
fixed dilated- uncal hernation.
decrease LOC-due to affection of ascending reticular activating
system.
“Knowledge is not simply another commodity. On the
contrary. Knowledge is never used up. It increases by
diffusion and grows by dispersion.”

Daniel J. Boorstin

Thank you and Good Day!

Maria Cristina S. Alteran RN MN