Pharmacology-1

increase force of myocardial contraction

heart muscle failure

• cardiac glycoside (digoxin)
• phosphodiesterase inhibitor

heart unable to pump blood in sufficient amt from ventricles to meet body metabolic needs

Digoxin comes from foxglove plant and used in heart failure to control ventricle response to A Fib or flutter

• increase contractility
• decrease rate of electrical conduction
• prolong refractory period (between SA node/AV node)
• results in decrease HR/improve cardiac efficiency

changes rate of heartbeat

change conduction of electrical impulses

increase force/velocity of contraction w/o increase of O2 consumption

reduce heart rate

• decrease automaticity at SA node
• decrease AV nodal conduction

• increase stroke volume
• reduction in heart size at diastole
• decrease venous BP / vein engorgement
• promotion of diuresis d/t improve blood circulation

• narrow therapeutic window-toxicity
• low potassium levels increase toxicity
• dysrhythmia (brady/tachycardia),
• headache, fatigue, confusion, convulsion
• colored vision/halo vision, flickering lights
• anorexia, nausea, vomit, diarrhea

digoxin immune Fab

• hypokalemia, hypercalcemia
• cardiac pacemaker
• hepatic dysfunction
• dysrhythmia
• hypothyroid/respiratory/ or renal disease
• advanced age

inhibit enzyme phosphodiesterase giving a positive inotropic response and vasodilation

• inamrinone
• milrinone

• short term management of heart failure
• no response to digoxin, diuretics, and/or vasodilator

• Inamrionon: thrombocytopenia, dysrhythmia, nausea, hypotension, elevated liver enzyme w/ long term use
• milrinone: dysrhythmia, hypotension, angina, tremor, thromboycytopenia, hypokalemia

potassium, sodium, magnesium, calcium, renal/liver fxn

• apical pulse < 60 or > 120 bpm
• toxicity (s/s: anorexia, nausea, vomit, diarrhea, blur vision, halo lights, flickering)

binds with medication

report >2 lb in 1 day or > 5 lb in 1 week

• do not mix glucose with IV inamrinone
• IV inamrinone soln is true yellow in color

• increase urine output
• decrease edema, SOB, dyspnea, crackles, fatigue
• resolve NOC dyspnea
• improve peripheral pulse, skin color, temp

any deviation from normal rhythm of heart

used for tx and prevention of disturbances in cardiac rhythm

change in distribution of ions that cause cardiac cells to become excited. the movement of ions across cells membrane that results in electrical impulse across cardiac cell and leads to contraction of myocardial muscle.

• supraventricular
• ventricular
• ectopic foci
• conduction block

system used to classify antidysrhythmic drugs based on the drug and how it effects action potential

• class 1 drug: moricizine - characteristic of all 3 classes and use for life threaten dysrhythnmia .
• membrane stabilizing drug,
• fast sodium channel blocker
• 1a) quinidine, procainamide, disopyramide : block sodium channel, delay repolarization, incrase APD (use for A fib, vent tachycardia)
• 1b) mexiletine, phenytoin, lidocaine: block sodium channel, accelerate repolarization, increase/decrease APD (use for vent dysrhythmia ONLY)
• 1c) flecainide, propafenone: block sodium channel, (use for severe vent dysrhythmia, A fib, supraventricular tachycardia dysrhthymia)

• Drugs: Beta blockers (atenolol, esmolol, metaprolol, propranolol)
• action: they reduce/block SNS stimulation and reduce transmission of impulse in conduction system, depress phase 4 depolarization

• drugs: amiodarone, sotalol, ibutilide
• action: increase APD, prolong repolarization in phase 3
• use: dysrhythmia difficult to treat (life threaten vent. tachycardia or flutter, resist to other drug, sustain vent. tachycardia)

• drugs: verapamil, diltiazem
• action: calcium channel blocker that inhibit slow channel pathway, depress phase 4 depolarization, reduce AV node conduction
• use: paroxysmal supraventrical tachycardia, rate control for A fib and flutter

• Adensosine (adenocard)
• digoxin

slow conduction through AV node and convert paroxysmal supraventrical tachycardia to sinus rhythm

fast IV push (1/2 life < 10 sec)

asystole for few seconds

dysrhymia, nausea, vomit, diarrhea, dizziness, blur vision, headache

• baseline I/O, BP, P, cardiac rhythm
• measure serum potassium at start
• assess for contraindication
• monitor for toxicity (SOB, edema, dizziness, syncope, chest pain, GI distress, blur vision)
• if dose missed call doctor
• dont crush/chew medication
• class 1: monitor ECG for QT interval prolong > 50%
• IV infusion w/ pump
• lidocaine soln w/ epinephrine NOT given w/ IV only as local anesthetic

• decrease BP, decrease edema, fatigue
• regular HR w/o major irregularities
• improved regularity of rhythm and cardiac output

chest pain brought on when O2 supply and nutrients in blood is insufficient to meet demands of heart

poor blood supply to an organ

poor blood supply to heart muscle (atherosclerosis, coronary heart disease)

necrosis or death of cardiac tissue that is disabling or fatal

• chronic stable /classic / effort
• unstable / preinfarction / crescendo
• vasospastic / prinzmetal's/ variant

• nitrates(nitrites)
• beta blockers
• calcium channel blockers

• increase blood flow to ischemic heart muscle
• decrease myocardial oxygen demand
• minimize frequency of attacks
• decrease duration/intensity of anginal pain
• improve pt fxn capacity with few side effect
• prevent / delay worst outcome (MI)

• sublingual
• buccal
• chewable tab
• oral tab/capsule
• IV soln
• ointment
• TD patch
• TL spray

vasodilation d/t relaxation of smooth muscle

prevention/tx of angina

• rapid acting: tx of acute anginal attack, sublingual or IV
• long acting: use for prevention of anginal episodes

• large first pass effect with oral form
• used: symptomatic tx of ischemic heart condition (angina)
• IV form use: BP control perioperative, hypertension, tx of CHF, ischemic pain, pulm edema assoc w/ acute MI, hypertensive emergency

• nitroglycerin
• isosorbide dinitrate (isordil, sorbitrate)
• isosoride mononitrate (imdur, monoket)
• use: acute relief of angina, prophalaxis that may provoke angina, long term angina

• head ache
• tachycardia, posteral hypotension
• tolerance

• long acting forms or with round clock usage
• prevented by allow nitrate free period to allow enzyme pathways to replenish (remove patch after 8 hr and reapply in morn)

• atenolol (tenormin)
• metoprolol (lopressor)
• propranolol (inderal)
• nadolol (corgard)

• beta receptor on heart blocked which decreases HR result in decrease myocardial O2 demand /increase O2 delivery to heart
• decrease contractility help to conserve energy/decrease demand

• angina
• antihypertensive
• cardiac dysrythmia
• cardioprotective effect (after MI)
• migraine headache, tremor, stage fright

bradycardia, hypotension, 2nd/3rd degree block, heart failure, change in glucose/lipid metabolism, dizziness, depression, lethargy, unusual dream, impotence, wheeze, dyspnea

• verapamil (calan, isoptin)
• diltiazem (cardizem)
• nifedipine (procardia)
• amlodipine (norvasc)

vasodilation, decrease system vascular resistance, reduce workload of heart all which decrease O2 demand

angina, hypertension, supraventricular tachycardia, coronoary artery spasm, short term manage of A fib and flutter

hypotension, palpitation, tachy/bradycardia, constipation, nausea, dyspnea

• baseline VS include resp pattern/rate
• limit caffiene intake
• report blur vision, fainting, edema, wt gain 2+ /day or 5+/week, HR < 60 bpm , dyspnea
• no alcohol, hot tub, d/t vasodilation/ hypotension or fainting
• postural hypotension so change position slowly
• keep record of angina attacks
• nitroglycerin: no chew/swallow SL form, burn sensation indicates still potent, take PRN at first sign of angina pain, IV form must be given with special non PVC tubing /bags and discard if soln blue/green/dark red
• calcium channel block: constipation common drink extra water and high fiber food
• beta blocker: monitor HR report < 60 bpm. dizziness / fainting report, constipation common, never stop medication abruptly, for long term angina pain

• stop activity/ sit or lie down
• take SL tab wait 5 min
• if not releif, take 2nd SL tab
• wait 5 min, if no relief take 3rd SL tab
• after 3 tab/ 15 min: if no relief of chest pain call 911- DO NOT DRIVE SELF TO HOSP

measured by cardiac output (x) systemic vascular resistance

• normal
• prehypertension
• stage 1 hypertension
• stage 2 hypertension

• high DBP is no longer considered more danger then high SBP (high SBP assoc w/ heart fail, stroke, renal failure)
• older then age 50: SBP more important risk for cardiovascular disease then DBP
• prehypertension: BP no longer considered high normal and require lifestyle change
• thiazide diuretic initial drug therapy (alone or w/ others)
• mild/moderate/severe have been dropped

• beta blocker/ ACE inhibitor more effective in caucasian vs. african american
• calcium channel block/ diuretic more effective with african american vs caucasion

• unknown cause: known as essential, idiopathic, or primary (90% )
• known cause: secondary hypertension (10%)

• parasympathetic: stimulate smooth/cardiac muscle and glands
• sympathetic: stimulate heart, blood vessel, skeletal muscle

• adrenergic drug
• angiotensisn converting enzyme inhibitor (ACE inhibitor)
• angiotensin II receptor blocker (ARB)
• calcium channel blocvker (CCB)
• diuretic
• vasodilator

• doxazosin (cardura)
• prazosin (minipress)
• terazosin (hytrin)

• action: block alpha 1 adreneric receptor
• result: decrease BP

• clonidine (catapres)
• guanfacine (tenex)
• methyldopa (aldomet) drug of choice for pregnancy

• action: stimulate alpha 2 receptor in brain, NE production is decreased and renin in kidney reduced
• result: lower BP

• propranolol
• atenolol
• action: reducing HR through Beta 1 block, cause reduction of renin secretion, long term causes peripheral vascular resistance

• labetalol
• carvedilol
• action: reduce HR adn vasodilation

reserpine (rarely used r/t side effect)

• other drugs fail d/t side effect
• dysmenorrhea, menopausal flush, glaucoma
• clonidine: withdrawal symptom in opioid or nicotine dependent

dry mouth, sedation, sleepiness, constipation, headache, rash, cardiac disturbances, palpitaion, orthostatic hypotension

block angiotenson converting enzyme which prevents formation of angiotensin II, and prevents breakdown of vasodilation substance (bradykin) and results in decrease vascular resistance / vasodilation which decrease BP

• captopril (capoten) - short half life
• enalapril (vasotec)- oral or parenteral form
• lisinopril (prinovil/zestril)- newer drugs, long half life, once daily

fatigue, head ache, impaired taste, dizziness, mood change, hyperkalemia, dry nonproductive cough, angioedema, first dose hypotensive effect

angiotension 1 to convert to angiotensin II but block receptors that recieve angiotensin II which blocks vasoconstriction and release of aldosterone

• losartan (cozaar, hyzaar)
• valsartan (diovan)
• eprosartan
• irbesartan

• hyptertension
• adjunctive drug for tx of HF
• use alone or w/ other drug as diuretic
• use for pt who cant tolerate ACE inhibitor

• URI, head ache, occasional dizziness, unable to sleep, dirrhea, dyspnea, heartburn, nasal congestion, back pain, fatigue, hyperkalemia (less likely)
• NO DRY COUGH

• smooth muscle relaxation by blocking binding of calcium to receptors
• prevent muscle contraction
• causing decrease in peripheral smooth muscle tone/ decrease vascular resistance

• benzothiazepines: diltiazem (cardizem, dilacor)
• phenylalkamines: verapamil (calan, isoptin)
• dihydrophyridines: amlodipine (norvasc), bepridil (vascor), nicardipine (cardene), nifedipine (procardia), nimodipine (nimotop)

• angina
• hypertension
• dysrhythmia
• migraine headache
• raynauds disease

hypotension, palpitation, tachycardia, constipation, nausea, rash, flush, edema, dermatitis