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Types of cardiovascular drugs

Positive inotropic drugs: increase the force of myocardial contraction

Negative inotropic drugs: decrease the force of myocardial contraction
Positive chronotropic drugs: increase heart rate by altering the rate of impulse formation
at the SA node
Negative chronotropic drugs: decrease heart rate by altering the rate of impulse
formation at the SA node
Positive dromotropic drugs: increase the conduction of electrical impulses
Negative dromotropic drugs: decrease the conduction of electrical impulses
Epinepherine (Adrenalin)
Epinephrine stimulates alpha-, beta1-, and beta2-adrenergic receptors in dose-related
fashion. It is the initial drug of choice for treating bronchoconstriction and hypotension
resulting from anaphylaxis as well as all forms of cardiac arrest. It is useful in managing
reactive airway disease, but beta-adrenergic agents are often used initially because of
their convenience and oral inhalation route. Rapid injection produces a rapid increase in
systolic pressure, ventricular contractility, and heart rate. In addition, epinephrine
causes vasoconstriction in the arterioles of the skin, mucosa, and splanchnic areas and
antagonizes the effects of histamine.
Onset & Duration
(SQ) 5-10 min (IV) 1-2 min
5-10 min
Bronchial asthma
Acute allergic reaction
Cardiac arrest
Electromechanical dissociation
Ventricular fibrillation unresponsive to initial defibrillatory attempts
Hypovolemic shock
Coronary insufficiency
Nursing Implication and intervention:
1. Monitor BP, pulse, respirations, and urinary output and observe patient closely
following IV administration. Epinephrine may widen pulse pressure. If disturbances in
cardiac rhythm occur, withhold epinephrine and notify physician immediately.
2. keep physician informed of any changes in intake-output ratio.
3. Use cardiac monitor with patients receiving epinephrine IV. Have full crash cart

immediately available.
4. Check BP repeatedly when epinephrine is administered IV during first 5 min, then
q35min until stabilized.
5. Advise patient to report to physician if symptoms are not relieved in 20 min or if they
become worse following inhalation.
6. Advise patient to report bronchial irritation, nervousness, or sleeplessness. Dosage
should be reduced.
7. Monitor blood glucose & HbA1c for loss of glycemic control if diabetic
Generic name: atropine.
Trade name: Sal-tropine.
Class: anticholinergic or parasympatholytic agents
blocks the bradycardia associated with some drugs used in anesthesia such as
To restore cardiac rate and arterial pressure during anesthesia, when vagal stimulation
produced by intra-abdominal surgical traction causes a sudden decrease in pulse rate
and cardiac action.
Atropine is contraindicated in patients with narrow-angle glaucoma, hypersensitivity to
anticholinergic drugs, cardiac insufficiency, myocardial ischemia, unstable cardiac status
during acute hemorrhage, GI obstructive disease.
Side effect
Dryness of the mouth, blurred vision, photophobia and tachycardia commonly occur
with chronic administration of therapeutic doses.
Nursing Implication and intervention:
1. Assess for allergies, presence of BPH, glaucoma, tachycardia, MI, CHF, hiatal
hernia,and GI or GU obstruction.
2. Perform baseline assessment of VS and systems overview .
3. Medications should be taken exactly as prescribed to have the maximum therapeutic
4. Overdosing can cause life-threatening problems.
5. Check with physician before taking any other medication, including OTC medications.
6. Patients should report the following to their physician: urinary hesitancy and/or
retention, constipation, palpitations, confusion, excessive dry mouth or fever.
7. Teach patients to limit physical exertion, and avoid high temperatures and strenuous
8. Monitor for therapeutic effects.

Dopamine (Inatropin)
Dopamine is chemically related to epinephrine and norepinephrine. It acts primarily on
alph1- and beta1- adrenergic receptors, increasing systemic vascular resistance and
exerting a positive inotropic effect on the heart. In addition, the actions of this drug on
dopaminergic receptors dilate renal and splanchnic vasculature, maintaining blood flow.
Dopamine is commonly used to treat hypotension associated with cardiogenic shock.
Onset & Duration
2-4 min
10-15 min
Low cardiac output states
Ventricular fibrillation
Patients with pheochromocytoma
Side effect
Nausea, vomiting, headache, chest pain; dizziness; irregular heartbeat; pain, redness,
or swelling at the injection site.

Assessment & Drug Effects

Monitor blood pressure, pulse, peripheral pulses, and urinary output at intervals
prescribed by physician. Precise measurements are essential for accurate titration of
Report the following indicators promptly to physician for use in decreasing or
temporarily suspending dose: Reduced urine flow rate in absence of hypotension;
ascending tachycardia; dysrhythmias; disproportionate rise in diastolic pressure
(marked decrease in pulse pressure); signs of peripheral ischemia (pallor, cyanosis,
mottling, coldness, complaints of tenderness, pain, numbness, or burning sensation).
Monitor therapeutic effectiveness. In addition to improvement in vital signs and urine
flow, other indices of adequate dosage and perfusion of vital organs include loss of
pallor, increase in toe temperature, adequacy of nail bed capillary filling, and reversal of
confusion or comatose state.
Pharmacologic class: Cardiac glycoside
Therapeutic class: Inotropic, antiarrhythmic
action: acts by inhibiting the sodium-potassium ATPase, which makes more calcium

available for contractile proteins;

uses: CHF, atrial fibrillation, atrial flutter, paroxysmal atrial tachycardia.
Inhibits sodium potassium ATPase (Sodium potassium exchange pump)
Results in increased quantity of Ca in sarcoplasmic reticulum
Increased Ca will result in greater contractile strength
Increased contractile strength results in increased glomerular pressure (Mild diuretic)
Ventricular fibrillation; ventricular tachycardia except in certain cases; digitalis toxicity;
beriberi heart disease; hypersensitivity to digoxin; some cases of hypersensitive carotid
sinus syndrome.
The most common side effects are related to digoxin toxicity and heart rhythm
disturbances. Other side effects include abdominal pain, nausea, vomiting, loss of
appetite, breast enlargement, skin rash, blurred vision, and mental changes.
Assessment & Drug Effects
Be familiar with patients baseline data (e.g., quality of peripheral pulses, blood
pressure, clinical symptoms, serum electrolytes creatinine clearance) as a foundation
for making assessments
Lab tests:
Baseline and periodic serum digoxin, potassium, magnesium, and calcium. Notify
physician of abnormal values. Draw blood samples for determining plasma digoxin
levels at least 6 h after daily dose and preferably just before next scheduled daily dose.
Therapeutic range of serum digoxin is 0.82 ng/ml; toxic levels are >2 ng/mL.
Take apical pulse for 1 full min noting rate, rhythm, and quality before administering. If
changes are noted, withhold digoxin, take rhythm strip if patient is on ECG monitor,
notify physician promptly.
Withhold medication and notify physician if apical pulse falls below ordered
parameters (e.g., >50 or 60/min in adults and >60 or 70/min in children).

Digitalis Toxicity
Visual Disturbances
Flashing lights
Altered color vision

GI Disturbances
Cardiac Rhythm Disturbances

K and Digoxin both bind to the same site on the sdoium/K pump
Isoproteronol (Isuprel)

Isoproterenol is a synthetic catecholamine that stimulates both beta1- and beta2adrenergic receptors (no alpha-receptor capabilities). The drug affects the heart by
increasing inotropic and chronotropic activity. In addition, isoproterenol causes arterial
and bronchial dilation and is sometimes administered via aerosolization as a
bronchodilator to treat bronchial asthma and bronchospasm. (Because of the
undesirable beta2 cardiac effects, the use of this drug as a bronchodilator is uncommon
in the pre-hospital setting.)
Onset & Duration
1-5 min
15-30 min
Hemodynamically stable bradycardias that are resistant to atropine.
Heart blocks with palpable pulse
Ventricular tachycardia
Ventricular fibrillation
Pulseless idioventricular rhythm
Ischemic heart disease
Cardiac arrest
Dobutamine (Dobutrex)
Mechanism : The effects of this drug include positive inotropic effects with minimal
changes in chronotropic activities or systemic vascular resistance. For these reasons,
dobutamine is useful in managing congestive heart failure when an increase in heart
rate is not desired.
1-2 min; peak after 10 min
10-15 min
Inotropic support for patients with left ventricular dysfunction
Severe hypotension

Side effect:
Headache, nausea or vomiting and restlessness, hypertension, allergic reaction, muscle
cramps or weakness, chest pain, trouble breathing, dizziness.
Nursing implication:
1. Correct hypovolemia by administration of appropriate volume expanders prior to
initiation of therapy.
2. Monitor therapeutic effectiveness. At any given dosage level, drug takes 1020 min to
produce peak effects.
3. Monitor ECG and BP continuously during administration
4. Note: Marked increases in blood pressure (systolic pressure is the most likely to be
affected) and heart rate,or the appearance of arrhythmias or other adverse cardiac
effects are usually reversed promptly by reduction in dosage.
5. Monitor I&O ratio and pattern. Urine output and sodium excretion generally increase
because of improved cardiac output and renal perfusion.
Generic name: Ephedrine sulfate.
Brand name: Levophed.
Class: ACLS ( Advanced Cardiac Life Support)
Noradrenaline functions as a peripheral pressor and as an inotropic stimulator of the
heart and dilator of coronary arteries.
For blood pressure control in certain acute hypotensive states ; myocardial infarction
septicemia ,blood transfusion, and drug reactions.
As in the treatment of cardiac arrest and profound hypotension.
1. vascular thrombosis
2. hypoxia,
3. hypercapnia
4. volume depletion
5. caution if TCA use ( Tricyclic Antidepressants )
6. caution if MAO-inhibitor use (Monoamine oxidase inhibitor )
Side effect:
Bradycardia, rise in blood pressure, arrhythmias,Anxiety, headache, Respiratory
Assessment & Drug Effects
Monitor constantly while patient is receiving norepinephrine. Take baseline BP and
pulse before start of therapy, then q2min from initiation of drug until stabilization occurs

at desired level, then every 5 min during drug administration.

Adjust flow rate to maintain BP at low normal (usually 80100 mm Hg systolic) in
normotensive patients. In previously hypertensive patients, systolic is generally
maintained no higher than 40 mm Hg below preexisting systolic level.
Observe carefully and record mental status (index of cerebral circulation), skin
temperature of extremities, and color (especially of earlobes, lips, nail beds) in addition
to vital signs
Monitor I&O. Urinary retention and kidney shutdown are possibilities, especially in
hypovolemic patients. Urinary output is a sensitive indicator of the degree of renal
perfusion. Report decrease in urinary output or change in I&O ratio.