•PHARMACOLO

GY 106

JB RAYMOND A. RALLOS, RN , MN
 Drugs Affecting the Body Systems H. Respiratory
G. Cardiovascular 1. Antihistamines
1. Drugs for Hypertension 2. Decongestants
2. Drugs for Heart Failure 3. Antitussives
3. Drugs for Angina Pectoris and Myocardial Infarction 4. Expectorants
4. Drugs for Dysrhythmias 5. Mucolytics
5. Drugs for Lipid Disorders 6. Sympathomimetics
6. Drugs for Hematopoietic Disorders 7. Anticholinergics
7. Drugs for Coagulation Disorders 8. Methylxanthines
8. Drugs for Shock 9. Leukotriene Modifiers
10. Mast Cell Stabilizers
I. Gastro-Intestinal
1. Drugs for Peptic Ulcer Disease K. Drugs for Eye and Ear Disorders
2. Laxatives 1. Ophthalmic Solutions
3. Antidiarrheals 2. Otic Preparations
4. Antiemetics
5. Anorexiants L. Dietary Supplements
6. Pancreatic Enzymes 1. Vitamins
J. Renal System 2. Minerals
1. Diuretic Therapy
2. Drugs for Fluid Balance, Electrolytes, and Acid Base Disorders
 Antihypertensive Drugs
Blood pressure is regulated by cardiac output (CO) and peripheral vascular
resistance (PVR). Medications that influence either one of these systems lead
to blood pressure control. Antihypertensive drugs that influence these systems
to lower blood pressure are

Actions •

A—ACE inhibitors block the conversion of angiotensin I to angiotensin II, a

vasoconstrictor. This block causes vasodilation and therefore decreases PVR,
resulting in a decrease in blood pressure. Aldosterone is also blocked, causing a
decrease in sodium and water retention.

B—Beta-adrenergic blockers block the beta1-receptors in the heart, which results

in decreased heart rate and decreased force of contraction.

C—Calcium Channel Blockers block calcium influx into beta-receptors, decrease

the force of myocardial contraction, reduce heart rate, and decrease PVR.
 CARDIOVASCULAR DRUGS NORMAL PHYSIOLOGY

PERIPHERAL VASCULAR
CARDIAC OUTPUT
RESISTANCE
-CO
-PVR
BP (BLOOD PRESSURE)

ANTIHYPERTENSIVE DRUGS
-ANTI HPN

BP (BLOOD PRESSURE)
 A. ACE INHIBITORS

KIDNEYS
LIVER ANG
ACE INHIBITORS
KIDNEYS
(RENIN) ANG 1 BLOCKS ALD
-ALDOSTERONE

ACE (Na)
-ANGIOTENSIN CONVERTING ENZYME ANG 2 SODIUM
-MULTI ORGANS

H20 RETENTION

ACE INHIBITORS VASOCONSTRICTOR

NO H20 RETENTION

STABLE VOLUME

PVR / BP BP STABLE BP
Angiotensin-Converting Enzyme (ACE) Inhibitors Action Blocks production of
angiotensin II from the renin-angiotensin-aldosterone system, reduces peripheral
resistance, and improves cardiac output (PERIPHERALS)

Uses • Hypertension, heart failure, myocardial infarction (MI)

Contraindications
• Pregnancy
• Renal failure
• Hypovolemia

Side Effects
• hypotension
• dry, irritating, nonproductive cough

Nursing Implications

• Closely monitor blood pressure- hypotension

• Rise slowly - reduce postural hypotension
• Assess renal impairment.
• Notify if cough develops.
• avoid potassium supplements.
B1- HEART CATECHOLAMINES:
B. BETA ADRENERGIC BLOCKERS EPI- HEART
B2- RESPIRATORY
NOREPI- VESSELS

EPINEPHRINE
ADRENAL GLANDS

BETA ADRENERGIC BLOCKERS

B1 ADRENERGIC RECEPTORS B1 ADRENERGIC RECEPTORS

HEART HEART

HEART CONTRACTION HEART CONTRACTION

BLOOD PRESSURE BLOOD PRESSURE

Beta-Adrenergic Antagonists (Beta-Blockers) (CENTRAL)

Actions:
Block sympathetic nervous system catecholamines, resulting in reduced renin and
aldosterone release and fluid balance.
Vasodilation of arterioles leads to a decrease in pulmonary vascular resistance
Blockade leads to reduced heart rate, reduced force of contraction

Uses:
Hypertension and antianginal
Dysrhythmias
Myocardial infarction (MI)
Contraindications
• bradycardia
• Can cause bronchoconstriction
• Postural hypotension, drowsiness
• Bronchospasm, malaise, lethargy

Nursing Implications
Assess vital signs
Report any weakness, dizziness, bradycardia, or fainting.
Report difficulty breathing.
Monitor patients with diabetes
 C. CALCIUM CHANNEL BLOCKERS

CALCIUM CHANNEL
CALCIUM++
BLOCKERS

MUSCLE CONTRACTIONS MUSCLE CONTRACTIONS

OTHER PARTS HEART HEART OTHER PARTS

PVR HEART HEART

PVR
RATE RATE

MYOCARDIAL MYOCARDIAL
CONTRACTION CONTRACTION

BLOOD PRESSURE BLOOD PRESSURE

 Calcium Channel Blockers

Action- Block calcium access to the cells, causing decreased heart contractility and conductivity
and leading to a decreased demand for oxygen; promote vasodilation. (PERIPHERAL AND
CENTRAL)

Uses - Angina, hypertension, and dysrhythmias

Contraindications
cardiogenic shock
decreased blood pressure,
pulmonary congestion
Side Effects
• Decreased blood pressure, headache
• Constipation, nausea, skin flushing, dysrhythmias

Nursing Implications
Administer before meals. Monitor vital signs.
Teach about postural HpoN
Check liver and renal function
Weigh patient; report any peripheral edema or weight gain.
Teach patient to avoid grapefruit juice.
Teach patient about constipation
What is Heart Failure?

Heart failure is characterized by the heart’s inability to pump an adequate supply of

blood to the body.

Without sufficient blood flow, all major body functions are disrupted.

Heart failure is a condition or a collection of symptoms that weaken or stiffen your

heart.
Left-sided heart failure

Left-sided heart failure is the most common type of heart failure.

The left ventricle is located in the bottom left side of your heart.
This area pumps oxygen-rich blood to the rest of your body.

Left-sided heart failure occurs when the left ventricle doesn’t pump
efficiently. This prevents your body from getting enough oxygen-
rich blood.

The blood backs up into your lungs instead, which causes shortness
of breath and a buildup of fluid.
Right-sided heart failure

Right-sided heart failure occurs when the right side of your

heart can’t perform its job effectively.

It’s usually triggered by left-sided heart failure. The

accumulation of blood in the lungs caused by left-sided heart
failure makes the right ventricle work harder.

Right-sided heart failure is marked by swelling of the lower

extremities or abdomen. This swelling is caused by fluid
backup in the legs, feet, and abdomen.
Medicines for heart failure
Most people with heart failure are treated with medication. Often you'll need to
take 2 or 3 different medicines.

Some of the main medicines for heart failure include:

ACE inhibitors

Beta Blockers

Angiotensin-2 Receptor Blockers (ARBs or AIIRAs)

Diuretics

Digoxin
 ARBS (ANGIOTENSIN II RECEPTOR
BLOCKERS)

LIVER ANG

KIDNEYS
(RENIN) ANG 1

ANG 2

VASOCONSTRICTOR ARBS (ANGIOTENSIN II

RECEPTOR BLOCKERS)

VASODILATION

in heart, blood vessels, and adrenals

Angiotensin II Receptor Blockers (ARBs)

Actions
Blocks the action, but not the production, of angiotensin II. Blocks the access of
angiotensin II to its receptors in heart, blood vessels, and adrenals, causing vasodilation.

Uses
Heart failure, myocardial infarction (MI)
Hypertension
Diabetic neuropathy • Stroke prevention (losartan)
Stroke, death from cardiovascular causes

Contraindications
• Pregnancy and lactation
• Bilateral renal artery stenosis; kidney failure
• History of angioedema
Side Effects
• Angioedema—can be severe and life-threatening
• Fetal injury
• Incidence of cough

Nursing Implications
Monitor (BP).
Assess for angioedema -discontinue immediately if it occurs.
Monitor kidney function.
Monitor potassium levels.
Avoid salt substitutes with increased amounts of potassium.
Digitalis

Actions
Affects the mechanical and electrical actions of the heart, which increases myocardial contractility
(the force of ventricular contraction) and cardiac output.

Uses
• Heart failure—to improve cardiac output
• Atrial fibrillation and flutter

Contraindications and Precautions

• Hypersensitivity, ventricular tachycardia, ventricular fibrillation
• Renal insufficiency, hypokalemia, advanced heart failure, pregnancy
• When given with amiodarone, can increase digoxin level
Side Effects

• Dizziness, headache, malaise, fatigue

• Nausea, vomiting, visual disturbances (blurred or yellow vision; halos around dark
objects), anorexia—frequently foreshadow serious toxicity
• Hypokalemia

Nursing Implications

1. Monitor digoxin serum levels; toxicity (2 ng/mL is considered toxic).

2. Monitor pulse, Report a pulse rate less than 60 or greater than 100
3. Administer intravenous (IV) doses slowly over 5 minutes.
4. not double up with missed doses.
5. Teach patients to recognize early signs of hypokalemia (muscle weakness) and digitalis
toxicity (nausea, vomiting, anorexia, diarrhea, blurred or yellow visual disturbances, halos
around dark objects), and notify health care provider.
Medications to treat
Angina
and
Myocardial Infarction
Nitrates. Often used to treat angina, nitrates relax and widen your blood vessels, allowing
more blood to flow to your heart muscle. Nitrates in pills or sprays act quickly to relieve pain
during an event. There are also long-acting nitrate pills and skin patches.

Aspirin. Aspirin and other anti-platelet medications reduce the ability of your blood to clot,
making it easier for blood to flow through narrowed heart arteries.

Beta blockers. These block the effects of the hormone epinephrine, also known as
adrenaline. They help your heart beat more slowly and with less force, decreasing the effort
your heart makes and easing the angina pain.

Statins. Statins lower blood cholesterol by blocking a substance your body needs to make
cholesterol. They might also help your body reabsorb cholesterol that has accumulated in
the buildup of fats (plaques) in your artery walls, helping prevent further blockage in your
blood vessels.

Calcium channel blockers. Also called calcium antagonists, these drugs relax and widen
blood vessels by affecting the muscle cells in the arterial walls. This increases blood flow in
your heart, reducing or preventing angina.
Nitroglycerin

Actions
Vasodilator that relaxes vascular smooth muscle (arterial and venous) system with
more prominent effects on veins. These actions decrease cardiac oxygen demand.

Uses
• To relieve acute anginal pain and prevent further angina pain

Contraindications and Precautions

• Hypersensitive patients
• Severe anemia
• Erectile dysfunction medications
• Severe hepatic or renal disease and use of other vasodilators
• Beta-blockers
Side Effects
• Orthostatic hypotension, headache

Nursing Implications
1. carry nitroglycerin with them at all times.
2. When angina occurs, teach patient to take a sublingual tablet (place under tongue);
if pain is not relieved in 5 minutes, call 9-1-1.
May take one tablet every 5 minutes for a total of 3
4. Avoid alcoholic beverages
5. Avoid swallowing or chewing sustained-release tablets
6. Rotate transdermal patches and remove after 12 to 14 hours to have a “patch free” interval
of 10 to 12 hours daily.
7. check blood pressure (BP)
8. Teach to direct the translingual spray against the oral mucosa
Acetylsalicylic Acid (ASA)—Aspirin

Classification
Analgesic, antipyretic, antiplatelet; nonsteroidal antiinflammatory drug (first-
generation NSAID)

Action
Is a nonselective cyclooxygenase inhibitor that decreases the formation of
prostaglandins involved
in the production of inflammation, pain, and fever. Inhibits platelet aggregation.

Uses
• Relieves pain
• Decreases inflammation
• Is a prophylactic medication to reduce the risk of transient ischemic attack,
ischemic stroke, and myocardial infarction
Side Effects

• Decreases platelet aggregation; increases bleeding potential

• Epigastric distress, heartburn, and nausea
• toxicity—respiratory alkalosis that progresses to respiratory
depression and acidosis

Nursing Implications:

Give with milk or full glass of water

The potential for toxicity
Teach patient to avoid concurrent use of alcohol to decrease GI irritation.
Not to take aspirin for at least 1 week before surgery.
Determine purpose of medication—pain, inflammation, or antiplatelet action.
4. Drugs for Dysrhythmias
A cardiac dysrhythmia (arrhythmia) is an abnormal or irregular heartbeat.
If you have a dysrhythmia, your heart might beat too fast or too slowly. Or
your heart's rhythm might be disrupted, leading you to feel like your heart
skipped a beat.
Antidysrhythmics
Actions
• Sodium channel blockers block sodium, slowing the impulse in the atria, ventricles,
and nodal and Purkinje systems

• Beta-adrenergic blockers reduce automaticity the (SA) node, slow conduction velocity
in the atrioventricular (AV) node, reduce contractility in the atria and ventricles (Inderal

• Potassium channel blockers delay repolarization of fast potentials, prolong action

potential duration and effective refractory period (amiodarone), and prolong the QT
interval.

• Calcium channel blockers block calcium channels and, delay conduction through the
AV node, delay reduction of myocardial contractility (diltiazem, verapamil),

• Adenosine and digoxin decrease conduction through the AV node and reduce
automaticity of the SA node.
Uses
• Tachydysrhythmia:, atrial Fibrillation

Precaution
• bradycardia; medications can cause new dysrhythmias as well as exacerbate existing
ones.

Side Effects
• Quinidine: cinchonism effects—tinnitus, headaches, nausea, vomiting, dizziness
• Hypotension, fatigue, bradycardia
• Amiodarone—pulmonary toxicity, visual impairment, cardiotoxicity, photosensitivity,
thyroid toxicity (hypo- or hyperthyroidism), liver toxicity

Nursing Implications
1. Monitor cardiac rhythm, particularly during initial dose for effectiveness; report
apical pulse rate less than 60 beats/min.
2. Report changes in dysrhythmias , assess for hypotension.
3. Instruct patient to take all prescribed doses
4. Instruct patient to report shortness of breath; pain; and irregular, fast, or slow
heartbeats.
 Drugs for Lipid Disorders
If your doctor says you have a lipid disorder, that means you have high blood
levels of low-density lipoprotein (LDL) cholesterol, and fats called triglycerides,
or both. High levels of these substances increase your risk for developing
heart disease.
HMG-CoA Reductase Inhibitors (Statins)
Examples
Atorvastatin (Lipitor), simvastatin (Zocor), pravastatin (Pravachol), lovastatin
(Mevacor), rosuvastatin (Crestor)

Action
Lower cholesterol levels by inhibiting the formation of HMG-CoA reductase, which is
an enzyme that is required for the liver to synthesize cholesterol. Effective in
decreasing low-density
lipoprotein (LDL) and increasing high-density lipoprotein (HDL) levels and may lower
triglycerides in some patients.

Uses
• Hypercholesterolemia
• Primary and secondary prevention of cardiovascular events
• Patients with type 2 diabetes and coronary heart disease
Contraindications
• Viral or alcoholic hepatitis; pregnancy

Precautions
• Liver disease, depending on severity
• Excessive alcohol use

Side Effects
• Headache, rash, or gastrointestinal (GI) disturbances (dyspepsia, cramps, flatulence,
constipation, abdominal pain)
• Myopathy—myositis, rhabdomyolysis (severe form; rarely occurs)
• Hepatotoxicity—liver injury with increases in levels of serum transaminases

Nursing Implications
1. report unexplained muscle pain or tenderness.
2. Monitor liver function
3. childbearing age about the potential for fetal harm
4. Administer medication in the evening without regard to meals, except for lovastatin, which
is taken with the evening meal (extended-release tablet taken at bedtime).
5. dietary changes to reduce weight and cholesterol.
Fenofibrate

is used together with a proper diet to reduce and treat high cholesterol and
triglyceride (fat-like substances) levels in the blood. This may help prevent the
development of pancreatitis (inflammation or swelling of the pancreas) caused by
high levels of triglycerides in the blood.
Drugs for Hematopoietic
Disorders
Hematopoietic medications increase the amount of
blood cells.

Ηema refers to blood and poiesis means to make.

Specifically, hematopoietic medications increase the

production:
1. erythrocytes or red blood cells
2. leukocytes or white blood cells
3. platelets, which are small clot forming fragments of a
larger cell called a megakaryocyte.
Hematopoietic growth factor medications are produced by
recombinant DNA technology and used clinically to increase
the production of three major blood cell groups:

• erythrocytes (red blood cells [RBCs])

• megakaryocytes (give rise to platelets)
• leukocytes (white blood cells)

and to enhance the mature cell function.

They work by binding to the receptors found on the

membrane of the cells and produce cells belonging to the
hemopoietic lineages
•Ancestim, a recombinant stem cell factor that stimulates the proliferation of primitive
hematopoietic and nonhematopoietic cells.

EPO recombinant factors, epoetin alfa and darbepoetin alfa increase RBCs

G-CSF recombinant products, namely, filgrastim, lenograstim, and pegfilgrastim

maintain neutrophil production during a steady state and increase neutrophil
production during infections.

Oprelvekin, a recombinant product--stimulates the production of megakaryocyte

precursors, megakaryocytes, and platelets.
Hematopoietic growth factors are used for the following:

• Anemia of renal disease

• Anemia due to cancer chemotherapy
• Aplastic anemia
• Bone marrow transplantation
• Congenital or acquired bone marrow failure
• Peripheral blood progenitor mobilization
• Anti-tumor vaccination therapy
• Chemotherapy and drug-induced neutropenia
• Immune-mediated thrombocytopenia
• Supportive care for leukemia patients
Side effects associated with Serious side effects associated
hematopoietic growth factors with hematopoietic growth
include: factors may include:

Headache Cardiac arrhythmias

Nausea Thrombocytosis
Injection site reactions Venous fistula occlusion
Fever and Chills
Edema
Shortness of breath
Bone pain
Hyperuricemia
Skin rash
Diarrhea
Hypertension
Generic and brand names of hematopoietic growth factors include:

Ancestim (Stemgen)
Darbepoetin alfa (Aranesp)
Eflapegrastim (Pending FDA Approval)
Eltrombopag (Promacta)
Epoetin alfa (Epogen, Eprex, Procrit, Retacrit)
Epoetin alfa-epbx
Erythropoietin
Filgrastim (G-CSF, Granix, Neupogen, Nivestym, tbo-filgrastim, Zarxio)
Filgrastim-aafi
Filgrastim-sndz
Methoxy polyethylene glycol / epoetin beta (Mircera)
Oprelvekin (Neumega, Interleukin 11, il 11)
Pegfilgrastim (Fulphila, Neulasta, Nyvepria, Ziextenzo, Udenyca)
Pegfilgrastim-apgf
Pegfilgrastim-bmez
Pegfilgrastim-cbqv
Pegfilgrastim-jmdb
Peginesatide (Omontys)
Romiplostim (Nplate)
Sargramostim (gmcsf, Leukine)
 DRUGS FOR
COAGULATION
DISORDERS
Vitamin K helps to make various proteins that are needed for
blood clotting and the building of bones.

Prothrombin is a vitamin K- protein directly involved with blood

clotting.

Osteocalcin is another protein that requires vitamin K to

produce healthy bone tissue.

Vitamin K is found throughout the body including the liver,

brain, heart, pancreas, and bone. It is broken down very quickly
and excreted in urine or stool. Because of this, it rarely reaches
toxic levels in the body even with high intakes, as may
sometimes occur with other fat-soluble vitamins.
Action
Heparin is an anticoagulant that exerts a direct effect on blood coagulation by
enhancing the inhibitory actions of antithrombin on several factors essential to
normal blood clotting, thereby blocking the conversion of prothrombin to
thrombin and fibrinogen to fibrin.

Uses
• Rapid acting (within minutes) to prevent and treat deep vein thrombosis (DVT),
pulmonary embolism, and emboli in atrial fibrillation
• Used to treat disseminated intravascular coagulation (DIC)
• Is preferred anticoagulant during pregnancy (doesn't cross the placenta or
enter breast-milk)
• Prevents coagulation in heart-lung machines and dialyzers in patients after
open-heart
surgery and dialysis
• Used as an adjunct to thrombolytic therapy of acute myocardial infarction (MI)
Precautions and Contraindications
• Bleeding tendencies
• Thrombocytopenia, uncontrollable bleeding, threatened abortion
• Postoperative

Side Effects
• Injection site reactions
• May result in spontaneous bleeding.

Nursing Implications
1. Monitor partial thromboplastin time (PTT) and activated PTT (aPTT)—Watch for bleeding.
2. May not be given orally, or by intramuscular (IM) injection= protamine sulfate is the antidote.
3. Caution patients not to take aspirin or any medication that decreases platelet aggregation
(clopidogrel)
4. do not massage site after injection.
5. Dosage is prescribed in units, not milligrams (mg).
Warfarin Sodium (Coumadin)
Actions
Warfarin is an oral anticoagulant that antagonizes vitamin K, which is necessary for the synthesis of clotting
factors VII, IX, X, and prothrombin.

As a result, it disrupts the coagulation cascade.

Uses
• Long-term prophylaxis of thrombosis; is not useful in emergency because of delayed onset
• Prevents venous thrombosis and thromboembolism
• Decreases risk of recurrent transient ischemic attacks (TIAs) and recurrent myocardial infarction

Contraindications
• Bleeding disorders
• Lumbar puncture; regional anesthesia
• Vitamin K deficiency; severe hypertension
• breast-feeding (crosses into breast milk)
• Liver disease, alcoholism
Side Effects:

• Spontaneous bleeding
• Hypersensitivity reactions
• Red-orange discoloration of urine (not to be confused with hematuria)
• weakening of bones
• risk of fractures

Nursing Implications:

• Monitor prothrombin time (PT) and international normalized ratio (INR)

• Monitor for bleeding tendencies; vitamin K is an antidote.
• Teach patient to maintain intake of vitamin K (keep constant intake of
foods such as green,
• leafy vegetables, mayonnaise, and canola oil)
• Very slow to be excreted from the body.
• Teach patient to wear a medical alert braceleT
 Antidotes
 Protamine Sulfate is a medication used to
reverse and neutralize the anticoagulant
effects of Heparin

 A dose of Vitamin K is used to reverse the

action of Warfarin (Coumadin)
 BP RR CR

RR CR BP

ICP (INCREASED SHOCK

INTRACRANIAL
PRESSURE)
What is medical shock?
Shock is a critical condition brought on by the sudden drop in blood flow through the
body.

Shock may result from trauma, heatstroke, blood loss, an allergic reaction, severe
infection, poisoning, severe burns or other causes.

When a person is in shock, his or her organs aren't getting enough blood or oxygen.

What are the 4 types of shocks?

• Hypovolemic shock (caused by too little blood volume)

• Anaphylactic shock (caused by allergic reaction)

• Septic shock (due to infections)

• Neurogenic shock (caused by damage to the nervous system)

Modified Trendelenburg
1. Dobutamine

Action :
has both ionotropic and chronotropic effects depending on the dose. Because of its
inotropic effects on the myocardium through binding and activating the beta-1
receptors selectively.

Dobutamine's ionotropic effect increases contractility and therefore, increased

stroke volume.

Stimulation of the Beta1-adrenergic receptors in the heart results in positive

inotropic (increases contractility), chronotropic (increases heart rate)

Side Effects:
Dobutamine toxicity is rare, and the half-life is short at 2 minutes.
sympathetic overstimulation:
chest pain
Palpitations
Headaches
Tremors
shortness of breath
Nausea
vomiting
Contraindications:

• acute myocardial infarction

• unstable angina
• severe hypertension
• arrhythmias
• acute myocarditis or pericarditis
• Hypokalemia
• idiopathic hypertrophic sub-aortic stenosis.

Nursing Consideration:

• Observe IV site closely and avoid extravasation.

• Dobutamine can cause inflammatory response and tissue ischemia.
• Monitor for adverse reactions.
• Continuous blood pressure monitoring.
• Continuous cardiorespiratory monitoring.
• Document vital signs hourly and PRN.
• Monitor fluid balance.
2. Epinephrine
activates α- and β-adrenoceptors. The effects include positive inotropic, chronotropic, and
enhanced conduction in the heart (β1) relaxation of smooth muscle in the vasculature and
bronchial tree (β2); and vasoconstriction (α1).
Uses:

cardiac asystole
circulatory collapse
anaphylaxis.

no absolute contraindications against using epinephrine.

Some relative contraindications include hypersensitivity to sympathomimetic drugs,
closed-angle glaucoma, watch out for HYPERS
Side effects:
• tachycardia
• hypertension
• headache
• anxiety
• palpitations
• diaphoresis
• nausea
• vomiting
• weakness
• tremors.
NURSING IMPLICATIONS

• Monitor BP, pulse, respirations, and urinary output

• disturbances in cardiac rhythm occur, withhold epinephrine
and notify physician
• Check BP repeatedly when epinephrine is administered IV
during first 5 min, then q3–5min until stabilized.
• Report bronchial irritation, nervousness, or sleeplessness.
• Monitor blood glucose & HbA1c
3. Dopamine
Actions
Low doses, causes renal vasodilation.
Moderate doses increase cardiac contractility, stroke volume, and cardiac output.
Higher doses increase peripheral vascular resistance, blood pressure, and renal vasoconstriction.

Contraindication:
pheochromocytoma - NET
tachyarrhythmias including
ventricular fibrillation
ventricular tachycardia.
Reduce the dopamine dose if an increased number of ectopic beats is observed.
Correct hypovolemia before dopamine administration.
Adverse Effects:

Tachycardia
Dysrhythmias
Anginal pain
Vasoconstriction leading to tissue necrosis with extravasation

Nursing Implications:

• Correct hypovolemia with fluid resuscitation before initiating dopamine

infusion.
• Monitor blood pressure, pulse, and peripheral pulses every 15 minutes.
• Monitor hourly urine output.
• Cardiac monitor should be used on patients receiving dopamine infusion.
• Weigh patient daily to determine accurate infusion dose.
• Calculate infusion drips and doses carefully.
• IV site should not be used for any other infusions
• Extravasation of dopamine may cause tissue necrosis to skin.  
• Therefore, monitor IV site every hour. 
…and those are the basics of our
Cardiovascular Drugs