Cardiac Drugs Quick Sheet!

July 21, 2019.Reading time 2 minutes.

Just a quick overview for the major cardiac/ACLS drugs as pertaining to adults. This is essentially what my flash cards would pertain! Get your AHA ACLS Manual here!

Digoxin

Action
- Positive inotrope – increases the force of cardiac contraction
- Decrease HR
- Allow for more complete emptying of the ventricles, thus increasing CO
- Decrease conduction through the AV node, reduce automaticity of the SA node
Indications
- Heart failure
- A-fib and A-flutter
- Paroxysmal atrial tachycardia
Special Considerations
- Monitor potassium levels
- Count apical for 1 min prior to administration

Atropine

Action
- An anticholinergic drug and increases the firing of the SA node by blocking the action of the vagus nerve.
- Increases HR
Indications
- 1^st line for symptomatic bradycardia
Special Considerations
- Anticholinergic S/E
- Increases myocardial oxygen demand à be careful in presence of myocardial ischemia

Mosby’s Drug Guide for Nursing Students (13th ed)

Adenosine

Action
- Antiarrhythmic that decreases conduction through the AV node
Indications
- Paroxysmal Supraventricular Tachycardia
Special Considerations
- Commonly causes a few seconds of asystole
- Very short half-life (6-10 seconds)
- Push FAST
- Patient may feel “like they got punched in the chest”

Amiodarone

Action
- Delay repolarization resulting in prolonged duration of action potential and refractory period
- Class III Potassium Channel Blocker
- Decreases heart rate and contractility
Indications
- Pulseless V-fib or V-tach
- Oral – Atrial fibrillation
Special Considerations
- Do NOT use with cardiogenic shock or severe sinus bradycardia – may cause hypotension

Epinephrine

Action
- Stimulate beta1 receptors – cardiac stimulation
- Increased HR, CO, and contractility
Indications
- Cardiogenic shock, Anaphylactic shock, Septic shock
- Cardiac arrest, pulseless ventricular tachycardia, ventricular fibrillation, asystole
Special Considerations
- Raises BP and increases HR; may cause myocardial ischemia, angina
- May contribute to post-resuscitation myocardial dysfunction

Dopamine

Action
- Positive inotropic
- Increased myocardial contractility, increased automaticity, increased AV conduction, increased HR, CO, BP, MAP
Indications
- Cardiogenic shock
- 2^nd line for symptomatic bradycardia
Special Considerations
- Correct hypovolemia with volume replacement before using dopamine
- DO NOT mix with Sodium Bicarb

Lidocaine

Action
- Sodium channel blocker
Indications
- V-fib, V-tach – with and without pulse
Special Considerations
- *REMOVED from ACLS Guidelines*
- Can cause toxicity!

Sources: 2018 ACLS Guidelines (Provider Manual), Medical-Surgical Nursing : Assessment and Management of Clinical Problems, 10th Ed (Lewis)

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Pharmacology: Seizures and Epilepsy

July 1, 2019.Reading time 3 minutes.

Definitions:

Convulsion: abnormal motor phenomena (jerking, movements, tics, rigors)
Seizure: a sudden, excessive synchronous electrical discharge of neurons in the brain that can spread to other foci
Epilepsy: group of chronic neurological disorders characterized by recurring seizures

Main Types of Seizures:

Simple Partial: discrete motor, sensory, autonomic and psychoillusionry symptoms. No loss of consciousness. Persists 20-30 seconds.
Tonic-Clonic: major convulsions characterized by a period of muscle rigidity (tonic phase) followed by synchronous muscle jerks (clonic phase). Immediate loss of consciousness. Followed by postictal state. Lasts 90 seconds or less.

Therapeutic Goals:

Enable patient to live a normal life.
Ideally eliminate seizures, but may not be possible

How do Anti-Epileptic Drugs Work?

suppress discharge of neurons within a seizure focus
suppress the spread of seizure activity from the focus to other areas of the brain
decrease in sodium influx, decrease in calcium influx, increase in potassium influx

Traditional AED’s

Phenytoin (Dilantin): Therapeutic range: 10-20mcg/mL, can cause gingival hyperplasia and nystagmus
Carbamazepine (Tegretol): Also treats trigeminal neuralgia and bipolar disorder. Contraindicated if patient has bone marrow depression or hypersensitivity. Avoid grapefruit juice!
Valproic Acid (Depakote): Also treats migraines and bipolar disorder. Therapeutic range: 50-100mcg/mL. Highly teratogenic! Can cause hepatotoxicity, pancreatitis and hypersensitivity.
Ethosuximide (Zarontin): Treats absence seizures. Therapeutic range: 40-100mcg/mL. Generally devoid of adverse effects.
Phenobarbital: Older drug, long-acting. Toxicity can cause nystagmus and ataxia. Overdose can cause respiratory depression and possibly death. Has a sedative effect, cognitive/learning impairment, CNS depression and drug dependence. May make children hyper.

Status Epilepticus

A MEDICAL EMERGENCY in which a patient is continually having tonic-clonic seizures for 20-30 minutes and is not conscious the whole time.

Immediate treatment includes: turning patient to the side, administering oxygen, removing objects that could potentially harm, having padded bedrails, suction secretions, and DO NOT restrain the patient or put anything in their mouth. Administer one of the following medications:

Diazepam (Valium): Used for emergency treatment of status epilepticus. Short half-life. May develop physical dependence and withdrawal symptoms.
Lorazepam (Ativan): Drug of choice used in status epilepticus because of prolonged effects. A rectal gel is available for out of hospital use.

Source: Lehne Pharmacology for Nursing Care, 9th Edition, Chapter 24

Pharmacology: Parkinson’s Disease Quick Sheet

July 1, 2019.Reading time 2 minutes.

Parkinson’s disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. Nearly one million people in the US are living with Parkinson’s disease. The cause is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage its symptoms.
Parkinson’s Disease Foundation, 2016

Parkinson’s Disease:

Idiopathic degenerative disorder of CNS from loss of dopamine-secreting neurons in the substantia nigra
– Clinical presentation: resting tremor, rigidity, bradykinesia, postural disturbances
Therapeutic goals: Improve ADL’s

Dopaminergic Drugs:

Activates dopamine receptors, increase dopamine levels, inhibit actions of ACH
LEVODOPA: metabolic precursor of dopamine that crosses the BBB, converted to dopamine once in the brain. Disappointing long term effects such as “wearing-off” and “on-off” phenomenon. 2% reaches the brain
CARBIDOPA-LEVODOPA: carbidopa prevents levodopa from getting destroyed by decarboxylase enzymes in the peripheral blood. Allows for lower dose of levodopa and less side effects
Major side effects: N/V, dyskinesias, orthostatic hypotension

Anticholinergic Drugs:

Decreases effects of ACH
Can reduce tremor, possibly rigidity, but not bradykinesia
Less effective than dopaminergic drugs
Most used: BENZOTROPINE (COGENTIN) and TRIHEXYPHENIDYL (ARTANE)
Major side effects: dry mouth, blurred vision, tachycardia, constipation, urinary retention, decreased sweating, increased body temp

COMT Inhibitors

inhibit metabolism of levodopa in the periphery
have no therapeutic effects of their own
ENTACAPONE and TOLCAPONE

MAO-B Inhibitors

inhibit inactivation of dopamine in the brain
when combined with levodopa, can reduce “wearing off” effect
SELEGILLINE (ELDEPRYL)

Source: Lehne’s Pharmacology for Nursing Care, 9th Edition. Burchum and Rosenthal, Chapter 21. | Medical-Surgical Nursing : Assessment and Management of Clinical Problems, 10th Ed (Lewis)

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