FIRST DO NO HARM
A. There are 5 rights to patient medication
administration:
- Right patient
- Right drug
- Right dose
- Right route
- Right time
Once you have given the Drug,
you can’t get it back, so do it right the first time!
- Autonomic Nervous System
- Sympathetic system ("fight or flight")
- Parasympathetic system ("rest and digest" or "feed and breed")
Sympathetic system à
Adrenal medulla à Epinephrine and Norepinephrine à
Adrenergic Receptors (alpha
or beta receptors
B. Drugs Affecting the Autonomic Nervous System
1. Drugs stimulate sympathetic nervous system = Agonists
= Sympathomimetics
2.
Drugs
inhibit sympathetic nervous system = Antagonists = sympatholytics = Blockers
(alpha and beta)
C. Drugs Affecting the Autonomic Nervous System
1. Drugs stimulate parasympathetic nervous system =
Parasympathomimetics (↑ACH)
2.
Drugs
inhibit parasympathetic nervous system = Parasympatholytics (↓ACH)
D. Beta blockers
1. Reduce the rate and force of contraction of the heart
2.
Bronchoconstriction
3.
Given
for hypertension and angina
4.
Not
for asthma
5.
E.g.
Inderal
E. Beta agonists
1. Bronchodilation
2.
Tachycardia
and elevation of blood pressure
3.
Used
in anaphylactic shock and cardiac arrest
4.
E.g.
Adrenalin
F. Beta-2 agonists
1. Bronchodilation
2.
May
also cause tachycardia and palpitations in high dose
3.
E.g.
Ventolin
G. Parasympathomimetics
1. Mimic the effects of acetylcholine, e.g. bethanechol
(Urecholine),
2.
Or
mimic acetylcholine by blocking acetylcholinesterase (e.g. Physostigmine)
H. Parasympathetic blockers (Parasympatholytics)
1. Block effect of acetylcholine. Common example is
Atropine
I. Medications Affecting the Cardiovascular System
1. Medications Used for Cardiovascular Conditions
2.
Medications
by Therapeutic classifications
J. Medications Used for Cardiovascular Conditions
1. Antihypertensives:
·
Diuretics
·
Alpha
Blockers
·
Beta
Blockers
·
Calcium
Channel Blockers
·
Angiotensin
Converting Enzyme Inhibitors (ACE Inhibitors)
·
Angiotensin
Receptor Blockers
·
Vasodilators
·
Centrally
Acting Agents
2.
Antianginals:
·
Beta
Blockers
·
Calcium
Channel Blockers
·
Coronary
Vasodilators including Nitrates
3.
Antidysrythmics:
·
Cardiac
Glycosides including Digoxin
·
Beta
Blockers
·
Calcium
Channel Blockers
·
Various
– Adenosine, Procainamide, Quinidine, Lidocaine, Bretylium
4.
Cardiac
Sympathomimetics:
·
Dobutamine
·
Dopamine
·
Epinephrine
·
Norepinephrine
·
Isoproterenol
·
Phenylephrine
5.
Congestive
Heart Failure Therapy:
·
Angiotensin
Converting Enzyme (ACE)
·
Inhibitors
·
Cardiac
Glycosides (Digoxin)
·
Diuretics
·
Sympathomimetics/Inotropes
K. Medications by Therapeutic Classifications
1. Diuretics:
a.
Loop
Diuretics – Furosemide
b.
Osmotic
Diuretics – Mannitol
c.
Potassium
Sparing Diuretics – Amiloride, Spironolactone, Triamterene
d.
Thiazide
Diuretics – Hydrochlorothiazide
2.
Beta
Adrenergic Blocking Agents
a.
Propranolol
(Inderal)
b.
Atenolol
(Tenormin)
c.
Metoprolol
(Lopressor)
d.
Labetolol
(Trandate)
e.
Esmolol
(Brevibloc
3.
Calcium
Channel Blocking Agents
a.
Nifedipine
(Adalat)
b.
Diltiazem
(Cardizem)
c.
Verapamil
(Isoptin)
d.
Amlodipine
(Norvasc)
e.
Felodipine
(Renedil)
4.
Angiotensin
converting enzyme inhibitors
a.
Captopril
(Capoten)
b.
Enalapril
(Vasotec)
c.
Enalaprilat
(Vasotec IV)
d.
Fosinopril
(Monopril)
e.
Ramipiril
(Altace)
5.
Angiotensin
II receptor antagonists
a.
losartan
(Cozaar)
b.
valsartan
(Diovan)
6.
Vasodilators
a.
Hydralazine
(Apresoline)
b.
Nitroglycerin
c.
Sodium
Nitroprusside
7.
Sympathomimetics:
a.
Dobutamine
b.
Dopamine
c.
Epinephrine
d.
Norepinephrine
e.
Isoproterenol
f.
Phenylephrine
8.
Antidysrythmics:
a.
Cardiac
glycosides including Digoxin
b.
Beta
Blockers
c.
Calcium
Channel Blockers
d.
Various
– Adenosine, Procainamide, Quinidine, Lidocaine, Bretylium
L. Drugs Actions
1. Beta Adrenergic Blocking Agents
2.
Calcium
Channel Blocking Agents
3.
Angiotensin
Converting Enzyme Inhibitors
4.
Angiotensin
II Receptor Blockers
5.
Diuretics
6.
Cardiac
Sympathomimetics and Antidysrythmics
M. Beta Adrenergic Blocking Agents
1. These drugs block the beta-receptors in the
sympathetic nervous system
2.
can
be useful in situations where sympathetic activity is excessive or
inappropriate. E.g. hypertension, angina, dysrythmias
N. Calcium Channel Blocking Agents
1. Contractions of cardiac and smooth muscle cells are
dependent on the movement of calcium ions into the cells through specific
channels.
2.
If
calcium reduced, there will be changes in cardiac electrical activity and
vasodilation
3.
Used
in dysrythmias, angina, and hypertension
O. Angiotensin Converting Enzyme Inhibitors
1. Acts on renin-angiotensin-aldosterone system
2.
If
the conversion of angiotensin I to angiotensin II by enzymes is blocked, there
will be reduction in blood pressure by vasodilation
P. Angiotensin II Receptor Blockers
1. They block angiotensin II effect at the angiotensin type 1 receptors.
Thus there is vasodilation and blood pressure lowering.
Q. Diuretics
1. Most diuretics act by increasing sodium excretion by
the kidney
2.
Where
sodium goes, so does water, so that when the sodium remains in the kidney
filtrate (urine), more water will be held, and thus urine volume or fluid
excretion goes up.
3.
As
sodium is excreted, so is potassium, so these drugs can considerably upset
potassium levels in the blood, leading to cardiac abnormalities.
4.
Potassium
supplements like Slow K
R. Cardiac Sympathomimetics and Antidysrythmics
Most are used within the context of resuscitation from
cardiac arrest.
- Medications in the Context of Cardiac Arrest
1. Inotropes (Sympathomimetics)
2.
Antidysrythmics
3.
Vasodilators
4.
Beta
Blockers
5.
Diuretics
6.
Analgesics
7.
Thrombolytics
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