Atropine

Drug for Rate Management

Blocks parasympathetic receptors (muscarinic)

Used to treat symptomatic bradycardia

Use caution with myocardial ischemia

S/E: dry mouth, blurred vision, photophobia, tachycardia, urinary retention, constipation

Digoxin (Lanoxin)

Cardiac Glycoside

Drug for Heart Failure

Alters electrolyte composition in myocardial cells

Inhibits Na-K ATPase pump, inc intracellular Na and Ca

Slower, stronger heart rate

Toxicity: N/V/D, anorexia, slow irr HR

Monitor K and Ca levels

Digitalization: IV loading dose followed by oral dose

Catopril (Capoten) & Enalapril (Vasotec)

ACE inhibitors

Drugs for Heart Failure

Inhibits the RAAS

Inc vasodilation, dec afterload and preload

Inhibits cardiac remodeling in heart failure

Promote accumulation of kinins

Inc excretion of Na and H20, dec excretion of K

S/E: dry cough, angioedema, hyperkalemia (blocks aldosterone), hypotension

Losartan (Cozaar) & Valsartan (Diovan)

Angiotensin II Receptor Blockers (ARB's)

Drugs for Heart Failure

Blocks vasoconstrictor effects of Angio II at receptor sites

For people who don't tolerate ACE inhibitors (usually due to cough)

Inc vasodilation to dec afterload

Dec formation of aldosterone to dec preload

Have lesser effects on cardiac remodeling

Spironolactone (Aldactone) & Eplerenone (Inspra)

Aldosterone Antagonists

Drugs for Heart Failure

Block aldosterone receptors in the heart and blood vessels

Unlike ACE inhibitors or ARB's, which only reduce aldosterone production

Major S/E is hyperkalemia

Risk inc with ACE inhibitors/ARB's and renal impairment

Propranolol (Inderal), Meoprolol (Lopressor), & Carvedilol (Coreg)

Beta Blockers

Drugs for Heart Failure

Blocks stimulation of beta adrenergic receptors, which blocks cardiac remodeling in HF

Dec in SV leads to dec BP

Dec HR, Preload, & Afterload

Lowest dose initially, then gradual inc to prevent cardiosuppresion

S/E: dec HDL, dec libido, impotence

Propranolol = Nonselective

Nesiritide (Natrecor)

IV vasodilator

Drug for Heart Failure

Synthetic form of brain naturetic peptide (BNP)

Used for short-term support of pts in acute decompensated HF

Suppresses RAAS, suppresses sympathetic outflow from CNS

Binds w/ receptors on arterioles/veins --> direct vasodilation

Dobutamine (Dobutrex) & Dopamine (Intropin)

Inotropes: Sympathomimetics

Drugs for Heart Failure

Inc rate and/or force of contraction

Administered IV only

Dobutamine: Stimulates B1 receptors to improve CO and contractility. Can cause HTN, PVC's, arrhythmias, angina, tachycardia.

Dopamine: Stimulate B1 and alpha-receptors to cause inc contractility and peripheral vasoconstriction. Used in treatment of shock. S/E: arrhythmias, hypotension, tissue necrosis at IV site if infiltration occurs. Monitor BP and P.

HCTZ and Lasix

Diuretics

Drugs for Heart Failure

First line drugs for pts with volume overload

Used for symptom management

Will dec preload and afterload

HCTZ: moderate diuresis

Lasix: profound diuresis

Check urine output.

Procainamide (Procanbid)

Class 1 - Sodium Channel Blocker

Antidysrhythmic

Used for ventricular and supraventricular dysrhythmias

S/E: Wide QRS, diarrhea, cardiac toxicity, ringing in ears, dec pulse

Amiodarone (Cordarone)

Class III: K channel blocker

Antidysrhythmic

Used for highly symptomatic atrial and life threatening ventricular arrhythmias

Can cause multiple serious S/E: damage to lungs, eyes, liver and thyroid

Treatment should be reserved for pts who haven't responded to safer drugs

Extremely long 1/2 life: 25-110 days

Diltiazem (Cardizem)

Class IV: Ca Channel Blocker

Antidysrhythmic

Used for ventricular rate control for supraventricular arrhythmias

For pts with A fib or A flutter

Slows SA nodal automaticity, slow AV node conduction, and dec myocardial contractility

S/E: bradycardia, AV block, hypotension, peripheral edema, constipation, heart failure

Adenosine (Adenocard)

Antidysrhythmic

Dec automaticity in SA node and slows conduction through AV node

IV bolus doses used for supraventricular tachycardia (SVT)

Can cause transient (< 1 min) dyspnea, flushing, chest discomfort, and bradycardia

1/2 life: 1.5-10 sec; 6 mg IV push given rapidly. Repeat 12 mg after 1-2 min PRN.