PHARMACOLOGY

John Nicholas M. Villamor, RN, NCII

M W F 1:00pm 2:0pm ______________________________________________________________________________

CARDIAC GLYCOSIDES, ANTIANGINALS AND ANTIDYSRHYTHMICS

CARDIAC GLYCOSIDES also called digitalis glycosides, are group of drugs that inhibit the sodium potassium pump; thus they increase intracelluylar calcium, which causes the cardiac muscle fibers to contract more efficiently. Four effects of Digitalis preparation on the hear muscle: 1. Positive Inotropic Action increases myocardial contraction stroke volume 2. Negative chronotropic action decreases heart rate 3. Negative dromotropic action decreases conduction of the heart cells Digoxin (Lanoxin) Drug Classification: Glycoside Contraindication: Ventricular dysrhytmias Therpeutic Effect : To treat CHF ; atrial tachycardia, flutter, or fibrillation Mode of Action: Inhibits the sodium potassium ATPase thus promoting increased force of cardiac contraction, cardiac output and tissue perfusion; decreases ventricular rate Normal Therapeutic Level: 6-2 ng/ml Digitalis Toxicity: 2 ng/ml Signs of Digitalis Toxicity: BRADYCARDIA ANOREXIA NAUSEA/VOMITING DROWSINESS ABDOMINAL PAIN VISUAL DISTURBANCE (Yellow Green Halos) Antidote for Digitalis Toxicity Digoxin immune Fab (ovine, Digibind) ANTI-ANGINAL DRUGS are used to treat angina pectoris. Types of Anti-anginal Drugs 1. Nitrates a. It affects the blood vessel in the venous circulation and coronary arteries. They cause generalized vascular and coronary vasodilation, thus

increasing blood flow through the coronary arteries to the myocardial cells. Nitroglycerin (Nitrates) Drug Classification: Anti - anginal Contraindication: Marked hypotension, AMI, severe anemia Therpeutic Effect To control angina pectoris (anginal pain) Mode of Action Decrease myocardial demand for oxygen; decrease preload by dilating veins thus indirectly decreasing afterload Considerations Store it in a dark, glass container Assess BP for hypertension Replace every 3 to 6 months Preparation Sublingual (Emergency) Under the tongue 3 doses for 5 minutes If 3 doses are not effective, rush the patient to the hospital Transdermal Patch (Maintenance) Chest Left side of the chest If hair is visible; cut or clip Apply every 10 to 12 hours BEST TIME: Morning Rest for 10 to 12 hours Adverse Reactions: Hypotension Reflex Tachycardia Paradoxical Bradycardia 2. Beta Blockers a. Beta 1 and Beta 2 Receptor sites. It decreases the effects of the sympathetic nervous system by blocking the action of the catecholamines, epinephrine and norepinephrine. Propanolol (Inderal), Atenlol (Tenormin), Metoprolol (Lopressor) Drug Classification: Beta-Blockers Contraindication: Asthma Therpeutic Effect Decreasing the heart rate and myocardial contractility thus reducing the oxygen consumption and consequently, they reduce anginal pain Mode of Action It decreases the effects of the sympathetic nervous system by blocking the action of the catecholamines, epinephrine and norepinephrine. 3. Calcium Channel Blockers

a. Calcium activates myocardial contraction, increasing the workload of the heart and the need for more oxygen, b. Calcium channel blockers decreases: i. Cardiac contractility (negative inotropic effect that relaxes smooth mucle) ii. Afterload iii. Peripheral resistance iv. Workload of the heart thus decreasing the need for oxygen. Nifedipine (Procardia, Adalat), Nicardipine HCI (Cardine, Cardene SR), Nisoldipine (Sulzar, Nisocor) Drug Classification: Calcium Channel Blockers Therpeutic Effect Effective in controlling angina by relaxing coronary arteries thus decreasing oxygen demand. Mode of Action Cardiac contractility (negative inotropic effect that relaxes smooth mucle) Afterload Peripheral resistance Workload of the heart thus decreasing the need for oxygen. Side Effects: Headache Hypotension Dizziness Flushing of skin Adverse Effects: Kidney and Liver Damage Cardiac Arryhtmias ANTIDYSRHYTMIC DRUGS Cardiac dysrhytmia (arrhythmia) is defined as any deviation from the normal rate or pattern of heartbeat, this includes heart rates that are too slow (bradycardia), too fast (tachycardia), or irregular. Types of Antidysrhytmic Drugs 1. Fast (Sdium) Channel Blockers a. Decrease the fast sodium influx to the cardiac cells e.g. Lidocaine 2. Beta Blockers e.g. Propanolol (Inderal), Atenlol (Tenormin), Metoprolol (Lopressor)3. Prolong Repolarization a. Used in emergency treatment of ventricular dysrhythmias when other antidysrhthmics are ineffectives e.g. Bretylium (Bretylol) and Aiodarone (Coradarone) 4. Calcium Channel Blockers

e.g. Nifedipine (Procardia, Adalat), Nicardipine HCI (Cardine, Cardene SR), Nisoldipine (Sulzar, Nisocor)