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Chapter 17. Cardiac Stimulants and Depressants. The Heart . The heart is a four-chamber organ located in the upper left thoracic cavity. Purpose Pumps the blood around the body so that oxygen and nutrients can be distributed to all areas of the body

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Chapter 17

Chapter 17

Cardiac Stimulants and Depressants


The heart
The Heart

  • The heart is a four-chamber organ located in the upper left thoracic cavity.

  • Purpose

    • Pumps the blood around the body so that oxygen and nutrients can be distributed to all areas of the body

    • Maintains the blood pressure at an acceptable level

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.


Antiarrhythmics and antianginals
Antiarrhythmics and Antianginals

  • Cardiac illnesses

    • Cardiac stimulants

    • Cardiac depressants

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.


Treatment of heart failure
Treatment of Heart Failure

  • Cardiac glycosides

    • Digoxin

    • Treat arrhythmias

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.


Digoxin
Digoxin

  • Decreases electrical conduction

  • Prolongs refractory period

  • Increases the force of the myocardial contraction

    • Positive inotropic action

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.


Digoxin dose considerations
Digoxin: Dose Considerations

  • Duration of action

  • Method of administration

  • Other

    • Physical size of the client

    • Other medications

    • Renal or hepatic function

    • Advanced age

    • Presence of other illnesses

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.


Antiarrhythmics and antianginals1
Antiarrhythmics and Antianginals

  • Require a digitalizing dose

    • To bring serum levels to a therapeutic level

    • All glycosides have a low therapeutic level

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.


Antiarrhythmics and antianginals side effects

Gastrointestinal effects

Nausea and vomiting

Anorexia

Diarrhea

Cardiac effects

Cardiac arrhythmias

Antiarrhythmics and Antianginals: Side Effects

(continues)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.


Antiarrhythmics and antianginals side effects1

(continued)

Antiarrhythmics and Antianginals: Side Effects

  • Neurological effects

    • Restlessness

    • Irritability

    • Drowsiness

    • Vision changes

    • Headache

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.


Cardiac glycoside toxicity
Cardiac Glycoside Toxicity

  • Predispose to cardiac glycoside toxicity

    • Hypokalemia

    • Renal impairment

    • Rapid IV administration

(continues)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.


Cardiac glycoside toxicity1

(continued)

Cardiac Glycoside Toxicity

  • Treatment

    • Stop the drug

    • Physical assessment

    • Check potassium level

      • Administer if needed

    • Monitor heart rate

      • Administer antiarrhythmics

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.


Antiarrhythmic and antidysrhythmic drugs
Antiarrhythmic and Antidysrhythmic Drugs

  • Grouped together according to their similar actions

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.


Antiarrhythmics and antianginals drug action
Antiarrhythmics and Antianginals: Drug Action

  • Work three ways:

    • Decrease the automaticity of cardiac tissues in the ectopic sites

    • Alter the rate of conduction of electrical impulses through the heart.

    • Alter the refractory period of cardiac muscle between consecutive contractions

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.


Antidysrhythmic agents
Antidysrhythmic Agents

  • Group 1, 1A, 1B, 1C: decrease the influx of sodium ions, stabilizing membranes

  • Group 2: depress phase 4 in depolarization

  • Group 3: prolong repolarization in phase 3

  • Group 4: depress phase 4 depolarization and prolong repolarization of phases 1 and 2

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.


Beta adrenergic blocking agents
Beta-adrenergic Blocking Agents

  • Inhibit beta1 and beta2 sympathetic receptors

  • Reduce heart rate

  • Reduce contractility

  • Decrease supraventricular and ventricular rhythms

  • Decrease blood pressure

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.


Antidysrhythmic agents1
Antidysrhythmic Agents

  • Adverse effects

    • Cause bronchoconstriction

    • Cause heart failure

  • Examples: propanolol (Inderal), esmolol, bretylium tosylate (Bretylol)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.


Calcium channel antagonists
Calcium Channel Antagonists

  • Reduce the influx of calcium into the cell:

    • Prevention or reversal of spasms of the coronary blood vessels

      • Coronary artery dilation

      • Reduction of myocardial oxygen consumption

  • Example: verapamil

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.


Adenosine
Adenosine

  • Slow conduction through the AV node

  • Cardioverts paroxysmal supraventricular tachycardia (PSVT)

  • Side effects

    • Facial flushing

    • Shortness of breath

    • Headache

    • Nausea and vomiting

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.


Adrenergic or sympathomimetic drugs
Adrenergic or SympathomimeticDrugs

  • Affect alpha- or beta-adrenergic receptors

  • Treat shock

    • Mimic epinephrine and/or norepinephrine

    • Cause increase in heart rate

    • Cause vasoconstriction

    • Reverse hypotension from shock

      • Cardiac or trauma

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.


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