Cardiovascular Drugs

Cardiac Glycosides1048708 Digitalis is derived from the foxglove plantand has been used for over 400 years to treatsymptoms of heart failure1048708 Lanoxin (digoxin) ndash most often used formCan be given PO or IV1048708 MOA Positive inotrophic action ndash increasesstrength of myocardial contraction causingincrease in COP and decrease in O2demand

Lanoxin MOA 1 Positive inotrophic action ndashincreases strength of myocardial contractioncausing increase in COP and decrease in O2demand 2 Negative chronotropic action ndashdecreases HR by decreasing impulseformation in the SA node It indirectlystimulates the vagus nerve Together theseactions lead to a decrease in compensatorytachycardia (sympathetic nervous system)3 Negative dronotrophic action ndash slowedconduction of impulses through the AV node

Lanoxin1048708 Uses CHF to treat sx of decreased COPA-fib A flutter1048708 Adverse Effects Anorexia NVD fatiguedizziness visual disturbances (yellow visionblurred vision seeing halos around lightsdouble vision) These are helpful in dx oftoxic levels Dose reductions may benecessary due to decreased renal function inthe elderly

Digoxin1048708 Digoxin has a narrow therapeutic range (05-20ngml) Levels are drawn just prior to adose Doses should be given at the sametime each day1048708 Nursing Measures Take apical pulse for afull minute prior to each dose Hold drug andnotify HCP if pulse lt 60 Be aware of factorsthat predispose to toxicity ndash hypokalemiahypercalcemia hypoxia related to heart oflung disease and renal or liver disease

DigoxinNursing measures continued1048708 Quinaglute and other antiarrythmic drugscalcium salts and calcium channel blockersadrenergic drugs and anticholinergics whengiven with digoxin cause increased digoxinlevels1048708 Digoxin may have to be decreased by 50when given with quinidine or amidrome and25 for calcium channel blockers1048708 Antiacids Questran (cholestyramine)laxatives and neomycin decrease effects oforal digoxin

1048708 Antidote DigibindDigoxinNursing measures continued1048708 Instruct patient regarding Take pulse beforeeach dose take same time each day do notdouble dose if misses a dose report adverseeffects report weight gain of more than 1per day or more than 3 per week

Antiarrythmic Drugs This class of drugs alter the conduction of electricalimpulses in the heart and are primarily used fortachydisrhythmias

Research has shown that patients treated for somedysrhythmias had a higher death rate than those whodid not receive the therapy These deaths wereattributed to the effects of the drugs worseningexisting dysrhythmias or causing new dysrhythmias

These studies have lead to a decrease in use someof these class I drugs (quinidine) and higher use ofclass II drug (beta blockers) and class III drugs(amiodrone)

Antiarrythmic Drugs1048708 There is now greater use of radiofrequency catheterablation surgically implanted cardioverter -defibrillators (ICDs)1048708 Uses Convert A-fib or flutter to NSRMaintain NSR after conversion from a-fib or flutterWhen ventricular rate is so fast that decreased COPleads to sx of decreased systemic cerebral andcoronary circulationTo terminate dangerous dysrhythmias that may befatal such as ventricular tachycardia

Class I Antidysrhythmias1048708 Examples Class 1aQuinaglute (quinidine) prototype for class 1aNorpace (disopyramide)Pronestyl (procainamide)1048708 Uses symptomatic PVCS SVT V tach prevent vfibClass 1bXylocaine (lidocaine) prototype for class 1b1048708 Uses symptomatic PVCs V tach prevent v-fib

Quinaglute (quinidine) Adverse Effects NVD hearing losstinnitus visual disturbancesNursing Measures Inform all HCPs thatpatient is taking the drug Report adverseeffects and feeling faint (V-tach or fib) Bestto take on empty stomach with glass of waterbut may take with food if GI sx Avoidexcessive citrus juices because they changeurine pH and decrease excretion of quinidine

Pronestyl (procainamide)1048708 Similar to quinidine1048708 Adverse effects Anorexia N hypotension(IV) SLE like syndrome V fib1048708 Contraindications Allergy to procaine 2nd or3rd degree heart block liver or renal disease1048708 Nursing Measures Give with food avoidhazardous activities until effects are knownavoid OTC drugs

Norpace (disopyramide)1048708 Similar to quinidine1048708 Adverse Effects Dizziness fatigue HAblurred vision dry mouth CHF arrhythmiashypotension constipation N urinaryretention hypoglycemia1048708 Contraindications Cardiogenic shock 2nd and3rd degree blocks sick sinus syndrome wopacemaker1048708 Interactions Many - cimetidine warfarinerythromycin dilantin etc

Xylocaine (lidocaine)1048708 Local anesthetic drug of choice for treatingserious ventricular arrhythmias Decreasesmyocardial irritability in the ventricles but haslittle or no effect on the artria1048708 Differs from quinidine in that Always givenIV no decrease in AV conduction or cardiaccontractility in therapeutic doses rapid onset1to2 minutes and short duration 20 min ofaction it is less likely to cause heart blocksasystole heart failure or V arrhythmias

Lidocaine1048708 Adverse Effects Drowsiness tinnitusblurred or double vision anaphylaxisseizures1048708 Contraindications Allergy to localanesthetics heart blocks1048708 Nursing Measures Ensure correctpreparation and dose prior to administrationMonitor EKG

Anticoagulants1048708 Anticoagulants prevent formation of new clotsand the extension of existing clots They donot dissolve clots improve blood flow totissues or prevent damage from ischemia totissues beyond the clot1048708 Uses Prevention or management ofthrombophlebitis DVT or pulmonaryembolism1048708 Adverse Effects Bleeding

Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Cardiac Glycosides1048708 Digitalis is derived from the foxglove plantand has been used for over 400 years to treatsymptoms of heart failure1048708 Lanoxin (digoxin) ndash most often used formCan be given PO or IV1048708 MOA Positive inotrophic action ndash increasesstrength of myocardial contraction causingincrease in COP and decrease in O2demand

Lanoxin MOA 1 Positive inotrophic action ndashincreases strength of myocardial contractioncausing increase in COP and decrease in O2demand 2 Negative chronotropic action ndashdecreases HR by decreasing impulseformation in the SA node It indirectlystimulates the vagus nerve Together theseactions lead to a decrease in compensatorytachycardia (sympathetic nervous system)3 Negative dronotrophic action ndash slowedconduction of impulses through the AV node

Lanoxin1048708 Uses CHF to treat sx of decreased COPA-fib A flutter1048708 Adverse Effects Anorexia NVD fatiguedizziness visual disturbances (yellow visionblurred vision seeing halos around lightsdouble vision) These are helpful in dx oftoxic levels Dose reductions may benecessary due to decreased renal function inthe elderly

Digoxin1048708 Digoxin has a narrow therapeutic range (05-20ngml) Levels are drawn just prior to adose Doses should be given at the sametime each day1048708 Nursing Measures Take apical pulse for afull minute prior to each dose Hold drug andnotify HCP if pulse lt 60 Be aware of factorsthat predispose to toxicity ndash hypokalemiahypercalcemia hypoxia related to heart oflung disease and renal or liver disease

DigoxinNursing measures continued1048708 Quinaglute and other antiarrythmic drugscalcium salts and calcium channel blockersadrenergic drugs and anticholinergics whengiven with digoxin cause increased digoxinlevels1048708 Digoxin may have to be decreased by 50when given with quinidine or amidrome and25 for calcium channel blockers1048708 Antiacids Questran (cholestyramine)laxatives and neomycin decrease effects oforal digoxin

1048708 Antidote DigibindDigoxinNursing measures continued1048708 Instruct patient regarding Take pulse beforeeach dose take same time each day do notdouble dose if misses a dose report adverseeffects report weight gain of more than 1per day or more than 3 per week

Antiarrythmic Drugs This class of drugs alter the conduction of electricalimpulses in the heart and are primarily used fortachydisrhythmias

Research has shown that patients treated for somedysrhythmias had a higher death rate than those whodid not receive the therapy These deaths wereattributed to the effects of the drugs worseningexisting dysrhythmias or causing new dysrhythmias

These studies have lead to a decrease in use someof these class I drugs (quinidine) and higher use ofclass II drug (beta blockers) and class III drugs(amiodrone)

Antiarrythmic Drugs1048708 There is now greater use of radiofrequency catheterablation surgically implanted cardioverter -defibrillators (ICDs)1048708 Uses Convert A-fib or flutter to NSRMaintain NSR after conversion from a-fib or flutterWhen ventricular rate is so fast that decreased COPleads to sx of decreased systemic cerebral andcoronary circulationTo terminate dangerous dysrhythmias that may befatal such as ventricular tachycardia

Class I Antidysrhythmias1048708 Examples Class 1aQuinaglute (quinidine) prototype for class 1aNorpace (disopyramide)Pronestyl (procainamide)1048708 Uses symptomatic PVCS SVT V tach prevent vfibClass 1bXylocaine (lidocaine) prototype for class 1b1048708 Uses symptomatic PVCs V tach prevent v-fib

Quinaglute (quinidine) Adverse Effects NVD hearing losstinnitus visual disturbancesNursing Measures Inform all HCPs thatpatient is taking the drug Report adverseeffects and feeling faint (V-tach or fib) Bestto take on empty stomach with glass of waterbut may take with food if GI sx Avoidexcessive citrus juices because they changeurine pH and decrease excretion of quinidine

Pronestyl (procainamide)1048708 Similar to quinidine1048708 Adverse effects Anorexia N hypotension(IV) SLE like syndrome V fib1048708 Contraindications Allergy to procaine 2nd or3rd degree heart block liver or renal disease1048708 Nursing Measures Give with food avoidhazardous activities until effects are knownavoid OTC drugs

Norpace (disopyramide)1048708 Similar to quinidine1048708 Adverse Effects Dizziness fatigue HAblurred vision dry mouth CHF arrhythmiashypotension constipation N urinaryretention hypoglycemia1048708 Contraindications Cardiogenic shock 2nd and3rd degree blocks sick sinus syndrome wopacemaker1048708 Interactions Many - cimetidine warfarinerythromycin dilantin etc

Xylocaine (lidocaine)1048708 Local anesthetic drug of choice for treatingserious ventricular arrhythmias Decreasesmyocardial irritability in the ventricles but haslittle or no effect on the artria1048708 Differs from quinidine in that Always givenIV no decrease in AV conduction or cardiaccontractility in therapeutic doses rapid onset1to2 minutes and short duration 20 min ofaction it is less likely to cause heart blocksasystole heart failure or V arrhythmias

Lidocaine1048708 Adverse Effects Drowsiness tinnitusblurred or double vision anaphylaxisseizures1048708 Contraindications Allergy to localanesthetics heart blocks1048708 Nursing Measures Ensure correctpreparation and dose prior to administrationMonitor EKG

Anticoagulants1048708 Anticoagulants prevent formation of new clotsand the extension of existing clots They donot dissolve clots improve blood flow totissues or prevent damage from ischemia totissues beyond the clot1048708 Uses Prevention or management ofthrombophlebitis DVT or pulmonaryembolism1048708 Adverse Effects Bleeding

Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Lanoxin MOA 1 Positive inotrophic action ndashincreases strength of myocardial contractioncausing increase in COP and decrease in O2demand 2 Negative chronotropic action ndashdecreases HR by decreasing impulseformation in the SA node It indirectlystimulates the vagus nerve Together theseactions lead to a decrease in compensatorytachycardia (sympathetic nervous system)3 Negative dronotrophic action ndash slowedconduction of impulses through the AV node

Lanoxin1048708 Uses CHF to treat sx of decreased COPA-fib A flutter1048708 Adverse Effects Anorexia NVD fatiguedizziness visual disturbances (yellow visionblurred vision seeing halos around lightsdouble vision) These are helpful in dx oftoxic levels Dose reductions may benecessary due to decreased renal function inthe elderly

Digoxin1048708 Digoxin has a narrow therapeutic range (05-20ngml) Levels are drawn just prior to adose Doses should be given at the sametime each day1048708 Nursing Measures Take apical pulse for afull minute prior to each dose Hold drug andnotify HCP if pulse lt 60 Be aware of factorsthat predispose to toxicity ndash hypokalemiahypercalcemia hypoxia related to heart oflung disease and renal or liver disease

DigoxinNursing measures continued1048708 Quinaglute and other antiarrythmic drugscalcium salts and calcium channel blockersadrenergic drugs and anticholinergics whengiven with digoxin cause increased digoxinlevels1048708 Digoxin may have to be decreased by 50when given with quinidine or amidrome and25 for calcium channel blockers1048708 Antiacids Questran (cholestyramine)laxatives and neomycin decrease effects oforal digoxin

1048708 Antidote DigibindDigoxinNursing measures continued1048708 Instruct patient regarding Take pulse beforeeach dose take same time each day do notdouble dose if misses a dose report adverseeffects report weight gain of more than 1per day or more than 3 per week

Antiarrythmic Drugs This class of drugs alter the conduction of electricalimpulses in the heart and are primarily used fortachydisrhythmias

Research has shown that patients treated for somedysrhythmias had a higher death rate than those whodid not receive the therapy These deaths wereattributed to the effects of the drugs worseningexisting dysrhythmias or causing new dysrhythmias

These studies have lead to a decrease in use someof these class I drugs (quinidine) and higher use ofclass II drug (beta blockers) and class III drugs(amiodrone)

Antiarrythmic Drugs1048708 There is now greater use of radiofrequency catheterablation surgically implanted cardioverter -defibrillators (ICDs)1048708 Uses Convert A-fib or flutter to NSRMaintain NSR after conversion from a-fib or flutterWhen ventricular rate is so fast that decreased COPleads to sx of decreased systemic cerebral andcoronary circulationTo terminate dangerous dysrhythmias that may befatal such as ventricular tachycardia

Class I Antidysrhythmias1048708 Examples Class 1aQuinaglute (quinidine) prototype for class 1aNorpace (disopyramide)Pronestyl (procainamide)1048708 Uses symptomatic PVCS SVT V tach prevent vfibClass 1bXylocaine (lidocaine) prototype for class 1b1048708 Uses symptomatic PVCs V tach prevent v-fib

Quinaglute (quinidine) Adverse Effects NVD hearing losstinnitus visual disturbancesNursing Measures Inform all HCPs thatpatient is taking the drug Report adverseeffects and feeling faint (V-tach or fib) Bestto take on empty stomach with glass of waterbut may take with food if GI sx Avoidexcessive citrus juices because they changeurine pH and decrease excretion of quinidine

Pronestyl (procainamide)1048708 Similar to quinidine1048708 Adverse effects Anorexia N hypotension(IV) SLE like syndrome V fib1048708 Contraindications Allergy to procaine 2nd or3rd degree heart block liver or renal disease1048708 Nursing Measures Give with food avoidhazardous activities until effects are knownavoid OTC drugs

Norpace (disopyramide)1048708 Similar to quinidine1048708 Adverse Effects Dizziness fatigue HAblurred vision dry mouth CHF arrhythmiashypotension constipation N urinaryretention hypoglycemia1048708 Contraindications Cardiogenic shock 2nd and3rd degree blocks sick sinus syndrome wopacemaker1048708 Interactions Many - cimetidine warfarinerythromycin dilantin etc

Xylocaine (lidocaine)1048708 Local anesthetic drug of choice for treatingserious ventricular arrhythmias Decreasesmyocardial irritability in the ventricles but haslittle or no effect on the artria1048708 Differs from quinidine in that Always givenIV no decrease in AV conduction or cardiaccontractility in therapeutic doses rapid onset1to2 minutes and short duration 20 min ofaction it is less likely to cause heart blocksasystole heart failure or V arrhythmias

Lidocaine1048708 Adverse Effects Drowsiness tinnitusblurred or double vision anaphylaxisseizures1048708 Contraindications Allergy to localanesthetics heart blocks1048708 Nursing Measures Ensure correctpreparation and dose prior to administrationMonitor EKG

Anticoagulants1048708 Anticoagulants prevent formation of new clotsand the extension of existing clots They donot dissolve clots improve blood flow totissues or prevent damage from ischemia totissues beyond the clot1048708 Uses Prevention or management ofthrombophlebitis DVT or pulmonaryembolism1048708 Adverse Effects Bleeding

Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Lanoxin1048708 Uses CHF to treat sx of decreased COPA-fib A flutter1048708 Adverse Effects Anorexia NVD fatiguedizziness visual disturbances (yellow visionblurred vision seeing halos around lightsdouble vision) These are helpful in dx oftoxic levels Dose reductions may benecessary due to decreased renal function inthe elderly

Digoxin1048708 Digoxin has a narrow therapeutic range (05-20ngml) Levels are drawn just prior to adose Doses should be given at the sametime each day1048708 Nursing Measures Take apical pulse for afull minute prior to each dose Hold drug andnotify HCP if pulse lt 60 Be aware of factorsthat predispose to toxicity ndash hypokalemiahypercalcemia hypoxia related to heart oflung disease and renal or liver disease

DigoxinNursing measures continued1048708 Quinaglute and other antiarrythmic drugscalcium salts and calcium channel blockersadrenergic drugs and anticholinergics whengiven with digoxin cause increased digoxinlevels1048708 Digoxin may have to be decreased by 50when given with quinidine or amidrome and25 for calcium channel blockers1048708 Antiacids Questran (cholestyramine)laxatives and neomycin decrease effects oforal digoxin

1048708 Antidote DigibindDigoxinNursing measures continued1048708 Instruct patient regarding Take pulse beforeeach dose take same time each day do notdouble dose if misses a dose report adverseeffects report weight gain of more than 1per day or more than 3 per week

Antiarrythmic Drugs This class of drugs alter the conduction of electricalimpulses in the heart and are primarily used fortachydisrhythmias

Research has shown that patients treated for somedysrhythmias had a higher death rate than those whodid not receive the therapy These deaths wereattributed to the effects of the drugs worseningexisting dysrhythmias or causing new dysrhythmias

These studies have lead to a decrease in use someof these class I drugs (quinidine) and higher use ofclass II drug (beta blockers) and class III drugs(amiodrone)

Antiarrythmic Drugs1048708 There is now greater use of radiofrequency catheterablation surgically implanted cardioverter -defibrillators (ICDs)1048708 Uses Convert A-fib or flutter to NSRMaintain NSR after conversion from a-fib or flutterWhen ventricular rate is so fast that decreased COPleads to sx of decreased systemic cerebral andcoronary circulationTo terminate dangerous dysrhythmias that may befatal such as ventricular tachycardia

Class I Antidysrhythmias1048708 Examples Class 1aQuinaglute (quinidine) prototype for class 1aNorpace (disopyramide)Pronestyl (procainamide)1048708 Uses symptomatic PVCS SVT V tach prevent vfibClass 1bXylocaine (lidocaine) prototype for class 1b1048708 Uses symptomatic PVCs V tach prevent v-fib

Quinaglute (quinidine) Adverse Effects NVD hearing losstinnitus visual disturbancesNursing Measures Inform all HCPs thatpatient is taking the drug Report adverseeffects and feeling faint (V-tach or fib) Bestto take on empty stomach with glass of waterbut may take with food if GI sx Avoidexcessive citrus juices because they changeurine pH and decrease excretion of quinidine

Pronestyl (procainamide)1048708 Similar to quinidine1048708 Adverse effects Anorexia N hypotension(IV) SLE like syndrome V fib1048708 Contraindications Allergy to procaine 2nd or3rd degree heart block liver or renal disease1048708 Nursing Measures Give with food avoidhazardous activities until effects are knownavoid OTC drugs

Norpace (disopyramide)1048708 Similar to quinidine1048708 Adverse Effects Dizziness fatigue HAblurred vision dry mouth CHF arrhythmiashypotension constipation N urinaryretention hypoglycemia1048708 Contraindications Cardiogenic shock 2nd and3rd degree blocks sick sinus syndrome wopacemaker1048708 Interactions Many - cimetidine warfarinerythromycin dilantin etc

Xylocaine (lidocaine)1048708 Local anesthetic drug of choice for treatingserious ventricular arrhythmias Decreasesmyocardial irritability in the ventricles but haslittle or no effect on the artria1048708 Differs from quinidine in that Always givenIV no decrease in AV conduction or cardiaccontractility in therapeutic doses rapid onset1to2 minutes and short duration 20 min ofaction it is less likely to cause heart blocksasystole heart failure or V arrhythmias

Lidocaine1048708 Adverse Effects Drowsiness tinnitusblurred or double vision anaphylaxisseizures1048708 Contraindications Allergy to localanesthetics heart blocks1048708 Nursing Measures Ensure correctpreparation and dose prior to administrationMonitor EKG

Anticoagulants1048708 Anticoagulants prevent formation of new clotsand the extension of existing clots They donot dissolve clots improve blood flow totissues or prevent damage from ischemia totissues beyond the clot1048708 Uses Prevention or management ofthrombophlebitis DVT or pulmonaryembolism1048708 Adverse Effects Bleeding

Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Digoxin1048708 Digoxin has a narrow therapeutic range (05-20ngml) Levels are drawn just prior to adose Doses should be given at the sametime each day1048708 Nursing Measures Take apical pulse for afull minute prior to each dose Hold drug andnotify HCP if pulse lt 60 Be aware of factorsthat predispose to toxicity ndash hypokalemiahypercalcemia hypoxia related to heart oflung disease and renal or liver disease

DigoxinNursing measures continued1048708 Quinaglute and other antiarrythmic drugscalcium salts and calcium channel blockersadrenergic drugs and anticholinergics whengiven with digoxin cause increased digoxinlevels1048708 Digoxin may have to be decreased by 50when given with quinidine or amidrome and25 for calcium channel blockers1048708 Antiacids Questran (cholestyramine)laxatives and neomycin decrease effects oforal digoxin

1048708 Antidote DigibindDigoxinNursing measures continued1048708 Instruct patient regarding Take pulse beforeeach dose take same time each day do notdouble dose if misses a dose report adverseeffects report weight gain of more than 1per day or more than 3 per week

Antiarrythmic Drugs This class of drugs alter the conduction of electricalimpulses in the heart and are primarily used fortachydisrhythmias

Research has shown that patients treated for somedysrhythmias had a higher death rate than those whodid not receive the therapy These deaths wereattributed to the effects of the drugs worseningexisting dysrhythmias or causing new dysrhythmias

These studies have lead to a decrease in use someof these class I drugs (quinidine) and higher use ofclass II drug (beta blockers) and class III drugs(amiodrone)

Antiarrythmic Drugs1048708 There is now greater use of radiofrequency catheterablation surgically implanted cardioverter -defibrillators (ICDs)1048708 Uses Convert A-fib or flutter to NSRMaintain NSR after conversion from a-fib or flutterWhen ventricular rate is so fast that decreased COPleads to sx of decreased systemic cerebral andcoronary circulationTo terminate dangerous dysrhythmias that may befatal such as ventricular tachycardia

Class I Antidysrhythmias1048708 Examples Class 1aQuinaglute (quinidine) prototype for class 1aNorpace (disopyramide)Pronestyl (procainamide)1048708 Uses symptomatic PVCS SVT V tach prevent vfibClass 1bXylocaine (lidocaine) prototype for class 1b1048708 Uses symptomatic PVCs V tach prevent v-fib

Quinaglute (quinidine) Adverse Effects NVD hearing losstinnitus visual disturbancesNursing Measures Inform all HCPs thatpatient is taking the drug Report adverseeffects and feeling faint (V-tach or fib) Bestto take on empty stomach with glass of waterbut may take with food if GI sx Avoidexcessive citrus juices because they changeurine pH and decrease excretion of quinidine

Pronestyl (procainamide)1048708 Similar to quinidine1048708 Adverse effects Anorexia N hypotension(IV) SLE like syndrome V fib1048708 Contraindications Allergy to procaine 2nd or3rd degree heart block liver or renal disease1048708 Nursing Measures Give with food avoidhazardous activities until effects are knownavoid OTC drugs

Norpace (disopyramide)1048708 Similar to quinidine1048708 Adverse Effects Dizziness fatigue HAblurred vision dry mouth CHF arrhythmiashypotension constipation N urinaryretention hypoglycemia1048708 Contraindications Cardiogenic shock 2nd and3rd degree blocks sick sinus syndrome wopacemaker1048708 Interactions Many - cimetidine warfarinerythromycin dilantin etc

Xylocaine (lidocaine)1048708 Local anesthetic drug of choice for treatingserious ventricular arrhythmias Decreasesmyocardial irritability in the ventricles but haslittle or no effect on the artria1048708 Differs from quinidine in that Always givenIV no decrease in AV conduction or cardiaccontractility in therapeutic doses rapid onset1to2 minutes and short duration 20 min ofaction it is less likely to cause heart blocksasystole heart failure or V arrhythmias

Lidocaine1048708 Adverse Effects Drowsiness tinnitusblurred or double vision anaphylaxisseizures1048708 Contraindications Allergy to localanesthetics heart blocks1048708 Nursing Measures Ensure correctpreparation and dose prior to administrationMonitor EKG

Anticoagulants1048708 Anticoagulants prevent formation of new clotsand the extension of existing clots They donot dissolve clots improve blood flow totissues or prevent damage from ischemia totissues beyond the clot1048708 Uses Prevention or management ofthrombophlebitis DVT or pulmonaryembolism1048708 Adverse Effects Bleeding

Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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DigoxinNursing measures continued1048708 Quinaglute and other antiarrythmic drugscalcium salts and calcium channel blockersadrenergic drugs and anticholinergics whengiven with digoxin cause increased digoxinlevels1048708 Digoxin may have to be decreased by 50when given with quinidine or amidrome and25 for calcium channel blockers1048708 Antiacids Questran (cholestyramine)laxatives and neomycin decrease effects oforal digoxin

1048708 Antidote DigibindDigoxinNursing measures continued1048708 Instruct patient regarding Take pulse beforeeach dose take same time each day do notdouble dose if misses a dose report adverseeffects report weight gain of more than 1per day or more than 3 per week

Antiarrythmic Drugs This class of drugs alter the conduction of electricalimpulses in the heart and are primarily used fortachydisrhythmias

Research has shown that patients treated for somedysrhythmias had a higher death rate than those whodid not receive the therapy These deaths wereattributed to the effects of the drugs worseningexisting dysrhythmias or causing new dysrhythmias

These studies have lead to a decrease in use someof these class I drugs (quinidine) and higher use ofclass II drug (beta blockers) and class III drugs(amiodrone)

Antiarrythmic Drugs1048708 There is now greater use of radiofrequency catheterablation surgically implanted cardioverter -defibrillators (ICDs)1048708 Uses Convert A-fib or flutter to NSRMaintain NSR after conversion from a-fib or flutterWhen ventricular rate is so fast that decreased COPleads to sx of decreased systemic cerebral andcoronary circulationTo terminate dangerous dysrhythmias that may befatal such as ventricular tachycardia

Class I Antidysrhythmias1048708 Examples Class 1aQuinaglute (quinidine) prototype for class 1aNorpace (disopyramide)Pronestyl (procainamide)1048708 Uses symptomatic PVCS SVT V tach prevent vfibClass 1bXylocaine (lidocaine) prototype for class 1b1048708 Uses symptomatic PVCs V tach prevent v-fib

Quinaglute (quinidine) Adverse Effects NVD hearing losstinnitus visual disturbancesNursing Measures Inform all HCPs thatpatient is taking the drug Report adverseeffects and feeling faint (V-tach or fib) Bestto take on empty stomach with glass of waterbut may take with food if GI sx Avoidexcessive citrus juices because they changeurine pH and decrease excretion of quinidine

Pronestyl (procainamide)1048708 Similar to quinidine1048708 Adverse effects Anorexia N hypotension(IV) SLE like syndrome V fib1048708 Contraindications Allergy to procaine 2nd or3rd degree heart block liver or renal disease1048708 Nursing Measures Give with food avoidhazardous activities until effects are knownavoid OTC drugs

Norpace (disopyramide)1048708 Similar to quinidine1048708 Adverse Effects Dizziness fatigue HAblurred vision dry mouth CHF arrhythmiashypotension constipation N urinaryretention hypoglycemia1048708 Contraindications Cardiogenic shock 2nd and3rd degree blocks sick sinus syndrome wopacemaker1048708 Interactions Many - cimetidine warfarinerythromycin dilantin etc

Xylocaine (lidocaine)1048708 Local anesthetic drug of choice for treatingserious ventricular arrhythmias Decreasesmyocardial irritability in the ventricles but haslittle or no effect on the artria1048708 Differs from quinidine in that Always givenIV no decrease in AV conduction or cardiaccontractility in therapeutic doses rapid onset1to2 minutes and short duration 20 min ofaction it is less likely to cause heart blocksasystole heart failure or V arrhythmias

Lidocaine1048708 Adverse Effects Drowsiness tinnitusblurred or double vision anaphylaxisseizures1048708 Contraindications Allergy to localanesthetics heart blocks1048708 Nursing Measures Ensure correctpreparation and dose prior to administrationMonitor EKG

Anticoagulants1048708 Anticoagulants prevent formation of new clotsand the extension of existing clots They donot dissolve clots improve blood flow totissues or prevent damage from ischemia totissues beyond the clot1048708 Uses Prevention or management ofthrombophlebitis DVT or pulmonaryembolism1048708 Adverse Effects Bleeding

Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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1048708 Antidote DigibindDigoxinNursing measures continued1048708 Instruct patient regarding Take pulse beforeeach dose take same time each day do notdouble dose if misses a dose report adverseeffects report weight gain of more than 1per day or more than 3 per week

Antiarrythmic Drugs This class of drugs alter the conduction of electricalimpulses in the heart and are primarily used fortachydisrhythmias

Research has shown that patients treated for somedysrhythmias had a higher death rate than those whodid not receive the therapy These deaths wereattributed to the effects of the drugs worseningexisting dysrhythmias or causing new dysrhythmias

These studies have lead to a decrease in use someof these class I drugs (quinidine) and higher use ofclass II drug (beta blockers) and class III drugs(amiodrone)

Antiarrythmic Drugs1048708 There is now greater use of radiofrequency catheterablation surgically implanted cardioverter -defibrillators (ICDs)1048708 Uses Convert A-fib or flutter to NSRMaintain NSR after conversion from a-fib or flutterWhen ventricular rate is so fast that decreased COPleads to sx of decreased systemic cerebral andcoronary circulationTo terminate dangerous dysrhythmias that may befatal such as ventricular tachycardia

Class I Antidysrhythmias1048708 Examples Class 1aQuinaglute (quinidine) prototype for class 1aNorpace (disopyramide)Pronestyl (procainamide)1048708 Uses symptomatic PVCS SVT V tach prevent vfibClass 1bXylocaine (lidocaine) prototype for class 1b1048708 Uses symptomatic PVCs V tach prevent v-fib

Quinaglute (quinidine) Adverse Effects NVD hearing losstinnitus visual disturbancesNursing Measures Inform all HCPs thatpatient is taking the drug Report adverseeffects and feeling faint (V-tach or fib) Bestto take on empty stomach with glass of waterbut may take with food if GI sx Avoidexcessive citrus juices because they changeurine pH and decrease excretion of quinidine

Pronestyl (procainamide)1048708 Similar to quinidine1048708 Adverse effects Anorexia N hypotension(IV) SLE like syndrome V fib1048708 Contraindications Allergy to procaine 2nd or3rd degree heart block liver or renal disease1048708 Nursing Measures Give with food avoidhazardous activities until effects are knownavoid OTC drugs

Norpace (disopyramide)1048708 Similar to quinidine1048708 Adverse Effects Dizziness fatigue HAblurred vision dry mouth CHF arrhythmiashypotension constipation N urinaryretention hypoglycemia1048708 Contraindications Cardiogenic shock 2nd and3rd degree blocks sick sinus syndrome wopacemaker1048708 Interactions Many - cimetidine warfarinerythromycin dilantin etc

Xylocaine (lidocaine)1048708 Local anesthetic drug of choice for treatingserious ventricular arrhythmias Decreasesmyocardial irritability in the ventricles but haslittle or no effect on the artria1048708 Differs from quinidine in that Always givenIV no decrease in AV conduction or cardiaccontractility in therapeutic doses rapid onset1to2 minutes and short duration 20 min ofaction it is less likely to cause heart blocksasystole heart failure or V arrhythmias

Lidocaine1048708 Adverse Effects Drowsiness tinnitusblurred or double vision anaphylaxisseizures1048708 Contraindications Allergy to localanesthetics heart blocks1048708 Nursing Measures Ensure correctpreparation and dose prior to administrationMonitor EKG

Anticoagulants1048708 Anticoagulants prevent formation of new clotsand the extension of existing clots They donot dissolve clots improve blood flow totissues or prevent damage from ischemia totissues beyond the clot1048708 Uses Prevention or management ofthrombophlebitis DVT or pulmonaryembolism1048708 Adverse Effects Bleeding

Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Antiarrythmic Drugs This class of drugs alter the conduction of electricalimpulses in the heart and are primarily used fortachydisrhythmias

Research has shown that patients treated for somedysrhythmias had a higher death rate than those whodid not receive the therapy These deaths wereattributed to the effects of the drugs worseningexisting dysrhythmias or causing new dysrhythmias

These studies have lead to a decrease in use someof these class I drugs (quinidine) and higher use ofclass II drug (beta blockers) and class III drugs(amiodrone)

Antiarrythmic Drugs1048708 There is now greater use of radiofrequency catheterablation surgically implanted cardioverter -defibrillators (ICDs)1048708 Uses Convert A-fib or flutter to NSRMaintain NSR after conversion from a-fib or flutterWhen ventricular rate is so fast that decreased COPleads to sx of decreased systemic cerebral andcoronary circulationTo terminate dangerous dysrhythmias that may befatal such as ventricular tachycardia

Class I Antidysrhythmias1048708 Examples Class 1aQuinaglute (quinidine) prototype for class 1aNorpace (disopyramide)Pronestyl (procainamide)1048708 Uses symptomatic PVCS SVT V tach prevent vfibClass 1bXylocaine (lidocaine) prototype for class 1b1048708 Uses symptomatic PVCs V tach prevent v-fib

Quinaglute (quinidine) Adverse Effects NVD hearing losstinnitus visual disturbancesNursing Measures Inform all HCPs thatpatient is taking the drug Report adverseeffects and feeling faint (V-tach or fib) Bestto take on empty stomach with glass of waterbut may take with food if GI sx Avoidexcessive citrus juices because they changeurine pH and decrease excretion of quinidine

Pronestyl (procainamide)1048708 Similar to quinidine1048708 Adverse effects Anorexia N hypotension(IV) SLE like syndrome V fib1048708 Contraindications Allergy to procaine 2nd or3rd degree heart block liver or renal disease1048708 Nursing Measures Give with food avoidhazardous activities until effects are knownavoid OTC drugs

Norpace (disopyramide)1048708 Similar to quinidine1048708 Adverse Effects Dizziness fatigue HAblurred vision dry mouth CHF arrhythmiashypotension constipation N urinaryretention hypoglycemia1048708 Contraindications Cardiogenic shock 2nd and3rd degree blocks sick sinus syndrome wopacemaker1048708 Interactions Many - cimetidine warfarinerythromycin dilantin etc

Xylocaine (lidocaine)1048708 Local anesthetic drug of choice for treatingserious ventricular arrhythmias Decreasesmyocardial irritability in the ventricles but haslittle or no effect on the artria1048708 Differs from quinidine in that Always givenIV no decrease in AV conduction or cardiaccontractility in therapeutic doses rapid onset1to2 minutes and short duration 20 min ofaction it is less likely to cause heart blocksasystole heart failure or V arrhythmias

Lidocaine1048708 Adverse Effects Drowsiness tinnitusblurred or double vision anaphylaxisseizures1048708 Contraindications Allergy to localanesthetics heart blocks1048708 Nursing Measures Ensure correctpreparation and dose prior to administrationMonitor EKG

Anticoagulants1048708 Anticoagulants prevent formation of new clotsand the extension of existing clots They donot dissolve clots improve blood flow totissues or prevent damage from ischemia totissues beyond the clot1048708 Uses Prevention or management ofthrombophlebitis DVT or pulmonaryembolism1048708 Adverse Effects Bleeding

Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Research has shown that patients treated for somedysrhythmias had a higher death rate than those whodid not receive the therapy These deaths wereattributed to the effects of the drugs worseningexisting dysrhythmias or causing new dysrhythmias

These studies have lead to a decrease in use someof these class I drugs (quinidine) and higher use ofclass II drug (beta blockers) and class III drugs(amiodrone)

Antiarrythmic Drugs1048708 There is now greater use of radiofrequency catheterablation surgically implanted cardioverter -defibrillators (ICDs)1048708 Uses Convert A-fib or flutter to NSRMaintain NSR after conversion from a-fib or flutterWhen ventricular rate is so fast that decreased COPleads to sx of decreased systemic cerebral andcoronary circulationTo terminate dangerous dysrhythmias that may befatal such as ventricular tachycardia

Class I Antidysrhythmias1048708 Examples Class 1aQuinaglute (quinidine) prototype for class 1aNorpace (disopyramide)Pronestyl (procainamide)1048708 Uses symptomatic PVCS SVT V tach prevent vfibClass 1bXylocaine (lidocaine) prototype for class 1b1048708 Uses symptomatic PVCs V tach prevent v-fib

Quinaglute (quinidine) Adverse Effects NVD hearing losstinnitus visual disturbancesNursing Measures Inform all HCPs thatpatient is taking the drug Report adverseeffects and feeling faint (V-tach or fib) Bestto take on empty stomach with glass of waterbut may take with food if GI sx Avoidexcessive citrus juices because they changeurine pH and decrease excretion of quinidine

Pronestyl (procainamide)1048708 Similar to quinidine1048708 Adverse effects Anorexia N hypotension(IV) SLE like syndrome V fib1048708 Contraindications Allergy to procaine 2nd or3rd degree heart block liver or renal disease1048708 Nursing Measures Give with food avoidhazardous activities until effects are knownavoid OTC drugs

Norpace (disopyramide)1048708 Similar to quinidine1048708 Adverse Effects Dizziness fatigue HAblurred vision dry mouth CHF arrhythmiashypotension constipation N urinaryretention hypoglycemia1048708 Contraindications Cardiogenic shock 2nd and3rd degree blocks sick sinus syndrome wopacemaker1048708 Interactions Many - cimetidine warfarinerythromycin dilantin etc

Xylocaine (lidocaine)1048708 Local anesthetic drug of choice for treatingserious ventricular arrhythmias Decreasesmyocardial irritability in the ventricles but haslittle or no effect on the artria1048708 Differs from quinidine in that Always givenIV no decrease in AV conduction or cardiaccontractility in therapeutic doses rapid onset1to2 minutes and short duration 20 min ofaction it is less likely to cause heart blocksasystole heart failure or V arrhythmias

Lidocaine1048708 Adverse Effects Drowsiness tinnitusblurred or double vision anaphylaxisseizures1048708 Contraindications Allergy to localanesthetics heart blocks1048708 Nursing Measures Ensure correctpreparation and dose prior to administrationMonitor EKG

Anticoagulants1048708 Anticoagulants prevent formation of new clotsand the extension of existing clots They donot dissolve clots improve blood flow totissues or prevent damage from ischemia totissues beyond the clot1048708 Uses Prevention or management ofthrombophlebitis DVT or pulmonaryembolism1048708 Adverse Effects Bleeding

Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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These studies have lead to a decrease in use someof these class I drugs (quinidine) and higher use ofclass II drug (beta blockers) and class III drugs(amiodrone)

Antiarrythmic Drugs1048708 There is now greater use of radiofrequency catheterablation surgically implanted cardioverter -defibrillators (ICDs)1048708 Uses Convert A-fib or flutter to NSRMaintain NSR after conversion from a-fib or flutterWhen ventricular rate is so fast that decreased COPleads to sx of decreased systemic cerebral andcoronary circulationTo terminate dangerous dysrhythmias that may befatal such as ventricular tachycardia

Class I Antidysrhythmias1048708 Examples Class 1aQuinaglute (quinidine) prototype for class 1aNorpace (disopyramide)Pronestyl (procainamide)1048708 Uses symptomatic PVCS SVT V tach prevent vfibClass 1bXylocaine (lidocaine) prototype for class 1b1048708 Uses symptomatic PVCs V tach prevent v-fib

Quinaglute (quinidine) Adverse Effects NVD hearing losstinnitus visual disturbancesNursing Measures Inform all HCPs thatpatient is taking the drug Report adverseeffects and feeling faint (V-tach or fib) Bestto take on empty stomach with glass of waterbut may take with food if GI sx Avoidexcessive citrus juices because they changeurine pH and decrease excretion of quinidine

Pronestyl (procainamide)1048708 Similar to quinidine1048708 Adverse effects Anorexia N hypotension(IV) SLE like syndrome V fib1048708 Contraindications Allergy to procaine 2nd or3rd degree heart block liver or renal disease1048708 Nursing Measures Give with food avoidhazardous activities until effects are knownavoid OTC drugs

Norpace (disopyramide)1048708 Similar to quinidine1048708 Adverse Effects Dizziness fatigue HAblurred vision dry mouth CHF arrhythmiashypotension constipation N urinaryretention hypoglycemia1048708 Contraindications Cardiogenic shock 2nd and3rd degree blocks sick sinus syndrome wopacemaker1048708 Interactions Many - cimetidine warfarinerythromycin dilantin etc

Xylocaine (lidocaine)1048708 Local anesthetic drug of choice for treatingserious ventricular arrhythmias Decreasesmyocardial irritability in the ventricles but haslittle or no effect on the artria1048708 Differs from quinidine in that Always givenIV no decrease in AV conduction or cardiaccontractility in therapeutic doses rapid onset1to2 minutes and short duration 20 min ofaction it is less likely to cause heart blocksasystole heart failure or V arrhythmias

Lidocaine1048708 Adverse Effects Drowsiness tinnitusblurred or double vision anaphylaxisseizures1048708 Contraindications Allergy to localanesthetics heart blocks1048708 Nursing Measures Ensure correctpreparation and dose prior to administrationMonitor EKG

Anticoagulants1048708 Anticoagulants prevent formation of new clotsand the extension of existing clots They donot dissolve clots improve blood flow totissues or prevent damage from ischemia totissues beyond the clot1048708 Uses Prevention or management ofthrombophlebitis DVT or pulmonaryembolism1048708 Adverse Effects Bleeding

Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Antiarrythmic Drugs1048708 There is now greater use of radiofrequency catheterablation surgically implanted cardioverter -defibrillators (ICDs)1048708 Uses Convert A-fib or flutter to NSRMaintain NSR after conversion from a-fib or flutterWhen ventricular rate is so fast that decreased COPleads to sx of decreased systemic cerebral andcoronary circulationTo terminate dangerous dysrhythmias that may befatal such as ventricular tachycardia

Class I Antidysrhythmias1048708 Examples Class 1aQuinaglute (quinidine) prototype for class 1aNorpace (disopyramide)Pronestyl (procainamide)1048708 Uses symptomatic PVCS SVT V tach prevent vfibClass 1bXylocaine (lidocaine) prototype for class 1b1048708 Uses symptomatic PVCs V tach prevent v-fib

Quinaglute (quinidine) Adverse Effects NVD hearing losstinnitus visual disturbancesNursing Measures Inform all HCPs thatpatient is taking the drug Report adverseeffects and feeling faint (V-tach or fib) Bestto take on empty stomach with glass of waterbut may take with food if GI sx Avoidexcessive citrus juices because they changeurine pH and decrease excretion of quinidine

Pronestyl (procainamide)1048708 Similar to quinidine1048708 Adverse effects Anorexia N hypotension(IV) SLE like syndrome V fib1048708 Contraindications Allergy to procaine 2nd or3rd degree heart block liver or renal disease1048708 Nursing Measures Give with food avoidhazardous activities until effects are knownavoid OTC drugs

Norpace (disopyramide)1048708 Similar to quinidine1048708 Adverse Effects Dizziness fatigue HAblurred vision dry mouth CHF arrhythmiashypotension constipation N urinaryretention hypoglycemia1048708 Contraindications Cardiogenic shock 2nd and3rd degree blocks sick sinus syndrome wopacemaker1048708 Interactions Many - cimetidine warfarinerythromycin dilantin etc

Xylocaine (lidocaine)1048708 Local anesthetic drug of choice for treatingserious ventricular arrhythmias Decreasesmyocardial irritability in the ventricles but haslittle or no effect on the artria1048708 Differs from quinidine in that Always givenIV no decrease in AV conduction or cardiaccontractility in therapeutic doses rapid onset1to2 minutes and short duration 20 min ofaction it is less likely to cause heart blocksasystole heart failure or V arrhythmias

Lidocaine1048708 Adverse Effects Drowsiness tinnitusblurred or double vision anaphylaxisseizures1048708 Contraindications Allergy to localanesthetics heart blocks1048708 Nursing Measures Ensure correctpreparation and dose prior to administrationMonitor EKG

Anticoagulants1048708 Anticoagulants prevent formation of new clotsand the extension of existing clots They donot dissolve clots improve blood flow totissues or prevent damage from ischemia totissues beyond the clot1048708 Uses Prevention or management ofthrombophlebitis DVT or pulmonaryembolism1048708 Adverse Effects Bleeding

Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Class I Antidysrhythmias1048708 Examples Class 1aQuinaglute (quinidine) prototype for class 1aNorpace (disopyramide)Pronestyl (procainamide)1048708 Uses symptomatic PVCS SVT V tach prevent vfibClass 1bXylocaine (lidocaine) prototype for class 1b1048708 Uses symptomatic PVCs V tach prevent v-fib

Quinaglute (quinidine) Adverse Effects NVD hearing losstinnitus visual disturbancesNursing Measures Inform all HCPs thatpatient is taking the drug Report adverseeffects and feeling faint (V-tach or fib) Bestto take on empty stomach with glass of waterbut may take with food if GI sx Avoidexcessive citrus juices because they changeurine pH and decrease excretion of quinidine

Pronestyl (procainamide)1048708 Similar to quinidine1048708 Adverse effects Anorexia N hypotension(IV) SLE like syndrome V fib1048708 Contraindications Allergy to procaine 2nd or3rd degree heart block liver or renal disease1048708 Nursing Measures Give with food avoidhazardous activities until effects are knownavoid OTC drugs

Norpace (disopyramide)1048708 Similar to quinidine1048708 Adverse Effects Dizziness fatigue HAblurred vision dry mouth CHF arrhythmiashypotension constipation N urinaryretention hypoglycemia1048708 Contraindications Cardiogenic shock 2nd and3rd degree blocks sick sinus syndrome wopacemaker1048708 Interactions Many - cimetidine warfarinerythromycin dilantin etc

Xylocaine (lidocaine)1048708 Local anesthetic drug of choice for treatingserious ventricular arrhythmias Decreasesmyocardial irritability in the ventricles but haslittle or no effect on the artria1048708 Differs from quinidine in that Always givenIV no decrease in AV conduction or cardiaccontractility in therapeutic doses rapid onset1to2 minutes and short duration 20 min ofaction it is less likely to cause heart blocksasystole heart failure or V arrhythmias

Lidocaine1048708 Adverse Effects Drowsiness tinnitusblurred or double vision anaphylaxisseizures1048708 Contraindications Allergy to localanesthetics heart blocks1048708 Nursing Measures Ensure correctpreparation and dose prior to administrationMonitor EKG

Anticoagulants1048708 Anticoagulants prevent formation of new clotsand the extension of existing clots They donot dissolve clots improve blood flow totissues or prevent damage from ischemia totissues beyond the clot1048708 Uses Prevention or management ofthrombophlebitis DVT or pulmonaryembolism1048708 Adverse Effects Bleeding

Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Quinaglute (quinidine) Adverse Effects NVD hearing losstinnitus visual disturbancesNursing Measures Inform all HCPs thatpatient is taking the drug Report adverseeffects and feeling faint (V-tach or fib) Bestto take on empty stomach with glass of waterbut may take with food if GI sx Avoidexcessive citrus juices because they changeurine pH and decrease excretion of quinidine

Pronestyl (procainamide)1048708 Similar to quinidine1048708 Adverse effects Anorexia N hypotension(IV) SLE like syndrome V fib1048708 Contraindications Allergy to procaine 2nd or3rd degree heart block liver or renal disease1048708 Nursing Measures Give with food avoidhazardous activities until effects are knownavoid OTC drugs

Norpace (disopyramide)1048708 Similar to quinidine1048708 Adverse Effects Dizziness fatigue HAblurred vision dry mouth CHF arrhythmiashypotension constipation N urinaryretention hypoglycemia1048708 Contraindications Cardiogenic shock 2nd and3rd degree blocks sick sinus syndrome wopacemaker1048708 Interactions Many - cimetidine warfarinerythromycin dilantin etc

Xylocaine (lidocaine)1048708 Local anesthetic drug of choice for treatingserious ventricular arrhythmias Decreasesmyocardial irritability in the ventricles but haslittle or no effect on the artria1048708 Differs from quinidine in that Always givenIV no decrease in AV conduction or cardiaccontractility in therapeutic doses rapid onset1to2 minutes and short duration 20 min ofaction it is less likely to cause heart blocksasystole heart failure or V arrhythmias

Lidocaine1048708 Adverse Effects Drowsiness tinnitusblurred or double vision anaphylaxisseizures1048708 Contraindications Allergy to localanesthetics heart blocks1048708 Nursing Measures Ensure correctpreparation and dose prior to administrationMonitor EKG

Anticoagulants1048708 Anticoagulants prevent formation of new clotsand the extension of existing clots They donot dissolve clots improve blood flow totissues or prevent damage from ischemia totissues beyond the clot1048708 Uses Prevention or management ofthrombophlebitis DVT or pulmonaryembolism1048708 Adverse Effects Bleeding

Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Pronestyl (procainamide)1048708 Similar to quinidine1048708 Adverse effects Anorexia N hypotension(IV) SLE like syndrome V fib1048708 Contraindications Allergy to procaine 2nd or3rd degree heart block liver or renal disease1048708 Nursing Measures Give with food avoidhazardous activities until effects are knownavoid OTC drugs

Norpace (disopyramide)1048708 Similar to quinidine1048708 Adverse Effects Dizziness fatigue HAblurred vision dry mouth CHF arrhythmiashypotension constipation N urinaryretention hypoglycemia1048708 Contraindications Cardiogenic shock 2nd and3rd degree blocks sick sinus syndrome wopacemaker1048708 Interactions Many - cimetidine warfarinerythromycin dilantin etc

Xylocaine (lidocaine)1048708 Local anesthetic drug of choice for treatingserious ventricular arrhythmias Decreasesmyocardial irritability in the ventricles but haslittle or no effect on the artria1048708 Differs from quinidine in that Always givenIV no decrease in AV conduction or cardiaccontractility in therapeutic doses rapid onset1to2 minutes and short duration 20 min ofaction it is less likely to cause heart blocksasystole heart failure or V arrhythmias

Lidocaine1048708 Adverse Effects Drowsiness tinnitusblurred or double vision anaphylaxisseizures1048708 Contraindications Allergy to localanesthetics heart blocks1048708 Nursing Measures Ensure correctpreparation and dose prior to administrationMonitor EKG

Anticoagulants1048708 Anticoagulants prevent formation of new clotsand the extension of existing clots They donot dissolve clots improve blood flow totissues or prevent damage from ischemia totissues beyond the clot1048708 Uses Prevention or management ofthrombophlebitis DVT or pulmonaryembolism1048708 Adverse Effects Bleeding

Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Norpace (disopyramide)1048708 Similar to quinidine1048708 Adverse Effects Dizziness fatigue HAblurred vision dry mouth CHF arrhythmiashypotension constipation N urinaryretention hypoglycemia1048708 Contraindications Cardiogenic shock 2nd and3rd degree blocks sick sinus syndrome wopacemaker1048708 Interactions Many - cimetidine warfarinerythromycin dilantin etc

Xylocaine (lidocaine)1048708 Local anesthetic drug of choice for treatingserious ventricular arrhythmias Decreasesmyocardial irritability in the ventricles but haslittle or no effect on the artria1048708 Differs from quinidine in that Always givenIV no decrease in AV conduction or cardiaccontractility in therapeutic doses rapid onset1to2 minutes and short duration 20 min ofaction it is less likely to cause heart blocksasystole heart failure or V arrhythmias

Lidocaine1048708 Adverse Effects Drowsiness tinnitusblurred or double vision anaphylaxisseizures1048708 Contraindications Allergy to localanesthetics heart blocks1048708 Nursing Measures Ensure correctpreparation and dose prior to administrationMonitor EKG

Anticoagulants1048708 Anticoagulants prevent formation of new clotsand the extension of existing clots They donot dissolve clots improve blood flow totissues or prevent damage from ischemia totissues beyond the clot1048708 Uses Prevention or management ofthrombophlebitis DVT or pulmonaryembolism1048708 Adverse Effects Bleeding

Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Xylocaine (lidocaine)1048708 Local anesthetic drug of choice for treatingserious ventricular arrhythmias Decreasesmyocardial irritability in the ventricles but haslittle or no effect on the artria1048708 Differs from quinidine in that Always givenIV no decrease in AV conduction or cardiaccontractility in therapeutic doses rapid onset1to2 minutes and short duration 20 min ofaction it is less likely to cause heart blocksasystole heart failure or V arrhythmias

Lidocaine1048708 Adverse Effects Drowsiness tinnitusblurred or double vision anaphylaxisseizures1048708 Contraindications Allergy to localanesthetics heart blocks1048708 Nursing Measures Ensure correctpreparation and dose prior to administrationMonitor EKG

Anticoagulants1048708 Anticoagulants prevent formation of new clotsand the extension of existing clots They donot dissolve clots improve blood flow totissues or prevent damage from ischemia totissues beyond the clot1048708 Uses Prevention or management ofthrombophlebitis DVT or pulmonaryembolism1048708 Adverse Effects Bleeding

Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Lidocaine1048708 Adverse Effects Drowsiness tinnitusblurred or double vision anaphylaxisseizures1048708 Contraindications Allergy to localanesthetics heart blocks1048708 Nursing Measures Ensure correctpreparation and dose prior to administrationMonitor EKG

Anticoagulants1048708 Anticoagulants prevent formation of new clotsand the extension of existing clots They donot dissolve clots improve blood flow totissues or prevent damage from ischemia totissues beyond the clot1048708 Uses Prevention or management ofthrombophlebitis DVT or pulmonaryembolism1048708 Adverse Effects Bleeding

Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Anticoagulants1048708 Anticoagulants prevent formation of new clotsand the extension of existing clots They donot dissolve clots improve blood flow totissues or prevent damage from ischemia totissues beyond the clot1048708 Uses Prevention or management ofthrombophlebitis DVT or pulmonaryembolism1048708 Adverse Effects Bleeding

Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Heparin1048708 Uses Prevention and management ofthromboembolic disorders DVT PE and Afibwith embolization1048708 MOA Prevents the ultimate formation offibrin in stage III of the clotting mechanismAntagonizes thrombin and preventsconversion of fibrinogen to fibrin1048708 Adverse Effects Bleeding ndash hematuria nosebleeds rash alopecia thrombocytopenia(decreased platelets can be very severe)

Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Heparin1048708 Contraindications Bleeding disorders recentsurgery renal or liver disease Pregnancycat C Does not cross placenta1048708 Given subcutaneously or IV1048708 PTT (partial thromboplastin time) and INR(international normalized ratio) are labs usedto evaluate therapeutic effect Dose isadjusted based on these tests1048708 AntagonistAntidote Protamine sulfate

Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Heparin1048708 Nursing MeasuresTeach to wear or carry ID and notify all HCPs that heis taking drug Smoking and alcohol may alterresponse to drug Avoid ASA NSAIDS amp OTC drugswo consulting HCPMay increase menstrual flow Alopecia is reversibleShould be able to carry out normal activities such asshaving because it does not affect bleeding timewhen platelets are normal

Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Coumadin (warfarin)1048708 Uses DVT PE A-fib prosthetic valvesprophylaxis1048708 MOA Indirectly interferes with the hepaticsynthesis of Vitamin K-dependent coagulationfactors (II VII IX X)1048708 Adverse Effects Bleeding purple toesyndrome (microemboli to toes)1048708 Contraindications Pregnancy Cat D (neveruse in first trimester) liver disease

Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Coumadin1048708 Nursing Measures PT (prothrombin time)and INR are labs used to determinetherapeutic effects Avoid IM injections whileon Coumadin1048708 Teach patient regarding Purpose dose andSS of adverse effects Avoid all alcohol andexcessive intake of foods high in Vit K1048708 Carry ID amp notify all HCPs he is taking drug1048708 Antidote Vitamin K

Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Lovenox (enoxaparin)1048708 Low molecular weigh heparin1048708 Uses Prevention and management of DVTand PE Management of unstable angina toprevent MI1048708 Adverse Effects Less thrombocytopenia thanstandard heparin Can be used for outpatienttherapy because they do not require closemonitoring of labs1048708 Platelet counts should be monitored1048708 Antidote Protamine sulfate

Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Antiplatelet DrugsAspirin1048708 Antiplatelet effect lasts for the life of the platelet 7-10days1048708 Uses Long term for prevention of MI or CVA and forpatients with prosthetic heart valves Immediatetreatment for MI TIA or thrombotic CVA1048708 Adverse Effects Low with therapeutic dosesBleeding and hemorrhagic strokes1048708 Nursing Measures Teach to report GI irritation orsigns of bleeding

Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Thrombolytic Drugs1048708 Uses To dissolve thrombi in MI CVA andileofemoral thrombosis and to dissolve clots in IVcatheters1048708 MOA Stimulate the conversion of plasminogen toplasmin a protelytic enzyme that breaks down fibrinwhich is the framework of a clot1048708 Examples Urokinase and streptokinase Urokinasecan be used for patients who are allergic tostreptokinase1048708 Adverse Effects Bleeding

Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Antianginal Drugs1048708 Relieve angina pain by reduction in myocardial O2demand and increasing blood supply to themyocardium1048708 Nitrates beta blockers and calcium channel blockersare used1048708 Nitrates Nitroglycerine (prototype) Nitro-bid IsordilMOA Reduce PVD (afterload) results in decreasedsystolic BP which reduces workload of the heartReduce venous pressure and venous return to theheart which decreases volume and pressure in theheart (preload) which reduces O2 demand At higherdoses they dilate coronary arteries and increaseblood flow to the heart muscle

Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Nitrates1048708 Routes Has a short half-life of 1-5 minregardless of route Sustained release oral ortransdermal patch is used for preventionPO ndash act slowly used for preventionSublingual ndash acts within 1-3 min and last for30-60 min Used for acute attacks and toprevent exercise induced anginaTransdermal - effective for 12 hoursIV is used when other agents are noteffective

Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Nitroglycerine1048708 Patches must be removed for 10-12 hourseach night to prevent nitrate tolerance1048708 Adverse Effects HA dizziness hypotensionand tachycardia1048708 Contraindications Current use of Viagrasevere anemia1048708 Interactions Viagra antihypertensivesalcohol haldol anticholinergics1048708 Nursing Measures Teaching re storagesafety use of different preparations

Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Beta Blockers1048708 Examples Inderal Tenormin Lopressor Corgard1048708 MOA Decrease sympathetic stimulation to decreaseHR and myocardial contractility especially duringincreased exercise decreasing need for SLnitroglycerine Also reduce BP which decreasesworkload of heart and O2 demand1048708 Uses Angina hypertension etc1048708 Contraindications Vasospastic Angina because theymay increase frequency and severity of vasospasms

Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Calcium Channel Blockers1048708 Examples Cardizem (diltiazem) Calan(verapamil)1048708 MOA Improve blood supply to heart muscleby dilating coronary vessels and decrease theworkload of the heart by dilating peripheralvessels which lowers BP They reducecoronary artery spasm Verapamil and Calanare the only CCBs that slow the ventricularresponse to A-fib flutter and SVT

Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Calcium Channel Blockers1048708 Uses Angina hypertension etc1048708 Contraindications 2nd or 3rd degree blockscardiogenic shock severe bradycardia heartfailure hypotension1048708 CCB can be monotherapy but are frequentlyused in combination with beta blockers

Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Antihyprelipidemics1048708 Agents to decrease blood lipid levels Theyare adjunct in antianginal therapy1048708 Bile Acid Sequestering Agents1048708 Example Questran (cholestyramine)1048708 MOA Decreases LDL levels by absorbingand combining with bile acid salts in theintestines to form an insolublenonabsorbable complex that is excreted inthe feces1048708 Uses Decrease LDL

Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Questran1048708 Adverse Effects GI sx which usually subsideby a month increased bleeding tendencyDecreases absorption of many drugs Longterm use may result in deficiencies of fatsoluble vitamins ndash ADEK and Ca1048708 Nursing Measures Give other meds 1 hourbefore or at least 2 hours after Dissolve inflavored liquids or semisolid foods to disguisetaste Teach SS bleeding need for Ca andvitamin supplements with long term use

Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

• Slide 1
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Fibric Acid Deriviatives1048708 Lopid (gemfibrozil)1048708 MOA Unclear but decreases Triglyceridesand VLDL increases HDL cholesterol mayincrease or decrease1048708 Uses Decrease triglycerides decrease LDLis secondary effect1048708 Adverse Effects Myalgias impaired liverfunction gall stones abd pain N D1048708 Less hyperglycemic effect best for diabetics1048708 Teach Restrict alcohol fats chol and sugar

HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

• Slide 1
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HMG-CoA Reductase Inhibitors(statins)1048708 Examples Zocor Mevacor Lipitor Pravachol1048708 MOA Inhibit HMG-CoA reductase an enzymeessential in synthesis of cholesterol Lower LDL andVLDL and triglycerides and increase HDL Manyhealth benefits unrelated to lipids1048708 Uses Decrease LDL inhypercholesterolemiahypertriglyceridemia1048708 Adverse Effects Myalgias liver damage HA rashGI sx1048708 Nursing Measures Monitor labs give in eveningteach compliance with diet and sx to report

Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Antihypertensives1048708 Review Pathophysiology of hypertension1048708 Antihypertensives work in three basic ways todecrease BP1 Decrease fluid volume diuresis2 Decrease HR3 Decrease PVR1048708 There are different classes that work indifferent ways They may be used alone or incombinations

Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Central Sympatholytic(Central Acting Adrenergic Inhibitors)1048708 Example Catapress (clonidine)1048708 MOA Stimulates alpha receptors in brain toinhibit peripheral sympathetic activityresulting in vasodilatation (decreased PVR)and decreased BP Reduces HR1048708 Uses Hypertension Off-label Migraineprophylaxis drug withdrawal sx1048708 Adverse Effects depression1048708 Avoid alcohol amp CNS depressants gradualwithdrawal to prevent rebound hypertension

Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Alpha Adrenergic Blockers1048708 Example Hytrin (terazosin) Minipress(prazosin)1048708 MOA Decreases PVR and lowers BP byselectively blocking the alpha 1 adrenergicreceptors in vascular smooth muscle1048708 Uses Hypertension Off-label Urinary flowobstruction in BPH1048708 Adverse Effects Severe orthostasisespecially first dose ndash give at bedtime1048708 Nursing Measures Standing BP

Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Beta Adrenergic Blockers1048708 Examples Tenormin (atenolol) Inderal(propanolol) Lopressor (metoprolol)1048708 MOA Non-selective blockers of beta 1 andbeta 2 receptors by competing withepinephrine and NE for available betareceptor sites Lower COP and BP bydecreasing HR force of contraction and reninrelease from the kidneys1048708 Uses Hypertension angina prevent 2nd MItachyarrythmias Off-label Migraineprophylaxis antianxiety acute panic sx

Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Beta Blockers1048708 Contraindications CHF COPD Asthma(may cause bronchospasms) heart block gt1st degree Caution Diabetes (blocks sx ofhypoglycemia)1048708 Nursing Measures Teach that abruptwithdrawal may lead to angina MI or death

ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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ACE Inhibitors1048708 Examples Quinipril (accupril) Capoten(captopril) Vasotec (enalapril) Lotensin(benaepril)1048708 MOA Block the conversion of angiotensin Ito angiotensin II a potent vasoconstrictor byspecific inhibition of the angiotensinconverting enzyme This results indecreased PVR1048708 Uses Hypertension Used after MI if ejectionfraction lt 40 protects diabetics from renalfailure

ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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ACE Inhibitors1048708 Adverse Effects Dry cough angioneuroticedema hyperkalemia ARF1048708 Contraindications Pregnancy ndash renal failurein infants renal impairment1048708 Nursing Measures Instruct regarding needfor return to have K drawn

Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Vasodilators1048708 Examples Apresoline (hydralazine) Nipride(nitroprusside) Nitroglycerine1048708 MOA Vasodilators cause a direct relaxation ofvascular smooth muscle to decrease PVR and lowerBP There are two types atreriolar dilators andvenous dilators1048708 Uses Hypertension angina1048708 They are usually given with a beta blocker to preventhypotension-induced compensatory mechanisms oftachycardia and fluid retention that raise BP

Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Calcium Channel Blockers1048708 Examples Cardizem (diltiazam) Calan(verapamil) Procardia (nifedipine)1048708 MOA Selectively block Ca ions fromcrossing cell membranes in cardiac andvascular smooth muscles without affectingserum Ca levels They relax and preventcoronary artery spasm and reducemyocardial O2 use and may reduce HR byslowing conduction through SA amp AV nodesCause vasodilatation of coronary andperipheral vessels

Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Ca Channel Blockers1048708 Uses Hypertension Angina (verapamil anddiltiazem) SVT cerebrospasm in SAH(nimodipine) Off-label Migraine prophylaxis1048708 Most effective in blacks and elderly

Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Agents for Anemia1048708 Iron deficiency anemia is a symptom not adisease The cause should always beinvestigated especially in men1048708 80 of iron in the plasma goes to the bonemarrow for use in erythropoesis ndashmanufacture of RBC1048708 When iron stores are low iron absorptionincreases by 20-30 When iron stores arehigh the rate of absorption is 5-10

Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Ferrous Sulfate1048708 It is the gold standard1048708Cheapest just are effective as any1048708MOA Corrects erythropoeticabnormalities caused by irondeficiency Does not stimulateerythropoesis1048708Uses Iron deficiency anemia

Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Ferrous Sulfate1048708 Adverse Effects Generally mild intherapeutic doses N heartburnconstipation or diarrhea1048708 Contraindications PUD1048708 Better absorption on empty stomach ndashgive with food for GI sx Stains teethMilk eggs and caffeine decreaseabsorption VitC increases absorption

Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Imferon (iron dextran)1048708 Given IV or IM by Z tract1048708 Uses Severe iron deficiency anemia1048708 Adverse Effects Anaphylaxis stains tissues1048708 Builds iron stores faster but does not correctanemia any faster than oral iron1048708 Nursing Measures Skin test prior to IV doseTest dose prior to IM Give in dorsoglutealChange needle after drawing up med use airlock Monitor for adverse effects for 24 hr

Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Vitamin B 12(cyanocobalamin)1048708MOA Activates folic acid enzymes thatare necessary for synthesis of RBC1048708 Uses Pernicious anemia (IM) Arrestsdisease does not reverse itNutritional supplement Must haveintrinsic factor to absorb PO1048708 Adverse Effects Transient itching andpain at site optic nerve atrophy CHF

Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Overview of Four ACLSAlgorithm Protocols

Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Objectives1048708 To review routes of administration formedications used in code blue emergencies1048708 To introduce several common ECG rhythms1048708 To familiarize the pharmacists with four ACLSalgorithms1048708 To identify the most common drugs used by theACLS algorithms

IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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IV Push1048708 Route of most medications used1048708Convenient1048708Fast onset of action1048708Immediate bioavailability

Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Intravenous Infusion1048708 Medications for continuous infusion only1048708 P ndash procainamide1048708 I ndash isoproterenol1048708 N ndash norepinephrine1048708 D ndash dopamine1048708 Medications given IV push or infusion1048708 A ndash amiodarone1048708 L ndash lidocaine1048708 E ndash epinephrine

Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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Endotracheal Administration1048708 Tracheal administration of medications1048708 L ndash lidocaine (2-4 mgkg)1048708 E ndash epinephrine (2-25 mg)1048708 A ndash atropine (2-3 mg)1048708 N ndash naloxone (08-16 mg)1048708 Doses usually 2-25 times those given IVP1048708 Follow each dose with 10 ml NS flush downtracheal tube if not diluted to that volume foradministration

bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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bullUse of Algorithmsbull1048708 Meant to treat broadest range possible ofbullpatientsbull1048708 Meant to be good memory aidsbull1048708 Meant to be used ldquowiselyrdquo not blindlybull1048708 Not meant to replace clinical judgment

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