Drug Classifications

Sherry L. Knowles, RN, CCRN, CRNI

Cardiac DrugsCardiac Drugs ACE Inhibitors ACE Inhibitors Anti- Anti-

CoagulantsCoagulants Nitrates Nitrates Calcium Channel Calcium Channel

Blockers Blockers VasopressorsVasopressors Anti-DysrhythmiiasAnti-Dysrhythmiias

GPIIGPIIbbIIIIIIaa Inhibitors Inhibitors DiureticsDiuretics

Angiotensin II Angiotensin II Anti-Inflammatory Anti-Inflammatory Antagonists Antagonists

InotropicsInotropics Beta Blockers Beta Blockers

Alpha Blockers Alpha Blockers Anti-LipidemicsAnti-Lipidemics

ThrombolyticsThrombolytics

InotropicInotropic

Drug actions

ChronotropicChronotropic

Dromotropic Dromotropic

Cardiac DrugsCardiac Drugs

InotropicInotropic Affects ContractilityAffects Contractility


Positive Inotropics Positive Inotropics the force the force

of myocardial contraction.of myocardial contraction. Negative Inotropics Negative Inotropics the force the force

of myocardial contraction.of myocardial contraction.

CHRONOTROPICCHRONOTROPIC Affects Heart RateAffects Heart Rate


Beta Adrenergic and Blocking AgentsBeta Adrenergic and Blocking Agents Slowing rates can Slowing rates can filling time filling time

AntiarrhythmicsAntiarrhythmics Beta BlockersBeta Blockers Calcium Channel Blockers Calcium Channel Blockers

Cardiac DrugsCardiac Drugs DromotropicDromotropic

Affects ConductivityAffects Conductivity

AlphaAlpha receptorsreceptors

DDopaopa receptorsreceptors

BetaBeta receptorsreceptors


Alpha receptorsAlpha receptors On Blood VesselsOn Blood Vessels

Stimulation causes vasoconstrictionStimulation causes vasoconstriction Blocking cause vasodilationBlocking cause vasodilation


Beta receptorsBeta receptors On Heart and LungsOn Heart and Lungs

BetaBeta11 and Beta and Beta22

Cardioselective vs Non-SelectiveCardioselective vs Non-Selective


Beta receptorsBeta receptors BetaBeta11

Stimulation causes positiveStimulation causes positive

inotropic effectsinotropic effects Blocking causes negative Blocking causes negative

inotropic effectinotropic effect


Beta receptorsBeta receptors BetaBeta22

Stimulation causes bronchodilationStimulation causes bronchodilation Blocking causes Blocking causes

bronchoconstrictionbronchoconstriction


Dopa receptorsDopa receptors On Renal (Mesenteric) VesselsOn Renal (Mesenteric) Vessels

Stimulation causes vasodilationStimulation causes vasodilation Blocking causes vasoconstrictionBlocking causes vasoconstriction


ALPHA BLOCKERSALPHA BLOCKERS


Used for hypertension, Used for hypertension,

BETA BLOCKERSBETA BLOCKERS


Slow Heart RateSlow Heart Rate Negative ChronotropicNegative Chronotropic

Lower BPLower BP

Slow ConductionSlow Conduction Negative DromotropicNegative Dromotropic

Encourage Electrical Encourage Electrical StabilityStability

CALCIUM CHANNEL BLOCKERSCALCIUM CHANNEL BLOCKERS


Slows Heart RateSlows Heart Rate Negative ChronotropicNegative Chronotropic

VasodilatorVasodilator

Prevents Arterial VasospasmPrevents Arterial Vasospasm

Beta BlockersBeta Blockers:: Adverse EffectsAdverse Effects


FatigueFatigue BronchospasmBronchospasm ImpotenceImpotence DepressionDepression Aggravation of heart failureAggravation of heart failure

VASODILATORSVASODILATORS


ACE INHIBITORSACE INHIBITORS


Causes VasodilationCauses Vasodilation

Reduces AfterloadReduces Afterload Reduces work of heartReduces work of heart

Remodeling EffectsRemodeling Effects

ANGIOTENSIN II ANTAGONISTSANGIOTENSIN II ANTAGONISTS



Reduces AfterloadReduces Afterload

May be used in May be used in place of ace place of ace inhibitorsinhibitors

NITRATESNITRATES


Arterial & Venous VasodilatorArterial & Venous Vasodilator

Reduces Preload & AfterloadReduces Preload & Afterload

Reduces Work of the HeartReduces Work of the Heart

Improves Cardiac OutputImproves Cardiac Output

CaCa2+2+ Channel Blockers Channel Blockers: Adverse Effects: Adverse Effects


Less severe with oral than intravenous Less severe with oral than intravenous applicationapplication

HypotensionHypotension Severe sinus bradycardia or heart block Severe sinus bradycardia or heart block

(especially with (especially with -blockers)-blockers)

DIURETICSDIURETICS


Reduce PreloadReduce Preload

Reverse Fluid OverloadReverse Fluid Overload

Reduces Pulmonary CongestionReduces Pulmonary Congestion

VASOPRESSORSVASOPRESSORS


VasoconstrictorsVasoconstrictors Alpha AdrenergicAlpha Adrenergic

Blood PressureBlood Pressure

Heart RateHeart Rate Positive ChronotropicPositive Chronotropic

ANTIDYSRHYTHMICSANTIDYSRHYTHMICS


Heart RateHeart Rate Negative Chronotropic Negative Chronotropic

Slow ConductionSlow Conduction Negative DromotropicNegative Dromotropic

Also Includes: Also Includes: Beta Blockers Beta Blockers Calcium Channel BlockersCalcium Channel Blockers

ANTI-HYPERTENSIVESANTI-HYPERTENSIVES


Presynaptic agents: centrally acting, Presynaptic agents: centrally acting, peripherally acting peripherally acting

Dieuretics Dieuretics

Beta Blockers Beta Blockers

Alpha Blockers Alpha Blockers

Vasodilators Vasodilators

Calcium Entry Blockers Calcium Entry Blockers

Angiotensin Converting Enzyme (ACE) Angiotensin Converting Enzyme (ACE) Inhibitors Inhibitors

GpIIbIIIa InhibitorsGpIIbIIIa Inhibitors


ReoProReoPro Long Half-lifeLong Half-life

IntegrilinIntegrilin

Aggrastat Aggrastat

GpIIbIIIa InhibitorsGpIIbIIIa Inhibitors


ReoPro, Integrilin, AggrastatReoPro, Integrilin, Aggrastat

Monitor Platelet LevelsMonitor Platelet Levels

Check within 4-6 hours after initiationCheck within 4-6 hours after initiation

Monitor daily and prn any bleedingMonitor daily and prn any bleeding

ANTICOAGULANTSANTICOAGULANTS


Heparin – administered by injection

Low Molecular Weight HeparinCan be given on fix-dosed schedule and do not require APTT monitoringLess likely to cause thrombocytopenia

Warfarin – CoumadinRat poisonAntagonist of vitamin K – blocks synthesis of vitamin K dependent factors in coagulation cascadePeak effects take several days

Antiplatelet drugs

THROMBOLYTICSTHROMBOLYTICS


StreptokinasetPA

ANTI-SEPSIS / ANTI-INFLAMMATORYANTI-SEPSIS / ANTI-INFLAMMATORY


Activated Protein C Activated Protein C (Xygris)(Xygris)

May cause bleedingMay cause bleeding

ANTI-LIPIDEMICSANTI-LIPIDEMICS


HDLHDL High Density LipoproteinHigh Density Lipoprotein Associated with Associated with risk risk

LDLLDL Low Density LipoproteinLow Density Lipoprotein Associated with Associated with risk risk

Look at Ratio Look at Ratio HDL HDL LDLLDL

ADENOSINEADENOSINE


Stops supraventricular tachycardiaExtremely short half-life

AMIODARONEAMIODARONE


Amiodarone – Class III potassium channel blockers – delays repolarization – prolongs refractory periodReduced automaticity SA node, reduced conduction thru AV node

DIGOXINDIGOXIN


Positive InotropicPositive Inotropic Increases force of contractionIncreases force of contraction

Negative DromotropicNegative Dromotropic Slows conductionSlows conduction

Negative ChronotropicNegative Chronotropic Slows heart rateSlows heart rate

DOPAMINEDOPAMINE


Positive InotropicPositive Inotropic

Increases contractilityIncreases contractility

Alpha, Beta, & Dopa AdrenergicAlpha, Beta, & Dopa Adrenergic

Dose dependentDose dependent

Positive ChronotropicPositive Chronotropic

May increase heart rateMay increase heart rate

DOBUTAMINEDOBUTAMINE



Increases contractility (BetaIncreases contractility (Beta1 1 stimulation)stimulation)

BetaBeta11 and Beta and Beta2 2 AdrenergicAdrenergic


Positive ChronotropicPositive Chronotropic

May increases heart rateMay increases heart rate

PRIMACORPRIMACOR



Increases contractilityIncreases contractility


Acts similar to Dobutamine Acts similar to Dobutamine

EPINEPHRINEEPINEPHRINE


Alpha AdrenergicAlpha Adrenergic

Potent VasoconstrictorPotent Vasoconstrictor

BetaBeta11 and Beta and Beta22 Adrenergic Adrenergic

Positive InotropePositive Inotrope

BronchodilatorBronchodilator

LEVOPHED LEVOPHED (Norepinephrine)(Norepinephrine)


Alpha AdrenergicAlpha Adrenergic

Potent VasoconstrictorPotent Vasoconstrictor

BetaBeta11 Adrenergic Adrenergic

Positive InotropePositive Inotrope

NEO-SYNEPHRINENEO-SYNEPHRINE


Alpha AdrenergicAlpha Adrenergic VasoconstrictorVasoconstrictor

Used for Severe HypotensionUsed for Severe Hypotension

Used for Drug Induced HypotensionUsed for Drug Induced Hypotension

NITROGLYCERINNITROGLYCERIN


Venous & Arterial VasodilatorVenous & Arterial Vasodilator

Dilates Coronary ArteriesDilates Coronary Arteries

NitrateNitrate VasodilatorVasodilator

Preload (primarily)Preload (primarily) Venous CapitanceVenous Capitance SVR (slightly)SVR (slightly) Work of HeartWork of Heart

MORPHINEMORPHINE


Vasodilator (venous)Vasodilator (venous) Pulmonary CongestionPulmonary Congestion

Work of HeartWork of Heart

AnalgesicAnalgesic

Sedative PropertiesSedative Properties

Reduces AnxietyReduces Anxiety

REFLUDINREFLUDIN


CLASSIFICATION• Anticoagulant• Anti-thrombin

USES• AMI• HIT• Venous thrombosis• DVT prophylaxis

ADVERSE EFFECTS• Bleeding• Anemia

ReferencesReferences

Hudak, B., Gallo, B., & Morton, P. (1998). Hudak, B., Gallo, B., & Morton, P. (1998). Critical Care NursingCritical Care Nursing (7th (7th ed.). Philadelphia, PA: Lippincott.ed.). Philadelphia, PA: Lippincott.

Clochesy, J., Breu, C., Cardin, S., Whittaker, A., & Rudy, E. (1996). Clochesy, J., Breu, C., Cardin, S., Whittaker, A., & Rudy, E. (1996). Critical Care Nursing Critical Care Nursing (2nd ed.). Philadelphia, PA: Saunders. (2nd ed.). Philadelphia, PA: Saunders.

American Association of Critical-Care Nurses. (1991). American Association of Critical-Care Nurses. (1991). Core Core Curriculum for Critical Care NursingCurriculum for Critical Care Nursing (4th ed.). Philadelphia, PA: (4th ed.). Philadelphia, PA: Saunders. Saunders.

Knowles, Sherry. (2002-2004). Inservice Handout.Knowles, Sherry. (2002-2004). Inservice Handout.


Drug Classifications

Education

Transcript of Drug Classifications