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TitleSEMINAR on Drugs Used in Cardiac Disease
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Seminar on drugs used in cardiac diseases

Introduction

Cardiovascular drugs encompass a large number of prescription medications that are used to

control heart disease. It is a complicated group of drugs with many being used for multiple heart

conditions. You may also encounter patients who have one or more cardiovascular conditions

such as CHF, hypertension and an arrhythmia. These patients may be taking multiple

medications for each condition. If you look at the list of Top 200 drugs, you will find that 25% of

those drugs are cardiovascular drugs, which is another good reason to become familiar with these

drugs and how they might interact with other medications.



CLASSIFICATION OF CARDIAC USED IN CARDIAC DISEASES



1. Anti-arrhythmic agent

The arrhythmias are conceptually sirnple-dysfunctions cause abnormalities in impulse

formation and conduction in the myocardium. However, in the clinic, arrhythmias present

as a complex family of disorders that show a variety of symptoms. For example, cardiac

arrhythmias may cause the heart

 to beat too slowly (sinus bradycardia)

 to beat too rapidly (sinus or ventricular tachycardia, atrial or ventricular premature

depolarization, atrial flutter)

 to respond to impulses originating from sites other than the SA node

 to respond to impulses traveling along accessory (extra) pathways that lead to

deviant depolarizations (A-V reentry, Wolff-Parkinson White syndrome).

In order to make sense of this large group of disorders, it is useful to organize the

arrhythmias into groups according to the anatomic site of the the abnormality-the

atria, AV node, or the ventricles.



Class of anti-arrhythmia drug

Class 1 sodium channel blocker e.g. flecanide, quinidine

Class 2 beta adrenoreceptor blocker e.g. metoprolol, propanolol

Class 3 sodium channel blocker e.g. amiodarone

Class 4 calcium blocker e.g. diltiazem, verapamil, nifedipine

Other Anti-arrhythmic drug e.g. adenosine, digoxin

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o Oral antibiotics, quinidine, amiodarone, calcium channelblocker therapy.

o Decreased potassium level (hypokalemia), which increases theaction of digoxin

and which may be caused by malnutrition,diarrhea, vomiting, or prolonged

muscle wasting

o Impaired renal function, particularly in patients age 65 andolder with decreased

renal clearance.

 Before administering digoxin, it is standard nursing practice to asses sapical heart rate.

When the patient’s rhythm is atrial fibrillation and the heart rate is less than 60, or the

rhythm becomes regular, the nurse may withhold the medication and notify thephysician,

because these signs indicate the development of AVconduction block. Although

withholding digoxin is a common practice, the medication does not need to be withheld

for a heartrate of less than 60 if the patient is in sinus rhythm becausedigoxin does not

affect sinoatrial node automaticity. Measuringthe PR interval for a patient with cardiac

monitoring is moreimportant than the apical pulse in determining whether digoxinshould

be held.Note: If monitoring discloses that the patient is in sinusrhythm, the nurse

monitors the patient’s PR interval instead ofthe patient’s heart rate. If the patient is in

atrial fibrillation, thenurse monitors for the development of regular R-R

intervals,indicating AV block.

 Monitor for gastrointestinal side effects: anorexia, nausea, vomiting,abdominal pain and

distention.

 Monitor for neurologic side effects: headache, malaise, nightmares,forgetfulness, social

withdrawal, depression, agitation,confusion, paranoia, hallucinations, decreased visual

acuity,Yellow or green halo around objects (especially lights), or―snowy‖ vision.

 Observe for and anticipate potential drug interactions whenother medications are added

to the patient’s regimen. This isan important step in preventing toxicity. For example,

antiarrhythmicand antibiotic medications may increase theamount of digoxin available to

the patient. Diuretics maydecrease the amount of potassium and increase the

availabilityof digoxin. In addition, because digoxin is eliminated by thekidneys, renal

function (serum creatinine and urine creatinineclearance) are monitored carefully.







ISOSORBIDE DINITRATE

Group of drug:- antaniginal,

Pharmacological name:- isosorbide dinitrate

Dose of drug

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