Introduction to CV Pharmacology - Orlando Health

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CV Pharmacology Hydralazine Hydralazine has direct vasodilatory effects on the vascular smooth muscle resulting in blood pressure lowering. It is one of the parenteral drugs of choice for management of pregnancyassociated hypertensive emergencies. However, other parenteral therapies (i.e., nitroprusside) are recommended for hypertensive crises in non-pregnant patients. When used parenterally, hydralazine is administered as intermittent doses. Hydralazine has been used in combination with isosorbide dinitrate as a second-line treatment of heart failure. Nesiritide (Natrecor) Nesiritide is a synthetic human B-type natriuretic peptide (BNP) with potent vasodilator properties. Nesiritide binds to the receptor sites of vascular smooth muscle resulting in an increase in cGMP, which is responsible for vasodilation of veins and arteries. It promotes diuresis and natruresis. It is currently indicated for the patient in acutely decompensated heart failure who is symptomatic with either minimal activity or dyspnea at rest. Precautions When B-type natriuretic peptide (BNP) lab values are ordered, the blood must be obtained prior to the administration of nesiritide (Natrecor). Since nesiritide (Natrecor) is a synthetic BNP, the lab results will be altered after this drug is administered. Due to its potent hypotensive properties, it is important to institute frequent blood pressure monitoring. Review your institution’s policy regarding placement of the patient in an appropriate telemetry unit. © 2010 Orlando Health, Education & Development 31
CV Pharmacology Morphine Sulfate Morphine sulfate is a powerful narcotic analgesic used to relieve severe acute or chronic pain and to relieve anxiety. It primarily stimulates venous vasodilation and a reduction in preload (the volume of blood in the ventricles at the end of diastole). An additional property is arterial vasodilation, resulting in a decrease in afterload (the force the ventricles must push against to pump blood into the aorta and pulmonary vasculature). By reducing preload and afterload, morphine diminishes myocardial workload and oxygen demand. Morphine is the drug of choice to relieve the pain and anxiety associated with ischemic chest discomfort and myocardial infarction because it decreases the myocardial oxygen. Morphine is also useful in the management of cardiogenic pulmonary edema by increasing venous capacitance (capacity), thus decreasing the return of blood to the right side of the heart and to the lungs. Precautions The most serious adverse effect of morphine is depression of the respiratory system. Careful monitoring of the respiratory rate and depth is necessary during administration of morphine. Rapid administration of morphine may result in respiratory arrest. Morphine causes venous and arterial vasodilation, thus hypotension may occur. The blood pressure must be closely monitored in patients receiving morphine. The effects of morphine can be reversed with naloxone (Narcan) 0.2mg – 2.0mg at 2-3 minute intervals, to a maximum of 10mg. Atropine Atropine has numerous clinical applications so we will limit our discussion to those that involve the cardiovascular system. Atropine is known as a vagolytic or parasympatholytic because it counteracts the effects of the parasympathetic nervous system. This leaves the actions of the sympathetic nervous system unopposed so patients who have received atropine will display signs of increased sympathetic activity. Because parasympathetic innervation of the heart is primarily in the atria, atropine affects atrial activity. Atropine is indicated for symptomatic bradydysrhythmias. It enhances automaticity of the sinus node, and increases electrical conduction through the atria and the AV node. It is used in sinus bradycardia to increase heart rate. Calcium Salts Calcium is an essential electrolyte for normal cardiac and vascular function. Calcium is available in oral and parenteral forms for a wide variety of indications. Calcium Chloride is usually reserved for emergent situations requiring calcium replacement. Calcium Chloride must be given carefully because rapid administration can result in cardiac arrest. Calcium Gluconate is used more frequently because it is associated with fewer side effects than Calcium Chloride. Calcium replacement should be guided by ionized calcium levels to avoid hypercalcemia. Calcium salts will not be discussed further in this packet. © 2010 Orlando Health, Education & Development 32
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