DRUGS USED IN

CARDIAC
EMERGENCIES

GOAL OF USING EMERGENCY

DRUGS
To prevent the patient from
deteriorating
situation

to

an

arrest

DRUGS FOR ACUTE

CORONARY
SYNDROME

 Acute coronary syndrome (ACS) refers to a

spectrum
associated

of

clinical

with

manifestations

acute

myocardial

infarction and unstable angina

In ACS, a plaque in a coronary artery
ruptures or becomes eroded, triggering
the clotting cascade.
A blood clot forms, occluding the artery
and interrupting blood and oxygen flow to
cardiac muscle.

M
O
N
A

Morphine
Oxygen
Nitroglycerin
Aspirin

MORPHINE

CATEGORY
Opioid analgesics
USES
Sever pain

ACTION
An opioid acting primarily on
receptors that perceive
pain

morphine also acts as a

venodilator,

reducing

 DOSAGE
If chest pain doesnt resolve with
sublingual or I.V. nitroglycerin,
morphine 2 to 4 mg may be given
every 5 to 15 minutes via I.V. push.

NURSING IMPLICATION
Assess
GI status: bowel pattern, number of
stools
Cardiac status: rate, rhythm, quantity
Chest x-ray, pulmonary function test
during treatment.
I & O ratio, check for decreasing output
BP for fluctuation
Increased respiration, increased pulse
drug should be discontinued

Administer
Initiate therapy in hospital
Dosage adjustment should be 3 days

Evaluate
Therapeutic response: absence of

dysrhythmias
Teach patient/family
To report if any adverse effect observed.

OXYGEN
Oxygen (O2) is given first in ACS,
regardless of the patients O2
saturation level.
The heart uses 70% to 75% of the
oxygen it receives, compared to
skeletal muscle, which uses roughly
20% to 25%.

NURSING IMPLICATION

Use appropriate delivery device for

amount of O2 ordered.
Monitor O2 saturation regularly.
Avoid

excessive

patients

with

administration
concurrent

in

chronic

obstructive pulmonary disease.

NITROGLYCERINE

CATEGORY
Antianginal
Coronary vasodilator

USES
Chronic stable angina pectoris
prophylaxis of angina pain
chronic heart failure associated with
acute MI
controlled hypotension in surgical
procedures

ACTION
Relaxes smooth muscles especially in the blood
vessels.
Reduces venous return (preload) and facilitates
subendocardial blood flow with redistribution
into ischemic areas.
Relives coronary vasospasm.
Dilates arterioles and reduces afterload
usefull for relief and prevention of angina attacks
It
also
decreases
myocardial
oxygen
consumption, allowing the heart to work with a
lower oxygen demand.

DOSAGE
0.4 mg is given sublingually via a spray
or rapidly dissolving tablet.
If the first dose doesnt reduce chest
pain, the dose can be repeated every 3
to 5 minutes for a total of three doses.
If chest pain reoccurs once the initial
pain resolves or decreases, the patient
may be placed on a continuous I.V.
infusion of nitroglycerin.

NURSING IMPLICATION
Assess
Electrolytes K, Na, Cl, CO 2, serum glucose
level
Renal function studies: catacolamines, BUN,
creatinine
Liver function test: AST, ALT
BP by direct means if possible, check ECG
continuously,
pulse,
jugular
venous
distention,
pulmonary
capillary
wedge
pressure, rebound hypertension may occur
after discontinuing the drug.
Edema in feet, legs daily

Administer
IV ROUTE
Depending on BP q 15min
IV infusion after diluting in 50mg/2-3
ml of D5.
Use infusion pump only.

Evaluate
Theraupetic response: Decreased BP,
absence of bleeding
Teach patient/family
To report headache, dizziness, loss of
hearing, blurred vision, faintness.

ASPIRIN

CATEGORY

Platelet inhibitor
Anticoagulant

USES
Thromboembolic disorders
Transient ischemic attacks
Post myocardial infarction
Prophylaxis of MI
Ischemic stroke
Angina

ACTION
Inhibits

the

platelets

aggregration

and

coagulation.
Inhibits thrombus formation
Inhibits

the

binding

of

adniosine

diphosphate to its platelets receptor and

the subsequent ADP-medicated activation
of glycoprotein complex, thereby inhibiting
thrombos formation.

Dosage
The standard recommended aspirin
dosage to treat ACS is 160 to 325 mg
Given as chewable

NURSING IMPLICATION
Assess
Pain: character, location, intensity range of
motion before and after 1hr of administration
Fever: temperature before and after 1hr of
administration
Allergic reactions: rash, urticaria, if these
happens drug has to be discontinued.
Patients with asthma, nasal polyps sever
allergic reaction may occur
Visual changes
Edema of feet, ankles and legs

Administer
ORAL ROUTE
Crush or whole tablet may be given
to chew
With food or milk to decrease gastric
irritation

Evaluate
Therapeutic

response:

decreased

pain,

inflammation, fever

Teach patient/family
To report any symptom of hepatic toxicity,
renal toxicity, visual changes etc
To take with water and sit upright for hr
after dose
To avoid effervescent products

OTHER MEDICATIONS
FOR ACUTE
CORONARY
SYNDROME

METOPROLOL

CATEGORY
Beta1 Receptor
USES
Mild to moderate hypertension
Acute MI to reduce cardiovascular mortality
Angina pectoris
Heart failure

ACTION
It is a cardioselective (beta1 receptor) drug
Its a betaadrenergic blocker that dilates
peripheral vascular beds, in turn reducing
blood pressure, decreasing cardiac
workload, and lowering cardiac oxygen
demands.
Mild analgesic effect in ACS related chest
pain.

DOSAGE
ORAL
Management of angina pectoris
Adults : 50 mg at 2 min intervals to a total of
150mg if tolerated, followed after 15min by
the initiation of an oral therapy of 50mg every
6 hours for 2 days.
Maintenance :
Adults 100 200mg daily at divided dosages.

NURSING IMPLICATION
Assess
ECG directly when giving IV during initial
treatment
I & O, daily weight should be recorded
BP during initial treatment
Apical pulse before administering, notify
prescriber of any significant changes or
pulse 50 bpm
Edema in feet, legs daily
Skin
turgor,
dryness
of
mucous
membrane

Administer
ORAL ROUTE
Tablets may be crushed or swallowed
whole
IV ROUTE
IV undiluted, give over 1min 3
doses at 2min intervals, start oral 15
min after last IV dose

Evaluate
Therapeutic response
Teach patient/family
To take with or immediately after meal
Not to discontinue drug abruptly
To

report

bradycardia,

dizziness,

confusion,

depression
To avoid alcohol, smoking, sodium intake
To report difficulty in breathing, especially on
exertion or when laying down, night cough, swelling
on extremities.

HEPARIN OR ENOXAPARIN
(low molecular weight heparin)

CATEGORY
Anticoagulant

USES

Deep vein thrombosis

Pulmonary embolism
Myocardial infarction
Open heart surgery
Disseminated intravascular clotting
syndrome
Atrial fibrillation with embolization
Prevention of DVT/PE
To maintain patency of indwelling
venipunture devices

ACTION
Helps prevent the original arterial
clot from expanding and allows it to
break down on its own
Causes the vessel to opens and new
clot formation is inhibited.
It acts by enhancing the inhibition
rate of activated clotting factors
including thrombin and factor Xa
through its action on antithrombin III.

DOSAGE
Subcutaneous
PROPHYLAXIS OF VENOUS
THROMBOEMBOLISM DURING SURGICAL
PROCEDURES
Adults 20mg (2000 units) once daily for 7
10days.
Give the first dose approximately 12hrs pre
operatively

TREATMENT OF DEEP VEIN

THROMBOSIS
Adults 1mg (100 units)/kg body
weight every 12 hrs for 5 days

 NURSING IMPLICATION

ASSESS
Blood

studies

(CBC,

coagulation

studies, platelet, occult blood in stool)

For bleeding: gums, ecchymosis, black

tarry stool, hematuria

For neurological symptoms in patients

who have received spinal anesthesia

Administer
Only after screening patient for bleeding disorders
Subcutaneous only
Do not give IM
Begin 2hr prior to surgery
Rotate sites
Insert whole length of needle into skin fold

Evaluate
Therapeutic response: prevention of
deep vein thrombosis
Teach patient/family
To use soft bristle tooth brush to
avoid bleeding gums
To report any signs of bleeding:
gums, under skin, urine, stool

ABCIXIMAB

CATEGORY
Platelet aggregation inhibitor

USES
Used with heparin and asprin to
prevent

acute

cardiac

ischemia

following Percutaneous transluminal

angioplasty in patients at high risk
for recolosure of affected artery.

ACTION
These drugs bind to glycoprotein IIbIIIa receptor sites on platelets

Prevent further aggregation and

stopping expansion of the original
clot or formation of new clots.

DOSAGE
STABILIZATION IN PATIENT WITH
UNSTABLE ANGINA
Adults 250mcg/kg body weight
Bolus injection over 1min followed by
0.125 mcg/kg body weight/ min
infusion
Started up to 24hrs before and 12
hrs after possible intervention.

ADJUNCT FOR THE PREVENTION OF

ACUTE ISCHEMIC COMPLICATIONS IN
PERCUTANEOUS TRANSLUMINAL
CORONARY PROCEDURES
Adults 250mcg/kg body weight
bolus injection over 1min followed by
0.125mcg/kg body weight/min
infusion.
Maximum dose 10mcg/min
infusion.

NURSING IMPLICATION
ASSESS
Hypoglycemia (weakness, hunger,
dizziness, tremors, sweating)
1hr postprandial for establishing
effectiveness
ADMINISTER
ORAL ROUTE
Tid with first bite if each meal

Evaluate
Therapeutic response
Teach patient/family
The symptoms of hypo/hyper glycemia what to
do about each
The medication must be taken as prescribed:
explain consequence of discontinuing medicine
abruptly
The

diet

followed.

and

exercise

regimen

must

be

ALTEPLASE
CATEGORY
Fibrinolytics
USES
Lysis of obstructing thrombi associated with acute MI
Ischemic
(pulmonary

conditions
embolism,

required
deep

venous

thrombolysis
thrombosis,

unclotting arteriovenous shunts, acute ischemic CVA)

ACTION
These agents break down the original
clot
Open the vessel for blood flow.

NURSING IMPLICATION
ASSESS
Vital signs
Temperature >104o F (400 C)
indicates internal bleeding
Ventricular dysrhythmias may occur
with hypo perfusion
Blood studies (platelets PTT, PT,
APTT) before starting therapy
ECG continuously, cardiac enzymes

ADMINISTER
Within 6hrs of coronary occlusion for
best result
TEACH PATIENT/FAMILY
The purpose of and expected results
of treatment
To report adverse events

DRUGS FOR ARRHYTHMIAS

GOAL
To return the heart rate and rhythm
to normal
Maximizing cardiac pumping and
restoring hemodynamic stability


INTERVENING FOR BRADYCARDIA

Bradycardia is defined as a heart

rate slower than 60 beats/minute
(bpm).
This

instability

may

manifest

as

dizziness, light-headedness, nausea,

vomiting,
chest

hypotension,

pain,

and

altered

syncope,
mental

ATROPINE

CATEGORY
Antimuscarinic
USES
Brasycardia 40 50 bpm
Bradydyssrhythmia
reversal of anticholinesterate agents
insecticide poisoning
blocking cardiac vagal reflexes
decreasing secreations before surgery
bronchodilators

ACTION
It competitively blocks the muscarinic
receptors in peripheral tissues such
as the heart, intestine, bronchial
muscles.
Atropine abolishes bradycardia and
reduces heart block due to vagal
activity.
Smooth muscle in the bronchi and gut
is relaxed
Glandular secreations are reduced.

DOSAGES
0.5 to 1 mg by I.V push

NURSING IMPLICATION
ASSESS
I & O ratio, check for urinary retention,
daily output
ECG for ectopic ventricular beats,
tachycardia,
Bowel sounds: check for constipation
Increased intra ocular pressure
Cardiac rate, rhythm, character, BP
continuously
Allergic reaction: rash, urticaria

Administer
ORAL
Water in diet if constipation occurs
IV route
Undiluted or diluted with 10ml sterile
H2O
given at 0.6mg/min

EVALUATE
Theraputic response:
Decreased dysarythmias
Increased heart rate
Secretions
GI irritation

TEACH PATIENT/FAMILY
To report blurred vision, chest pain,
allergic reactions, constipation,
urinary retention
Not to perform sternous activities in
high temperature, heat stroke may
occur
Not to operate machineries if
drowsiness occurs

EPINEPHRINE

CATEGORY
Cathecholamine

USES

Actue ischemic attack

Hemostasis
Bronchospasm
Anaphalaxis
Allergic reactions
Cardiac arrest
Shock

ACTION
1 and 2 antagonist causing bronchodilation,
cardiac and CNS stimulation.
L a rg e d o s e s c a u s e s v a s o c o n s t r i c t i o n
v i a - receptors.
Small doses can cause vasodilation
v i a 2 vascular receptors.
DOSAGE
2 to 10 mcg/minute by I.V infusion

NURSING IMPLICATION
ASSESS
ECG during continious administration
If BP increases drug is decreased
Monitor Central venous pressure,
pulmonary capillary wedge pressure
during infusion.

ADMINISTER
Increase dose of insulin if diabetic
patients
Check for correct concentration, route,
dosage before administration
IM / SC ROUTE
Rotate injection site
Massage injection site
Shake before using

IV route
1 mg (1:1000 sol) / 10ml or more
EVALUATE
Therapautic response
Increased BP
Ease of breathing

Teach patient/family
The reason for drug administration
To rinse mouth after use of inhalers

DPOAMINE
CATEGORY
Antishock drug
USES
Shock
increased perfusion
hypotension

ACTION
Dopamine also may be used to
support

hemodynamic

status

by

correcting hypotension.
It enhances cardiac output, minimally
increasing oxygen consumption and
causing peripheral vasoconstriction.

DOSAGE
5 to 15 mcg/kg/minute by IV
infusion

NURSING IMPLICATION
ASSESS
Hypovolemia, if present correct
first
Oxygenation check BP, chest
pain, dizziness, loss of
consciousness
Heart failure : S3 gallop,dysponea,
neck vein distension
I & O ratio
ECG

Administer
IV after diluting 200-400 mg / 250 500ml
of D5
Evaluate
Therapeutic response
Increase in BP with stabilization
Increase in urine out put
Teach patient / family
Reason for drug administration

INTERVENING FOR TACHYCARDIA

Tachycardia, usually refers to a heart

rate faster than 100 bpm
Most tachycardias are classified as one
of two types:
Narrow-QRS-complex tachycardias
Wide-QRS-complex tachycardias

NARROW- QRS COMPLEX

TACHYCARDIAS
Adenosine
Beta blockers
Calcium channel blockers
Amiodarone or ibutilide

WIDE-QRS COMPLEX TACHYCARDIA

Same treatment as narrow QRS
complex tachycardias
Amiodarone alone or with
amiodarone in conjunction with
synchronized cardioversion.

ADENOSINE

CATEGORY
Antidysrhythmic
USES
Supraventricular tachycardia
As

diagnostic

aid

to

assess

myocardial perfusion defects in

CAD

ACTION
Slows

conduction

through

AV

node
Can interrupt reentry pathway
through AV node
Restore normal sinus rhythm in
patients

with

tachycardia.

supraventricular

DOSAGE
6mg by IV push
followed by 10 20 ml of normal
saline solution (NSS) flush
may repeat a 12 mg dose twice
followed by NSS flush

NURSING IMPLICATION
ASSESS
I & O ratio, electrolytes ( K, Na, Cl)
Cardiopulmonary status : BP, pulse, respiration, ECG

intervals

(PQ,

QRS,

QT),

check

for

transient

dysrhythmias
Respiratory status: rate, rhythm, watch for respiratory

depression
Increased respiration, increased pulse drug should be

discontinued.
CNS

effects:

dizziness,

confusion,

psychosis,

paresthesias, convulsions, drug should be discontinued.

Administer
IV BOULUS ROUTE
Undiluted given 6mg or less by rapid inj:
if using an IV line, use port near insertin
site, flush with normal saline (50 ml)
Perform/provide
Storage at room temperature
Solution should be clear
Discard unused drug.

Evaluate
Therapeutic response: normal sinus

rhythm or diagnosis of perfusion

defects
Teach patient/family
To report facial flushing, dizziness,

sweating, palpitation, chest pain.

To raise from sitting or standing slowly

to prevent orthostatic hypotension.

DILTIAZEM

CATEGORY
Antidysrhythmic
USES
A first-line agent in controlling heart rate in
narrow QRS-complex tachycardias
This drug can be used both in patients with
preserved cardiac function and in those
with impaired ventricular function (ejection
fraction below 40%) or heart failure.

ACTION

Stimulates

dopamine

receptors

and

increases cardiac output

With

minimal

consumption;

increase
causes

in

oxygen

peripheral

vasoconstriction.
DOSAGE
5 20mg by IV push over 2 5 min,
Followed by IV infusion or additional
2025 mg by IV push after 15min.

NURSING IMPLICATION
Monitor

for

bradycardia

and/or

pause in
heart rhythm
Monior

blood

pressure

for

hypotension
Begin oral drug before stopping
infusion,

AMIODARONE

CATEGORY
Antidysrhythmic
USES
To treat certain narrow- and wide QRS

complex

tachycardias

identified as ventricular tachycardia

or tachycardias of unknown origin.

ACTION
Block potassium channels in the cell,

but it also prolongs the action potential

duration
depresses conduction velocity, slows

conduction

through

and

prolongs

refractoriness in the AV node

has some alpha, beta, and calcium

channel blocking capabilities

DOSAGE
Narrow-QRScomplex

tachycardias

Amiodarone is given as a bolus of 150 mg over

10minutes,

followed

by

continuous

I.V.

infusion starting at 1 mg/minute for 6 hours

and then 0.5 mg/minute for 18 hours.
If the patient is on nothing-by-mouth status for
an extended time, the infusion can be kept
running at 0.5 mg/minute. Otherwise, an oral
dose usually is started before the infusion ends.

NURSING IMPLICATION
ASSESS
Electrolytes (K, Na, Cl)
Liver function test
Chest x-ray
Thyroid function test
ECG
Hypovolemia
hypertension

Administer
ORAL ROUTE
Load doase with food to decrease
nausea
IV ROUTE
1000mg/24hr during loading
Initial loading : add 3ml (150mg)
100ml D5 given over next 10min

Evaluate
Therapeutic response
Decrease in ventricular
tachycardia
Supraventricular tachycardia

Teach patient / family

To take this drug as directed, avoid
missed
doses
To report side effects immediately

OTHER DRUGS
Selected beta blockers are used to help
control

the

heart

rate

associated

narrow-QRS-complex tachycardias
They include
Metoprolol
Atenolol
Propranolol
esmolol

with

Thank
you