Cardiac Drugs

• Cardiac arrest


  During a cardiac arrest, drugs intervention is SECONDARY only to other interventions. Most important aspect is still high quality chest compressions and early defibrillation!
• Vasopressin is already removed in Cardiac medication for Cardiac arrest bases on latest 2015 guidelines
• Epinephrine


  • Increases SVR, BP, HR, Contractility, Automaticity
  • Increases blood flow to heart and brain, AV conduction velocity
  • Alpha-adrenergic effects can increase coronary & cerebral perfusion pressure during CPR
  • Beta-adrenergic effects may increase myocardial work & reduce subendocardial perfusion
• Epinephrine dose


  1 mg IV bolus every 3-5 mins
• No evidence to show that epinephrine improves survival
• Norepinephrine


  • Naturally occuring potent vasoconstrictor and intropic agent
  • Usually induces renal and splanchnic vasoconstriction
• Norepinephrine indications


  • Severe hypotension (SBP <70mmHg)
  • Low total peripheral resistance
• Norepinephrine dose


  0.1 - 0.5 mcg/kg/min infusion
• Norepinephrine is not used for cardiac arrest
• Dopamine


  • Catecholamine
  • Alpha and Beta-adrenergic receptor agonist
  • Peripheral dopamine receptor agonist
• Dopamine indications


  • Hypotension (SBP 70-100mmHg)
  • Symptomatic significant bradycardia
  • After ROSC (Return of Spontaenous CIrculation)
• Dopamine dose


  1. 20 mcg/kg/min infusion, titrate to patient response
• Dobutamine


  • Synthetic sympathomimetic amine with positive inotropic action
  • Minimal positive chronotropic activity at low doses (2.5 ug/kg/min), but moderate choronotropic activity at higher doses
• Dobutamine indications


  Severe systolic heart failure (SBF 70-100mmHg)
• Dobutamine dose


  1. 20 ug/kg/min
• Dobutamine's vasodilating activity precludes its use when a vasoconstrictor effects is required
• Alpha-adrenergic


  Plays an important role in the regulation of blood pressure (BP)
• Automaticity


  The ability to contract without direct stimulation by nervous system
• AV conduction velocity


  The speed at which electrical impulses travel through the atrioventricular node (AV node) and the subsequent conduction system of the heart
• Beta-adrenergic


  A type of drug that blocks the action of substances, such as adrenaline, on nerve cells and causes blood vessels to relax and dilate (widen). This allows blood to flow more easily and lowers blood pressure and the heart rate
• Bolus


  A single, large dose of medicine
• Blood Pressure (BP)


  The amount of force your blood uses to get through your arteries
• Catecholamine


  A type of neurohormone (a chemical that is made by nerve cells and used to send signals to other cells)
• Contractility


  The force of contraction of the heart muscle
• Chronotropic


  Affecting the rate or timing of a physiologic process, as the heart rate
• Dobutamine


  A medication that treats heart failure by strengthening your heart muscle
• Dopamine


  Used to treat low blood pressure and heart failure
• Epinephrine (Heart)


  Used for emergency treatment of severe allergic reactions (including anaphylaxis) to insect bites or stings, medicines, foods, or other substances
• Hypotension


  • The pressure of blood circulating around the body is lower than normal or lower than expected
  • Severe Hypotension can be caused by sudden loss of blood (shock), severe infection, heart attack, or severe allergic reaction (anaphylaxis)
• Heart Rate (HR)


  The frequency of the heartbeat measured by the number of contractions of the heart per minute
• Intropic agent


  Medicines that change the force of your heart's contractions
• Norepinephrine (Blood Vessels)


  Used to raise blood pressure in patients with severe, acute hypotension (short-term low blood pressure)
• Perfusion


  • Coronary and Cerebral Perfusion is the process of delivering oxygen-rich blood to the heart muscle (myocardium) via the coronary arteries
  • Subendocardial Perfusion refers to the blood flow to the subendocardium, which is the innermost layer of the heart muscle (myocardium) adjacent to the endocardium, the inner lining of the heart chambers
• Potent Vasoconstrictor


  A substance that strongly narrows the blood vessels, leading to an increase in vascular resistance and blood pressure
• Blood Pressure


  • Diastolic is the pressure in your arteries when your heart is at rest between heartbeats
  • Systolic is the pressure in your arteries when your heart is beating and sending blood into your arteries
  • Systolic Heart Failure is a specific type of heart failure that occurs in the heart's left ventricle
• Symptomatic significant bradycardia


  A slow heart rate that causes a person to experience various symptoms due to the decreased beats per minute
• Titrate


  Slowly increasing the dose of a medicine by very small amounts over days, weeks, or even months, to find the right dose that is effective for you
• Vasoconstriction


  • The narrowing (constriction) of blood vessels by small muscles in their walls
  • Renal helps direct blood flow from nonexercising tissues, such as the kidneys, to tissues with increased metabolic demands, such as exercising muscle
  • Transient refers to a temporary narrowing of blood vessels, which can affect blood flow and blood pressure
  • Splanchnic refers to the narrowing of blood vessels in the splanchnic circulation, which includes the blood supply to the gastrointestinal organs, liver, spleen, and pancreas
• Vasopressin


  Also known as antidiuretic hormone (ADH), is a peptide hormone that plays a crucial role in regulating water balance, blood pressure, and blood volume in the body. It is produced in the hypothalamus and released from the posterior pituitary gland
• Sodium Bicarbonate (Buffers)


  • Little data indicates that therapy with buffers improves outcome
  • Does not improve ability to defibrillate or improve survival rates in animals
  • Can compromise coronary perfusion pressure
  • May cause adverse effects due to extracellular alkalosis, including shifting the oxyhemoglobin saturation curve
  • May induce hyperosmolality and hypernatremia
  • Produce carbon dioxide
  • May inactivate simultaneously administered catecholamine
  • Reverses acidosis caused by global hypoperfusion