General Discussion

HTN Meds

• End result-It will lower the BP or prevent increases in BP

ACE Inhibitors

• Blocks the ACE enzyme from the lungs, thus preventing vasoconstriction, resulting in lowered BP

• "ACE cough

Alpha-1-Vessels-excitability=vasoconstricts

Alpha-2-Vessels-relaxation=vasodilation

Beta-1-Heart (Excitability)-HR increases

Beta-2-Lungs (Relaxation)-Bronchodilation

Beta Blockers

Tachycardia-using up more oxygen!!!-Increases the workload of the heart

NTG-nitrate=vasodilator

CHF

• The ventricles are failing, they are overworking

• So, take the workload off the heart

• We do that by decreasing the pressure in the vessels

• Nitrates, ACE inhibitors, ARBS

RAAS System

• ACE inhibitors

• ARBs

• Renin Inhibitors

Sodium

• Responsible for nerve conduction & muscle contraction

• Fluid balance and BP

• Neuro function

Calcium

• Nerve conduction & muscle contraction

• Bone/teeth health

• Blood clotting

Potassium

• Nerve conduction & Muscle contraction

Antidysrhythmic Drugs

Class I-Sodium Channel Blockers

• Used for ventricular dysrhythmias!!!

• Lidocaine

• V-Fib, V-tach, Multiple PVCs

Class II-Beta Blockers=Beta adrenergic blockers

• -lol

• HTN & Tachydysrhythmias

• CHF-takes the workload off the heart

Class III-Potassium Channel Blockers

• Amiodarone

• Ventricular dysrhythmias (V-fib/V-tach/Multiple PVCs)

Class IV-Calcium Channel Blockers

• HTN

• Atrial Dysrhythmias (A-fib-Rapid Afib=Afib w/ RVR, A-flutter)

• Tachydysrhythmias

• CHF

• Cardizem, Diltiazem, Amlodipine, Verapamil

Miscellaneous

• Digoxin

• Adenosine-used for SVT (narrow complex tachycardia)

Chronotropic-Refers to the HR. The speed of the heart

• Speed

Inotropic-Refers to the strength of the contraction

• Strength

Dromotropic-Refers to the hearts ability to conduct an electrical impulse

• Electricity

Threshold

• Seizure threshold-making it harder to have a seizure

• Ventricular Threshold-making it harder to go into a ventricular dysrhythmia

68 M patient, who is unconscious, Pulseless and apneic. EKG shows a wide complex tachycardia=V-Tach. CPR is in progress and an IV has been established.

• CPR

• Immediate Defibrillation

• Epinephrine 1 mg

• Lidocaine or Amiodarone

• CPR

• Defibrillation

• ROSC-Return of Spontaneous Circulation

• Pulses are present

• Give Lidocaine on post arrest-to increase the ventricular threshold

Cardiac Arrest

• NO breathing

• No pulse

50 F-c/o weakness, dizziness, pale skins, and she is lethargic. VS as follows-HR-220-V, BP-112/60, RR-24, Spo2-94%. What is the most appropriate immediate intervention?

A. Epinephrine

B. Amiodarone

C. Immediate Sync. cardioversion

D. Calcium channel blocker

• Lidocaine-Class 1

• Amiodarone-Class 3

V-Tach w/o pulse-Cardiac Arrest

V-Tach w/ pulses (Stable or Unstable)

Action Potential

• An electrical impulse that travels down a neuron

• A stimulus must trigger the nerve cell in order for a muscle to depolarize (contract)

• In order for an impulse or depolarization to occur, there needs to be an influx of electrolytes

• Resting state

• Depolarization

• Repolarization

Phase 0-Depolarization-Na+ gates open

Phase 1-Repolarization-K+ gates open/Na+ Gates close

Phase 2-Plataeu-Ca+ gates open/K+ gates close

Phase 3-Rapid Repolarization-Calcium gates close and K+ gates close

Phase 4-Resting potential

***During these phases, there cannot be another action potential=Absolute Refractory period

Refractory=means resistant

SPC-The electrolyte channels open and close in this order

Sodium

Potassium

Calcium

a0b25b042c2a91dbc27c2463f0b0db33.png (1000×1000)