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Which drugs increase O2 supply to the heart?
-Oxygen

-Those that increase blood flow:

NTG by vasodilating

ASA / Anticoagulants (Heparin) by antiplatelet/anticoagulation action

Morphine - peripheral vasodilation

Emergency - Thrombolytic (TPA) drugs to break up any clots occluding blood flow
Which drugs decrease O2 demand on the heart by decreasing HR?
-Beta blockers

-Digoxin, but it also increases contractility, increasing workload on heart
Which drugs decrease O2 demand on the heart by decreasing preload (volume)?
-Diuretics - decrease circulating blood volume

-NTG by vasodilating

-ACE Inhibitors by inhibiting RAAS, countering fluid retention and vasoconstriction

-Morphine by peripheral vasodilation
Which drugs decrease O2 demand on the heart by decreasing afterload (resistance)?
-ACE Inhibitors by inhibiting RAAS, countering fluid retention and vasoconstriction

-Beta blockers cause slight vasodilation by affecting smooth muscles in vascular walls
Which drugs decrease O2 demand on the heart by decreasing contractility (pumping action of heart)?
Beta blockers
Nitroglycerin
Decreases afterload and preload by vasodilating.

Given first-line (after Oxygen) in treatment of an acute MI and taken PRN for chronic stable angina. Have fluids ready because the Nitro may drop their BP.

Patient teaching:
Take up to 3 tablets every 5 minutes until chest pain relieved. If symptoms are unchanged or worse after 5 minutes, call 911. Can also take 10 minutes before activity known to cause angina. Can take Tylenol to relieve HA. Replace prescription q 6 months.
Emergency Drug management for acute MI
"MONA" In this order:
1 - Oxygen
2 - Nitroglycerin
3 - Aspirin
4 - Morphine if still having chest pain
Nesiritide (Natrecor)
Vasodilator - given in the management of acute decompensated HF

You should see a decreased PAWP and increased CO. Can cause symptomatic hypotension - closely monitor for drop in BP.
Morphine Sulfate
Given to treat acute decompensated HF and acute MI.

Vasodilates to decrease preload/afterload -> decrease demand on heart
Relieves pulmonary edema and anxiety associated with ADHF
How can we increase preload and hemodynamically measure its increase?
Volume expanders:
Crystalloids - NS, LR
Colloids - Albumin, Hetastarch
Blood - PRBCs, whole blood

Increased CVP, PAWP
How can we decrease preload and hemodynamically measure its decrease?
Diuretics - Furosemide (Lasix), Bumetanide, Torsemide

Venous dilators - morphine, nitrogylcerin, nitroprusside

Decreased CVP, PAWP
How can we increase afterload and hemodynamically measure its increase?
Vasopressors:
Dopamine 10-20 mcg/kg/min
Epinephrine
Norepinephrine (Levophed)
Phenylaphrine (Neo)
Vasopressin

Increased PVR, SVR, MAP
How can we decrease afterload and hemodynamically measure its decrease?
Vasodilators:
Nitroprusside
Nitroglycerin (higher doses)
PDE inhibitors (milrinone)
Ca-channel blockers (Cardene, Nifedipine)
ACE Inhibitors (-pril)
Hydralazine
Nesiritide (Natrecor)

Decreased SVR, PVR, MAP
How can we increase contractility and hemodynamically measure its increase?
Positive inotropes:
Dobutamine
Dopamine (3-10 mcg/kg/min)
Epinephrine
Norepinephrine
PDE Inhibitors (Milrinone)
Digoxin

Increased CO/CI
How can we decrease contractility and hemodynamically measure its decrease?
Negative inotropes

Beta blockers
Ca-Channel blockers

Decreased CO/CI