Pharmacology

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Pharmacology

• Cardiovascular Medications
• Classifications Characteristics

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Objectives

• Identify cardio-inotropic agents.
• Describe antiarrythmic drugs.
• Identify common antianginal drugs.
• Describe common diuretics.

• Identify purpose and use of anticoagulant,
  antiplatelet, and thromboembolytic agents.
• Identify and describe antilipemics and peripheral
  dilators.

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Cardiotonic - Inotropic Agents

• PURPOSE
• Used in the treatment of cardiovascular disease.
• Examples
• Digitalis
• Phosphodresterase inhibitors

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Digitalis Preparations

• Action increases force of myocardial contraction
  of heart, slows rate of ventricular
  contraction(heart rate).
• Example digoxin (Lanoxin)
• Uses acute chronic CHF, atrial fibrillation,
  atrial flutter.
• Side effects Visual disturbances, bradycardia,
  arrythmias, anorexia, N/V, H/A, fatigue,
  weakness, drowsiness, confusion..

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Question?

• Digitalis preparations ___________ the force of
  myocardial contractions ______ the heart rate.
• The daily dose of digoxin is called the
  _____________ dose.
• Administration of a relatively large initial dose
  of digoxin is called the ___________ dose.
• Visual disturbances such as photophobia altered
  color perception may be a sign of toxicity in
  clients taking _______________gt

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Phosphodresterase Inhibitors

• Action increases cardiac contractility
  decreases preload afterload by relaxing muscle
  of the heart to produce vasodilation.
• Example Primacor, Inocar
• Uses Short term treatment of CHF
• Side effects Ventricular arrythmias,
  hypotension, H/A, thrombocytopenia, anorexia,
  N/V, abdominal pain, hepatotoxicity.

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Antiarrythmic Drugs

• Purpose
• Used to treat the tachyarrythmias of the heart.
• Examples
• Na channel blockers
• beta adrenergic blockers
• K channel blockers
• Ca channel blockers

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Antiarrythmic Drugs

• Action reduce automaticity, slow conduction
  of electrical impulses through the heart and
  prolong refractory (rest) period of myocardial
  cells.

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Examples

• Examples
• Class I Na channel blockers
• Class I A quinidine (Cardioquin)
• Class I B lidocaine (Xylocaine)
• Class I C
• Class II beta-adrenergic blockers propanolol
  (Inderal)

• Examples
• Class III K channel blockers
• amiodarone(Cordarone)
• Class IV Ca channel blockers
• diltiazem(Cardizem)
• Unclassified
• adenosine(Adenocard)

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Antiarrythmics - Uses

• To convert atrial fibrillation or flutter to a
  normal sinus rhythm, maintain normal sinus rhythm
  after conversion, when ventricular rate is so
  fast or irregular that cardiac output is
  impaired, and when dangerous arrythmias occur
  may be fatal.
• Check apical/radial pulse before each dose.
• Check blood pressure daily.

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Antiarrythmics - Side Effects

• Heart Block
• Arrythmias
• Hypotension
• Dizziness
• Fatigue
• Malaise
• Bradycardia

• Confusion
• Weight gain
• Seizures
• N/V
• hypothyroidism
• Paresthesia
• Peripheral neuropathy

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Questions?

• _____________ drugs reduce automaticity of
  myocardial cells slow conduction of electrical
  impulses through the heart.

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Antianginal Drugs

• PURPOSE to treat angina pectoris
• ACTION decrease myocardial demand for oxygen or
  increase blood supply to the myocardium.
• EXAMPLES
• Organic Nitrates nitroglycerin
• Beta-adrenergic Tenormin, Inderal
• Ca channel blockers Cardizem, Procardia

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Antianginal DrugsTreatment of acute chronic
angina

• Purpose
• To treat angina pectoris
• Action
• To decrease myocardial demand for oxygen or
  increase blood supply to the myocardium.
• Examples
• Organic nitrates
• Beta-adrenergic blocking agents
• Ca channel blockers

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Organic Nitrates

• Example
• nitroglycerin (Nitrostat, Nitrobid) Prototype
• Side effects
• dizziness
• H/A
• hypotension
• tachycardia

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Beta-adrenergic Blocking Agents

• Example
• propanolol (Inderal)
• atenolol (Tenormin)
• Side effects
• fatigue - CHF
• weakness - pulmonary edema
• impotence
• bradycardia

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Ca Channel Blockers

• Example
• diltiazem (Cariazem) - verapamil (Isoptin)
• Nifedipine (Procardia)
• Side effects
• peripheral edema - dizziness
• H/A - CHF
• flushing - weakness
• arrythmias - constipation

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Antihypertensive DrugsTo Treat Hypertension

• Action decrease BP by decreasing cardiac output
  or peripheral vascular resistance.
• Uses
• Angiotensin-converting enzyme (ACE) inhibitors
• Example catopril (Capoten)
• Side effects cough, hypotension, taste
  disturbance, proteinuria

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Antihypertensives

• Angiotensin II Receptor Antagonist
• losartan ( Cozaar)
• valsartan (Diovan)
• Antiadrenergics
• Alpha1 blocking agents
• Alpha2 agonists
• Postganglionic-active drugs
• Beta-adrenergic blocking agents

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Antihypertensives

• Calcium channel blockers
• dilitiazem (Cardiazem)
• nifedipine (Procardia)
• verapamil (Isopton)
• Other vasodilators
• hydralazine (Apresoline)

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Antihypertensives

• Use
• to treat primary hypertension
• Side effects
• postural hypotension - impotence
• dizziness - bradycardia
• weakness - GI disturbances
• Na water retention

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Diuretics

• Purpose to treat excessive fluid in the body.
• Action act on kidneys to decrease reabsorption
  of Na, Cl, water other substances.
• Uses edema hypertension

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Diuretics

• Thiazide related
• chlorothiazide (Diuril)
• indapamide (Lozol)
• Loop diuretics
• furosemide (Lasix)
• torsemide (Demadex)

• K-sparing diuretics
• spironolactone (Aldactone)
• Osmotic diuretics
• mannitol (Osmitrol)

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Diuretics - Side Effects

• Hypokalemia (Lasix)
• Dehydration
• Low Na levels
• Low magnesium levels
• Low chloride levels
• Hyperglycemia
• Hyperuricemia

• Give diuretics in the early AM for daily dose.

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Anticoagulant, Antiplatelet Thrombolytic Agents

• Purpose To treat clotting disorders.
• Action alter some aspect of the blood
  coagulation process in the body.
• Uses prevention or treatment of blood clot
  formation.

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Diuretics - Examples

• Anticoagulants
• heparin
• Enoxaparin (Lovenox)
• warfarin(Coumadin)
• Antiplatelet agents
• aspirin
• Thrombolytic agents
• alteplase(Activase)

• Side effects
• bleeding (gums, vomitus, stool, urine, sputum),
  bruising, petechiae, tissue irritation at
  injection site.

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Diuretics - Key Points

• The antidote for heparin is protamine sulfate.
• The antidote of warfarin is vitamin K.
• Do not aspirate or massage injection site.

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Antilipemics

• Purpose
• To lower blood lipids, especially total LDL
  cholesterol to prevent or delay development of
  fatty plaques to promote regression of
  existing fatty plaques.

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Antilipemics

• Action alter production, metabolism or removal
  of lipoproteins from the body, resulting in lower
  lipid levels.
• Uses
• hyperlipoproteinemia not controlled by diet and
  exercise
• clients with S S of CAD, family hx CAD
• Other risk factors (HTN, diabetes, smoking)

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Antilipemics

• Examples
• HMG-CoA reductase inhibitors (Statins)
• atorvastatin (Lipitor)
• simvastatin (Zocor)
• Fibrates
• Bile acid sequestrants
• cholestyramine (Questran)

• Side effects
• GI problems
• abdominal cramps
• constipation
• diarrhea
• flatus
• heartburn
• rashes

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Questions?