Medications Used for Cardiovascular System Disorders UNIT 23 Medications Used for Cardiovascular System Disorders

Key Terms Angiotensin Atherosclerosis Glycoside Hypokalemia Mast cells Megaloblastic anemia Plasminogen

The Cardiovascular System Heart Arteries Arterioles Veins Venules Capillaries Blood

Heart Disease Every 29 seconds someone in the United States suffers a CHD-related event Leading cause of death in both men and women Primary cause: atherosclerosis Refined carbohydrates and saturated fats increase risk

Warning Signs of Heart Attack Pressure, fullness, squeezing pain in center of chest, for 2 minutes or more Pain spreads to shoulders, neck, or arms Dizziness, fainting, diaphoresis, nausea, SOB

Angina vs. MI Angina Sudden, agonizing substernal pain May radiate to left shoulder, arm, or jaw Skin cold and clammy Normal pulse and BP Anxious and apprehensive (continues)

Angina vs. MI MI Severe, crushing substernal pain Radiates to shoulders, arms, and jaw Skin cold and clammy Pulse rapid, weak, irregular; BP drops Extremely apprehensive

Heart Disease Risk Factors Males 55 or older Females 65 or older Females younger than 65 with premature menopause Smokers Hypertension (continues)

Heart Disease Risk Factors Diabetes Hyperlipidemia Family history of heart disease Obesity

The Older Adult More than 2.7 million people older than 60 years of age suffer from heart disease Four out of five people who die of heart attacks are older than 65 Age is directly related to development of heart disease Age complicates treatment regimens (continues)

The Older Adult Factors that affect actions, absorption, metabolism, and excretion of cardiovascular drugs Slowed intestinal motility Decrease in lean body mass and total body water Low serum albumin levels Age- or disease-related cardiovascular changes Kidney and liver efficiency

Congenital Heart Disease May be exogenous or endogenous Exogenous: viruses and alcohol Viruses: Rubella common cause Prevention: Rubella vaccination Alcohol: Causes fetal alcohol syndrome Prevention: Avoid alcohol during pregnancy Endogenous: chromosomal abnormalities

How Drugs Affect the Heart Inotropic effect Increase or decrease force of myocardial contraction Chronotropic effect Increase or decrease heart rate Dromotropic effect Increase or decrease conduction of electrical impulses through heart muscle

Digitalis Part of cardiac glycosides classification of medicines Usually used for CHF Derived from foxglove plant Strengthen and slow heart muscle Improves myocardial muscle tone Used in conjunction with diuretics

Signs of Digitalis Toxicity Most common Anorexia, nausea, vomiting, arrhythmias Gastrointestinal Anorexia, nausea, vomiting, diarrhea, abdominal pain Nervous system Headache, restlessness, irritability, drowsiness, depression, confusion, insomnia, psychosis, convulsions, coma, blurred or yellow vision (continues)

Signs of Digitalis Toxicity Cardiovascular Bradycardia, tachycardia, ventricular bigeminy, AV block Musculoskeletal Severe weakness Always check apical heart rate for a full minute before administration, and withhold and notify physician if below 60 bpm

Antiarrhythmic Agents Arrhythmia: irregular heartbeat Antiarrhythmic drugs help regulate heart rhythm Not all arrhythmias require treatment (continues)

Antiarrhythmic Agents Did you know? Lidocaine HCl (Xylocaine HCl), a commonly used local anesthetic, is also used, in much higher concentration, as an antiarrhythmic agent?

Vasopressors Cause contraction of muscles associated with capillaries and arteries Useful to help elevate blood pressure in treatment of shock

Vasodilators Peripheral: used in treatment of PVD Coronary: used in treatment of angina pectoris Most common coronary vasodilator: nitroglycerin Also used to treat hypertension

Hypertension Normal <120/<80 Prehypertension 120–139/80–89 Stage 1 140–159/90–99 Stage 2 >160/>100

Hypertension Treatment Goal: prevent other complications, such as stroke, heart attack, and kidney disease Must consider degree of elevation, target organ damage, and other risk factors Medication may be used if unable to control blood pressure by diet and exercise

Antihypertensive Drugs Diuretics Beta-blockers, alpha-blockers, or combination blockers ACE inhibitors Angiotensin antagonists Calcium channel blockers Nervous system inhibitors Vasodilators

Implications for Patient Care BP should be monitored regularly May have to take meds for rest of life Med does not “cure” hypertension, only manages it Avoid alcohol and OTC meds unless authorized by physician Increase potassium intake if on potassium-depleting diuretics

Drugs That Affect the Blood Anticoagulants Prevent formation of clots Keep existing clots from increasing in size. Do NOT dissolve existing clots Thrombolytic agents Dissolve existing fresh thrombi and emboli Diffuse into clot and activate plasminogen

Heparin Produced by mast cells found in liver, lungs, and other parts of the body Used during open heart surgery, renal hemodialysis, and treatment of deep venous thrombosis or pulmonary infarction (continues)

Heparin Given sq or IV, never IM Dosage should be adjusted based on patient’s coagulation test results Be aware of signs of bleeding Petechiae, ecchymosis, black tarry stools, bleeding gums, hematuria

Coumadin Oral anticoagulant Uses: Acts by inhibiting synthesis of vitamin K–dependent coagulation factors Uses: Prophylaxis or treatment of venous thrombosis, pulmonary embolism, atrial fibrillation with embolization, and as adjunct in prophylaxis of systemic embolism after myocardial infarction (continues)

Coumadin Patient teaching Avoid salicylates, large amounts of green vegetables, or drastic dietary changes May discolor alkaline urine reddish-orange Watch for signs of bleeding

Antiplatelet Drugs Help reduce occurrence of and death from vascular events Aspirin most widely available Other drugs: Plavix, Persantine, Ticlid Warning! When clopidogrel and omeprazole are taken together, the effectiveness of clopidogrel is reduced. Patients at risk of heart attacks or strokes using clopidogrel to prevent blood clots will not get the full effect of this medicine.

Thrombolytic Agents 80% of all acute myocardial infarctions are caused by a thrombus that occludes a coronary artery Thrombolytic agents dissolve existing thrombus when administered soon after its occurrence Dissolve clot, reopen artery, restore blood flow to heart, prevent further damage to myocardium (continues)

Thrombolytic Agents Approved drugs: streptokinase, anistreplase, alteplase, urokinase, single-chain urokinase-plasminogen activator Bleeding is the most common complication IM injections should be avoided during treatment

Hemostatic Agents Administered systemically to overcome coagulation defects or topically to control surface bleeding Uses Treatment of hemophilia and hypofibrinogenemia Control capillary oozing Control surface bleeding

Hematinic Agents Used to treat iron-deficiency anemia Contraindicated in hemolytic anemia, cirrhosis, peptic ulcer disease, regional enteritis, hemosiderosis, hemochromatosis, and ulcerative colitis

Hematinic Agents: Patient Teaching Do not take with tetracycline, as iron interferes with absorption Take liquid preparations through a straw May discolor stool dark green or black May cause constipation (continues)

Hematinic Agents: Patient Teaching Include iron-rich foods in diet Do not crush tablets Do not substitute one preparation for another

Iron Dextran (Imferon) Given IM Z-track or IV 19–20 gauge, 2- to 3-inch needle IV given only by physician Patient must remain in recumbent position for 30 minutes after injection Monitor cardiac status Store medication in cool environment

Megaloblastic Anemias Decreased erythrocyte formation and immaturity, fragility and early destruction of these cells Usually from vitamin B12 (cyanocobalamin) or vitamin B9 (folic acid) deficiency Treated with vitamin B12, vitamin B9, or Epogen

Epogen Epogen: ESA, similar to naturally occurring protein erythroprotein BP must be carefully monitored for hypertension May cause seizures in first 90 days Do not shake; will render drug inactive Do not use if particles or discoloration are present Use one dose per vial (continues)

Epogen Warning! When administered ESAs, patients experience greater risks for death and serious cardiovascular events. ESAs shortened overall survival and/or time-to-tumor progression in clinical studies. Epogen increased the rate of deep venous thromboses in perisurgery patients not receiving prophylactic anticoagulation.

Antihyperlipidemic Agents Used to reduce elevated cholesterol levels Alternatives to medications Diet Stress and weight management Exercise Treat other conditions (continues)

Antihyperlipidemic Agents Statins Work well on LDL cholesterol; very few short-term side effects Resins Work in intestines to dispose of cholesterol Nicotinic acid Works in liver on blood fat Gemfibrozil Lowers blood fat and raises HDL

Antihyperlipidemic Agents: Patient Teaching Decrease dietary intake of fats and cholesterol Need regular exercise regimen Use stress management techniques Avoid grapefruit products if taking statins