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

2. Key Terms Angiotensin Atherosclerosis Glycoside Hypokalemia Mast cells
Megaloblastic anemia
Plasminogen

3. The Cardiovascular System
Heart
Arteries
Arterioles
Veins
Venules
Capillaries
Blood

4. 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

5. 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

6. 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
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7. 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

8. Heart Disease Risk Factors
Males 55 or older
Females 65 or older
Females younger than 65 with premature menopause
Smokers
Hypertension
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9. Heart Disease Risk Factors
Diabetes
Hyperlipidemia
Family history of heart disease
Obesity

10. 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
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11. 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

12. 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

13. 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

14. 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

15. 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
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16. 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

17. Antiarrhythmic Agents
Arrhythmia: irregular heartbeat
Antiarrhythmic drugs help regulate heart rhythm
Not all arrhythmias require treatment
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18. 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?

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

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

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

22. 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

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

24. 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

25. 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

26. 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
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27. 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

28. 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
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29. 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

30. 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.

31. 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
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32. 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

33. 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

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

35. 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
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36. Hematinic Agents: Patient Teaching
Include iron-rich foods in diet
Do not crush tablets
Do not substitute one preparation for another

37. 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

38. 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

39. 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
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40. 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.

41. Antihyperlipidemic Agents
Used to reduce elevated cholesterol levels
Alternatives to medications
Diet
Stress and weight management
Exercise
Treat other conditions
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42. 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

43. 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