1. AFAMS Cardiovascular Drugs (Insert Dari) EO 003.01 Part 19

2. AFAMS Lesson Overview (Insert Dari) Cardiac Therapy Cardiac Glycosides Antiarrythmics Cardiac Stimulants - adrenergic and dopaminergic agents - phosphodiesterase inhibitors Vasodilators used in cardiac diseases Other cardiac drugs Insert Dari

3. AFAMS Lesson Overview (Insert Dari) Antihypertensives Diuretics Peripheral Vasodilators Beta-blockers Calcium Channel Blockers Agents that Act on the Renin- Angiotensin System Lipid Modifying Agents Insert Dari

4. AFAMS What I need to know as a pharmacy technician (Insert Dari) In this lecture we will cover the drugs listed in the ANA Formulary which are classified according to the ATC system under (C) Cardiovascular Drugs For each of these medications/classes students must obtain an understanding of: (1) Mechanism of Action (2) Indications (Uses) (3) Efficacy (4) Side Effects Insert Dari

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9. C01 Cardiac Therapy (Insert Dari)

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11. Cardiac Glycosides: Digoxin (Insert Dari) Mechanism of Action Allows the heart to contract better. Indication It is used to help a weak heart. It is used to treat a fast heartbeat. Insert Dari Digitalis Purpura (foxglove) (Insert Dari)

12. AFAMS Cardiac Glycosides: Digoxin (Insert Dari) Side Effects Signs of too much drug Hallucinations Inability or change in ability to think logically and clearly. Sudden changes in vision (objects may have yellow/green halos). A heartbeat that does not feel normal. Bloody or black tarry stools. Other side effects Loose stools (diarrhea). Dizziness. Headache. Upset stomach. Insert Dari

13. AFAMS Important Points Can be given intravenously or orally. Should be kept in original container to prevent degradation of product. Many drug interactions exist, it is important that a pharmacist speak with a patient who is starting this medication for the first time. Cardiac Glycosides: Digoxin (Insert Dari) Insert Dari

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15. Antiarrythmics: Amiodarone (Insert Dari) Mechanism of Action Decreases cardiac nerve stimulation, which slows down the heart beat. Indications (Use) Abnormal heart rhythm. Insert Dari

16. AFAMS Side Effects Serious – need to seek medical attention Cough, coughing up blood and difficulty breathing. Change in energy levels (up or down) Change in vision Signs of liver problems: right abdomen pain, yellowing of the skin. A burning, numbness, or tingling feeling that is not normal. Less Serious Upset stomach Headache Antiarrythmics: Amiodarone (Insert Dari) Insert Dari

17. AFAMS Important Points Tell the patient to take the medication at the same time each day. Can be taken with or without food. Antiarrythmics: Amiodarone (Insert Dari) Insert Dari

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19. Adrenergic and Dopaminergic Agents (Insert Dari) Mechanism of Action Increased blood pressure and heart rate, pupil dilation and bronchodilation. Includes: Epinephrine Ephedrine Norepinephrine Dopamine Dobutamine These drugs are used to combat life- threatening disorders, which include acute attacks of bronchial asthma, shock, cardiac arrest, and allergic reactions. In addition these drugs are used as nasal decongestants and appetite suppressants. Insert Dari

20. AFAMS Adrenergic and Dopaminergic Agents (Insert Dari) Specific Indications Epinephrine – anaphylaxis and when the heart stops beating. Ephedrine – to treat low blood pressure (pseudoephedrine used to treat a stuffy nose). Norepinephrine – to treat low blood pressure. Dopamine – used to help a weak heart. Dobutamine – used to help a weak heart. Insert Dari

21. AFAMS Side Effects Dizziness Headache Excitable and Nervous A fast heartbeat Important Points Administered intravenously. Adrenergic and Dopaminergic Agents (Insert Dari)

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23. Milrinone (Insert Dari) Mechanism of Action Causes vasodilation of cardiac vessels and increases the force of hearts contractions. Indication To help a weak heart. Side Effects Headache. Low blood pressure. Insert Dari

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25. Nitroglycerin Formulations (Insert Dari) Mechanism of Action Vasodilator of vessels to the heart. Indications Is used to treat chest pain or chest pressure. Many different formulations exist: oral tablets, patch, spray, cream and injection. Injection may also be used to treat a weak heart. Insert Dari

26. AFAMS Nitroglycerin Formulations (Insert Dari) Side Effects Dizziness or passing out. Headache. Fast or slow heartbeat. Blurred eyesight. Dry mouth. Sweating a lot, pale skin. Upset stomach or throwing up. Important Points Chest pain or pressure lasting more than 15 minutes. Get emergency medical care right away Side Effects

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28. Adenosine (Insert Dari) Mechanism of Action Restores normal heart rhythm. Indication It is used to treat heart rhythm that is not normal. Side Effects Dizziness. Flushing. Headache. Numbness and tingling of feet or hands. Important Points Administered intravenously. Insert Dari

29. AFAMS C02 Anti-hypertensives (Insert Dari)

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31. Methyldopa (Insert Dari) Mechanism of Action Increases the contractility of the heart and causes vasodilation. Indications (Uses) It is used to treat high blood pressure Side Effects Dizziness Dry mouth Headache Feeling tired or weak Important Points Administered orally. Insert Dari

32. AFAMS C03 Diuretics (Insert Dari)

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34. Diuretics (Insert Dari) Hydrochlorothiazide Spironolactone Furosemide Mechanism of Action Causes the kidneys to release more water through the urine, thus decreasing blood volume and decreasing blood pressure. Indications It is used to treat high blood pressure. It is used to get rid of extra fluid. Sprinolactone and Furosemide are also used to treat a weak heart. Insert Dari

35. AFAMS Diuretics (Insert Dari) Side Effects All diuretics: Feeling dizzy, rise slowly from a sitting or laying down position. Furosemide and hydrochlorothiazide: Symptoms of low potassium, which include muscle cramps and a heartbeat that does not feel normal. Spironolactone: Enlarged breasts in men and changes to menstrual cycle for women. Insert Dari

36. AFAMS Diuretics (Insert Dari) Important Points Spironolactone and Furosemide are available in a combination product. Insert Dari

37. AFAMS C04 Peripheral Vasodilators (Insert Dari)

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39. Hydergine (Insert Dari) Mechanism of Action Dilates the cerebral and peripheral vessels. Indication (Use) Although classified as a vasodilator, it is used to treat dementia due to insufficient cerebral blood flow. Side Effects Slow heart rate Feeling dizzy or lightheaded upon standing. Blurred vision Insert Dari

40. AFAMS C07 Beta blocking agents (Insert Dari)

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42. Beta-blockers (Insert Dari) Mechanism of Action Decreases the amount of work the heart has to do (slows the heart rate) and decreases blood pressure. Indications (Use) To treat high blood pressure May be used after a heart attack to try and prevent a second heart from occurring. Used to treat a weak heart (heart failure).

43. AFAMS Beta-blockers (Insert Dari) Side Effects May worsen symptoms of asthma in patients. Patients may feel a decrease in energy when they first start this type of medication. May cause dizziness or light headedness when standing up. May decrease sexual function in men. Important Points Can be administered orally and intravenously. Insert Dari

44. AFAMS C07 Calcium Channel Blockers (Insert Dari)

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46. Calcium Channel Blockers (Insert Dari) Mechanism of Action Causes vasodilatation of the peripheral and coronary arteries. Indications (Use) It is used to treat chest pain or pressure. It is used to treat high blood pressure. Insert Dari

47. AFAMS Calcium Channel Blockers (Insert Dari) Side Effects Dizziness and light headedness when standing up or in general. Headache Shortness of breath Feeling tired or weak. Important Points Can be administered orally or intravenously. Insert Dari

48. AFAMS C10 Agents that act on the Renin-Angiotensin System (Insert Dari)

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50. ACE Inhibitors (Insert Dari Mechanism of Action Angiotensin-converting enzyme (ACE) inhibitors block production of the hormone, angiotensin II, a compound in the blood that causes narrowing of blood vessels and increases blood pressure. By reducing production of angiotensin II, ACE inhibitors allow blood vessels to widen, which lowers blood pressure and improves heart output. Indications (Use) It is used to treat high blood pressure. It is used to help heart function after a heart attack. Is used to help a weak heart. Insert Dari

51. AFAMS ACE Inhibitors (Insert Dari Side Effects A bothersome cough that doesn’t go away. Feeling light headed or dizzy. Swelling of the lips and face (rare but serious). May feel tired or weak. Important Points Administered orally. Insert Dari

52. AFAMS Angiotensin II Antagonists (Insert Dari) Mechanism of Action The angiotensin II receptor blockers (ARBs) block the effects of angiotensin II on cells in the heart and blood vessels. Similar to ACE inhibitors, ARBs can widen blood vessels and lower blood pressure. Indications (Use) It is used to treat high blood pressure. It is used to protect kidney function in diabetic patients who have protein loss. Insert Dari

53. AFAMS Angiotensin II Antagonists (Insert Dari) Side Effects Feeling light headed or dizzy May feel tired and weak Headache Important Points Administered orally. Insert Dari

54. AFAMS C11 Lipid Modifying Agents (Insert Dari)

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56. Statins (Insert Dari) Atorvastatin Rosuvastatin Mechanism of Action Prevents the body from producing cholesterol. Indications (Uses) It is used to lower cholesterol. It is used to prevent heart attacks and slow the progression of heart disease. Insert Dari

57. AFAMS Statins (Insert Dari) Side Effects Rare but can occur Abnormal muscle pain (patient should see a physician immediately and stop taking the medication). Liver problems, pain in the right abdomen and dark urine (should also see a physician immediately. More common Tiredness Important Points Significant drug interactions do exist. Insert Dari

58. AFAMS Fibrates (Insert Dari) Mechanism of Action Helps to lower cholesterol in the body. Indications Is used to treat high cholesterol. Side Effects Abnormal muscle pain. Feelings tired or weak. Upset stomach. Headache. Important Points Can be taken in combination with a statin. Insert Dari

59. AFAMS Questions? (Insert Dari)

60. AFAMS In-class Assignment (Insert Dari) This assignment will consist of 5 questions which are to be completed individually. Once complete the instructor will review the answers with the class. Insert Dari

61. AFAMS 1. Match the following drugs with their class (Insert Dari) A)Digoxin B)Amiodarone C)Milrinone D)Dopamine 1)Antiarrythmic 2)Adrengeric/Dopaminergic Agent 3)Phosphodiesterase Inhibitor 4)Cardiac Glycoside Insert Dari

62. AFAMS 1. Answer: Match the following drugs with their class (Insert Dari) A)Digoxin (4) Cardiac Glycoside B)Amiodarone (1) Antiarrythmic C)Milrinone (3) Phosphodiesterase Inhibitor D)Dopamine (2) Adrenergic/Dopaminergic Agent Insert Dari

63. AFAMS 2. Which of the following drugs can cause a patient to see yellow or green halos? (Insert Dari) A)Amiodarone B)Digoxin C)Epinephrine D)Milrinone Insert Dari

64. AFAMS 2. Answer: Which of the following drugs can cause a patient to see yellow or green halos? (Insert Dari) A)Amiodarone B)Digoxin C)Epinephrine D)Milrinone Insert Dari

65. AFAMS 3. Match the following drugs with their mechanism of action? (Insert Dari) A)Metoprolol B)Hydrochlorothiazide C)Verapamil D)Ramipril (1)Decreases the amount of work the heart has to do (slows the heart rate) and decreases blood pressure. (2)Causes vasodilatation of the peripheral and coronary arteries. (3)Causes the kidneys to release more water through the urine, thus decreasing blood volume and decreasing blood pressure. (4)Block production of the hormone, angiotensin II, a compound in the blood that causes narrowing of blood vessels and increases blood pressure. Insert Dari

66. AFAMS 3. Answer: Match the following drugs with their mechanism of action? (Insert Dari) (A) Metoprolol - (1) Decreases the amount of work the heart has to do (slows the heart rate) and decreases blood pressure. (C) Verapamil - (2) Causes vasodilatation of the peripheral and coronary arteries. (B) Hydrochlorothiazide - (1) Causes the kidneys to release more water through the urine, thus decreasing blood volume and decreasing blood pressure. (D) Ramipril (4) Block production of the hormone, angiotensin II, a compound in the blood that causes narrowing of blood vessels and increases blood pressure. Insert Dari

67. AFAMS 4. Which of the following drugs is generally used to relieve chest pain? (Insert Dari) A)Epinephrine B)Nitroglycerin C)Hydrochlorothiazide D)Metoprolol Insert Dari

68. AFAMS 4. Answer: Which of the following drugs is generally used to relieve chest pain? (Insert Dari) A)Epinephrine B)Nitroglycerin C)Hydrochlorothiazide D)Metoprolol Insert Dari

69. AFAMS 5. Which of the following is NOT a side effect of a statin? (Insert Dari) A)Abnormal muscle pain B)Liver complications C)Tiredness D)Persistent cough Insert Dari

70. AFAMS 5. Answer: Which of the following is NOT a side effect of a statin? (Insert Dari) A)Abnormal muscle pain B)Liver complications C)Tiredness D)Persistent cough Insert Dari