Transcript Document

Week 5
Cardiovascular and
Respiratory Systems
Chapters 26 and 27:
HS140 – Pharmacology
Cardiovascular Disorders
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Functions of Circulatory System
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Composed of heart (pump) and blood vessels
Delivers oxygen, nutrients, hormones etc to
various cells throughout the body
Removal of waste products
Pulmonary Circulation filter blood through lungs to
drop off CO2 and pick up O2
Systemic Circulation delivers fresh (oxygenated) blood
to all tissues except heart/lungs
Coronary Circulation provides fresh blood to
myocardium
Diseases of the Heart & Vessels
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Coronary Artery Disease (CAD)decreased blood
flow through coronary arteries from …
 Atherosclerosishardening/narrowing of blood
vessels
 Statins are especially useful
Anginaspasms of the cardiac muscle as a result of
ischemia (oxygen deprivation)
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Nitrates are pivotal in treatment
Myocardial Infarction (MI, heart attack) heart is
deprived of blood supply and tissues become necrotic
Hypertension (increased blood pressure) >140/90;
>120/80 = pre-hypertension
 Dangerous: increased blood flow damages the artery
walls and more likely for plaque formation to occur
CHF
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Congestive Heart Failure heart muscle is
weak and cannot pump sufficient volume of
blood – ‘pooling’
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Drug combination most often used is: Digoxin and
Lasix (furosemide)
Digoxin is a positive ionotrope-increasing strength
of contraction of heart
Lasix is a diuretic that causes ‘elimination’ of
excess body fluid, reducing edema(swelling)
Drugs in treatment of
CV diseases
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Diuretics for HTN
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Inhibit sodium chloride reabsorption to excrete more
H2O
May lead to decreased K+ levels (hypokalemia)
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Lasix®-furosemideloop diuretic-most potent
Hydrodiuril®-hydrochlorothiazide (hctz) commonly used
Aldactone®-spironolactonepotassium sparing
Many combinations with HCTZ, ex:Hyzaar®= Losartan/HCTZ
Patient counseling points: take diuretics in
morning (otherwise pee all night long), sip water
or chew gum to relieve dry mouth, avoid
sunlight with loops or thiazides
Nitrates for Angina
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Oldest, most used for angina attack to relieve
intense pain via Sublingual route (SL)= under
tongue
Dilate systemic blood vessels to reduce cardiac
work and oxygen consumption
Work by relaxing smoothe blood vessel walls
Isosorbide mononitrate/dinitrate-differ in duration
of action, and are swallowed (PO)
SE’s: headache, tachycardia, lightheadedness,
dizziness, hypotension
Nitroglycerin (NTG)
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Sublingual NTG: acute anginal attacks (dosing)
 1 tab SL at onset of pain; may repeat 1 tab every 5
minutes for 2 doses. If pain persists, pt to seek
medical attention
 NTG unstable, should be kept original bottle (dark,
tightly closed vial); expiration date is 6 months from
bottle opening
Transdermal NTG: available as a patch that slowly
releases NTG through the skin
 Applied to hairless area of skin; rotated daily
 Do not keep on longer than 12 hours !!
NTG spray-good for those with poor dexterity
Beta blockers for HTN, angina
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Block sympathetic output and decrease
oxygen use
Decrease heart rate, force of contraction, and
blood pressure
Examples: (olol’s)
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Inderal®-propranolol
Tenormin®-atenolol
Toprol XL®-metoprolol succinate
Lopressor®-metoprolol tartrate
SE’s: tachycardia, dizziness, bronchospasm, beware
hide symptoms of hypoglycemia in DM pts
ACE Inhibitors & ARB’s
for HTN, CHF
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Inhibit the renin-angiotensin-aldosterone system
from causing vasoconstriction
Treat CHF, severe HTN result in renal and
systemic vasodilation
ARB (angiotensin-2 receptor blockers) “sartans” ie.
Cozaar®=losartan
ACE I’s (angiotensin-converting-enzyme inhib) “prils”
ie. Zestril®=prinivil; Altace®=ramipril
SE’s: “ace” cough,hyperkalemia, angio-edema
Calcium Channel Blockers
for HTN, angina
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Interfere with influx of calcium in vascular and
smooth muscle
Reduce ability of vessels to constrict – result
is decreased blood pressure
Calan®=verapamil
Cardizem®=diltiazem
Plendil®=felodipine
SE’s: edema, headache, reflex tachycardia
Hyperlipidemia
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We all need cholesterol and triglycerides (fats) to
form cell membrane and nervous tissue!
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Excessive lipids in circulation leads to hyperlipidemia
and potential for artherosclerosis (plaques which
accumulate and harden the artery walls)
HDL(‘good cholesterol’) - high density lipoproteins carry
cholesterol out of blood stream and into liver for storage;
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GOAL >35
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LDL(‘bad’ cholesterol) low density lipoproteins
carry cholesterol from the liver to the blood stream
GOAL <130
HMG-CoA reductase inhibitors
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aka “STATIN’s” ex: Lipitor (atorvastatin) Zocor
(simvastatin) Crestor (resuvastatin)
Most effective agents to lower TOTAL cholesterol
and LDL levels
Must be continued for life to reduce the progression
of Coronary Artery Disease (CAD)
Major side effect: rhabdomyolysis (muscle
breakdown, symptom is muscle-aches)
Other SE’s: Headache, cramping
Bile Acid Sequestrants
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Non-absorbable drugs bind bile acids in the GIT
to form insoluble complexes that are excreted in
feces
Not commonly used since Statins arrived
Can decrease LDL and total cholesterol
Beware using in pts with gallstones,
hemorrhoids, and vitamin A, D, E, K
Ex: cholestyramine, colestipol
SE’s: constipation, n/v, dizziness
Important Facts about
Hypolipemics
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Diet modification is the PRIMARY method for
reducing LDL & cholesterol levels
Statins are the most effective drugs for
lowering LDL & total cholesterol
Bile-acid-binding resins prevent reabsorption
of bile acids in the intestines
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Cholestyramine powder must be mixed with 8ox
of water prior to administering
Coagulation
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Blood clot formation is necessary to prevent
excessive blood loss (wounds, surgery)
Platelet plugs followed by coagulation results
in hemostasis (stoppage of blood flow)
Thromboembolism occurs if blood clot or
undissolved matter forms in blood vessel,
blocking blood flow
Common Anticoagulants
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Heparin – immediate action, short duration
 Administered parenterally
Warfarin (Coumadin) – delayed onset
 Administered orally
 Used prophylactically to prevent deep vein thrombosis
or thrombus formation in Atrial Fib
BEWARE! monitor pt for bruising, bloody stools,
bleeding gums
Coumadin has lots of drug-interactions... PT/INR
levels must be monitored closely!
Other drugs
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Antiplatelet drugs: suppress clumping of
platelets in arteries
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Thrombolytics: dissolve clots already
formed
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Ex: aspirin, Plavix®
Activase(alteplase), Streptase(streptokinase)
Topical hemostatics: gelatin or cellulose
sponges that absorb excess blood and fluids
Coagulation - Key Points
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Hemostasis occurs with the formation of the platelet
plug, followed by coagulation.
Anticoagulants help prevent venous thrombi;
antiplatelet drugs help prevent arterial thrombi
Heparin is adminstered intramuscularly or deep
subcutaneously
Warfarin is the prototype for oral anticoagulants
Respiratory System/Disorders
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Respiratory Tract – Upper/Middle/Lower
- carries Oxygen to, and …
- removes Carbon Dioxide from, the lungs
Any change in the Resp.System will affect all
body systems, therefore … before treating
other problems, this oxygen-carbon dioxide
exchange system must be corrected!
See diagrams on page-525 of your textbook
Upper Resp Tract Conditions
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Allergic Rhinitis – caused by histamine release
Symptoms include: *sneezing,*runny nose,
*itching, and *congestion
Histamine protects us from environment!
Greatest concentration of Histamine found in
*skin,*GI tract, and the *lungs – those organs
most exposed to potenially damaging
elements around us
Drugs for Nasal Congestion(1)
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Antihistamines – notice … ‘anti-Histamine’
these block the H1 receptor sites, preventing
histamine’s action
1st Generation: -- sedating, short acting
examples -chlorpheniramine (ChlorTrimeton)
-diphenhydramine (Benadryl)
2nd Generation: -less, or NON-sedating, and
much longer duration of action (Claritin, Zyrtec)
Drugs for Nasal Congestion(2)
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Decongestants: reduce congestion by shrinking
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swollen mucous membranes of the nasal passage
Often combined with AntiHistamines
Oral and Nasal preparations are both available
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Phenylephrine – most widely used, less
elevation of blood pressure, no METH link!
Pseudoephedrine(e.g.,Sudafed) – stimulates the
CNS causing elevated BP, insomnia, agitation
… used in Crystal-Meth production!
Drugs for Nasal Congestion(3)
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Nasal Decongestant Sprays/Drops (topical)
examples: Afrin, NeoSynephrine
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Important Patient Warning and Info: Use exactly as directed on
package (usually q12h), DO NOT USE more than 3-5 consecutive
days … why? “Rebound Congestion”, makes these habit-forming!
Tolerance occurs rapidly, resulting in patients using larger and
larger doses to get the same level of symptom-relief
Topical Decongestants act much faster than Oral Decongestants,
but Oral agents do not cause Rebound Congestion!
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Glucocorticoids (steroids)
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Nasal Glucocorticoids (Flonase, Nasacort)
Most effective meds for prolonged seasonal
or year-round allergic rhinitis
Excellent relief of symptoms such as:
*congestion, *runny nose, *sneezing, *itching
Interesting Drug! –NOT a STEROIDCromolynSodium (Nasalcrom) – actually
prevents the release of Histamine – unique!
Drugs for Cough (antitussives)
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Productive Cough – should not be suppressed!
–the act of coughing serves important function
… the clearing of mucous from the airway
Dry, Hacking, ‘Tickling’ Cough – o.k. to suppress
–usually deprives patient of sleep, can cause
discomfort if not treated
OPIOID(syrups): elevate the cough ‘threshold’ –may
be habit-forming (codeine,hydrocodone)
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nonOPIOID’s: less GI side-effects, NOT habit forming
Other Agents for cough …
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Cough suppressant Tessalon(benzonatate)
-a local anesthetic, relieves cough by
numbing the cough receptors (gag reflex)
AntiHistamines(again!) – reduces the
drainage of nasal secretions, which many
times is the cause of the ‘Tickly’ cough!
Lower Respiratory Tract
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The Bronchial Tree and the Lungs
Pneumonia
Thick Mucous Secretion(sputum)
COPD (Chronic Obstructive Pulmonary Disease) …
Asthma
Emphysema
Chronic Bronchitis
EXPECTORANTS required to thin and mobilize sputum