Transcript Chapter 11 lesson 3 - ROP Pharmacology for Health Care

Understanding Pharmacology
for Health Professionals
FIFTH EDITION
CHAPTER
11
Cardiovascular Drugs
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Learning Objectives
1. When given the name of a well-known
cardiovascular generic drug, identify its
trade name.
2. When given the generic and trade names of
a cardiovascular drug, identify what drug
category it belongs to and what disease it is
used to treat.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Learning Objectives
3. When given a cardiovascular drug category,
identify several generic and trade name
drugs in that category.
4. When given an ending common to several
generic drugs, identify the related drug
category.
5. Define the Key Words and Phrases for this
chapter.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Congestive
Heart Failure
• Congestive heart failure (CHF)
 Occurs when the heart muscle is
weakened by:
• Disease
• Structural defect (leaky valve)
 Unable to adequately pump blood
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Congestive
Heart Failure
• Right-sided heart failure
 Causes backup of blood
• From the right ventricle into the venous
circulation
• Produces:
• Distended neck veins
• Liver enlargement
• Peripheral edema in the extremities
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Congestive
Heart Failure
• Left-sided heart failure
 Causes backup of blood
• From the left ventricle into the
pulmonary circulation
• Produces pulmonary edema in the lungs
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Congestive
Heart Failure
• Drugs used to treat CHF
 Help the heart
• Beat slower
• Contract more efficiently
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Congestive
Heart Failure
• Diuretic drugs for congestive heart
failure
 Help the body excrete the excess fluid
of edema in the urine
• Sodium
• Water
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Congestive
Heart Failure
• Digitalis drugs for congestive heart
failure
 Make the heart pump slower, more
strongly
 Also known as cardiac glycoside drugs
• Have a molecular structure that consists
of chains of glucose sugar known as
glycosides
• Used to treat the heart (cardiac)
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Congestive
Heart Failure
• Digitalis drugs for congestive heart
failure
 Digoxin (Digitek, Lanoxicaps, Lanoxin)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Figure 11–14 Digoxin. This pharmacy stock bottle of digoxin shows two equivalent
doses measured in the metric system: 125 mcg (0.125 mg). The handwritten black "X"
on the label tells the pharmacist that this stock bottle is already open and to us it to fill
the next patient's prescription for digoxin. Digoxin's well-known trade name is Lanoxin.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Figure 11–15 Foxglove plant. In the past, the dried leaves of the foxglove plant
were used to treat congestive heart failure. This plant has the Latin botanical name
Digitalis lanata because its flowers resemble digits or fingers. The original drug derived
from this plant was also called digitalis. The only drug remaining today in the digitalis
category is digoxin (Lanoxin). Physicians often use a slang term—dig (pronounced
"dij")—to refer to digoxin.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Digoxin Animation
Click on the screenshot to view an animation showing digoxin.
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Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
In Depth
• Digitalis drugs cause the release of
acetylcholine, a neurotransmitter that
depresses the SA node in the heart;
this slows the electrical conduction and
the heart rate.
• This action is known as a negative
chronotropic effect (Chron/o- means
time).
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
In Depth
• Digitalis drugs also inhibit the flow of
positive sodium ions into the cell;
instead, positive calcium ions flow in
and this results in a stronger, more
forceful contraction of the myocardial
cells.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
In Depth
• This action is known as a positive
inotropic effect (In/o- means [cardiac
muscle] fibers).
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
In Depth
• The negative chronotropic effect in
combination with the positive inotropic
effect allows the heart to pump more
slowly, to fill completely with blood
before the next contraction—an
important therapeutic effect for
patients with congestive heart failure—
and then to contract strongly.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• Digitalis toxicity is a serious adverse
effect.
• Nearly one-third of patients taking a
digitalis drug develop symptoms of
digitalis toxicity.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• This is because these drugs have a low
therapeutic index (i.e., there is a
narrow margin between the therapeutic
dose and the toxic dose) and a long
half-life, which is even more prolonged
in elderly patients with decreased
kidney function.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• Symptoms of toxicity include a pulse
rate below 60 beats per minute,
confusion, restlessness, nausea and
vomiting, diarrhea, hallucinations, or
seeing yellow-green halos around
lights.
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• To prevent toxic effects, physicians
periodically order blood tests to monitor
the drug level.
• These tests are often referred to as "dig
levels" (pronounced "dij").
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Focus on Health Care
• Symptoms of toxicity may be treated in
one of three ways:
 Decrease the dose of the digitalis drug
 Give the digitalis drug less frequently
 Or, in severe cases, administer an
antidote drug to reverse the toxic
effects of the digitalis drug.
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Congestive
Heart Failure
• Drugs for digitalis toxicity
 Digoxin immune Fab (Digibind, DigiFab)
• Antibody drug
• Given intravenously
• Binds with and activates digitalis in the
blood
• Forms an antibody-antigen complex that is
excreted in the urine
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Figure 11–16 The source of digoxin immune Fab. Digoxin immune Fab is obtained
from sheep that have been treated to produce antibodies against the molecular structure
of the drug digoxin. The word Fab in the generic drug name stands for fragment,
antibody binding. The trade names Digibind and DigiFab reflect the therapeutic effect of
binding as well as the structure of the drug (Fab). Source: Budimir Jevtic/Fotolia
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Congestive
Heart Failure
• ACE inhibitor drugs for congestive heart
failure
 Block the enzyme that converts
angiotensin I to angiotension II (a
vasoconstrictor)
• Cause vasodilation
• Decrease the blood pressure against
which the heart must pump
• Pulmonary vascular resistance
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Congestive
Heart Failure
• ACE inhibitor drugs for congestive heart
failure
 Block the enzyme that converts
angiotensin I to angiotension II (a
vasoconstrictor)
• Allows the heart to pump with less effort
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Congestive
Heart Failure
• Angiotensin II receptor blocker drugs
for congestive heart failure
 Block the action of angiotensin II
• Allows the smooth muscle in the blood
vessels to dilate
• Decreases blood pressure
• Allows the heart to pump with less effort
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Congestive
Heart Failure
• Angiotensin II receptor blocker drugs
for congestive heart failure
 Two drugs specifically indicated for CHF
• Candesartan (Atacand)
• Valsartan (Diovan)
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Congestive
Heart Failure
• Other drugs for congestive heart failure
 Metoprolol (Lopressor, Toprol)
• Shown to decrease hospitalizations and
deaths due to congestive heart failure
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Congestive
Heart Failure
• Other drugs for congestive heart failure
 Carvedilol (Coreg)
• In the smooth muscle of the blood
vessels, blocks both:
• Alpha receptors
• Beta1 and beta2 receptors
• Lowers the blood pressure against which
the heart must pump
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Congestive
Heart Failure
• Other drugs for congestive heart failure
 Eplerenon (Inspra)
• Aldosterone receptor inhibitor drug
• Blocks the action of aldosterone
• Lowers the pressure against which the
heart must pump
continued on next slide
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved
Drugs Used to Treat Congestive
Heart Failure
• Other drugs for congestive heart failure
 Nesiritide (Natrecor)
• Human B-type natriuretic peptide drug
• Binds to receptors on smooth muscle of
arteries and veins, causing dilation
• Decreases blood pressure and pressure
against which heart must pump
• Manufactured from E. coli using
recombinant DNA technology
Understanding Pharmacology for Health Professionals, 5th Ed.
Susan M. Turley
Copyright © 2016, 2010, 2003
by Pearson Education, Inc.
All Rights Reserved