Transcript EO 003.01 - Part 19 - Cardiovascular Drugs

Cardiovascular Drugs
(Insert Dari)
EO 003.01 Part 19
AFAMS
Lesson Overview
(Insert Dari)
Insert Dari
Cardiac Therapy
• Cardiac Glycosides
• Antiarrythmics
• Cardiac Stimulants
- adrenergic and dopaminergic
agents
- phosphodiesterase inhibitors
• Vasodilators used in cardiac diseases
• Other cardiac drugs
AFAMS
Lesson Overview
(Insert Dari)
Insert Dari
Antihypertensives
Diuretics
Peripheral Vasodilators
Beta-blockers
Calcium Channel Blockers
Agents that Act on the ReninAngiotensin System
Lipid Modifying Agents
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
Insert Dari
For each of these medications/classes
students must obtain an understanding of:
(1) Mechanism of Action
(2) Indications (Uses)
(3) Efficacy
(4) Side Effects
AFAMS
AFAMS
AFAMS
AFAMS
AFAMS
C01 Cardiac Therapy
(Insert Dari)
AFAMS
AFAMS
Cardiac Glycosides: Digoxin
(Insert Dari)
Mechanism of Action
Allows the heart to contract
better.
Insert Dari
Indication
• It is used to help a weak heart.
• It is used to treat a fast
heartbeat.
Digitalis Purpura (foxglove)
(Insert Dari)
AFAMS
Cardiac Glycosides: Digoxin
(Insert Dari)
Side Effects
Insert Dari
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.
AFAMS
Cardiac Glycosides: Digoxin
(Insert Dari)
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.
Insert Dari
AFAMS
AFAMS
Antiarrythmics: Amiodarone
(Insert Dari)
Mechanism of Action
Decreases cardiac nerve stimulation,
which slows down the heart beat.
Insert Dari
Indications (Use)
Abnormal heart rhythm.
AFAMS
Antiarrythmics: Amiodarone
(Insert Dari)
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
Insert Dari
AFAMS
Antiarrythmics: Amiodarone
(Insert Dari)
Important Points
•Tell the patient to take the medication at
the same time each day.
•Can be taken with or without food.
Insert Dari
AFAMS
AFAMS
Adrenergic and Dopaminergic Agents
(Insert Dari)
Mechanism of Action
Insert Dari
Increased blood pressure and heart rate,
pupil dilation and bronchodilation.
Includes:
Epinephrine
Ephedrine
Norepinephrine
Dopamine
Dobutamine
These drugs are used to combat lifethreatening 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.
AFAMS
Adrenergic and Dopaminergic Agents
(Insert Dari)
Specific Indications
Insert Dari
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.
AFAMS
Adrenergic and Dopaminergic Agents
(Insert Dari)
Side Effects
•Dizziness
•Headache
•Excitable and Nervous
•A fast heartbeat
Important Points
•Administered intravenously.
AFAMS
AFAMS
Milrinone
(Insert Dari)
Mechanism of Action
Causes vasodilation of cardiac vessels
and increases the force of hearts
contractions.
Insert Dari
Indication
To help a weak heart.
Side Effects
•Headache.
•Low blood pressure.
AFAMS
AFAMS
Nitroglycerin Formulations
(Insert Dari)
Mechanism of Action
Vasodilator of vessels to the heart.
Insert Dari
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.
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.
Side Effects
Important Points
Chest pain or pressure lasting more
than 15 minutes. Get emergency
medical care right away
AFAMS
AFAMS
Adenosine
(Insert Dari)
Mechanism of Action
Restores normal heart rhythm.
Insert Dari
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.
AFAMS
C02 Anti-hypertensives
(Insert Dari)
AFAMS
AFAMS
Methyldopa
(Insert Dari)
Mechanism of Action
Increases the contractility of the heart
and causes vasodilation.
Insert Dari
Indications (Uses)
It is used to treat high blood pressure
Side Effects
•Dizziness
•Dry mouth
•Headache
•Feeling tired or weak
Important Points
Administered orally.
AFAMS
C03 Diuretics
(Insert Dari)
AFAMS
AFAMS
Diuretics
(Insert Dari)
Hydrochlorothiazide
Spironolactone
Furosemide
Insert Dari
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.
AFAMS
Diuretics
(Insert Dari)
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.
AFAMS
Diuretics
(Insert Dari)
Insert Dari
Important Points
•Spironolactone and Furosemide are
available in a combination product.
AFAMS
C04 Peripheral Vasodilators
(Insert Dari)
AFAMS
AFAMS
Hydergine
(Insert Dari)
Mechanism of Action
Dilates the cerebral and peripheral
vessels.
Insert Dari
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
AFAMS
C07 Beta blocking agents
(Insert Dari)
AFAMS
AFAMS
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).
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.
Insert Dari
Important Points
•Can be administered orally and
intravenously.
AFAMS
C07 Calcium Channel Blockers
(Insert Dari)
AFAMS
AFAMS
Calcium Channel Blockers
(Insert Dari)
Mechanism of Action
Causes vasodilatation of the peripheral
and coronary arteries.
Insert Dari
Indications (Use)
•It is used to treat chest pain or
pressure.
•It is used to treat high blood pressure.
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.
Insert Dari
Important Points
•Can be administered orally or
intravenously.
AFAMS
C10 Agents that act on the
Renin-Angiotensin System
(Insert Dari)
AFAMS
AFAMS
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.
Insert Dari
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.
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.
Insert Dari
Important Points
•Administered orally.
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.
Insert Dari
Indications (Use)
• It is used to treat high blood
pressure.
• It is used to protect kidney function
in diabetic patients who have protein
loss.
AFAMS
Angiotensin II Antagonists
(Insert Dari)
Side Effects
•Feeling light headed or dizzy
•May feel tired and weak
•Headache
Insert Dari
Important Points
Administered orally.
AFAMS
C11 Lipid Modifying Agents
(Insert Dari)
AFAMS
AFAMS
Statins
(Insert Dari)
•Atorvastatin
•Rosuvastatin
Insert Dari
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.
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
Insert Dari
Important Points
Significant drug interactions do exist.
AFAMS
Fibrates
(Insert Dari)
Mechanism of Action
Helps to lower cholesterol in the body.
Insert Dari
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.
AFAMS
Questions?
(Insert Dari)
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
AFAMS
1. Match the following drugs with their class
(Insert Dari)
A)Digoxin
B)Amiodarone
C)Milrinone
D)Dopamine
Insert Dari
1)Antiarrythmic
2)Adrengeric/Dopaminergic Agent
3)Phosphodiesterase Inhibitor
4)Cardiac Glycoside
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
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
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
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
AFAMS
3. Answer: Match the following drugs with
their mechanism of action?
(Insert Dari)
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.
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
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
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
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
AFAMS