Transcript Nursing Care Everything an LPN/LVN Needs to Know and Do

Focus on
Pharmacology
Essentials for Health
Professionals
Jahangir Moini, MD, MPH
Chapter 18, 19 & 20
Effects of Drugs on the
Cardiovascular & Vascular System
and Anticoagulants
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Cardiac Drugs
• Broadly classified according to effects on
heart:
– Rate of heartbeat
– Rhythm of heartbeat
– Amount of blood output
– Strength of contraction
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Heart
Muscular pump with three layers:
– Endocardium (thin inner lining)
– Myocardium (heart muscle)
– Epicardium: (thin outer lining)
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 18-1
Anatomy of the heart.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 18-2
Electrical conduction system of the heart.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nitroglycerin (Nitrostat):
Uses
• Dilates blood vessels in vascular smooth
muscles to decrease cardiac oxygen
demand; also relaxes spasms of variant
angina
• Used to treat stable and variant angina
• Most effective, inexspensive & fast acting
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nitroglycerin (Nitrostat):
How it works:
• Directly affects vascular smooth muscle to dilate blood vessels
•Administered a variety of routes:
•Sublingual: effective rapidly, last about 1 hour, ideal for acute
anginal pain, if one does is not effective can take 1-2 additional
doses in 5 minute intervals, bottle should not be opened unless it is
needed (light decreases shelf life)
•Transdermal: patch applied once a day to a hairless site, patches
should be rotated daily to prevent irritation, worn for no more than
10-12 hours
•Topical Ointment: must be measures on a paper provided with
drug to ensure proper dosage
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nitroglycerin:
Adverse Effects
• Headache
• Hypotension
• Tachycardia
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nitroglycerin:
Contraindications
• Hypertrophic cardiomyopathy (heart
muscle (myocardium) becomes abnormally
thick), pronounced hypovolemia (decrease
in volume of circulating blood), MI, raised
intracranial pressure, and cardiac
tamponade (compression of the heart that
occurs when blood or fluid builds up)
• Contraindicated in pregnancy and
lactation
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nitroglycerin:
Patient Information
• Advise patients to avoid carrying
nitroglycerin close to body and to store in
cool, dark place.
• Advise patients to avoid alcohol.
• Instruct patients to seek emergency
medical attention if pain continues after
3 tablets.
• Discard unused tablets after 6 months.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Beta-Adrenergic Blockers
• Beta-blockers (propranolol, atenolol)
reduce heart’s oxygen demand by
decreasing heart rate
• Prevent development of myocardial
ischemia and pain
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Calcium Channel Blockers
• Interfere with movement of calcium ions
through cell membranes
• Can affect heart or peripheral vasculature
• Used to treat pain of angina and to lower
blood pressure
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Myocardial Infarction
• Caused by severe , prolonged lack of
oxygen, which kills an area of heart muscle
• Leading cause of death in industrialized
nations
• CAD, clot formation in the coronary artery,
spasm of arteries, heavy exertion, abrupt
increase in blood pressure can all cause MI
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Therapeutic Agents for MI
•
•
•
•
•
•
Goal is to limit damage to myocardium
IV fluids
Nitroglycerin
Aspirin and thrombolytic drugs
Morphine sulfate
Beta-blockers and calcium channel
blockers
• Oxygen
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Dysrhythmias
•Can occur from heart
disease of chronic drug
therapy
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Quinidine (Quinidex): Uses
• Depresses myocardium and conduction
system to decrease contractile force of
heart and slow heart rate
• Used to treat atrial fibrillation and flutter
and ventricular tachycardia
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Quinidine: Adverse Effects
• Common: diarrhea, flatulence, abdominal
pain, fever, reduced platelet, liver
function abnormalities
• Serious: sudden ventricular fibrillation
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Quinidine: Contraindications
• Contraindicated in pregnancy, lactation,
bacterial endocarditis, myasthenia gravis
• Interacts with digoxin, amiodarone,
verapamil
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Quinidine: Patient Information
• Instruct patients to immediately report
chest pain or a change in heart rhythm
• Advise patients to take with food and to
report diarrhea to health-care provider.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Propranolol (Inderal): Uses
• Affects beta receptors to slow heart rate
and lower blood pressure
• Used to treat tachycardia, hypertension,
angina, and to prevent MI
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Propranolol: Adverse Effects
• Hypotension and bradycardia
• Diminished sex drive
• Impotence
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Propranolol: Contraindications
• Contraindicated in bronchial asthma,
severe chronic obstructive airway
disease, allergic rhinitis, pregnancy
• Interacts with Catapres, Tagamet,
epinephrine, insulin
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Propranolol:
Patient Information
• Warn patients not to discontinue abruptly.
• Tell patients to monitor pulse and report
a rate less than 60 bpm.
• Advise patients to rise slowly from a lying
or sitting position to avoid dizziness.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Amiodarone: Uses
• Blocks potassium and sodium ion
channels to prolong heart’s resting stage
• Used to treat atrial dysrhythmias in
patients with heart failure
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Amiodarone:
Adverse Effects
• Common: dizziness, nausea, vomiting,
anorexia, bitter taste, weight loss,
numbness of fingers and toes
• Serious: pulmonary fibrosis (formation or
development of excess fibrous connective
tissue (fibrosis) in the lungs) with long-term
use
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Amiodarone:
Contraindications
• Contraindicated in severe liver disease,
pregnancy, severe sinus bradycardia,
and in children
• Interacts with many drugs including
digoxin and phenytoin
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Amiodarone:
Patient Information
• Advise patients to immediate report
shortness of breath, cough, change in
heart rate and rhythm, or vision changes.
• Advise patients to protect skin and eyes
from sun.
• Instruct patients to change positions
slowly to avoid dizziness.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Verapamil (Calan, Isoptin):
Uses
• Acts primarily on AV node to slow
conduction, causing depression of
myocardial contractibility and dilation of
coronary arteries
• Used to stabilize dysrhythmias and to
treat angina and hypertension
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Verapamil:
Adverse Effects
•
•
•
•
•
•
•
•
Dizziness or vertigo
Emotional depression
Sleepiness
Headache
Peripheral edema
Hypotension
Nausea
Constipation
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Verapamil:
Contraindications
• Contraindicated in patients with
hypotension and CHF and in pregnancy
and lactation
• Interacts with lithium, cyclosporine,
digoxin, calcium salts
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Verapamil:
Patient Information
• Instruct patients to monitor blood
pressure and report if less than
90/60 mm Hg.
• Advise patients to report breathing
difficulty or change in heart rhythm.
• Instruct patients to take with food and to
increase fiber intake.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Vascular System
•
•
•
•
Arterial pressure
Capillary pressure
Venous pressure
Blood pressure (BP): created by pumping
action of heart; in arteries, BP rises
during ventricular systole and falls during
ventricular diastole
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Factors That Affect BP
• Cardiac output: volume of blood pumped
per minute (determined by heart rate and
stroke volume—amount of blood pumped
by ventricle in one contraction)
• Peripheral resistance: friction in arteries
as blood flows through
• Blood volume: amount of blood in
vascular system
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Hypertension
• Primary: 90% of cases
• Hypertensive crisis: severe elevation in
BP
• Major cause of CVA (stroke)
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Antihypertensive Agents
• Diuretics: reduce blood volume
• Beta-blockers: slow heart rate and dilate
vessels
• Vasodilators: dilate vessels
• Calcium channel blockers: slow heart rate,
reduce conduction irritability, dilate vessels
• ACE inhibitors: vasodilate and increase renal
blood flow
• Angiotensin-receptor blockers (ARBs): block
vasoconstriction
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Alpha- and Beta-Blockers:
Uses
• Used to treat mild, moderate, and severe
hypertension
• Used alone or in combination with other
antihypertensive agents, especially
diuretics
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Alpha- and Beta-Blockers:
Adverse Effects
• Postural hypotension (Low blood pressure
on standing up, AKA -orthostatic hypotension)
• Dizziness or vertigo
• Headache
• Bronchospasm (spasmodic contraction of the
smooth muscle of the bronchi, as in asthma.)
• Dyspnea
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Alpha- and Beta-Blockers:
Contraindications
• Contraindicated in bronchial asthma,
uncontrolled cardiac failure, severe
bradycardia
• Safe use during pregnancy and lactation,
or in children not established
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Alpha- and Beta-Blockers:
Patient Information
Advise patients to change positions
slowly to avoid dizziness and to avoid
driving or hazardous activities until
response to drug is known.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Alpha- and Beta-Blockers
Use in Older Adults
• Older adults are especially sensitive to
hypotensive effects of these drugs
• Warn patients to avoid hazardous
activities
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Centrally Acting
Adrenergic Blockers: Uses
• Work by reducing hyperactivity in
medulla oblongata in brain to reduce
vascular resistance and cardiac output
• Used to manage hypertension and
usually combined with diuretics
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Centrally Acting Adrenergic
Blockers: Adverse Effects
•
•
•
•
•
•
Drowsiness or sedation
Headache
Nightmares
Anxiety
Hypotension
Congestive heart failure
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Centrally Acting Adrenergic
Blockers: Contraindications
• Contraindicated in pregnancy, lactation,
hepatitis, cirrhosis, blood dyscrasias
• Use cautiously in kidney disease, angina,
and a history of mental depression
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Centrally Acting Adrenergic
Blockers: Patient Information
• Advise patients to avoid hazardous activities
until response to drug is known
• Instruct patients to check with physician
before taking OTC medications.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Peripherally Acting
Adrenergic Blockers: Uses
• Inhibit norepinephrine release to reduce
vascular tone (relating to, or containing blood
vessels) in veins and arteries
• Used for severe hypertension or as
adjunctive therapy in severe
hypertension
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Peripherally Acting Adrenergic
Blockers: Adverse Effects
•
•
•
•
•
•
•
•
Drowsiness
Fatigue
Headache
Confusion
Palpitation
Dry mouth
Dyspnea
Nausea and vomiting
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Peripherally Acting Adrenergic
Blockers: Contraindications
• Contraindications include mental
depression, acute peptic ulcer, and
ulcerative colitis (a type of inflammatory
bowel disease)
• Use cautiously in diabetes mellitus,
impaired renal or hepatic function,
coronary disease, recent MI.
• Interact with alcohol, norepinephrine, and
antidepressants
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Peripherally Acting Adrenergic
Blockers: Patient Information
• Advise patients to change positions
carefully and slowly to avoid dizziness.
• Instruct patients to take at same time
each day.
• Advise patients to check with their
physician before taking OTC drugs.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
ACE inhibitors: Uses
• Decrease formation of angiotensin II,
which lowers blood volume and BP
• Used to treat severe hypertension and
CHF; drug of choice for primary
hypertension
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
ACE Inhibitors:
Adverse Effects
•
•
•
•
Loss of taste
Photosensitivity
Severe hypotension
Hyperkalemia (a condition caused by abnormally
high levels of potassium in the blood)
•
•
•
•
Renal impairment
Blood dyscrasias (A diseased state of the blood)
Dizziness
Angioedema
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
ACE Inhibitors:
Contraindications
• Contraindicated in angioedema, CHF,
pregnancy and lactation, renal
impairment, scleroderma, lupus,
hypovolemia (a state of decreased blood
volume)
• Interact with potassium-sparing diuretics,
aspirin and NSAIDs, lithium
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
ACE Inhibitors:
Patient Information
• Instruct patients to report vomiting or
diarrhea and to check with physician
before taking OTC drugs.
• Advise patients to inform surgeons or
dentists of ACE inhibitor use.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
ACE Inhibitors and Diabetes
• ACE inhibitors can produce
hypoglycemia in diabetic patients.
• Advise patients to monitor blood glucose
levels during first few weeks of ACE
inhibitor therapy.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
ARBs: Uses
• Inhibit binding of angiotensin II to
angiotensin I receptor in vascular smooth
muscle, thereby blocking
vasoconstriction and aldosterone
secretion
• Used to manage hypertension and treat
CHF
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
ARBs: Adverse Effects
Common: similar to those of ACE
inhibitors
•
•
•
•
•
•
•
•
Loss of taste
Photosensitivity
Severe hypotension
Hyperkalemia (a condition caused by abnormally high levels of potassium in the
blood)
Renal impairment
Blood dyscrasias (A diseased state of the blood)
Dizziness
Angioedema
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
ARBs: Contraindications
• Contraindicated in bilateral artery stenosis,
cardiac failure, pregnancy, lactation
• Use cautiously in asthma, COPD, peripheral
vascular disease, diabetes, hyperthyroidism,
renal and hepatic insufficiency
• Interact with amiodarone and beta-blockers
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
ARBs: Patient Information
• Advise patients to report dizziness.
• Advise female patients to immediately
report pregnancy and to avoid
breastfeeding.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Vasodilators:
Uses
• Produce direct relaxation of vascular
smooth muscle, resulting in vasodilation
• Used with beta-blockers and diuretics to
treat hypertension
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Vasodilators:
Adverse Effects
•
•
•
•
Headache
Dizziness
Tachycardia
Nausea and vomiting
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Vasodilators:
Contraindications
• Use of corlopam and beta-blockers is
contraindicated.
• Use of hydralazine is contraindicated in
CAD, mitral valvular rheumatic heart
disease, and MI.
• Use cautiously in CVA (stroke), renal
impairment, CAD
• Interact with epinephrine, norepinephrine
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Congestive Heart Failure (CHF)
• Heart pumps at insufficient rate
• Kidneys retain sodium and water
• Fluid accumulates in interstitial space
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Cardiac Glycosides:
Uses
• Work by increasing cell calcium
concentration to enhance contractility of
cardiac muscle
• Include cardiac glycosides and betaadrenergic agonists
• Used to relieve CHF symptoms; do not
reverse CHF
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Cardiac Glycosides:
Adverse Effects
•
•
•
•
•
•
•
•
Fatigue
Muscle weakness
Headache
Mental depression
Visual disturbances
Anorexia
Nausea and vomiting
Diarrhea
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Cardiac Glycosides:
Contraindications
• Contraindicated in ventricular fibrillation,
ventricular tachycardia
• Use cautiously in renal insufficiency,
advanced heart disease, acute MI,
hypothyroidism, pregnancy, lactation,
and in older adults
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Cardiac Glycosides:
Patient Information
• Advise patients to report any of the
following:
– Anorexia
– Nausea and vomiting
– Diarrhea
– Visual disturbances (which may be signs of
toxicity)
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Digoxin and Foxglove
• Digoxin is derived from foxglove, a purple
flowering plant
• Oleander and lily of the valley also have
cardiac glycoside properties
• Patient must not take digoxin along with
oleander or lily of the valley
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Other Agents for CHF
• Beta-agonists: improve cardiac
performance vasodilation
• Phosphodiesterase inhibitors (amrinone
and Primacor): increase force of heart
contraction and cause vasodilation
• Diuretics: relieve pulmonary congestion
and peripheral edema by decreasing
plasma volume
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Hyperlipidemia
•
•
•
•
•
High-density lipoproteins (HDL)
Low-density lipoproteins (LDL)
Very-low-density lipoproteins (VLDL)
Triglycerides (TG)
Hypercholesterolemia: several types
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Bile Acid Sequestrants:
Uses
• Increase binding of cholesterol to bile
acids that are excreted in feces; lowers
levels of circulating LDL and cholesterol
• Used to treat primary hyperlipidemias
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Bile Acid Sequestrants:
Adverse Effects
•
•
•
•
Constipation
Nausea
Flatulence
Impaired absorption of fat-soluble
vitamins
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Bile Acid Sequestrants:
Contraindications
• Contraindicated in bowel obstruction,
dysphagia, swallowing disorders, major
GI tract surgery
• Safety in pregnancy and lactation or in
children not known
• Interact with intestinal absorption of many
drugs
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Bile Acid Sequestrants:
Patient Information
• Advise patients to report severe gastric
distress
• Inform patients to increase fluid intake to
avoid constipation.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Statins: Uses
• Reduce LDL and total triglyceride
production
• Used to treat hyperlipidemia
• Often given with other antihyperlipidemic
drugs
• Zocor, Lescol, Pravachol
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Statins: Adverse Effects
• Common: abdominal pain, flatulence,
constipation, dyspepsia, headache,
cramping
• Serious: rhabdomyolysis (the breakdown of
muscle fibers that leads to the release of
muscle fiber contents (myoglobin) into the
bloodstream)
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Statins: Contraindications
• Contraindicated in myopathy (muscular disease
in which the muscle fibers do not function for any one of many
reasons, resulting in muscular weakness), active
liver
disease, or during pregnancy and
lactation
• Interact with digoxin,ethinyl estradiol (an
oral contraceptive)
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Statins: Patient Information
• Instruct patients to follow dosing
instructions of physician.
• Advise patients to report muscle
tenderness or pain, especially if
accompanied by fever or malaise.
• Advise patients to avoid alcohol.
• Warn female patients to avoid if pregnant
or lactating.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Grapefruit and Statins
Advise patients to avoid
grapefruit/grapefruit juice when taking
simvastatin. Regular consumption of the
fruit or the juice can lead to higher levels
of the drug in the blood.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Statins in Children
• The safety of statins in children and
adolescents is not established
• These drugs should not be prescribed for
this age group
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nicotinic Acid:
Uses
• Appears to reduce levels of VLDL, LDL,
and total cholesterol
• Used as adjuvant treatment of
hypercholesterolemia in patient who do
not respond to diet or weight loss
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nicotinic Acid:
Adverse Effects
• Common: cutaneous flush, pruritus,
nausea and abdominal pain, syncope
(fainting), nervousness, blurred vision
• Serious: hepatotoxicity
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nicotinic Acid:
Contraindications
• Avoid in hepatic impairment, severe
hypotension, active peptic ulcer,
pregnancy, lactation, and in children
younger than 16
• Use cautiously in patients with history of
gallbladder disease, liver disease, peptic
ulcer, glaucoma, CAD, and diabetes.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nicotinic Acid:
Patient Information
• Warn patients of cutaneous flush
(reddness of the skin) that may occur
within 2 hours of oral ingestion and last
for several hours
• Relief can be obtained by reducing the
dosage and then increasing dose in small
increments over time
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Fibric Acid Derivatives:
Uses
• Block lipolysis of stored triglycerides in
adipose tissues and inhibit liver uptake of
fatty acids
• Used to treat hypertriglyceridemia and
severe familial hypercholesterolemia
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Fibric Acid Derivatives:
Adverse Effects
• Common: GI disturbances, dizziness,
blurred vision
• Serious: cancer
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Fibric Acid Derivatives:
Contraindications
• Contraindicated in gallbladder disease,
biliary cirrhosis, hepatic or severe renal
dysfunction, and during pregnancy and
lactation
• Safe use in children younger than 18 not
established
• May increase hypoprothrombinemic
effects of anticoagulants
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Fibric Acid Derivatives:
Patient Information
• Instruct patients to report unexplained
bleeding, including:
– Easy bruising
– Epistaxis
– Hematuria.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Hemostasis:
Three Events After Injury
1.
Vascular spasms: Platelets release serotonin, which causes
blood vessel to spasm and decrease blood loss until clotting
occurs
2.
Platelet plug: Platelets become sticky and adhere to vessel lining
and each other, forming platelet plug, which is invaded by
clotting factors
3.
Coagulation: clot forms through chemical reactions that create
netlike structure of fibrin, sealing off opening in injured vessel
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Anticoagulants
• Medications that prolong bleeding time
• Do not dissolve clots already formed, but
may prevent clots from becoming larger
• Used to treat MI, venous thrombosis,
pulmonary emboli
• Primarily used for thrombosis in veins
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Heparin: Uses
• Works by increasing length of
coagulation; inhibits thrombi from forming
or growing larger
• Treat emboli, thrombi, MI, and to prevent
clotting during open-heart surgery,
coronary artery bypass graft, and dialysis
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Heparin: Adverse Effects
Hemorrhage in urinary or GI tracts,
subdural hematomas, hemorrhagic
pancreatitis, hemarthrosis (Bleeding into a
joint), ecchymosis (escape of blood into the
tissues from ruptured blood vessels)
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Heparin: Contraindications
• Contraindicated in serious and
intracranial bleeding, severe liver or
kidney disease, malignant hypertension
• Interacts with aspirin, NSAIDs,
anesthetics, valproic acid, thrombolytics,
and other drugs
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Heparin: Patient Information
• Teach patients how to administer heparin
subcutaneously.
• Advise patients to protect themselves
from injury (e.g., use electric shaver).
• Warn patients to avoid aspirin and other
OTC drugs.
• Instruct patients to report signs of
bleeding.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Heparin in Older Adults
• Older adults are more susceptible to
effects of anticoagulants. Signs of
overdose include epistaxis (nasal
bleding), blood in stool or urine,
excessive bruising, and prolonged
bleeding.
• Overdose can be treated by slow infusion
of 1% protamine sulfate.
Focus on Pharmacology, First Edition
By Jahangir Moini
Copyright ©2008 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.