Transcript Document

Week 5
Respiratory and
Cardiovascular Systems
Chapters 26 and 27:
HS140 – Pharmacology
Includes information from: Christo Stevens, Pharm.D.
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 -______________________
-______________________
2nd Generation: -less, or NON-sedating, and
much longer duration of action
examples - ___________________________
- ___________________________
Drugs for Nasal Congestion(2)
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______________: 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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_______________ – most widely used, less
elevation of blood pressure, no METH link!
_______________ – 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: _________________
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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!
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Tolerance occurs rapidly, resulting in patients using larger and
larger doses to get the same level of symptom-relief
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Topical Decongestants act much faster than Oral Decongestants,
but Oral agents do not cause Rebound Congestion!
Glucocorticoids (steroids)
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Nasal Glucocorticoids
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Examples - ______________,
______________
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Most effective meds for prolonged seasonal or
year-round allergic rhinitis
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Excellent relief of symptoms such as: *congestion,
*runny nose, *sneezing, *itching
Interesting Drug! –NOT a STEROID_____________________ – actually prevents the
release of Histamine – unique!
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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
Examples: ________________________________,
________________________________
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nonOPIOID’s: less GI side-effects, NOT habit forming
Other Agents for cough …
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Cough suppressant ___________________
-a local anesthetic, relieves cough by
numbing the cough receptors (gag reflex)
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AntiHistamines(again!) – reduces the
drainage of nasal secretions, which many
times is the cause of the ‘Tickly’ cough!
Lower Respiratory Tract
The Bronchial Tree and the Lungs
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Pneumonia
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Thick Mucous Secretion(sputum)
Mucalytics/expectorants examples:
______________________________
______________________________
COPD (Chronic Obstructive
Pulmonary Disease)
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Asthma
Glucocorticoids examples:
______________________
______________________
Emphysema
Chronic Bronchitis
Bronchodilator examples:
__________________________
__________________________
Questions??
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
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
Antianginals
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Nitrate
_____________________
_____________________
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Beta-adrenergic Blockers
_____________________
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Calcium Channel Blockers
_____________________
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:
_______________ and ___________________
________________ is a positive ionotropeincreasing strength of contraction of heart
_________________ a diuretic that causes
‘elimination’ of excess body fluid, reducing
edema(swelling)
Cardiac Antidysrhythmics
(aka antiarrhythmics)
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Class II
____________________________
____________________________
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Class II
____________________________
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Class III
____________________________
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Class IV
____________________________
Drugs in treatment of
Hypertension
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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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________________loop diuretic-most potent
________________ commonly used
________________potassium sparing
Many combinations with 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
Adrenergic-inhibiting
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Beta Blockers
_________________________
_________________________
Alpha/Beta Blockers
_____________________________
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Centrally acting adrenergic blockers
_____________________________
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Peripherally acting adrenergic blockers
_____________________________
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Angiotensin II receptor antagonists
_____________________________
Additional HTN Medications:
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Angiotensin Converting Enzyme (ACE)
Inhibitors
_____________________________
_____________________________
_____________________________
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Vasodilators
_____________________________
_____________________________
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Calcium Channel Blockers
_____________________________
_____________________________
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” examples:
________________________
____________________________
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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
Example: _________________________
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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_______________ 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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________________ – immediate action, short duration
 Administered parenterally
________________ – 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
______________ 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
___________________________
___________________________
Questions??
Class Dismissed, Have an
awesome week!!
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