focus on pharmacology essentials for health professionals chapter drugs used to treat cardiovascular...

Focus onFocus on

PHARMACOLOGYPHARMACOLOGYESSENTIALS FOR HEALTH PROFESSIONALS

CHAPTER

Drugs Used to Treat Cardiovascular Conditions

21

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Multimedia DirectoryMultimedia Directory

Slide 9 Angina VideoSlide 10 Coronary Artery Disease AnimationSlide 11 Coronary Artery Disease VideoSlide 23 Heart Attacks VideoSlide 26 Dysrythmias AnimationSlide 31 Mechanism of Action of Epinephrine VideoSlide 32 Mechanism of Action of Dopamine Animation

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Cardiac DrugsCardiac Drugs

• Broadly classified according to effects on heart:– Rate of heartbeat– Rhythm of heartbeat– Amount of blood output– Strength of contraction

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Cardiovascular SystemCardiovascular System

• Pulmonary circulation: picks up oxygen, discards carbon dioxide

• Systemic circulation (including coronary circulation): carries oxygen and nutrients to all active cells and transports wastes to kidneys, liver, and skin for excretion

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

HeartHeart

• Muscular pump with three layers:– Endocardium (thin inner lining)– Myocardium (heart muscle)– Epicardium (thin outer lining)

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Figure 21-1 Anatomy of the heart.

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Figure 21-2 Electrical conduction system of the heart.

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Coronary Heart Disease (CHD)Coronary Heart Disease (CHD)

• Ischemia: oxygen delivered to heart is insufficient to meet needs

• Coronary artery disease: atherosclerosis and arteriosclerosis

• Angina pectoris: episodic, reversible oxygen insufficiency– Classical, variant, unstable

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Angina VideoAngina Video

Click on the screenshot to view a video on the topic of angina.

Back to Directory

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Coronary Artery Disease AnimationCoronary Artery Disease Animation

Click on the screenshot to view an animation on the topic of coronary artery disease.

Back to Directory

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Coronary Artery Disease VideoCoronary Artery Disease Video

Click on the screenshot to view a video on the topic of coronary artery disease.

Back to Directory

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Table 21-1 Organonitrates and Other Anginal Medications

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Table 21-1 (continued) Organonitrates and Other Anginal Medications

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Nitroglycerin (Nitrostat): UsesNitroglycerin (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

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Nitroglycerin: Adverse EffectsNitroglycerin: Adverse Effects

• Headache• Hypotension• Tachycardia

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Nitroglycerin: ContraindicationsNitroglycerin: Contraindications

• Hypertrophic cardiomyopathy, pronounced hypovolemia, inferior MI, raised intracranial pressure, and cardiac tamponade

• Contraindicated in pregnancy and lactation

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Nitroglycerin: Nitroglycerin: Patient InformationPatient 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: Essentials for Health Professionals, Second EditionJahangir Moini

NitroglycerinNitroglycerin

• Nitroglycerin can cause severe hypotension.

• People should use nitroglycerin with caution if they:– Are taking diuretic medication– Have hypertension

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Other Anginal AgentsOther Anginal Agents

• Isosorbide dinitrate and isosorbide mononitrate: longer-acting antianginals

• Erythrityl tetranitrate: principal use is prophylaxis of angina in acute situations

• Pentaerythritol tetranitrate: long-acting organic nitrate for prophylaxis of angina, but not for acute attack

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Beta-Adrenergic BlockersBeta-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: Essentials for Health Professionals, Second EditionJahangir Moini

Calcium Channel BlockersCalcium 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: Essentials for Health Professionals, Second EditionJahangir Moini

Myocardial InfarctionMyocardial 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: Essentials for Health Professionals, Second EditionJahangir Moini

Heart Attacks VideoHeart Attacks Video

Click on the screenshot to view a video on the topic of heart attacks.

Back to Directory

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Therapeutic Agents for MITherapeutic 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: Essentials for Health Professionals, Second EditionJahangir Moini

Table 21-2 Various Dysrhythmias

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Dysrythmia AnimationDysrythmia Animation

Click on the screenshot to view an animation on the topic of dysrhythmia.

Back to Directory

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Table 21-3 Antidysrhythmic Medications

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Table 21-3 (continued) Antidysrhythmic Medications

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Table 21-3 (continued) Antidysrhythmic Medications

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Table 21-3 (continued) Antidysrhythmic Medications

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Mechanism of Action of Mechanism of Action of Epinephrine AnimationEpinephrine Animation

Click on the screenshot to view an animation showing the mechanism of action of epinephrine.

Back to Directory

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Mechanism of Action Mechanism of Action of Dopamine Animationof Dopamine Animation

Click on the screenshot to view an animation showing the mechanism of action of dopamine.

Back to Directory

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Quinidine (Quinidex): UsesQuinidine (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: Essentials for Health Professionals, Second EditionJahangir Moini

Quinidine: Adverse EffectsQuinidine: Adverse Effects

• Common: diarrhea, flatulence, abdominal pain, fever, reduced platelet, liver function abnormalities

• Serious: sudden ventricular fibrillation

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Quinidine: ContraindicationsQuinidine: Contraindications

• Contraindicated in pregnancy, lactation, bacterial endocarditis, myasthenia gravis

• Interacts with digoxin, amiodarone, verapamil

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Quinidine: Patient InformationQuinidine: 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: Essentials for Health Professionals, Second EditionJahangir Moini

Propranolol (Inderal): UsesPropranolol (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: Essentials for Health Professionals, Second EditionJahangir Moini

Propranolol: Adverse EffectsPropranolol: Adverse Effects

• Hypotension and bradycardia• Diminished sex drive• Impotence

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Propranolol: ContraindicationsPropranolol: Contraindications

• Contraindicated in bronchial asthma or bronchospasm, severe chronic obstructive airway disease, allergic rhinitis, pregnancy

• Interacts with clonidine, cimetidine, epinephrine, insulin

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Propranolol: Propranolol: Patient InformationPatient 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: Essentials for Health Professionals, Second EditionJahangir Moini

Amiodarone: UsesAmiodarone: 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: Essentials for Health Professionals, Second EditionJahangir Moini

Amiodarone: Amiodarone: Adverse EffectsAdverse Effects

• Common: dizziness, nausea, vomiting, anorexia, bitter taste, weight loss, numbness of fingers and toes

• Serious: pulmonary fibrosis with long-term use

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Amiodarone: ContraindicationsAmiodarone: Contraindications

• Contraindicated in severe liver disease, pregnancy, severe sinus bradycardia, and in children

• Interacts with many drugs including digoxin and phenytoin

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Amiodarone: Amiodarone: Patient InformationPatient 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: Essentials for Health Professionals, Second EditionJahangir Moini

Verapamil (Calan, Isoptin): UsesVerapamil (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: Essentials for Health Professionals, Second EditionJahangir Moini

Verapamil: Adverse EffectsVerapamil: Adverse Effects

• Dizziness or vertigo• Emotional depression• Sleepiness• Headache• Peripheral edema• Hypotension• Nausea• Constipation

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Verapamil: ContraindicationsVerapamil: Contraindications

• Contraindicated in patients with hypotension and CHF and in pregnancy and lactation

• Interacts with carbamazepine, lithium, cyclosporine, digoxin, calcium salts

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Verapamil: Patient InformationVerapamil: 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.