Week 5 Cardiovascular and

Respiratory Systems

Chapters 26 and 27:

HS140 – Pharmacology

Cardiovascular Disorders

Functions of Circulatory System 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 Coronary Artery Disease (CAD)decreased blood flow

through coronary arteries from … Atherosclerosishardening/narrowing of blood vessels Statins are especially useful

Anginaspasms of the cardiac muscle as a result of ischemia (oxygen deprivation) 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

CHF

Congestive Heart Failure heart muscle is weak and cannot pump sufficient volume of blood – ‘pooling’ Drug combination most often used is: Digoxin and

Lasix (furosemide) Digoxin is a positive ionotrope-increasing strength

of contraction of heart Lasix is a diuretic that causes ‘elimination’ of

excess body fluid, reducing edema(swelling)

Drugs in treatment of CV diseases Diuretics for HTN

Inhibit sodium chloride reabsorption to excrete more H2O May lead to decreased K+ levels (hypokalemia)

Lasix®-furosemideloop diuretic-most potent Hydrodiuril®-hydrochlorothiazide (hctz) commonly used Aldactone®-spironolactonepotassium sparing Many combinations with HCTZ, ex:Hyzaar®= Losartan/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

Nitrates for Angina

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) 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

Beta blockers for HTN, angina

Block sympathetic output and decrease oxygen use

Decrease heart rate, force of contraction, and blood pressure

Examples: (olol’s) Inderal®-propranolol Tenormin®-atenolol Toprol XL®-metoprolol succinate Lopressor®-metoprolol tartrate SE’s: tachycardia, dizziness, bronchospasm, beware

hide symptoms of hypoglycemia in DM pts

ACE Inhibitors & ARB’s for HTN, CHF

Inhibit the renin-angiotensin-aldosterone system from causing vasoconstriction

Treat CHF, severe HTN result in renal and systemic vasodilation

ARB (angiotensin-2 receptor blockers) “sartans” ie. Cozaar®=losartan

ACE I’s (angiotensin-converting-enzyme inhib) “prils” ie. Zestril®=prinivil; Altace®=ramipril

SE’s: “ace” cough,hyperkalemia, angio-edema

Calcium Channel Blockers for HTN, angina

Interfere with influx of calcium in vascular and smooth muscle

Reduce ability of vessels to constrict – result is decreased blood pressure

Calan®=verapamil Cardizem®=diltiazem Plendil®=felodipine SE’s: edema, headache, reflex tachycardia

Hyperlipidemia

We all need cholesterol and triglycerides (fats) to form cell membrane and nervous tissue!

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; GOAL >35

LDL(‘bad’ cholesterol) - low density lipoproteins carry cholesterol from the liver to the blood stream

GOAL <130

HMG-CoA reductase inhibitors

aka “STATIN’s” ex: Lipitor (atorvastatin) Zocor (simvastatin) Crestor (resuvastatin)

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

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 Ex: cholestyramine, colestipol SE’s: constipation, n/v, dizziness

Important Facts about Hypolipemics

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 Cholestyramine powder must be mixed with 8ox

of water prior to administering

Coagulation

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 Heparin – immediate action, short duration

Administered parenterally Warfarin (Coumadin) – 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 Coumadin has lots of drug-interactions... PT/INR

levels must be monitored closely!

Other drugs

Antiplatelet drugs: suppress clumping of platelets in arteries Ex: aspirin, Plavix®

Thrombolytics: dissolve clots already formed Activase(alteplase), Streptase(streptokinase)

Topical hemostatics: gelatin or cellulose sponges that absorb excess blood and fluids

Coagulation - Key Points

Hemostasis occurs with the formation of the platelet plug, followed by coagulation.

Anticoagulants help prevent venous thrombi; antiplatelet drugs help prevent arterial thrombi

Heparin is adminstered intramuscularly or deep subcutaneously

Warfarin is the prototype for oral anticoagulants

Respiratory System/Disorders

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

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)

Antihistamines – notice … ‘anti-Histamine’ these block the H1 receptor sites, preventing histamine’s action

1st Generation: -- sedating, short acting examples -chlorpheniramine (ChlorTrimeton)

-diphenhydramine (Benadryl) 2nd Generation: -less, or NON-sedating, and

much longer duration of action (Claritin, Zyrtec)

Drugs for Nasal Congestion(2)

Decongestants: reduce congestion by shrinking swollen mucous membranes of the nasal passage

Often combined with AntiHistamines Oral and Nasal preparations are both available Phenylephrine – most widely used, less

elevation of blood pressure, no METH link! Pseudoephedrine(e.g.,Sudafed) – stimulates the

CNS causing elevated BP, insomnia, agitation … used in Crystal-Meth production!

Drugs for Nasal Congestion(3)

Nasal Decongestant Sprays/Drops (topical) examples: Afrin, NeoSynephrine

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!

Tolerance occurs rapidly, resulting in patients using larger and larger doses to get the same level of symptom-relief

Topical Decongestants act much faster than Oral Decongestants, but Oral agents do not cause Rebound Congestion!

Glucocorticoids (steroids)

Nasal Glucocorticoids (Flonase, Nasacort) Most effective meds for prolonged seasonal

or year-round allergic rhinitis Excellent relief of symptoms such as:

*congestion, *runny nose, *sneezing, *itching Interesting Drug! –NOT a STEROID-

CromolynSodium (Nasalcrom) – actually prevents the release of Histamine – unique!

Drugs for Cough (antitussives)

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 (codeine,hydrocodone)

nonOPIOID’s: less GI side-effects, NOT habit forming

Other Agents for cough …

Cough suppressant Tessalon(benzonatate) -a local anesthetic, relieves cough by numbing the cough receptors (gag reflex)

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 Pneumonia Thick Mucous Secretion(sputum) COPD (Chronic Obstructive Pulmonary Disease) … Asthma Emphysema Chronic Bronchitis EXPECTORANTS required to thin and mobilize sputum