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Drugs Affecting the Cardiovascular System

Terms in this set (86)

Spironolactone
Aldactone
Diuretic
K+ Sparing
Triamterene
Dyrenium
Diuretic
K+ Sparing
Chlorothiazide
Diuril
Diuretic
Thiazides
Hydrochlorothiazide
Microzide
Diuretic
Thiazides
Diuretics
-makes the patient get rid of extra fluids by urination
-given to patients in the morning so that they are not awkened at night to urinate
-INTERACTIONS:
---NSAIDS (nonsteroidal antiinflammatory drugs), steriods, antidiabetics, anticoagulants, take precautions on patients recieving other hypertensive meds
Loop Diuretics
-Loop of henle
-produce greatest amount of pee (diuresis)
-makes the patient pee a lot
-patient excretes potassium in their pee
-make sure the patient is recieving potassium supplements at eh same time
-potassium chloride is given in pill form
-you can give loop diuretics through IV if the patient has dysphagia or you want a rapid effect
-BLOCKS Na REABSORPTION IN THE THICK ASCENDING LOOP OF HENLE
K+ Sparing Diuretics
-K+ sparing drugs= the patient does not excrete potassium when urinating (spares it)
-also given to patients with CHF and liver failure
-BLOCKS ALDOSTERONE ACTION IN THE KIDNEY
Thiazide Diuretics
-also spare K+ but not as much as K+ sparing drugs
-increase blood glucose
-monitor diabetics on thiazides
-BLOCK Na REABSORPTION IN DISTAL CONVOLUTED TUBULE
Furosemide
Lasix
Diuretic
Loop diuretics
-PO or IV
Therapeutic Effects of Diuretics
-THERAPEUTIC USES:
---HTN
---Edema
---CHF (Spironolactone)
---Acites from liver cirrhosis (alcohol, viral infection)
Adverse Effects of Diuretics
-ADVERSE EFFECTS
---hyponatremia (loss of sodium in urine)
---hypokalemia (loss of potassium in urine)
---ototoxicity (side effect of lasik, if the IV is pushed too fast hearing loss or ringing in the ears an occur)
---dehydration
---hyperglycemia (increased blood glucose)
---dizziness (due to dehydration and low BP)
---hypotension (low BP)
---electrolyte imbalance (lost in urine)
Calcium Channel Blockers
-End in "-dipine"
-vasodilation(decrease BP)
-decrease heart rate
-decrease force of contraction
-INTERACTIONS:
---digoxin (increased Dig level)
---alcohol
---watch for other BP meds
---beta blocker (increased risk for CHF)
Therapeutic Effects of Calcium Channel Blockers
-HTN
-Angina pectoris related to spasm
-Cardiac dysrythmias (abnormal)
Adverse Effects of Calcium Channel Blockers
-constipation (very common)
-dizziness
-facial flushing
-dry mouth
-headache
-edema of feet and ankles (very common)
Nifedipine
Adalat, Procardia
Calcium Channel Blocker
Verapamil
Calan, Verelan, Isoptin
Calcium Channel Blocker
Diltiazem
Cardizem, Tiamate, Tiazac
Calcium Channel Blocker
Angiotensin Converting Enzyme (ACE) Inhibitors
-ends in "-pril"
-Action: block coversion of angiotensin I to angiotensin II
-decreases aldosterone levels -reduce or inhibit angiotensin II
-inhibit kinase II (ACE) which leads to an increase in levels of bradykinin (vasodilator)
-increase in bradykinin causes a nonproductive cough
How ACE inhibitors work
-RAAS (renin angiotensin aldosterone system)
-liver produes angiotensinogen and when a probelm arises the kidneys release renin and angiotensin I is formed, if the problem continues angiotensin II is formed with ACE from the lungs and stimulates aldosterone from adrenal medulla and increases sodium retention and water retention (increase volume/fluid) and increases the BP
-if the is no ACE from the lungs then angitensin II is not formed and BP does not rise
Benazepril
Lotensin
ACE inhibitor
Enalapril
Vasotec
ACE inhibitor
Lisinopril
Prinivil, Zestoretic, Zestril
ACE inhibitor
Ramipril
Altace
ACE inhibitor
Therapeutic Effects of ACE Inhibitors
-HTN
-other uses:
--heart failure
--myocardial infarction
--diabetic and nondiabetic neuropathy
-prevention of MI, stroke, and death in patients at high cardiovascular risk
-good for diabetics because it protects the kidneys
Adverse Effects of ACE Inhibitors
-hypotension (1st dose hypotension)
-cough (nonproductive)
-hyperkalemia
-renal failure (renal stenosis)
-angioedema (swelling of dermis)
-neutropenia (low levels of neutrophils (WBCs) which reduced the body's ability to fight infection)
-loss of taste
Angiotensin II receptor blockers (ARBs)
-Used if patients are allergic or cannot tolerate ACE inhibitors
-Ends in "-sartan"
-BLOCKS ACTIONS OF ANGIOTENSIN II RECEPTORS ON BLOOD VESSELS, IN HEART, AND ADRENAL GLANDS
--blood vessels= vasodilation
--heart= prevent pathologic changes
--adrenals= decrease release of aldosterone
Irbesartan
Avapro
ARBs
Valsartan
Diovan
ARBs
Losartan
Cozaar
ARBs
Olmesartaan
Benicar
ARBs
Therapeutic Uses of ARBs
-Hypertension
-Diovan for CHF
-Avapro and Cozaar for Diabetic Neuropathy (=kidney disease due to high blood sugar damaging the glomerulus)
Adverse Effects of ARBs
-same as ACE inhibitors, but cough (common), dizziness and syncope (LOC) have also been reported
-watch for orthostatic hypotension

Adverse effects of ACE inhibitors:
-hypotension (1st dose hypotension)
-cough (nonproductive)
-hyperkalemia
-renal failure (renal stenosis)
-angioedema (swelling of dermis)
-neutropenia (low levels of neutrophils (WBCs) which reduced the body's ability to fight infection)
-loss of taste
Beta I Receptors
-Beta I receptors are located in the heart and some skeletal muscles (Beta 1= ONE HEART)
-Stimulating Beta I receptors can increase the heart rate
Beta II Receptors
-Beta II receptors are located in the lungs (Beta 2= TWO LUNGS)
-Stimulating Beta II receptors can cause bronchodilation
Beta Blockers
-end in "-lol"
-Non-selective Beta Blockers block either Beta I or II receptors
-Cardioselective Beta Blockers block only Beta I receptors
-BBs decrease HR and heart contractions
-BBs decrease BP and by doing this decrease the demand on the heart
Atenolol
Tenormin
Beta Blocker
Metoprolol
Lopressor
Toprol XL
Beta Blocker
Carvedilol
Coreg
Beta Blocker
Propranolol
Inderal
Inderal LA
Beta Blocker
Sotalol
Betapace
Beta Blockers
Therapeutic Effects of Beta Blockers
-Angina Pectoris (reduce the demand on the heart and decrease HR)
-Cardiac Dysrythmias (decreases the conduction of the heart)
-MI (decrease the demand on the heart)
-CHF
-Migranes
Adverse Effects of Beta Blockers
-Bradycardia (less than 50 bpm)
-Impotence (errectile dysfunction)
-Heart block- AV block (check EKG)
-Dizziness
-Hypotension
Direct Acting Vasodilators
-dilates the blood vessels and reduces BP
-Action: DIRECT VASODILATION OF ARTERIAL SMOOTH MUSCLE CAUSING DECREASE IN BLOOD PRESSURE
Hydralazine
Apresoline
Direct Acting Vasodilator
Therapeutic Effects of Direct Acting Vasodilators
-HTN
-Heart Failure
-Hypertensive crisis (IV)
Adverse Effects of Direct Acting Vasodilators
-Reflex tachycardia (a rapid heart sinus rhythm caused by a variety of autonomic nervous system effects such as BP changes, fever, or emotional stress= increases the HR)
-Palpitations
-Hypotension
-Dizziness
-Headache
-Nausea
-Diarrhea
-Drowsiness
Nitroglycerin
-Action: VASODILATION OF VEINS AND VASCULAR SMOOTH MUSCLE
-not given PO because of the first pass effect of the GI tract
-given sublingual or IV for emergencies
-given by patch for maintenence
-vasodilation can help ischemia because it lowers the pressure of deoxugenated blood returning to the heart
-CHD- not much supply of blood but a lot of demand by the heart
-vasodilation decreases the demand of the heart because the blood coming back to the heart is traveling slower
Adverse Effects of Nitroglycerin
-headache (common)
-orthostatic hypotension
-tachycardia
Interactions of Nitroglycerin
-BP meds
-Viagra (increasing the blood flow to the penis will decrease the little amount of blood going to the heart due to CHD to even less and result in a massive MI)
Other Drugs for Angina, MI
-Beta Blockers
-Calcium Channel Blockers
-ACE inhibitors
-Antiplatelets
-Morphine Sulfate
-Thrombolytics (actue MI)
Heart Failure
-heart failure secondary to heart attack, HTN, atherosclerosis
-all of those diseases reduces the heart's ability to pump normally (loses elasticity)
-common denominator on CHF is low cardiac output because the ventricles are not squeezing as much= no perfusion
-low cardiac output= increased HR
-not good for CHF because it makes the heart worse
Drugs for Heart Failure
-ACE inhibitors (altace, accupril, prinivil, monopril, vasotec, capoten- decrease BP, decrease volume, decrease heart demand)
-Beta Blockers (coreg- decrease cardiac demand)
-Diuretics (lasix, damadex, aldactone- decrease fluids (preload))
-Direct Vasodilators (bidil-decrease BP)
-Phosphodiesterase Inhibitors (inocor, primacor)
-Cardiac Glycoside (lanoxin, digoxin, digitex)

CHF= pulmonary congestion, too much fluid
Cardiac Glycosides (DIGOXIN)
-Action- INCREASE FORCE OF CONTRACTION (INOTROPIC) - INCREASE CARDIAC OUTPUT
-AFFECTS THE ELECTRICAL ACTIVITY OF THE HEART
-you must check the levels of digoxin before you administer the medication because if you decrease the HR too much it can lead to death
Digoxin
Cardiac Glycosides
Dopamine
Cardiac Glycosides
Dobutamine
Cardiac Glycosides
Lanoxin
Cardiac Glycosides
Lanoxicaps
Cardiac Glycosides
Digitex
Cardiac Glycosides
Therapeutic Effects of Digoxin
-CHF
-Dysrhythmias
-decreases the contractility of the heart because this makes the heart contract correctly
-stabilizes the electrical conduction of the heart
Adverse Effects of Digoxin
-visual distubances (yellowing)
-dysrythmias
-N/V
-Fatigue
Drug Interactions of Digoxin
-Increased digoxin levels in the presence of hypokalemia
-check potassium levels
-K should be 3.5-5.5
Dislipidemia
-high cholesterol
-caused by poor diet (high in fat and cholesterol), family history of high cholesterol. genetic predisposition
-exercise and diet can treat
Iron Deficiency Anemia
-people most at risk are those individuals with Chron's disease, ulcerative colitis, pregnant women, and children
Hydroxymethylglutaryl Coenzyme (HMG-CoA) Reductase Inhibitors: "Statins"
-end with "-statin"
-the liver produces cholesterol at night so these drugs are best given right before bed time
-Action: REDUCE SERUM CHOLESTEROL AND LDL LEVELS
Atorvastatin
Lipitor
HMG-CoA Reductase Inhibitor
Simvastatin
Zocor
HMG-CoA Reductase Inhibitor
Therapeutic Effects of HMG-CoA Reductase Inhibitors
-Hyperlipidemia
-Hypercholesterolemia
-CAD
-MI
LDLs
-Low density lipoproteins
-BAD! L=Lousy
-You want a LDL level of less than 160 for healthy patients
-You want a LDL level of less than 100 for patients with CHD, disbetes, etc.
-For the total cholesterol level look at the LDLs and HDLs together
HDLs
-High density lipoproteins
-GOOD! H=happy
-the higher the better
-Low HDL= bad diet, no exercise, medications
-High HDL= good diet- fish is good to get a high level of HDLs because of the Omega 3 Fatty Acids
Triglycerides
-stores energy in the body
-good= 150
-high triglycerides put patient at risk for panceratitis
Bile-Acid Sequestrants
Action: BIND WITH BILE ACIDS WHICH CAUSE THEM TO BE EXCRETED IN FECES
-draw blood for lipid panel during fasting becaseu fod can affect the cholesterol level
-12 hour fasting cholesterol- patient cannot even drink water because anything ingested could stimulate the liver to produce cholesterol
Therapeutic Effects of Bile-Acid Sequestrants
-hypercholesterolemia
-also used as an adjunct to diet and exercise
-all diabetic patients should be on a high cholesterol medication
Adverse Effects of Bile-Acid Sequestrants
-Myoalgia (muscle pain caused by the breakdown of the muscles due to high levels of creatinine in the body. Too much creatinine can overwhelm the kidneys and cause rhabdomyolysis)
-Flatulence and abdominal upset
Cholestyamine
Questran
Bile Acid Sequestrant
Fibric Acid Agents ("fibrates")
-bring down the triglyceride level more than the Statins or bile acid sequestrants
Action: STIMULATES BREAKDOWN OF LIPOPROTEINS FROM TISSUES AND THEIR REMOVAL FROM THE PLASMA
-Lowers TG 20-50%, Raises HDL 10-20%
Therapeutic Effects of Fibric Acid Agents
-Hyperlipidemia
Adverse Effects of Fibric Acid Agents
-myoalgia (check ROM for pain)
Gemfibrozil
Lopid
Fibric Acid Agents
Fenofibrate
Tricor
Fibric Acid Agents
Nicotinic Acid, Niacin (Niaspan)
-AKA Vitamin B3
-Action: INHIBIT LIPOPROTEIN SYNTHESIS
-Lower LDL and triglyceride levels
Therapeutic Uses of Nicotinic Acid
Hypercholesterolemia
Adverse Effects of Nicotinic Acid
Intense flushing, abdominal discomfort, nausea
Interactions of Nicotinic Acid
Alpa blockers, diabetes medications
Ezetimibe (Zetia)
Action: INHIBITS ABSORPTION OF CHOLESTEROL FROM SMALL INTESTINE
Contraindication: liver problems (highly metabolized my liver)
Indications/ Therapeutic Uses of Ezetimibe
-Used as adjunct to diet and exercise
-Hypercholesterolemia
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