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1Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Chapter 15Chapter 15
Cardiovascular and Renal Medications
2Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Chapter 15
Lesson 15.1
3Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Learning ObjectivesLearning Objectives
• Identify the approved way to give different forms of antianginal therapy
• Discuss the uses and general actions of cardiac drugs used to treat dysrhythmias
• Describe the common treatment for various types of lipoprotein disorders
4Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Cardiovascular System: Major Arteries
Cardiovascular System: Major Arteries
5Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Cardiovascular System: Major Veins
Cardiovascular System: Major Veins
6Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Urinary SystemUrinary System
7Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Antianginals and Peripheral Vasodilators
Antianginals and Peripheral Vasodilators
Antianginals– Nitrates: “Universal Vasodilators”
• Directly cause vascular smooth muscle to relax in arterial and venous circulation
• Decrease myocardial oxygen use• Increase collateral-vessel circulation to the heart
– Calcium Channel Blockers• Dilate coronary arteries and arterioles• Reduce response of electrical conduction system
8Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Main Components of Microcirculation
Main Components of Microcirculation
9Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Antianginals and Peripheral Vasodilators (cont.)
Antianginals and Peripheral Vasodilators (cont.)
Action and Uses• Nitrates
– Acute and chronic anginal attacks– Reduce the workload of the heart
• Peripheral Vasodilators– Relax the smooth muscles of peripheral arterial
vessels to increase peripheral circulation– Used to treat leg pain caused by vasoconstriction
10Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Site of Action of Peripheral Vasodilators
Site of Action of Peripheral Vasodilators
11Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Antianginals and Peripheral Vasodilators (cont.)
Antianginals and Peripheral Vasodilators (cont.)
Adverse Reactions• Nitrates: Flushing, postural hypotension,
tachycardia, confusion, dizziness, fainting, headache, lightheadedness, vertigo, weakness, drug rash, localized pruritus, skin lesions, eye and mouth edema, local burning in mouth, nausea and vomiting
• Peripheral Vasodilators: Headache, weakness, tachycardia, flushing, postural hypotension, dysrhythmias, confusion, severe rash, nervousness, tingling, and sweating
12Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
AntidysrhythmicsAntidysrhythmics
Four Classes• Class I: disopyramide, procainamide, quinidine
– Lengthen the refractory period– Decrease cardiac excitability
• Class II: acebutolol, esmolol, propranolol– Reduce sympathetic excitation (reduce loading)
• Class III: amiodarone– Lengthen the time it takes for one cell to fire and recover
• Class IV: verapamil– Blocks calcium entry into the myocardium, prolongs resting
phase
13Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Conduction System of the Heart
Conduction System of the Heart
14Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Antidysrhythmics (cont.)Antidysrhythmics (cont.)
Action and Uses• Quinidine and Procainamide
– Treat rapid and irregular dysrhythmias by decreasing the excitability of myocardial cells
• Bretylium– Slows conduction rate in the ventricles, slows
norepinephrine release in the myocardium
• Disopyramide– Slows the depolarization of cardiac cells
15Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Antidysrhythmics (cont.)Antidysrhythmics (cont.)
• Lidocaine– Increases the strength of electrical impulses
• Adenosine– Stops the heart for several seconds to allow it to
convert to normal sinus rhythm
• Beta-adrenergic blockers (propranolol)– Decrease the heart beta-receptor response to
epinephrine and norepinephrine
16Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
AntihyperlipidemicsAntihyperlipidemics
Types of Lipoproteins• Chylomicrons (mostly triglycerides)
– Formed from absorption of dietary fat in intestine
• Very low-density lipoproteins (VLDLs)– Made up of large amounts of triglycerides that were made in the
liver (pre-beta lipoproteins)
• Low-density lipoproteins (LDLs)– Breakdown of VLDLs linked with cholesterol and protein
• High-density lipoproteins (HDLs)– Clear out excess cholesterol from tissue
17Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Path of Lipid MetabolismPath of Lipid Metabolism
18Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Antihyperlipidemics (cont.)Antihyperlipidemics (cont.)
• HMG-CoA Reductase Inhibitors– Highly effective for lowering LDL levels
• Fibric Acid Derivatives– Highly effective for lowering triglyceride and
increasing HDL levels• Bile Acid Sequestrants
– Form an insoluble compound with bile salts to reduce serum cholesterol levels
• Niacin– Effective at lowering LDL levels and increasing HDLs
19Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Chapter 15
Lesson 15.2
20Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Learning ObjectivesLearning Objectives
• List the general uses and actions of cardiotonic drugs
• Explain the actions of different categories of drugs used to treat hypertension
• Identify indications for electrolyte replacement
21Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Internal Anatomy of the HeartInternal Anatomy of the Heart
22Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Coronary ArteriesCoronary Arteries
23Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Coronary ArteriesCoronary Arteries
24Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
CardiotonicsCardiotonics
Actions• Increase the contraction strength or force
(positive inotropic action)• Slow the heart rate
Uses• Treatment of CHF and rapid or irregular
heartbeats (atrial fibrillation, atrial flutter, frequent PVCs or paroxysmal atrial tachycardia)
25Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Cardiotonics (cont.)Cardiotonics (cont.)
Adverse Reactions• Digitalis toxicity: serum digoxin levels verify• The amount of medication that is helpful (therapeutic)
and the amount that is harmful (toxic) are not very different.
• Don’t confuse the sound-alikes digoxin and digitoxin
Drug Interactions
Nursing Implications and Patient Teaching
26Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Antihypertensives, Diuretics, and Other Drugs Affecting the Urinary Tract
Antihypertensives, Diuretics, and Other Drugs Affecting the Urinary Tract
Diuretics• Indirectly reduce blood pressure by producing
sodium and water loss and lowering the tone or rigidity of the arteries
• Types– Thiazide and sulfonamide diuretics– Loop diuretics– Potassium-sparing diuretics
27Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Antihypertensives, Diuretics, and Other Drugs Affecting the Urinary Tract (cont.)Antihypertensives, Diuretics, and Other Drugs Affecting the Urinary Tract (cont.)
Adrenergic InhibitorsBeta-adrenergic blockers
Nonselective; block beta1 and beta2 sites
Selective; block beta1 sites
Central adrenergic inhibitorsCause vascular relaxation and lower blood pressure
Peripheral adrenergic antagonistsLimit norepinephrine release, prevent vasoconstriction
28Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Antihypertensives, Diuretics, and Other Drugs Affecting the Urinary Tract (cont.)Antihypertensives, Diuretics, and Other Drugs Affecting the Urinary Tract (cont.)
Alpha1-adrenergic inhibitors
Lower peripheral resistance and blood pressure
Combined alpha- and beta-adrenergic blockers
Angiotensin-Related AgentsAngiotensin-converting enzyme inhibitors
Angiotensin II receptor antagonists
Vasodilators
Calcium Channel Blocking Agents
29Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
High Blood PressureHigh Blood Pressure
• Stage I: Lifestyle Changes
• Stage II: Drug Therapy
• Adverse Reactions– Drug specific
• Drug Interactions
30Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
Drugs Useful in Treating Urinary Problems
Drugs Useful in Treating Urinary Problems
• Urinary incontinence– Treatment: anticholinergics/antispasmodics, alpha-
adrenergic agonists, estrogens, cholinergic agonists, and alpha-adrenergic antagonists
• Benign prostatic hyperplasia– Treatment: alpha1-adrenergic receptor blockers
• Analgesia– Treatment: phenazopyridine
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