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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