This document provides an overview of cardiovascular agents used to treat conditions like hypertension, heart failure, angina, and cardiac dysrhythmias. It discusses classes of drugs like diuretics, beta blockers, ACE inhibitors, calcium channel blockers, and nitrates. It also covers topics like digitalis, antiplatelets, anticoagulants, antihyperlipidemics, and peripheral vasodilators. The document was prepared by Professor Florence D. Villarias and references a pharmacology textbook for further information.
This document provides an overview of cardiovascular agents used to treat conditions like hypertension, heart failure, angina, and cardiac dysrhythmias. It discusses classes of drugs like diuretics, beta blockers, ACE inhibitors, calcium channel blockers, and nitrates. It also covers topics like digitalis, antiplatelets, anticoagulants, antihyperlipidemics, and peripheral vasodilators. The document was prepared by Professor Florence D. Villarias and references a pharmacology textbook for further information.
This document provides an overview of cardiovascular agents used to treat conditions like hypertension, heart failure, angina, and cardiac dysrhythmias. It discusses classes of drugs like diuretics, beta blockers, ACE inhibitors, calcium channel blockers, and nitrates. It also covers topics like digitalis, antiplatelets, anticoagulants, antihyperlipidemics, and peripheral vasodilators. The document was prepared by Professor Florence D. Villarias and references a pharmacology textbook for further information.
This document provides an overview of cardiovascular agents used to treat conditions like hypertension, heart failure, angina, and cardiac dysrhythmias. It discusses classes of drugs like diuretics, beta blockers, ACE inhibitors, calcium channel blockers, and nitrates. It also covers topics like digitalis, antiplatelets, anticoagulants, antihyperlipidemics, and peripheral vasodilators. The document was prepared by Professor Florence D. Villarias and references a pharmacology textbook for further information.
LeFever Kee, Joyce; Hayes, Evelyn; McCuistion, Linda (2015). PHARMACOLOGY. A
Patient- Centered Nursing Process Approach. 8th ed. Elsevier. Inc. Pages 599- 672 Chapter
42. Cardiac Glycosides, Antianginals,
& Antidysrhythmics 43. Diuretics 44. Antihypertensives 45. Anticoagulants, Antiplatelets & Thrombolytics 46. Antihyperlipidemics & Peripheral Vasodilators Risk Factors for Stroke Atherosclerosis Smoking LOW PRESSURE HIGH PRESSURE HIGH VOLUME of liquid LOW VOLUME of liquid Good Prerenal LOW Pressure perfusion
HIGH VOLUME Poor Prerenal HIGH Pressure perfusion
LOW VOLUME R-A-A-S Phenomenon The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-8) uses three classifications for defining elevated systolic blood pressure (SBP): ❑ Prehypertension ❑ Stage 1 ❑ Stage 2 When hypertension cannot be controlled nonpharmacologically, antihypertensive drugs may be prescribed. Three of the five sympatholytic groups are: beta-adrenergic blockers centrally acting alpha2 agonists alpha adrenergic blockers adrenergic neuron blockers alpha1- and beta1-adrenergic blockers
Two categories of antihypertensives in addition to the sympatholytics
are diuretics, direct-acting arteriolar vasodilators; also ACE inhibitors, angiotensin II-receptor blockers, and calcium channel blockers. Thiazide diuretics may be combined with other antihypertensive drugs. Examples of other antihypertensives include: ▪ Beta blockers ▪ ACE inhibitors ▪ Angiotensin II receptor blockers ▪ Potassium-sparing diuretics ▪ Centrally acting alpha2 agonist
▪ Beta blockers and calcium channel blockers decreases the
workload of the heart. • Angiotensin II – receptor blockers (ARBs) can be combined with the thiazide diuretic hydrochlorothiazide to enhance the antihypertensive effect by promoting sodium and water loss • The primary side effect of ACE inhibitors is a constant, irritated cough and may be relieved upon discontinuation of the drug. ARBs do not have such a side effect so it much preferred for hypertensive patients. • Many antihypertensive drugs can cause fluid retention. To decrease body fluid, the drug group often administered with antihypertensive drugs is diuretics. • African Americans are not as responsive to ACE inhibitors given as monotherapy but may respond better if an ACE inhibitor is combined with a thiazide diuretic. Atenolol and metoprolol are examples of cardioselective antihypertensive drugs.
A cardioselective beta-adrenergic blocker is also known as beta blocker.
Direct-acting vasodilators act in the
smooth muscles of the blood vessels to decrease blood pressure.
The alpha blockers are useful in
treating hypertensive patients with lipid abnormalities. Thrombos formation TIME is MUSCLES ▪ Anticoagulants are used to inhibit clot formation. They do not dissolve clots. ▪ Anticoagulants and thrombolytics do not have the same action.
▪ A thrombus can form in an artery and in a vein. And it can be
disintegrated when a thrombolytic is administered within 4 hours following an acute myocardial infarction. Bleeding or hemorrhage is the major complication with the use of thrombolytic drugs, Lipidemia, technically, is the presence of lipids in the blood. • Four categories of lipoprotein:
• High density lipoproteins (HDLs) are the densest lipoproteins and contain more protein and less fat than the other lipoproteins. • Persons with elevated low-density lipoproteins (LDLs) have the risk of developing atherosclerotic plagues, and heart disease. • In addition to LDL, apolipoprotein (a lipoprotein) is a better indicator of risk for coronary artery disease (CAD). Elevated apoB-100 can be an indication of risk for coronary artery disease. Peripheral Vasoconstriction • Primary causes of peripheral arterial disease include arteriosclerosis and hyperlipidemia.
• B vitamins and folic acid can lower
serum homocysteine levels. Homocysteine is a protein in the blood that has been linked to cardiovascular disease and stroke. It may also promote loss of blood vessel flexibility. Patients with heart failure should avoid alcohol and cigarettes. PUMPING FAILURE
• Heart failure occurs when the myocardium weakens and enlarges, which causes the heart to lose its ability to pump blood through the heart and circulatory system. • With heart failure there is an increase in preload and afterload. Cardiac glycosides are also called digitalis, glycosides which inhibits the sodium potassium pump.
Four effects of digitalis preparations on heart
muscle (myocardium):
❑ Positive inotropic action
(increases heart contraction) ❑ Negative chronotropic action (decreases heart rate) ❑ Negative dromotropic action (decreases conduction of the heart cells) ❑ Increased stroke volume Electrolyte imbalances such as hypokalemia (low potassium), hypomagnesemia, and Hypercalcemia can increase digitalis toxicity. • Classic angina occurs when the patient is stressed (or exerted). • Unstable angin (preinfarction) occurs frequently, unpredictable, and manifests with progressive severity. • Variant angina (Prinzmetal angina) occurs when the patient is at rest. Prinzmetl angina is due to spasm of the vessels. TIME is MUSCLES Semi Fowler’s position The major systemic effect of nitrates is reduction of venous tone or coronary vasodilation. • Nitroglycerin acts directly on the smooth muscle of the blood vessels, causing relaxation and dilation. Its common side effect is headache.
• Nitroglycerin (NTG) is not swallowed
because it undergoes first-pass metabolism by the liver, thereby decreasing its effectiveness. If taken sublingually, it acts within 1-3 minutes and administration may be repeated 3 Sublingual times. The action of antianginal drugs is to increase blood flow and to increase oxygen supply or to decrease oxygen demand by the myocardium. ACE inhibitors help patients with heart failure by dilating venules and arterioles, which improves renal blood flow and Decreases blood fluid volume.
To prevent thromboembolus in patients with atrial dysrhythmias, warfarin is prescribed concurrently with antidysthmics. Cardiac dysrhythmias can result from hypoxia and hypercapnia. • The two drug groups that may be used as an antianginal , antidysrhythmic, and antihypertension are beta blockers and calcium channel blockers.
• Calcium channel blockers that are effective in the long-term
treatment of angina, dysrhythmia, and hypertension and have the side effect of bradycardia are verapamil and chest diltiazem.
• Beta blockers and calcium channel blockers should not be
discontinued without health care provider approval. Withdrawal symptoms may include reflex tachycardia and pain. Diuretics Two main purposes: ▪ To decrease fluid ▪ To decrease hypertension
Most diuretics promote sodium
and water loss by blocking sodium and chloride reabsorption from the Renal tubules. This causes a decrease in fluid volume in the tissues and circulation, which lowers blood pressure. Diuretics are frequently given with a variety of antihypertensive agents to decrease fluid retention and peripheral edema. Hypokalemia or low serum potassium level, is risk for patients taking thiazides. This could be a life threatening condition. With thiazides, sodium is also lost causing hyponatremia. Calcium level is elevated because thiazides block calcium excretion. Furosemide will cause an increased loss of potassium (hypokalemia) when given with amiodarone, which may predispose the patient to ventricular arrhythmias.
Muscle weakness, abdominal distention, severe leg
cramping, and cardiac arrhythmias are indications of hypokalemia. Low potassium levels may occur with the use of loop diuretics.
The combination of furosemide and alcohol can increase
orthostatic hypotension. Loop diuretics are contraindicated in patients with anuria. Giving diuretics to a patient without any urine output will not force urine production. To prevent hearing loss, furosemide must be administered slow IV push over at least 1-2 minutes.
Daily weights and vital signs need
to be trended at home on a daily basis. The patient and family should be educated on how to take these measurements or arrangements should be made for assessment by home health services, at least initially. CARDIOVASCULAR Agents Prepared by: Prof. Florence D. Villarias
Reference:
LeFever Kee, Joyce; Hayes, Evelyn; McCuistion, Linda (2015). PHARMACOLOGY. A
Patient- Centered Nursing Process Approach. 8th ed. Elsevier. Inc. Pages 599- 672
