Ch 2: Drug Effect and Indication

Cardiovascular System

— circulates blood: this is the job of the heart

— Blood carries nutrients, waste, hormones, and other substances dissolved or suspended in liquid plasma

— Blood’s most important parts are the White blood Cells - fight infection- Red Blood Cells - transports oxygen

Heart

— Circulates blood

— muscular organ

— has four chambers

• right and left atria

• right and left ventricles 

— Chambers are isolated by valves that prevent back flow of blood once it passes through 

Blood Vessels

blood that leaves the heart go through these

— their diameter decreases as they get farther from the heart toward organs and tissues

Arteries

Blood exit the heart through _______, which become arterioles and capillaries ( smallest branch in the cardiovascular system)

Veins

deoxygenated blood travels back to the heart though this ______

Blood Pressure (BP)

the pressure exerted by blood on vessel walls; expressed by two numbers

• Systolic Pressure

• Diastolic Pressure

Systolic BP

Higher number; found when the heart is contracting

Diastolic BP

is found when the heart relaxes

Coagulation

formation of blood clots (Thrombus) to stop bleeding

• Begins when platelets clump together to block blood flow; activation of of platelets is followed by complex cascade of rxns including called clotting factors

Heart Disease

most common cause of death in the United States; is an umbrella term that includes different pathologies that cause heart to weaken or stop

Atherosclerosis

Harding or narrowing of the arteries due to plaque deposits 

Hypertension

— High Blood Pressure

Risk factor for heart disease, stroke, and kidney disease

Hypotension

decreased blood pressure

Myocardial Infarction

— Heart Attack

The death of heart tissue, typically cause by lack of blood flow to heart muscle due to a thrombus (heart clot) that blocks blood vessels

Angina

small or temporary blockage in the heart’s blood vessels that does not lead to tissue death

Heart Failure

occurs when either or both ventricles in the heart cannot efficiently pump blood. Its typically due to another disease or illness, most commonly atherosclerosis

Dysrythmia 

abnormal heart rhythm

Category X

medication poses a high risk of causing serious birth defects or other harm to the developing fetus

Category D

Category that indicates positive evidence of human fetal risk when a medication is taken during pregnancy

Contraindications

Medical conditions or factor that makes it unsafe or inadvisable to administer specific treatment procedure or medications

Digoxin *****

Digitek, Digox, Lanoxin *****

• Dysrhythmias, heart failure

ADR: nausea, headache, dizziness

interactions: macrolide (type of antibiotics), antibiotics, azole anti fungal, other antidysrhthmias

Amiodarone ~~~~

Nexterone, Pacerone ~~~~

• dysrhythmia

ADR: nausea, vomiting, dizziness, vision problems 

BBW: Pulmonary Toxicity 

Interactions: grapefruit Juice

Linsopril

Prinivil or Zestril

Treats: Hypertension and Heart Failure

ACE Inhibitor

BBW: Fetal Toxicity

ADR: Cough, hypotension, dizziness

Interactions: other medication that lowers BP

Benazepril

Lotensin

Treats: Hypertension and Heart Failure

ACE Inhibitor

BBW: Fetal Toxicity

ADR: Cough, dizziness, hypotension

Interactions: other medications that lower BP

Enalapril

Epaned or Vasotec

Treats: Hypertension and Heart Failure

ACE Inhibitor

BBW: Fetal Toxicity

ADR: Cough, dizziness, hypotension

Interactions: other medications that lower BP

Rampril 

Atlace

Treats: Hypertension and Heart Failure

ACE Inhibitor

BBW: Fetal Toxicity

ADR: Cough, dizziness, hypotension

Interactions: other medications that lower BP

Clopidogrel

Plavix 

Thrombus Prevention

Anticoagulant

BBW: Bleeding, abrupt discontinuations

ADR: Bleeding

Interaction: omeprazole/esomeprazole, NSAIDs

Warfarin

Coumadin or Jantoven

Thrombus Prevention

Anticoagulant

BBW: Bleeding, abrupt discontinuations

ADR: Bleeding

Pregnancy: Category X

Interaction: NSAIDs

Apixaban

Eliquis

Thrombus Prevention

Anticoagulant

BBW: Bleeding, abrupt discontinuations

ADR: Bleeding

Interaction: NSAIDs

Rivaroxaban

Xarleto

Thrombus Prevention

Anticoagulant

BBW: Bleeding, abrupt discontinuations

ADR: Bleeding

Pregnancy: Category X

Interaction: NSAIDs

Lostartan 

Cozoor

Hypertension and Heart failure

Angiotensin II Receptor Blocker (A2RBs)

BBW: Fetal Toxicity

ADR: Dizziness, headache, fatigue

Interactions: potassium supplement, other drugs that lower BP

Pregnancy: Category D

Losartan and Hydrochlorothiazide

Hyzaar

Hypertension and Heart failure

Angiotensin II Receptor Blocker (A2RBs)

BBW: Fetal Toxicity

ADR: Dizziness, headache, fatigue

Interactions: potassium supplement, other drugs that lower BP

Pregnancy: Category D

Valstartan

Diovan

Hypertension and Heart failure

Angiotensin II Receptor Blocker (A2RBs)

BBW: Fetal Toxicity

ADR: Dizziness, headache, fatigue

Interactions: potassium supplement, other drugs that lower BP

Pregnancy: Category D

Valstartan and Hydrochlorothiazide

N/A on Brand 

Hypertension and Heart failure

Angiotensin II Receptor Blocker (A2RBs)

BBW: Fetal Toxicity

ADR: Dizziness, headache, fatigue

Interactions: potassium supplement, other drugs that lower BP

Pregnancy: Category D

Metoprolol

Troprol-XR or Lopressor

Beta-Blocker

Hypertension, angina, migraine

BBW: Abrupt discontinuation

ADR: dizziness, fatigue, weight gain

Interaction: other drugs that lower BP

Carvedilol

Coreg

Beta-Blocker

Hypertension, angina, migraine,

BBW: Abrupt discontinuation

ADR: dizziness, fatigue, weight gain

Interaction: other drugs that lower BP

Atenolol

Tenormin

Beta-Blocker

Hypertension, angina, migraine, anaphylaxis

BBW: Abrupt discontinuation

ADR: dizziness, fatigue, weight gain

Interaction: other drugs that lower BP

Propranolol

Inderal or Hemangeol

Beta-Blocker

Hypertension, angina, migraine

BBW: Abrupt discontinuation

ADR: dizziness, fatigue, weight gain

Interaction: other drugs that lower BP

Nebivolol 

Bystolic 

Beta-Blocker

Hypertension, angina, migraine, anaphylaxis

BBW: Abrupt discontinuation

ADR: dizziness, fatigue, weight gain

Interaction: other drugs that lower BP

Timolol

N/A on Brand

Beta-Blocker

Hypertension, angina, migraine

BBW: Abrupt discontinuation

ADR: dizziness, fatigue, weight gain

Interaction: other drugs that lower BP

Diltazem

Cardizem

Calcium Channel Blocker

Hypertension, Angina, Dysrhythmia

ADR: headache, edema, tiredness, dizziness

Interaction: other drugs that lower BP

Amlodipine

Amvaz or Norvasc

Calcium Channel Blocker

Hypertension, Angina, Dysrhythmia

ADR: headache, edema, tiredness, dizziness

Interaction: other drugs that lower BP

Nifedipine

Procardia

Calcium Channel Blocker

Hypertension, Angina, Dysrhythmia

ADR: headache, edema, tiredness, dizziness

Interaction: other drugs that lower BP and Grapefruit

Verapamil

Calan or Verelan

Calcium Channel Blocker

Hypertension, Angina, Dysrhythmia

ADR: headache, edema, tiredness, dizziness

Interaction: other drugs that lower BP

Amlodipine and Benazepril

Lotrel

Calcium Channel Blocker

Hypertension, Angina, Dysrhythmia

ADR: headache, edema, tiredness, dizziness

Interaction: other drugs that lower BP

Atorvastatin

Lipitor 

HMG-CoA Reductase Inhibitor 

High Cholesterol

ADR: Muscle/Joint pain

Interactions:grapefruit + Juice, some antibiotic (cyclosporine, clarithromyocin), some anitfungals (e.g. intraconazole)

Pregnancy: Category X

Simvastatin

FloLipid or Zocor

HMG-CoA Reductase Inhibitor 

High Cholesterol

ADR: Muscle/Joint pain

Interactions:grapefruit + Juice, some antibiotic (cyclosporine, clarithromyocin), some anitfungals (e.g. intraconazole)

Pregnancy: Category X

Pravastatin

Pravachol

HMG-CoA Reductase Inhibitor 

High Cholesterol

ADR: Muscle/Joint pain

Interactions:grapefruit + Juice, some antibiotic (cyclosporine, clarithromyocin), some anitfungals (e.g. intraconazole)

Pregnancy: Category X

Rosuvastatin

Crestor

HMG-CoA Reductase Inhibitor 

High Cholesterol

ADR: Muscle/Joint pain

Interactions:grapefruit + Juice, some antibiotic (cyclosporine, clarithromyocin), some anitfungals (e.g. intraconazole)

Pregnancy: Category X

Lovastatin

Altoprev

HMG-CoA Reductase Inhibitor 

High Cholesterol

ADR: Muscle/Joint pain

Interactions:grapefruit + Juice, some antibiotic (cyclosporine, clarithromyocin), some anitfungals (e.g. intraconazole)

Pregnancy: Category X

Fenofibrate

Tricor

Antilipemic

High Cholesterol

ADR: abdominal/back pain, muscle/joint pain, headache, nausea, diarrhea

INTERACTIONS: grapefruit juice, anticoagulant, other drugs that lower cholesterol; cyclosporine (ezetimibe)

CONTRAINDICATIONS: liver or gallbladder

disease

Gemfibrozil

Lopid

Antilipemic

High Cholesterol

ADR: abdominal/back pain, muscle/joint pain, headache, nausea, diarrhea

INTERACTIONS: grapefruit juice, anticoagulant, other drugs that lower cholesterol; cyclosporine (ezetimibe)

CONTRAINDICATIONS: liver or gallbladder

disease

Ezetimibe

Zetia

Antilipemic

High Cholesterol

ADR: abdominal/back pain, muscle/joint pain, headache, nausea, diarrhea

INTERACTIONS: grapefruit juice, anticoagulant, other drugs that lower cholesterol; cyclosporine (ezetimibe)

CONTRAINDICATIONS: liver or gallbladder

disease

Omega-3-Acid Ethyl Esters (Fish oil)

Antilipidemics

ADR: Indigestion

INTERACTIONS: anitcoagulants

CONTRAINDICATIONS: Fish or shellfish allergy

Hydralazine

Apresoline or Dralzine

Vasodilator 

ADR: Headache, Nausea, Vomiting, Diarrhea

INTERACTIONS: MAOIs, other drugs that lower BP

Isosorbide

N/A Brand

Vasodilators

ADR: Dizziness, Lightheadedness

INTERACTIONS: other drugs that lower BP, Sildenafil (erectile disfunction drug), alcohol

Nitroglycerin

N/A Brand 

Vasodilators

ADR: Dizziness, Lightheadedness

INTERACTIONS: other drugs that lower BP, Sildenafil (erectile disfunction drug), alcohol

Digoxin ~~~

Digitek, Digox, Lanoxin

Dysrhythmias, heart failure

ADR: nausea, headache, dizziness

interactions: macrolide, antibiotics, azole

anti fungal, other antidysrhthmias

Amiodarone

Nexterone, Pacerone

dysrhythmia

ADR: nausea, vomiting, dizziness, vision

problems

BBW: Pulmonary Toxicity

Interactions: grapefruit Juice

Respiratory System 

responsible for the exchange of gases between the human body and the environment 

• oxygen is brought into the body for glucose metabolism and the CO2 created by glucose metabolism is expelled 

  • air goes down the trachea, bronchi, and bronchioles into the lungs; which contain aveoli where O2 and CO2 are exchanged between air and blood

Respiratiory Disorders

caused by infections other than by pathophysiological process that damage respiratory tract tissues

Bronchospasm

sudden constriction of the bronchioles which restrict airflow.

• COMMON CAUSE: asthma, COPD

  • TREATED WITH: inhaled albuterol (reopens the airways)

Chronic Obstructive Pulmonary Disease (COPD)

progressive restriction of airflow caused by constriction of airways and the deconstruction go lung tissue

Asthma 

Chronic condition in which the airways narrow, swell, and produce excess mucus 

Common Respiratory Infections

• cold

• flu

• pneumonia

Children are at high risk for more serious one:

• pertussis - Whooping Cough

• croup - inflammation of the larynx and trachea in children

• bronchiolitis - inflammation of the bronchioles.

-actone

Potassium-Sparing Diuretic

increase fluid excreted by kidney but retains potassium

reduces cardiovascular congestion and edema caused by Congested Heart Failure (CHF)

Spirolactone

aldactone

-ase

Thrombolytics

breaks down clots that lead to heart attacks or strokes; restores blood flow to affected area

streptokinase

alteplase

-azine

Antiemetics

treats/prevents nausea and vomiting

promethazine

-caine

Local Anesthetics

prevents transmissions of nerves impulses or pain w/o cause unconsciousness

lidocaine

xylocaine

-cycline

Tetracyclines

broad spectrum antibiotics

that treat bacteria

doxycycline

tetracycline

-dipine

Calcium Channel Blockers

relax blood vessels; increasing blood supply and O2 to heart; lower blood pressure

amlodipine

nifedipine

-floxicine

Fluorquinolones

spectrum of antibiotics that treat bacterial infection

ciprofloxacine

-ide 

Meglitinides (class of oral antidiabetic medications used to treat type 2 diabetes) and Sulfonylureas (type 2 diabetes.)

lower blood glucose levels by trigger the production of of insulin used to treat type 2 diabetes 

glipzide

-ine

Antihistamine and Selective Serotonin Reuptake inhibitors (SSRIs)

Block or delay the reabsorption of serotonin; used to treat major depressive disorders (SSRIs)

treat allergies (Antihistamine)

-lam

Benzodiazepines

treat anxiety; prolonged used can lead to dependance

-lol`

Beta Blockers 

reduce blood pressure by slowing the heart rate and reducing myocardial contractility

-lone

Corticosteroids

anti-inflammatory

-micin

-mycine

Amino-glycosides

broad spectrum antibiotics that treat bacterial infections

-pam

Benzodiazepines

treat anxiety

alprazolam

diazepam

-phylline

Broncodilaters 

dilate the bronchi and bronchioles 

-pram

Selective Serotonin Reuptake inhibitors (SSRIs)

Block or Delay the reabsorption of Serotonin treat major depressive disorders

-prazole

Protone Pump Inhibitor

anti-ulcer drugs that reduce gastric acid production

-pril

ACE Inhibitor

reduce blood pressure by dilating blood vessels; reduces heart work load

-sartan

Angiotensin II Receptor Blockers 

inhibits blood vessels constrictions helping blood vessels to relax; lower blood pressure

-sone

Corticosteroids

anti-inflammatory

predisone

-statin

Antilipidemic (HMG-CoA Inhibitor)

Reduce LDL Cholesterol and lower risks from cardiovascular disease

-terol ~~

Brochodilaters ~~

dilate the bronchi and bronchioles

-thiazide 

Thiazide Diuretics 

increase fluid and potassium excreted by the kidneys 

-tidine

H2-Receptor Antagonist (H2 Blockers)

blocks the action of histamine in the stomach; decrease production of stomach acid.

-triptyline

Tricyclic Antidepressants

Treats depression, bipolar disorders, anxiety, OCD

Expectorants

quaifenesin (Mucinex) help loosen and thin mucous to make cough more productive

Antitussives

relieve coughing, Dextromethorphan is a common OTC of this

Decongestants

helps relieve stuffy noses. Phenylephrine is a common OTC for this, however pseudoephedrine (Sudafed, Claritin D, Allegra D) is more effective.

Pseudoephedrine 

purchases of this drug are strictly regulated because the can be used to make methemphetamine

Albuterol

Ventolin HFA, Proventil HFA, Combivent, Respimat, Duo NAB, ProAir HFA

Bronchodilator: Asthma, COPD

ADR: headache, fast HR, dizziness, sore throat, nasal congestion

Interactions: beta blockers, Digoxin, MAOI, Tricyclic antidepressants

Montelukast 

Singular 

Bronchodilator: Asthma, COPD

BBW: neuropsychiatric symptoms 

ADR: headache, Respiratory infection, fever, sore throat, cough

Tiotropium

Spiriva

Bronchodilator: Asthma, COPD

ADR: sore throat, cough, dry mouth, headache, visual disturbance

Interactions: other anticholinergics (block effects of acetylcholine neurotransmitters)

Ipratropium and Albuterol

Combivent, Respimat

Bronchodilator: Asthma, COPD

ADR: upper respiratory infection, sore throat, cough, headache

Interaction: beta blockers, Digoxin, MAOI, tricyclic antidepressants 

Fluticasone and Solmeterol

Advair Diskus/ HFA, Airduo, RespiClick, Symbiocort

Bronchodilator and Corticosteroids: Asthma, COPD

BBW: worsening asthma symptoms (formoterol)

ADR: Respiratory infections, sore throat, oral candidiasis, cough, headache, nausea, vomiting

Interactions: Beta Blockers, Diuretics, MAOI

Budesonide and Formpterol 

Symbicort

Bronchodilator and Corticosteroids: Asthma, COPD

BBW: worsening asthma symptoms (formoterol)

ADR: Respiratory infections, sore throat, oral candidiasis, cough, headache, nausea, vomiting

Interactions: Beta Blockers, Diuretics, MAOI