Cardiovascular pharmacology

Angiotensin

A vasopressor substance that is formed in the body by the interaction of renin and angio tensinogen

Atherosclerosis

The building up of fatty plaques and hardening of the arteries

Glycosides

A substance that is derived from plants and upon hydrolysis yields a sugar plus additional products

Hypokalemia

A deficient amount of potassium in the blood. This condition may cause muscle weakness, thirst, dizziness, mental confusion, paralysis, tetany, and postural hypotension

Mast cell

Connective tissue cells that contain herapin and histamine

Megaloblastic anemia

An anemia in which megaloblasts (large-sized nucleated abnormal red blood cells) are found in the blood. Also known as Pernicious Anemia

Plasminogen

A protein that is found in many body tissues and fluids. It is important in the prevention of fibr in clot formation.

What is the percentage of adults who are at risk of heart disease?

25%

What is the leading cause of death for men and women?

Coronary Heart Disease

How oftenn does does someonein the US suffer from a CHD-event?

Every 29 seconds

How often does someone in the US die from a CHD-event?

Approximately every minute

What is the lifetime risk of having CHD after age 40 in men?

49%

What is the lifetime risk of having CHD after age 40 in women?

32%

What is the primary cause of Coronary Heart Disease?

Atherosclerosis

What types of foods increase the risk of Coronary Heart Disease?

Refined carbohydrates and saturated fats: starchy foods

What are some examples of refined carbohydrates?

White bread, white rice, white potatoes, low fiber cereal

What is the real danger of artherosclerosis

When plaque fractures or cracks causing clotting material to be released and blood clots to form inside the vessels.

What two ways can a clot affect the blood vessel?

1. Partially block the vessel and create chest pain (angina pectoris). 2. Completely block the artery = myocardial infarction (heart attack)

About how many Americans will have a heart attack this year?

1.5 million

About how many Americans will die from a heart attack this year?

600,000

How many Americans will die before they reach medical help?

350,000

How long does it usually take heart attack victims to seek medical help after showing symptoms and why?

3 hours, they think its indigestion.

What is a powerful trigger for a heart attack?

Inflammation, those with high levels of inflammation are more likely to die from heart attacks or strokes.

C-Reactive Protein (CRP)

A test that can be performed to indicate the presence of bacterial infections but NOT viral infections

How long before CRP appearsin the blood after an acute inflammatory process or tissue destruction (necrosis), or both?

6 to 10 hours

What is the time frame in which CRP peaks in the blood?

48 to 72 hours

Studies show individuals with these predominately small,dense particles are at increased risk for CHD, even when that level is not elevated

LDL: low-density lipoprotein.

What are these s/s of? Pressure, fullness, squeezing pain in center of chest for 2 minutes or more; pain spreads to shoulders, neck, arms, back; dizziness, fainting, diaphoresis, nausea, and shortness of breath?

Heart attack

What condition has s/s: sudden, agonizing, substernal pain, MAY radiate to left shoulder, arm, and/or jaw; skin is cold and clammy; NORMAL PULSE AND BLOOD PRESSURE; anxious or apprehensive

Angina Pectoris

What condition has s/s: Severe, crushing substernal pain; radiates to shoulders, arms, and jaw; skin cold and clammy; PULSE RAPID AND WEAK; BLOOD PRESSURE DROPS (S/S OF SHOCK); extremely apphrensive

Myocardial infarction

What is the cause of Angina Pectoris?

DECREASED blood flow through coronary arteries that causes less oxygen to reach the myocardium

What are the causes of myocardial infarction?

OCCULSION of a coronary artery. Area become NECROTIC

What are the predisposing factors for angina pectoris?

Atherosclerosis, hypertension, diabetes, syphilis, rheumatic heart disease

What are the predisposing factors for myocardial infarction?

Atherosclerosis, hypertension, diabetes, obesity, family history, smoking, blood cholesterol 200-239 (borderline) and 240 (high); LDL 130-159 (borderline) and 160 (high)

What are the established risk factors for angina pectoris and myocardial infarction (9 of them)?

1. Male 55 or older; 2.. Female 65 or older; 3. Female under 65 with premature menopause; 4. Smoker; 5. Hypertension; 6. Diabetes; 7. Hyperlipidemia; 8. Family history of early heart disease (parents/siblings: Male under 55, female under 65); 9. Obesity

More than how many people over age 60 suffer from heart disease?

27 million

What ratio of people who die of heart attacks are over 65 years?

4 out of 5

What is directly related to the development of heart disease?

Age

How is age directly related to the development of heart disease?

1. Increased blood pressure and hardening of the arteries = heart working harder. 2. Decreased blood flow. 3. Increased lipids; 4. Decreased ability of the body to restore and repair itself

How does age complicate treatment regimens for heart disease?

1. Normal physiologic changes 2. Chronic diseases 3. Polypharmacy 4. Nutritional deficiencies 5. Substance abuse

What are the normal physiological changes in aging that complicate treatment regimens?

1, decreased intestinal mobility leads to decreased absorption of medications; 2. Decreased lean body mass and total body water means increased chance of drug toxicity. 3. Low serum albumin leads to increased drug plasma concentration, which leads to increased chance of toxicity. 4. Age or disease-related cardiovascular changes leads to slower drug distribution. 5. Decreased kidney and liver efficiency leads to decreased excretion and metabolism.

Approximately how many babies are born in the US with congenital heart defects?

25,000

Most congenital heart defects develop before what week of pregnancy?

10th

How many types of congential birth defects are there?

More than 50

What are some exogenous causes of congenital birth defects?

Viruses - Rubella is a common cause; Alcohol- Causes Fetal Alcohol Syndrome (FAS) - no safe amounts

What is an endogenous cause of congenital birth defects?

Chromosomal abnormalities

How drugs affect the heart: Inotropic Effect

Exerts a positive or negative effect by increasing or decreasing the FORCE OF THE MYOCARDIAL CONTRACTION. “Influencing the force of muscular contraction”

How drugs affect the heart: Chronotropic effect

Exerts a positive or negative effect by increasing/decreasing HEART RATE. “Influencing the rate of the heartbeat”

How drugs affect the heart: Dromotropic effect

Exerts positive or negative effect by increasing/decreasing the CONDUCTION OF ELECTRICAL IMPULSES THROUGH THE HEART MUSCLE. “Influencing the conductivity of nerve or muscle fibers”

What nervous system controlsthe rate and rhythm of the heartbeat

Autonomic

The tissues of the heart are comprised of what three types:

1. Sinoatrial (SA) node (pacemaker; 2. Atrioventricular (AV) node; 3. Atrioventricular bundle (Bundle of His)

What drug is derived from the foxglove plant?

Cardiac Glycoside (Digoxin)

What action does Digoxin have?

Inotropic and chronotropic

What five things does Digoxin do?

1. Strengthens myocardial contraction: by improving cadiac muscle strength and tone - improves cardiac output

2. Slows the heart rate

3. Increases the force of systolic contraction

4. Decreases the venous pressure as the heart takes in larger amounts of venous blood

5. Improves the effectiveness of the heart’s pumping action reducing the size of the heart and increasing the flow of blood to the kidneys, thereby causing DIURETIC effect and removal of some of the excess fluid from the body.

What are the uses of Digoxin?

1. Congestive Heart failure (CHF); used along with diuretics, low sodium diet, and modified activity.

2. Atrial arrhythmias

3. Used in conjunction with diuretics

What are the routes of Digoxin

1. Oral - usual route

2. IM

3. IV

What is the dosage for digoxin?

1. Initial or digitalizing dose: given to bring serum level up to desired level.

2. Maintenance dosage: given daily to maintain blood levels; if no digitalizing dose given, takes about 7 days of maintenance dose to reach desired effect.

3. Dosage varies with patient size and renal and hepatic function.

4. Frequently, maintenance doses of digitalis drugs must be taken throughout remainder of patient’s life.

5. THERE IS SOMETIMES A NARROW MARGIN BETWEEN THERAPEUTIC AND TOXIC DOSE

What are the s/s of digitalis toxicity?

1. GI: Anorexia, NV, diarrhea

2. Neuro: HA, drowsiness, blurred or yellow vision (sometimes yellow halos in visual field)

3. Cardiac: Bradycardia, arrhythmias, possible tachycardia

4. Fluid/electrolyte: weakness, hypokalemia

5. Musculoskeletal: severe weakness

What are the 8 points of patient teaching for digoxin?

1. Always check apical pulse for full minute before giving, withholding and notifiy dr if below 60 bpm.

2. Watch for s/s of toxicity

3. Take as prescribed and don’t discontinue without ok from dr.

4. Increase calcium foods and decrease sodium foods

5. How to monitor pulse and note changes

6. Monitor weight weekly and report gain of 5 lbs or more

7. Wear a medic alert bracelet

8. Interacts with other meds - get dr ok before taking others

What do arrhythmias do?

Help regulate heart rhythm

What type of drug is Disopyramide (Norpace and Norpace CR)?

antiarrhythmias

What are the doses for Disopyramide (Norpace and Norpace CR)

600 mg/day divided doses (150 mg every 6 hours); less than 110 lbs: 100 mg every 6 hours

What are the adverse reactions for Disopyramide (Norpace and Norpace CR)

1. Hypotension

2. Nausea

3. CHF

4. Urinary retention

5. Headache

6. Dry mouth

7. Blurred vision

8. Dry nose, eyes, and throat

What type of medication is Flecainide acetate

Antiarrhythmia

What is the dose of Flecainide acetate?

Oral 100 mg every 12 hrs with increases of 50 mg b.i.d. Every four days until efficacy is achieved.

What are the advserse reactions of Flecainide acetate?

Chest discomfort and tinnitus, leg cramps, blurred vision, ataxia, dry mouth, nasal congestion, nausea

What type of medication is Lidocaine HCl (Xylocaine HCl)

Antiarrhythmia

What is the dose of Lidocaine HCl (Xylocaine HCl)?

IM, 2 mg/lb. 10 % solution as needed

What are the adverse reactions of Lidocaine HCl?

Lightheadedness, visual disturbances, tinnitus, muscle twitches

What antiarrhythmial medication can be used as a local anesthesia, given via IV drip?

Lidocaine HCl

What type of drug is Propranolo HCl (Inderal)?

Antiarrhythmia

What is the dosage for Propranolol HCl (Inderal)?

Oral: 10 to 30 mg, 3-4 times daily before meals and at bedtime.

What are the adverse reactions of Propranolol HCl (Inderal)

Light-headedness, mental depression, insomnia, nausea, vomiting, visual disturbances

What type of medication is Quinidine Sulphate (Extentabs)

Antiarrhythmias

What is the dosage for Quinidine sulfate?

Oral, 200 to 300 mg 3 to 4 times daily

What are the adverse reactions for Quinidine Sulfphate (Extentabs)

Tinnitus, visual disturbances, N/V, HA, vertigo; HYPERSENSITIVITY: angiodema, acute asthmatic episode, and sometimes vascular collapse.

What do vasopressors do?

Vasoconstriction: causes contractions of muscles associated with capillaries and arteries

What is the use of vasopressors?

Help elevate blood pressure in the treatment of shock

What type of medication is phenylephrine HCl? (Neo-synephrine 1% injection)

Vasopressor

What is the dosage for phenylephrine HCl (Neo-syndephrine)

IM, SC 2 to 5 mg

What are the adverse reactions of phenylephrine HCl?

Headache, reflex bradycardia, excitability, restlessness.

What is the action of vasodilators

Relax smooth muscle of blood vessels, causing vasodilation, increased blood flow and decreased blood pressure

What are the two types of vasodilators?

1. Peripheral vasodilators

2. Coronary vasodilators

What are the uses of peripheral vasodilators

1. Treatment of peripheral vascular disease (PVD)

2. Treatment of cerebral vascular insufficiency

3. Many classified as “possibly effective“

What are the uses of coronary vasodilators

1. Treatment of angina pectoris and CAD

2. Most common is NITROGLYCERINE (NTG tabs rapidly absorb through mucous membranes of mouth and stomach)

3. Treatment of hypertesion (HTN)

What kind of medication is Cyclandelate (Cyclospasmol)?

Peripheral vasodilator

What are the adverse reactions to Cyclandelate (Cyclospasmol)

Gi distress, mild flush, headache,feeling of weakness, tachycardia

What type of medication is Isoxsurprine HCl (Vasodilan)

Peripheral vasodilators

What are the adverse reactions to Isoxsuprine HCl (Vasodilan)

Occasional hypotension, tachycardia, nausea, dizziness, chest pain, rash

What type of medication is Papaverine HCl

Peripherial vasodilator

What are the adverse reactions to papaverine HCl

Nausea, abdominal distress,anorexia, constipatin, headache, drowsiness, sweating

Nitrates belong to what drug group?

Coronary Vasodilators

What type of drug is Isosorbide dinitrate (Isordil)?

Coronary vasodilators

What are the routes of isosorbide dinitrate (Isordil)?

Sublingual; chewable; oral; oral-suspension

What are the adverse reactions to Isosorbide dinitrate (Isordil)

Headache, hypotension, cutaneous vasodilation with flushing, transient episodes of dizziness

What type of drug does Nitroglycerin (Nitrolingual Spray) (Nitrostat)(Nitro Dur Transderm) belong to?

Coronary vasodilators

What are the routes of nitroglycerin?

Topical, sublingual, oral-sustained release, transdermal, lingual aerosol, transmucosal

What are the adverse reactions to nitroglycerin?

Headache, hypotension, cutaneous vasodilation with flushing, drug rash or exfoliative dermatitis.