Focus on PHARMACOLOGY ESSENTIALS FOR HEALTH PROFESSIONALS CHAPTER Drugs Used to Treat Cardiovascular Conditions 21

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PHARMACOLOGYPHARMACOLOGYESSENTIALS FOR HEALTH PROFESSIONALS

CHAPTER

Drugs Used to Treat Cardiovascular Conditions

21

Focus on Pharmacology: Essentials for Health Professionals, Second EditionJahangir Moini

Multimedia DirectoryMultimedia Directory

Slide 9 Angina VideoSlide 10 Coronary Artery Disease AnimationSlide 11 Coronary Artery Disease VideoSlide 23 Heart Attacks VideoSlide 26 Dysrythmias AnimationSlide 31 Mechanism of Action of Epinephrine VideoSlide 32 Mechanism of Action of Dopamine Animation


Cardiac DrugsCardiac Drugs

• Broadly classified according to effects on heart:– Rate of heartbeat– Rhythm of heartbeat– Amount of blood output– Strength of contraction


Cardiovascular SystemCardiovascular System

• Pulmonary circulation: picks up oxygen, discards carbon dioxide

• Systemic circulation (including coronary circulation): carries oxygen and nutrients to all active cells and transports wastes to kidneys, liver, and skin for excretion


HeartHeart

• Muscular pump with three layers:– Endocardium (thin inner lining)– Myocardium (heart muscle)– Epicardium (thin outer lining)


Figure 21-1 Anatomy of the heart.


Figure 21-2 Electrical conduction system of the heart.


Coronary Heart Disease (CHD)Coronary Heart Disease (CHD)

• Ischemia: oxygen delivered to heart is insufficient to meet needs

• Coronary artery disease: atherosclerosis and arteriosclerosis

• Angina pectoris: episodic, reversible oxygen insufficiency– Classical, variant, unstable


Angina VideoAngina Video

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Coronary Artery Disease AnimationCoronary Artery Disease Animation

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Coronary Artery Disease VideoCoronary Artery Disease Video

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Table 21-1 Organonitrates and Other Anginal Medications


Table 21-1 (continued) Organonitrates and Other Anginal Medications


Nitroglycerin (Nitrostat): UsesNitroglycerin (Nitrostat): Uses

• Dilates blood vessels in vascular smooth muscles to decrease cardiac oxygen demand; also relaxes spasms of variant angina

• Used to treat stable and variant angina


Nitroglycerin: Adverse EffectsNitroglycerin: Adverse Effects

• Headache• Hypotension• Tachycardia


Nitroglycerin: ContraindicationsNitroglycerin: Contraindications

• Hypertrophic cardiomyopathy, pronounced hypovolemia, inferior MI, raised intracranial pressure, and cardiac tamponade

• Contraindicated in pregnancy and lactation


Nitroglycerin: Nitroglycerin: Patient InformationPatient Information

• Advise patients to avoid carrying nitroglycerin close to body and to store in cool, dark place.

• Advise patients to avoid alcohol.• Instruct patients to seek emergency

medical attention if pain continues after 3 tablets.

• Discard unused tablets after 6 months.


NitroglycerinNitroglycerin

• Nitroglycerin can cause severe hypotension.

• People should use nitroglycerin with caution if they:– Are taking diuretic medication– Have hypertension


Other Anginal AgentsOther Anginal Agents

• Isosorbide dinitrate and isosorbide mononitrate: longer-acting antianginals

• Erythrityl tetranitrate: principal use is prophylaxis of angina in acute situations

• Pentaerythritol tetranitrate: long-acting organic nitrate for prophylaxis of angina, but not for acute attack


Beta-Adrenergic BlockersBeta-Adrenergic Blockers

• Beta-blockers (propranolol, atenolol) reduce heart’s oxygen demand by decreasing heart rate.

• Prevent development of myocardial ischemia and pain


Calcium Channel BlockersCalcium Channel Blockers

• Interfere with movement of calcium ions through cell membranes

• Can affect heart or peripheral vasculature

• Used to treat pain of angina and to lower blood pressure


Myocardial InfarctionMyocardial Infarction

• Caused by severe, prolonged lack of oxygen, which kills an area of heart muscle

• Leading cause of death in industrialized nations

• CAD, clot formation in the coronary artery, spasm of arteries, heavy exertion, abrupt increase in blood pressure can all cause MI.


Heart Attacks VideoHeart Attacks Video

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Therapeutic Agents for MITherapeutic Agents for MI

• Goal is to limit damage to myocardium• IV fluids• Nitroglycerin• Aspirin and thrombolytic drugs• Morphine sulfate• Beta-blockers and calcium channel

blockers• Oxygen


Table 21-2 Various Dysrhythmias


Dysrythmia AnimationDysrythmia Animation

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Table 21-3 Antidysrhythmic Medications


Table 21-3 (continued) Antidysrhythmic Medications






Mechanism of Action of Mechanism of Action of Epinephrine AnimationEpinephrine Animation

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Mechanism of Action Mechanism of Action of Dopamine Animationof Dopamine Animation

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Quinidine (Quinidex): UsesQuinidine (Quinidex): Uses

• Depresses myocardium and conduction system to decrease contractile force of heart and slow heart rate

• Used to treat atrial fibrillation and flutter and ventricular tachycardia


Quinidine: Adverse EffectsQuinidine: Adverse Effects

• Common: diarrhea, flatulence, abdominal pain, fever, reduced platelet, liver function abnormalities

• Serious: sudden ventricular fibrillation


Quinidine: ContraindicationsQuinidine: Contraindications

• Contraindicated in pregnancy, lactation, bacterial endocarditis, myasthenia gravis

• Interacts with digoxin, amiodarone, verapamil


Quinidine: Patient InformationQuinidine: Patient Information

• Instruct patients to immediately report chest pain or a change in heart rhythm.

• Advise patients to take with food and to report diarrhea to health-care provider.


Propranolol (Inderal): UsesPropranolol (Inderal): Uses

• Affects beta receptors to slow heart rate and lower blood pressure

• Used to treat tachycardia, hypertension, angina, and to prevent MI


Propranolol: Adverse EffectsPropranolol: Adverse Effects

• Hypotension and bradycardia• Diminished sex drive• Impotence


Propranolol: ContraindicationsPropranolol: Contraindications

• Contraindicated in bronchial asthma or bronchospasm, severe chronic obstructive airway disease, allergic rhinitis, pregnancy

• Interacts with clonidine, cimetidine, epinephrine, insulin


Propranolol: Propranolol: Patient InformationPatient Information

• Warn patients not to discontinue abruptly.

• Tell patients to monitor pulse and report a rate less than 60 bpm.

• Advise patients to rise slowly from a lying or sitting position to avoid dizziness.


Amiodarone: UsesAmiodarone: Uses

• Blocks potassium and sodium ion channels to prolong heart’s resting stage

• Used to treat atrial dysrhythmias in patients with heart failure


Amiodarone: Amiodarone: Adverse EffectsAdverse Effects

• Common: dizziness, nausea, vomiting, anorexia, bitter taste, weight loss, numbness of fingers and toes

• Serious: pulmonary fibrosis with long-term use


Amiodarone: ContraindicationsAmiodarone: Contraindications

• Contraindicated in severe liver disease, pregnancy, severe sinus bradycardia, and in children

• Interacts with many drugs including digoxin and phenytoin


Amiodarone: Amiodarone: Patient InformationPatient Information

• Advise patients to immediate report shortness of breath, cough, change in heart rate and rhythm, or vision changes.

• Advise patients to protect skin and eyes from sun.

• Instruct patients to change positions slowly to avoid dizziness.


Verapamil (Calan, Isoptin): UsesVerapamil (Calan, Isoptin): Uses

• Acts primarily on AV node to slow conduction, causing depression of myocardial contractibility and dilation of coronary arteries

• Used to stabilize dysrhythmias and to treat angina and hypertension


Verapamil: Adverse EffectsVerapamil: Adverse Effects

• Dizziness or vertigo• Emotional depression• Sleepiness• Headache• Peripheral edema• Hypotension• Nausea• Constipation


Verapamil: ContraindicationsVerapamil: Contraindications

• Contraindicated in patients with hypotension and CHF and in pregnancy and lactation

• Interacts with carbamazepine, lithium, cyclosporine, digoxin, calcium salts


Verapamil: Patient InformationVerapamil: Patient Information

• Instruct patients to monitor blood pressure and report if less than 90/60 mm Hg.

• Advise patients to report breathing difficulty or change in heart rhythm.

• Instruct patients to take with food and to increase fiber intake.

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Focus on PHARMACOLOGY ESSENTIALS FOR HEALTH PROFESSIONALS CHAPTER Drugs Used to Treat Cardiovascular Conditions 21