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DRUGS FOR CARDIOVASCULAR SYSTEMC35-36
INTRODUCTION
Coronary Heart Disease (CHD ) Largest killer of men and women in USA 2500 deaths per day Although numbers are high, death rate has
decreased by 36% from 1999 to 2005. R/O CHD increases as cholesterol increases Antihyperlipidemic & Cholesterol lowering
drugs to treat
RISK FACTORS FOR HEART DISEASE
Can’t Control Age Gender Family history (genetics)
Can Control Diet Weight activity
INTRODUCTION CON’T
Hypertension=>140/90 Untreated hypertension can lead to
cardiovascular problems as well as renal and respiratory problems
Early treatment reduces risk Antihypertensive drugs to treat
INTRODUCTION CON’T
Coronary Artery Disease (CAD), Peripheral Vascular Disease (PVD), Cerebral Vascular Disease (CVD)
All caused by narrowing of arteries (plaque) Result in pain when tissues are denied
oxygen Antianginal Drugs used to treat
INTRODUCTION CON’T
Blockage of vessels by blood clots can occur Can cause heart attack (MI) or Stroke Anticoagulants, antiplatelets or thrombolytics
to treat
INTRODUCTION CON’T
Heart Failure (CHF) Heart fails as a pump Higher risk over 65, Obese, & African
Americans Most common cause of hospitalization in
Americans over 65 Ace Inhibitors first drug of choice Also Cardiotonic & Inotropic drugs
INTRODUCTION CON’T
Conduction disorders: Cardiac arrhythmias Abnormally slow or rapid heart rates Irregular heart beats Antiarrhythmic drugs to treat
ANTIHYPERLIPIDEMIC
Lipids: group of fats in blood. Cholesterol and triglycerides are two lipids in
the blood Levels of cholesterol above 240 and
triglycerides above 150 associated with atherosclerosis
Atherosclerosis=condition of plaque formation (lipid deposits) in lining of blood vessels. Causes narrowing of vessel
Ateriosclerosis=thickening and loss of elasticity of the arteries (hardening of the arteries)
ANTIHYPERLIPIDEMICS CON’T
High triglycerides may be forerunner to diabetes
Triglycerides and cholesterol travel throughout body bound to a lipoprotein.
LDL==bad cholesterol HD==good cholesterol LDL cholesterol is diverse…. All through body.
When cells have all the cholesterol they need, excess is discarded into blood. (results in plaques—atherosclerosis)
HDL—transport cholesterol to liver where metabolized and excreted. Good cholesterol, more condensed
ANTIHYPERLIPIDEMICS CON’T
Higher the HDL, lower risk of atherosclerosis Lab test: lipid profile—
Total cholesterol (<200 optimal) LDL (< 100 optimal) HDL (60) Triglycerides (<150)
Therapeutic lifestyle changes (TLC) Low cholesterol diet Quit smoking Weight management 30 min physical activity/day
STATINS
Action: Inhibit manufacture of, or increase breakdown of cholesterollower cholesterol levels
USE: Hyperlipidemia Prevent coronary events Slow progression of atherosclerosis Reduce death from stroke, MI
STATINS
Side Effect: Mild Headache GI
CI: Serious liver disorder Use cautiously in alcholism
Drug Names Lipitor (atorvastatin) Prevachol (prevastatin) Crestor(rosuvastatin) Zocor (simvastatin)
BILE ACID RESINS
Bile is produced in liver Stored in gallbladder Emulsifies (breaks down) fats for ease of
absorption into intestine
Action: bile acid resins bind to bile acid to make
them “insoluble”—can’t be absorbed into intestine and systemically. Instead: secreted in feces….thereby decreasing cholesterol levels
BILE ACID RESINS
Use: Hyperlipidemia
Side effects GI Constipation Cramps Nausea
CI: Biliary obstruction
Drug Names Questran (cholestyramine)
OTHER ANTIHYPERLIPIDEMICS
Action: increase breakdown of LDL’sdecrease cholesterol
Use: Hyperlipidemia
Side effects:GI upset
Lopid (gemfibrozil)Zetia (ezetimibe)
NURSING PROCESS
Constipation r/t medication
Cholesterol levels and liver function studies Ongoing assessment of lab values 6 weeks to
6 months Assess bowel function Bile acid resins may interfere with fat-soluble
vitamins (A,D,E,K) and folic acid Avoid grapefruit juice in large amounts ( may
increase risk of toxicity
ANTIHYPERTENSIVES
Hypertension—causes heart to work too hard, and contributes to atherosclerosis
Increases r/o heart failure, heart disease, stroke, kidney disease
Primary Hypertension: no known cause Linked to risk factors of diet and lifestyle
Secondary Hypertension: Known Cause Kidney disease Tumor of adrenal glands
ANTIHYPERTENSIVES
Treatment of hypertension Weight loss Stress reduction Exercise Smoking cessation Reduction of Alcohol consumption Dietary changes Drug therapy
See p 329 in textbook
ANTIHYPERTENSIVES
Drug therapy Diuretics Beta adrenergic blockers (Beta blockers) Calcium channel blockers Other antihypertensives
ANTIHYPERTENSIVES
Actions: adrenergic blockers, calcium channel blockers, vasodilators Lower bp by vasodilaing arterial blood vessels Creates increase in lumen Allows blood to circulate
DIURETICS: Act by increasing excretion of sodium Ace Inhibitors act by suppressing the renin-
angiotensin-aldosterone system
USE: treatment of hypertension
ANTIHYPERTENSIVES
Side Effects: Dizziness Hypotension (orthostatic)