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PTP 546

PTP 546. Module 6 Cardiovascular Pharmacology: Part I Jayne Hansche Lobert, MS, RN, ACNS-BC, NP. Cardiovascular Pharmacology . Hypertension (HTN) Classification Prehypertension <120-139/80-89 Stage 1 hypertension 140-150/90-99 Stage 2 hypertension > 160/100 Incidence

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PTP 546

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  1. PTP 546 Module 6 Cardiovascular Pharmacology: Part I Jayne Hansche Lobert, MS, RN, ACNS-BC, NP Lobert

  2. Cardiovascular Pharmacology • Hypertension (HTN) • Classification • Prehypertension <120-139/80-89 • Stage 1 hypertension 140-150/90-99 • Stage 2 hypertension > 160/100 • Incidence • 30% of general population • 51% of African American population • 90% of HTN is considered “essential or primary” Lobert

  3. Cardiovascular Pharmacology • Cardiac Output (CO)= Stroke Volume x Heart Rate • Blood Pressure = CO x Peripheral Vascular Resistance (PVR) Lobert

  4. Cardiovascular Pharmacology • Antihypertensive Drug Classes • Diuretics • Sympatholytic Drugs • Beta Blockers, Mixed Blockers & Centrally Acting Adrenergics • Angiotensin Converting Enzyme (ACE)Inhibitors • Angiotensin Receptor Blockers (ARB) • Calcium Channel Blockers (CCB) • Step Approach to Management of HTN • Lifestyle modification • Classes of drugs added one at a time Lobert

  5. Cardiovascular Pharmacology • Diuretics • Thiazide Diuretics • Hydrocholorothiazide • Chlorothiazide (Diuril) • Loop Diuretics • Bumetanide (Bumex) • Furosemide (Lasix) • Potassium Sparing Diuretics • Spironolactone (Aldactone) • Triamterene (Dyrenium) Lobert

  6. Cardiovascular Pharmacology • Thiazide Diuretics • Ex: Hydrodiuril (Diuril) • Action: Inhibits sodium reabsorption in distal tubules  sodium retention in the nephrons  osmotic water attraction to nephrons  increased renal excretion of fluids • Therapeutic Effect: Reduces Blood Pressure • Side Effect: fluid loss, hypotension, electrolyte loss especially potassium loss  hypokalemia • Loop Diuretics • Ex: Furosemide (Lasix) • Action: Inhibits sodium and chloride reabsorption in nephron  prevents water reabsorption  increased renal excretion of fluids • Therapeutic Effect: Reduces blood pressure • Side Effect: fluid loss, hypotension, dizziness, fatigue, electrolyte loss  especially potassium loss hypokalemia Lobert

  7. Cardiovascular Pharmacology • Potassium Sparing Diuretics • Ex: Spironolactone (Aldactone) • Action: Sodium is reabsorbed in tubules (while potassium is spared)  water reabsorption with increased renal excretion of fluids • Therapeutic Effect: reduction in blood pressure • Side Effects: fluid loss, hypotension, hyponatremia, hyperkalemia with Dysrhythmias Lobert

  8. Cardiovascular Pharmacology • Sympatholytics • Beta Blockers • Atenolol (Tenormin) • Metoprolol (Lopressor) • Propanolol (Inderal) • Nadolol (Corgard) • Mixed Alpha & Beta Blocker • Carvedilol (Coreg) • Centrally Acting Agents • Clonidine (Catapres) Lobert

  9. Cardiovascular Pharmacology • Beta Blockers • Ex: Atenolol (Tenormin); Propanolol (Inderal) • Action: decreases beta receptor stimulation heart rate & cardiac contractility reduction in CO; decreases general sympathetic activity including to peripheral vessels • Therapeutic Effect: reduces blood pressure • Side Effects: hypotension, bradycardia, impaired glucose levels, fatigue, insomnia, activity intolerance, bronchoconstriction, impotence Lobert

  10. Cardiovascular Pharmacology • Mixed Alpha & Beta Blocker • Ex: Carvedilol (Coreg) • Centrally Acting Agents • Ex. Clonodine (Catapres) • Action: inhibits sympathetic discharge from the brainstem  decreased sympathetic receptor stimulus to heart and peripheral vessels • Therapeutic Effect: reduces blood pressure • Side Effects: hypotension, peripheral edema, decreased libido Lobert

  11. Cardiovascular Pharmacology • Angiotension Converting Enzyme Inhibitors (ACE) Inhibitors & Angiotension Receptor Blockers (ARB) • Ex: ACE = Enalopril (Vasotec); Captopril (Capoten) • Ex: ARB = Lorsartan (Cozaar); Lobert

  12. Cardiovascular Pharmacology • Angiotension Converting Enzyme Inhibitors (ACE) Inhibitors & Angiotension Receptor Blockers (ARB) • Ex: ACE = Enalopril (Vasotec); Captopril (Capoten) • Ex: ARB = Lorsartan (Cozaar); • Action: blocks angio I to angio II  prevents vasoconstriction & blocks renin & aldosterone  impairment of fluid retention • Therapeutic Effect: decreased blood pressure • Side Effects: ACE = headache, dizziness, hypotension, persistent dry cough, renal impairment, hyperkalemia • Side Effect: ARB = same side effects….. except less cough Lobert

  13. Cardiovascular Pharmacology • Calcium Channel Blockers (CCB) • Ex: Amlodipine (Norvasc); Diltiazem (Cardizem); Nifedipine (Adalat); Verapamil (Calan) • Action: blocks the entry of calcium into vascular smooth muscle  vasodilation and reduced pvr • Therapeutic Effect: reduces blood pressure • Side Effects: hypotension, edema in ankles and feet; dizziness, weakness, Dysrhythmias, myalgias, arthralgias Lobert

  14. Cardiovascular Pharmacology • Angina • Chest pain associated with cardiac ischemia • Presents differently in men and women • Oxygen supply to tissues do not meet oxygen demand; metabolites build up  pain • Precipitators: physical and/or emotional exertion Lobert

  15. Cardiovascular Pharmacology • Drugs used to treat Angina • Nitrates • Fast Acting: Nitroglycerin (Nitro Stat) • Long Acting: Nitroglycerin (Nitro Dur, NitroBid); Isosorbide Dinitrate (Isordil) • Beta Blockers • Propanolol (Inderal) • Calcium Channel Blockers • Continuous Release: Nifedipine (Procardia XL) Lobert

  16. Cardiovascular Pharmacology • Nitrates • Ex: Nitroglycerine (Nitro Stat) • Ex: Nitroglycerine (Nitrodur Patch) • Action: potent vasodilator in vascular smooth muscle • Therapeutic Effect: coronary vasodilation and reduction in chest pain • Side Effect: headache, postural hypotension, facial flushing, dizziness Lobert

  17. Cardiovascular Pharmacology • Beta Blockers • Action: blocks sympathetic output  decreases heart rate & decreases contractility  reduction in cardiac workload (less oxygen demand) • Therapeutic Use: treatment of stable angina • Calcium Channel Blockers • Action: relaxes vascular & coronary smooth muscles  less vascular resistance  less cardiac workload  less oxygen demand • Therapeutic Use: treatment of angina Lobert

  18. Cardiovascular Pharmacology • Arrhythmias • Sinus • Ex: sinus bradycardia; sinus tachycardia • Supraventricular • Ex: atrial fibrillation with rapid ventricular response • Atrioventricular Junctional • Ex: junctional rhythm • Conduction Disturbances: • Ex: heart blocks • Ventricular • Ex: V tachycardia, V fibrillation Lobert

  19. Cardiovascular Pharmacology • Classification of Antiarrhythmic Drugs • Class I: Sodium Channel Blockers • Subclass A: Procainamide (Pronestyl) • Subclass B: Lidocaine • Sub Class C: Propafenone (Rythmol) • Class II: Beta Blockers • Ex: Propranolol (Inderal) • Class III: Drugs that prolong repolarization • Ex: Amiodarone (Cordarone) • Class IV: Calcium Channel Blockers • Ex: Verapmil (Calan) Lobert

  20. Cardiovascular Pharmacology • Class I Antiarrhythmics • Class I: Sodium Channel Blockers • Subclass A: Procainamide (Pronestyl) • Subclass B: Lidocaine • Sub Class C: Propafenone (Rythmol) • Action: alter depolarization and repolarization of cardiac cells • Therapeutic Effect: primary treatment of ventricular arrhythmias • Side Effects: increased arrhythmias; dizziness; visual disturbances Lobert

  21. Cardiovascular Pharmacology • Class II Antiarrhythmic • Class II: Beta Blockers • Ex: Propranolol (Inderal) • Action: decrease stimulation of sympathetic nervous system beta receptors  slowing of conduction in the heart and decreased heart rate • Therapeutic effect: primarily used to treat atrial tachycardia's • Side effects: bradycardia; increase in other arrhythmias; bronchoconstriction Lobert

  22. Cardiovascular Pharmacology • Class III Antiarrhythmic Drugs • Class III: Drugs that prolong repolarization • Ex: Amiodarone (Cordarone) • Action: delay repolarization of cardiac cells slowing and stabilization of heart rate • Therapeutic effect: primarily used to treat ventricular arrhythmias • Side effects: increase in arrhythmias; liver toxicity Lobert

  23. Cardiovascular Pharmacology • Class IV Antiarrhythmic Drugs • Class IV: Calcium Channel Blockers • Ex: Verapamil (Calan) • Action: blocks calcium entry into cardiac cells  decreased conduction and excitability of cardiac cells • Therapeutic effect: primarily used to treat atrial arrhythmias • Side effects: bradycardia, dizziness; headaches Lobert

  24. Cardiovascular Pharmacology • Heart Failure • The heart is unable to pump a sufficient blood supply to meet the demands of the body • Chronic condition effects 5 million+ individuals • Prevalence increases with age • One of the most common causes for hospitalization • High incidence of rapid readmission following discharge Lobert

  25. Cardiovascular Pharmacology • Pathophysiology of Heart Failure Lobert

  26. Cardiovascular Pharmacology Right Sided Heart Failure Left Sided Heart Failure Cough & frothy sputum Weight gain Difficulty breathing Dyspnea Orthopnea Abnormal lung sounds Pleural effusion Weakness Fatigue Confusion, Restlessness • Weight gain • Peripheral edema • Enlarged liver • Abdominal pain • Neck vein distention • Weakness • Fatigue • Nausea Lobert

  27. Cardiovascular Pharmacology • Heart Failure Treatment Goals • Improve activity tolerance • Improve oxygenation • Maintain and/or improve quality of life • Pharmacologics can improve the hearts pumping ability by: • Increasing the force of myocardial contractions • Decreasing the workload of the myocardium Lobert

  28. Cardiovascular Pharmacology • Agents that decrease cardiac workload • ACE Inhibitors • Ex: Captopril (Capoten); Lisinopril (Prinivil); Enalapril (Vasotec) • Action: • Therapeutic Effect: • Side Effects: Lobert

  29. Cardiovascular Pharmacology • Agents that decrease cardiac workload • Beta Blockers • Ex: Carvediol (Coreg); Metoprolol (Lopressor) • Action: • Therapeutic Effect: • Side Effects: Lobert

  30. Cardiovascular Pharmacology • Agents that decrease cardiac workload • Diuretics • Ex: Furosemide (Lasix); Hydrodiuril (Diuril); Spironolactone (Aldactone) • Action: • Therapeutic Effect: • Side Effects: Lobert

  31. Cardiovascular Pharmacology • Agents that decrease cardiac workload • Nitrates • Ex: Isosorbide Dinitrate (Isordil) • Action: • Therapeutic Effect: • Side Effects: Lobert

  32. Cardiovascular Pharmacology • Agents that increase the force of the myocardial contractions • Cardioglycosides • Ex: Digoxin (Lanoxin) • Action: increases intracellular calcium  enhanced cardiac contractility; inhibits sympathetic activity normalized conduction  decreased heart rate • Therapeutic Effect: positive inotrope and negative chronotrope contributes to therapeutic usefulness in heart failure • Side Effects: bradycardia, gi disturbances, fatigue, malaise, weakness Lobert

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