Pharmacology Basics: Cardiovascular System Medication: Part I

By Paul Henry / in , , /

This is PowerPoint lecture on chapter 16, cardiovascular medications. The major role of the cardiovascular system is to deliver nutrients such as oxygen, hormones, immune, and clotting factors to the body. Then to carry waste products like CO2 out of the cells. The heart has four chambers; left and right atrium and left to right ventricle, which contract and relax in a coordinated rhythm. When we think about the pulmonary circulation, simply put; the blood goes from the body, to the right side of the heart, to the lungs, to the left side of the heart, and back to the body again. Many cardiovascular medications exists today to help patients with all kinds of illnesses. Cardiovascular medications make the environment less hostile for the heart to function, they can increase or decrease the heart rate, they can make the heart function more efficiently, or make it less irritable. Lastly these medications can make the heart tissue less sensitive, When blood flow is impaired tremendous damage can happen to our bodies. Many times this is caused by a blood clot. A thrombus is a clot in a vessel and an embolism is a clot that breaks loose and travels. A clot can form in the heart and cause a myocardial infarction or heart attack. A clot can travel to the brain and cause a CVA, or cerebral vascular accident, or stroke simply put. A thrombus can form a vein as a DVT or a deep vein thrombosis. Clots can cause damage wherever they lodge! Myocardial infarction is another name for heart attack and with that you have angina pectoris which is chest pain. This is caused by lack of oxygen to the heart. Symptoms of a heart attack are angina, sweating, pale skin and cyanosis, which is bluing of the skin Anti-anginal medications dilate the arteries and veins so we get more blood and oxygen to the heart. Nitroglycerin is our primary anti-anginal medication. It can be given sublingual, buccal, IV, or trans-dermal. Sublingual is the most common root and that’s what we use a give in the little bottle that patience take home with them. The directions for that sublingual nitroglycerin is to take one every five minutes for angina, with a maximum of three tablets. If you’re still having pain after three tablets which would be 15 minutes, you need to call EMS (911). Anti-coagulants prevent clot formation by interrupting production of cofactors that help in the clotting process. There is a long clotting cascade. If any of you have taken pathophysiology class you learned about that. Medications that do this are warfarin or Coumadin, heparin, and Enoxaparin. Heparin and lovenox are given sub-q and patients who are at risk for patient who are risk for developing DVTs. Coumidin is taken orally. Patients that are risk for DVT s are patients who are on bed rest, if they’ve had fractures of the pelvis, patients that are obese, have had recent surgery, and a family history of blood clots. When a patient has a DVT as as shown here in this picture, they’ll have pain, swelling, and redness in the leg. Heparin may also be given for DVTs and can dissolve blood clots and it’s usually given IV. Antiplatelet medication works a little differently and it prevents the platelets from clumping together and clotting. Over-the-counter aspirin is a great antiplatelet medication, besides it being an NSAID. I has shown promise in increasing survival rate of heart attack victims if taken with initial symptoms and is also showing promise in preventing subsequent heart attacks if taken daily. Usually that’s a “baby aspirin” or 81 milligrams. The adenosine triphosphate (ADP) receptor blockers are another kind of antiplatelet medication. These can be used long term for prevention of blood clots. Clopidogrel or plavix is our most popular one of these. When we have patients on anti platelets, it is really important that they learn about signs of bleeding and precautions which include limiting vitamin K. Vitamin K plays a key role in helping the body clot, thus preventing excess bleeding. So does it make sense that patients should avoid foods high in vitamin K when they’re taking blood thinners, AKA anticoagulants and antiplatelet medications? Foods that are high in vitamin K are mainly your green leafy vegetables. Thrombolytic agents dissolve clots. tPA or tissue plasminogen activators are one example of these. These medications need to be given within 60 minutes of the onset of a stroke and they can minimize those two horrific symptoms that can happen with the stroke. When patients are on these medicines it disrupts clotting; so many times we have to do blood tests and monitor how their clotting is going. We certainly don’t want the blood too “thin. ” APTT which is a Active Thromboplastin Time; PT which is a prothrombin time; or an INR, which is International Nationalize Ratio are common blood test that evaluate clotting- so it’s a PT PTT and INR. On the opposite side of the coin, we have an anti-fibrinolytic and they helped clots to form when patients are hemorrhaging. We do have antidotes for anticoagulants. Vitamin K is an antidote for coumadin,,, vitamin K coumadin and protamine sulfate PMS is the antidote for Heparin. Hematopoetic stimulant medications stimulate growth of blood cells. These medications are used to treat anemia, low blood iron levels, and patients on chemotherapy. Chemotherapy patients have lowered blood levels due to bone marrow suppression. Hematopoietic medications include ferrous sulfate which is iron, cyancobalamin which is vitamin B12 and filgastrin which is Neupogen. Let’s review shock. With shock the cardiovascular system collapses. This affects every portion of the body. The metabolism slows, urine output decreases, blood pressure lowers, heart rate increases respirations get rapid and shallow, and the patient can have anxiety, confusion; they can get lethargic which is kinda sleepy and restless. To treat shock we target the underlying cause. Vasopressors are most commonly used to increase blood pressure which are epinephrine and norepinephrine. Remember these from the adrenergic medication? Lastly let’s talk about cholesterol. You know our bodies naturally make cholesterol. Cholesterol is critical for normal cell function but too much cholesterol in the blood can cause a buildup of plaque on the walls of the arteries. This build-up can eventually cause the arteries to narrow or hardened. Sudden blood clots in these narrowed arteries can cause again heart attack or stroke. But not all lipids or fats are the same. The high-density lipids, HDL; those are healthy lipids. They clean out the blood vessels. Low-density lipids, LDL, that’s our lousy lipids. They deposit fat in the vessels and then we have very lousy for the very low-density lipids(VLDL) and those wedge themselves in vessel walls. Lifestyle change is always the first and best option for those that have high cholesterol, but when that’s not enough HMG-COa reductase inhibitors are our first line of defense. These drugs encourage delivered to make less cholesterol and increase the number of LDL receptors in the liver. By doing this the LDL receptors grab the circulating LDL or that lousy cholesterol from the blood. These drugs are also known as statins because they all end in “statin”… lovastatin which is Mevicor or simivastin which is Zocor; and the list goes on. Fatty Statin. Side effects are H- hepatotoxicity so the blood will need to be drawn to make sure that the livers handling these medications ok. M is for myalgia which is muscle pain and this is really common with these meds. Also rash can happen. Lastly G for girls. Girls who are pregnant should not take this medication. These meds are category x!

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