Pharm Cardiac Antihypertensives, Vasodilators

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cswett
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Pharm Cardiac Antihypertensives, Vasodilators
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2012-03-19 14:47:24
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Pharm Cardiac Antihypertensives Vasodilators
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Pharm Cardiac Antihypertensives, Vasodilators
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  1. Shock
    Dopamine
    • Shock - low systemic BP, so low, vital organs are not getting perfused (can be hypovalemic, or cardiogenic)
    • goal is to bring up BP
    • Tx. with pressors (raise BP)

    • Dopimine = vasoconstrictor - SNS agonist
    • similar to EPI (adrenalin)

    • Titrateable
    • Low: 0.5 to 5 mg/min -also called RENAL dopamine - Dopamine receptor agonist - vasodilator (only at low doses) increases blood supply to vital organs - - blood flows to kidneys so they produce urine
    • Med: 5-10 mcg/min - Cardiac Dopamine Beta -1 agonsit
    • increases HR & strength (so inceases CO)

    • High: Alpha & Beta1 agonist - same as NOR
    • increases HR & strength (so inceases CO) - vasoconstrictor - increases blood pressure
  2. Titrateable
    • different doses do different things - have to find out what
    • effects are desired
    • ASA is titratable - baby ANA for blood thinner vs full dose for HA
  3. Dobutamine
    • beta-adrenergic agonists
    • - selective beta 1 adrenergic agonist - increases strength of beats - increases CO which increases blood flow to vital organs - renal blood flow enhanced
    • only used for cardiogenic shock -not useful for hypovalemia
  4. Chronotropic
    • RATE
    • - positive or negative
    • Positive chronotropic = increases HR
    • Negative chronotropic = decreases HR
  5. Inotropic
    • STRENGTH
    • positive or negative
    • positive inotropic = increase strength
    • negative inotropic = decrease strength
  6. Antihypertensives
    Drugs that work on the heart
    • 1. Beta Blockers
    • 2. Old Ca Channel Blockers
  7. Beta Blockers
    • - suffix - olol (also -ilol, -alol)
    • Block both Beta1 and Beta2 mediators

    • Propranolol - Lopressor/ Lopressor XLPD: SNS Antagonist, Neg chronotropic & Neg Inotropic
    • (lowers rate and strength)

    • SE/ ADR - Flat affect - subdued, calm, nightmares
    • *Contraindications
    • * 1) Treated Diabetic - interferes with glucose metabolism & mask the early signs & symptoms of hypoglycemia (tachycardia & tremors) SNS response - beta blocker is SNS antagonist
    • 2) Asthma - bronchoconstrictor -beta blockers block beta2 medicated bronchodilation

    *Atenolol and Metorolol are beta1 selective AT LOW DOSES - may be used in COPD
  8. Old Calcium Channel Blockers
    • no suffix - only 2 to learn
    • Verapamil/ Calan
    • Diltiazim/ Cardizem

    • PD: Neg Chrono & Ino - Prevent Ca from participating in myocardial contractions, and cardiac impulse conduction.
    • -causes vasodilation and reduced contractility of myocardium
    • -used to stabilize certain types of dysrhymithias and angian (dialates arterioles and coronary arteries)

    • *does not effect Beta receptors - can be used by diabetics & asthamatics
    • SE/ ADR: (PO) constipation (slows down peristalsis) - stay hydrated
    • *Contraindications - CHF, bradycardia, AV block
  9. Vasodilators
    • 1. Alpha blockers
    • 2. New Ca Channel blockers
    • 3. ACE inhibitors
  10. Alpha blockers
    • - suffix - zosin
    • Terazosin/ Hytrin
    • PD: POTENT vasodilators
    • used for HTN

    SE/ADR - First Dose Effect - profound Orthostatic hypotension - causes syncopy (passing out) mild edema

    Halflife 4-6 hours - can be take while sleeping - take at bedtime to reduce risk for falls
  11. New Ca Channel Blockers
    • suffix - dipine
    • nifedipine/ Procardia XL

    PD: vasodilator, prevents Ca from participating in smooth muscle contraction

    SE/ADR - Orthostatic hypotension, constipation (hydrate), mild edema in lower extremity - put feet up when get home or use TED hose
  12. ACE inhibitors
    ARB's
    • ACE inhibitors- suffix -pril
    • captopril/ Capoten
    • Prevents conversion of Angiotensin I to angiotensin 2 = no vasoconstricon & prevents fluid retention

    • ARB's - Angiotensin 2 receptor blockers -
    • suffix - sartan
    • valsartan/ Diovan
    • allow conversion but blocks it from acting = vasodilation + no aldosterone production (no fluid retention)
    • esentailly same as ACE inhibitors

    Both used to treat HTN -can be used on pts with CHF
  13. Renin - Angiotensin - Aldosterone System
    Renin - prduced by kidneys when blood flow is low

    Angiotensinogen - produced by liver in large quantities (not biologically active)

    Angiotensinogen in BS + Renin (from kidneys )= Angiotensin 1

    Angiotensin 1 + ACE (Angiotensin Converting Enzyme) largely in lungs = Angiotensin 2

    Angiotensin 2 in BS = Vasoconstriction + salt rentenion in kidneys +release of Aldosterone form adrenal cortex

    Aldosterone = kidney reabsorbs Na and excrets K+ and H+ = fluid retention
  14. SE/ ADR of ACE inhibitors & ARB's
    • ACE - pril
    • -cough
    • -dysguesia - change in taste
    • -Angioedema - RARE - swelling of face & neck -D/C STAT
    • -Risk of hyperkalemia - Geriatric - report muscle issues and HR issues

    ARB -sartan have no cough but are more expensive - all other SE are same
  15. Diuretics
    • PD: Where salt goes, water follow
    • - salt loss agents (pull water with them)
    • Risk of electrolite imbalances
  16. Diuretics : Strongest to Weakest
    • 1. Loop diuretics - loop of henle
    • 2. Thiazide
    • 3. Potassium sparing diruetics
  17. Loop Diuretics
    • Furosemide - Lasix
    • Work in the loop of henle - prevent sodium and chloride reabsorption - can cause profound diuresis (loop normally filters large amts of Na and Cl

    PO and IV: Loss of Na, K, Ca, Mg, Cl, CO2, UA (uric acid) - all salts - pull water with them


    Loop and thiazide diuretics are related to Sulfa drugs - could have Ax potential
  18. Thiazide diuretics
    • HCTZ - Hydrochlorothiazide
    • Chlorthalidone/ Hygroton - thiazide like
    • most commonly prescribed diuretics - most PO only

    • most popular add-on diruetics - easier to add cheap diretic if other HTN drugs not enough
    • Cause you to retain Ca - good for geriatrics


    Loop and thiazide diuretics are related to Sulfa drugs - could have Ax potential
  19. Potassium Sparing Diuretics
    • Spironolactone/ Aldactone
    • low effectiveness but can help prevent hypokalemia
    • Loose Na but retain K-need to report muscle issues or heart rate issues
    • ACE Inhibitors/ ARBs also cause K retention




  20. Angina definition and tx
    • defined - mismatch of myocardial oxygen supply to myocardial oxygen demand
    • Tx
    • I) increase O2 supply (micro) - colateral circulation -will be slower- side streets to go around problems
    • 2) Decreasing O2 demands - (macro) -
  21. Angina Prevention
    • 1. Drugs that decrease O2 demand
    • -beta blockers
    • -old CCB's

    • 2. Increase supply and decrease demand (vasodilators)
    • -New CCB's
    • -Ace inhibitors/ ARB's
    • *Avoid Alpha blockers in angina - HR will speed up to compensate for way low BP
  22. Nitroglycerine
    • Tx for Acute Angina Attackes
    • -Notroglycerine SL (sublingural) / Many brands or Buccal spray

    • PD: Increase O2 supply (micro) & decrease O2 demand (Macro)
    • *Massively potent vasodilator - must be sitting or laying and stay that way for 5 to 10 minutes
    • Short halflife: about 1 minute can drop Diastolic up to 40 mm Hg

    • Work= force x distance (volume)
    • Preload - blood presented to the heart
    • Starlings law - the heart will try to accomodate any amount of blood presented to it - causes ventricular hypertorphy
    • Increased preload = increased ventricular stretch
    • Decreased preload = decreased ventricular stretch = less work (decrease O2 demand)

    Heart is well oxygenated organ - no lactic acid buildup - takes lots of clogging (artherosclerosis)to cause Angina -
  23. NGT - Patient Education
    • 1. Will cause headache
    • 2. must be sitting or laying down for 5 to 10 minutes after
    • 3. Must protect from heat, light, and moisture - very volitile (used in dynomite)
    • 4. good until expiration date - BUT should keep extra unopened bottle ready (we live in FL - heat and moisture)
    • 5. Should tingle or sizzle under the tongue - if not then no good anymore
    • *contriversial guideline - chest pain - take nitro SL - after 5 minutes take more then Call 911used to be at 3rd dose

    • - NGT patch - for prevention of angian
    • 1. tolerance develops - must have approx 8 hours of nitrate free interval -bedtime is a good time to take patch off
    • 2. avoid ETOH consumption - consult with Doc if told to have red wine

    NGT IV - requires special IV sets -highly reactive with normal tubing
  24. CHF defined
    • CHF - Congestive (Chronic) Heart Failure
    • defined - inability of the heart to keep up with the demands of the body
    • efficiency issue - concerned with rate and strength
    • -it IS a disease of the entire cardiovascular system
    • -it is progressive - it will get worse with time
    • - most people with CHF die within 15 years of diagnosis
    • - heart transplant is only cure

    • Tx: vasodilators and diruetics - ACE/ ARB vasodilate and prevent fluid retention can add diuretics
    • late heart failure - cardomegaley - due to increased ventricular stretch - stiff and fibrotic ventricles
    • ADL's decreased (more difficult) - Digoxin - Lenoxin

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