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Chapter 15 & 20 Class 11 Cardiac, renal and hematological medications.

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Presentation on theme: "Chapter 15 & 20 Class 11 Cardiac, renal and hematological medications."— Presentation transcript:

1 Chapter 15 & 20 Class 11 Cardiac, renal and hematological medications

2 Learning Objectives Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 2 Identify the approved way to give different forms of antianginal therapy Discuss the uses and general actions of cardiac drugs used to treat dysrhythmias Describe the common treatment for various types of lipoprotein disorders

3 Antianginals and Peripheral Vasodilators Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 3 Antianginals Nitrates: “Universal Vasodilators” Directly cause vascular smooth muscle to relax in arterial and venous circulation Decrease myocardial oxygen use Increase collateral-vessel circulation to the heart Calcium Channel Blockers Dilate coronary arteries and arterioles Reduce response of electrical conduction system

4 Antianginals and Peripheral Vasodilators (cont.) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 4 Adverse Reactions Nitrates: Flushing, postural hypotension, tachycardia, confusion, dizziness, fainting, headache, lightheadedness, vertigo, weakness, drug rash, localized pruritus, skin lesions, eye and mouth edema, local burning in mouth, nausea and vomiting Peripheral Vasodilators: Headache, weakness, tachycardia, flushing, postural hypotension, dysrhythmias, confusion, severe rash, nervousness, tingling, and sweating

5 Nitrate Products Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 5 Any drug with NITR- in the generic with cause vasodilation Nitroglycerin** isosorbide dinitrate isosorbide mononitrate These are the main drugs in this category. Nitroglycerin (NTG) can be given in multiple forms: PO pills & spray; sublingual; IV medication; ointment; & slow release topical patches.

6 Peripheral vasodilator Apresoline (hydralazine) Treatment of hypertension and high afterload heart failure Causes blood dyscrasias so monitor the CBCs

7 Question 2 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 7 Which are the best drugs for treating coronary artery disease? 1. Beta blockers 2. Calcium channel blockers 3. Diuretics 4. Nitrates

8 Antidysrhythmics Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 8 Four Classes Class I: disopyramide, procainamide, quinidine Lengthen the refractory period Decrease cardiac excitability Class II: acebutolol, esmolol, propranolol Reduce sympathetic excitation (reduce loading) Class III: amiodarone Lengthen the time it takes for one cell to fire and recover Class IV: verapamil Blocks calcium entry into the myocardium, prolongs resting phase **A good reference for understanding classes.

9 Antidysrhythmics CLASS 1 A Norpace (V) dysopyramide Pronestyl (V,A) Procainamide (V) = ventricular action (A) = atrial action CLASS 1B Xylocaine (V) lidocaine

10 Antidysrhythmics Class 2 Beta blockers Brevibloc (V) esmolol Inderal (V) propranolol Class 3 Cordarone / Pacerone (V) Amiodarone 100 day half life !! Betapace (V) sotalol

11 Antidysrhythmics Class 4 Adenocard (V) adenosine Given rapid IV push & flush Causes SOB & dyspnea Facial flushing Calcium channel blocker Calan / Isoptin Verapamil Can cause hypotension Can not have any grapefruit while on any calcium channel blockers

12 Antidysrhythmics (cont.) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 12 Action and Uses Quinidine and Procainamide Treat rapid and irregular dysrhythmias by decreasing the excitability of myocardial cells Bretylium Slows conduction rate in the ventricles, slows norepinephrine release in the myocardium Disopyramide Slows the depolarization of cardiac cells

13 Antidysrhythmics (cont.) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 13 Lidocaine Increases the strength of electrical impulses Adenosine Stops the heart for several seconds to allow it to convert to normal sinus rhythm Beta-adrenergic blockers (propranolol) Decrease the heart’s beta-receptor response to epinephrine and norepinephrine

14 Antihyperlipidemics Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 14 Types of Lipoproteins Chylomicrons (mostly triglycerides) Formed from absorption of dietary fat in intestine Very low-density lipoproteins (VLDLs) Made up of large amounts of triglycerides that were made in the liver (pre-beta lipoproteins) Low-density lipoproteins (LDLs) Breakdown of VLDLs linked with cholesterol and protein High-density lipoproteins (HDLs) Clear out excess cholesterol from tissue

15 Antihyperlipidemics Bile Acid Sequestrants (chole or cole = bile) Questran Cholestyramine resin Colestid colestipol WelChol colesevelam HMG-COA reductase inhibitors (-statins) Lipitor atorvostatin calcium Pravachol pravastatin Zocor simvastatin

16 Antihyperlipidemics Miscellaneous Tricor fenofibrate Lopid genfribrozil Niaspan nicotinic acid or naicin Make sure you check what time of day the drugs must be given. Some are with food, others are before food. Some do not matter.

17 Cardiotonics Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 17 Actions Increase the contraction strength or force (positive inotropic action) Slow the heart rate Uses Treatment of CHF and rapid or irregular heartbeats (atrial fibrillation, atrial flutter, frequent PVCs or paroxysmal atrial tachycardia)

18 Cardiotonics (cont.) Adverse Reactions  Digitalis toxicity: serum digoxin levels verify  The amount of medication that is helpful (therapeutic) and the amount that is harmful (toxic) are not very different. This is called a narrow therapeutic window.  Don’t confuse the sound-alikes digoxin and digitoxin Drug Interactions Nursing Implications and Patient Teaching 18 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

19 Cardiotonics Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 19 Lanoxin / Digitek Digoxin Primacor milrinone dobutamine

20 Mrs. Moskaluk’s HTN Guide Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 20 A = ACE inhibitors (vasodilation and decrease plasma volume) and ARBs for vasodilation (-pril & - sartan drugs) B = Beta blockers – lowers heart rate and vasodilates (-lol) C = Calcium channel blockers (-dipine drugs) D = Diuretics (-thiazide and loop are K+ losers; aldactone is K+ sparing) E = Exercise to clean the vessels ‘F’ diet = fish, fluid, fiber, and fruit -zosin drugs are alpha 1 adrenergic blockers

21 Urinary incontinence drugs Antispasmotics/ anticholinergics Ditropan (p in the pan) oxybutynin Pro-Banthine propantheline Detrol Tolterodine ‘Gotta go right now’ TV commercial BPH meds Proscar (think prostate) finasteride Flomax Tamulosin ‘maximize the flow’ Urinary Tract Analgesic Pyridium phenazopyridine

22 Hematologic Products Chapter 20 7 th ed.

23 Learning Objectives  Describe the influence of anticoagulants on blood clotting  Identify drugs that act in the formation, repair, or function of red blood cells  Identify at least three adverse reactions associated with hematologic products. 23 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

24 Anticoagulants Two Categories Coumarin and indandione derivatives Limit the formation of blood coagulation factors II, VII, IX, and X in the liver by interfering with vitamin K Antidote: Vitamin K injection/ infusion Heparin sodium Increases the action of antithrombin III (heparin cofactor) on several other coagulation factors to slow new clot development Antidote: Protamine sulfate 24 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

25 Low Molecular Weight Heparins  Lovenox **  enoxaparin  Fragmin  dalteparin  Used to prevent clotting  Require less lab monitoring than Heparin 25 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

26 Anticoagulants (cont.) Nursing Implications and Patient Teaching  Monitoring blood values  Coumadin = prothrombin time (PT); therapeutic is 1.5 to 2.5 × normal or an INR of 2.0 to 3.0  Heparin = activated partial thromboplastin time (aPPT); therapeutic is 2.5 to 3 × the control value 26 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

27 Thrombolytic Agents Action  Convert plasminogen to the enzyme plasmin, which breaks down fibrin clots, fibrinogen, and other plasma proteins Uses  Acute myocardial infarctions  Acute pulmonary emboli  Acute ischemic stroke  Acute arterial occlusion  Activase (altepase; recombinant)  Retevase (reteplase) 27 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

28 Antiplatelet Agents Action  Inhibit platelet aggregation (clumping)  Reduce thrombus formation Uses  Salicylic acid (aspirin)  Reduces incidence of myocardial infarction-related deaths in men over 50  Drug of choice in ischemic stroke  81 mg used prophylactically 28 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

29 Antiplatelet Agents  ASA  acetylsalicyclic acid  Pletal  cilostazol  Plavix  clopridogrel  Persantine  dipyridamole  Ticlid  ticlopidine 29 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

30 Question 1 Cellular damage first results in the formation of: 1. Prothrombin. 2. Thrombin. 3. Thromboplastin. 4. Fibrinogen. 30 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

31 Question 2 Which is true about emboli? 1. Emboli are not life threatening. 2. The function of heparin is to dissolve existing blood clots that may form emboli. 3. Emboli can only travel to nearby blood vessels. 4. An embolism can cause stroke or death. 31 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

32 Question 3 Which is the anticoagulant of choice when an immediate effect is needed? 1. Warfarin 2. Plavix (clopidogrel bisulfate) 3. Heparin 4. Aspirin 32 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

33 Questions?


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