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

Cardiovascular Pharmacology Drugs used to treat excessive clot formation – Anticoagulants (only stop you for making new clots, they do NOT break down clots) Heparin Low Molecular Weight Heparin (Lovenox) Warfarin (Coumadin) – Antithrombotics Aspirin Clopidogrel (Plavix) – Thrombolytics Streptokinase (Streptase) 2Lobert

Cardiovascular Pharmacology Anticoagulant – Ex: Heparin (special spot, niche for action) – Action: potentiates antithrombin  renders clotting factors inactive; inhibits synthesis and function of clotting factors – Therapeutic Effect: prevents clot formation; prevents extension of existing venous thromboembolism (VTE prophylaxsis) – Side Effects: Bleeding (gums, bruises, urine, stool, internal bleeding) ; thrombocytopenia (platelet reduction in blood, so huge potential to bleed); HIT  increased thrombosis (opposite effect, freak thing) – Note: requires extensive monitoring of labs (PTT) For PT it may mean limiting exercise: look at PPT and platelet count. 3Lobert

Cardiovascular Pharmacology Anticoagulant – Ex: Low Molecular Weight Heparin Enoxaprin (Lovenox-done in home setting, super expensive so need insurance); Dalteparin (Fragmin) – Action: Inhibits synthesis of clotting factors – Therapeutic Effect: prevention of clot formation and prevention of extension of an existing venous thromboembolism – Side Effect: Bleeding- – Requires less monitoring 4Lobert

Cardiovascular Pharmacology Anticoagulant – Ex: Fondaparinux (Arixtra) – Action: inhibits clotting factor Xa  prevention of clot formation – Therapeutic Effect: prevention of venous (VTE) thromboembolism for patients at risk ex: post op orthopedic surgery; immobile – Side Effects: Bleeding 5Lobert

Cardiovascular Pharmacology Anticoagulant – Ex: Warfarin (Coumadin)-super common/easy – Action: inhibits vitamin K  decreases synthesis of clotting factors II, VII, IX, X Leafy greens could not be processed so increased rate of clotting. – Therapeutic Effect: long term prevention of blood clots in persons with valve replacements, atrial fibrillation, DVT history – Side Effects: bleeding Pts. are commonly admitted to the hospital for Coumadin toxicity – Note: requires long term lab analysis of PT/INR Pro-time/International normalized ratio (want INR to be 2-3 seconds, lower if A-Fib) Lobert6

Cardiovascular Pharmacology Antithrombotic Drugs – Ex: Aspirin – Action: suppress of proaggregation substances  inhibition of platelet aggregation – Therapeutic Effect: prevention of myocardial infarction, prevention of cerebral ischemia/stroke – Side Effects: gi upset, gi bleeding; tinnitus at high doses Baby aspirin: 81mg – Monitor Hgb: normal (12 females,14-16 males), 7Lobert

Cardiovascular Pharmacology Antithrombic Drugs: ADP Receptor Inhibitors – Ex: Clopidogrel (Plavix), used to prevention of MI when have a high risk – Action: inhibits ADP (a compound that increases platelet activity) – Therapeutic Effect: prevention of myocardial infarction; ischemic stroke and peripheral vascular diseases – Side Effects: Bleeding 8Lobert

Cardiovascular Pharmacology Thombolytics “take away a clot” – Ex: Streptokinase (Streptase);t-PA (alteplase) – Action: converts plasminogen to plasmin the enzyme which breaks down clots – Therapeutic Effect: treatment of ischemic strokes, myocardial infarctions; treatment of peripheral arterial occlusions; treatment of occluded venous access devices Have a therapeutic window, when given 1hr inside window then reduce death rate by 50%. – Side Effects: intracerebral hemorrhage; bleeding 9Lobert

Cardiovascular Pharmacology Agents used to treat hyperlipidemia – HMG-CoA Reductase Inhibitors (Statins) Simvastatin (Zocor) Lovastatin (Mevacor) – Fibric Acid Agents Gemfibrozil (Lopid) Fenofibrate (Tricor) – Cholesterol Absorption Inhibitor Ezetimbe (Zetia) 10Lobert

Cardiovascular Pharmacology Statins – Ex: Lovastatin (Mevacor); Simvastatin (Zocor) – Action: inhibits critical enzyme for cholesterol production  decrease cholesterol production – Therapeutic Effect: decrease levels of LDL and triglycerides with moderate increase in HDL  (HDL can also be increased with exercise) – Side Effects: nausea, cramping, myopathies-muscle pain, rhabdomyolysis-kidney faliure, liver dysfunction – Labs 6 to 12 months to check liver enzymes 11Lobert

Cardiovascular Pharmacology Fibric Acid Agents – Ex: Gemfibrozil (Lopid); Fenofibrate (Tricor) – Action: mechanism is unknown – Therapeutic Effects: decreases triglyceride levels, increased HDL – Side Effects: abdominal pain, fatigue, nausea and vomiting, liver dysfunction 12Lobert

Cardiovascular Pharmacology Cholesterol Absorption Inhibitors – Ex: Ezetimibe (Zetia) – Action: inhibits cholesterol absorption production in the GI tract – Therapeutic Effect: reduces LDL & triglycerides; increased HDL – Side Effects: gi distress, abdominal pain 13Lobert