1. 21
Drugs Used to Treat Cardiovascular Conditions

2. Cardiac Drugs Broadly classified according to effects on heart:
Rate of heartbeat
Rhythm of heartbeat
Amount of blood output
Strength of contraction

3. Cardiovascular System
Pulmonary circulation: picks up oxygen, discards carbon dioxide
Systemic circulation (including coronary circulation): carries oxygen and nutrients to all active cells and transports wastes to kidneys, liver, and skin for excretion

4. Heart Muscular pump with three layers: Endocardium (thin inner lining)
Myocardium (heart muscle)
Epicardium (thin outer lining)

5. Figure 21-1 Anatomy of the heart.

6. Figure 21-2 Electrical conduction system of the heart.

7. Coronary Heart Disease (CHD)
Ischemia: oxygen delivered to heart is insufficient to meet needs
Coronary artery disease: atherosclerosis and arteriosclerosis
Angina pectoris: episodic, reversible oxygen insufficiency
Classical, variant, unstable

8. Coronary Artery Disease Video
Click on the screenshot to view a video on the topic of coronary artery disease.
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9. Table 21-1 Organonitrates and Other Anginal Medications

10. Table 21-1 (continued) Organonitrates and Other Anginal Medications

11. Nitroglycerin (Nitrostat): Uses
Dilates blood vessels in vascular smooth muscles to decrease cardiac oxygen demand; also relaxes spasms of variant angina
Used to treat stable and variant angina

12. Nitroglycerin: Adverse Effects
Headache
Hypotension
Tachycardia

13. Nitroglycerin: Contraindications
Hypertrophic cardiomyopathy, pronounced hypovolemia, inferior MI, raised intracranial pressure, and cardiac tamponade
Contraindicated in pregnancy and lactation

14. Nitroglycerin: Patient Information
Advise patients to avoid carrying nitroglycerin close to body and to store in cool, dark place.
Advise patients to avoid alcohol.
Instruct patients to seek emergency medical attention if pain continues after 3 tablets.
Discard unused tablets after 6 months.

15. Nitroglycerin Nitroglycerin can cause severe hypotension.
People should use nitroglycerin with caution if they:
Are taking diuretic medication
Have hypertension

16. Other Anginal Agents
Isosorbide dinitrate and isosorbide mononitrate: longer-acting antianginals
Erythrityl tetranitrate: principal use is prophylaxis of angina in acute situations
Pentaerythritol tetranitrate: long-acting organic nitrate for prophylaxis of angina, but not for acute attack

17. Beta-Adrenergic Blockers
Beta-blockers (propranolol, atenolol) reduce heart’s oxygen demand by decreasing heart rate.
Prevent development of myocardial ischemia and pain

18. Calcium Channel Blockers
Interfere with movement of calcium ions through cell membranes
Can affect heart or peripheral vasculature
Used to treat pain of angina and to lower blood pressure

19. Myocardial Infarction
Caused by severe, prolonged lack of oxygen, which kills an area of heart muscle
Leading cause of death in industrialized nations
CAD, clot formation in the coronary artery, spasm of arteries, heavy exertion, abrupt increase in blood pressure can all cause MI.

20. Therapeutic Agents for MI
Goal is to limit damage to myocardium
IV fluids
Nitroglycerin
Aspirin and thrombolytic drugs
Morphine sulfate
Beta-blockers and calcium channel blockers
Oxygen

21. Table 21-2 Various Dysrhythmias

22. Table 21-3 Antidysrhythmic Medications

23. Table 21-3 (continued) Antidysrhythmic Medications

24. Table 21-3 (continued) Antidysrhythmic Medications

25. Table 21-3 (continued) Antidysrhythmic Medications

26. Quinidine (Quinidex): Uses
Depresses myocardium and conduction system to decrease contractile force of heart and slow heart rate
Used to treat atrial fibrillation and flutter and ventricular tachycardia

27. Quinidine: Adverse Effects
Common: diarrhea, flatulence, abdominal pain, fever, reduced platelet, liver function abnormalities
Serious: sudden ventricular fibrillation

28. Quinidine: Contraindications
Contraindicated in pregnancy, lactation, bacterial endocarditis, myasthenia gravis
Interacts with digoxin, amiodarone, verapamil

29. Quinidine: Patient Information
Instruct patients to immediately report chest pain or a change in heart rhythm.
Advise patients to take with food and to report diarrhea to health-care provider.

30. Propranolol (Inderal): Uses
Affects beta receptors to slow heart rate and lower blood pressure
Used to treat tachycardia, hypertension, angina, and to prevent MI

31. Propranolol: Adverse Effects
Hypotension and bradycardia
Diminished sex drive
Impotence

32. Propranolol: Contraindications
Contraindicated in bronchial asthma or bronchospasm, severe chronic obstructive airway disease, allergic rhinitis, pregnancy
Interacts with clonidine, cimetidine, epinephrine, insulin

33. Propranolol: Patient Information
Warn patients not to discontinue abruptly.
Tell patients to monitor pulse and report a rate less than 60 bpm.
Advise patients to rise slowly from a lying or sitting position to avoid dizziness.

34. Amiodarone: Uses
Blocks potassium and sodium ion channels to prolong heart’s resting stage
Used to treat atrial dysrhythmias in patients with heart failure

35. Amiodarone: Adverse Effects
Common: dizziness, nausea, vomiting, anorexia, bitter taste, weight loss, numbness of fingers and toes
Serious: pulmonary fibrosis with long-term use

36. Amiodarone: Contraindications
Contraindicated in severe liver disease, pregnancy, severe sinus bradycardia, and in children
Interacts with many drugs including digoxin and phenytoin

37. Amiodarone: Patient Information
Advise patients to immediate report shortness of breath, cough, change in heart rate and rhythm, or vision changes.
Advise patients to protect skin and eyes from sun.
Instruct patients to change positions slowly to avoid dizziness.

38. Verapamil (Calan, Isoptin): Uses
Acts primarily on AV node to slow conduction, causing depression of myocardial contractibility and dilation of coronary arteries
Used to stabilize dysrhythmias and to treat angina and hypertension

39. Verapamil: Adverse Effects
Dizziness or vertigo
Emotional depression
Sleepiness
Headache
Peripheral edema
Hypotension
Nausea
Constipation

40. Verapamil: Contraindications
Contraindicated in patients with hypotension and CHF and in pregnancy and lactation
Interacts with carbamazepine, lithium, cyclosporine, digoxin, calcium salts

41. Verapamil: Patient Information
Instruct patients to monitor blood pressure and report if less than /60 mm Hg.
Advise patients to report breathing difficulty or change in heart rhythm.
Instruct patients to take with food and to increase fiber intake.