1. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar The Pharmacy Technician FOUNDATIONS AND PRACTICES Chapter 26 The Cardiovascular, Circulatory, and Lymph Systems

2. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Figure 26.1 The heart.

3. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Anatomy of the Heart Composed of four chambers: two upper and two lower Atria—top two chambers Ventricles—bottom two chambers Septum—divides heart into right and left sides

4. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Valves of the Heart Tricuspid valve—located between the right atrium and the right ventricle Pulmonary valve—located between the right ventricle and the pulmonary artery Mitral or bicuspid valve—located between the left atrium and the left ventricle Aortic valve—located between the left ventricle and the aorta

5. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Layers of the Heart Pericardium—fluid-filled sac that surrounds and protects the heart –Permits free movement of the heart during contraction Endocardium—innermost wall layer; covers the inside surface of the heart Myocardium—surrounds heart and causes chamber contractions

6. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Figure 26.2 Blood flow through the heart.

7. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Function of the Heart Provides oxygenated blood throughout the body by a pumping mechanism Oxygenated blood deposits materials necessary for growth and nourishment Receives from tissues the waste products resulting from metabolism

8. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Hypertension Sustained elevation of systemic arterial blood pressure Symptoms include: –Severe headache –Chest pain –Irregular heartbeat –Fatigue

9. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Hypertension (cont.) Pharmaceutical treatment includes diuretics, vasodilators, ACE inhibitors, beta blockers, and calcium channel blockers

10. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Congestive Heart Failure Heart pumps out less blood than it receives Results in weakened and enlarged heart

11. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Congestive Heart Failure (cont.) Symptoms of CHF include: –Upright posture or leaning forward –Anxiety and restlessness –Cyanotic and clammy skin –Persistent cough –Rapid breathing –Fast heart rate –Edema of the lower limbs

12. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Congestive Heart Failure (cont.) Pharmaceutical treatment includes cardiac glycosides, diuretics, vasodilators, ACE inhibitors, beta-adrenergic blockers, and phosphodiesterase inhibitors

13. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Coronary Artery Disease Occurs when there is insufficient blood flow to the heart Can lead to: –Angina –Heart attack –Arrythmias –Stroke –Pulmonary embolism –Heart failure

14. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Coronary Artery Disease (cont.) Pharmaceutical treatment includes platelet aggregation inhibitors, anticoagulants, tissue plasminogen activators, and thrombin inhibitors

15. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Cardiovascular Pharmaceuticals Antiarrhythmic drugs—restore normal rhythm patterns but do not cure the cause of the irregular heartbeat Cardiac glycosides—used to increase the force of myocardial contraction, without causing an increase in the consumption of oxygen

16. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Cardiovascular Pharmaceuticals (cont.) Diuretics—used to eliminate excess sodium and water via the urinary tract Vasodilators—allow more blood to exit the heart, preventing or mitigating congestion; lower blood pressure

17. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Cardiovascular Pharmaceuticals (cont.) Angiotensin-converting enzyme inhibitors (ACE inhibitors)—lower high blood pressure; thought to reshape the heart; prevent the body from producing natural vasodilators Angiotensin II receptor blockers—similar to ACE inhibitors; block the body’s natural vasodilators

18. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Cardiovascular Pharmaceuticals (cont.) Beta-adrenergic blockers—used to block cells from receiving natural vasoconstrictors Antiadrenergic agents—interfere with the manufacture of vasoconstrictors at nerve endings Platelet aggregation inhibitors—reduce the ability of the blood to coagulate

19. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Cardiovascular Pharmaceuticals (cont.) Anticoagulants—prevent clots from forming or existing clots from getting bigger Tissue plasminogen activators—break down blood clots by reversing the clotting order and interfering with the synthesis of various clotting factors

20. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Cardiovascular Pharmaceuticals (cont.) Thrombin inhibitors—inactivate bound thrombin by binding to the enzyme and blocking its interaction with its substrates of fibrin Antihyperlipidemics—help prevent the progression of coronary artery disease by lowering plasma lipid levels

21. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Anticoagulants Do not thin out the blood Prevent clots from forming Prevent existing clots from getting bigger Cannot dissolve existing blood clots

22. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Warfarin Oral drug of choice Works by preventing the synthesis of clotting factors II, VII, IX, and X

23. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Warfarin (cont.) Used in the long-term prevention or management of venous thromboembolic disorders, including: –Deep vein thrombosis –Pulmonary embolism –Clotting associated with atrial fibrillation and prosthetic heart valves Vitamin K may be used as an antidote when too much warfarin has been given

24. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Heparin Parenterally administered drug of choice Works by inactivating clotting factors IX, X, XI, and XII Used prophylactically to: –Prevent and treat deep vein thrombosis –Prevent and treat pulmonary embolism –Treat thrombophlebitis –Prevent clotting during cardiac and vascular surgery

25. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Heparin (cont.) The only antidote for heparin overdose is protamine sulfate

26. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.2 Antiarrhythmic Agents

27. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.2 (continued) Antiarrhythmic Agents

28. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.2 (continued) Antiarrhythmic Agents

29. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.2 (continued) Antiarrhythmic Agents

30. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.3 Thiazide Diuretics

31. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.4 Loop Diuretics

32. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.5 Potassium Sparing Diuretics

33. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.7 Peripheral Vasodilators

34. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.8 Coronary Vasodilators

35. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.9 Angiotensin-Converting Enzyme Inhibitors

36. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.9 (continued) Angiotensin-Converting Enzyme Inhibitors

37. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.9 (continued) Angiotensin-Converting Enzyme Inhibitors

38. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.10 Angiotensin II Receptor Blockers (Angiotensin II Antagonists)

39. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.11 Nonselective Beta-Adrenergic Blocking Agents

40. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.12 Selective Beta-Adrenergic Blocking Agents

41. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.13 Antiadrenergic Agents

42. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.14 Antiplatelet Agents

43. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.15 Comparison of Antiplatelet Agents

44. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.15 (continued) Comparison of Antiplatelet Agents

45. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.16 Anticoagulants

46. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.17 Thrombolytics and Tissue Plasminogen Activators

47. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.18 Thrombin Inhibitors

48. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Cholesterol and Triglycerides HDL—high-density lipoproteins or “good” cholesterol LDL—low-density lipoproteins or “bad” cholesterol Triglycerides—a form of energy stored in adipose and muscle tissues –Often measured to depict fat ingestion and metabolism –Can be used to assess CAD risk factors

49. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.19 Total Cholesterol Levels

50. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.20 High-Density Lipid (HDL) Levels (Good Cholesterol)

51. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.21 Low-Density Lipid (LDL) Levels (Bad Cholesterol)

52. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 26.22 Triglycerides

53. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Lymphatic System Complex system of lymph organs, nodes, ducts, tissues, vessels, and capillaries Transports lymph fluid to the circulatory system Cardiovascular and lymphatic systems work in tandem –Joined by a capillary system through which lymph and blood move

54. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Lymphatic System (cont.) Lymphatic system supports the immune system by: –Filtering out organisms that cause disease –Producing specific white blood cells –Manufacturing antibodies –Distributing fluids and nutrients throughout the body –Draining excess fluids and protein so that tissues do not swell or become inflamed