Top 200 Section 4. Cardiovascular Drugs

Transcription

1 Top 200 Section 4 Cardiovascular Drugs

2 Objectives After finishing this presentation the audience should be able to: Describe conditions/disease states that would make a person a candidate for drug therapy. List some possible options for therapy. Describe how these therapy options work in our patients as well as some possible side effects.

3 Hypertension

4 Risk Factors Cardiovascular Risk Factors Hypertension Obesity Inactivity Cigarette smoking Dyslipidemia Diabetes mellitus Age Genetics Patients with any of these risk factors are at a higher risk of cardiovascular events such as heart attack or stroke. Reference:

5 Hypertension Description Blood pressure measured by two numbers Systolic (first number) pressure created when heart beats Diastolic (second number) pressure inside blood vessels when heart rests In general, a desirable level for a healthy adult is < 120/80 Pre-hypertension ( )/(80 139)/(80-89) 89) Hypertension 140/90 (or more) Only one of the two values needs to be within the category to put a person into the group A person should have repeat readings to ensure that the number is accurate Reference:

6 Signs/symptoms Hypertension Most people with high blood pressure experience few if any symptoms. Some possible signs/symptoms include: Dizziness Visual disturbances Headaches Nausea/vomiting Hypertension is usually a diagnosis made by the doctor during a routine health visit. Reference:

7 Treatment Hypertension The first-line choice of therapy is lifestyle modifications Weight loss/exercise Smoking cessation Dietary changes If these alterations are not sufficient then we may want to recommend the addition of drug therapy.

8 Hypertension Commonly used drug classes ACE-Inhibitors Alpha-blockers Angiotensin-II Receptor Blockers (ARBs( ARBs) Beta-blockers Calcium Channel Blockers Diuretics Various Combinations of the Classes Note: most of these drugs can be used for other conditions. To be concise, we will limit our discussion to hypertension at this point.

9 ACE-Inhibitors

10 ACE-Inhibitors Angiotensin-converting enzyme (ACE) inhibitors work in our body to decrease the production of angiotensin- II. Angiotensin-II is responsible for constricting blood vessels and releasing hormones that can raise blood pressure. Decreasing the levels of angiotensin-ii can help to lower our blood pressure. Reference:

11 Top 200 Examples Zestril/Prinivil (lisinopril) Altace (ramipril) Vasotec (enalapril) ACE-Inhibitors Hint: the suffix of pril generally gives this class away.

12 ACE-Inhibitors Possible side effects: Dry cough Hyperkalemia (high potassium levels) Rash Dizziness Swelling of body tissues such as lips, throat, hands, and feet (can be life threatening) Reference:

13 Alpha-blockers

14 Alpha-blockers Alpha receptors can be found in many places throughout the body. Some of these receptors regulate hormones that constrict muscles around our vessels. Block these receptors and more muscles surrounding vessels relax, blood begins to flow easier, and blood pressure drops. Since these receptors are in other places of the body, the alpha- blockers can also be used to relax other muscles and may improve symptoms in other patients such as those suffering with prostate problems. Reference:

15 Top 200 Examples Cardura (doxazosin) Hytrin (terazosin) Alpha-blockers

16 Alpha-blockers Possible side effects: First dose effect dizziness and possible fainting when the patient rises suddenly caused by a sudden drop in blood pressure Can go away once the patient is established on the medication Give initial doses at doctor office to help lower risk Headache Nausea Weakness Weight gain Reference:

17 Alpha-adrenergic adrenergic Agonists

18 Alpha-adrenergic adrenergic Agonists These therapy agents will act as agonists at the receptors in the brain stem. The result is a decrease in vasculature resistance, heart rate, and blood pressure. Additionally, the agonists at these sites can also lower the outflow from the sympathetic nervous system. This calming effect helps to better explain the use of this class in pediatric patients that are on stimulant medications for such conditions as ADHD. Reference:

19 Alpha-adrenergic adrenergic Agonists Top 200 Example Catapres (clonidine)

20 Alpha-adrenergic adrenergic Agonists Possible side effects: Dry mouth Drowsiness/dizziness Constipation Sedation Weight gain Loss of libido Weakness Reference:

21 Angiotensin-II Receptor Blockers (ARBs)

22 ARBs Similar to ACE-Inhibitors, these agents are used to decrease the amount of angiotensin-ii Unlike the ACE-Inhibitors, they don t t inhibit production but block the receptors for angiotensin-ii. The end result is the same and with less angiotensin-ii in the body the blood pressure should be reduced. Reference:

23 ARBs Top 200 Examples Diovan (valsartan) Cozaar (losartan) Benicar (olmesartan) Avapro (irbesartan)

24 ARBs Possible side effects: Dizziness Rarely kidney and liver problems Diarrhea Back and leg pain Headache Same localized swelling risk as the ACE-inhibitors (angioedema) NOTE: the dry cough is not an issue with this class. Reference:

25 Beta-blockers

26 Beta-blockers These agents block beta receptors that would normally be stimulated by epinephrine. This results in a slower beating heart and more relaxed blood vessels. Ultimately, blood pressure is reduced and blood flow is improved. Reference:

27 Top 200 Examples Beta-blockers Tenormin (atenolol) Toprol XL (metoprolol( succinate) Lopressor (metoprolol tartrate) Coreg (carvedilol)

28 Beta-blockers Possible side effects: Fatigue Cold hands Dizziness/weakness Depression Trouble sleeping Loss of sexual desire Shortness of breath Decreased exercise capacity Reference:

29 Calcium Channel Blockers

30 Calcium Channel Blockers Prevent calcium from entering the cells of our heart and blood vessel walls. This helps to relax the vessels and widen the walls. The end result is a decrease in blood pressure. Some of these agents will also slow the heart rate as an added benefit and can be useful in patients with other health conditions as well. Reference:

31 Calcium Channel Blockers Top 200 Examples Norvasc (amlodipine) Calan SR (verapamil( verapamil) Adalat CC, Procardia XL (nifedipine( extended release) Cardizem (diltiazem) Cardizem CD, Tiazac (diltiazem extended release) Cartia XT (diltiazem( sustained release)

32 Calcium Channel Blockers Possible side effects: Constipation Headache Rapid heartbeat Drowsiness Nausea Flushing Swelling in the feet and lower extremities Reference:

33 Diuretics (water pills)

34 Diuretics These agents work by increasing the amount of sodium and other elements that our kidneys put in the urine. This change in concentration then draws more water out with it. The end result is less fluid in our blood vessels and less pressure on the vessel walls which decreases overall blood pressure. There are numerous classes of diuretics that work at different points in our kidneys but the overall goal remains the same less fluid = less pressure. Reference:

35 Top 200 Examples Diuretics Hydrodiuril (HCTZ/hydrochlorothiazide) Lasix (furosemide)

36 Diuretics Possible side effects: Low sodium (hyponatremia( hyponatremia) Increased blood sugar Increased cholesterol Gout Impotence Menstrual irregularities Gynecomastia (breast enlargement in men) Reference:

37 Other agents Klor-con, K-durK dur,, K-tab K (potassium chloride) Lanoxin (digoxin) Isordil (isosorbide dinitrate) Imdur, Ismo (isosorbide mononitrate)

38 Klor-con, K-durK dur,, K-tabK (potassium chloride)

39 Klor-con, K-durK dur,, K-tabK (potassium chloride) Potassium supplement used to replace potassium levels in the body. Used to treat or prevent hypokalemia Hypokalemia may be caused by some medications, vomiting, diarrhea, and bowel surgery to name a few. Potassium is vital for heart conduction. Too much or too little can throw off the heart rate and/or rhythm and could be fatal. Reference:

40 Lanoxin (digoxin)

41 Lanoxin (digoxin) Found naturally in digitalis plants. Use results in an increase in sodium in cells which then causes an increase in calcium in the cells. The rise of calcium in the cardiac cells results in a strong pump of the heart and slowing of rate (the heart can pump harder without beating faster). Useful especially in heart failure and atrial fibrillation patients. Reference:

42 Lanoxin (digoxin) Possible side effects (generally dose dependent) Dizziness/fainting Fast, pounding, or irregular heartbeat Slow heartbeat Visual disturbances Unusual bleeding/bruising Black stools Pinpoint red rash Reference:

43 Isosorbide

44 Isosorbide Falls into the nitrates family. Relaxes blood vessels and increases supply of blood and oxygen to the heart. This reduces the workload on the heart. Used on a long-term basis the try and prevent angina attacks (chest pain). Not to be used as an acute attack relief. Reference:

45 Isosorbide mononitrate vs. dinitrate Very similar with the big difference being the recommended frequency of dosing. mononitrate = often once (maybe twice) a day dinitrate = often twice (maybe three times) a day Both forms require a daily drug free period so that tolerance does not develop. A period of hours depending on the patient should be enough to ensure the medicine keeps being effective. Reference:

46 Isosorbide Possible side effects Cold sweats Clammy skin Visual disturbances Heartbeat changes Dark urine Blue-colored lips and extremities Commonly used drug with a long list of possible side effects. See the reference link for the list. Reference:

47 The End This presentation was designed to assist in remembering the brand/generic section. Use this file, the list, and the worksheet to prepare for the upcoming assessment. Feel free to any comments/concerns/questions to