Essential Cardiovascular & Renal Medications Guide

1. Chapter 15 Cardiovascular and Renal Medications

2. Chapter 15 Lesson 15.1

3. Learning Objectives • 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

4. Cardiovascular System: Major Arteries

5. Cardiovascular System: Major Veins

6. Urinary System

7. Antianginals and Peripheral Vasodilators 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

8. Main Components of Microcirculation

9. Antianginals and Peripheral Vasodilators (cont.) Action and Uses • Nitrates • Acute and chronic anginal attacks • Reduce the workload of the heart • Peripheral Vasodilators • Relax the smooth muscles of peripheral arterial vessels to increase peripheral circulation • Used to treat leg pain caused by vasoconstriction

10. Site of Action of Peripheral Vasodilators

11. Antianginals and Peripheral Vasodilators (cont.) 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

12. Antidysrhythmics 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

13. Conduction System of the Heart

14. Antidysrhythmics (cont.) 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

15. Antidysrhythmics (cont.) • 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 beta-receptor response to epinephrine and norepinephrine

16. Antihyperlipidemics 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

17. Path of Lipid Metabolism

18. Antihyperlipidemics (cont.) • HMG-CoA Reductase Inhibitors • Highly effective for lowering LDL levels • Fibric Acid Derivatives • Highly effective for lowering triglyceride and increasing HDL levels • Bile Acid Sequestrants • Form an insoluble compound with bile salts to reduce serum cholesterol levels • Niacin • Effective at lowering LDL levels and increasing HDLs

19. Chapter 15 Lesson 15.2

20. Learning Objectives • List the general uses and actions of cardiotonic drugs • Explain the actions of different categories of drugs used to treat hypertension • Identify indications for electrolyte replacement

21. Internal Anatomy of the Heart

22. Coronary Arteries

23. Coronary Arteries

24. Cardiotonics 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)

25. 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. • Don’t confuse the sound-alikes digoxin and digitoxin Drug Interactions Nursing Implications and Patient Teaching

26. Antihypertensives, Diuretics, and Other Drugs Affecting the Urinary Tract Diuretics • Indirectly reduce blood pressure by producing sodium and water loss and lowering the tone or rigidity of the arteries • Types • Thiazide and sulfonamide diuretics • Loop diuretics • Potassium-sparing diuretics

27. Antihypertensives, Diuretics, and Other Drugs Affecting the Urinary Tract (cont.) Adrenergic Inhibitors Beta-adrenergic blockers Nonselective; block beta1 and beta2 sites Selective; block beta1 sites Central adrenergic inhibitors Cause vascular relaxation and lower blood pressure Peripheral adrenergic antagonists Limit norepinephrine release, prevent vasoconstriction

28. Antihypertensives, Diuretics, and Other Drugs Affecting the Urinary Tract (cont.) Alpha1-adrenergic inhibitors Lower peripheral resistance and blood pressure Combined alpha- and beta-adrenergic blockers Angiotensin-Related Agents Angiotensin-converting enzyme inhibitors Angiotensin II receptor antagonists Vasodilators Calcium Channel Blocking Agents

29. High Blood Pressure • Stage I: Lifestyle Changes • Stage II: Drug Therapy • Adverse Reactions • Drug specific • Drug Interactions

30. Drugs Useful in Treating Urinary Problems • Urinary incontinence • Treatment: anticholinergics/antispasmodics, alpha-adrenergic agonists, estrogens, cholinergic agonists, and alpha-adrenergic antagonists • Benign prostatic hyperplasia • Treatment: alpha1-adrenergic receptor blockers • Analgesia • Treatment: phenazopyridine