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Chapter 26

Chapter 26. Circulatory System and Blood Disorders. 1. Learning Objectives. Discussing how medications are used for circulatory and blood disorders and the need for patient compliance through education.

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Chapter 26

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  1. Chapter 26 Circulatory System and Blood Disorders 1

  2. Learning Objectives Discussing how medications are used for circulatory and blood disorders and the need for patient compliance through education. Describing use of medications used to relieve stable (exertional) angina and variant (vasospastic) angina. Explaining how cardiotonics are used in coronary disease.

  3. Learning Objectives (cont’d.) Explaining how medications are used to maintain regular and adequate cardiac rhythm. Explaining objectives of antihypertensive therapy, the medications used, and the need for individualization for patient compliance. Describing prevention of atherosclerotic heart disease through use of hypolipidemics and peripheral vasodilators.

  4. Learning Objectives (cont’d.) Discussing role of anticoagulants and their antagonists, thrombolytics, and antiplatelet agents in heart disease. Describing use of hematopoietics and erythropoietics for building blood components. Providing patient education for compliance with medications used to treat diseases and conditions of the circulatory system.

  5. Internal View of the Heart Circulatory System Figure 26-1 Internal view of heart. (From Young AP, Proctor DB: Kinn’s the medical assistant: an applied learning approach, ed 11, St Louis, 2011, Saunders.)

  6. pallor, cyanosis edema syncope unusual sweating nausea, vomiting, anorexia headache anxiety Circulatory Disorders Common Symptoms chest pain dyspnea, tachypnea fatigue, weakness palpitations tachycardia bradycardia

  7. Circulatory MedicationsCommon Side Effects Orthostatic hypotension Urinary frequency Headaches, dizziness, lightheadedness Anorexia Nausea, diarrhea, or constipation Fatigue, weakness Bradycardia

  8. Drugs used for Cardiovascular Disease Cardiac glycosides affect myocardial contractions, slow heart rate. Antidysrhythmics affect cardiac conduction. Calcium channel blockers affect coronary arteries.

  9. Conduction System of the Heart Affected by Antiarrythmic Agents How Drugs Affect the Cardiac Electrical Conduction System Figure 26-3 The heart’s conduction system affected by antiarrhythmic agents. (From Young AP, Proctor DB: Kinn’s the medical assistant: an applied learning approach, ed 11, St Louis, 2011, Saunders.)

  10. Diseases of the Heart and its Vessels Coronary Artery Disease (CAD) Arteriosclerosis Atherosclerosis Figure 26-4 Atherosclerosis and narrowing of artery lumen.

  11. Drugs That Directly Affect the Heart Vasodilators Relax, or dilate, vessels throughout the body Work on veins, arteries, or both

  12. Diseases of the Heart and its Vessels:Angina Pectoris Angina: temporary interference of blood, oxygen, nutrients to heart Stable (exertional) angina: triggered by stress Variant (vasospastic) angina: caused by coronary artery spasms Treatment goal is to reduce number and severity of attacks.

  13. Angina Pectoris Drugs: Nitrates Dilate systemic vessels Reduce cardiac work and oxygen consumption Relieve intense pain during angina attacks May be used to help prevent attacks

  14. Other Drugs for Angina Pectoris Beta-blockers reverse sympathetic heart action caused by exercise, stress, or physical exertion. Calcium channel blockers interfere with the movement of calcium ions through cell membranes.

  15. Patient Education for Medications for Angina Label nitroglycerin sublingual tablets on date of opening Medical evaluation necessary if 3 to 5 tablets do not relieve acute angina Rotate patches daily; do not wear more than 10 to12 hours per day Mouth should be moist to dissolve/absorb sublingual and buccal tablets Do not abruptly discontinue long-acting nitroglycerin

  16. Congestive Heart Failure (CHF) Reduced cardiac output Inefficient contraction of heart ventricles Fluid accumulation in tissues, lungs Weakened heart unable to pump sufficient oxygenated blood throughout body

  17. CHF Medications Vasodilators ACE inhibitors Diuretics reduce edema and blood overload Cardiac glycosides reduce symptoms; used long-term

  18. CHF Medications (cont’d.) Digoxin—narrow therapeutic dose range before causing side effects (nausea, vomiting, fatigue, headaches, slow pulse, visual disturbances) Many drugs interact with digoxin.

  19. Patient Education when Treating CHF Warn patients not to double up on missed doses of digoxin. Switching between brands of digoxin may lead to altered responses. Monitor pulse for rate and rhythm daily prior to taking digoxin. Signs of digitalis toxicity are nausea, vomiting, fatigue, headache, slow pulse, and visual disturbance.

  20. Medications for Treating CHF CHF characterized by ventricular dysfunction, inadequate exchange in the tissues, overload of fluid in tissues Therapy goals: relieve pulmonary and peripheral edema, increase quality of life, and prolong life Diuretics and ACE inhibitors are used with cardiac glycosides

  21. Digitalis in Treating CHF Digoxin may increase cardiac output, decrease heart rate and heart size, decrease vasoconstriction, reverse water retention, decrease blood volume, weight, pulmonary and peripheral edema, and increase exercise tolerance. Digoxin lowers pulse rate and has a narrow therapeutic dose range before causing adverse reactions. Digitalization is done when quick therapeutic levels are needed.

  22. Dysrhythmias Deviation from normal heart rhythm Alteration of cardiac electrical impulses Contributors: chronic drug therapy; heart disease; electrolyte imbalance; cardiac conduction abnormalities; thyroid disease May have mild or severe effect on cardiac output

  23. Class I: bind to sodium channels, slow impulse conduction Class II: beta-adrenergic blockers: increase heart rate, excitability, conduction velocity, automaticity Class III: interfere with potassium outflow, prolong potential contraction duration Class IV: calcium channel blockers: decrease entry of calcium into heart and blood vessel cells Antidysrhythmia

  24. Common Cardiac Antidysrhythmics Class I quinidine procainamide Norpace Dilantin Class II Inderal Sectral Class III • Cordarone • Betapace • Tikosyn Class IV • Calan, Isoptin • Cardizem • Tiazac

  25. Treating Dysrhythmia Control rhythm by correcting or compensating for altered rhythm Treatment of supravasculartachycardiacdysrhythmia: block impulse conduction at the AV node Treatment of ventricular dysrhythmia: eliminate abnormal rhythm Antidisrhythmics can worsen existing conditions and generate new rhythm disorders Class I medications block sodium channels, slow conduction

  26. Treating Dysrhythmia (cont’d.) Quinidine blocks sodium channels, delays ventricular repolarization. Many Class II medications are beta-blockers that decrease sinoatrialautomacity, atrioventricular velocity, and myocardial contractility; similar to Class IV. The effects of proprandol and calcium channel blockers are nearly identical. Class III medications block potassium channels, prolong ventricular repolarization.

  27. Hypertension Prehypertension – blood pressure of 120 to139/80 to 89 high blood pressure (greater than 140/90 mm Hg) for extended period chronic condition, often no apparent cause known as the “silent killer”

  28. Categories of Antihypertensive Medications Diuretics Adrenergic inhibiting agents Centrally acting Peripherally acting ACE inhibitors Angiotensin II receptor antagonists Vasodilators

  29. Hypertension and Lifestyle Lifestyle Modifications to Treat Hypertension Figure 26-5 For treatment of hypertension, striving for multidisciplinary lifestyle modifications is necessary.

  30. Beta Blockers Sectral Tenormin Kerlone Zebeta Cartrol Lopressor Corgard Levatol Visken Inderal Blocadren Common Antihypertensives Diuretics Lasix Demadex Edecrin Bumex HCTZ Hygroton Lozol Midamor Aldactone HCTZ plus other antihypertensive/diuretic for combination medications

  31. Adding Medications Treatment Program for Hypertension Figure 26-6 Typical treatment of hypertension.

  32. Diuretics Kidney Nephron and Diuretics Figure 26-7 Action of kidney nephron and its relationship to diuretics.

  33. Patient Education with Diuretics Sip water or chew gum to relieve dry mouth. Take once-a-day medications in the morning, twice-a-day medications at 8 a.m. and 2 p.m. May cause postural hypotension; change position slowly. Keep track of weight while taking medications. Patients with diabetes should test blood more frequently. Drink adequate fluids.

  34. Diuretics in Treatment of Hypertension Management may involve lifestyle changes. Most diuretics block active reabsorption of sodium and chloride, which prevents reabsorption of water. Drugs that act early on the nephron create the most diuresis by blocking the most water reabsorption. Thiazide diuretics and loop diuretics reduce blood pressure by reducing blood volume and lowering arterial resistance.

  35. Common Antihypertensives Alpha/Beta-Blockers Normodyne Centrally Acting Blockers Catapres Wytensin Tenex Aldomet Peripherally Acting Blockers • Cardura • Hylorel • Ismelin • Minipress • Serpalan • Hytrin

  36. Common Antihypertensives Angiotension II Receptor Antagonists Cozaar Diovan Avapro Vasodilators Apresoline Loniten ACE Inhibitors • Lotensin • Capoten • Vasotec • Monopril • Prinivil, Zestril • Univasc • Accupril • Altace • Aceon

  37. Calcium Channel Blockers Norvasc Lotrel Cardizem, Tiazac Plendil DynaCirc Common Antihypertensives • Posicor • Cardene • Procardia, Adalat • Sular • Calan, Isoptin

  38. Patient Education with Antihypertensives Lifelong medications; control, not cure Patients should report signs of peripheral edema when taking calcium channel blockers Might cause drowsiness, dizziness, or lightheadedness

  39. Review of Antihypertensives Treatment requires lifestyle changes, lifelong medications. Vasodilators and calcium channel blockers promote dilation of arterioles. Beta-blockers, diuretics preferred for initial treatment. When combinations are used, each drug should have different action. ACE inhibitors: treat hypertension, CHF, and MI. Calcium channel blockers: cause vasodilatation; have similar therapeutic effect as beta-blockers.

  40. Peripheral Vascular Disease cold, numb extremities intermittent claudication (pain in calves of legs on exercise) ulcers common among elderly persons caused by atherosclerosis or hyperlipidemia treated with hemorrheologic agents

  41. Hyperlipidemia increased concentrations of cholesterol, triglycerides atherosclerosis: fatty plaque deposits in artery linings obstructs blood flow, leads to coronary artery disease requires periodic cholesterol (HDL, LDL) testing Make diet and lifestyle changes before using hypolipidemics.

  42. Common Hypolipidemics Statins Lipitor Lescol Mevacor Pravachol Zocor Bile Acid-Binding Renin • Questran, Prevalite • Colestid Miscellaneous • Nicobid, Niacor • Lopid • Atromid-S • Choloxin • Zetia

  43. Patient Education with Hypolipidemics Diet modifications should be carefully followed before using hypolipidemics. Cholestyramine powder must be mixed with 4 to 6 ounces of water or noncarbonated beverage. Colestipol granules will not dissolve and should be mixed with thicker liquids for ingestion.

  44. Review of Hypolipidemics Lipoproteins transport lipids in the blood. LDLs transport cholesterol to peripheral tissue; HDLs transport cholesterol to the liver. Diet modification is primary method for reducing LDL. Statins are most effective drugs for lowering LDL. Bile acid-binding resins prevent the reabsorption of bile acids in the intestines; may have GI side effects. Oral medications should be given 1 hour before or 4 hours after bile acid-binding resins.

  45. Coagulation Blood clot formation prevents excessive blood loss from wounds or surgery. Platelet plugs followed by coagulation results in hemostasis, stoppage of blood flow. Thromboembolism occurs if blood clot or undissolved matter forms in blood vessel, blocking blood flow.

  46. Common Anticoagulants Heparin administered parenterally Warfarin (Coumadin) administered orally

  47. Patient Teaching with Anticoagulants Avoid injury by using a soft toothbrush, electric razor Regularly evaluate Prothrombin levels when on anticoagulant therapy

  48. Other Medications Affecting Coagulation Antiplatelet drugs: suppress clumping of platelets in arteries Thrombolytics: dissolve clots already formed Topical hemostatics: gelatin or cellulose sponges that absorb excess blood and fluids

  49. Review of Use of Anticoagulants Hemostasis occurs with the formation of the platelet plug followed by coagulation. Anticoagulants help prevent venous thrombi; antiplatelet drugs help prevent arterial thrombi. Heparin is administered intramuscularly or deep subcutaneously. Warfarin is the prototype for oral anticoagulants.

  50. Hamtopoeitcs/Erythropoeitics Hematopoeitics – used to increase the level of white blood cells by stimulating the bone marrow to make more leukocytes Erythropoeitics – used to force the bone marrow to make more red blood cells by stimulating the production of erythrocytes Reduce the need for blood transfusion following hyemodialysis Treat anemias Administered parenterally

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