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Transcript of Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 1...

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Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 1 Chapter 15 Cardiovascular and Renal Medications Slide 2 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 2 Chapter 15 Lesson 15.1 Slide 3 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 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 Slide 4 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 4 Cardiovascular System: Major Arteries Slide 5 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 5 Cardiovascular System: Major Veins Slide 6 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 6 Urinary System Slide 7 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 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 Slide 8 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 8 Main Components of Microcirculation Slide 9 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 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 Slide 10 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 10 Site of Action of Peripheral Vasodilators Slide 11 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 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 Slide 12 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 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 Slide 13 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 13 Conduction System of the Heart Slide 14 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 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 Slide 15 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 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 Slide 16 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 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 Slide 17 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 17 Path of Lipid Metabolism Slide 18 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 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 Slide 19 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 19 Chapter 15 Lesson 15.2 Slide 20 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 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 Slide 21 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 21 Internal Anatomy of the Heart Slide 22 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 22 Coronary Arteries Slide 23 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 23 Coronary Arteries Slide 24 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 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) Slide 25 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 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. Dont confuse the sound-alikes digoxin and digitoxin Drug Interactions Nursing Implications and Patient Teaching Slide 26 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 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 Slide 27 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 27 Antihypertensives, Diuretics, and Other Drugs Affecting the Urinary Tract (cont.) Adrenergic Inhibitors Beta-adrenergic blockers Nonselective; block beta 1 and beta 2 sites Selective; block beta 1 sites Central adrenergic inhibitors Cause vascular relaxation and lower blood pressure Peripheral adrenergic antagonists Limit norepinephrine release, prevent vasoconstriction Slide 28 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 28 Antihypertensives, Diuretics, and Other Drugs Affecting the Urinary Tract (cont.) Alpha 1 -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 Slide 29 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 29 High Blood Pressure Stage I: Lifestyle Changes Stage II: Drug Therapy Adverse Reactions Drug specific Drug Interactions Slide 30 Elsevier items and derived items 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 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