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Chapter 15Chapter 15

Cardiovascular and Renal Medications

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Chapter 15

Lesson 15.1

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Learning ObjectivesLearning 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

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Cardiovascular System: Major Arteries

Cardiovascular System: Major Arteries

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Cardiovascular System: Major Veins

Cardiovascular System: Major Veins

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Urinary SystemUrinary System

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Antianginals and Peripheral Vasodilators

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

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Main Components of Microcirculation

Main Components of Microcirculation

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Antianginals and Peripheral Vasodilators (cont.)

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

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Site of Action of Peripheral Vasodilators

Site of Action of Peripheral Vasodilators

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Antianginals and Peripheral Vasodilators (cont.)

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

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AntidysrhythmicsAntidysrhythmics

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

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Conduction System of the Heart

Conduction System of the Heart

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Antidysrhythmics (cont.)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

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Antidysrhythmics (cont.)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

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AntihyperlipidemicsAntihyperlipidemics

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

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Path of Lipid MetabolismPath of Lipid Metabolism

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Antihyperlipidemics (cont.)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

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Chapter 15

Lesson 15.2

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Learning ObjectivesLearning 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

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Internal Anatomy of the HeartInternal Anatomy of the Heart

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Coronary ArteriesCoronary Arteries

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Coronary ArteriesCoronary Arteries

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CardiotonicsCardiotonics

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)

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Cardiotonics (cont.)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

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Antihypertensives, Diuretics, and Other Drugs Affecting the Urinary Tract

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

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Antihypertensives, Diuretics, and Other Drugs Affecting the Urinary Tract (cont.)Antihypertensives, Diuretics, and Other Drugs Affecting the Urinary Tract (cont.)

Adrenergic InhibitorsBeta-adrenergic blockers

Nonselective; block beta1 and beta2 sites

Selective; block beta1 sites

Central adrenergic inhibitorsCause vascular relaxation and lower blood pressure

Peripheral adrenergic antagonistsLimit norepinephrine release, prevent vasoconstriction

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Antihypertensives, Diuretics, and Other Drugs Affecting the Urinary Tract (cont.)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 AgentsAngiotensin-converting enzyme inhibitors

Angiotensin II receptor antagonists

Vasodilators

Calcium Channel Blocking Agents

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High Blood PressureHigh Blood Pressure

• Stage I: Lifestyle Changes

• Stage II: Drug Therapy

• Adverse Reactions– Drug specific

• Drug Interactions

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Drugs Useful in Treating Urinary Problems

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