DRUGS FOR CARDIOVASCULAR SYSTEMC35-36

INTRODUCTION

Coronary Heart Disease (CHD ) Largest killer of men and women in USA 2500 deaths per day Although numbers are high, death rate has

decreased by 36% from 1999 to 2005. R/O CHD increases as cholesterol increases Antihyperlipidemic & Cholesterol lowering

drugs to treat

RISK FACTORS FOR HEART DISEASE

Can’t Control Age Gender Family history (genetics)

Can Control Diet Weight activity

INTRODUCTION CON’T

Hypertension=>140/90 Untreated hypertension can lead to

cardiovascular problems as well as renal and respiratory problems

Early treatment reduces risk Antihypertensive drugs to treat

INTRODUCTION CON’T

Coronary Artery Disease (CAD), Peripheral Vascular Disease (PVD), Cerebral Vascular Disease (CVD)

All caused by narrowing of arteries (plaque) Result in pain when tissues are denied

oxygen Antianginal Drugs used to treat

INTRODUCTION CON’T

Blockage of vessels by blood clots can occur Can cause heart attack (MI) or Stroke Anticoagulants, antiplatelets or thrombolytics

to treat

INTRODUCTION CON’T

Heart Failure (CHF) Heart fails as a pump Higher risk over 65, Obese, & African

Americans Most common cause of hospitalization in

Americans over 65 Ace Inhibitors first drug of choice Also Cardiotonic & Inotropic drugs

INTRODUCTION CON’T

Conduction disorders: Cardiac arrhythmias Abnormally slow or rapid heart rates Irregular heart beats Antiarrhythmic drugs to treat

ANTIHYPERLIPIDEMIC

Lipids: group of fats in blood. Cholesterol and triglycerides are two lipids in

the blood Levels of cholesterol above 240 and

triglycerides above 150 associated with atherosclerosis

Atherosclerosis=condition of plaque formation (lipid deposits) in lining of blood vessels. Causes narrowing of vessel

Ateriosclerosis=thickening and loss of elasticity of the arteries (hardening of the arteries)

ANTIHYPERLIPIDEMICS CON’T

High triglycerides may be forerunner to diabetes

Triglycerides and cholesterol travel throughout body bound to a lipoprotein.

LDL==bad cholesterol HD==good cholesterol LDL cholesterol is diverse…. All through body.

When cells have all the cholesterol they need, excess is discarded into blood. (results in plaques—atherosclerosis)

HDL—transport cholesterol to liver where metabolized and excreted. Good cholesterol, more condensed

ANTIHYPERLIPIDEMICS CON’T

Higher the HDL, lower risk of atherosclerosis Lab test: lipid profile—

Total cholesterol (<200 optimal) LDL (< 100 optimal) HDL (60) Triglycerides (<150)

Therapeutic lifestyle changes (TLC) Low cholesterol diet Quit smoking Weight management 30 min physical activity/day

STATINS

Action: Inhibit manufacture of, or increase breakdown of cholesterollower cholesterol levels

USE: Hyperlipidemia Prevent coronary events Slow progression of atherosclerosis Reduce death from stroke, MI

STATINS

Side Effect: Mild Headache GI

CI: Serious liver disorder Use cautiously in alcholism

Drug Names Lipitor (atorvastatin) Prevachol (prevastatin) Crestor(rosuvastatin) Zocor (simvastatin)

BILE ACID RESINS

Bile is produced in liver Stored in gallbladder Emulsifies (breaks down) fats for ease of

absorption into intestine

Action: bile acid resins bind to bile acid to make

them “insoluble”—can’t be absorbed into intestine and systemically. Instead: secreted in feces….thereby decreasing cholesterol levels

BILE ACID RESINS

Use: Hyperlipidemia

Side effects GI Constipation Cramps Nausea

CI: Biliary obstruction

Drug Names Questran (cholestyramine)

OTHER ANTIHYPERLIPIDEMICS

Action: increase breakdown of LDL’sdecrease cholesterol

Use: Hyperlipidemia

Side effects:GI upset

Lopid (gemfibrozil)Zetia (ezetimibe)

NURSING PROCESS

Constipation r/t medication

Cholesterol levels and liver function studies Ongoing assessment of lab values 6 weeks to

6 months Assess bowel function Bile acid resins may interfere with fat-soluble

vitamins (A,D,E,K) and folic acid Avoid grapefruit juice in large amounts ( may

increase risk of toxicity

ANTIHYPERTENSIVES

Hypertension—causes heart to work too hard, and contributes to atherosclerosis

Increases r/o heart failure, heart disease, stroke, kidney disease

Primary Hypertension: no known cause Linked to risk factors of diet and lifestyle

Secondary Hypertension: Known Cause Kidney disease Tumor of adrenal glands

ANTIHYPERTENSIVES

Treatment of hypertension Weight loss Stress reduction Exercise Smoking cessation Reduction of Alcohol consumption Dietary changes Drug therapy

See p 329 in textbook

ANTIHYPERTENSIVES

Drug therapy Diuretics Beta adrenergic blockers (Beta blockers) Calcium channel blockers Other antihypertensives

ANTIHYPERTENSIVES

Actions: adrenergic blockers, calcium channel blockers, vasodilators Lower bp by vasodilaing arterial blood vessels Creates increase in lumen Allows blood to circulate

DIURETICS: Act by increasing excretion of sodium Ace Inhibitors act by suppressing the renin-

angiotensin-aldosterone system

USE: treatment of hypertension

ANTIHYPERTENSIVES

Side Effects: Dizziness Hypotension (orthostatic)