Pharmacology for Pharmacy Technicians, 4th Ed PDF

Pharmacology for Pharmacy Technicians, 4th Ed by Kathy Moscou PhD RPh MPH and Karen Snipe CPhT AS BA MEd 1  Chapter 19 Treatment of Heart Disease and Stroke 2  Lesson 24.1 Treatment...

Pharmacology for Pharmacy Technicians, 4th Ed by Kathy Moscou PhD RPh MPH and Karen Snipe CPhT AS BA MEd 1  Chapter 19 Treatment of Heart Disease and Stroke 2  Lesson 24.1 Treatment of Heart Disease and Stroke 1. Learn the terminology associated with heart failure, myocardial infarction, and stroke. 2. List the risk factors for heart failure, myocardial infarction, and stroke. 3. List the symptoms of heart failure, myocardial infarction, and stroke. 4. List and categorize medications used to treat heart failure, myocardial infarction, stroke, and hyperlipidemia. 5. Describe mechanism of action for each class of drugs used to treat heart failure, myocardial infarction, stroke, and hyperlipidemia. 6. Identify warning labels and precautionary messages associated with medications used to treat heart failure, myocardial infarction, stroke, and hyperlipidemia. 3  Key Terms Anticoagulant, Antithrombotic, Atherothrombos Antiplatelet Atherosclerosis is Automaticity Cholesterol HDL, Ejection Hyperlipidemia, Myocardial Fraction Heart Failure Ischemia Infarction LDL, triglycerides Tissue Natriuretic PTT, Plaque, Prothrombin plasminogen peptides Platelets Time Thrombolytic activator Transient ischemic attack 4  Heart Diseases Heart failure- heart is unable to pump blood at a rate necessary to meet the body's metabolic needs MI (Heart attack)- sudden loss of blood supply in the heart causing damage to the heart muscle Angina- chest pain or discomfort caused by a temporary disruption in the flow of blood and oxygen to the heart. May be a sign of MI Stroke- brain cells are deprived of oxygen or are damaged by sudden bleeding into the brain. 5  Heart Failure Overview (1 of 2) Kidney dysfunction Diabetes Ischemic heart disease Hypertension Hypothyroidism Hyperthyroidism Bradyarrhythmia and tachyarrhythmia Pulmonary embolism HIV/AIDS Myocardial infarction 6  Heart Failure Overview (2 of 2) Lifestyle: Excessive salt consumption Excessive alcohol consumption Lack of physical activity NSAIDs: Worsen edema Interfere with the effect of drugs used to treat heart failure 7 Pathophysiology of Heart Failure (1 of 3) Left-sided heart failure: Unable to effectively pump sufficient blood to the rest of the body = ↓ EF EF - the percentage of blood ejected from the left ventricle with each heartbeat. Reduces volume of oxygen and nutrient- rich blood pumped from left ventricle to body Fluids back up, causing pulmonary edema and shortness of breath Right-sided heart failure: Reduces capacity of heart to pump blood to lungs Produces swelling in legs and ankles and feeling of being fatigued Fluid accumulation can result in weight gain and increased urination 8  Pathophysiology of Heart Failure (2 of 3) Left sided heart failure can be of two types: Systolic heart failure: Ventricular contractions reduced Stroke volume and cardiac output reduced EF reduced Diastolic heart failure: The left ventricle loses its ability to relax normally because the muscle has become stiff Stroke volume and cardiac output reduced EF preserved Fatigue, Dyspnea, Pulmonary hypertension 9  Pathophysiology of Heart Failure (3 of 3) Compensatory mechanisms: Renin–aldosterone–angiotensin system activated Increase in blood volume and cardiac output Chronic sympathetic nervous system increases heart rate Natriuretic peptides released: Atrial natriuretic peptide and brain natriuretic peptide promote sodium and water elimination, vasodilation, and diastolic relaxation 10  Drugs Used to Treat Heart Failure Cardioglycosides Diuretics Aldosterone antagonists Beta blockers ACE inhibitors Angiotensin II receptor blockers HMG CoA reductase inhibitors Vasodilators 11  Cardioglycosides Digoxin: Only commercially available cardioglycoside Capsules, tablets, elixir, and parenteral solution Derived from foxglove plant Reduces hospitalization, improves exercise tolerance, does not increase patient survival 12  Cardioglycosides: MOA Digoxin: Positive inotropic effect on the heart Increases the force of myocardial contractions Increases cardiac output Decreases compensatory sympathetic activity 13  Cardioglycosides: Adverse Effects Digoxin: Diarrhea Constipation Nausea and vomiting Fatigue Weakness Visual disturbances (altered color perception, hazy vision) Photophobia Impotence Gynecomastia 14 Poll Question 15  Digoxin toxicity Narrow therapeutic index Signs of digitalis toxicity Arrhythmia Dizziness Headache Convulsions Delusions Coma 16  Warning Labels: Cardioglycosides Warning for digoxin: Take as directed; don’t skip or exceed dosage If you miss a dose, take it as soon as you remember unless the next dose is scheduled to be taken in fewer than 12 hours 17  Diuretics: Info and MOA Treat volume overload Reduce blood pressure Reduce pulmonary edema and peripheral swelling 18  Aldosterone Antagonists: Info and MOA Decrease Na+ and water levels Increased K+ levels Adjunct therapy for hypertension and congestive heart failure 19  Beta Blockers: Info and MOA Block excess sympathetic stimulation induced by heart failure Reduce heart rate Lower peripheral arterial resistance Decrease cardiac workload Reduce left ventricular hypertrophy 20  Beta Blockers: Adverse Effects Dizziness Fatigue Bradycardia Hypotension Impotence Heart block Palpitations 21  ACEi, ARBs, HMG CoA Reductase Inhibitors and Vasodilators ACE Inhibitors and ARBs Shown to reduce mortality Reduce left ventricular hypertrophy , improve diastolic filling, increase cardiac output and reduce peripheral vascular resistance ARBs improve exercise tolerance and diastolic filling in patients with HF HMG CoA reductase inhibitors (statins): Reduce inflammation caused by heart failure Vasodilators: Reduce peripheral resistance, cardiac preload, and cardiac afterload 22 Poll Question 23  Lifestyle Modifications Follow a diet low in salt. Limit the amount of fluids that you drink. Increase physical activity. Lose weight if you are overweight. Quit smoking if you smoke. Limit alcohol consumption. 24  Stroke Overview Third leading cause of death in the United States Stroke – blood supply to brain is interrupted Myocardial infarction- blood supply to heart is interrupted. Transient ischemic attack: ministroke 25% of patients have second stroke within 5 years of the first 25  Types of Stroke Ischemic Thrombotic Embolic Hemorrhagic Transient ischemic attack 26 Stroke 27  Symptoms of Stroke (1 of 3) Limbs: Numbness or weakness of arms and legs Difficulty walking Loss of balance or coordination 28  Symptoms of Stroke (2 of 3) EENT: Facial numbness or weakness Impaired speech Impaired vision 29  Symptoms of Stroke (3 of 3) Cognitive: Confusion Difficulty understanding speech Other: Dizziness Severe headache 30 Symptoms of Myocardial Infarction 31 Pathophysiology of Stroke and Myocardial Infarction Blood supply to brain / heart is interrupted Damage and death to cells Atherosclerosis Atherothrombosis 32  Risk Factors for Stroke and Myocardial Infarction Nonmodifiable: Age, gender, and family history Modifiable: Lifestyle Hypertension Atrial fibrillation High cholesterol Infection 33  Treatment of Stroke and Myocardial Infarction Clots that form in arteries may dislodge and obstruct the supply of blood and oxygen to the brain or heart. Drugs that control hemostasis- process of stopping the flow of blood Treatment of Stroke and MI involves Prevention of clot formation Dissolution of clots Antiplatelets – agents that inhibit platelets Anticoagulants - lessen coagulation Fibrinolytic agents - dissolve existing clots 34 Drugs That Control Hemostasis: Antiplatelet drugs Aspirin Clopidogrel Dipyridamole Ticlopidine Abciximab Eptifibatide Tirofiban 35  Antiplatelet Drugs: MOA (1 of 2) Aspirin: Blocks enzyme cyclooxygenase Reduces plaque formation Inhibits platelet aggregation Glycoprotein IIb/IIIa inhibitors: Blocks final pathway of platelet aggregation 36  Antiplatelet Drugs: MOA (2 of 2) Ticlopidine and clopidogrel: Interfere with platelet adhesion and aggregation Decrease concentration of fibrinogen Dipyridamole: Inhibits platelet aggregation Coronary vasodilator 37  Antiplatelet Drugs: Adverse Reactions Bleeding Skin rash or itching Stomach pain Pain at the injection site (abciximab) Difficulty breathing Dizziness Weakness Joint pain Bone-marrow toxicity 38  Drugs That Control Hemostasis: Anticoagulants Warfarin Dalteparin Enoxaparin Heparin Tinzaparin Fondaparinux Argatroban Dabigatran 39  Anticoagulants: MOA Increase activity of antithrombin III Inhibit common pathway of clotting factors Xa and IIa Prevent clot formation Warfarin: Interferes with formation of vitamin K–dependent clotting factors 40  Anticoagulants: Adverse Reactions Fever Difficulty breathing Dizziness or fainting Irritation or bleeding at injection site Rash or red spots on skin, itching, bruising Pain in back or stomach; cold, painful hands and feet Bleeding gums or in eye, nosebleeds, heavy menstrual bleeding, coughing up blood 41  Drugs That Control Hemostasis: Thrombolytics/fibrinolytics Alteplase Reteplase Tenecteplase 42  Thrombolytics: MOA Increase activity of plasmin Dissolve blood clots Work rapidly 43  Thrombolytics: Adverse Reactions Nausea Vomiting Hypotension Transient arrhythmia Allergic reaction Fever Bruising and bleeding in GI tract, genitourinary tract, mouth, gums, and brain 44  Drugs That Treat Hyperlipidemia HMG CoA reductase inhibitors Atorvastatin Fluvastatin Lovastatin Pravastatin Rosuvastatin Simvastatin Pitavastatin 45  HMG CoA Reductase Inhibitors: MOA Interfere with steps in lipid metabolism pathway Reduce LDL and triglyceride levels HMG CoA inhibitors: Increase LDL clearance 46 HMG CoA Reductase Inhibitors: Adverse Reactions Diarrhea Gas Headache Joint pain Nausea and vomiting Stomach pain Tiredness Myositis Liver dysfunction Rhabdomyolysis 47  Look-Alike/Sound-Alike Drugs that Control Hemostasis Plavix and Paxil Ticlid and Tequin Lovenox, Lanoxin, Avonex, Luvox, Levaquin, and Lotronex Coumadin, Cardura, Cordarone, Kemadrin, and Ambien Activase and Altace 48  Common Endings Common endings for thrombolytic drugs are “-plase” and “- kinase” All HMG CoA inhibitors have the common ending “-statin” 49  Fibric Acid Derivatives, Bile Acid Sequestrants, and Nicotinic Acid Derivatives Fibric acid derivatives: Gemfibrozil, fenofibric acid, fenofibrate Bile acid sequestrants: Cholestyramine, colesevelam, colestipol, ezetimibe Nicotinic acid derivative: Niacin 50  Fibric Acid Derivatives, Bile Acid Sequestrants, and Nicotinic Acid Derivatives: MOA Fibric acid derivatives: Increase clearance of VLDL Bile acid sequestrants: Lower body levels of fat-soluble vitamins such as A, D, E, and K Promote intestinal clearance of cholesterol Nicotinic acid derivatives: Lipid-lowering agent and increases HDL 51  Look-Alike/Sound-Alike Drugs Atorvastatin and pravastatin Lipitor and Zocor Fluvastatin and fluoxetine Lovastatin and Lotensin Lopid, Levbid, Lorabid, and Slo-bid 52  Warning Labels: Antiplatelet Drugs (1 of 2) Do not shake Avoid aspirin, nsaids, and other OTC without supervision Refrigerate at 2° to 8° C. Do not freeze (abciximab, eptifibatide, tirofiban) Stable at room temperature for 24 hours; discard diluted solutions within 24 hours (eptifibatide, tirofiban) 53  Warning Labels: Antiplatelet Drugs (2 of 2) Take on an empty stomach (clopidogrel, dipyridamole) Take with a full glass of water (dipyridamole) Report signs of bleeding (ticlopidine) Take with food (aspirin and ticlopidine) Avoid pregnancy (3rd trimester) (aspirin) 54  Warning Labels: Thrombolytics Refrigerate reconstituted solution (2° to 8° C) Stable for 24 hours after reconstitution (under refrigeration) Do not shake 55  Warning Labels: Drugs That Treat Hyperlipidemia Avoid grapefruit juice Avoid alcohol Avoid pregnancy Swallow whole; don’t chew (extended release) 56  Warning Labels: Fibric Acid Derivatives May cause drowsiness Avoid prolonged exposure to sunlight Take on an empty stomach (gemfibrozil) 57  Warning Labels: Bile Acid Sequestrants Take 1 hour before or 4 hours after other drugs Reconstitute with 2 to 6 ounces liquid—shake well Swallow whole (colesevelam) Take with 1/2 glass water and food (colesevelam) 58  Warning Labels: Nicotinic Acid Derivatives Avoid alcohol (niacin) Take with food (niacin) 59 Questions? 60