NUR2047 Pharmacology Cardiovascular and Hematopoietic System PDF

NUR2047 Pharmacology Cardiovascular and Hematopoietic System Winsy Wan  Medications for Cardiovascular System A B Anti-hypertension Antianginal drugs drugs C D Drugs for Lipid lowering drugs...

NUR2047 Pharmacology Cardiovascular and Hematopoietic System Winsy Wan  Medications for Cardiovascular System A B Anti-hypertension Antianginal drugs drugs C D Drugs for Lipid lowering drugs Cardiovascular Diseases  Medications for Cardiovascular System E F Anticoagulants Antiplatelets G Thrombolytics  A. Anti-hypertension drugs A1. Beta-blocker A2. Calcium Channel Blocker A3. Diuretics A4. Angiotensin-converting Enzyme Inhibitors (ACE) A5. Angiotensin II Receptor Blockers (ARB) A6. Centrally Acting Antihypertensive Drugs A7. Vasodilators  Hypertension ?? Pressure exerted on blood vessels during contraction & relaxation of the heart Sescribed in terms of mmHg o "systolic blood pressure" (SBP): recorded during contraction of heart o "diastolic blood pressure" (DBP): recorded during relaxation of the heart  Asymptomatic, mild headache  Dangerous high blood pressure (called malignant hypertension) → may cause stroke, Myocardial infarction, kidney damage, etc. A1. Beta-blocker (β受體阻斷劑) beta adrenergic blocking agents block the release of the stress hormones, adrenaline and noradrenaline; resulting in heart rate slowing, and reduces the force blocking kidneys from producing a hormone called angiotensin II, resulting in lower blood pressure https://www.youtube.com/watch?v=uiYJKvwVhEU&t=48s A1. Beta-blocker (β受體阻斷劑) - Examples Generic name Brand name Suffix: -olol = beta-blockers Selective Acebutolol Sectral o Selective beta blockers (B1) - beta Atenolol Tenormin blockers such as Atenolol, and bisoprolol, (B1) Bisoprolol Concor are used more commonly by Metoprolol Betaloc cardiologists Esmolol Brevibloc Bisoprolol + Ziac o Non-selective beta blockers Hydrochlorot (B1,B2) - such as propranolol, hiazide are active in blocking Non-selective beta Labetalol Normodyne adrenaline and noradrenaline in blockers (B1,B2) Trandate other areas of the body, as well Nadolol Corgard as the heart. This can cause Propranolol Inderal some unwanted side effects, including cold hands and a Sotalol Sotacor predisposition to asthma attacks Carvedilol Dilatrend  A1. Beta-blocker (β受體阻斷劑) Side-effect: Tiredness, cold hands and feet, slow heartbeat, diarrhea and nausea, sleep disturbances, nightmares Erectile dysfunction is occasionally a problem for some men Special Nursing alerts: ◆ may trigger asthmatic attack in patients with asthma or chronic bronchitis ◆ symptoms of hypo-glycaemia may be masked in diabetic patients ◆ uncontrolled heart failure, hypotension, certain problems with the rhythm of your heart, or bradycardia A2. Calcium Channel Blockers (鈣離子通道阻斷劑) REDUCE amount of calcium entering cells of the heart and blood vessel walls calcium is necessary to contract the muscular linings of blood vessels Calcium passes into these cells through special pores in the surfaces of these cells called ion channels. These channels are blocked by CCBs, thereby reducing the amount of calcium entering cells of the heart and blood vessel walls. As a result, blood vessels relax and the heart muscle receives more oxygenated blood, which is how CCBs can lower blood pressure and treat angina Some CCBs also block calcium going into the conducting cells in the heart and have the added effect of slowing the heart rate. A2. Calcium Channel Blocker- Examples o Dihydropyridines - act The suffix for calcium channel blockers - Dihydropyridines is “-dipine” predominantly on blood vessels Generic name Brand name to promote vasodilation without having much direct effect on Dihydropyridines Nifedipine Adalat cardiac function di·hy·dro·pyr·i·di ne (DHP) Amlodipine Norvasc o Non-dihydropyridines - less Felodipine Plendil effective in promoting Nimodipine Nimotop vasodilation, but have an additional effect on the heart’s Lercanidipine Zanidip conduction system and can help to control certain fast heart Lacidipine (LO) Lacipil rhythms (such as atrial Non-dihydropyridines Verapamil Isoptin fibrillation) (Non- DHP) Diltiazem Herbesser o both help to relax and widen arteries  A2. Calcium Channel Blocker Side-effect: Flushed face, headaches, dizziness, swollen ankles Dihydropyridines (DHP) - hypotension, reflex tachycardia Non-dihydropyridines(non-DHP) - constipation, bradycardia Special Nursing alerts: ◆ Avoid drinking large quantities of grapefruit juice (Dihydropyridines: Adalat, Norvasc) ◆ Have high fiber diet and drink plenty of fluid to reduce the side effect of constipation A3. Diuretics Examples: Indapamide, Furosemide (Lasix), Spironolactone (Aldactone) Side-effect: Flushed face, headaches, swollen ankles, constipation, dizziness and tiredness Special Nursing alerts: Take it in the morning Hypokalaemia can occur with some diuretics Educate patient measures in preventing postural hypotension Check serum electrolyte, alert for hypokalemia and hyponatremia Educate patient keep accurate records of daily body weights A4. Angiotensin-converting Enzyme (ACE) Inhibitors ACEI reduce blood pressure by relaxing and widening blood vessels Angiotensin II is a potent vasoconstrictor that increases peripheral resistance and promotes secretion of aldosterone, which causes sodium and water retention. Also, a quarter of the blood pumped out in each heartbeat flows through the kidneys, so if your heart becomes less efficient, your kidneys also suffer. Therefore, ACE inhibitors improve kidney, as well as heart Types of ACE inhibitor: perindopril is long-acting and only needs to be taken once a day, whereas captopril is short-acting and needs to be taken three times a day https://www.youtube.com/watch?v=xIlaQuRaZmk&t=17s A4. ACE Inhibitors - Examples Side-effect: o Persistent dry cough (most common), dizziness, Generic name Brand name taste disturbance, rashes SUFFIX: “- pril” Special Nursing alerts: Captopril Capoten Enalapril Renitec o Not suitable during pregnancy Lisinopril Zestril o ACE inhibitors can increase the amount of potassium in your body, so Avoid salt Perindopril Acertil substitutes or potassium supplements Ramipril Tritace o Apart from captopril and perindopril which should be taken BEFORE meals, these medications can be taken before or after meals A5. Angiotensin II Receptor Blockers (ARB) ARBs help relax your blood vessels which lower your blood pressure and makes it easier for your heart to pump blood hormone angiotensin II has a powerful constricting effect on blood vessels, increasing blood pressure. Angiotensin II also stimulates salt and water retention in the body, which further increases blood pressure ARBs work by blocking receptors that the hormone angiotensin II acts on receptors, which are found in the heart, blood vessels and kidneys. Blocking the action of angiotensin II helps to lower blood pressure and prevent damage to the heart and kidneys. A5. Angiotensin II Receptor Blockers (ARB) - Examples Side-effect: o Headache, dizziness Generic name Brand name SUFFIX: “- sartan ” Special Nursing alerts: Candesartan Blopress o Not suitable during pregnancy Irbesartan Aprovel o These medications may raise potassium level in Losartan Cosaar blood. Do NOT use any potassium-containing Telmisartan Micardis medications, supplement or potassium salt Valsartan Diovan substitutes without consulting your doctor o ARB are less likely to have side effects than ACE Inhibitors A6. Centrally Acting Antihypertensive Drugs Alpha2‐adrenergic Agonists act by stimulation of alpha 2 adrenoceptors in the central nervous system which results in a reduction in sympathetic tone and a fall in blood pressure. Examples: Methyldopa (brand name: Aldomet) Side-effect: Headache, postural hypotension Special Nursing alerts: should not drive or operate machinery (dizziness) NO alcohol because this may worsen the side effects rarely caused fatal liver disease or anemia. Alert for s/s. Methyldopa may be used for the management of hypertension in pregnancy A7. Vasodilators used with or without other medications to treat high blood pressure & heart failure Thus, helps prevent strokes, heart attacks, kidney damage It works by relaxing blood vessels so blood can flow through the body more easily Examples: hydralazine (brand name: Apresoline) Side-effect: angina, swelling in arms and legs, flushing, gastrointestinal disorder, headache, joint disorders, muscle pain, nasal congestion, palpitations Special Nursing alerts: Should tell your doctor if you develop symptoms of arthritis, unexplained fever or tiredness  Anti-hypertensive drugs– General advice  Combination with lifestyle modification (diet + regular exercising + quit smoking + less alcohol) for better & lifelong management of HT  often begins with low doses of a single medication. If this medication proves ineffective, a second drug from a different class may be added → Proper education!  Take drugs regularly as instructed, check for drug compliance  NOT drive or operate machinery  Inform your doctor if you are pregnant  Have regular follow-ups as advised by your doctor and discuss with your doctor how to self-monitor your blood pressure at home B. Antianginal drugs drugs B1. Nitrates (硝酸鹽) a. Short-acting nitrates b. Long-acting nitrates B2. Beta-blockers (β受體阻斷劑) B3. Calcium Channel Blockers (鈣離子通道阻斷劑)  Angina ?? 3 types of Details Angina Stable angina The most common type and has a regular pattern. Attacks occur due to an obvious trigger (such as exercise). Rest and medicines usually help. Unstable angina More unpredictable and the most dangerous. Attacks occur WITHOUT any obvious trigger and continue despite resting or medicine. sign that you could have a heart attack soon. If there is a change in your usual pattern of angina and an attack lasts longer than expected, it may be unstable angina. medical emergency and should be admitted under hospital care. Variant angina Rare. Attacks usually occur when you are resting. Medicines can help (Isordil) (Elantan) B1. Nitrates (硝酸鹽) Mechanism of action (MoA): 1. Nitrates NO3- convert to NO2- (nitrite), then convert to NO (nitric oxide) 2. Peripheral vasodilation: reduce blood return to ventricle → reduce preload 3. Reduce preload, less blood to pump out → reduce afterload → reduce cardiac workload 4. Coronary vasodilation  Routes for TNG Medications TNG IV Injection/Infusion TNG Sublingual Spray TNG Sublingual Tablet TNG Transdermal Patch Slow IV infusions: IV TNG 50mg in 50ml (1mg/ml) at 1ml/hour, keep systolic blood pressure > 90mmHg. Patient Instructions – What to DO, when feel angina Assess angina If chest pain If you need to take TNG Sublingual tablet - released 1. Sit or lie down for rest to reduce dizziness 2. Take one TNG tablet under/onto the tongue and allow it to dissolve slowly or take one TNG spray; 3. Wait 5 mins, Still have symptoms? Take another dose (repeat step 2), regardless whether the tablet has fully dissolved or not. If chest pain persists 4. Wait 5 mins, Still have symptoms? Take another dose (repeat step 2), regardless whether the tablet has fully dissolved or not. 5. Wait 5 mins, assess angina symptoms after taken 3 doses Nitrate: Side Effect, Contraindications Contraindication: Hypotension  Alcohol, Erectile dysfunction drugs, e.g. Viagra (Sildenafil) Persistent Nitrates interact with alcohol, Viagra (Sildenafil), Throbbing induce severe hypotension Headache Both erectile dysfunction medications e.g., Viagra Nitrate-induced headache (Sildenafil) and nitrates cause blood vessels to dilate, cause a sharp drop in blood pressure, may lead to cardiovascular collapse and possibly death. Hot, Flushed Face Nitrate: More Special Nursing Alerts/ Cares o Avoid operation of machinery or doing tasks which required high alertness o Caution in SEVERE hepatic and renal impairment o Nitrates increase effects of beta-blockers, diuretics, calcium channel blockers. o Do not cut/crush/chew/swallow the tablet. o Treating acute phrase: Q5 minutes for 3 times if pain continues. No more than 3 tablets in 15 min. o If chest pain persists after 3 doses, seek medical attention immediately. o Store at cool and dry place, protect from light or heat (reduce drug effect) o TNG SL tab: Discard unused tab 8wk after opening. o Report unrelieved chest pain, severe headache. o Replace q3/ q 6 months after the bottle is opened according to drug company. o Teach male patients that erectile dysfunction drugs (e.g., Viagra (Sildenafil) 威而鋼 (偉哥) should not be taken within 24 hours of nitrate administration. How To Apply Glyceryl Trinitrate (TNG) - Transdermal Patch? DO NOT ✓ Clean and dry the skin area before application. (free ꓫ Use patch that is broken or damaged. from lotion, cream…) ꓫ Tough patch‘s stick side with finger(s) – cause severe headache ✓ skin with little or no hair, free of scars, cut or irritation ꓫ Trim or cut the patch. ✓ Change patch at the same time Patch Application Site everyday; Rotate patch sites ✓ Press patch firmly- ensure patch is attached to skin ✓ Take bath, shower and exercise as usual ꓫ Expose the application site to direct source of heat, such as heating pads, electric pads, heated ✓ CAUTION: patch may contain waterbeds and saunas, as heat may speed up the metal. Remove the patch drug release. before MRI scan. ꓫ Apply patch to the same site within 14 days  PRIME Glyceryl Trinitrate Sublingual Spray and its fluids level regularly with reference to patient Information leaflet How To USE TNG Sublingual (SL) Spray? 1. Spray may be used 5 to 10 minutes prior to engaging in activities which might provoke an acute attack. 2. Arrange in a sitting position. 3. DO NOT SHAKE. Remove plastic cover. 4. Hold container upright with forefinger on top of the grooved button. 5. Open mouth and bring the container as close as possible. 6. Hold your breath while pressing down the pump, release the spray ONTO or UNDER the tongue. DO NOT INHALE THE SPRAY. 7. Release button and close mouth. Avoid swallowing immediately after administering the spray. The medication should NOT be expectorated or the mouth rinsed for 5 to 10 minutes following administration. 8. If you require a second administration to obtain relief, repeat steps 4 - 7 If chest pain 9. Replace plastic cover. released o A spray may be repeated approximately every 5 minutes as needed. o No more than three metered sprays are recommended within a 15-minute period. If chest pain 10. Store at 15-30°C persists C. Drugs for Cardiovascular Diseases C1. Anti-dysrhythmics C2. Intropin  C1. Anti-dysrhythmics – Digoxin Generic name Brand name Digoxin Lanoxin Under groups of Cardiac glycosides ⚫ Inhibiting cell membranes from pumping sodium out >> increase amount of sodium stays in cells ⚫ Thus, allow more calcium to build up in cells Indications: ⚫ When cells release the calcium, it creates stronger heart muscle contractions o Heart failure accompanied by atrial fibrillation ⚫ Final, This leads to a higher cardiac output o Chronic heart failure where systolic Actions: dysfunction or ventricular dilatation is ✓ Increase contractility of myocardium/ increase dominant cardiac output (positive inotropic effect) o Certain supraventricular arrhythmias, ✓ Decrease AV conduction and prolong PR interval particularly atrial flutter & fibrillation C1. Anti-dysrhythmics – Digoxin Special Nursing alerts: Side effects: o Monitoring for any slow heart rate, low blood ⚫ Cardiac symptoms: bradycardia, heart pressure, blurred vision block, palpitations o Monitoring on Renal function test (especially ⚫ Neurologic symptoms: e.g., headache, potassium) dizziness, confusion, hallucinations, etc., o Report electrolyte deficit, especially that can be life-threatening hypokalemia (if K