PHAR 370 Module 04: Cardiovascular and Respiratory Systems PDF

PHAR 370 FUNDAMENTALS OF PHARMACOLOGY AND THERAPEUTICS MODULE 04 Pharmacology of the Cardiovascular and Respiratory Systems Please note: This course was designed to be interacted and engaged with using the online modules....

PHAR 370 FUNDAMENTALS OF PHARMACOLOGY AND THERAPEUTICS MODULE 04 Pharmacology of the Cardiovascular and Respiratory Systems Please note: This course was designed to be interacted and engaged with using the online modules. This Module Companion Guide is a resource created to complement the online slides. If there is a discrepancy between this guide and the online module, please refer to the module. How can you help protect the integrity and quality of your Queen’s University course? Do not distribute this Module Companion Guide to any students who are not enrolled in PHAR 370 as it is a direct violation of the Academic Integrity Policy of Queen’s University. Students found in violation can face sanctions. For more information, please visit https://www.queensu.ca/academic- calendar/health-sciences/bhsc/. MODULE 04 COMPANION GUIDE PHAR 370 TABLE OF CONTENTS INTRODUCTION..................................................................................................................................................... 7 Learning Outcomes........................................................................................................................................... 7 Course Icons...................................................................................................................................................... 7 Module Assignments........................................................................................................................................ 8 Module Outline.................................................................................................................................................. 8 SECTION 01: Drugs for the Treatment of Hypertension................................................................................... 9 Introduction to Hypertension.......................................................................................................................... 9 Controlling Blood Pressure.............................................................................................................................. 9 What is Normal Blood Pressure?...................................................................................................................10 Regulation of Blood Pressure........................................................................................................................10 Arterial Blood Pressure..................................................................................................................................11 Video: Regulation of Blood Pressure............................................................................................................11 Classification of Hypertension.......................................................................................................................11 Types of Hypertension....................................................................................................................................12 How Can Hypertension be Controlled?........................................................................................................12 Classes of Antihypertensive Agents..............................................................................................................13 Drugs That Alter Sodium and Water Balance..........................................................................................13 Diuretics.......................................................................................................................................................14 Major Classes of Diuretics..........................................................................................................................14 Loop Diuretics.........................................................................................................................................15 Thiazide Diuretics....................................................................................................................................15 Potassium Sparing Diuretics..................................................................................................................16 Video: Classes of Diuretics.........................................................................................................................17 Question: Diuretics Case Study.................................................................................................................17 Drugs That Decrease Sympathetic Nervous System Activity.................................................................18 Β1 Blockers..................................................................................................................................................18 Alpha Blockers.............................................................................................................................................18 Vasodilators.................................................................................................................................................19 Vascular Smooth Muscle Contraction......................................................................................................19 Drugs Modifying The Renin-Angiotensin System....................................................................................20 RAS and Antihypertensive Therapy...........................................................................................................20 ACE Inhibitors...........................................................................................................................................20 Clinical Use and Adverse Effects Of Ace Inhibitors.............................................................................20 PAGE 2 MODULE 04 COMPANION GUIDE PHAR 370 Angiotensin Receptor Blocking Drugs (ARBS).......................................................................................21 Video: Drugs Modifying The Renin-Angiotensin System........................................................................21 Choice of Antihypertensive Drug...................................................................................................................22 Question 1 of 4: Choice of Antihypertensive Drug......................................................................................22 Question 2 of 4: Choice of Antihypertensive Drug......................................................................................23 Question 3 of 4: Choice of Antihypertensive Drug......................................................................................23 Question 4 of 4: Choice of Antihypertensive Drug......................................................................................23 Question 1 of 1: Clinical Application: Hypertension....................................................................................24 Answer 1 of 1: Clinical Application: Hypertension Feedback.....................................................................24 Compliance With Therapy..............................................................................................................................24 Conclusion........................................................................................................................................................25 Question 1 of 2: End of Section Quiz............................................................................................................25 Question 2 of 2: End of Section Quiz............................................................................................................25 SECTION 02: Drugs for the Treatment of Angina and Heart Failure.............................................................27 Introduction to Coronary Artery Disease.....................................................................................................27 Angina Pectoris................................................................................................................................................27 Types of Angina Pectoris................................................................................................................................27 Classes of Drugs that Treat Angina...............................................................................................................28 Organic Nitrates: Nitroglycerin......................................................................................................................28 Mechanism of Nitroglycerin...........................................................................................................................29 Video: Mechanism of Action of Nitroglycerin...............................................................................................29 Sublingual Nitroglycerin.................................................................................................................................30 Transdermal GTN and Tolerance...................................................................................................................30 Tolerance of GTN.........................................................................................................................................30 Therapeutic Uses of GTN................................................................................................................................31 Question 1 of 1: Nitroglycerin........................................................................................................................31 Antianginal Drugs: β Blockers........................................................................................................................32 Antianginal Drugs: Calcium Channel Blocking Drugs..................................................................................32 Video: Drugs Used to Treat Angina...............................................................................................................33 Question 1 of 1: Mechanisms of Antianginal Drugs....................................................................................33 Development of Heart Failure.......................................................................................................................33 Compensation for Heart Failure....................................................................................................................34 Mechanisms of Heart Failure.........................................................................................................................34 Goals of Heart Failure Treatment..................................................................................................................34 PAGE 3 MODULE 04 COMPANION GUIDE PHAR 370 Non-Pharmacological Treatment of Heart Failure......................................................................................35 Pharmacological Treatment of Heart Failure...............................................................................................35 Question 1 of 3: Mechanism of Action..........................................................................................................36 Question 2 of 3: Mechanism of Action..........................................................................................................36 Question 3 of 3: Mechanism Of Action.........................................................................................................36 Positive Inotropic Agents: Cardiac Glycosides.............................................................................................37 Video: Mechanism of Action Of Cardiac Glycosides....................................................................................37 Therapeutic Uses of Digoxin..........................................................................................................................38 Adverse Effects of Digoxin..............................................................................................................................38 Drug-Drug Interactions of Digoxin................................................................................................................38 Question 1 of 2: End of Section Quiz............................................................................................................39 Question 2 of 2: End of Section Quiz............................................................................................................39 SECTION 03: Drugs for The Treatment and Prevention of Atherosclerosis.................................................40 Introduction to Atherosclerosis.....................................................................................................................40 The Coronary Arteries.....................................................................................................................................40 Behavioural Risk Factors................................................................................................................................40 Lipoproteins.....................................................................................................................................................41 Types of Lipoproteins.....................................................................................................................................41 Hyperlipoproteinemias...................................................................................................................................41 The Link Between Cholesterol and Heart Disease......................................................................................42 Therapeutic Measures....................................................................................................................................43 Behavioural Changes: Diet.............................................................................................................................43 Drug Therapies for Hyperlipoproteinemias.................................................................................................43 Statins...........................................................................................................................................................44 Statins: Clinical Trial....................................................................................................................................44 Inhibitors of Sterol Absorption..................................................................................................................45 Fibric Acid Derivatives.................................................................................................................................45 Bile Acid Binding Resins.............................................................................................................................45 Bile Acid Binding Resins and L D L-Cholesterol Levels...........................................................................46 PCSK9 Inhibitors...........................................................................................................................................46 Question 1 of 1: Mechanism Of Action.........................................................................................................47 Question 1 of 1: Hyperlipoproteinemia Drugs Case Study........................................................................47 Video: Drugs Used in the Treatment of Hyperlipoproteinemia.................................................................48 Question 1 of 2: End of Section Quiz............................................................................................................48 PAGE 4 MODULE 04 COMPANION GUIDE PHAR 370 Question 2 of 2: End of Section Quiz............................................................................................................48 SECTION 04: Drugs for the Treatment Coagulation Disorders......................................................................50 Introduction to Coagulation Disorders.........................................................................................................50 Blood Coagulation Cascade...........................................................................................................................50 Video: Blood Coagulation Cascade................................................................................................................50 The Coagulation Cascade...............................................................................................................................51 Intrinsic Pathway.........................................................................................................................................51 Extrinsic Pathway........................................................................................................................................51 Fibrinolysis.......................................................................................................................................................51 Regulation of the Coagulation Cascade........................................................................................................52 Thromboembolic Disease..............................................................................................................................52 Pharmacological Treatment of Thromboembolic Diseases.......................................................................52 Anticoagulant Therapy....................................................................................................................................53 Thrombin Inhibitors....................................................................................................................................53 Warfarin.......................................................................................................................................................54 Pharmacokinetics of Warfarin...................................................................................................................54 Clinical Uses of Anticoagulants......................................................................................................................55 Video: Anticoagulation Therapy.....................................................................................................................55 Triggers For Platelet Aggregation..................................................................................................................56 Antiplatelet Drugs...........................................................................................................................................56 COX-1 Inhibitors............................................................................................................................................56 ADP Receptor Inhibitors..............................................................................................................................57 Platelet Glycoprotein IIB/IIIA Receptors.....................................................................................................57 Question 1 of 1: Antiplatelet Drugs...............................................................................................................58 Video: Platelet Aggregation............................................................................................................................58 Video: Thrombolytic Drugs.............................................................................................................................58 Streptokinase and Alteplase..........................................................................................................................58 Question 1 of 1: Mechanism of Action of Antithrombotic Agents.............................................................59 Drugs Used in Bleeding Disorders................................................................................................................59 Question 1 of 2: End of Section Quiz............................................................................................................59 Question 2 of 2: End of Section Quiz............................................................................................................60 SECTION 05: Drugs for The Treatment of Asthma and COPD........................................................................61 Introduction to Asthma and COPD................................................................................................................61 Factors That Increase Airway Narrowing......................................................................................................61 PAGE 5 MODULE 04 COMPANION GUIDE PHAR 370 Pathogenesis of Asthma.................................................................................................................................61 Mechanism of the Allergen-Induced Model.............................................................................................62 Nonspecific Bronchial Hyperreactivity Model.........................................................................................62 Treatment of Asthma......................................................................................................................................63 Bronchodilators...........................................................................................................................................63 Sympathomimetics.....................................................................................................................................63 Antimuscarinics...........................................................................................................................................64 Anti-Inflammatory Agents..........................................................................................................................64 Anti-Inflammatory Agents: Corticosteroids.............................................................................................65 Anti-Inflammatory Agents: Leukotriene Receptor Antagonists.............................................................65 Anti-Inflammatory Agents: Anti-I G E Antibodies....................................................................................65 Question 1 of 1: Asthma Drugs Case Study.................................................................................................66 Choosing Asthma Therapies..........................................................................................................................67 Asthma Management Continuum.................................................................................................................67 Video: Drugs Used for the Treatment of Asthma........................................................................................67 Chronic Obstructive Pulmonary Disease (COPD).........................................................................................67 COPD Risk Factor: Inhalation Of Noxious Particles/Gas..............................................................................68 Pathogenesis of C O P D.................................................................................................................................69 Treatment of COPD..........................................................................................................................................69 Question 1 of 2: End of Section Quiz............................................................................................................70 Question 2 of 2: End of Section Quiz............................................................................................................70 CONCLUSION.......................................................................................................................................................71 End of Module 04: Complete!........................................................................................................................71 PAGE 6 MODULE 04 COMPANION GUIDE PHAR 370 INTRODUCTION Please see the online learning module for the full experience of interactions within this document. This content was retrieved from Introduction Slide 1 of 5 of the online learning module. In Module 04, you will be introduced to the drug classes and associated pharmacology that influence the cardiovascular and respiratory systems. First, you will learn about the drugs that act on the cardiovascular system, including: Diuretics and antihypertensive drugs Drugs for the treatment of angina and heart failure Drugs used for the treatment and prevention of atherosclerosis Drugs used in disorders of coagulation Next, you will focus on the drugs that exhibit their effects on the respiratory system. In particular, drugs used for the treatment of asthma and chronic obstructive pulmonary disease (COPD) will be discussed. LEARNING OUTCOMES This content was retrieved from Introduction Slide 2 of 5 of the online learning module. On successful completion of Module 04, students will be able to: Identify common antihypertensive drug classes and describe how they work. Discuss drugs commonly used for the treatment of heart failure. Describe the basic mechanisms of action of drugs used to treat abnormal hemostasis. Discuss how drugs prevent the development of atherosclerosis. Explain how drugs can relieve symptoms of asthma and chronic obstructive pulmonary disease. COURSE ICONS This content was retrieved from Introduction Slide 3 of 5 of the online learning module. Throughout PHAR 370, you should watch for several icons throughout the course modules. Continue each icon to learn about its role in the course. Did You Know? This icon lives in the sidebar of the slide. Clicking this icon will reveal additional non-testable information related to the concept presented on the slide. Click For An Example This icon lives inline with the slide text. When you see this icon, click it to reveal an example related to content you just learned. PAGE 7 MODULE 04 COMPANION GUIDE PHAR 370 References This icon lives in the sidebar. Clicking it will reveal the sources of course content and/or images. MODULE ASSIGNMENTS This content was retrieved from Introduction Slide 4 of 5 of the online learning module. These assessments must be completed as part of Module 04. For specific details about the research presentation, visit the assignment page in your online learning environment. Activities throughout the Module: Note that text responses and interactions will not be graded unless otherwise notified. However, they are recorded within the module and viewable by your instructor. MODULE OUTLINE This content was retrieved from Introduction Slide 5 of 5 of the online learning module. Section 01: Drugs for the Treatment of Hypertension Section 02: Drugs for the Treatment of Angina and Heart Failure Section 03: Drugs for the Treatment and Prevention of Atherosclerosis Section 04: Drugs for the Treatment of Disorders of Coagulation Section 05: Drugs for the Treatment of Asthma and COPD PAGE 8 MODULE 04 COMPANION GUIDE PHAR 370 SECTION 01: DRUGS FOR THE TREATMENT OF HYPERTENSION INTRODUCTION TO HYPERTENSION This content was retrieved from Section 01 Slide 2 of 22 of the online learning module. Hypertension, or chronically high blood pressure (BP), is the most prevalent cardiovascular disease in North America, occurring in approximately 24% of Canadians. It is estimated that by age 80, 60% to 80% of men and women will have hypertension. Consistently elevated blood pressure damages blood vessels in three important organs - the kidneys, heart, and brain. Continue to highlight three organs largely affected by hypertension. Kidneys Damage to the blood vessels that supply the kidneys can lead to an increased likelihood of kidney failure. Heart Damage to the blood vessels that supply the heart can lead to heart failure, angina*, or stroke. Brain Damage to the blood vessels that supply the brain may lead to dementia. Definitions: Angina: Chest pain or discomfort caused when your heart muscle doesn't get enough oxygen-rich blood. It may feel like pressure or squeezing in your chest. Content Reference: Padwal, R. S., Bienek, A., McAlister, F. A., & Campbell, N. R. C. (2016). Epidemiology of hypertension in Canada: An update. Canadian Journal of Cardiology, 32(5), 687-694. Retrieved July 2024 from https://proxy.queensu.ca/login?url=https://www.sciencedirect.com/science/article/abs/pii/S0828282X1 5013069?via%3Dihub%E2%80%AF CONTROLLING BLOOD PRESSURE This content was retrieved from Section 01 Slide 3 of 22 of the online learning module. Clinically, hypertension is controlled through the use of antihypertensive drugs. The different classes of antihypertensive drugs have diverse mechanisms of action, however, they all have one goal: to decrease blood pressure. Control of blood pressure by use of antihypertensive drugs has been shown to reduce damage to blood vessels, and thus, reduce mortality and hospitalization rates for vascular disease. PAGE 9 MODULE 04 COMPANION GUIDE PHAR 370 The goal of this section is to discuss the role of drugs in controlling blood pressure and the benefits derived from appropriate control of hypertension. WHAT IS NORMAL BLOOD PRESSURE? This content was retrieved from Section 01 Slide 4 of 22 of the online learning module. Blood pressure is defined as the force that circulating blood exerts on the arterial walls, and it must be kept within relatively narrow limits. The body has several mechanisms to achieve control of blood pressure. In some individuals, however, the pressure in blood vessels rises above normal, resulting in hypertension. The definition of normal blood pressure depends on age, and the normal value increases with age; in a young adult the normal blood pressure value is 120/80 mmHg*. Continue for an introduction on how to interpret a blood pressure reading. The top figure is the pressure in millimetres of mercury during systole, or when the heart is contracting. The lower figure is the pressure in millimetres of mercury during diastole, or between contractions of the heart. Definition*: mmHg: Millimetres of mercury. REGULATION OF BLOOD PRESSURE This content was retrieved from Section 01 Slide 5 of 22 of the online learning module. Arterial blood pressure is the product of the amount of blood pumped by the heart (cardiac output, CO) and the resistance in the peripheral arterioles (total peripheral resistance, TPR). Thus, in order to understand how to calculate arterial blood pressure, you must first learn about the cardiac output of the heart. CO is a function of the heart rate and stroke volume of the heart. Learn how CO can be measured. Cardiac Output (CO) The volume of blood that is pumped by each ventricle per unit time. This value is the same for both the left and right side of the heart. Heart Rate (HR) The number of heartbeats per unit time. Normal resting heart rate for adults is between 60-100 beats per minute. Stroke Volume (SV) PAGE 10 MODULE 04 COMPANION GUIDE PHAR 370 The amount of blood pumped from a ventricle per unit time. At rest, stroke volume is approximately 70 mL/beat for an adult. Note: This content is covered in more detail in PHGY 216. ARTERIAL BLOOD PRESSURE This content was retrieved from Section 01 Slide 6 of 22 of the online learning module. Arterial blood pressure can, therefore, be measured using the equation: Blood Pressure (BP) = Cardiac Output (CO) x Total Peripheral Resistance (TPR) *CO = HR x SV Thus, if the amount of blood pumped per unit time increases, blood pressure will increase. Likewise, if the resistance of the peripheral arterioles increases, blood pressure will also increase. VIDEO: REGULATION OF BLOOD PRESSURE This content was retrieved from Section 01 Slide 7 of 22 of the online learning module. There is moment to moment control of blood pressure, where heart rate and vascular resistance are controlled by the sympathetic nervous system. Watch the video for a refresher on how blood pressure is controlled. As you watch: Focus on the four factors that influence blood pressure. Page Link: https://player.vimeo.com/video/290319599 CLASSIFICATION OF HYPERTENSION This content was retrieved from Section 01 Slide 8 of 22 of the online learning module. Hypertension is usually silent, meaning the person is not aware they have the disease. Wide scale screening has been an ongoing process to diagnose the condition, as hypertension leads to an increase in vascular disease, heart attack, stroke, and renal disease. An individual is generally diagnosed with hypertension when their blood pressure is chronically elevated above 140/90 mmHg. However, the diagnosis of hypertension is also influenced by age and co-existing disease. Hypertension Canada lists the systolic and diastolic blood pressures under various conditions where drug intervention is warranted. You do not need to memorize the values in the table, however you should be aware that the definition of hypertension can change depending on comorbidities and age. Population SBP DBP PAGE 11 MODULE 04 COMPANION GUIDE PHAR 370 Diabetes