Cardiovascular drugs Flashcards
What are the type of drugs acting on CVS?
anti-hypertensive
cardiotonic drugs
antiarrhythmic drugs
antianginal agents
lipid lowering agents
drugs affecting blood coagulation
drugs used to treat anemia
hypertension with no known underlying cause
essential hypertension
drugs that work by altering the normal reflexes that control blood pressure aimed at maintaining the blood pressure within normal limits to prevent the damage that hypertension can cause
anti-hypertensive drugs
subclasses of anti-hypertensive drugs
angiotensin-converting enzyme (ACE) inhibitors
angiotensin II receptor blockers (ARBs)
calcium-channel blockers
vasodilators
act in the lungs to prevent ACE from converting angiotensin I to angiotensin II, a powerful vasoconstrictor and stimulator
of aldosterone release
ACE inhibitors
action leads to a decrease in BP an in
aldosterone secretion, with a resultant of?
slight increase in serum potassium and loss of serum sodium and fluid
Drugs Under ACE inhibitors?
- Benazepril (Lotensin)
- Captopril (Capoten)
- Enalapril (Vasotec)
- Enalaprilat (Vasotec IV)
- Fosinopril (Monopril)
*Lisinopril (Prinivil, Zestril) - Moexipril (Univasc)
- Perindopril (Aceon)
- Quinapril (Accupril)
- Ramipril (Altace)
- Trandolapril (Mavik)
for the treatment of heart failure and left ventricular dysfunction, ACE inhibitors can be taken with?
digoxin and diuretics
Contraindication for ACE inhibitors?
Allergy
Impaired Renal Function
Pregnancy
Lactation
Heart Failure
Salt/volume depletion
selectively bind with the angiotensin II receptors in vascular smooth
muscle and in the adrenal cortex to block vasoconstriction and the release of
aldosterone
Angiotensin II Receptor Blockers (ARBs)
Drugs under ARBs
- Azilsartan (Edarbi)
- Candesartan (Atacand)
- Eprosartan (Teveten)
- Irbesartan (Avapro)
- Losartan (Cozaar)
- Olmesartan (Benicar)
- Telmisartan (Micardis)
- Valsartan (Diovan)
These drugs are indicated to be used alone or in combination therapy for
the treatment of hypertension and for the treatment of heart failure in
patients who are intolerant to ACE inhibitors.
ARBs
They also slow the progression
of renal disease in patients with hypertension and type 2 diabetes
ARBs
ARBs are well
absorbed and undergo metabolism in the liver by
the?
cytochrome P450 system
ARBs cross the placenta and are excreted via?
urine and feces
ARBs contraindication?
Allergy
PRegnancy
Lactation
Presence of hepatic or renal dysfunction
Hypovolemia
The risk of decreased serum levels and loss of effectiveness
increases if the ARB is taken in combination with?
phenobarbital,
indomethacin, or rifamycin.
There may be a decrease in anticipated antihypertensive effects if
the ARBs is combined with
ketoconazole, fluconazole, or diltiazem
ARBs should not be used with ___ because of the potential for serious adverse effects
ACE inhibitors or renin inhibitors
These drugs inhibit the movement of calcium ions
across the membranes of myocardial and arterial muscle cells,
altering the action potential and blocking muscle cell contraction.
calcium-channel inhibitors
Drugs under calcium-channel blockers
- Amlodipine (Norvasc)
- Felodipine (Plendil)
- Isradipine (DynaCirc, DynaCirc CR)
- Nicardipine (Cardene, Cardene SR)
- Diltiazem (Cardizem, Dilacor CR)
- Nifedipine (Procardia XL)
- Nisoldipine (Sular)
- Verapamil (Calan SR)
- Clevidipine (Cleviprex)
Calcium-channel blockers are also sometimes
used in the treatment of?
Raynaud’s disease and migraine headache
These calcium channel blockers are available in IV form for short-term
use when oral administration is not feasible
Nicardipine
Clevidipine
Contraindications of calcium-channel blockers
Allergy
Heart block or sick sinus syndrome
Renal or hepatic dysfunction
Pregnancy
Lactation
diltiazem calcium-channel blocker should not be taken with — cause it potentially serious effect to note which is an increase in serum levels and toxicity
cyclosporine
These anti-hypertensive drug act directly on vascular smooth muscle to cause muscle relaxation, leading to vasodilation and drop in BP.
vasodilators
Example of vasodilators
Diazoxide (Hyperstat)
* Hydralazine (Apresoline)
* Minoxidil (Loniten)
* Nitroprusside (Nitropress)
vasodilators that are used intravenously
Diazoxide and nitroprusside
vasodilator that is available for oral and intramuscular
hydralazine
contraindication of vasodilators
Allergy
Pregnancy
Lactation
Peripheral vascular disease, CAD, heart failure,
tachycardia
Functional hypoglycemia
Hydralazine can produce additive hypotensive effects when given with
adrenergic or other anti-hypertensive drugs
medications used to treat hypertension
anti-hypertensive drugs
specific receptors found in blood
vessels and in the adrenal gland that react with angiotensin II to cause
vasoconstriction and release of aldosterone.
angiotensin II receptors
common, often asymptomatic disorder in which systolic blood pressure persistently exceeds 140 mm Hg and/or diastolic pressure exceeds 90
mm Hg
hypertension
sustained blood pressure that is lower than that required to adequately perfuse all of the body’s tissues
hypotension
force that resists the flow of blood through the vessels, mostly determined by the arterioles, which contract to increase resistance; important in determining overall blood pressure
peripheral resistance
are drugs used to increase
the contractility of the heart muscle for patients experiencing heart failure
cardiotonic agents
subclasses of cardiotonic agents
cardiac glycoside
phosphodiesterase inhibitors
The cardiac glycosides were originally derived from the
foxglove or digitalis plant
e foxglove or digitalis plant were once
ground up to make
digitalis leaf
a cardiotonic drug subclass which is indicated for treating heart failure and irregular heartbeats
cardiac glycosides
drugs under cardiac glycoside
digoxin
digitoxin
it has a brand name called Lanoxin.
digoxin
digoxin is most
frequently it is used for
atrial fibrillation, atrial flutter,
and heart failure
is a cardiac glycoside used for the
treatment of heart failure and certain kinds of heart arrhythmia
digitoxin
It is a phytosteroid and is similar in
structure and effects to digoxin.
digitoxin
cardiac glycosides has a rapid onset of action and rapid absorption of ___ when taken orally, and ___ minutes
when given intravenously
30-120, 5-30
There is a risk of increased therapeutic effects and toxic effects of
cardiac glycosides if it is taken with
verapamil, amiodarone,
quinidine, quinine, erythromycin, tetracycline, or cyclosporine
Cardiac glycosides drugs may be less effective if it is combined
with
thyroid hormones, metoclopramide, or penicillamine
Absorption of oral cardiac glycosides may be decreased if it is taken with
cholestyramine, charcoal, colestipol, antacids, bleomycin, cyclophosphamide, or methotrexate
This belongs to a second class
of drugs that act as cardiotonic (inotropic) agents
phosphodiesterase inhibitors
phosphodiesterase inhibitors include
inamrinone (Inocor) and milrinone (Primacor)
Approved only for use in patients with HF who does not have been responsive to digoxin, diuretics, or vasodilators
phosphodiesterase inhibitors
phospodiesterase inhibitors that are used intravenously
Inamrinone and milrinone
enlargement of the heart, commonly seen with chronic hypertension, valvular disease, and heart failure
cardiomegaly
a disease of the heart muscle that leads to an enlarged heart and eventually to complete heart muscle failure and death
cardiomyopathy
discomfort with respirations, often with a feeling of anxiety and inability to breathe, seen with left-sided heart failure.
dyspnea
a condition in which the heart muscle fails to adequately pump
blood around the cardiovascular system, leading to a backup or congestion of
blood in the system
heart failure
blood-tinged sputum, seen in left-sided heart failure when blood
backs up into the lungs and fluid leaks out into the lung tissue
hemoptysis
getting up to void at night, reflecting increased renal perfusion with fluid
shifts in the supine position when person has gravity-dependent edema related to
heart failure; other medical conditions, including urinary tract infection, increase
the need to get up and void
nocturia
difficulty breathing when lying down, often referred to by the
number of pillows required to allow a person to breath comfortably
orthopnea
effect resulting in an increased force of contraction
positive inotropic
severe left-sided heart failure with backup of blood into the lungs, leading to loss of fluid into the lung tissue
pulmonary edema
rapid and shallow respirations, seen with left sided heart failure
tachypnea
also known as
cardiac dysrhythmia medications, are a
group of pharmaceuticals that are used to
suppress abnormal rhythms of the heart
(cardiac arrhythmias), such as atrial
fibrillation, atrial flutter, ventricular
tachycardia, and ventricular fibrillation
antiarrhythmic agents
classes of antiarrhythmic agents
class 1,2,3,4
antiarrhythmics that are fast sodium channel blockers
class 1
class 1a antiarrhythmic drugs
Disopyramide (Norpace)
Procainamide (Pronestyl)
quinidine (Generic)
class 1b antiarrhythmics
lidocaine (Xylocaine)
mexiletine (Mexitil)
class 1c antiarrhythmics
Flecainide (Tambocor)
Propafenone (Ryhtmol)
antiarrhythmic drugs preferable in conditions such as tachycardia, in which the sodium gates are open frequently
class 1a
Also for the treatment of potentially life-threatening ventricular arrhythmias and should not be used to treat other arrhythmias because of the risk of a proarrhythmic effect
class 1a antiarrhythmic drugs
class 1a antiarrhythmic drugs should not be used to treat other arrhythmias because of the risk of
proarrhythmic effect
class 1 antiarrhythmic available in oral form
Disopyramid, Flecainide, and propafenone
class 1a available in intramuscular (IM), intravenous (IV), and oral forms
Procainamide and Quinidine
class 1b antiarrythmic that is administered by the IM or IV route, and can also be
given as a bolus injection in emergencies when monitoring is not available to document the exact arrhythmia
Lidocaine
class 1b antiarrhythmics that is an oral drug administered to adults only
Mexiletine
antiarrhythmics that are conventional beta blockers
class 2
Drug under Class II Antiarrhythmics
● Acebutolol
● Esmolol
● Propranolol
these drugs competitively block
beta-receptor sites in the heart and kidneys
class 2 antiarrythmics
class 2 antiarrhythmics are indicated for the treatment of
supraventricular tachycardias and PVCs
Acebutolol is administered
orally
Esmolol is administered
intravenously
Propranolol is administered
orally or intravenously
The use of class 2 antiarrhythmic drugs is contraindicated in the presence
of
sinus bradycardia (rate less than 45 beats/min)
AV block
cardiogenic shock
HF
asthma
respiratory depression
diabetes
thyroid dysfunction
these drugs act by blocking depolarizing currents and thereby prolonging the
effective refractory period of the myocardium.
class 3 antiarrhythmics
drugs under class 3 antiarrhythmics
● Amiodarone
● Dofetilide
● Ibutilide
● sotalol
these drugs block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, prolonging it. All of these drugs are proarrhythmic and have the potential of inducing arrhythmias
class 3 antiarrhythmics
class 3 antiarrhythmic drug that is indicated for initiation of treatment
and prophylaxis of frequently recurring ventricular fibrillation and hemodynamically unstable ventricular tachycardia in patients refractory to
other therapy
Amiodarone HCl injection
Amiodarone is available in
an oral or intravenous form
Dofetilide and sotalol are administered only in
oral form
Ibutilide is given
IV
antiarrhythmic drugs that are slow non-dihydropyridine calcium channel blockers
class 4 antiarrhythmics
Drug under Class IV Antiarrhythmics
● Diltiazem
● Verapamil
these antiarrhythmic drugs block the movement of calcium ions across the
cell membrane, depressing the generation of action potentials and delaying
phases 1and 2 of repolarization, which slows automaticity and conduction.
class 4 antiarrhythmics
diltiazem and verapamil are used as
antihypertensives and to treat
angina
● Diltiazem is administered .
intravenously
When used as an antiarrhythmic, verapamil is used
intravenously
drugs that affect the action potential of cardiac cells and are used to
treat arrhythmias and restore normal rate and rhythm
antiarrhythmics
slower-than-normal heart rate (usually less than60 beats/min)
bradycardia
the amount of blood the heart can pump per beat; influenced by the
coordination of cardiac muscle contraction, heart rate, and blood return to the heart
cardiac output
large research study run by the National
Heart and Lung Institute that found that long-term treatment of arrhythmias may havea questionable effect on mortality, and in some cases actually lead to increased cardiac death; basis for the current indication for antiarrhythmics (short-term use to treat life-threatening ventricular arrhythmias).
Cardiac Arrhythmia Suppression Test (CAST)
-blocks to conduction of an impulse through the cardiac conduction
system; can occur at the atrioventricular node, interrupting conduction from the
atria into the ventricles, or in the bundle branches within the ventricles,preventing
the normal conduction of the impulse.
heart blocks
the study of the forces moving blood throughout the cardiovascular
hemodynamics
drugs are used to reduce ischemia by increasing the delivery of oxygen-rich blood to cardiac tissues or by reducing oxygen consumption by the coronary vessels.
Either of these mechanisms can reduce ischemia and lead to a decrease in anginal pain.
antianginal agents
antianginal agents subclasses
nitrites and nitrates
beta blockers
calcium channel blockers
antianginals that work mainly by decreasing venous return to the heart (preload) and decreasing systemic vascular resistance (afterload)
nitrites and nitrates
are the rapid- and long-acting nitrates available for clinical use
Amyl nitrite (rapid acting)
Nitroglycerin (both rapid and long acting
Isosorbide dinitrate (both rapid and long acting)
Isosorbide mononitrate (primarily long acting)
antianginal agent that are used to treat stable, unstable, and vasospastic (Prinzmetal) angina.
nitrates
Rapid-acting dosage forms of nitrates are most often
sublingual nitroglycerin tablets, or an intravenous drip
contraindication of nitrites and nitrates
severe anemia
allergy to nitrates
head trauma and cerebral hemorrhage
pregnancy and lactation
renal and hepatic disease
Nitrate antianginal drugs can produce additive hypotensive effects when taken in combination with
alcohol
beta blockers
calcium channel blockers,
phenothiazines
erectile dysfunction drugs
erectile dysfunction drugs examples
sildenafil (Viagra) , tadalafil, and vardenafil.
sildenafil should not be taken with erectile dysfunction drugs coz it will ___
cause dangerous drop in bp
Nitroglycerin is contraindicated in patients who have
severe anemia
increased intracranial pressure
hypersensitivity
circulatory failure
these antianginals help by slowing the heart rate and decreasing
contractility, thereby decreasing oxygen demands
beta blockers
beta blockers approved as antianginal drugs are
atenolol,
metoprolol,
nadolol,
propranolol
these drugs are most effective in the treatment of exertional
angina (i.e., that caused by exercise).
beta blockers
For an individual (often elderly) with significant angina, “exercise” may simply be carrying out the activities of daily living, such as
bathing
dressing
cooking
housekeeping
The beta blockers are also approved for the treatment of
MI
hypertension
cardiac dysrhythmias
essential tremor
these drugs decrease calcium influx into the smooth muscle, causing vascular relaxation. This either reverses or prevents
the spasms of coronary vessels that cause the anginal pain associated with Prinzmetal or chronic angina.
calcium-channel blockers
There are three chemical classes of calcium channel blockers (CCBs)
phenylalkylamines, benzothiazepines, and
dihydropyridines, commonly represented by verapamil, diltiazem, and amlodipine, respectively
these are considered first-line
drugs for the treatment of such conditions as angina, hypertension, and
supraventricular tachycardia
calcium-channel blockers
The dihydropyridine CCB nimodipine is indicated solely for
cerebral artery spasms
associated with aneurysm rupture
CCBs are also used for the
short-term management of
atrial fibrillation and flutter, migraine headaches, and Raynaud’s disease (a type of peripheral vascular disease)
contraindications of CCB
drug allergy
acute MI
second or third-degree AV block (unless the patient has a pacemaker)
hypotension
Chest pain that occurs when the heart’s supply of blood carrying oxygen is insufficient to meet the demands of the heart
angina pectoris
A common form of arteriosclerosis involving deposits of fatty,
cholesterol-containing material (plaques) within arterial walls
atherosclerosis
Chest pain that is primarily caused by atherosclerosis, which results in a long-term but relatively stable level of obstruction in one or more coronary arteries
chronic stable angina
Arteries that deliver oxygen to the heart muscle
coronary arteries
Any one of the abnormal conditions that can affect the arteries of the heart and produce various pathological effects,
especially a reduced supply of oxygen and nutrients to the myocardium
coronary artery disease
Poor blood supply to an organ
ischemia
Poor blood supply to the heart via the coronary arteries
ischemic heart disease
Necrosis of the myocardium following interruption of
blood supply; it is almost always caused by atherosclerosis of the coronary
arteries and is commonly called a heart attack
Myocardial Infarction
A rapid heartbeat caused by a variety of autonomic nervous
system effects, such as blood pressure changes, fever, or emotional stress.
reflex tachycardia
Early stage of progressive coronary artery disease.
unstable angina
induced myocardial chest pain caused by spasms of the coronary arteries; also referred to as Prinzmetal or variant angina.
vasospastic angina ischemia
these drugs lower serum levels of
cholesterol and various lipids. These include bile acid sequestrants, HMG-CoA reductase inhibitors, and a
cholesterol absorption inhibitor
lipid-lowering agents
subclasses of lipid lowering agents
bile acid sequestrants
HMG-COA Reductase Inhibitors/ Statins
cholesterol absorption inhibitors
these drugs prevent the reabsorption of bile salts, which are very high in cholesterol. Consequently, the liver will pull
cholesterol from the blood to make new bile acids, lowering the
serum cholesterol level.
bile acid sequestrants
drugs under bile acid sequestrants
● Cholestyramine (Questran)
● Colestipol (Colestid)
● Colesevelam (WelChol)
these drugs bind with bile acids in the intestine to form an insoluble complex that is then excreted in the feces.
bile acid sequestrants
these contain
high levels of cholesterol.
bile acids
the liver use it to make more bile acids
cholesterol
This is used to treat
pruritus associated with partial biliary obstruction.
Cholestyramine
Cholestyramine is a power that must be mixed with liquids
and taken up to
6x a day
Colestipol is available in
powder and tablet form
Colestipol is taken only
4x a day
Colesevelam is available in
tablet form
Colesevelam is taken only
once or 2x a day
Bile Acid sequestrants are contraindicated in the presence of allergy to
any bile acid sequestrant
bile acid sequestrants also are contraindicated in the following
conditions:
complete biliary obstruction
abnormal intestinal function
pregnancy or lactation
bile acid sequestrants decrease or
delay the absorption of
thiazide diuretics
digoxin
warfarin
thyroid hormones
corticosteroids
Consequently, any
of these drugs should be taken ____
after the bile acid sequestrant
1hour before or 4 to 6 hours
these drugs block the enzyme HMG-CoA reductase, resulting in lower serum cholesterol levels, a resultant breakdown of LDLs, and a slight increase in HDLs
HMG-CoA reductase inhibitors, or statins
Drug under HMG-COA Reductase inhibitors/ statins
● Artovastatin (Lipitor)
● Fluvastatin (Lescol)
● Lovastatin (Mevacor)
● Pravastatin (Pravachol)
● Rosuvastatin (Crestor)
● Simvastatin (Zocor)
The early rate-limiting step in the synthesis of cellular cholesterol
involves the enzyme
HMG-COA reductase
if HMG-CoA reductase is blocked, what happens
serum cholesterol and LDL levels decrease because more LDLs are absorbed by the cells for processing into cholesterol
these enzymes block HMG-CoA reductase from completing the
synthesis of cholesterol
HMG-CoA reductase inhibitor
(one of the oldest HMG-CoA drugs available
pravastatin
lovastatin
are indicated for patients with documented CAD to slow
progression of the disease
simvastatin
these statins are used to prevent a first myocardial infarction (MI) in patients who have multiple risk factors for developing CAD.
pravastatin
lovastatin
simvastatin
atorvastatin
The peak effect of statin drugs is usually seen
within 2 to 4 weeks
a breakdown of muscles whose waste
products can injure the glomerulus and cause acute renal failure, has also occurred with the use of all of these drugs
Rhabdomyolysis
The risk of rhabdomyolysis increases if any of statin drugs is combined with
erythromycin
cyclosporine
gemfibrozil
niacin
antifungal drugs
Serum levels and the risk of toxicity increase if statin drugs are
combined with
grapefruit juice
works in the brush border of the small intestine to prevent the absorption of dietary cholesterol, which leads to increased clearance of cholesterol by
the liver and a resultant fall in serum cholesterol.
cholesterol absorption inhibitor ezetimibe
these are very important parts of
the overall treatment of a patient receiving a cholesterol absorption inhibitor
Change in diet and increased exercise
this drug works in the brush border of the small intestine to decrease
the absorption of dietary cholesterol from the small intestine.
ezetimibe
Ezetimibe is absorbed well after oral administration, reaching
peak levels in
4-6 hours
ezetimibe is metabolized in the liver and the small intestine, with a half-life of
22 hours
The risk of elevated serum levels of ezetimibe increases if it is given with
cholestyramine
fenofibrate
gemfibrozil
antacids
ezetimibe should be taken
at least___ before or ___ after the other drugs.
2 hours before
4 hours after
The risk of toxicity also increases if ezetimibe is combined with
cyclosporine
If ezetimibe is combined with any fibrate, the risk of ___ increases.
cholethiasis
___ levels increase
in a patient who is also taking ezetimibe
warfarin
general term used for drugs used to lower lipid levels in the blood.
Antihyperlipidemic agents
cholesterol-containing acids found in the bile that act like detergents
to break up fats in the small intestine
bile acids
necessary component of human cells that is produced and
processed in the liver, then stored in the bile until stimulus causes the
gallbladder to contract and send the bile into the duodenum via the common
bile duct; a fat that is essential for the formation of steroid hormones and cell
membranes; it is produced in cells and taken in by dietary sources
cholesterol
carrier for lipids in the bloodstream, consisting of proteins, lipids,
cholesterol, and so forth.
chylomicron
endogenous substances that activate nervous system receptors that are important in the regulation of appetite, food intake, and metabolism.
Endocannabinoids
loosely packed chylomicron containing fats, able to absorb fats and fat remnants in the periphery; thought to have a protective
effect, decreasing the development of coronary artery disease.
HDL
enzyme that regulates the last step in cellular cholesterol synthesis
HMG-CoA reductase
HMG-CoA reductase stands for
hydroxymethylglutaryl-coenzyme A reductase
increased levels of lipids in the serum, associated with increased
risk of coronary artery disease development.
hyperlipidemia
tightly packed fats that are thought to contribute to the development of coronary artery disease when remnants left over from the LDL are processed in the arterial lining.
LDL
a collection of factors, including insulin resistance, abdominal obesity, low high-density lipoprotein and high triglyceride levels, hypertension, and proinflammatory and prothrombotic states, that increase the
incidence of coronary artery disease
metabolic syndrome
factors that have been identified as increasing the risk of the
development of a disease; for coronary artery disease, risk factors include
genetic predisposition, gender, age, high-fat diet, sedentary lifestyle, gout,
hypertension, diabetes, and estrogen deficiency
risk factors
subclasses of drugs affecting blood coagulation
anticoagulants
antiplatelet drugs
thrombolytic drugs
are drugs that interfere with the normal coagulation process
by interfering with the clotting cascade and thrombin formation
anticoagulants
Drug under Anticoagulants
·antithrombin III (Thrombate III)
·argatroban (Acova)
·bivalirudin (Angiomax)
·desirudin (Iprivask)
·fondaparinux (Arixtra)
·heparin (generic)
· warfarin (Coumadin)
these drugs interfere with the normal cascade of events
involved in the clotting process
anticoagulants
these block the formation of thrombin from prothrombin
Heparin, argatroban, and bivalirudin
Adverse effects of anticoagulants can range from
bleeding gums with tooth brushing to severe internal hemorrhage
Warfarin has been associated with
alopecia
dermatitis
bone marrow depression
what happens if heparin is combined with oral anticoagulants, salicylates, penicillins, or cephalosporins
increased bleeding
this can occur if heparin is combined with nitroglycerin
decreased anticoagulation
To treat heparin drug overdose,
protamine sulfate
used to treat warfarin overdose
Vitamin K
this drug decrease the formation of the platelet plug by decreasing the
responsiveness of the platelets to stimuli that would cause them to stick and
aggregate on a vessel wall
antiplatelet agents
Drug under anticoagulant
·abciximab (ReoPro)
·anagrelide (Agrylin)
·aspirin
·cilostazol (Pletal)
·clopidogrel (Plavix)
·dipyridamole (Persantine)
·eptifibatide (Integrilin)
·sulfinpyrazone (Anturane)
·ticlopidine (Ticlid)
·tirofiban (Aggrastat).
this inhibit platelet adhesion and aggregation by blocking receptor sites on the platelet membrane, preventing platelet–platelet interaction or the interaction of platelets with other clotting chemicals.
antiplatelet agents
One drug ___
blocks the production of platelets in the bone marrow.
anagrelide
These agents are used
effectively to treat cardiovascular diseases that are prone to produce occluded
vessels; for the maintenance of venous and arterial grafts; to prevent
cerebrovascular occlusion; and as adjuncts to thrombolytic therapy in the
treatment of myocardial infarction (MI) and the prevention of reinfarction after
MI. T
antiplatelet
these drugs break down the thrombus that has been formed by
stimulating the plasmin system
thrombolytic agents
drugs under thrombolytic agents
·alteplase (Activase)
·reteplase (Retavase)
·streptokinase (Streptase)
·tenecteplase (TNKase)
·urokinase (Abbokinase)
All of the
drugs that are available for this purpose work to activate the
natural anticlotting system—conversion of plasminogen to ___
plasmin
The thrombolytics are effective only if
the patient has ___ in the plasma
plasminogen
The most common adverse effect associated with the
use of thrombolytic agents is
bleeding
The risk of hemorrhage increases if thrombolytic agents are
used with
any anticoagulant or antiplatelet drug
Arrange to administer ___ to
reduce mortality associated with acute MI as soon as
possible after the onset of symptoms
tenecteplase or streptokinase
what to do with heparin if it is being given
administration of a thrombolytic agent
discontinue
drugs that block or inhibit any step of the coagulation process,
preventing or slowing clot formation
anticoagulants
drugs that interfere with the aggregation or clumping of
platelets to form the platelet plug
antiplatelet agents
the process of blood’s changing from a fluid state to a solid state
to plug injuries to the vascular system
coagulation
drugs that lyse, or break down, a clot that has formed; these drugs activate the plasminogen mechanism to dissolve fibrin threads
thrombolytic agents
drugs used to treat anemia subclasses
erythropoiesis stimulating agents
agents used for iron-deficiency anemia
agents used for other anemias
A substance that stimulates the bone marrow to make more red blood cells
erythropoiesis stimulating agents
are used to treat anemia caused by chronic
kidney failure, some anticancer drugs, and certain treatments for HIV. They may also be used to lower the number of blood transfusions needed during and after
certain major surgeries
erythropoiesis stimulating agents
drugs under erythropoiesis stimulating agents
● Darbepoetin alfa
● Epoetin alfa
● Methoxy polyethylene glycol-epoetin beta
Is a man-made form of a
protein that helps your body produce red blood-cells. It is used to treat anemia caused by chemotherapy or chronic
kidney disease.
Darbepoetin alfa (Aranesp)
This medicine is used to treat anemia
associated with renal failure and patients on dialysis; reduction in
need for transfusions in surgical patients; treatment of anemia
associated with AIDS therapy; treatment of anemia associated
with cancer chemotherapy
Epoetin alfa (Epogen)-
Used to
treat anemia associated with chronic renal failure, including in
dialysis patients
Methoxy polyethylene glycol-epoetin beta (Mircera)
Generally indicated in conditions where there is
impaired red blood
cell production
The two primary FDA approved indications for ESAs are
anemia secondary to chronic kidney disease
chemotherapy-induced anemia in patients with cancer
All ESA drugs are contraindicated in the presence of
uncontrolled hypertension
drugs under agents used for iron-deficiency anemia
● Ferrous fumarate (Feostat)
● Ferrous gluconate (Fergon)
● Ferrous sulfate (Feosol)
● Ferrous sulfate exsiccated (Feratab, Slow FE)
● Iron dextran (InFeD)
Treatment of iron deficiency in
patients undergoing chronic hemodialysis or nondialysis patients with renal failure who are also receiving supplemental erythropoietin therapy
Iron sucrose (Venofer)
Treatment of iron deficiency in patients undergoing chronic hemodialysis who are also receiving supplemental
erythropoietin therapy
Sodium ferric gluconate complex (Ferrlecit)
agents used for iron-deficiency anemia may also be used as adjunctive therapy in patients receiving an
erythropoiesis-stimulating drug
is a parenteral form of iron given by the Z-track method
Iron dextran
agents used for iron-deficiency anemia that are available for oral administration
Ferrous fumarate
ferrous gluconate
ferrous sulfate
agents used for iron-deficiency anemia are contraindicated in the following conditions
hemochromatosis
(excessive iron)
hemolytic anemias
normal iron balance
peptic ulcer
colitis
regional enteritis
Iron absorption decreases if iron preparations are taken with
antacids,
tetracyclines, or cimetidine
Increased iron levels occur if iron preparations are
taken with
chloramphenicol
AGENTS FOR MEGALOBLASTIC ANEMIAS
- Folic Acid Derivatives
- Vitamin B12
AGENT FOR SICKLE CELL ANEMIA
Hydroxyurea
a synthetic form of folate, a B vitamin, used
to treat or prevent low folate levels, which can lead to certain types of anemia or birth defects.
Folic acid (Folvite)
used as “leucovorin rescue” after
chemotherapy, allowing non cancerous cells to survive the chemotherapy; used with fluorouracil for palliative treatment of
colorectal cancer
Leucovorin (Wellcovorin)
Folic Acid Derivatives
Folic acid (Folvite)
Leucovorin (Wellcovorin)
Levoleucovorin
used in adults and children to prevent harmful effects of methotrexate (Trexall) when methotrexate is used to treat osteosarcoma (cancer that forms in bones)
Levoleucovorin
a man-made form of vitamin B12 used
to prevent and treat low blood levels of this vitamin.
Cyanocobalamin (Nascobal)
a manufactured version of the
vitamin B12. It is used to treat and prevent vitamin B12 deficiency anemia
Hydroxocobalamin (Hydro-Crysti-12)
Vitamin B12 drugs
Cyanocobalamin (Nascobal)
Hydroxocobalamin (Hydro-Crysti-12)
Megaloblastic anemia is treated with folic acid and vitamin B12 tissue.
folic acid and vitamin B12 tissue.
Vitamin B12 is also necessary for
maintenance of the
myelin sheat in nerve tissue
Folate deficiency may result from increased loss of
folate
False low serum and red cell folate levels may occur if the patient has been taking
antibiotics, such as tetracycline, which suppress the growth of
Lactobacillus casei
a cytotoxic antineoplastic drug that is also used to treat leukemia, ovarian cancer and melanoma. It
interferes with the growth of cancer cells, which are eventually destroyed by the body.
Hydroxyurea
Reduction of frequency of painful crisis and need for blood
transfusions in adult patients with
sickle cell anemia
used to treat sickle cell anemia
hydroxyurea
hydroxyurea has a half life of
3-4 hours
hydroxyurea has a peak levels of
1-4 hours
disorder involving too few red blood cells (RBCs) or ineffective RBCs that can
alter the blood’s ability to carry oxygen
anemia
RBCs, responsible for carrying oxygen to the tissues and removing
carbon dioxide; they have no nucleus and live approximately 120 days
erythrocytes
process of RBC production and life cycle; formed by megaloblastic cells in the bone marrow, using iron, folic acid, carbohydrates, vitamin B12, and amino
acids; they circulate in the vascular system for about 120 days and then are lysed and
recycled
erythropoiesis
glycoprotein produced by the kidneys, released in response to
decreased blood flow or oxygen tension in the kidney; controls the rate of RBC
production in the bone marrow
erythropoietin
low RBC count with low iron available because of high
demand, poor diet, or poor absorption; treated with iron replacement
iron-deficiency anemia
anemia caused by lack of vitamin B12 and/or folic acid, in which RBCs are fewer in number and have a weak stroma and a short lifespan; treated by
replacement of folic acid and vitamin B12
megaloblastic anemia
