Medications for Cardiovascular diseases Flashcards
Medications for ischemia heart disease
1) nitrates
2) beta-blockers
3) calcium-channel blockers
4) anticoagulants
5) thrombolytics
vasodilation
decreases demand on heart
heart demand increase
pain
increase in BP
increase in HR
Nitrates
- powerful vasodilator(veins and arteries)
- inhibits smooth muscle contraction
- systemic vasodilation reduces cardiac workload by reducing both preload and afterload
administration of nitrates
1) sublingual
- emergency use(onset in 2-3 minutes)
2) oral
- long term use
3) chewable tablets
4) lingual spray
5) ointment forms
6) transdermal patch
- lasts up to 6 hours, generally given during day
side effects of nitrates
- orthostatic hypotension = decreased BP from changing positions
- reflex tachycardia = sudden decrease in BP so body increases HR to compensate
- headache, dizziness, nausea
Beta-blockers
- olol
- beta-1 selective = blocks receptor on the heart
- reduces contractility and exertional tachycardia
- decreases HR by suppressing sympathetic activity
- beta-2 selective = bronchodilator receptor
- general beta blocker = decreases HR and decreased bronchodilation
PT implications for B-blockers
- reduces HRmax by 20-30 bpm
- bronchoconstriction may occur
- orthostatic hypotension
- some elderly may not tolerate
contraindications for B-blockers
- HR < 60bpm(bradycardia)
- Systolic BP < 100(hypotension)
- moderate to severe LV failure
- heart block
- severe COPD
- signs of peripheral hypotension
Calcium channel blockers
- CCB
- ipine
- coronary vasodilation(increase blood supply to heart)
- blocks calcium entry into vascular smooth muscle
- side effects = reflex tachycardia
Diltiazem and verapamil
- reduce cardia contractility
- side effects = may cause disturbance in heart rhythm(arrhythmia)
Anti-coagulants
1) heparin(IV injection)
2) Low-molecular-weight heparins(subcutaneous injection)
- Lovenox
3) Warfarin(oral)
- coumadin
4) aspirin and other anti-platelets
Heparin
- anti-coagulant
- prevent blood clot and embolism
- inhibits formation of thrombin
- monitor activated partial thromboplastin time
- side effects = bleeding, thrombocytopenia, osteoporosis after long-term use
Warfarin
- Coumadin
- inhibits vitamin K-dependent activation of clotting factors
- cannot take vitamin K supplements or eat foods high in vitamin K
monitor prothrombin time
normally maintain the International Normalized Ratio(INR) at 2 to 3
- allow abnormal INR for heart valve replacement
anti-platelets
suppress platelet aggregation by inhibiting the COX enzyme
- reduces activation of blood platelets - COX important for the synthesis of prostaglandins and thromboxanes - Ex: aspirin, dipyridamole
aspririn
For acute phase:
- limit the progression of platelet-induced occlusion
- prevent re-infarction, ischemic stroke, DVT, thromboembolism
For chronic anti-thrombotic therapy:
- very low dosage is effective
- very cost-effective
aspirin contraindications
thrombocytopenia
aspirin related allergies
deep friction massage, vigorous mobilization
aspirin side effects
increased risk of bleeding
GI irritation
toxic to liver and kidney in high doses
ADP inhibitors
block ADP receptor on the platelet membrane
- well tolerated by pt’s
glycoprotein 2b-3a inhibitors
block GP receptor on the platelet membrane
- inhibit the ability of fibrinogen to activate platelets
- via IV injection
thrombolytic agents
dissolves clot
- converts plasminogen to plasmin which then hydrolyzes fibrin
- Ex: streptokinase and anisoylated plasminogen(antigen/autoimmune response)
- Ex: urokinase and recombinant tissue plasminogen activator(no antigen effect)
contraindications for thrombolytics
- internal bleeding, recent stroke, healing wounds, cancer metastasis
- precautions = no debridement, no rigorous manual techniques
MONA
prevent further clot
- M = morphine
- O = oxygen
- N = nitroglycerine
- A = aspirin
