Title: Cardiovascular Pharmaceuticals
1Cardiovascular Pharmaceuticals
- Irene Mueller, EdD, RHIA
- MHA
- 2010
2Objectives First Hour
- Medications
- Heart
- Vessels
3Objectives - 2nd hour
- Medications
- Vessels, continued
- Using the ICD-9-CM Table of Drugs
- Homework Answers
- Responses to Questions
- Resources
4CV System Pharmaceuticals
- Many can be used for
- Multiple Heart AND/OR vessel conditions
- Dosage, etc. variations
- Therefore, can be grouped many ways
- Many used in combination
- Many can interact with
- each other
- Other types of meds
- Following lists are most common
- Many other drugs
5Actions of Heart Drugs
- Possible actions of cardiac drugs
- change the rate of the heartbeat
- change the rhythm of the heartbeat
- change the amount of output of blood
- change the strength of contraction
- Inotropic and Cardiotonic
- Blood vessel/Blood drugs can help heart
6Classifications of Heart Drugs
ACE Inhibitors Anti-coagulants/Anti-platelets
Anti-anginals Anti-fibinolytics
Beta-adrenergic Blockers Anti-hyperlipidemics
Calcium channel Blockers Cardiac glycosides
Nitrites and Nitrates Diuretics
Anti-arrhythmic (-Dysrhythmic) agents Carbonic Anhydrase Inhibitors
Beta-adrenergic Blockers (Class II) Osmotic
Calcium channel Blockers (Class IV) Thiazide/Thiazide -like
Potassium channel Blockers (Class III) Thrombolytics
Sodium Channel Blockers (Class I)
Italics in vessel section
Bold in heart section
7Anti-anginals
Contraindications Interactions Side Effects
Anemia, severe alcohol Blurred vision
GI disease Viagra Dry mouth
Glaucoma Flushing
Intracranial pressure GI - Constipation
Low blood pressure Headache
Hypersensitivity reaction
Orthostatic hypotension
8Beta-adrenergic Blockers
- Reverse the sympathetic system effects
- Caused by exercise, mental exertions
- Decrease heart rate and force of contractions
- Decrease cardiac work oxygen consumption
- Often prevents myocardial ischemia and pain
- Long-term mgt of angina pectoris
- Can be combined with nitrates
9Types of CV Beta receptors
- Beta-1 (ß1) - heart
- Beta (ß2) - blood vessels
- Beta (ß3) - fat cells
- Block the effect of norepinephrine and
epinephrine at receptor sites - reduce heart rate (B1)
- reduce blood pressure by dilating blood vessels
(B2)
10NS Beta-adrenergic Blockers
- Nonselective Blockers (beta 1 and 2)
- Labetalol (Normodyne) HTN
- Nadolol (Corgard) HTN, angina pectoris
- Pindolol (Visken) HTN
- Propranolol (Inderal)
- HTN, angina, arrhythmias, migraine
- Timolol (Blocadren) HTN, post MI
11Selective Beta-1 Blockers
- acebutolol (Sectral)
- HTN, ventricular arrhythmias
- atenolol (Tenormin) HTN, angina pectoris
- bisoprolol (Zebeta) HTN
- esmolol (Brevibloc) SV Tachycardia
- metoprolol (Lopressor) HTN, angina pect.
12Calcium Channel Blockers
- Can be used to treat
- Tachyarrhythmias, angina pectoris, HTN
- Decrease calcium entry into cells with actions
potentials (heart and blood vessels) - 2 effects in heart (conduction muscle)
- Decrease rate of SA node, AV conduction
- Decrease force of contractions
- Effect in vessels relaxation, vasodilation
13Calcium Channel Blockers
- verapamil (Calan, Isoptin)
- AV node/SV arrhythmias, angina
- diltiazem (Cardizem)
- More effective as anti-hypertensive
- nifedipine (Procardia)
- Vasodilator
- nicardipine (Cardene)
- Vasodilation, relax coronary artery spasm
- Newer
- amlodipene (Norvasc)
- bepridil (Vascor)
- felodipine (Plendil)
- Isradipine (DynaCirc)
14Nitrites and Nitrates
- Oldest/Most frequently used antianginals
- General dilation of systemic veins/arteries
- Vascular smooth muscle
- Ions are converted by enzymes to Nitric Oxide
- Lower doses more venous dilation
15Nitrites and Nitrates
- Decrease preload and afterload of heart
- Preload force of venous return to heart
- Afterload arterial pressure (blood pressure) L
ventricle must work against to eject blood - Reduce cardiac work/oxygen consumption
- Used prophylactically and during angina
- Also to tx CHF
- Nitrates relieve vasospasm in coronary art.
16Nitrites and Nitrates
- amyl nitrite (Vaporole)
- erythrityl Tetranitrate (Cardilate)
- isosorbie Dinitrate (Isordil)
- nitroglycerin (Nitrol, Notrostat, Nitrong,
Nitro-Bid, Transderm-Nitro - pentaerythritol Tetranitrate (Peritrate)
17Nitroglycerin
- Sublingual
- Almost immediate onset, but short duration
- Acute anginal attacks
- Ointment (2)
- Extended release tablets/capsules
- Transdermal patches
- IV Emergencies/surgeries in hospital
18Anti-arrhythmics
- 4 classes
- Class 1 Sodium channel blockers
- Class 2 Beta-adrenergic blockers
- Described in anti-anginals
- Class 3 Potassium channel blockers
- Class 4 Calcium channel blockers
- Described in anti-anginals
19Anti-arrhythmics
- Dromotrophics irregular rhythms
- Chronotropics too fast or too slow
- Several ions regulate electrical system
- Sodium, Potassium, Calcium
- Arrhythmias disturb movement of ions
- Drugs can help restore normal movement
- Anti-arrhythmics do NOT cure causes
20Sodium Channel Blockers (Class 1)
- Interfere with movement of sodium ions
- Slow conduction velocity
- Tx
- Supraventricular tachycardias
- Ventricular arrhythmias
- Side effects/Contraindications
- Specific to each drug
21Sodium Channel Blockers
- quinidine (chinchona bark)
- procainamide (Procanbid)
- disopyramide (Norpace)
- lidocaine (Xylocaine)
- phenytoin (Dilantin)
- Newer
- flecainide (Tambocor), moricizine (Ethmozine),
propafenone (Rythmol)
22Potassium Channel Blockers
- Decrease frequency of arrhythmias
- bretylium (Bretylol)
- Adrenergic neuronal blocker
- amiodarone (Cordarone)
- Blocks alpha, beta, calcium receptors
- sotalol (Betapace)
- Non-selective beta blocker
23Other Anti-arrhythmics
- quinidine sulfate (Class 1)
- decreases the of atrial muscle contractions
- used to treat Afib
- Pronestyl
- ventricular arrhythmias w/premature contractions
- Afib
- Lidocaine (Xylocaine) (Class 1)
- IV - prevents controls Vfib, pt w/recent severe
MI - (SE) drowsiness, disorientation, confusion,
convulsions, coma
24Cardiac Glycosides
- Derived from Digitalis plants
- Oleander, Lily of valley, Cane toads
- Increase force of contractions (Inotropic)
- Lowers ventricular rate
- w/o increasing oxygen consumption
- Kidney function improves, reducing edema
- Decrease heart rate and AV conduction
- Increase kidney function, reduces edema
25Cardiac Glycosides
Contraindications Interactions Side Effects
Hypothyroidism Adrenergics Arrhythmias
Lactation, Pregnancy Antacids Dizziness
MI Anti-arrhythmics Electrolyte imbalance
Impaired kidneys Diuretics GI upset
Monitor Neomycin Headache
High/low potassium Phenobarbital Irritability
Irregular rhythm Rifampin Lethargy
Slow heart rate Sulfa drugs Muscle weakness
Discontinue if noted Seizures
Tremors
26Cardiac Glycosides
- Digitalization, then maintenance
- Low potassium increases toxic effects
- High potassium antagonizes tx effects
- High calcium enhances action
- Tx CHF
27Cardiac Glycosides
- deslanoside (Cedilanid-D) IM, IV
- digitoxin (Purodigin) PO, IV
- digoxin (Lanoxin) PO, IV
- side effects (overdose of digoxin) - nausea,
vomiting, objects appear brighter, bradycardia
28Diuretics
- Used to tx CV conditions
- HTN, Edema (CHF)
- Diuretic actions
- Stimulate urine production
- inc glomerular filtration
- Decrease sodium reabsorption (diuresis)
- Five major classes of Diuretics
29Diuretics
Contraindications Interactions Side Effects
Anuria Cardiac glycosides Anorexia
Breastfeeding Corticosteroids Hypersensitivity reactions (skin rash)
Known hypersensitivity Lithium Hyperuricemia
Pregnancy NSAIDs Hypokalemia
Oral hypoglycemics Hyponatremia
Hypotension
Nausea
Ototoxicity (loop)
30Classes of Diuretics
Carbonic anhydrase inhibitors
Organic acids (Loop)
Osmotic (Lumenal) (no ? uses)
Potassium-sparing
Thiazide/Thiazide-like
OTC (Xanthine derivatives)
31Carbonic Anhydrase Inhibitors
- Increase sodium and water excretion
- Not used as often today
- Still adjunct tx in CHF (Acetazolamide)
- Also used to tx
- Glaucoma
- Petit mal seizures
- dichlorphennamide, mathazolamide
- Acute mountain sickness (Acetazolamide)
32Organic Acid (Loop) Diuretics
- Inhibit sodium and chloride ion transport in loop
of Henle - Great loss of sodium, chloride, and water
- Usu. Hypochloremic alkalosis
- Tx
- Edema inpts resistant to thiazides
- Severe peripheral and pulmonary edema
- Edema of CHF
33Organic Acid (Loop) Diuretics
- bumetanite (Bumex) CHF edema, ascites
- ethacrynic acid (Ederin) CHF edema
- furosemide (Lasix) CHF edema, HTN
- torsemide (Demadex) CHF edema
- http//media-2.web.britannica.com/eb-media/23/9942
3-004-BB1F574D.jpg
34Potassium-Sparing Diuretics
- Mild diuresis
- Inhibit potassium secretion in the distal
convoluted tubules - Primarily adjuncts to thiazide/loop diuretics
- Inhibit hypokalemia
- Hyperkalemia promoted in
- Impaired renal function/diabetic pts
35Potassium-Sparing Diuretics
- amiloride (Midamor) HTN
- spironolactone (Aldactone) HTN, Edema
- spironolactone
- w/thiazide (Aldactazide) HTN, Edema
- triamterene (Dyrenium) - Edema, HTN
36Thiazide/Thiazide-like Diuretics
- Largest group
- Inhibit sodium transport in the distal portion of
the nephron - Intense diuresis of sodium and water
- Increase excretion of chloride and potassium
- Produce alkalosis and hypokalemia
- Hyponatremia in elderly reported
37Uses of Thiazide Diuretics
- Edema of any cause
- immediate
- Mild/moderate HTN
- 4-6 weeks
- Decrease blood volume
- Relax smooth muscles in vessel walls
38Side Effects of Thiazides
- Drop in blood pressure
- Orthostatic hypotension
- Dizziness, faint
- Hypokalemia
- Hyperuricemia
- Hyperglycemia
- Muscle spasms/cramps
- Glucose changes in DM
- Nausea
- Diarrhea
- Constipation
- Anorexia
- Headache
- Impotence
- Elevation
- BUN
- Creatinine
39Thiazide Diuretics
- bendroflumethiazide (Naturetin)
- benzthiazide (ExNa)
- chlorothiazide (Diuril, Diurgen)
- hydrochlorothiazide (Exidrix, Ezide, HydroDIURIL,
Oretic) - methyclothiazide (Enduron, Aquatensin)
- polythiazide (Renese)
- trichlormethizade (Diurese, Metahydrin, Naqua)
40Thiazide-like Diruetics
- chlorthalidone (Hygroton)
- indapamide (Lozol)
- metalazone (Zaraxolyn)
- qinethazone (Hydromox)
41Classification of Vessel Drugs
Anti-coagulants/Antiplatelets Diuretics
Aspirin (Prostaglandin Inhibitor) Carbonic Anhydrase Inhibitors
Coumarins Osmotic
Heparin Thiazide/Thiazide -like
Thrombolytics
Antifibrinolytics Vasoconstrictors
Anti-hyperlipidemics Other Vasodilators
Anti-hypertensives Nitrites and Nitrates
ACE Inhibitors
Calcium channel Blockers
Vasodilators Bold in vessel section
Alpha-adrenergic Blockers Italics in heart sections
Angiotensin II receptor blockers (ARBs)
42Anti-coagulants (Veins)
- 4 stages in coagulation and clot resolution
- Anti-coagulant mechanisms
- Inhibit the function of preformed clotting
factors (heparin - IV/SQ) - Prevent synthesis of normal clotting factors
- Coumarin derivatives (PO)
- Mechanisms determines onset/duration of drug
effects - Used to prevent MIs
43Anti-coagulants
Contraindications Interactions Side Effects
Uncontrolled bleeding Acetaminophen, NSAIDs Bleeding (increased)
Pregancy (use with caution) Alcohol Blood irregularities
Anti-infectives GI disease
Barbiturates Kidney disease
Chloral hydrate Liver disease
Estrogen
Steroids anabolic and cortico-
Thyroid drugs
Tricyclic antidepressants
44Coumarin Derivatives
- Can be PO
- Warfarin sodium (Coumadin)
- Vitamin K antagonist
- Side effects
- Hematuria, petechiae
- Nausea, Diarrha, urticaria, alopecia
45Heparin (IV,SQ)
- Used to Prevent
- Venous thrombosis, esp. Pulmonary embolism
- Clots prior to blood transfusion, during open
heart surgery - Treat
- MI
- Thrombophlebitis
- Stroke
- Preferred anti-coagulant during pregnancy
46Antiplatelets (Arteries)
- Suppress aggregation of platelets
- Core of arterial thrombus
- Low-dose aspirin - Preventative
- Clopidgrogrel (Plavix)
- Previous MI
- Ticlopidine (Ticlid)
- More expensive than aspirin, same level of tx
- Dipyridamole (Persantin)
47Aspirin
- acetylsalicylic acid
- Hippocrates (460 B.C and 377 B.C)
- historical records of pain relief tx
- use of powder made from willow bark and leaves
for headaches, pains and fevers - 1829, scientists discovered called salicin in
willow plants which provide pain relief - Aspirin was patented on February 27, 1900 by Bayer
48Thrombolytics
- Dissolve existing clots
- Tx MI w/in 6 hours of symptoms onset
- 5 drugs
- streptokinase (streptase)
- alteplase (Activase)
- urokinase (Abbokinase)
- reteplase (Retavase)
- anistreplase (Eminase)
49Anti-fibrinolytics
- Help form blood clots
- Provide hemostasis
- Vitamin K antidote for anticoagulant overdose
50Anti-hyperlipidemics (Hypolipidemics)
- Atherosclerotic plaques usually in large/medium
arteries - Lifestyle changes first
- Diet changes needed even with meds
- Prophylactic tx, lifelong once begun
- Reduce cholesterol and LDL
51Anti-hyperlipidemics
Contraindications Interactions Side Effects
Biliary obstruction antacids abdominal pain
Elevated liver enzymes anticoagulants arrhythmias
Gallbladder disease cardiac glycosides asthenia
Lactation cimetidine constipation
Liver disease corticosteroids dizziness
Peptic ulcers cyclosporine headache
Pregnancy erythromycin myalgia
Renal dysfunction iron NV
sulfonylureas rash
52Anti-hyperlipidemics
- Bile Acid sequestrants
- HMG CoA Reductase Inhibitors (statins)
- Nicotinic Acid
- Fibric Acid Derivatives
- Estrogens
53Anti-hyperlipidemics
- cholestyramine (Questran, Prevalite) (BAS)
- colestipol (Colestid) (BAS)
- atorvastin (Lipitor)
- fluvastatin (Lescal)
- lovastatin (Mevacor)
- pravastatin (Pravachol)
- simvastatin (Zocor)
54Break Time
55Anti-hypertensives
- Treatment usually begins with
- lifestyle changes, then add
- diuretic or beta blocker, then
- add another med, etc.
- Compliance big problem, HTN asymptomatic
- ACE Inhibitors
- Vasodilators
- Alpha-adrenergic Blockers
- Angiotensin II receptor blockers (ARBs)
56ACE Inhibitors
- Angiotensin Converting Enzyme (ACE)
- Angiotensin is a vasoconstrictor
- Slow formation of angiotensin II
- Decrease blood volume/pressure
- Increase renal blood flow
- Interfere Less with mental/physical performance
better Quality of Life better compliance - SE nonprod cough, loss of taste, joint pain
57ACE Inhibitors (PO)
- benazepril (Lotensin)
- enalapril (Vasotec)
- fosinopril (Monopril)
- quinapril (Accupril)
- ramipril (Altace)
- Tx - CHF
58Alpha-adrenergic Blockers
- Alpha-adrenergics action similar to
norepinephrine (smooth muscle contraction) - Major alpha organ is blood vessels
- Alpha blockers effects
- Vasodilation, lower blood pressure
- SE nasal congestion, orthstatic hypotension,
fainting
59Alpha-adrenergic Blockers - PO
- doxazosin (Cardura)
- phentolamine (Regitine HCl)
- prazosin (Minipress)
- terazosin (Hytrin)
- Prescribed for Adults
60 Angiotensin II receptor blockers (ARBs)
- Angiotensin II is a vasoconstrictor
- ARBs have effects that are similar to angiotensin
converting enzyme (ACE) inhibitors - ACE inhibitors act by preventing the formation of
angiotensin II - ARBS block the binding of angiotensin II to
muscles on blood vessels
61Angiotensin II receptor blockers (ARBs)
- candesartan (Atacand)
- eprosartan (Teveten)
- irbesartan (Avapro)
- telmisartan (Micardis)
- valsartan (Diovan)
- losartan (Cozaar)
- olmesartan (Benicar)
62Vasoconstrictors
- Constrict the muscle fibers in blood vessel walls
by direct action on vessels OR stimulate the
vasomotor center in medulla - stop superficial hemorrhage
- relieve nasal congestion
- Raise blood pressure
- Increase force of heart
63Vasoconstrictors
- norepinephrine (Levophed)
- tx hypotension
- metaraminol (Aramine)
- prolonged duration, raises bl pressure
- epinephrine (Adrenalin)
64 Vasodilators
- Increase size of bl vessels
- Used to tx peripheral vascular disease, heart
conditions (CHF), HTN - Papaverine
- opium alkaloid, but NOT narcotic
- Alcohol - dilates blood vessels by depressing the
vasomotor center of medulla - can tx angina pectoris?
65(No Transcript)
66Using the Table of Drugs
- Coder must determine
- Adverse Effect vs Poisoning
- Decision Flow chart
- Taking less/stopping drug is
- NOT poisoning OR adverse effect
- 980 989 - Toxic effects of NON-medicinal
substances follow Poisoning steps
67Table of Drugs
- Rows Drugs, medicinal substances
- Columns Poisoning code, E codes
- ALWAYS VERIFY in TL
- Instructional Notes
- Ex 960 Poisoning by antibiotics
- Exclusion Note 976.x should be used for local
(topical) applications
68Adverse Effect
- Correct substance administered as prescribed
- Adverse effect (manifestation) sequenced 1st
- E code from Therapeutic use column 2nd
- CANNOT use E code from any other column
- Adverse Effect E codes MUST BE REPORTED
69Adverse Effect Documentation
- Dx statements of
- Toxic effect, toxicity, intoxication due to
prescription drug (digitalis, lithium) - w/o any further info
- Indicates Adverse Effect
- Other terms for AE
- Allergic reaction
- Cumulative effect (toxicity)
- Hypersensitivity
- Idiosyncratic reaction
- Paradoxical reaction
- Synergistic reaction
70Adverse Effects
- Toxicity
- Synergistic reaction
- Side effect
- Idiosyncratic reaction
- Because of
- Pt differences
- Age, sex, disease
- Genetic factors
- Drug-related
- Type
- Administration route
- Duration of tx
- Dosage
- Bioavailability
71 AE Drug E codes
- When agent causes multiple adverse reactions,
code the E code ONCE - When 2 drugs are responsible, code individually
unless there is a combo E code
72Unspec AE
- 995.2 Unspec AE effect of drug,
- CAN be used in OUTpatient setting
- Inappropriate for Inpatient setting
- Code SS or 796.0 w/ Ecode
73Late Effects of AE of Drugs
- Code residual condition
- 909.5
- E code (E930-E949)
- Chronic effects of drug taken for long time and
still being taken current AE - If delayed effects AFTER stopping LE
74Late Effects AE Examples
- Brain damage caused by penicillin allergy (while
taking med) - 348.9, E930.0
- Brain damage caused by penicillin allergy
(stopped using 6 months ago) - 348.9, 909.5, E930.0
75Poisoning
- Substance used incorrectly
- Error in prescription
- Drug overdose (Intentional/Accidental)
- Non-prescribed drug taken with correctly
prescribed/taken drug - Wrong administration method
- Wrong dosage given/taken
- Wrong medication given/taken
76Poisoning
- Code from Poisoning column first
- Manifestation
- E code for how substance used
- Accident, Assault, Suicide, etc.
- CANNOT use E code from Tx Use column
77Poisoning by Interaction
- Tx drug and non-prescription drug or alcohol
- Poisoning code for EACH substance
- Manifestation, if documented
- E code for EACH substance
- Ex Coma due to Adverse reaction to Valium taken
correctly, but with 2 martinis - 980.0
- 969.4
- 780.01
- E860.0
- E853.2
78Poisoning E codes
- Cause not stated undetermined E code
79Substance Abuse/Dependence
- Acute condition due to alcohol/drug
abuse/dependence Poisoning code - Code acute manifestation
- Code abuse/dependence
- E code
- Ex Acute pulmonary edema due to accidental
heroin overdose/pt dependent - 965.01, 518.4, 304.00, E850.0
- Chronic conditions are NOT poisoning
80Late Effects of Poisoning
- Same LE rules
- Residual coded first
- 909.0
- E929.2
81Specific Drug NOT in Table
- American Hospital Formulary Service (AHFS)
- Index from brand names, etc to
- Hospital Pharmacist is valuable resource
- ICD-9-CM Appendix 3 has list of AHFS by drug
functions (no brand names) - May have to research drug name to find type and
then find type in Appx 3
82Drug Resources
- Mayo Clinic
- http//www.mayoclinic.com/health/drug-information/
DrugHerbIndex - Medicinenet.com
- http//www.medicinenet.com/medications/article.htm
- MedlinePlus
- http//www.nlm.nih.gov/medlineplus/druginformation
.html
83Drug Resources
- NLM. NIH. Drug Information Portal.
- http//druginfo.nlm.nih.gov/drugportal/drugportal.
jsp - PDRHealth. Drugs and Supplements.
- http//pdrhealth.com/drugs/drugs-index.aspx
84Adverse Effects vs Poisoning
Condition due to Drug, Med. Bio? NO Code Condition
Yes
Med used exactly as prescribed? NO Code as Poisoning Add code for condition Add E code (Optional)
Yes
Alcohol/non-prescr. drug also taken? NO Code condition Add Tx use E code (E930-E949)
Yes
Code as Poisoning Add code for condition Add E code (Optional)
85Drug Coding
- Hypokalemia resulting from reaction to Diuril
given by mistake in Drs office - Electrolyte imbalance due to interaction between
lithium carbonate and Diruil, both taken as
prescribed - Toxic encephalopathy due to excessive use of
aspirin
86Drug coding
- Coumandin intoxication due to accumulative effect
resulting in gross hematuria - Severe bradycardia due to accidental double dose
of digoxin - Lightheadedness due to interaction between
Aldomet and peripheral vasodilating agent (both
taken as presc.)
87Drug Coding
- Bradycardia due to eating oleander leaves
- Systemic hypocalcemia and hypodalemia due to
using lye in housecleaning - Extrapyramidal disease due to attempted suicide
by overdose of Thorazine six months ago
http//biology.clc.uc.edu/graphics/steincarter/flo
rida/Oleander200220small.JPG
88Questions ? ? ?
ILEMten_at_gmail.com
Thank You !
89Resources
- Beaman, N. Pharmacology Clear and Simple. 2008.
PhiladelphiaF. A. Davis. - Fulcher, E. M., Soto, C. D., and Fulcher, R. M.
Pharmacology Principles and applications.
Saunders, 2003. - Hitner Nagle. Basic Pharmacology. 4th ed.
Glencoe,1999.
90Resources
- ICD-9-CM Official Guidelines for Coding and
Reporting, October 1, 2009 - http//www.cdc.gov/nchs/data/icd9/icdguide09.pdf
- Inotropic and Cardiotonic Drugs. Heart Rhythm
Society. - http//www.hrsonline.org/PatientInfo/Treatments/Me
dications/HFDrugs/ - Kapitanyan, Su, Landry. 2009. Plant Poisoning,
Glycosides Cardiac. - http//emedicine.medscape.com/article/816781-overv
iew
91Resources
- Klabunde, R. Cardiovascular pharmacology
concepts. - http//www.cvpharmacology.com/index.html
- Medicinenet. Angiotensin II Receptor Blockers
(ARBs). 2010. - http//www.medicinenet.com/angiotensin_ii_receptor
_blockers/article.htm - WebMD. Heart Disease Medications.
- http//www.webmd.com/heart-disease/guide/heart-dis
ease-medications-index