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Cardiovascular Drugs


Title: Slide 1 Author: weclient Last modified by: weclient Created Date: 1/12/2011 2:24:55 PM Document presentation format: On-screen Show Company – PowerPoint PPT presentation

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Title: Cardiovascular Drugs

Cardiovascular Drugs
ACE Inhibitor
  • Generic ends in pril
  • Works in the kidney (renin system) blocks
    angiotension I from forming angiotension II a
    strong vasoconstrictor
  • Generic names/trade name
  • quinapril (accupril), ramapril (altace),
    benazepril (lotensin), captopril (capoten),
    enalapril (vasotec), fosinopril (monopril),
    lisinopril (prinivil), ramipril (altace)

  • This drug will Side Effects
  • Lower BP hypotension
  • Raise pulse hyperkalemia
  • AceInduced renal insufficience/failu
  • Angioedema
  • dry hacking cough

  • Avoid if Hx of Renal artery
  • I teach my patient that the I monitor
    the following
  • benefit of this drug is
    blood pressure
  • Lowers BP (what are my parameters)
  • Strengthens a weak heart muscle
    Renal Function BUNCreatinine
  • Slows the progression of renal disease
    Potassium level (K)
  • Prevents strokes
  • Improve survival after MI

Angiotension II Receptor Antagonist
  • Generic ends in sartan
  • Works in the kidney cousin to the ACE, blocks
    the action of angiotension II, permits relaxation
    and dilation of blood vessels.
  • Generic names/trade name
  • candesartan (atacand), irbesartan (avapro),
    olmesartan (benicar),
  • losartan ( cozaar), valsartan (diovan),
  • telmisartan (micardis), eprosartan (teveten)

This drug will Side Effects Lower
BP hypotension Raise pulse
hyperkalemia AceInduced renal
DEATH I teach my patient that the I
monitor the following benefit of this drug is
blood pressure Lowers
BP (what are my parameters) Strengthen
s a weak heart muscle Renal
Function BUNCreatinine Slows the progression
of renal disease Potassium level (K)
Beta Blockers
  • Generic names end in olol
  • Beta1 cells in heart, eyes and kidneys. Beta 2
    cells in lungs, gi tract, liver, uterus, blood
    vessels, and skeletal muscle.
  • Block Beta cells by blocking effect of
    norepinephrine and epinephrine.
  • Generic/trade name
  • Non-selective beta blockers affect B1 and B2
    cells propranolol (Inderal) affects heart,
    blood vessels and air passages
  • Selective Beta blockers primarily block B1
    cellsAtenolol (tenormin), nebivolol (bystolic),
    metoprolol tartrate (lopressor), metoprolol
    succinate (toprol xl), bisoprolol (zebeta),
  • Block beta and alpha-1 receptors which add to
    blood vessel dilating effect carvedilol,
    (coreg), Labetalol (Normodyne, Trandate).

  • This drug will
    Side effects
  • Lower BP hypotension
  • Lowers pulse bradycardia (heart
  • may worsen copd and DM
  • I teach my patient I will monitor
    the following
  • the benefit of this drug
  • Lowers BP
  • Antiarrythmic
  • Strengthens weak heart muscle
  • Lowers risk of second MI
  • Angina
  • Reduce production of aqueous humor
  • Therefore reduce pressure for glaucoma

Calcium Channel Blockers
  • Generic/trade name differ in their duration
    action, elimination from body, and in their
    ability to affect heart rate and contraction.
    They dilate areteries.
  • Some have little affect on heart rate and
    contraction so they are safer to use in people
    with heart failure and bradycardia felodipine
    (plendil), amlodipine (norvasc),
  • nifedipine (procardia)
  • These have greatest effect on heart and reduce
    the strength and rate of contraction, therefore
    they are used quite often for their antiarrythmic
    affect diltiazem (cardizem), verapamil (calan,

  • This drug will Side effects
  • Lower BP hypotension
  • Lower pulse bradycardia
  • ankle edema
  • constipation
  • I teach my patient I
    will monitor
  • The benefit of this drug BP
  • Lowers BP pulse
  • antiarrythmic No grapefruit juice
    2hours ac
  • Angina or 4 hours after
    CCB cyp4503a4
  • Pulmonary HTN LFTs
  • Raynauds, subarachnoid hemorrhage
  • And prevention of migraines

  • These can have mild antiarrhythmic effect to a
    very strong effect.
  • Drug will slow heart rate and hopefully keep the
    heart in normal sinus rhythm
  • Common ones you will see Beta blockers/CCB
  • Lanoxin, sotalol (betapace), flecainide,
  • The most common and effective is amiodarone
    (cordarone, nexterone, pacerone)
  • The newest one Multaq may cause liver failure
    if used long term

  • This drug will Side effects are drug
  • slow the heart rate All can cause
  • is used to help maintain Used with
    caution in heart failure.
  • sinus rhythm . Caution with any
    2nd or 3rd degree heart block if
  • no pacemaker present.
  • Amiodarone causes hypothyroid,
    interstitial lung
    changes, visual disturbances, and
    potentiates coumadin,
  • liver damage
  • I teach my patient I will closely monitor
  • That the benefit of this drug is Heart rate
  • Helps rate control your heart If on amiodarone
  • Helps to maintain sinus rhythm coumadin (INR) ,
    TFT, LFTs, CXR with PFTs, eye exam along
  • fundoscopy exam, BP and ECG
  • Amiodarone is very effective anti arrhythmic
    with many side effects will see it often due to
    it is cheap
  • Multaq newer but more expensive used with
    extreme caution with any one with hx of CHF you
    wont see this one as often due to cost and
    concern over long term use due to liver failure.

  • Potassium wasting versus potassium sparing.
  • Thiazide (HCTZ) mild used genererally first for
    HTN treatment (minimal effect on K but still
    check) Metazolone (zaroxolyn) boosts loop use
    with caution will really make them increase urine
    output and waste K must give 30 minutes prior to
    loop to work!!!!!!
  • Loop Furosemide, torsemide(demadex),
    Bumetanide(bumex) lowers bp and decreases edema
  • Potassium sparing triamterene, Spironolactone
    (aldactone) Aldactone used in CHF with decreased
    EF lt 35-40 patients it increases long term
    survival used to decrease aldosterone levels in

  • This drug will Side effects
  • Increase urine output hypokalemia
  • hyperkalemia w/k sparing
  • hypotension
  • dehydration
  • I teach my patient I will closely monitor
  • That the benefit of this drug is BP
  • Decrease blood pressure
  • Decrease edema (lungs and legs) BUN
  • Creatinine

Antiplatelet aggregration
  • Aspirin (ASA) 81mg, 162mg or 325mg
  • Clopidogrel (plavix) 75mg
  • Prasugrel (effient) 10mg daily (5mg if wtlt60kg)
  • If s/p PCI with Stent placement must remain on
    above for at least 12 months minimum generally
    ASA325 plavix or effient x 90 days, then ASA
    81mg plavix or effient. Do not stop unless you
    speak with cardiologist and are told to do so.
    If they are stopped high risk for restenosis of
    drug eluting stent
  • Effient and plavix cost about 185 dollars for 30
    day supply very expensive.

Anti platelets
  • ASA reduces production of platelets ASA
  • Effient/plavix prevents platelet
    aggregation effient not advised if pateint is
    gt75 years old, actively bleeding, recent
    CVA/TIA, wtlt60kg. For Effients and
    Plavix bleeding and hemorrhage
  • Prevents MIs and embolic CVA/TIA monitor for
  • Actively Bleeding labs HH
  • S/P PCI with drug eluting stent Can the
    patient form a clot labs Plt
  • these patient must remain on asa
  • plus one of the antiplatelets as previously
  • described for at least one year with
  • no interruption in therapy

  • Warfarin (Coumadin) afib, aflutter
    thromboembolism/stroke prophylaxis, mechanical
    valve, DVT, VTE prophylaxis with hip/knee
    replacements QD dosing. Vit K reverses now
    given orally not IM
  • Dabigatran (Pradaxa) afib/aflutter
    thromboembolism/stroke prophylaxis
  • When switching from coumadin to pradaxa INR has
    to be lt 2 BID dosing No antidote
  • Rivaroxaban (Xarelto)afib, aflutter
    thromboembolism/stroke prophylaxis, DVT
    prophylaxis with hip/knee replacements when
    switching from coumadin to Xarelto INR has to be
    lt 3.,
  • DVT prophylaxis post op hip start 6-10h post op
    once hemostasis is established X 35 days
  • DVT prophylaxis post op knee start 6-10h post op
    once hemostasis is established X 12 days No

  • Coumadin inhibits Vit K dependent Bleeding
  • coagulation factor synthesis.
  • Pradaxa reversibly inhibits thrombin
  • Xarelto selectively blocks active site
  • of factor Xa, thus inhibiting blood
  • coagulation
  • Prevents Embolic events If on Coumadin watch
  • Types of embolic events? Assess for bleeding

Oral Antidiabetic Medications
  • Can insulin be given via oral route?
  • Remember that people with type 2 diabetes tend to
    have two problems that lead to increased sugar
    (glucose) in the bloodstream
  • They don't make enough insulin to move glucose
    into cells where it belongs.
  • The body's cells become "resistant" to insulin
    (insulin resistance), meaning they don't take in
    glucose as well as they should.
  • Oral antidiabetic medications work three
    different ways
  • Stimulates pancrease to produce insulin
  • Makes cells more sensitive to insulin
  • Decreases the GI tracts absorption of glucose.

Sulfonylureas. Increase insulin production
  • These diabetes pills lower blood sugar by
    stimulating the pancreas to release more insulin.
  • They include Glucotrol (glipizide), Glucotrol
    XL (extended release), DiaBeta (glyburide),
    Micronase (glyburide), Glynase PresTab
    (glyburide), and Amaryl (glimepiride). These
    drugs can cause a decrease in the hemoglobin A1c
    (HbA1c) of up to 1-2.

Sulfonylureas Side effects
  • Hypoglycemia (low blood sugar)
  • Upset stomach
  • Skin rash or itching
  • Weight gain

Biguanides. Make cells more receptive
  • These diabetes pills improve insulin's ability to
    move sugar into cells especially into the muscle
    cells. They also prevent the liver from releasing
    stored sugar.
  • Used along with diet and exercise.
  • Biguanides should not be used in people who have
    kidney damage or heart failure because of the
    risk of precipitating a severe build up of lactic
    acid (called lactic acidosis) in these patients.
    Biguanides can decrease the HbA1c 1-2.
  • An example includes metformin (Glucophage,
    Glucophage XR, Riomet, Fortamet, and Glumetza).

Side effects

  • Upset stomach (nausea, diarrhea)
  • Metallic taste in mouth
  • Vit B12 deficiency
  • Lactic Acidosis

Thiazolidinediones Makes the cells use insulin
  • Actos (pioglitazone)
  • Avandia (rosiglitazone) can only be used if
    client has already been on it and has had risks
    and benefits reviewed and they decide to stay on
    it. Due to increased risk of heart failure and
    CVS events
  • Typical reductions in glycolated hemoglobin (A1C)
    values are 1.52.0.

Alpha-glucosidase inhibitors
  • Precose (acarbose) and Glyset (miglitol).
  • These drugs block enzymes that help digest
    starches, slowing the rise in blood sugar.
  • They can lower hemoglobin A1c by 0.5-1.

Side effects of Alpha-glucosidase inhibitors
  • Diarrhea, nausea, cramps or gas

Meglitinides, stimulate release of insulin
  • Prandin (repaglinide) and Starlix (nateglinide).
  • The effects of these diabetes pills depend on the
    level of glucose. They are said to be glucose
  • High sugars make this class of diabetes
    medicines release insulin.
  • This is unlike the sulfonylureas that cause an
    increase in insulin release, regardless of
    glucose levels, and can lead to hypoglycemia

Side effects of meglitinides include
  • Hypoglycemia (low blood sugar)
  • Stomach upset

Dipeptidyl peptidase IV (DPP-IV) inhibitors
increasing insulin secretion from the pancreas
and reducing sugar production (great for lowering
postprandial blood sugar)
  • Januvia (sitagliptin), Onglyza (saxagliptin), and
    Tradjenta (linagliptin), Galvus (Vildagliptin) .
  • DPP-4 (dipeptidyl peptidase IV) is an enzyme
    that's responsible for inactivating hormones in
    your gut called incretins (glp-1). These helpful
    incretin hormones cause your pancreas to produce
    more insulin and your liver to stop producing
    glucose. By depressing or inhibiting the DPP-4
    enzyme that inactivates incretins, DPP-4
    inhibitors promote higher levels of incretins
    (glp-1) to keep your blood glucose in the normal
    range, especially after meals.
  • DPP-IV inhibitors control sugar without causing
    weight gain. The medication may be taken alone or
    with other medications such as metformin.

DPP-4 inhibitor Side effects
  • During the clinical studies, the most common side
    effects were
  • cold like symptoms, stuffy nose, sore throat,
    coughing, high cholesterol, high triglycerides
    and weight gain.
  • Hypoglycemia when used with metformin.