THE CARDIOVASCULAR SYSTEM
INATROPIC DRUGS- increase the force of mycardial contraction; treat
symptoms of heart failure and manage atrial arrythmias; increase
stroke volume and cardiac output, slow conduction and cause diuresis
by increasing bloodflow to the kidneys.
ANTI-ARRYTHMIC DRUGS- used to suppress or regulate atrial and
ventricular conductions, disturbances, resulting from myocardial
infraction or MI in other causes; mostly have pro-arrythmic properties
meaning, they can precipitate or aggrivate an arrythmia.
ANTI-HYPERTENSSIVE DRUGS- it lowers blood pressure by inhibiting the
central or peripheral nervous system, the renin angiotensis
mechanism or sodium and chloride reabsorption in the renal tubutles;
prescribed to treat hypertension.
ANTI-ANGINALS- this drugs reduces myocardial oxygen demand and
increase blood flow to schemic ares of th myocardium; they terminate
acute anginal attacks and prevent Angina from occuring;
ACUTE ANGINA- is managed by a short acting nitrate (nitro-glycerin) to
reduce unrelieved chest pain during acute MI
A NGINA PREVENTION- is managed with one or more drugs including:
nitrates, beta adrenergic blockers, and also calcium channel blockers;
Antilipemics
ANTILIPEMICS - are used to prevent and treat atherosclyrosis
(accumulation of fats in the blood vessels causing them to narrow) ;
because of the adverse effects of this drugs dietray modification,
weight loss, excercise and smoke cessation are considered firts line of
treatment; anti-lypimic therapy might be indicated if this measures
are ineffective.
ANATOPHYSIO:
Blood Pressure- pressure of blood in our systemic circulation it is
highest when blood is edjected during systolic pressure; and lowest
during diastolic pressure affected by various factors such as, activity,
age, hormones via kidneys etc.
Fluid transfer- cyclic flow of the fluid from the interstistial space to
the capilliaries and back into the extraterstistial space; it depend on
capilliary hydrostatic pressure, permiability, osmotic pressure , and
open lymphatic channels if distributed it may lead to edema or
excessive fluid in the interstistial space.
Cardiovascular system- maily delivers blood all throughout our
body and it helps with proper body PH, electrolyte composition and
also regulation of our body temperature.
ALL CARDIAC DRUGS except digoxin an inatropic drug can causes
descreased blood pressure and orthostatic hypotension.
ANTIHYPERTENSIVE DRUG CLASSES- Treat High Blood Pressure
(Hypertension; elevation or increase in systolic and or diastolic
pressure); ABCD
A- ANGIOTENSIN-CONVERTING ENZYME INHIBITORS (ACE
INHIBITORS)
• Angiotensin II Receptor Blockers (ARBs)
B- BETA BLOCKERS
C- CALCIUM CHANNEL BLOCKERS
D- DIURETICS (DILATORS)
1. ANGIOTENSIN- CONVERTING ENZYME (ACE) INHIBITORS
M.O. A: Block conversion of angiotensin I to angiotensin II,
preventing peripheral vasoconstriction; it enterupts the RAAS; can be
used alone or in combination with other agents such as diuretics and
or beta adrenergic blockers; reduces blood pressure but does not
affect the heart meaning it can be administered even with increased
HR
Angiotensin II- potent vasoconstrictor that increases peripheral
resistance and promotes the excretion of aldosterone that promotes
sodium and water retention
Reduction Angiotensin II- causes dilation of artereols; peripheral
vascular resistance also reduces; reduces aldosterone secretion, it
promotes excretion of sodium and water as a result, the amout of
blood the heart needs to pump also reduces decreasing blood
pressure.
DRUG EXAMPLE: (~PRIL)
• Captopril- for patients who have risk of heart failure; may become
less effective when administered with NSAIDS; can cause Proteinuria
(presence of protein in the urine) and severe allergic reactions;
usually given up to 3 doses
• Lisonipril and Ramipril- are for patients who have had an MI to
improve the survival rate; to reduce morbidity and mortality in
patients with left ventricular dysfunction
•Benezapril
•Enalapril
• INDICATIONS:
Treat mild hypertension; heart failure after an MI; reduce the risk of
MI, stroke, and death from cardiovascular causes; patient with water
and sodium retention and those who have impaired renal functions in
patients with diabetes
• C and PC:
- in patients with asthma, sinus bradycardia, cardiogenic shock,
second-or third-degree heart block, or overt cardiac failure;
- Used cautiously in pregnant or breast-feeding patients; impaired
hepatic function; and renal impairment.
•ADVERSE REACTIONS: Nagging nonproductive cough, headache,
fatigue, angioedema, Gl reactions, hyperkalemia, and increased blood
urea nitrogen (BUN) and creatinine levels
• NURSING RESPONSIBILITIES:
- Administer captopril on an empty stomach; 1 hour before meals for
maximum effectiveness.
- Monitor the patient taking captopril for proteinuria every 2 to 4
weeks for the first 3 months of therapy to detect decreased renal
function.
- avoid sudden position changes to minimize orthostatic hypotension
- Encourage nonpharmacologic treatments for hypertension
- mostly effective when taken sublingually, Instruct patient not to
chew nor swallow the drug. Allow the drug to be dissolved under the
tongue.
KEY POINTS:
A- avoided for pregnant women and breastfeeding; can cause Angio
Edema
C- avoided for patients who have Cough
E- elevate sodium-potassium levels; avoid potassium sparing diuretics
Special precautions: to patients with kidney problems and patients
with elecvated creatinine
2. ANGIOTENSIN II-RECEPTOR BLOCKING AGENTS (ARBS)
M.O.A - Block the binding of angiotensin II to the angiotensin II
receptor, preventing the vasoconstriction and aldosterone-secreting
effects of angiotensin, thus lowering the blood pressure; if ACE
inhibitor is contraindicated, we can used ARBS; does not inhibit ACE;
may be used with diuretics
DRUG EXAMPLE: (~SARTAN)
• Losartan and Ibesartan- indicated for patients with type 2 diabetes
because of thier inherent renal protective effect
• Valsartan- alternative for ace inhibitors; management of heart
failure
• Telmisartan- used cautiously in patients with biliary dysfunction
