Cardiovascular+Drugs

= Cardiovascular Drugs =

**Congestive Heart Failure Medications**
=== Problem: The heart is unable to provide adequate oxygen to meet the needs of the body, causing blood to accumulate in the lower chambers of the heart (ventricles). This results in ventricular enlargement and ineffectiveness. ===

__Medications __: Digoxin (Lanoxin): Pharmacologic Effects: a. Increases the force and strength of contraction of the myocardium b. Allows heart to do more work without increasing its oxygen usage c. Reduces the size of the heart, allowing it to be more efficient d. More blood is pumped through kidney Uses: Treatment of congestive heart failure, arrhythmias, atrial fibrillation, and tachycardias. Adverse Effects: toxicity, anorexia, nausea, vomiting, and copious saliva Signs of Toxicity: Headache, drowsiness, visual disturbances of green and yellow vision and halo around lights, pain in the lower face similar to trigeminal neuralgia, weakness, faintness, and mental confusion. Drug Interactions: sympathomimetics such as vasoconstrictors, erythromycin and tetracycline can cause toxicity Patient Management: watch for overdose side effects (nausea, vision changes, and copious saliva), use epinephrine with caution, monitor pulse to check for bradycardia, caution with patient taking tetracycline or erythromycin along with digoxin.

Antiarrhythmic Agents
=== Problem: Abnormal pulse conduction causing irregular heart beats, which disturbes the natural rhythm of the heart and interferes with its efficiency.Can be caused by arteriosclerosis, blocked arteries, and anoxia. === __Medications__: Groups I-IV ( ie: Quinidine, Esmolol, Amiodarone, Verapamil) Pharmacologic Effects:Depress parts of the heart that are beating irregularly by decreasing the slope of depolarization, which decreases the rate of electrical impulses in the heart Uses: regulate ventricular and supraventricular arrhythmias Adverse Effects: Vary based on the drug; can include dizziness, flushing, nausea, xerostomia, and gastrointestinal symptoms Patient Management: Possible increased potential for otrhtostatic hypotension and hypotensive syncope; the patient may require a medical consult for the use of epinephrine or other vasoconstrictors. Some antiarrhythmics may effect the action of local anesthetics and other durgs such as opioid analgesics, some may also cause drug reactions in the oral cavity resulting in oral hemorrhaging and petechia as well as changes in saliva.

Problem: Insufficient oxygen to the heart results in pain in the chest which may radiate to the shoulder, neck, back, left arm, and lower jaw
__Medications__: Nitroglycerin-like compounds: Pharmacologic Effects: Vasodialator releases nitrite ions and nitric oxide which reduced the workload of the heart which leads to decrease in oxgen demand. Reduces the angina pain. Uses: Nitroglycerin is the most commonly use to treat angina. Adverse Reactions:Occurs mostly because of its effect on the vascular smooth muscle. Causes severe headaches after the use of a vasodialator. Flushing, hypotension, light headness syncope and also localized burning or tingling at sight of administration. Storage/ Patient Management: Sould be in a brown container tightly sealed because it can be degraded by heat and moisture. Should not be refridgerated. If un opened will last until expiration date. Opened write the day that was opened and should discard after 3- 6 months. B-adrenergic blockers: Propanol(Inderal), Metoprolol (Lopressor), Atenenol (Tenormin) Pharmacologic Effects:Blocks the beta response to catecholamine stimulation which leads to myocardial oxygen demand. Uses: Effective in reducing excersise induced angina and stress induced angina. Adverse Reactions: Bradycardia, congestive heart failure, headache, xerostomia, blurred vision and unpleasant dreams. Calcium channel blockers: Verapamil (Calan, Isoptin) Diltizem ( Cardizem) Nifidepine (Procardia, Adalat) Pharmacologic Effects:Inhibits the calcium during contraction of the cardiac and vascular smooth muscle. Uses: antianginal, antihypertensive Adverse Effects: Dizziness, weakness, constipation and hypotension. The use of nifedipine can cause gingival hyperplasia.

Antihypertensives
=== Problem: Elevation of blood pressure resulting from any number of causes, such as lifestyle and habits (including diet), arteriosclerosis, aterial plaque build-up; results in increased workload of the heart as it tries to pump blood to the body. === Risk Factors: Family history, age, males, african-americans, diabetes, sodium intake, obesity, alcohol consuption, tabacco use and lack of excersise. Treatment: Step 1 treatment: Changes in life style either by tabacco cessation, stress reduction the increase of exersice, weight reduction, caffeine with tabacco use, calcium supplements and salt reduction. The restriction of salt can stimulate renin from the kidneys which leads to production of angiotension I and II and this will elevate the blood pressure. Step 2 treatment: Drug therapy along with life style changes. Step 3 treatement: Drug dose is increased, Step 4 treatment: The mixing of 2 to 3 drugs. __Medications__: Diuretics Thiazides: Benzothiazide Pharmacologic Effects: Increases the excretion of NA, Cl and K by increasing the reabsortion of filtered calcium this action differentiates thiazides from loop diuretics. Uses:The most commonly used for the treatment of essential hypertension Adverse Reactions: Hypokalemia, hyperuricemia, hyperglycemia, hyperlipidemia,hypecalcemia, anorexia. Oral: xerostomia and can rarely get lichenoid eruptions. NSAIDs can reduce the effect of thiazine and can take a few days of consistent use to produce this effect. Loop Diuretics: Acts on the ascending limb of the loop of henly and inhibits sodium and calcium reabsorption. Pharmacologic Effects: Loop diuretics bind to NA+, K+, and CL cotransporters which effectively arrest ions transportation preventing the reabsorption of NA and CL. Uses: primarily for edema Adverse Reactions:Hyperkalemia- greater amount of potassium ion in the circulating blood. Potassium-sparing:The pathway by which sodium is reabsorbed Pharmacologic Effects:Blockage of the sodium not producing the hyperkalemic effects on the other natriuretic drugs. Uses: To prevent hypokalemia caused by loop diuretics and thiazide. Adverse Reactions:Toxic effects of potassium sparing diuretics in hyperkalemi. Most common when these drugs are given alone or concommitantly with other inhibitors of potassium excretions. Dietary supplements of potassium can also percipitate hyperkalemia. Dental Implications for Diuretic Agents: Understand that the patient is taking a diuretic due to hypertension. Epinephrine should be used with caution. Drugs affecting angiotensin: Angiotensin converting enzyme (ACE) inhibitors ( ie: Captopril, Lisinopril, Fosinopril, Enalapril): Pharmacologic Effects: Blocks the major pathway to angiotensin II and raises the levels of bradykinin causing vasodialation with rapid onset and short duration that make this drug to be taken 2 to 3 times a day. Uses:Most commonly used drug for essential hypertension. Adverse Reactions: Coughing, altered taste sensation and may cause renal insuffinciency in patient with bilateral renal stenosis. Angiotensin Receptor Antagonists ( ie:Losartan, Candesartan): Pharmacologic Effects: Binds to angiotensin II receptors and competitively inhibits the action of angiotensin II and III. Uses:Reduces blood pressure and organ damage due to hypertension. Adverse Reactions: Calcium Channel Blockers (ie: Nifedipine, Verapamil, Diltiazem): Pharmacologic Effects: Prevents the influx of calcium into smooth and cardiac muscle cells. Uses:lowers blood pressure and reduces CO Adverse Reactions:Dizziness,Headache and nausea.