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PTP 546 Module 6 Cardiovascular Pharmacology: Part II

PTP 546 Module 6 Cardiovascular Pharmacology: Part II. Jayne Hansche Lobert, MS, RN, ACNS-BC, NP. Cardiovascular Pharmacology. Drugs used to treat excessive clot formation Anticoagulants (only stop you for making new clots, they do NOT break down clots) Heparin

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PTP 546 Module 6 Cardiovascular Pharmacology: Part II

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  1. PTP 546Module 6Cardiovascular Pharmacology: Part II Jayne Hansche Lobert, MS, RN, ACNS-BC, NP Lobert

  2. Cardiovascular Pharmacology • Drugs used to treat excessive clot formation • Anticoagulants (only stop you for making new clots, they do NOT break down clots) • Heparin • Low Molecular Weight Heparin (Lovenox) • Warfarin (Coumadin) • Antithrombotics • Aspirin • Clopidogrel (Plavix) • Thrombolytics • Streptokinase (Streptase) Lobert

  3. Cardiovascular Pharmacology • Anticoagulant • Ex: Heparin (special spot, niche for action) • Action: potentiates antithrombin renders clotting factors inactive; inhibits synthesis and function of clotting factors • Therapeutic Effect: prevents clot formation; prevents extension of existing venous thromboembolism (VTE prophylaxsis) • Side Effects: Bleeding (gums, bruises, urine, stool, internal bleeding) ; thrombocytopenia (platelet reduction in blood, so huge potential to bleed); HIT increased thrombosis (opposite effect, freak thing) • Note: requires extensive monitoring of labs (PTT) • For PT it may mean limiting exercise: look at PPT and platelet count. Lobert

  4. Cardiovascular Pharmacology • Anticoagulant • Ex: Low Molecular Weight Heparin Enoxaprin (Lovenox-done in home setting, super expensive so need insurance); Dalteparin (Fragmin) • Action: Inhibits synthesis of clotting factors • Therapeutic Effect: prevention of clot formation and prevention of extension of an existing venous thromboembolism • Side Effect: Bleeding- • Requires less monitoring Lobert

  5. Cardiovascular Pharmacology • Anticoagulant • Ex: Fondaparinux (Arixtra) • Action: inhibits clotting factor Xa prevention of clot formation • Therapeutic Effect: prevention of venous (VTE) thromboembolism for patients at risk ex: post op orthopedic surgery; immobile • Side Effects: Bleeding Lobert

  6. Cardiovascular Pharmacology • Anticoagulant • Ex: Warfarin (Coumadin)-super common/easy • Action: inhibits vitamin K decreases synthesis of clotting factors II, VII, IX, X • Leafy greens could not be processed so increased rate of clotting. • Therapeutic Effect: long term prevention of blood clots in persons with valve replacements, atrial fibrillation, DVT history • Side Effects: bleeding • Pts. are commonly admitted to the hospital for Coumadin toxicity • Note: requires long term lab analysis of PT/INR • Pro-time/International normalized ratio (want INR to be 2-3 seconds, lower if A-Fib) Lobert

  7. Cardiovascular Pharmacology • Antithrombotic Drugs • Ex: Aspirin • Action: suppress of proaggregation substances inhibition of platelet aggregation • Therapeutic Effect: prevention of myocardial infarction, prevention of cerebral ischemia/stroke • Side Effects: gi upset, gi bleeding; tinnitus at high doses • Baby aspirin: 81mg • Monitor Hgb: normal (12 females,14-16 males), Lobert

  8. Cardiovascular Pharmacology • Antithrombic Drugs: ADP Receptor Inhibitors • Ex: Clopidogrel (Plavix), used to prevention of MI when have a high risk • Action: inhibits ADP (a compound that increases platelet activity) • Therapeutic Effect: prevention of myocardial infarction; ischemic stroke and peripheral vascular diseases • Side Effects: Bleeding Lobert

  9. Cardiovascular Pharmacology • Thombolytics “take away a clot” • Ex: Streptokinase (Streptase);t-PA (alteplase) • Action: converts plasminogen to plasmin the enzyme which breaks down clots • Therapeutic Effect: treatment of ischemic strokes, myocardial infarctions; treatment of peripheral arterial occlusions; treatment of occluded venous access devices • Have a therapeutic window, when given 1hr inside window then reduce death rate by 50%. • Side Effects: intracerebral hemorrhage; bleeding Lobert

  10. Cardiovascular Pharmacology • Agents used to treat hyperlipidemia • HMG-CoA Reductase Inhibitors (Statins) • Simvastatin (Zocor) • Lovastatin (Mevacor) • Fibric Acid Agents • Gemfibrozil (Lopid) • Fenofibrate (Tricor) • Cholesterol Absorption Inhibitor • Ezetimbe (Zetia) Lobert

  11. Cardiovascular Pharmacology • Statins • Ex: Lovastatin (Mevacor); Simvastatin (Zocor) • Action: inhibits critical enzyme for cholesterol production  decrease cholesterol production • Therapeutic Effect: decrease levels of LDL and triglycerides with moderate increase in HDL (HDL can also be increased with exercise) • Side Effects: nausea, cramping, myopathies-muscle pain, rhabdomyolysis-kidney faliure, liver dysfunction • Labs 6 to 12 months to check liver enzymes Lobert

  12. Cardiovascular Pharmacology • Fibric Acid Agents • Ex: Gemfibrozil (Lopid); Fenofibrate (Tricor) • Action: mechanism is unknown • Therapeutic Effects: decreases triglyceride levels, increased HDL • Side Effects: abdominal pain, fatigue, nausea and vomiting, liver dysfunction Lobert

  13. Cardiovascular Pharmacology • Cholesterol Absorption Inhibitors • Ex: Ezetimibe (Zetia) • Action: inhibits cholesterol absorption production in the GI tract • Therapeutic Effect: reduces LDL & triglycerides; increased HDL • Side Effects: gi distress, abdominal pain Lobert

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