THE HEART
The Cardiovascular System & Drugs NEED TO INCLUDE LAB VALUES TO LOOK AT!!!!
Components
Pump (heart)
Interconnected series of tubes that continually move blood throughout the body
Functions
Delivering oxygen and nutrients to all of the cells of the body
Removing waste products for excretion
Blood Flow Through the Systemic and Pulmonary Vasculature Circuits
Direction of the Blood Flow of the Heart
Deoxygenated Blood
Right atrium, through tricuspid valve to right ventricle, through pulmonary valve to the lungs
Oxygenated Blood
Through the pulmonary veins to the left atrium, through the mitral valve to the left ventricle, through the aortic valve to the aorta
Periods of the Cardiac Cycle
Systole
Period of contraction, or systole
Blood is returned to the heart by veins
Diastole
Period of rest
Blood is returned to the heart by vein

Factors That May Affect the Cardiac Rate and Rhythm
Drugs
Acidosis
Decreased oxygen levels
Changes in the electrolytes in the area
Buildup of waste products
Renin-Angiotensin System

DRUGS AFFECTING BLOOD PRESSURE
Elements Determining Blood Pressure

Heart Rate
Stroke Volume
Amount of blood that is pumped out of the ventricle with each heartbeat
Total Peripheral Resistance
Resistance of the muscular arteries to the blood being pumped through

Categories Rating the Severity of Hypertension
Risks for Coronary Artery Disease Related to Hypertension
Thickening of the heart muscle
Increased pressure generated by the muscle on contraction
Increased workload on the heart

Stepped Care Approach to Treating Hypertension
Step 1: Lifestyle modifications are instituted
Step 2: If the measures in step 1 are not sufficient, drug therapy is added
Step 3: If the patient’s response is inadequate, drug dose or class may be changed or another drug added
Step 4: Includes all of the above measures with the addition of more antihypertensive agents until blood pressure is controlled

Types of Drugs Used to Control Blood Pressure
Diuretic: Decreases serum sodium levels and blood volume
Beta-Blocker: Leads to a decrease in heart rate and strength of contraction as well as vasodilatation
ACE Inhibitor: Blocks the conversion of angiotensin I to angiotensin II; an angiotensin II receptor blocker; blocking effects of angiotensin on blood vessels
Calcium Channel Blocker: Relaxes muscle contraction or other autonomic blockers
Ace Inhibitor
Actions
Blocks ACE from converting angiotensin I to angiotensin II, leading to a decrease in blood pressure and a decrease in aldosterone production
Indications
Treatment of hypertension, CHF, diabetic nephropathy, left ventricular dysfunction following an MI
Pharmacokinetics
Well absorbed, widely distributed, metabolized in the liver, and excreted in the urine and feces
Ace Inhibitors, cont.
Contraindications
Allergies
Impaired renal function
Pregnancy and lactation
Caution
CHF
Ace Inhibitors, cont.
Adverse Effects
Related to the effects of vasodilatation and alterations in blood flow
GI irritation
Renal insufficiency
Cough
Drug-to-Drug Interactions
Allopurinol
Ace Inhibitors, cont.
NEED TO KNOW ACE INHIBITORS lisinopril (Prinivil or Zestril) captopril (Capoten)
REMEMBER!!!
Often ends with “pril”
Angiotensin II Receptor Blockers, ARB’s
Therapeutic Actions and Indications:
Bind with angiotensin II receptors in vascular muscle and adrenal cortex to block vasoconstriction and release of aldosterone—thereby blocking the blood pressure raising effects of the renin-angiotensin system.
Angiotensin II Receptor Blockers, ARB’s
Contraindications
Allergy, pregnancy, and lactation
Caution
Hepatic or renal dysfunction, and hypovolemia
Adverse Effects
Headache, dizziness, syncope, weakness
GI complaints
Skin rash or dry skin
Drug-to-Drug Interactions
Phenobarbital
Angiotensin II Receptor Blockers, ARB’s
NEED TO KNOW ANGIOTENSIN II RECEPTOR BLOCKERS!!! valsartan (Diovan) losartan (Cozaar)
REMEMBER!!!
Usually ends with “sartan”
Calcium Channel Blockers
Actions
Inhibits the movement of