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Week 5 Respiratory and Cardiovascular Systems Chapters 26 and 27: HS140 – Pharmacology Includes information from: Christo Stevens, Pharm.D. Respiratory System/Disorders • • Respiratory Tract – Upper/Middle/Lower - carries Oxygen to, and … - removes Carbon Dioxide from, the lungs Any change in the Resp.System will affect all body systems, therefore … before treating other problems, this oxygen-carbon dioxide exchange system must be corrected! See diagrams on page-525 of your textbook Upper Resp Tract Conditions Allergic Rhinitis – caused by histamine release Symptoms include: *sneezing,*runny nose, *itching, and *congestion Histamine protects us from environment! Greatest concentration of Histamine found in *skin,*GI tract, and the *lungs – those organs most exposed to potenially damaging elements around us Drugs for Nasal Congestion(1) Antihistamines – notice … ‘anti-Histamine’ these block the H1 receptor sites, preventing histamine’s action 1st Generation: -- sedating, short acting examples -______________________ -______________________ 2nd Generation: -less, or NON-sedating, and much longer duration of action examples - ___________________________ - ___________________________ Drugs for Nasal Congestion(2) ______________: reduce congestion by shrinking swollen mucous membranes of the nasal passage Often combined with AntiHistamines Oral and Nasal preparations are both available _______________ – most widely used, less elevation of blood pressure, no METH link! _______________ – stimulates the CNS causing elevated BP, insomnia, agitation … used in Crystal-Meth production! Drugs for Nasal Congestion(3) Nasal Decongestant Sprays/Drops (topical) examples: _________________ Important Patient Warning and Info: Use exactly as directed on package (usually q12h), DO NOT USE more than 3-5 consecutive days … why? “Rebound Congestion”, makes these habit-forming! Tolerance occurs rapidly, resulting in patients using larger and larger doses to get the same level of symptom-relief Topical Decongestants act much faster than Oral Decongestants, but Oral agents do not cause Rebound Congestion! Glucocorticoids (steroids) Nasal Glucocorticoids Examples - ______________, ______________ Most effective meds for prolonged seasonal or year-round allergic rhinitis Excellent relief of symptoms such as: *congestion, *runny nose, *sneezing, *itching Interesting Drug! –NOT a STEROID_____________________ – actually prevents the release of Histamine – unique! Drugs for Cough (antitussives) Productive Cough – should not be suppressed! – the act of coughing serves important function … the clearing of mucous from the airway Dry, Hacking, ‘Tickling’ Cough – o.k. to suppress – usually deprives patient of sleep, can cause discomfort if not treated OPIOID(syrups): elevate the cough ‘threshold’ –may be habit-forming Examples: ________________________________, ________________________________ nonOPIOID’s: less GI side-effects, NOT habit forming Other Agents for cough … Cough suppressant ___________________ -a local anesthetic, relieves cough by numbing the cough receptors (gag reflex) AntiHistamines(again!) – reduces the drainage of nasal secretions, which many times is the cause of the ‘Tickly’ cough! Lower Respiratory Tract The Bronchial Tree and the Lungs Pneumonia Thick Mucous Secretion(sputum) Mucalytics/expectorants examples: ______________________________ ______________________________ COPD (Chronic Obstructive Pulmonary Disease) Asthma Glucocorticoids examples: ______________________ ______________________ Emphysema Chronic Bronchitis Bronchodilator examples: __________________________ __________________________ Questions?? Cardiovascular Disorders Functions of Circulatory System Composed of heart (pump) and blood vessels Delivers oxygen, nutrients, hormones etc to various cells throughout the body Removal of waste products Pulmonary Circulation filter blood through lungs to drop off CO2 and pick up O2 Systemic Circulation delivers fresh (oxygenated) blood to all tissues except heart/lungs Coronary Circulation provides fresh blood to myocardium Diseases of the Heart & Vessels Coronary Artery Disease (CAD)decreased blood flow through coronary arteries from … Atherosclerosishardening/narrowing of blood vessels Statins are especially useful Anginaspasms of the cardiac muscle as a result of ischemia (oxygen deprivation) Nitrates are pivotal in treatment Myocardial Infarction (MI, heart attack) heart is deprived of blood supply and tissues become necrotic Hypertension (increased blood pressure) >140/90; >120/80 = pre-hypertension Dangerous: increased blood flow damages the artery walls and more likely for plaque formation to occur Nitrates for Angina Oldest, most used for angina attack to relieve intense pain via Sublingual route (SL)= under tongue Dilate systemic blood vessels to reduce cardiac work and oxygen consumption Work by relaxing smoothe blood vessel walls Isosorbide mononitrate/dinitrate-differ in duration of action, and are swallowed (PO) SE’s: headache, tachycardia, lightheadedness, dizziness, hypotension Nitroglycerin (NTG) Sublingual NTG: acute anginal attacks (dosing) 1 tab SL at onset of pain; may repeat 1 tab every 5 minutes for 2 doses. If pain persists, pt to seek medical attention NTG unstable, should be kept original bottle (dark, tightly closed vial); expiration date is 6 months from bottle opening Transdermal NTG: available as a patch that slowly releases NTG through the skin Applied to hairless area of skin; rotated daily Do not keep on longer than 12 hours !! NTG spray-good for those with poor dexterity Antianginals Nitrate _____________________ _____________________ Beta-adrenergic Blockers _____________________ Calcium Channel Blockers _____________________ CHF Congestive Heart Failure heart muscle is weak and cannot pump sufficient volume of blood – ‘pooling’ Drug combination most often used is: _______________ and ___________________ ________________ is a positive ionotropeincreasing strength of contraction of heart _________________ a diuretic that causes ‘elimination’ of excess body fluid, reducing edema(swelling) Cardiac Antidysrhythmics (aka antiarrhythmics) Class II ____________________________ ____________________________ Class II ____________________________ Class III ____________________________ Class IV ____________________________ Drugs in treatment of Hypertension Diuretics for HTN Inhibit sodium chloride reabsorption to excrete more H2O May lead to decreased K+ levels (hypokalemia) ________________loop diuretic-most potent ________________ commonly used ________________potassium sparing Many combinations with HCTZ, _______________________ Patient counseling points: take diuretics in morning (otherwise pee all night long), sip water or chew gum to relieve dry mouth, avoid sunlight with loops or thiazides Adrenergic-inhibiting Beta Blockers _________________________ _________________________ Alpha/Beta Blockers _____________________________ Centrally acting adrenergic blockers _____________________________ Peripherally acting adrenergic blockers _____________________________ Angiotensin II receptor antagonists _____________________________ Additional HTN Medications: Angiotensin Converting Enzyme (ACE) Inhibitors _____________________________ _____________________________ _____________________________ Vasodilators _____________________________ _____________________________ Calcium Channel Blockers _____________________________ _____________________________ Hyperlipidemia We all need cholesterol and triglycerides (fats) to form cell membrane and nervous tissue! Excessive lipids in circulation leads to hyperlipidemia and potential for artherosclerosis (plaques which accumulate and harden the artery walls) HDL(‘good cholesterol’) - high density lipoproteins carry cholesterol out of blood stream and into liver for storage; GOAL >35 LDL(‘bad’ cholesterol) low density lipoproteins carry cholesterol from the liver to the blood stream GOAL <130 HMG-CoA reductase inhibitors aka “STATIN’s” examples: ________________________ ____________________________ Most effective agents to lower TOTAL cholesterol and LDL levels Must be continued for life to reduce the progression of Coronary Artery Disease (CAD) Major side effect: rhabdomyolysis (muscle breakdown, symptom is muscle-aches) Other SE’s: Headache, cramping Bile Acid Sequestrants Non-absorbable drugs bind bile acids in the GIT to form insoluble complexes that are excreted in feces Not commonly used since Statins arrived Can decrease LDL and total cholesterol Beware using in pts with gallstones, hemorrhoids, and vitamin A, D, E, K Example: _________________________ SE’s: constipation, n/v, dizziness Important Facts about Hypolipemics Diet modification is the PRIMARY method for reducing LDL & cholesterol levels Statins are the most effective drugs for lowering LDL & total cholesterol Bile-acid-binding resins prevent reabsorption of bile acids in the intestines _______________ powder must be mixed with 8ox of water prior to administering Coagulation Blood clot formation is necessary to prevent excessive blood loss (wounds, surgery) Platelet plugs followed by coagulation results in hemostasis (stoppage of blood flow) Thromboembolism occurs if blood clot or undissolved matter forms in blood vessel, blocking blood flow Common Anticoagulants ________________ – immediate action, short duration Administered parenterally ________________ – delayed onset Administered orally Used prophylactically to prevent deep vein thrombosis or thrombus formation in Atrial Fib BEWARE! monitor pt for bruising, bloody stools, bleeding gums ______________ has lots of drug-interactions... PT/INR levels must be monitored closely! Other drugs Antiplatelet drugs: suppress clumping of platelets in arteries ________________________ ________________________ Thrombolytics: dissolve clots already formed ___________________________ ___________________________ Questions?? Class Dismissed, Have an awesome week!! Alaska’s Northern Lights