CARDIOVASCULAR SYSTEM composed of two leaflets or cusps - where the specialized cells of the heart can conduct an
impulse rapidly through the system so that the muscle cells
* systole of the heart are stimulated at approximately the same time…
Cardiovascular System - the contraction of ventricles
- responsible for delivering oxygen and nutrients to all of * absolute refractory period
the cells of the body and for removing waste products for
excretion * The heart’s series of one- way valves keeps the blood ***** SA node is the dominant influences most of the time,
- consists: 1. heart 2. pump3. interconnected series of tubes flowing on the correct direction, as follows: keeping the resting heart rate at 70 to 80 beats per minute
1. Deoxygenated blood: right atrium, though tricuspid valve
THE HEART to right ventricle, through pulmonary valve to the lungs * Sarcomere- the basic unit of the cardiac muscle
- hollow, muscular organ divided into 4 chambers: atriums ( 2. Oxygenated blood: through the pulmonary veins to - made up of two contractile proteins: actin (thin filament)
“porch” or entryway) and ventricles ( lower part) ventricle, through aortic valve to the aorta and myosin (thick filament) kept apart by the protein
- is the pump that keeps blood flowing through 60,000 miles troponin
of tubes, constituting the cardiovascular system CONDUCTION SYSTEM OF THE HEART
- consist of: * Degree of shortening- determined by the amount of Ca
*auricle- attached to each atrium; collects blood that is 1. SA node- located in top of the right atrium, acts as the present—the more Ca is present, the more bridges will be
pumped into the ventricles by arterial contraction pacemaker of the heart formed…
2. AV nodes- slows the impulse, allowing for the delay
** a partition called a septum separates the right half of the needed for ventricular filling, and sends it from the atria into ARRYTHMIA OR DYSRYHTHMIA
heart from the left. The right receives deoxygenated blood the ventricles by way of the bundle of His - a disruption in cardiac rate or rhythm
from everywhere in the body through the veins ( vessels that 3. Bundle of His- w/c enters the septum and divides into - interfere with the work of the heart and can disrupt cardiac
carry blood toward the heart) and directs that blood into the three bundle branches output, which affects every cell in the body
lungs… 4. Bundle branches- w/c conduct impulses through the - occurs when there is a shift in the pacemaker of the heart
ventricles from the SA node to some other sit, called ectopic focus
*** arteries- where aorta delivers blood into the systemic 5. Purkinje fibers- w/c delivers the impulse the ventricular
circulation cells FIBRILLATION
- vessels that carry blood away from the heart - very serious arrhythmias arise when the combination of
***Sinoatrial (SA) node ectopic foci and altered conduction set off an irregular,
CARDIAC CYCLE uncoordinated twitching of the atrial or ventricular muscle
- … each period of the ventricles followed by a period of AUTOMATICITY
systole= cardiac cycle… - where the cells can generate action potentials or electrical ELECTROCARDIOGRAPHY
impulses without being excited to do so by external stimuli -is a process of recording the patterns of electrical impulses
* myocardium as they move through the heart
- fibers of cardiac muscle 5 phases: - an important diagnostic tool in the care of the cardiac
- form two intertwining networks called atrial and 1. Phase 0- points of stimulation; where: sodium gates open patients
ventricular syncytia along the cell membrane, and sodium rushes into the cell,
resulting in a positive state—an electrical potential called ELECTROCARDIOGRAPHY MACHINE
* Starling’s law of the heart depolarization - detects the patterns of electrical impulse generation and
-occurs when muscle fibers of the heart are stretched by the 2. Phase 1- when Na ions concentrations are equal inside conduction though the heart and translates that information
increase volume of blood that has returned spring back to and outside of the cell to a recorded pattern
normal size; is similar to stretching a rubber band… 3. Phase 2 (plateau stage)- cell membrane becomes less
permeable to Na Ca slowly enters the cell K slowly ELECTROCARDIOGRAM
* Diastole leaves the cell -a measure of electrical activity; provides no information
- the period of cardiac muscle relaxation where the heart 4. Phase 3- rapid repolarization K rapidly moves out of about the mechanical activity of the heart
from the systemic and pulmonic veins, w/c flow into the the cell
right and left… 5. Phase 4- cell comes to rest as the sodium- potassium The normal ECG pattern is made up of main waves:
pump returns the membrane spontaneous repolarization 1. P wave- formed as impulses originating in the SA node or
* tricuspid- valve on the right side of the heart; composed begins again pacemaker pass through the atrial tissue
of 3 leaflets or cusps 2. P wave- precedes the contraction of the atria
3. Ta wave- appear around the QRS complex
Critical points of the ECG are as follows : - also referred as arterial system - occur if the blood pressure falls, either from the loss of
1. P-R interval: reflects the delay of conduction at the AV - where the vessels can either constrict or dilate, increasing blood flowing from high- pressure to low pressure areas
node or decreasing resistance, based on the needs of the body - if severe, it can progress to shock and even death as cells
2. Q-T interval: reflects the critical timing of repolarization are cut off from their oxygen supply
of the ventricles * capillary system
3. S-T segment: reflects the important information about the - where blood from tiny arterioles flows * Hypertension
repolarization of the ventricles - connects the arterial and venous system - excessive high blood pressure
- can damage the fragile lining of blood vessel
TYPES OF ARRHYTHMIAS * capillary fluid shift - cause disruption of blood flow to the tissues
1. Sinus arrhythmias - shifting of fluid in the capillaries - caused by neurostimulation of the blood vessels that cause
- has a slower- than- to normal heart rate (usually less than - carefully regulated between hydrostatic (fluid pressure) them to constrict and to raise pressure
60 beats/ min) w/ Normal- appearing ECG pattern forces in the arterial end of the capillary and oncotic
2. Supraventricular Arrhythmias pressure ( the pulling pressure of the large, vascular * Vasomotor Tone
- arrhythmias that originate above the ventricles but not in proteins) - work to dilate the vessels if more blood flow is needed in
the SA node an area
- feature an abnormally shaped P wave *Capacitance system
- includes the following: - also referred as venous system *Cardiovascular center
a. Premature atrial contractions (PAC’s)- reflect an ectopic - where the veins has the capacity to hold large quantities of - the coordination of these impulses through the medulla
focus in the atria that is generating an impulse out of the fluid
normal rhythm RENIN – ANGIOTENSIN SYSTEM
b. Paroxysmal atrial tachycardia (PAT)- runs of rapid heart * sinuses of Valsalva -determinant of Blood pressure
originating in the atria - where the myocardium receives its blood through 2 main - activated when the blood flow to the kidneys is decreased
c. Atrial flutter- characterized b sawtooth- shaped P waves coronary arteries that branch off the base of the aorta -…cells in the kidney release an enzyme called rennin
reflecting a single ectopic focus that is generating a regular, - Angiotensin I travels to lungs Angiotensin- converting
fast atrial depolarization *coronary arteries enzyme (ACE) reacts Angiotensin II =
d. Atrial fibrillation- w/ irregular P waves representing many - these arteries encircle the heart in pattern resembling a Vasoconstriction
ectopic foci firing in an uncoordinated manner through the crown (read: p. 635)
atria
3. Ventricular Arrhythmias *pulse pressure CONGESTIVE HEART FAILURE
- impulses that originate below the AV node originate from - the pressure that fills the coronary arteries - if the heart fails to do its job of effectively pumping
ectopic foci that do not use the normal conduction pathways - it is systolic minus diastolic blood pressure readings through the system, blood backs up and system becomes
congested
ATRIOVENTRICULAR BLOCK * end- artery circulation - results: hydrostatic pressure on the venous end of the
- also called heart block - a pattern of circulation capillaries
- reflects a slowing or lack of conduction at the AV node
-occur because of structural damage, hypoxia, or injury to The main forces hat determine the heart’s use of oxygen or
the heart muscle oxygen consumption are as follows:
- First degree of heart block= P-R interval beyond the 1. Heart rate: the more the heart has to pump, the more
normal 0.16 to 0.20 seconds oxygen it will require to do that
2. Preload ( amount of blood that is brought back to the
CARDIOVASCULAR SYSTEM heart to be pumped around): the more blood that is returned
to the heart, the harder it will have to work to pump the
CIRCULATION blood around. The volume of blood that is determinant of
- follows two courses: preload
1. Heart lung or pulmonary circulation: the right side of the 3. Afterload ( resistance against which the heart has to beat):
heart sends blood to the lungs, where carbon dioxide and The higher the resistance in the system, the harder the heart
some waste products are removed from the blood and will have to contract to force open the valves and pump the
oxygen is picked up by the red blood cells blood along. The blood pressure is measure of afterload
2. Systemic circulation: the left side of the heart sends
oxygenated blood out to all of the cells in the body SYTEMIC ARTERIAL PRESSURE
Class I Antiarrhythmics
Pharmacokinetics
1. well absorbed
2. metabolized in the live
3. excreted in urine
4. cross placenta and enter milk
5. fetal toxicity reported
Contraindications
1. presence of allergy
2. with heart block or sick sinus syndrome
3. with renal or hepatic dysfunction
4. during pregnancy and lactation
Adverse Effects
1. CNS effects: dizziness, light- headedness,
headache, fatigue
→ liver must use cholesterol to make more bile
acids Therapeutic Actions
→ ↓ serum levels of cholesterol and LDLs → block the formation of cellular cholesterol
→ ↓ serum cholesterol and LDLs, slight ↑ or no
Indications change in HDLs
CHAPTER 47 - reduce serum cholesterol in patients with
LIPID-LOWERING AGENTS primary hypercholesterolemia as an adjunct Indications
to diet and exercise - adjuncts with diet and exercise for the
CORONARY ARTERY DISEASE (CAD) - cholestyramine: treat pruritus associated with treatment of ↑ cholesterol and LDL levels
partial biliary obstruction - slow the progression of CAD
- progressive growth of atheromatous - prevent first MI
plaques, or atheromas in the coronary Pharmacokinetics
arteries
→ plaques begin as fatty streaks in the
- form an insoluble complex Pharmacokinetics
- excreted in feces - absorbed from GI tract
endothelium
→ they injure the endothelial lining - not absorbed systematically - first-pass metabolism in liver
→ development of foam cells (by - excreted through feces and urine
inflammatory process) Contraindications - pregnancy category X
→ platelets, fibrin, other fats, and remnants - allergy
collect on the injured vessel lining - complete biliary obstruction Contraindications
→ cause atheroma to grow - abnormal intestinal function - allergy
→ blood vessel narrows and limits blood - pregnancy or lactation - active liver disease or history of alcoholic liver
flow disease
- injury to the vessel also causes scarring and Adverse Effects - pregnancy or lactation
thickening of cell wall - direct GI irritation
- ↑ bleeding times Caution
- vitamin A and D deficiencies - impaired endocrine function
the softer, more lipid atheromas appear to be
more likely to rupture than stable, harder - muscle aches and pains
Adverse Effects
cores - GI system
Drug-Drug Interactions
- ↓ or delay the absorption of thiazide diuretics, - CNS effects
digoxin, warfarin, thyroid hormones, - ↑ concentration of liver enzymes
ANTIHYPERLIPIDEMIC AGENTS corticostreriods: - rhabdomyolysis with acute renal failure
CHAPTER 49: DRUGS USED TO TREAT Megaloblastic Anemias - for patients who are no longer able to
ANEMIAS - there is no sufficient folic acid or vitamin B12 produce erythropoietin in the kidneys
to adequately create the stromal structure
BLOOD needed in a healthy RBC Prototype: epoetin alfa (Epogen, Procrit)
DRUGS: PHARMACOKINETICS:
OSMOTIC DIURETICS
- Pull water into the renal tubule without sodium loss.
- Drug of choice for Increase cranial pressure or acute Because these drugs are from
2 types: antibiotics & anti infectives
renal failure. several different chemical classes,
works to acidify the urine
the pharmacokinetic data are different
for each drug.
Antibiotics
CONTRAINDICATIONS:
Glycerin (osmoglyn)
Mannidol (Osmitrol) • Cinoxacin(Cinobac)- interferes These drugs are contraindicated
Urea (ureaphil) with the DNA replication in in the presence of any of these drugs.
gram negative bacteria They should be used with caution in
Therapeutic Actions and Indication
- It acts to pull large amounts of fluid into the urine by • Norfloxacin (Noroxin)- a newer the presence of renal dysfunction,
the osmotic pull of the large sugar molecule. and more broad spectrum drug, which could interfere with the
- These drugs are often used in acute situation . is effective against even more excretion and action of these drugs,
- Prevent oliguric phase of renal failure, and to gram negative strains than and with pregnancy and lactation
promote of toxic substances through the kidneys. cinoxacin because of the potential for adverse
• Fosfomycin (Monurol)- has the effects on the fetus or neonate.
Pharmacokinetics
- These drugs are freely filtered at the renal convenience of only one dose.
It is not recommended for ADVERSE EFFECTS:
glomerulus, poorly reabsorbed by the renal tubules
and not secreted by the tubule, and resistant to patients younger than 18 years
metabolism. of age • nausea, vomiting, diarrhea,
• Nalidixic (NegGram)- is an anorexia, bladder irritation,
Contraindications and Cautions older drug that is not and dysuria
- Renal disease and anuria from sever renal disease, • infrequent symptoms include
effective against as many
pulmonary congestion, intracranial bleeding, pruritus, urticaria, headache,
dehydration and CHF.
strains of gram-negative
bacteria as the other dizziness, nervousness, and
antibiotics used for UTIs confusion
Adverse Effects • Nitrofurantion (Furadantin)- is • GI irritation caused by the
- Sudden drop of fluid levels another older drug with a very agent, which is alleviated if
- Cardiac decompensation and even shock short half-life (20-60 minutes) drug is taken with food
Anti-infective works to acidify urine
DRUG-DRUG INTERACTIONS:
• Methenamine (Hiprex)- undergoes
metabolism in the liver and is Drug interactions that can
excreted in the urine occur are very specific to the drug
• Methylene blue (Urolene Blue)- being used.
is widely distributed,
metabolized in the tissues, and
excreted in urine, bile, and Urinary Tract Antispasmodics
feces
DRUGS:
ACTION:
Chapter 52- Drugs affecting the • Flavoxate (Urispas)- prevent
Urinary Tract and the Bladder The urinary anti-infectives act smooth muscle spasm
specifically within the urinary tract specifically in the urinary
tract, but it is associated in urine. Caution should be used in urinary tract mucosa. It is used to
with CNS effects (blurred the presence of hepatic or renal relieve symptoms related to urinary
vision, dizziness, confusion) impairment because of the potential of tract irritation from infection,
that make it less desirable to alterations in metabolism or excretion trauma, or surgery.
use in certain patients of the drugs.
• Oxybutynin (Ditropan)- is a PHARMACOKINETICS:
potent urinary antispasmodic, CONTRAINDICATIONS:
but it has numerous Phenazopyridine is rapidly
anticholinergic effects, making These drugs are contraindicated absorbed and has a very rapid onset of
it undesirable in certain in the presence of any allergy to action. It is widely distributed,
conditions or situations that these drugs; with pyloric or duodenal crossing the placenta and entering
might be aggravated by obstruction or recent surgery because breast milk. It is metabolized in the
decreased sweating, urinary anticholinergic effects can cause liver and excreted in the urine.
retention, tachycardia, and serious complications.
changes in the GI activity. CONTRAINDICATIONS:
• Tolterodine (Detrol,Detrol LA)- ADVERSE EFFECTS:
is a newer agent that blocks This drug is contraindicated in
muscarinic receptors, • adverse effects of urinary the presence of any allergy to the
preventing bladder contraction antispasmodics are related to drug and serious renal dysfunction,
and spasm blocking of the parasympathetic which would interfere with the
system excretion and effectiveness of the
• Trospium (Sanctura)- is the
• nausea and vommitng, dry mouth, drug.
newest drug approved to block
urinary tract spasms. It also nervousness, tachycardia, and
vision changes ADVERSE EFFECTS:
specifically blocks muscarinic
receptors and reduces the
muscle tone of the bladder. It DRUG-DRUG INTERACTIONS: • GI upset, headache, rash,
is specifically indicated for reddish-orange coloring of
the treatment of overactive Decreased effectiveness of urine
bladder with symptoms of urge phenothiazines and haloperidol has • Hepatic toxicity, this drug
urinary incontinence, urgency, been associated with the combination should not be used for longer
and urinary frequency. of these drugs with oxybutynin. If any than 2 days because the toxic
such combinations must be used, the effects may be increased.
ACTION: patient should be monitored closely
and appropriate dosage adjustments DRUG-DRUG INTERACTIONS:
Inflammation in the urinary made.
tract, such as cystitis, prostatics, The risk of toxic effects of
urethritis, and this drug increases if it is combined
euthrocystitis/urethrotrigonitis, Urinary Tract Analgesic with anti-bacterial agents used for
causes smooth muscle spasms along the treating UTIs. If this combination is
urinary tract. Irritation of the DRUGS: used, the phenazopyridine should not
urinary tract leading to muscle spasm be used for longer than 2 days.
also occurs in patient with neurologic • Phenazopyridine (Azo-Standard,
bladder. Baridium, and others) is a dye
that is used to relieve pain.
PHARMACOKINETICS: ACTION:
Central Reflexes
Two centrally mediated reflexes -
Swallowing reflex and Vomiting reflex –