Cardiovascular
Pharmaceuticals
Irene Mueller, EdD, RHIA
MHA
2010
Objectives – First Hour
• Medications
– Heart
– Vessels
Objectives - 2nd hour
• Medications
– Vessels, continued
• Using the ICD-9-CM Table of Drugs
• Homework Answers
• Responses to Questions
• Resources
CV System Pharmaceuticals
• Many can be used for
– Multiple Heart AND/OR vessel conditions
– Dosage, etc. variations
– Therefore, can be grouped many ways
• Many used in combination
• Many can interact with
– each other
– Other types of meds
• Following lists are most common
• Many other drugs
Actions of Heart Drugs
• Possible actions of cardiac drugs
– change the rate of the heartbeat
– change the rhythm of the heartbeat
– change the amount of output of blood
– change the strength of contraction
• Inotropic and Cardiotonic
• Blood vessel/Blood drugs can help heart
Classifications of Heart Drugs
ACE Inhibitors*
Anti-coagulants/Anti-platelets
Anti-anginals#
Anti-fibinolytics
Beta-adrenergic Blockers
Anti-hyperlipidemics
Calcium channel Blockers
Cardiac glycosides
Nitrites and Nitrates
Diuretics
Anti-arrhythmic (-Dysrhythmic) agents
Carbonic Anhydrase Inhibitors
Beta-adrenergic Blockers (Class II)
Osmotic
Calcium channel Blockers (Class IV)
Thiazide/Thiazide -like
Potassium channel Blockers (Class III)
Sodium Channel Blockers (Class I)
*Italics = in vessel section
#Bold
= in heart section
Thrombolytics
Anti-anginals
Contraindications
Interactions
Side Effects
Anemia, severe
alcohol
Blurred vision
GI disease
Viagra
Dry mouth
Glaucoma
Flushing
Intracranial pressure
GI - Constipation
Low blood pressure
Headache
Hypersensitivity reaction
Orthostatic hypotension
Beta-adrenergic Blockers
• Reverse the sympathetic system effects
– Caused by exercise, mental exertions
– Decrease heart rate and force of contractions
– Decrease cardiac work & oxygen consumption
– Often prevents myocardial ischemia and pain
• Long-term mgt of angina pectoris
• Can be combined with nitrates
Types of CV Beta receptors
•
•
•
•
Beta-1 (β1) - heart
Beta (β2) - blood vessels
Beta (β3) - fat cells
Block the effect of norepinephrine and
epinephrine at receptor sites
– reduce heart rate (B1)
– reduce blood pressure by dilating blood
vessels (B2)
NS Beta-adrenergic Blockers
• Nonselective Blockers (beta 1 and 2)
•
•
•
•
Labetalol (Normodyne) – HTN
Nadolol (Corgard) – HTN, angina pectoris
Pindolol (Visken) – HTN
Propranolol (Inderal)
– HTN, angina, arrhythmias, migraine
• Timolol (Blocadren) – HTN, post MI
Selective Beta-1 Blockers
• acebutolol (Sectral)
– HTN, ventricular arrhythmias
•
•
•
•
atenolol (Tenormin) – HTN, angina pectoris
bisoprolol (Zebeta) – HTN
esmolol (Brevibloc) – SV Tachycardia
metoprolol (Lopressor) – HTN, angina pect.
Calcium Channel Blockers
• Can be used to treat
– Tachyarrhythmias, angina pectoris, HTN
• Decrease calcium entry into cells with
actions potentials (heart and blood vessels)
• 2 effects in heart (conduction & muscle)
– Decrease rate of SA node, AV conduction
– Decrease force of contractions
• Effect in vessels – relaxation, vasodilation
Calcium Channel Blockers
• verapamil (Calan,
Isoptin)
– AV node/SV
arrhythmias, angina
• diltiazem (Cardizem)
– More effective as antihypertensive
• nifedipine (Procardia)
– Vasodilator
• nicardipine (Cardene)
– Vasodilation, relax
coronary artery spasm
•
•
•
•
•
Newer
amlodipene (Norvasc)
bepridil (Vascor)
felodipine (Plendil)
Isradipine (DynaCirc)
Nitrites and Nitrates
• Oldest/Most frequently used antianginals
• General dilation of systemic veins/arteries
– Vascular smooth muscle
• Ions are converted by enzymes to Nitric
Oxide
• Lower doses = more venous dilation
Nitrites and Nitrates
• Decrease preload and afterload of heart
– Preload – force of venous return to heart
– Afterload – arterial pressure (blood pressure)
L ventricle must work against to eject blood
• Reduce cardiac work/oxygen consumption
• Used prophylactically and during angina
• Also to tx CHF
• Nitrates relieve vasospasm in coronary art.
Nitrites and Nitrates
•
•
•
•
amyl nitrite (Vaporole)
erythrityl Tetranitrate (Cardilate)
isosorbie Dinitrate (Isordil)
nitroglycerin (Nitrol, Notrostat, Nitrong,
Nitro-Bid, Transderm-Nitro
• pentaerythritol Tetranitrate (Peritrate)
Nitroglycerin
• Sublingual
– Almost immediate onset, but short duration
– Acute anginal attacks
•
•
•
•
Ointment (2%)
Extended release tablets/capsules
Transdermal patches
IV – Emergencies/surgeries in hospital
Anti-arrhythmics
• 4 classes
• Class 1 – Sodium channel blockers
• Class 2 – Beta-adrenergic blockers
– Described in anti-anginals
• Class 3 – Potassium channel blockers
• Class 4 – Calcium channel blockers
– Described in anti-anginals
Anti-arrhythmics
• Dromotrophics – irregular rhythms
• Chronotropics – too fast or too slow
• Several ions regulate electrical system
– Sodium, Potassium, Calcium
• Arrhythmias disturb movement of ions
– Drugs can help restore normal movement
• Anti-arrhythmics do NOT cure causes
Sodium Channel Blockers
(Class 1)
• Interfere with movement of sodium ions
• Slow conduction velocity
• Tx
– Supraventricular tachycardias
– Ventricular arrhythmias
• Side effects/Contraindications
– Specific to each drug
Sodium Channel Blockers
•
•
•
•
•
quinidine (chinchona bark)
procainamide (Procanbid)
disopyramide (Norpace)
lidocaine (Xylocaine)
phenytoin (Dilantin)
• Newer
– flecainide (Tambocor), moricizine
(Ethmozine), propafenone (Rythmol)
Potassium Channel Blockers
• Decrease frequency of arrhythmias
• bretylium (Bretylol)
– Adrenergic neuronal blocker
• amiodarone (Cordarone)
– Blocks alpha, beta, calcium receptors
• sotalol (Betapace)
– Non-selective beta blocker
Other Anti-arrhythmics
• quinidine sulfate (Class 1)
– decreases the # of atrial muscle contractions
– used to treat Afib
• Pronestyl
– ventricular arrhythmias w/premature contractions
– Afib
• Lidocaine (Xylocaine) (Class 1)
– IV - prevents & controls Vfib, pt w/recent severe MI
– (SE) drowsiness, disorientation, confusion,
convulsions, coma
Cardiac Glycosides
• Derived from Digitalis plants
– Oleander, Lily of valley, Cane toads
• Increase force of contractions (Inotropic)
– Lowers ventricular rate
• w/o increasing oxygen consumption
• Kidney function improves, reducing edema
• Decrease heart rate and AV conduction
• Increase kidney function, reduces edema
Cardiac Glycosides
Contraindications
Interactions
Side Effects
Hypothyroidism
Adrenergics
Arrhythmias
Lactation, Pregnancy
Antacids
Dizziness
MI
Anti-arrhythmics
Electrolyte imbalance
Impaired kidneys
Diuretics
GI upset
Monitor
Neomycin
Headache
High/low potassium
Phenobarbital
Irritability
Irregular rhythm
Rifampin
Lethargy
Slow heart rate
Sulfa drugs
Muscle weakness
Discontinue if noted
Seizures
Tremors
Cardiac Glycosides
•
•
•
•
Digitalization, then maintenance
Low potassium increases toxic effects
High potassium antagonizes tx effects
High calcium enhances action
• Tx CHF
Cardiac Glycosides
• deslanoside (Cedilanid-D) IM, IV
• digitoxin (Purodigin)
PO, IV
• digoxin (Lanoxin)
PO, IV
• side effects (overdose of digoxin) - nausea,
vomiting, objects appear brighter, bradycardia
Diuretics
• Used to tx CV conditions
– HTN, Edema (CHF)
• Diuretic actions
– Stimulate urine production
• inc glomerular filtration
– Decrease sodium reabsorption (diuresis)
• Five major classes of Diuretics
Diuretics
Contraindications
Interactions
Side Effects
Anuria
Breastfeeding
Cardiac glycosides
Corticosteroids
Anorexia
Hypersensitivity
reactions (skin rash)
Known
hypersensitivity
Pregnancy
Lithium
Hyperuricemia
NSAIDs
Hypokalemia
Oral hypoglycemics Hyponatremia
Hypotension
Nausea
Ototoxicity (loop)
Classes of Diuretics
Carbonic anhydrase inhibitors
Organic acids (Loop)
Osmotic (Lumenal) (no  uses)
Potassium-sparing
Thiazide/Thiazide-like
OTC (Xanthine derivatives)
Carbonic Anhydrase Inhibitors
• Increase sodium and water excretion
• Not used as often today
• Still adjunct tx in CHF (Acetazolamide)
• Also used to tx
– Glaucoma
– Petit mal seizures
• dichlorphennamide, mathazolamide
– Acute mountain sickness (Acetazolamide)
Organic Acid (Loop) Diuretics
• Inhibit sodium and chloride ion transport in
loop of Henle
• Great loss of sodium, chloride, and water
– Usu. Hypochloremic alkalosis
• Tx
– Edema inpts resistant to thiazides
– Severe peripheral and pulmonary edema
– Edema of CHF
Organic Acid (Loop) Diuretics
•
•
•
•
bumetanite (Bumex) – CHF edema, ascites
ethacrynic acid (Ederin) – CHF edema
furosemide (Lasix) – CHF edema, HTN
torsemide (Demadex) – CHF edema
•
http://media-2.web.britannica.com/eb-media/23/99423-004-BB1F574D.jpg
Potassium-Sparing Diuretics
• Mild diuresis
• Inhibit potassium secretion in the distal
convoluted tubules
• Primarily adjuncts to thiazide/loop diuretics
– Inhibit hypokalemia
• Hyperkalemia promoted in
– Impaired renal function/diabetic pts
Potassium-Sparing Diuretics
• amiloride (Midamor) – HTN
• spironolactone (Aldactone) – HTN, Edema
• spironolactone
– w/thiazide (Aldactazide) – HTN, Edema
• triamterene (Dyrenium) - Edema, HTN
Thiazide/Thiazide-like Diuretics
• Largest group
• Inhibit sodium transport in the distal
portion of the nephron
• Intense diuresis of sodium and water
• Increase excretion of chloride and
potassium
• Produce alkalosis and hypokalemia
– Hyponatremia in elderly reported
Uses of Thiazide Diuretics
• Edema of any cause
– immediate
• Mild/moderate HTN
– 4-6 weeks
– Decrease blood volume
– Relax smooth muscles in vessel walls
Side Effects of Thiazides
• Drop in blood
pressure
• Orthostatic
hypotension
• Dizziness, faint
• Hypokalemia
• Hyperuricemia
• Hyperglycemia
• Muscle
spasms/cramps
•
•
•
•
•
•
•
•
Glucose changes in DM
Nausea
Diarrhea
Constipation
Anorexia
Headache
Impotence
Elevation
– BUN
– Creatinine
Thiazide Diuretics
•
•
•
•
bendroflumethiazide (Naturetin)
benzthiazide (ExNa)
chlorothiazide (Diuril, Diurgen)
hydrochlorothiazide (Exidrix, Ezide,
HydroDIURIL, Oretic)
• methyclothiazide (Enduron, Aquatensin)
• polythiazide (Renese)
• trichlormethizade (Diurese, Metahydrin,
Naqua)
Thiazide-like Diruetics
•
•
•
•
chlorthalidone (Hygroton)
indapamide (Lozol)
metalazone (Zaraxolyn)
qinethazone (Hydromox)
Classification of Vessel Drugs
Anti-coagulants/Antiplatelets*
Diuretics
Aspirin (Prostaglandin Inhibitor)
Carbonic Anhydrase Inhibitors
Coumarins
Osmotic
Heparin
Thiazide/Thiazide -like
Thrombolytics
Antifibrinolytics
Vasoconstrictors
Anti-hyperlipidemics
Other Vasodilators
Anti-hypertensives
Nitrites and Nitrates
ACE Inhibitors
Calcium channel Blockers#
Vasodilators
Alpha-adrenergic Blockers
Angiotensin II receptor blockers (ARBs)
*Bold = in vessel section
#Italics
= in heart sections
Anti-coagulants (Veins)
• 4 stages in coagulation and clot resolution
• Anti-coagulant mechanisms
– Inhibit the function of preformed clotting
factors (heparin - IV/SQ)
– Prevent synthesis of normal clotting factors
• Coumarin derivatives (PO)
• Mechanisms determines onset/duration of
drug effects
• Used to prevent MIs
Anti-coagulants
Contraindications
Interactions
Side Effects
Uncontrolled bleeding
Acetaminophen, NSAIDs
Bleeding (increased)
Pregancy (use with caution)
Alcohol
Blood irregularities
Anti-infectives
GI disease
Barbiturates
Kidney disease
Chloral hydrate
Liver disease
Estrogen
Steroids
anabolic and corticoThyroid drugs
Tricyclic antidepressants
Coumarin Derivatives
• Can be PO
• Warfarin sodium (Coumadin)
• Vitamin K antagonist
• Side effects
– Hematuria, petechiae
– Nausea, Diarrha, urticaria, alopecia
Heparin (IV,SQ)
• Used to Prevent
– Venous thrombosis, esp. Pulmonary
embolism
– Clots prior to blood transfusion, during open
heart surgery
• Treat
– MI
– Thrombophlebitis
– Stroke
• Preferred anti-coagulant during pregnancy
Antiplatelets (Arteries)
• Suppress aggregation of platelets
– Core of arterial thrombus
• Low-dose aspirin - Preventative
• Clopidgrogrel (Plavix)
– Previous MI
• Ticlopidine (Ticlid)
– More expensive than aspirin, same level of tx
• Dipyridamole (Persantin)
Aspirin
• acetylsalicylic acid
• Hippocrates (460 B.C and 377 B.C)
– historical records of pain relief tx
– use of powder made from willow bark and
leaves for headaches, pains and fevers
• 1829, scientists discovered called salicin
in willow plants which provide pain relief
• Aspirin was patented on February 27,
1900 by Bayer
Thrombolytics
• Dissolve existing clots
• Tx MI w/in 6 hours of symptoms onset
• 5 drugs
– streptokinase (streptase)
– alteplase (Activase)
– urokinase (Abbokinase)
– reteplase (Retavase)
– anistreplase (Eminase)
Anti-fibrinolytics
• Help form blood clots
• Provide hemostasis
• Vitamin K = antidote for anticoagulant
overdose
Anti-hyperlipidemics
(Hypolipidemics)
• Atherosclerotic plaques usually in
large/medium arteries
– Lifestyle changes first
– Diet changes needed even with meds
• Prophylactic tx, lifelong once begun
– Reduce cholesterol and LDL
Anti-hyperlipidemics
Contraindications
Interactions
Side Effects
Biliary obstruction
antacids
abdominal pain
Elevated liver enzymes
anticoagulants
arrhythmias
Gallbladder disease
cardiac glycosides
asthenia
Lactation
cimetidine
constipation
Liver disease
corticosteroids
dizziness
Peptic ulcers
cyclosporine
headache
Pregnancy
erythromycin
myalgia
Renal dysfunction
iron
N&V
sulfonylureas
rash
Anti-hyperlipidemics
• Bile Acid sequestrants
• HMG CoA Reductase Inhibitors (statins)
• Nicotinic Acid
• Fibric Acid Derivatives
• Estrogens
Anti-hyperlipidemics
• cholestyramine (Questran, Prevalite) (BAS)
• colestipol (Colestid) (BAS)
•
•
•
•
•
atorvastin (Lipitor)
fluvastatin (Lescal)
lovastatin (Mevacor)
pravastatin (Pravachol)
simvastatin (Zocor)
Break Time
Anti-hypertensives
• Treatment usually begins with
– lifestyle changes, then add
– diuretic or beta blocker, then
– add another med, etc.
• Compliance big problem, HTN asymptomatic
• ACE Inhibitors
• Vasodilators
– Alpha-adrenergic Blockers
– Angiotensin II receptor blockers (ARBs)
ACE Inhibitors
• Angiotensin Converting Enzyme (ACE)
– Angiotensin is a vasoconstrictor
•
•
•
•
Slow formation of angiotensin II
Decrease blood volume/pressure
Increase renal blood flow
Interfere Less with mental/physical
performance = better Quality of Life = better
compliance
• SE – nonprod cough, loss of taste, joint pain
ACE Inhibitors (PO)
•
•
•
•
•
benazepril (Lotensin)
enalapril (Vasotec)
fosinopril (Monopril)
quinapril (Accupril)
ramipril (Altace)
• Tx - CHF
Alpha-adrenergic Blockers
• Alpha-adrenergics action similar to
norepinephrine (smooth muscle contraction)
• Major alpha organ is blood vessels
• Alpha blockers effects
– Vasodilation, lower blood pressure
• SE – nasal congestion, orthstatic
hypotension, fainting
Alpha-adrenergic Blockers - PO
•
•
•
•
doxazosin (Cardura)
phentolamine (Regitine HCl)
prazosin (Minipress)
terazosin (Hytrin)
• Prescribed for Adults
Angiotensin II receptor blockers
(ARBs)
• Angiotensin II is a vasoconstrictor
• ARBs have effects that are similar to
angiotensin converting enzyme (ACE)
inhibitors
• ACE inhibitors act by preventing the
formation of angiotensin II
• ARBS block the binding of angiotensin II to
muscles on blood vessels
Angiotensin II receptor blockers
(ARBs)
•
•
•
•
•
•
•
candesartan (Atacand)
eprosartan (Teveten)
irbesartan (Avapro)
telmisartan (Micardis)
valsartan (Diovan)
losartan (Cozaar)
olmesartan (Benicar)
Vasoconstrictors
• Constrict the muscle fibers in blood vessel
walls by direct action on vessels OR
stimulate the vasomotor center in medulla
– stop superficial hemorrhage
– relieve nasal congestion
– Raise blood pressure
– Increase force of heart
Vasoconstrictors
• norepinephrine (Levophed)
– tx hypotension
• metaraminol (Aramine)
– prolonged duration, raises bl pressure
• epinephrine (Adrenalin)
Vasodilators
• Increase size of bl vessels
• Used to tx peripheral vascular disease,
heart conditions (CHF), & HTN
• Papaverine
– opium alkaloid, but NOT narcotic
• Alcohol - dilates blood vessels by
depressing the vasomotor center of
medulla
– can tx angina pectoris?
Using the Table of Drugs
• Coder must determine
– Adverse Effect vs Poisoning
– Decision Flow chart
• Taking less/stopping drug is
– NOT poisoning OR adverse effect
• 980 – 989 - Toxic effects of NON-medicinal
substances = follow Poisoning steps
Table of Drugs
• Rows = Drugs, medicinal substances
• Columns = Poisoning code, E codes
• ALWAYS VERIFY in TL
– Instructional Notes
• Ex: 960 Poisoning by antibiotics
– Exclusion Note: 976.x should be used for
local (topical) applications
Adverse Effect
• Correct substance administered as prescribed
• Adverse effect (manifestation) sequenced 1st
• E code from Therapeutic use column 2nd
• CANNOT use E code from any other column
• Adverse Effect E codes MUST BE
REPORTED
Adverse Effect Documentation
• Dx statements of
– Toxic effect, toxicity,
intoxication due to
prescription drug
(digitalis, lithium)
– w/o any further info
– Indicates Adverse
Effect
• Other terms for AE
– Allergic reaction
– Cumulative effect
(toxicity)
– Hypersensitivity
– Idiosyncratic reaction
– Paradoxical reaction
– Synergistic reaction
Adverse Effects
•
•
•
•
Toxicity
Synergistic reaction
Side effect
Idiosyncratic reaction
• Because of
• Pt differences
– Age, sex, disease
– Genetic factors
• Drug-related
–
–
–
–
–
Type
Administration route
Duration of tx
Dosage
Bioavailability
AE Drug E codes
• When agent causes multiple adverse
reactions, code the E code ONCE
• When 2+ drugs are responsible, code
individually unless there is a combo E code
Unspec AE
• 995.2 Unspec AE effect of drug, …
– CAN be used in OUTpatient setting
– Inappropriate for Inpatient setting
• Code S&S or 796.0 w/ Ecode
Late Effects of AE of Drugs
• Code residual condition
• 909.5
• E code (E930-E949)
• Chronic effects of drug taken for long time
and still being taken = current AE
• If delayed effects AFTER stopping = LE
Late Effects AE Examples
• Brain damage caused by penicillin allergy
(while taking med)
– 348.9, E930.0
• Brain damage caused by penicillin allergy
(stopped using 6 months ago)
– 348.9, 909.5, E930.0
Poisoning
• Substance used incorrectly
– Error in prescription
– Drug overdose (Intentional/Accidental)
– Non-prescribed drug taken with correctly
prescribed/taken drug
– Wrong administration method
– Wrong dosage given/taken
– Wrong medication given/taken
Poisoning
• Code from Poisoning column first
• Manifestation
• E code for how substance used
– Accident, Assault, Suicide, etc.
• CANNOT use E code from Tx Use column
Poisoning by Interaction
• Tx drug and nonprescription drug or
alcohol
– Poisoning code for
EACH substance
– Manifestation, if
documented
– E code for EACH
substance
• Ex: Coma due to
Adverse reaction to
Valium taken
correctly, but with 2
martinis
• 980.0
• 969.4
• 780.01
• E860.0
• E853.2
Poisoning E codes
• Cause not stated = undetermined E code
Substance Abuse/Dependence
• Acute condition due to alcohol/drug
abuse/dependence = Poisoning code
– Code acute manifestation
– Code abuse/dependence
– E code
• Ex: Acute pulmonary edema due to
accidental heroin overdose/pt dependent
– 965.01, 518.4, 304.00, E850.0
• Chronic conditions are NOT poisoning
Late Effects of Poisoning
•
•
•
•
Same LE rules
Residual coded first
909.0
E929.2
Specific Drug NOT in Table
• American Hospital Formulary Service
(AHFS)
• Index from brand names, etc to #
– Hospital Pharmacist is valuable resource
• ICD-9-CM Appendix 3 has list of AHFS #
by drug functions (no brand names)
• May have to research drug name to find
type and then find type in Appx 3
Drug Resources
• Mayo Clinic
– http://www.mayoclinic.com/health/druginformation/DrugHerbIndex
• Medicinenet.com
– http://www.medicinenet.com/medications/artic
le.htm
• MedlinePlus
– http://www.nlm.nih.gov/medlineplus/druginfor
mation.html
Drug Resources
• NLM. NIH. Drug Information Portal.
– http://druginfo.nlm.nih.gov/drugportal/drugport
al.jsp
• PDRHealth. Drugs and Supplements.
– http://pdrhealth.com/drugs/drugs-index.aspx
Adverse Effects vs Poisoning
Condition due to Drug, Med. Bio?
NO
Code Condition
Yes
Med used exactly as prescribed? NO Code as Poisoning
Add code for condition
Add E code (Optional)
Yes
Alcohol/non-prescr. drug also
NO Code condition
taken?
Add Tx use E code
(E930-E949)
Yes
Code as Poisoning
Add code for condition
Add E code (Optional)
Drug Coding
• Hypokalemia resulting from reaction to
Diuril given by mistake in Dr’s office
• Electrolyte imbalance due to interaction
between lithium carbonate and Diruil, both
taken as prescribed
• Toxic encephalopathy due to excessive
use of aspirin
Drug coding
• Coumandin intoxication due to
accumulative effect resulting in gross
hematuria
• Severe bradycardia due to accidental
double dose of digoxin
• Lightheadedness due to interaction
between Aldomet and peripheral
vasodilating agent (both taken as presc.)
Drug Coding
• Bradycardia due to eating oleander leaves
• Systemic hypocalcemia and hypodalemia
due to using lye in housecleaning
• Extrapyramidal disease due to attempted
suicide by overdose of Thorazine six months
ago http://biology.clc.uc.edu/graphics/steincarter/florida/Oleander%2002%20small.JPG
ILEMten@gmail.com
Resources
• Beaman, N. Pharmacology Clear and Simple. 2008.
Philadelphia:F. A. Davis.
• Fulcher, E. M., Soto, C. D., and Fulcher, R. M.
Pharmacology: Principles and applications. Saunders,
2003.
• Hitner & Nagle. Basic Pharmacology. 4th ed.
Glencoe,1999.
Resources
• ICD-9-CM Official Guidelines for Coding and
Reporting, October 1, 2009
– http://www.cdc.gov/nchs/data/icd9/icdguide09.pdf
• Inotropic and Cardiotonic Drugs. Heart Rhythm Society.
– http://www.hrsonline.org/PatientInfo/Treatments/Medications/HF
Drugs/
• Kapitanyan, Su, & Landry. 2009. Plant Poisoning,
Glycosides – Cardiac.
– http://emedicine.medscape.com/article/816781-overview
Resources
• Klabunde, R. Cardiovascular pharmacology concepts.
– http://www.cvpharmacology.com/index.html
• Medicinenet. Angiotensin II Receptor Blockers (ARBs).
2010.
– http://www.medicinenet.com/angiotensin_ii_receptor_blockers/article.htm
• WebMD. Heart Disease Medications.
– http://www.webmd.com/heart-disease/guide/heartdisease-medications-index