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