This document provides information on the clinical and pharmacologic management of residents with cardiovascular diseases. It discusses the anatomy and physiology of the cardiovascular system and covers the management of various conditions including congestive heart failure, angina, hypertension, blood clot diseases, and intermittent claudication. For each condition, it lists the classes of medications used for treatment, including diuretics, nitrates, cardiac glycosides, ACE inhibitors, ARBs, beta blockers, calcium channel blockers, and anticoagulants. It describes the actions, examples, side effects, and implications for care of the drugs used to treat diseases of the cardiovascular system.

1. MEDICATION AIDE
RECERTIFICATION
ONLINE PROGRAM

2. Alzheimer’s
Disease
Caring for
Alzheimer’s
Patient

3. Alzheimer’s Disease
Basic Stages of Alzheimer’s Disease
Stage 1: Normal
Stage 2: Mild
Stage 3: Moderate
Stage 4: Severe

4. Alzheimer’s
Disease
Basic characteristics of
Alzheimer’s patients.

5. Basic procedures in dealing with
Alzheimer’s patients.
a. Create calm and safe environment
b. Maximize patient’s freedom and independence
c. Monitor resident’s functional abilities.
d. Establish routine for medication administration.
i. Administer one drug at a time.
ii. Do not argue with patient who refuses medication.
v. Medications: Donepezil; memantine; tacrine; rivastigmine

6. The
Cardiovascular
System.
Drug & Diseases affecting the
cardiovascular system.

7. Module 3
Cardiovascular System
Clinical and pharmacologic management of residents with cardiovascular diseases.
Structure and functions of the system
– • Management of patients with congestive heart failure.
– • Management of patients with angina
– • Management of patients with arrhythmias
– • Management of patients with hypertension
– • Management of patients with blood clot diseases
– • Management of patients with intermittent claudication.

8. CLINICAL AND
PHARMACOLOGIC
MANAGEMENT OF
RESIDENTS WITH
CARDIOVASCULAR
DISEASES.
Anatomy and Physiology

9. Anatomy and physiology of the
heart.
– The cardiovascular system consists of the heart and blood vessel. The heart is
the size of the fist. a muscular, multi-chambered organ which rhythmically
pumps blood; heartbeat should be regular in rate and force at a normal range of
60 – 100 beats per minute. The heart has four chambers each separated by
valves. Blood vessels.
– Arteries – muscular tubes which carry blood containing oxygen and other
nutrients to body tissue; can constrict and dilate to changes blood pressure.
Veins carry deoxygenated blood, carbon dioxide and waste product. The
capillaries are microscopic vessels that connect the arteries and the veins.

10. Management of patients with
congestive heart failure
– Heart failure results from the hearts inability to work effectively as a pump;
many conditions can cause Congestive Heart Failure (CHF); coronary artery
disease (CAD), diabetes (DM)and hypertension (HTN) are example of such
diseases. In CHF, heart cannot pump effectively and fluid backs up in the
vessels/tissues causing edema in tissues spaces, abdomen and lungs; diuretics
are commonly administered to treat/prevent CHF in additions to cardiac-related
drugs

11. Signs and
Symptoms of
Heart Failure

12. Pharmacologic Management of
CHF.
– The following classes of medications are used in the management of CHF, these
include;
– Diuretics,
– Nitrates,
– Cardiac digitalis,
– Angiotensin II receptor blockers (ARBs),
– Angiotensin converting enzyme (ACE) inhibitors,
– and Beta blockers.

13. Diuretics:
There are two classes of diuretics, potassium wasting and potassium sparing diuretic. The latter retains potassium, while
the former reduces the amount of potassium in the body cause low potassium, a term called hypokalemia.
Action: promote urinary production and excretion. This drugs also promotes water and sodium excretion.
Potassium wasting diuretics
Generic name: furosemide
– Adverse Drug Reaction (ADR) / Side effects GI effects, dizziness,
headache and vertigo, dehydration,
Implication of care:
– Administer diuretics early in the day and with plenty of fluid unless
physician restricts.
– Monitor the effectiveness of diuretics by taking routine body weight
and observing for edema (Observe for pitting edema and report to the
nurse), checking blood pressure, presence of thirst, and input and
output according to physician orders or facility policy.
– Check daily weight change and report changes greater than +2lbs to
the nurse.
– Potassium depletion may result in confusion, gas, muscle weakness,
muscle cramping, and/or an irregular heartbeat; observe and report to
the nurse promptly.
Potassium sparing Diuretics
Genetic name: Spironolactone
– Adverse Drug Reactions: Headache, drug induced hyperkalemia (high
level of potassium)
Implication of care:
– Administer diuretics early in the day and with plenty of fluid unless
physician restricts.
– Monitor the effectiveness of diuretics by taking routine body weight
and observing for edema (Observe for pitting edema and report to the
nurse), checking blood pressure, presence of thirst, and input and
output according to physician orders or facility policy.
– Check daily weight change and report changes greater than +2lbs to
the nurse.

14. Nitrates
Action
– Nitrates decreased cardiac output secondary to
peripheral vasodilation. It dilates the coronary
arteries in the heart.
Generic names:
– Nitroglycerine (sublingual), isosorbide
mononitrate and isosorbide dinitrate, NTG patch
– Adverse Drug Reactions: Headache, Orthostatic
Hypotension, flushing, syncope, nausea/vomiting
Implication of care:
– Ensure the safe use of the NTG patch (12 hours on
and 12 hours off), this prevents the client from
developing tolerance to the drugs.
– Administration of NTG ointment requires the
medication aide to measure prescribed the
manufacturer’s application paper. The technique
for application is similar to the transdermal patch.
– Headache is a positive action of sublingual NTG,
report to nurse so that analgesic medication may
be administered.
– Instruct patient to rise slowly from lying position
to prevent orthostatic hypotension.
– Check apical pulse, using a stethoscope listen for
one full minute.

15. Cardiac Glycosides
Action
– slows and strengthens the heart’s
contraction so that it pumps more blood
with each beat. There is only one drug in
class known as digoxin Lanoxin.
Generic name; digoxin
Adverse Drug Reactions also Signs of toxicity
excessive slowing of the heart, irregular
heartbeat, GI symptoms, confusion,
weakness and visual blurring. This drug has a
narrow therapeutic window and so monitor
patient closely for side effects which is also
signs of toxicity.
Implementation of care:
– Patient may complain of green or yellow
halo when they stare at bright lights.
Report to nurse immediately as this is a
sign of toxicity.
– Check apical pulse before administration,
hold if pulse is less than 60bpm

16. Ace Inhibitors
– Angiotensin Converting Enzyme
inhibitor is used in the
maintenance of CHF.
– Generic name – captopril,
enalapril, fosinopril, lisinopril,
quinapril, ramipril, trandolapril.
These drugs have a common
suffix.

17. Ace Inhibitors
Adverse Drug Reactions; GI effects (nausea, vomiting,
diarrhea), loss of appetite, drowsiness and blurred vision.
Implementation of care:
– ACE inhibitor is a vasodilator (relaxes the blood vessel)
– Check the apical pulse and blood pressure before
administration.
– A non-productive cough is one of the more common
adverse drug reactions to ACE inhibitors. It is dose
dependent and usually relieved when the medication
is discontinued.

18. ARBs
(angiotensin II Receptor
Blockers)
– This class of vasodilator is needed for the
maintenance of CHF
– Generic name – candesartan, valsartan
– Adverse Drug Reactions – headache, dizziness
and hypotension. A headache may be a bad
symptom with ARBs which require notification
of the nurse in charge. Check blood pressure
and apical pulse prior to drug administration.

19. Beta blockers
Action; slows the heart rate; lowers blood
pressure; dilates the artery.
Generic names - carvedilol, metoprolol,
propranolol.
Adverse drug reactions - GI effects, dizziness,
fatigue, vivid dream or nightmares,
hallucinations.
Implementation of care
– Report side effects to nurse.
– Blood pressure should be taken for any
drug ending with lol.
– Patient should rise slowly from lying
position to avoid orthostatic hypotension.

20. Management of
Angina
Pectoris
Aka Chest Pain

21. Angina Pectoris
– Angina results from lack of oxygenated blood to areas of the heart muscle. The
pattern of pain remains constant for one individual but varies between
individuals, angina attacks are usually set off by physical activity or emotional
stress. Patients with Angina have a history of atherosclerosis. Drugs used to
treat transient angina are Nitrates, Ace Inhibitors, Calcium Channel Blockers,
and Piperazine derivatives.
Ques; what are the major causes of angina and how would you describe the
pain?

22. Calcium channel blockers
– This class of medication is prescribed for angina amongst other
diseases. The drug
– Generic names - amlodipine, diltiazem, nicardipine
– Adverse drug reactions: include edema (dose related), dizziness,
palpations, flushing.
– Implementation of care
– Calcium channel blockers may be both effective for angina, but may
also exacerbate symptoms.
– These include (excessive hypotension, increasing heart rate, and
worsening of symptoms)

23. Piperazine derivatives
– Generic names – ranolazine
– Adverse drug reactions include dizziness,
headache, asthenia, confusion, tremor
– Implementation of care: Check blood pressure
and apical pulse.

24. Management of
Hypertension
Blood Pressure Medication

25. What is
Hypertension
– With hypertension, the blood
pressure remains elevated. If
not reduced, blood vessels in
the brain, kidney, and heart
are likely to be damaged. To
lowers blood pressure, many
do this by dilating blood
vessels. This will not improve
hypertension caused by
arteriosclerosis. Often used in
conjunction with diuretics

26. Anti-hypertensives
Beta Blockers, Ace-Inhibitors, ARBs, Calcium Channel Blockers, and Diuretics When hypertension is not
relieved using one drug, a combination of two or more may by ordered either in combination as one drug
or two separate agents. Examples are Lisinopril/HCTZ, enalapril/HCTZ or Aldactone /HCTZ.
Side effects:
postural hypotension, drowsiness, dizziness.
Implementation of care
• Check blood pressure routinely.
• To minimize postural hypotension and resident safety encourage patient to seat down or avoid
standing on one spot after administering the medication.
• Resident should avoid taking a hot bath after medication.
• Encourage patient to rise slowly from lying position.

27. Management of
blood clot
diseases.
Anticoagulants

28. Anticoagulants
Anticoagulants are drugs that prevent new blood clot. Patients with history of Cerebrovascular accident, (stroke) myocardial infarction (heart attack),
pulmonary embolism, TIAs – Transient Ischemic Attacks (mini stroke).
Generic names: Pentoxifylline, cilostazol (For Intermittent Claudication)
Adverse drug reactions
– GI distress, weight loss, dizziness,
Stroke/DVT prophylaxis/atrial fibrillation
Generic names; Warfarin
– Other drugs that may be used instead of warfarin: apixaban, aspirin, clopidogrel, dabigatran, rivaroxaban, ticlopidine, vorapaxar
Adverse drug reactions
– GI distress, increased bleeding, headache, dizziness, vertigo
Implementation of care
– Nurse will be responsible for lab work, prior to the administration of medication. Patients that are stable may be placed on medication to be
administered every other day.
– Observe for signs of bleeding, bleeding gums, bruising, and blood in urine or stool.

29. Anticoagulant
Implication of Care