CardiovascularCardiovascular Pharmaceuticals Pharmaceuticals

Irene Mueller, EdD, RHIAIrene Mueller, EdD, RHIA

MHAMHA20102010

Objectives – First HourObjectives – First Hour

• Medications– Heart– Vessels

Objectives - 2Objectives - 2ndnd hour hour

• Medications– Vessels, continued

• Using the ICD-9-CM Table of Drugs

• Homework Answers

• Responses to Questions

• Resources

CV System PharmaceuticalsCV 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 DrugsActions 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 DrugsClassifications of Heart DrugsACE 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) Thrombolytics

Sodium Channel Blockers (Class I)

*Italics = in vessel section#Bold = in heart section

Anti-anginals 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 BlockersBeta-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 receptorsTypes 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 BlockersNS 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 BlockersSelective 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 BlockersCalcium 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 BlockersCalcium Channel Blockers• verapamil (Calan, Isoptin)

– AV node/SV arrhythmias, angina

• diltiazem (Cardizem)– More effective as anti-

hypertensive

• nifedipine (Procardia)– Vasodilator

• nicardipine (Cardene)– Vasodilation, relax

coronary artery spasm

• Newer• amlodipene (Norvasc)• bepridil (Vascor)• felodipine (Plendil)• Isradipine (DynaCirc)

Nitrites and NitratesNitrites 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 NitratesNitrites 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 NitratesNitrites and Nitrates

• amyl nitrite (Vaporole)

• erythrityl Tetranitrate (Cardilate)

• isosorbie Dinitrate (Isordil)

• nitroglycerin (Nitrol, Notrostat, Nitrong, Nitro-Bid, Transderm-Nitro

• pentaerythritol Tetranitrate (Peritrate)

Nitroglycerin 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-arrhythmicsAnti-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-arrhythmicsAnti-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 Sodium Channel Blockers (Class 1)(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 BlockersSodium Channel Blockers

• quinidine (chinchona bark)• procainamide (Procanbid)• disopyramide (Norpace)• lidocaine (Xylocaine)• phenytoin (Dilantin)

• Newer– flecainide (Tambocor), moricizine (Ethmozine),

propafenone (Rythmol)

Potassium Channel BlockersPotassium 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-arrhythmicsOther 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 GlycosidesCardiac 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 GlycosidesCardiac 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 GlycosidesCardiac Glycosides

• Digitalization, then maintenance

• Low potassium increases toxic effects

• High potassium antagonizes tx effects

• High calcium enhances action

• Tx CHF

Cardiac GlycosidesCardiac 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

DiureticsDiuretics

• 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

DiureticsDiuretics

Contraindications Interactions Side Effects

Anuria Cardiac glycosides Anorexia

Breastfeeding Corticosteroids Hypersensitivity reactions (skin rash)

Known hypersensitivity

Lithium Hyperuricemia

Pregnancy NSAIDs Hypokalemia

Oral hypoglycemics Hyponatremia

Hypotension

Nausea

Ototoxicity (loop)

Classes of DiureticsClasses of Diuretics

Carbonic anhydrase inhibitors

Organic acids (Loop)

Osmotic (Lumenal) (no uses)

Potassium-sparing

Thiazide/Thiazide-like

OTC (Xanthine derivatives)

Carbonic Anhydrase InhibitorsCarbonic 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) DiureticsOrganic 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) DiureticsOrganic 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 DiureticsPotassium-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 DiureticsPotassium-Sparing Diuretics

• amiloride (Midamor) – HTN

• spironolactone (Aldactone) – HTN, Edema

• spironolactone – w/thiazide (Aldactazide) – HTN, Edema

• triamterene (Dyrenium) - Edema, HTN

Thiazide/Thiazide-like DiureticsThiazide/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 DiureticsUses 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 ThiazidesSide 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 DiureticsThiazide Diuretics

• bendroflumethiazide (Naturetin)• benzthiazide (ExNa)• chlorothiazide (Diuril, Diurgen)• hydrochlorothiazide (Exidrix, Ezide,

HydroDIURIL, Oretic)• methyclothiazide (Enduron, Aquatensin)• polythiazide (Renese)• trichlormethizade (Diurese, Metahydrin, Naqua)

Thiazide-like DirueticsThiazide-like Diruetics

• chlorthalidone (Hygroton)

• indapamide (Lozol)

• metalazone (Zaraxolyn)

• qinethazone (Hydromox)

Classification of Vessel DrugsClassification of Vessel DrugsAnti-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 *Bold = in vessel section

Alpha-adrenergic Blockers #Italics = in heart sections

Angiotensin II receptor blockers (ARBs)

Anti-coagulants (Veins)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-coagulantsAnti-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 cortico-

Thyroid drugs

Tricyclic antidepressants

Coumarin DerivativesCoumarin Derivatives

• Can be PO

• Warfarin sodium (Coumadin)

• Vitamin K antagonist

• Side effects– Hematuria, petechiae– Nausea, Diarrha, urticaria, alopecia

Heparin (IV,SQ)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)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)

AspirinAspirin• 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

ThrombolyticsThrombolytics

• 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-fibrinolyticsAnti-fibrinolytics

• Help form blood clots

• Provide hemostasis

• Vitamin K = antidote for anticoagulant overdose

Anti-hyperlipidemics Anti-hyperlipidemics (Hypolipidemics)(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-hyperlipidemicsAnti-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-hyperlipidemicsAnti-hyperlipidemics

• Bile Acid sequestrants

• HMG CoA Reductase Inhibitors (statins)

• Nicotinic Acid

• Fibric Acid Derivatives

• Estrogens

Anti-hyperlipidemicsAnti-hyperlipidemics

• cholestyramine (Questran, Prevalite) (BAS)

• colestipol (Colestid) (BAS)

• atorvastin (Lipitor)

• fluvastatin (Lescal)

• lovastatin (Mevacor)

• pravastatin (Pravachol)

• simvastatin (Zocor)

Break TimeBreak Time

Anti-hypertensivesAnti-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 InhibitorsACE 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)ACE Inhibitors (PO)

• benazepril (Lotensin)

• enalapril (Vasotec)

• fosinopril (Monopril)

• quinapril (Accupril)

• ramipril (Altace)

• Tx - CHF

Alpha-adrenergic BlockersAlpha-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 - POAlpha-adrenergic Blockers - PO

• doxazosin (Cardura)

• phentolamine (Regitine HCl)

• prazosin (Minipress)

• terazosin (Hytrin)

• Prescribed for Adults

Angiotensin II receptor blockers Angiotensin II receptor blockers (ARBs)(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 Angiotensin II receptor blockers (ARBs)(ARBs)

• candesartan (Atacand)

• eprosartan (Teveten)

• irbesartan (Avapro)

• telmisartan (Micardis)

• valsartan (Diovan)

• losartan (Cozaar)

• olmesartan (Benicar)

VasoconstrictorsVasoconstrictors

• 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

VasoconstrictorsVasoconstrictors

• norepinephrine (Levophed)– tx hypotension

• metaraminol (Aramine) – prolonged duration, raises bl pressure

• epinephrine (Adrenalin)

VasodilatorsVasodilators

• 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 DrugsUsing 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 DrugsTable 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 EffectAdverse 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 DocumentationAdverse 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 EffectsAdverse 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 codesAE 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 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 DrugsLate 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 ExamplesLate 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

PoisoningPoisoning

• 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

PoisoningPoisoning

• 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 InteractionPoisoning by Interaction

• Tx drug and non-prescription 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 codesPoisoning E codes

• Cause not stated = undetermined E code

Substance Abuse/DependenceSubstance 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 PoisoningLate Effects of Poisoning

• Same LE rules

• Residual coded first

• 909.0

• E929.2

Specific Drug NOT in TableSpecific 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 ResourcesDrug Resources

• Mayo Clinic– http://www.mayoclinic.com/health/drug-

information/DrugHerbIndex

• Medicinenet.com– http://www.medicinenet.com/medications/

article.htm

• MedlinePlus– http://www.nlm.nih.gov/medlineplus/

druginformation.html

Drug ResourcesDrug Resources

• NLM. NIH. Drug Information Portal.– http://druginfo.nlm.nih.gov/drugportal/

drugportal.jsp

• PDRHealth. Drugs and Supplements.– http://pdrhealth.com/drugs/drugs-index.aspx

Adverse Effects vs PoisoningAdverse Effects vs PoisoningCondition due to Drug, Med. Bio? NO Code Condition

Yes

Med used exactly as prescribed? NO Code as PoisoningAdd code for conditionAdd E code (Optional)

Yes

Alcohol/non-prescr. drug also taken?

NO Code conditionAdd Tx use E code(E930-E949)

Yes

Code as PoisoningAdd code for conditionAdd E code (Optional)

Drug CodingDrug 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 codingDrug 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 CodingDrug 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 agohttp://biology.clc.uc.edu/graphics/steincarter/florida/Oleander%2002%20small.JPG

ILEMten@gmail.com

ResourcesResources

• 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.

ResourcesResources

• 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/

HFDrugs/

• Kapitanyan, Su, & Landry. 2009. Plant Poisoning, Glycosides – Cardiac. – http://emedicine.medscape.com/article/816781-overview

ResourcesResources• 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/heart-

disease-medications-index