cardiovascular pharmaceuticals irene mueller, edd, rhia mha2010
TRANSCRIPT
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
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