Cardiovascular Drugs1

7/31/2019 Cardiovascular Drugs1

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CARDIOVASCULAR DRUGS!!!!!


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Methyldopa

Use?

SE?

Sympathoplegic, HTN

Sedation, positive

coombs test


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Reserpine

Use?

SE?

Sympathoplegic, HTN

Sedation, depression,

nasal stuffiness,

diarrhea


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Hydrochlorothiazide

Use?

SE?

Diuretic, HTN

Hypo-K, Hyperlipidemia,

hyperuricemia,

lassitude, Hyper-Ca,Hyperglycemia


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Clonidine

Use?

SE?

Sympathoplegic, HTN

Dry mouth, sedation,

severe rebound HTN


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Guanethidine

Use?

SE?

Sympathoplegic, HTN

Orthostatic & exercise

hypotension, diarrhea,

sexual dysfxn


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Nitroglycerin, Isosorbide Dinitrate

Use?

MOA?

Decreased Preload orAfterload?

Toxicity

Vasodilatorangina, pulm edema,aphrodisiac/erection enhancer

Releases NO from smooth muscle:increased cGMP relaxation.Veins> Arteries Which does Arteries > Veins?

HYDRALAZINE

PRELOAD

Tachycardia, Flushing, HA,

hypotension, Monday Diseasedecreased tolerance over weekend tach, dizziness and HA onreexposure


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Prazosin

Use?

SE?

Sympathoplegic, HTN

Orthostatic hypotension

with 1st dose, dizziness,

headache


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Diazoxide

Use?

SE?

Vasodilator, HTN

Hyperglycemia,

decreased insulin

release, hypotension


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Beta blockers

Use?

SE?

Sympathoplegic, HTN

Impotence, asthma,

cardiovascular effects

(bradycardia, CHF, AVblock), CNS effects

sedation and changes in

sleep


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Hydralazine

Use?

Mechanismof Action?

Reduces

preload orafterload?

SE?

Vasodilator, severe HTN, CHF

Increased cGMP smooth musclerelaxation. Arterioles > veins.

AFTERLOAD (Vasodilator!)

Nausea, Headache, Lupus-like syndrome,reflex tachycardia (dont use in agina or

CAD!), angina, salt retention Use with beta blocker to avoid tachycardia

and with a diuretic to avoid salt retention


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Minoxidil

Use?

Mechanism

of Action?

SE?

Vasodilator, HTN

K channel opener, hyperpolarizes

smooth muscle cells

HAIRY MONSTER, pericardialeffusion, reflex tachycardia, angina,

salt retention

Use with beta blocker to avoidtachycardia and with a diuretic to

avoid salt retention


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Captopril

Use?

Other Examples?

SE?

ACE Inhibitor, HTN

Enalapril, Fosinopril

Hyper-K, cough,

angioedema, tastechanges, hypotension,

fetal renal damage,

rash, increased renin


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Hexamethonium

Use?

SE?

Sympathoplegic, HTN

Severe orthostatic

hypotension, blurry

vision, constipation,sexual dysfxn


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Verapamil

Use?

MOA?

More cardiac orsmooth muscleeffects?

SE?

Toxicity?

Calcium Channel Blocker,HTN, angina, arrhythmias,Raynauds

Blocks Voltage Dependant L-type Ca channels,

decreasing contractility Cardiac, but also vasodilator

Dizziness, flushing,

constipation, AV block,Nausea

Cardiac depression,peripheral edema, flushing,dizziness, constipation


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HOW DO YOU TREAT MALIGNANT

HYPERTENSION???

Three drugs in alphabetical order

#1: DIAZOXIDE

MOA?

K channel openerhyperpolarizes smooth muscle #2: Fenoldopam

MOA?

Dopamine1 Receptor Agonist: relaxes vascular smooth muscle

#3: Nitroprusside MOA?

Increased cGMP via direct NO release

SE?

CYANIDE POISONING!!!


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Nitroprusside

Use?

SE?

Vasodilator, HTN

Cyanide Poisoning

(Releases CN!)


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WHICH TWO DRUGS ARE THE

HYPERTENSION IN PREGNANCY

SUPERSTAR MEDS?

(Which are ok to use in Pregnancy?)

HYDRALAZINE &

METHYLDOPA

This, on the other hand is NOT safe in pregnancy.


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Diltiazem

Use?

MOA?

More cardiac orsmooth muscleeffects?

SE?

Toxicity?

Calcium Channel Blocker,HTN, angina, arrhythmias,Raynauds

Blocks Voltage Dependant L-type Ca channels,

decreasing contractility Somewhere in the middle

Dizziness, flushing,

constipation, AV block,Nausea

Cardiac depression,peripheral edema, flushing,dizziness, constipation


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Losartan

Use?

Good alternative to

what?

SE?

Angiotensin II Receptor

Blocker, HTN

ACE Inhibitors

Fetal renal toxicity,Hyper-K


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Nifedipine

Use?

MOA?

More Cardiacor SmoothMuscle

Effects? SE?

Toxicity?

Calcium Channel Blocker, HTN,angina, Raynauds

Blocks Voltage Dependant L-typeCa channels, decreasingcontractility

Smooth musclevasodilator

Dizziness, flushing

Cardiac depression, peripheraledema, flushing, dizziness,

constipation


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CHOLESTEROL DRUGS

Which is best for decreased triglycerides? Fibrates Examples?

Gemfibrozil, Clofibrate, Bezafibrate, Fenofibrate

Which are best for decreasing LDL? Statins MOA?

HMG CoA reductase inhibitorsinhibit cholestrol precursor:mevalonate

Which do patients hate taking because of GIdisturbances? Bile Acid Resins: Cholestyramine & Colestipol

What are two other possible drugs you could use? Cholesterol Absorption Blockers (Ezetimibe) and Niacin


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Anti-arrhythmicsBIG PICTURE

CLASS General MOA

Class I

Class II

Class III

Class IV


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CLASS General MOA

Class I Block FAST sodium channels responsible for phase 0 depolarization

Quinidine, Flecanide, Procainamide

Class II

Class III

Class IV


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CLASS General MOA



Class II Beta Adrenergic Receptor Antagonists

Propranolol, Metoprolol

Class III

Class IV


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CLASS General MOA





Class III Prolong action potential with little effect on phase 0

depolarization, mostly via blocking the K repolarizing current

Amiodarone, Sotalol, Ibutilide

Class IV


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CLASS General MOA





Class III Prolong action potential with little effect on phase 0

depolarization, mostly via blocking the K repolarizing current

Amiodarone, Sotalol, Ibutilide

Class IV Block slow L-type Calcium Channels

Verapamil, Diltiazem


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Class I Drugs:Broken up by degree of Na channel blockade and effect on AP duration

CLASS IC Drugs

MOA? Most potent sodium channel blockers! Decrease upstroke

of AP and conduction velocity everywhere!

No change in AP duration Uses?

Vtachs that progress to VF and intractable SVT

LAST RESORT FOR REFRACTORY TACHYARRHYTHMIAS

Examples? Flecanide, Encainide, Propafenone

SE Proarrhythmic, esp post MI: avoid in those with heart

diseaseincreased mortality!

Prolonged refractory period in AV node.


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Class II Drugs MOA?

Beta blockers: decreased cAMP and Ca currents. Decrease slopeof phase 4 depolarization. AV node very sensitive.

Uses? Abnormal pacemakers, Vtach, SVT, slow ventricular rate in a-fib

or a-flutter

Examples? Propranolol, Esmolol, Metoprolol, Atenolol, Timolol

Which one is super short acting? ESMOLOL

SE Impotence , asthma exacerbation, bradycardia, AV block,

CHF,sedation, sleep changes

Why use with caution in diabetics? Mask effects of hypoglycemia

Metoprolol Dyslipidemia


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Class III Drugs MOA?

Potassium Channel Blockers: increase AP duration

Uses? used when other drugs fail

Examples? Sotalol, Ibutilide, Bretylium, Amiodarone

Which is good for Wolf-Parkinson-White? Amiodarone

SE Sotalol

Increased QT Intervalwhy is this bad? Increased risk of torsades de points

Excessive beta block

Ibutilide Torsades

Bretylium Arrhythmias, hypotension

Amiodarone Pulm fibrosis, corneal deposits, Hepatotoxicity, photodermatitis, Neuro SE, constipation,

bradycardia, heart block, hypothyroid, hyperthyroid

CHECK PFTs, LFTs, and TFTs!!


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Class IV Drugs

MOA? Calcium Channel Blockers: AV node: decreased

conduction.

Uses?

Especially good for?

SVTs

Examples?

Verapamil and Diltiazem for Anti-arrhythmics

SE

Constipation, flushing, edema, CV effects,

torsades


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Adenosine

MOA

Increased K efflux: hyperpolarization.

Drug of choice for which conditions?

AV nodal arrhythmias.

Short or long acting?

Very short (~15 Seconds)

Toxicity

Flushing, Hypotension, Chest pain


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Potassium

MOA

Decreases ectopic pacers in hypokalemia


Dig toxicity


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Magnesium


Torsades and dig toxicity

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