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CARDIOVASCULAR DRUGS!!!!! - PowerPoint PPT Presentation


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CARDIOVASCULAR DRUGS!!!!!. Methyldopa. Use? SE? . Sympathoplegic, HTN Sedation, positive coombs test. Reserpine. Use? SE? . Sympathoplegic, HTN Sedation, depression, nasal stuffiness, diarrhea. Hydrochlorothiazide. Use? SE? . Diuretic, HTN

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methyldopa
Methyldopa
  • Use?
  • SE?
  • Sympathoplegic, HTN
  • Sedation, positive coombs test
reserpine
Reserpine
  • Use?
  • SE?
  • Sympathoplegic, HTN
  • Sedation, depression, nasal stuffiness, diarrhea
hydrochlorothiazide
Hydrochlorothiazide
  • Use?
  • SE?
  • Diuretic, HTN
  • Hypo-K, Hyperlipidemia, hyperuricemia, lassitude, Hyper-Ca, Hyperglycemia
clonidine
Clonidine
  • Use?
  • SE?
  • Sympathoplegic, HTN
  • Dry mouth, sedation, severe rebound HTN
guanethidine
Guanethidine
  • Use?
  • SE?
  • Sympathoplegic, HTN
  • Orthostatic & exercise hypotension, diarrhea, sexual dysfxn 
nitroglycerin isosorbide dinitrate
Nitroglycerin, Isosorbide Dinitrate
  • Use?
  • MOA?
  • Decreased Preload or Afterload?
  • Toxicity
  • Vasodilator—angina, 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 Disease—decreased tolerance over weekend  tach, dizziness and HA on reexposure
prazosin
Prazosin
  • Use?
  • SE?
  • Sympathoplegic, HTN
  • Orthostatic hypotension with 1st dose, dizziness, headache
diazoxide
Diazoxide
  • Use?
  • SE?
  • Vasodilator, HTN
  • Hyperglycemia, decreased insulin release, hypotension
beta blockers
Beta blockers
  • Use?
  • SE?
  • Sympathoplegic, HTN
  • Impotence , asthma, cardiovascular effects (bradycardia, CHF, AV block), CNS effects—sedation and changes in sleep
hydralazine
Hydralazine
  • Use?
  • Mechanism of Action?
  • Reduces preload or afterload?
  • SE?
  • Vasodilator, severe HTN, CHF
  • Increased cGMP smooth muscle relaxation. Arterioles > veins.
  • AFTERLOAD (Vasodilator!)
  • Nausea, Headache, Lupus-like syndrome, reflex tachycardia (don’t use in agina or CAD!), angina, salt retention
  • Use with beta blocker to avoid tachycardia and with a diuretic to avoid salt retention
minoxidil
Minoxidil
  • Use?
  • Mechanism of Action?
  • SE?
  • Vasodilator, HTN
  • K channel opener, hyperpolarizes smooth muscle cells
  • HAIRY MONSTER, pericardial effusion, reflex tachycardia, angina, salt retention
  • Use with beta blocker to avoid tachycardia and with a diuretic to avoid salt retention
captopril
Captopril
  • Use?
  • Other Examples?
  • SE?
  • ACE Inhibitor, HTN
  • Enalapril, Fosinopril
  • Hyper-K, cough, angioedema, taste changes, hypotension, fetal renal damage, rash, increased renin
hexamethonium
Hexamethonium
  • Use?
  • SE?
  • Sympathoplegic, HTN
  • Severe orthostatic hypotension, blurry vision, constipation, sexual dysfxn 
verapamil
Verapamil
  • Use?
  • MOA?
  • More cardiac or smooth muscle effects?
  • SE?
  • Toxicity?
  • Calcium Channel Blocker, HTN, angina, arrhythmias, Raynaud’s
  • 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
how do you treat malignant hypertension
HOW DO YOU TREAT MALIGNANT HYPERTENSION???
  • Three drugs in alphabetical order
    • #1: DIAZOXIDE
      • MOA?
        • K channel opener—hyperpolarizes smooth muscle
    • #2: Fenoldopam
      • MOA?
        • Dopamine1 Receptor Agonist: relaxes vascular smooth muscle
    • #3: Nitroprusside
      • MOA?
        • Increased cGMP via direct NO release
      • SE?
        • CYANIDE POISONING!!!
nitroprusside
Nitroprusside
  • Use?
  • SE?
  • Vasodilator, HTN
  • Cyanide Poisoning (Releases CN!)
which two drugs are the hypertension in pregnancy superstar meds which are ok to use in pregnancy

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…. 

diltiazem
Diltiazem
  • Use?
  • MOA?
  • More cardiac or smooth muscle effects?
  • SE?
  • Toxicity?
  • Calcium Channel Blocker, HTN, angina, arrhythmias, Raynaud’s
  • 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
losartan
Losartan
  • Use?
  • Good alternative to what?
  • SE?
  • Angiotensin II Receptor Blocker, HTN
  • ACE Inhibitors
  • Fetal renal toxicity, Hyper-K
nifedipine
Nifedipine
  • Use?
  • MOA?
  • More Cardiac or Smooth Muscle Effects?
  • SE?
  • Toxicity?
  • Calcium Channel Blocker, HTN, angina, Raynaud’s
  • Blocks Voltage Dependant L-type Ca channels, decreasing contractility
  • Smooth muscle—vasodilator
  • Dizziness, flushing
  • Cardiac depression, peripheral edema, flushing, dizziness, constipation
cholesterol drugs
CHOLESTEROL DRUGS
  • Which is best for decreased triglycerides?
    • Fibrates
    • Examples?
      • Gemfibrozil, Clofibrate, Bezafibrate, Fenofibrate
  • Which are best for decreasing LDL?
    • Statins
    • MOA?
      • HMG CoAreductase inhibitors—inhibit cholestrol precursor: mevalonate
  • Which do patients hate taking because of GI disturbances?
    • Bile Acid Resins: Cholestyramine & Colestipol
  • What are two other possible drugs you could use?
    • Cholesterol Absorption Blockers (Ezetimibe) and Niacin
class i drugs broken up by degree of na channel blockade and effect on ap duration
Class I Drugs: Broken up by degree of Na channel blockade and effect on AP duration

CLASS IA Drugs

  • MOA?
    • Moderate blockade of Na channels = raise AP threshold and slow AP upstroke. Also depress slope of phase 4 depolarization.
  • Uses?
    • Ectopic foci and reentrant rhythms
    • Atrial AND Ventricular Arrhythmias
  • Examples?
    • Quinidine, Amiodarone, Procainamide, Disopyramide
  • SE
    • Quinidine
      • Cinconchism: HA, tinnitus, thrombocytopenia
      • Increase AP duration, increased effective refractory period, increase QT interval (increased risk of what?)
      • Torsades de points
    • Procainamide
      • Reversible SLE-like syndrome
class i drugs broken up by degree of na channel blockade and effect on ap duration29
Class I Drugs: Broken up by degree of Na channel blockade and effect on AP duration

CLASS IB Drugs

  • MOA?
    • Bold Na channels, but unlike IA’s shorten duration of AP and refractory period
  • Uses?
    • Preferentially act on diseased tissue: ischemic or depolarized Purkinje/ventricular tissue.
    • Great post-MI and for dig-induced arrhythmias
  • Examples?
    • Lidocaine, Mexiletine, Tocainide, Phenytoin?
  • SE
    • CNS depression/stim and cardiovasc depression
class i drugs broken up by degree of na channel blockade and effect on ap duration30
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 diseaseincreased mortality!
    • Prolonged refractory period in AV node.
class ii drugs
Class II Drugs
  • MOA?
    • Beta blockers: decreased cAMP and Ca currents. Decrease slope of 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
class iii drugs
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 Interval—why 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 PFT’s, LFTs, and TFTs!!
class iv drugs
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
adenosine
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
potassium
Potassium
  • MOA
    • Decreases ectopic pacers in hypokalemia
  • Drug of choice for which conditions?
    • Dig toxicity
magnesium
Magnesium
  • Drug of choice for which conditions?
    • Torsades and dig toxicity