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CARDIOVASCULAR DRUGS!!!!!

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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CARDIOVASCULAR DRUGS!!!!!

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  1. CARDIOVASCULAR DRUGS!!!!!

  2. Methyldopa • Use? • SE? • Sympathoplegic, HTN • Sedation, positive coombs test

  3. Reserpine • Use? • SE? • Sympathoplegic, HTN • Sedation, depression, nasal stuffiness, diarrhea

  4. Hydrochlorothiazide • Use? • SE? • Diuretic, HTN • Hypo-K, Hyperlipidemia, hyperuricemia, lassitude, Hyper-Ca, Hyperglycemia

  5. Clonidine • Use? • SE? • Sympathoplegic, HTN • Dry mouth, sedation, severe rebound HTN

  6. Guanethidine • Use? • SE? • Sympathoplegic, HTN • Orthostatic & exercise hypotension, diarrhea, sexual dysfxn 

  7. 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

  8. Prazosin • Use? • SE? • Sympathoplegic, HTN • Orthostatic hypotension with 1st dose, dizziness, headache

  9. Diazoxide • Use? • SE? • Vasodilator, HTN • Hyperglycemia, decreased insulin release, hypotension

  10. Beta blockers • Use? • SE? • Sympathoplegic, HTN • Impotence , asthma, cardiovascular effects (bradycardia, CHF, AV block), CNS effects—sedation and changes in sleep

  11. 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

  12. 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

  13. Captopril • Use? • Other Examples? • SE? • ACE Inhibitor, HTN • Enalapril, Fosinopril • Hyper-K, cough, angioedema, taste changes, hypotension, fetal renal damage, rash, increased renin

  14. Hexamethonium • Use? • SE? • Sympathoplegic, HTN • Severe orthostatic hypotension, blurry vision, constipation, sexual dysfxn 

  15. 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

  16. 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!!!

  17. Nitroprusside • Use? • SE? • Vasodilator, HTN • Cyanide Poisoning (Releases CN!)

  18. 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…. 

  19. 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

  20. Losartan • Use? • Good alternative to what? • SE? • Angiotensin II Receptor Blocker, HTN • ACE Inhibitors • Fetal renal toxicity, Hyper-K

  21. 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

  22. 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

  23. Anti-arrhythmics—BIG PICTURE

  24. Anti-arrhythmics—BIG PICTURE

  25. Anti-arrhythmics—BIG PICTURE

  26. Anti-arrhythmics—BIG PICTURE

  27. Anti-arrhythmics—BIG PICTURE

  28. 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

  29. 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

  30. 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.

  31. 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

  32. 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!!

  33. 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

  34. 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

  35. Potassium • MOA • Decreases ectopic pacers in hypokalemia • Drug of choice for which conditions? • Dig toxicity

  36. Magnesium • Drug of choice for which conditions? • Torsades and dig toxicity

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