1. DMAT PA-1 PHARMACY CACHE CARDIOVASCULAR AGENTS Saundra Martino, RpH

2. ANGIOTENSIN CONVERTING ENZYME INHIBITORS LISINOPRIL 20MG TABS USES: ENALAPRIL 1.25 MG/ ML INJ 2ML Congestive heart failure Hypertension Inhibit conversion of Angiotensin I ---------------> Angiotensin II …..peripheral vasodilation/dec in total peripheral (weak vasoconstrictor) (potent vasoconstrictor) vascular resistance dec blood pressure dec workload on heart inc renal blood flow reduces aldosterone output ……dec fluid volume/dec water retention (na reabsorption in kidney) inc in potassium levels reflex inc in renin secretion KEY FACTS: chronic cough in up to 39% of patients first dose may cause profound dec in blood pressure angioedema—can occur at anytime during treatment esp. with blacks hyperkalemia>4% Never use in pregnancy dec. dose if CrCl<30ml/min CASCADE: renin--  angiotensinogen----  angiotensin I---  angiotensin II----  aldosterone

3. BETA-BLOCKERS ATENOLOL 50MG TABS METOPROLOL TARTRATE 50MG TABS B1 receptors : heart, vascular smooth muscle METOPROLOL INJ 1MG/ML 5ML B2 receptors: lungs (bronchioles), uterus PROPRANOLOL HCL 20MG TABS PROPRANOLOL INJ 1MG/ML MULTIPLE MECHANISMS: dec release of renin from kidneys dec peripheral vasoconstriction.. Dec bp systolic & diast dec stimulation of sympathetic NS in heart & vascular smooth olic muscle dec fluid retention negative chronotropic effect dec HR both resting & exercise negative inotropic effect dec cardiac output some posess antiarrhythmic properties / class II antiarrhythmic dec in myocardial oxygen demand inhibit reflex response to orthostatic hypotension USES: KEY FACTS; Angina *B1 selective can lose their selectivity at high doses –then block b2 receptors—causes problems in Hypertension asthmatics Migraine prophylaxis *Caution use with asthma, COPD, lung disease---may cause bronchospasms Tremors *Caution with diabetics—may cause hypoglycemia Arrhythmias *Slowly wean off over 1-2 weeks abrupt d/c can cause exacerbation of angina, MI, ventricular Pheochromocytoma arrhythmias

4. CALCIUM CHANNEL BLOCKERS NIFEDIPINE 10MG CAPS USES: VERAPAMIL 80MG TABS Angina VERAPAMIL SR 240MG TABS Hypertension DILTIAZEM HCL INJ. 5MG/ML 5ML Supraventricular arrhythmias Inhibit influx of extracellular calcium across the myocardial & peripheral vascular smooth inc oxygen to myocardial tissue muscle membranes---this inhibits contactile process of myocardial smooth muscle dec in total peripheral resistance cells --causes relaxation dec blood pressure dilation of coronary & systemic arteries dec afterload inc coronary blood flow dec heart rate Verapamil & Diltiazem depress impulse formation at SA & AV nodes antiarrhythmics /class IV antiarrhythmics slows conduction velocity dec automaticity KEY FACTS: depresses SA nodal firing

5. DIURETICS HYDROCHLOROTHIAZIDE 25MG TABS USES: FUROSEMIDE 40MG TABS Edema FUROSEMIDE INJ 10MG/ML 10ML Hypertension affect electrolyte transport in kidneys Thiazide Diuretics Loop Diuretics inhibit Na reabsorption at a point distal to Loop Of Henle inhibit Na reabsorption at Loop of Henle get inc excretion of Na & water get inc excretion of Na & water dec in total fluid volume interferes with Mg reabsorption at Loop of Henle alter carbohydrate metabolism therefore inc in glucose hypomagnesemia can inc effectiveness of other antihypertensive agents by very potent preventing reexpansion of extracellular & plasma volumes can exacerbate SLE ineffective iif CrCl<,30ml/min ototoxicity with injectable caution with diabetics can cause overdiuresis can exacerbate hyponatremia & hyperg;lycemia orthostatic hypotension, electrolyte imbalances sulfonamide derivatives-- pho tosensitivity & volume depletion potassium loss can cause hyperglycemia sulfonamide derivatives…photosensitivity potassium loss

6. CARDIAC GLYCOSIDES DIGOXIN 0.125MG TABS USES: DIGOXIN INJ 0.25MG/ML 2ML Congestive heart failure Atrial fibrillation Increase myocardial contractility & efficiency produce positive inotropic effect produce negative chronotropic effect inc cardiac output improve systemic circulation Improve renal perfusion KEY FACTS: reduce edema narrow therapeutic index effects on electrical activity of heart dec/slows ventricuar rate Digoxin,makes the heart beat stronger with more regular rhythms !!!!!

7. NITRATES NITROGLYCERIN SL 0.4MG TABS USES: NITROGLYCERIN TRANSDERM 0.2MG/HR relief of anginal pain NITROGLYCERIN INJ. 5MG/ML 10M ISOSORBIDE 10MG TABS vasodilation peripheral veins, peripheral arteries, & coronary arteries dec preload dec blood flow to heart dec afterload dec ventricular filling pressures dec myocardial work—dec oxygen demand dec in anginal pain By dec pressure in cardiac tissue facilitate collateral circulation Decrease workload of heart—dec oxygen demand !!!!!! inc blood distribution to ischemic areas Tolerance…develops within 24-48 hours prevent with a nitrate-free period of 8-12 hours interaction with PDE5 inhibitors—additive vasodilation—potentially fatal hypotension

8. CENTRALLY ACTING ALPHA2 AGONIST CLONIDINE 0.1MG TABS USES: Hypertension stimulation of alpha2 receptors ADHD (attention-deficit hyperac tivity disorder) inhibitory effect on sympathetic nervous system dec in heart rate dec in peripheral resistance dec in blood pressure dec cardiac output dec in stroke volume abrupt withdrawl after prolonged treatment can lead to hypertensive crisis Tricyclic antidepressants & beta-blockers enhance potential for hypertensive crisis upon withdrawl Can cause drowsiness Can exacerbate depression

9. DIRECT VASODILATORS HYDRALAZINE 20MG/ML 1ML USES: Hypertensive crisis peripheral vasodil;ator relaxes arterial smooth muscle dec peripheral vascular resistance dec blood pressure (diastolic more than systolic) reflex autonomic response inc hr, stroke volume, cardiac output, left ventricular ejection fraction inc plasma renin activity Dosage adjustments needed in renal impairment Risk of drug-induced SLE Never a single agent ---used with diuretic or beta-blocker in hypertensive emergencies produces reflex tachycardia Affected by genetic variation