1. Edit the text with your own short phrases. The animation is already done for you; just copy and paste the slide into your existing presentation. To change the background image, on the Design tab of the ribbon, click Format Background, and then Insert picture from File. Sample picture courtesy of Bill Staples. physiology of pharmacology cardiovascular system 1 EMS353. Lectures 4,5 Dr. Maha Khalid, PharmD. DPH,B.SC Pharmacy

2. Functional Components of the Heart Myocardium: cardiac muscle fibers are arranged into four chambers, 2 atria and 2 ventricles Conduction system: specialized tissue that conducts nerve impulses throughout the heart, SA and AV node, bundle of His, bundle branches, and Purkinje fibers Nerve supply: nerve branches from both the sympathetic and parasympathetic divisions of the autonomic nervous system, regulate heart rate and force of contraction

3. CARDIOVASCULAR SYSTEM HEART (PUMP) VESSELS (DISTRIBUTION SYSTEM) REGULATION AUTOREGULATION NEURAL HORMONAL RENAL-BODY FLUID CONTROL SYSTEM

4. Normal electrocardiogram at rest

5. Major Cardiovascular Pathologies

6. Edit the text with your own short phrases. The animation is already done for you; just copy and paste the slide into your existing presentation. To change the background image, on the Design tab of the ribbon, click Format Background, and then Insert picture from File. Sample picture courtesy of Bill Staples. 1.Cardiac Arrhythmias

7. heart needs to contract atria, then ventricles. Relaxation must occur between contractions Arrhythmias are disturbances in the normal electrical activity of conduction system 1 ThisThis disturbance interferes with the ability of the heart to pump blood, and may cause angina pectoris or congestive heart failure 2 Severe arrhythmias can cause ventricular fibrillation and sudden death 3

8. The heart beat originates in the SA node (the pacemaker) and spreads over the heart by cell to cell conduction through a complex pathway. Since many diseases affect conduction it is important to understand its complex route.

9. The SA node is the pacemaker because it has the fastest rhythm. It is the first structure to show electrical activity with each beat.

10. Normal heartbeat and atrial arrhythmia Normal rhythmAtrial arrhythmia AV septum

11. Ectopic foci An ectopic pacemaker or ectopic focus is an excitable group of cells that causes a premature heart beat outside the normally functioning SA node of the human heartSA node heart

12. Cardiac muscle Action Potentials Phase 0 due to opening of sodium channels. Potassium channels close at this time. Phase 1 due to brief opening potassium channels Phase 2 is due to slow Calcium channels Phase3 is due to reopening of the potassium channels and closure of calcium channels Phase 4 the resting condition (Potassium channels stay open).

13. 3 Na + 2 K + Normal Cell Physiology SR (Mitochondria) Phase 0 Na + Phase 1 Phase 2 Phase 3 Phase 4 K+K+K+K+ K+K+K+K+ Ca 2+ K+K+K+K+ K+K+K+K+ IK TO IK R K+K+K+K+ Na + 3 Na + Ca 2+ Na +

14. Cardiac Na+ channels

15. Edit the text with your own short phrases. The animation is already done for you; just copy and paste the slide into your existing presentation. To change the background image, on the Design tab of the ribbon, click Format Background, and then Insert picture from File. Sample picture courtesy of Bill Staples. Antidysrhythmic medications

16. Class I: Antidysrhythmic medications sodium channel blockers Mechanism of action Slow the movement of sodium in cardiac cells Examples Procainamide: suppresses activity of ectopic foci and slows conduction velocity Lidocaine: blocks sodium channels Resolves ventricular dysrhythmias; suppresses ectopic foci

17. Class II: B blockers Antidysrhythmic medications Sympathetic beta receptor on the heart Stimulation Increase force of contraction increase Oxygen consumption Increase heart rate Blockade of beta receptors decreases cardiac work decrease cardiac oxygen demand

18. beta-adrenergic blocking agents Inhibit catecholamine activation of beta receptor sites. May cause massive conduction abnormalities when given with calcium channel blockers Metoprolol (Lopressor): reduces heart rate during myocardial ischemia and atrial tachycardias Class II: Antidysrhythmic medications

19. mechanisn of action potassium channel blockers Treats atrial or ventricular tachycardias Amiodarone (Cordarone) Administered by IV route; can be continued orally May cause adverse cardiovascular effects and life- threatening pulmonary conditions Class III: Antidysrhythmic medications Potassium channel blockers

20. Your Logo Class IV: Antidysrhythmic medications/ calcium channel blockers calcium channel blockers used for Treatment of cardiac arrhythmia Treatment of angina pectoris Verapamil (Calan) and Diltiazem (Cardizem) Control heart rate in patients with atrial fibrillation or atrial flutter. Administered IV over 2 minutes Require continuous electrocardiographic and frequent blood pressure monitoring Verapamil (Calan) and Diltiazem (Cardizem) Control heart rate in patients with atrial fibrillation or atrial flutter. Administered IV over 2 minutes Require continuous electrocardiographic and frequent blood pressure monitoring Treatment of hypertension

21. Mechanism of action : – Displace calcium at certain receptor sites or enter smooth muscle cells in place of calcium. – Decrease automaticity of ectopic foci and velocity of cardiac contraction

22. Calcium Antagonists Block the influx of calcium into the heart and arterial blood vessels. Verapamil and diltiazem act on both the heart and blood vessels to lower BP. Nifedipine and other calcium blockers lower BP only by vasodilation. Calcium antagonists are also used to treat angina pectoris and cardiac arrhythmias.

24. Non dihydropyridine

25. Dihydropyridine calcium channel blocker selective vasodilators. Non dihydropyridine calcium channel blocker equal effect in cardiac tissue and vascular muscle

26. Your own footerYour Logo Adenosine (unnamed class) now are called class 5 antidysrhythmic medications. Decreases cardiac conduction velocity and prolongs the effective refractory period Produces pause in cardiac activity Rapid onset and brief duration Administered through large-bore proximal IV. Adenosine (unnamed class) now are called class 5 antidysrhythmic medications. Decreases cardiac conduction velocity and prolongs the effective refractory period Produces pause in cardiac activity Rapid onset and brief duration Administered through large-bore proximal IV. Antidysrhythmic medications

27. Pacemakers Implantation of Pacemaker Surgical implantation of electrical leads attached to a pulse generator

29. Edit the text with your own short phrases. The animation is already done for you; just copy and paste the slide into your existing presentation. To change the background image, on the Design tab of the ribbon, click Format Background, and then Insert picture from File. Sample picture courtesy of Bill Staples. 2. Hypertension

30. Hypertension Hypertension is the leading cause of cardiovascular disease and mortality Disease symptoms and organ damage caused by hypertension are not evident until 10–15 years after the disease has started Proper medication and patient compliance will control most cases of hypertension

31. Your Logo Causes of Hypertension 1.Increased sympathetic activity and sodium overload increase blood pressure (BP) 2.Renal disease and increased renin-angiotensin- aldosterone activity raise BP and cause sodium and fluid retention

32. Dilating resistance vessels Reduce heart rate Reduce blood volume B.P. Reduction mechanism

33. Autonomic nerves system kidney Regulation of blood pressure Baroreceptor Β 1antagonist α 1 agonist α2 antagonist Renin angiotensin. ACE inhibitors

35. Renin-Angiotensin System When blood volume and blood pressure the blood flow through renal arteries will decrease. The decreased blood flow will be sensed by the kidneys, which will then produce an enzyme, renin into the blood. Renin will convert angiotensinogen, a liver protein, into angiotensin 1  angiotensin II. Angiotensin II can directly cause vasoconstriction in small arteries and arterioles to increase blood pressure.

36. Diuretics Sympatholytic drugs Vasodilator drugs Calcium antagonist drugs Angiotensin-converting enzyme inhibitor and angiotensin receptor blocking drugs Drug Classes Used to Treat Hypertension

38. Diuretics increase sodium excretion and relax arterial blood vessels (vasodilation Thiazides are preferred in patients with adequate renal function Organic acid diuretics (loop diuretics) are used in patients with reduced renal function.Diuretics can be used alone or in combination with other antihypertensive drugs.Excessive loss of fluid, sodium, and potassium are common adverse effects Diuretics

39. Nephron sites of action of diuretics

40. Vasodilators decrease the muscular tone and contractile function of blood vessels 1 Hydralazine and minoxidil are potent vasodilators 2 Hydralazine and minoxidil must be used with diuretics and sympathetic blocking drugs 3 Vasodilators

41. Sympathetic Blocking Drugs  Alpha blockers lower BP by vasodilation  Beta blockers lower BP by decreasing heart rate and cardiac output  Centrally acting sympatholytic drugs decrease the activity of the cardiovascular centers in the medulla oblongata

42. Beta Adrenergic Blockers Calcium Antagonists Study them from Antidysrhythmic medications

43. Angiotensin-Converting Enzyme Inhibitors (ACEIs)  The ACEIs can be used with thiazide and organic acid diuretics, but not potassium-sparing diuretics  These drugs produce a low incidence of adverse effects and do not interfere with mental activity or renal function

44. Angiotensin Receptor Blockers  These drugs block angiotensin receptors on blood vessels and adrenal cortex  Like the ACEIs, these drugs produce vasodilation and decrease the activity of aldosterone  The angiotensin receptor blockers generally produce a lower incidence of adverse effects than the ACEIs

46. One Severe hypertension is a medical emergency that can lead to stroke and sudden death Two Supply immediate parenteral administration of antihypertensive drugs can avoid severe complications and irreversible damage Three Diazoxide and nitroprusside are potent vasodilators used in hypertensive crisis Treatment of Hypertensive Crisis