Drugs Affecting the Cardiovascular System

Slides:



Advertisements
Similar presentations
CLIs OMS I Fall 2013 Block 2. MOSBY’S Cholesterol (166 – 170) Normal Findings: Adult:
Advertisements

Cardiac Drugs in Heart Failure Patients Zoulikha Zair 28 th May 2013 N.B. some drugs overlap with treatment of hypertension….bonus revision wise!!!!
Antihypertensives. Approaches to Hypertension Treatment Inhibit Sympathetic impulses –Inhibit contractility –Inhibit heart rate –Inhibit vasoconstriction.
PTP 546 Module 6 Cardiovascular Pharmacology: Part I Jayne Hansche Lobert, MS, RN, ACNS-BC, NP Lobert1.
MEDPHARM DRUGS FOR ISCHEMIC HEART DISEASE FEBRUARY 10,2110.
CASE 21 Michelle Legaspi. 65 y/o male retired teacher sought consult because of occasional chest heaviness non-radiating occuring during a moderate physical.
PTP 546 Module 6 Cardiovascular Pharmacology: Part II Jayne Hansche Lobert, MS, RN, ACNS-BC, NP 1Lobert.
B) Drug Therapy (Antihypertensives) ACEi B.B CCB D iuretics. Centrally acting agents: alphametyldopa, HTN + pregnancy.
Antihypertensives or How not to blow your cork. Background  Cardiovascular pharmacology must always deal with two problems 1. Treating the disease state.
Pharmacology DOR 101 Abdelkader Ashour, Ph.D. 9 th Lecture.
Drugs Used In the Treatment of Congestive Heart Failure(Cont) Garrett J. Gross, Ph.D. Drugs Used In the Treatment of Congestive Heart Failure(Cont) Garrett.
Antihypertensives Chad Byworth. Hypertension What is hypertension? Blood pressure of greater than 140 systolic or 90 diastolic, confirmed in primary care.
CARDIVASCULAR DRUGS Sanjukta (2009). CARDIOVASCULAR DISEASE AND DRUGS ► Basic cardiovascular physiology and pathology depends on the control of heart.
Hypertension.
Drugs for CCF Heart failure is the progressive inability of the heart to supply adequate blood flow to vital organs. It is classically accompanied by significant.
Chapter 18 Agents that Dilate Blood Vessels. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Coronary.
ADRENERGIC ANTAGONITS
Cardio pharmacology Angina. angina Causes Atheroma Others: Aortic stenosis, aberrant coronary circulation, severe anaemia, arteritis Prevention Decrease.
1 ANTIHYPERTENSIVE DRUGS. 2 3 Definition Elevation of arterial blood pressure above 140/90 mm Hg. Can be caused by: - idiopathic process (primary or.
CARDIOVASCULAR DISEASE 1.HYPERTENSION 2.ISCHAEMIC HEART DISEASE 3.THROMBO-EMBOLIC DISEASE Myocardial infarction Stroke Medical Pharmacolgy & Therapeutics.
Drugs in the Therapy of Angina Dr. Thomas Abraham PHAR417: Fall 2004.
 Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension Moderate hypertension Severe Hypertension 180.
DIURETIC DRUGS.
Head Lines Etiology Risk factors Mechanism Complications Treatment.
Agents that Dilate Coronary Blood Vessels.  Coronary artery disease (CAD) results from atherosclerosis  Clinical symptoms caused by  narrowing of the.
1 Drug Treatment of heart failure. Prof. Azza El-Medani Prof. Abdulrahman Almotrefi.
CHAPTER © 2012 The McGraw-Hill Companies, Inc. All rights reserved. 25 Diuretics.
Antihypertensives Dr Thabo Makgabo.
1 Drug Therapy of heart failure. Prof. Azza El-Medani Prof. Abdulrahman Almotrefi.
for more lecture notes Antianginal Agents Dr.Shadi-Sarahroodi Pharm.D & PhD Qom University of Medical sciences Iran PUBLISHED.
PROF. AZZA El-Medany Department of Pharmacology OBJECTIVES At the end of lectures the students should Describe the different classes of drugs used for.
They bind to the channel from the inner side of the membrane. They bind to channels in depolarized membranes. Binding  ↓ frequency of opening of the channels.
Bipyridines :(Amrinone,Milrinone ) only available in parenteral form. Half-life 3-6hrs. Excreted in urine.
6/3/ CARDIOVASCULAR MEDICATIONS. FIRST DO NO HARM 6/3/ There are 5 rights to patient medication administration: 1. Right patient 2. Right.
Antianginal drugs Angina pectoris is the severe chest pain that occurs when coronary blood flow is inadequate to supply the oxygen required by the heart.
CARDIOVASCULAR DRUGS. Reference: Pharmacology in Rehabilitation 4th Edition Charles D. Ciccone, PT, PhD.
Anti-hypertensive Therapy. Introduction 50 million Americans age 6 and older have hypertension 90% suffer for primary (essential) hypertension People.
Angina pectoris Sudden,severe,pressing chest pain starting substernal &radiate to left arm. Due to imbalance between myocardium oxygen requirement and.
Antihypertensive Drugs Prof. Alhaider (1431H)
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 46 Vasodilators.
Drugs used in angina pectoris
Hypertension Treatment Dr.Negin Nezarat. 1.mechanisms and cardiovascular pathophysiology (Review). 2.major forms of clinical hypertension. 3.major classes.
Diuretics and Antihypertensives
Drugs used for Congestive Heart Failure
Clinical Pharmacology of Drugs for Controlling Vascular Tone
Cardiovascular Calcium Chanel Blockers Ace Inhibitors Anticoagulant/ Diuretics Lipid Lowering.
Antianginal drugs Antidysrrhytmic drugs
ANTIHYPERTENSIVE DRUGS
بسم الله الرحمن الرحيم.
Hypertension Hypertension can be classified as follows: Mild :Diastolic pressure mmHg Moderate: Diastolic pressure mmHg Sever: Diastolic pressure.
Angina pectoris Sudden,severe,pressing chest pain starting substernal &radiate to left arm & neck. Due to imbalance between myocardium oxygen requirement.
Section 3, Lecture 2 Diuretics: -increase in Na + excretion (naturesis) Thiazide and Related diuretics -decreased PVR due to decreases muscle.
CVS PHARMACOLOGY. Drugs to treat myocardial ischemia Etiology 1. Decrease in myocardial oxygen supply [determined by oxygen-carrying capacity of blood.
Instructions for using this template.
Effect of some adrenergic drugs and its blockers on the blood pressure.
Decreasing the Load After the Fill May the Force be with you Clearing the Path Let it Flow
 Prazosin, doxazosin, and terazosin  They causing relaxation of both arterial and venous smooth muscle. Postural hypotension may occur in some individuals.
1 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Chapter 42 CARDIAC GLYCOSIDES, ANTIANGINALS, AND ANTIDYSRHYTHMICS.
PHARMACOLOGY OF ANTI-ANGINAL DRUGS (ID#580) Dr. Mariam Yousif Pharmacology & Toxicology Dept. November 17 th, 2014.
CREATED BY Prof. Azza El-Medany
Drugs used for Congestive Heart Failure
Drug acting on the Heart
Drugs Affecting the Cardiovascular System
Pharmacology of the CVS
Hypertension (High Blood Pressure)
Antihypertensive Drugs
Antianginal Drugs.
Drugs Acting on the Heart
CARDIVASCULAR DRUGS.
CARDIOVASCULAR AGENTS
Presentation transcript:

Drugs Affecting the Cardiovascular System Felix Hernandez, M.D.

Diuretics Thiazide Diuretics Chlorothiazide MOA: inhibits sodium and chloride reabsorption in the distal tubule Indication: is the ideal starting agent for HTN. Is also used to treat chronic edema and hypercalcuria Side Effects: hypokalemia, hyponatremia, hyperglycemia, Contraindications: pregnancy, anuria

Diuretics Loop Diuretics Furosemide (Lasix) MOA: inhibits chloride reabsorption in the thick ascending loop. Causes high losses of potassium in the urine. Indications: preferred diuretic for patients with a low GFR and in hypertensive emergencies. Is also used for edema and to lower serum potassium levels Side Effects: hyponatremia, hypokalemia, hypocalcemia, dehydration, hypotension, ototoxicity Contraindications: anuria and electrolyte depletion

Diuretics Potassium Sparing Diuretics Amiloride MOA: directly increases sodium excretion and decreases potassium secretion in the DCT Indications: used in conjunction with other diuretics to treat HTN Side Effects: Hyperkalemia, glucose intolerance in DM patients Has a more rapid onset than Spironolactone Spironolactone (Aldactone) MOA: Antagonist of Aldosterone Indications: Used with thiazides for edema related to CHF, cirrhosis and nephrotic syndrome. Also used to diagnose and treat hyperaldosteronism Side Effects: Same as Amiloride plus endocrine imbalances (hirsutism, oily skin, acne)

Diuretics Osmotic Diuretics Mannitol MOA: osmotically inhibits sodium and water reabsorption Indications: ARF, brain edema, removing OD of some drugs Side Effects: headache, dizziness, polydipsia, confusion, chest pain

Presynaptic Adrenergic Blockers Clonidine  alpha 2 Methyldopa  methylnorepinephrine

Peripheral Anti-adrenergics Reserpine MOA: partially depletes catecholamine stores in the PNS and CNS causing a decrease in TPR, HR and CO Indications: seldom used for mild to moderate HTN Side Effects: parasympathetic predominance Contraindications: CHF, asthma, bronchitis, PUD, depression. All related to the parasympathetic predominance

Alpha and Beta Blockers Alpha-1 Blockers Prazosin Doxazosin (Cardura) Mixed alpha and beta blockers Labetolol Carvedilol (Coreg) Can cause further suppression of a failing heart Beta Blockers Atenolol Preferentially blocks Beta-1 receptors Metoprolol (Lopressor) Timolol

Vasodilators ACE Inhibitors MOA: Inhibit angiotensin converting enzyme in the lung which reduces the production of angiotensin II a vasoconstrictor. Also suppresses aldosterone. Indications: HTN, DOC for HTN with DM, CHF, MI for reperfusion Side Effects: first dose hypotension, dizziness, dry hacking cough Contraindications: pregnancy, bilateral renal artery stenosis Drugs: Captopril Lisinopril Enalapril

Vasodilators Angiotensin Receptor Blockers (ARB) MOA: antagonist at angiotensin II receptor Indications: HTN Side Effects: hypotension and dizziness Contraindications: pregnancy Drugs: Losartan (Cozaar) Valsartan (Diovan)

Direct Vasodilators Hydralazine MOA: relaxes arterioles (not veins) independent of sympathetic interactions. Causes a decrease in BP with a reflex tachycardia, increased CO and increased renal blood flow Indications: moderate HTN, can be used in pregnant women with HTN Side Effects: reflex tachycardia, fluid retention, Lupus like syndrome, peripheral neuritis with long term treatment due to vit. B6 Contraindications: patients with ischemic heart disease

Direct Vasodilators Nitroprusside MOA: is converted to nitric oxide which induces cGMP which then relaxes smooth muscles by dephosphorylating myosin Indications: Hypertensive crisis Side Effects: severe hypotension, cyanide toxicity and hepatotoxicity Contraindications: none

Calcium Chanel Blockers Verapamil (Isopten) MOA: blocks calcium influx causing dilation of peripheral arterioles and reducing afterload. Indications: DOC for acute paroxysmal supraventricular tachycardia, DOC to slow ventricular response in A-fib Side Effects: constipation, hypotension, bradycardia, edema, dizziness Contraindications: patients on IV Beta blockers or Digitalis, A-V node blocks, heart failure, hypotension

Calcium Chanel Blockers Diltiazem (Cardizem) MOA: dilates peripheral arterioles leading to a decreased afterload, increases oxygen supply to the myocardium by preventing sympathetic-induced coronary artery spasm. Indications: reduction of angina episodes, increased exercise tolerance in stable angina, HTN Side Effects: edema, headache, rash Contraindications: AV node block, SSS, hypotension, pulmonary congestion

Calcium Chanel Blockers Nifedipine (Procardia) MOA: more potent peripheral vasodilation, doesn’t dilate coronary arteries, causes a reflex in crease in HR and CO Indications: no longer used as a single agent due to toxicity Side Effects: MI, peripheral edema, pulmonary edema, transient hypotension, reflex tachycardia Contraindications: hypotension

Anti-anginal Agents Nitrates Nitroglycerin Isosorbide Dinitrate MOA: dilates large myocardial arteries to increase blood flow to the heart. Reduces cardiac preload by reducing venous tone which allows pooling of blood in the periphery Indications: DOC for angina. Used immediately before exercise or stress to prevent ischemic episodes Side Effects: hypotension with rebound tachycardia, cerebral ischemia, contact dermatitis with transdermal, aggravation of peripheral edema Isosorbide Dinitrate Used for prophylaxis of angina not for acute attacks Has a faster onset of action sublingual than oral

Cardiac Glycosides Digoxin MOA: inhibits sodium/potassium ATPase and increases the inward current of calcium. This leads to an increased contraction, increased CO and decreased heart size, venous return and blood volume. Causes diuresis by increased renal perfusion. Slows ventricular rate in A-fib by increased sensitivity of AV nodes to vagal inhibition. Increases peripheral resistance Indications: heart failure, A-fib, paroxysmal tachycardia Side Effects: bradycardia, nodal blocks, arrhythmias Contraindications: V-fib, severe bradyacrdia, allergic reactions to drug class

Drugs for Lipid Disorders Cholestyramine MOA: forms insoluble complexes with bile salts allowing them to be excreted in feces. The body compensates by increasing the number of LDL receptors and oxidizing cholesterol to bile acids Indications: LDL>190 or 160 with 2 risk factors Lipid Profile Effects: decreases TC, and LDL Increases Triglycerides, VLDL and HDL

Drugs for Lipid Disorders Niacin MOA: unclear, may reduce VLDL synthesis and secretion Indications: same as Cholestyramine Profile changes: Decreases TC, triglycerides, VLDL, and LDL Increases HDL

Drugs for Lipid Disorders Ezetimibe (Zetia) MOA: inhibits cholesterol absorption in the GI Indications: hypercholesterolemia Profile Changes: Decreases LDL and triglycerides Increases HDL

Statins MOA: inhibit HMG-CoA reductase in the liver which is the enzyme that catalyzes the rate limiting step in cholesterol synthesis. Indications: Same Profile Changes: Decreases TC, LDL, VLDL and Triglycerides Increases HDL Side Effects: Myalgia Drugs: Simvastatin (Zocor) Atorvastatin (Lipitor) Rosuvastatin (Crestor)

Anticoagulants Heparin MOA: binds to antithrombin III forming a complex which then binds to and inhibits activated clotting factors. Indications: DVT and PE prophylaxis post-op, maintaining extracorporeal circulation with open heart surgery and dialysis, and achieving immediate anticoagulation Side Effects: bleeding, hemorrhage, thrombocytopenia, necrosis at injection site Notes: Protamine Sulfate inactivates it and can be used as an antagonist if severe bleeding occurs. Monitor PTT

Anticoagulants Warfarin MOA: antagonizes vitamin K and inhibits the synthesis of vitamin K dependent clotting factors (II, VII, IX, and X) Indications: DVT, IHD, PE, artificial heart valves, A-fib Side Effects: bleeding, hemorrhage, necrosis Notes: Monitor PT

Antiplatelet Agents Aspirin/Ibuprofen Clopidogrel (Plavix) MOA: inhibits cyclooxygenase thus blocking platelet aggregation Indications: to reduce the risk of recurrent TIA or stroke, reduce risk of MI in patients with unstable angina or prior infarction Side Effects: GI ulceration, bleeding hemorrhage Clopidogrel (Plavix) MOA: blocks platelet aggregation by inhibiting ADP receptor Indications: reduction of atherosclerotic events Side Effects: neutropenia and same as aspirin

Thrombolytic Agents Streptokinase MOA: activates plasminogen to plasmin. Plasmin digests fribrin and fibrinogen into degradation products which also cause anticoagulation by inhibiting the formation of fibrin. Indications: to lyse thrombi in ischemic coronary arteries after infarction. PE, DVT, occluded cannula Side Effects: bleeding, bruising, rare but can have an anaphylactic response (strep toxin)

Thrombolytic Agents Tissue Plasminogen Activator (TPA) MOA: binds to fibrin, then activates fibrin-bound plasminogen to plasmin Indications: to reperfuse coronary arteries that are occluded Side Effects: hematoma at catheterization site Alteplase/Reteplase MOA: recombinant form of TPA Indications: Acute MI, Ischemic stroke, PE Side Effects: Bleeding