1. Drugs Affecting the Cardiovascular System

2. Cardiovascular System Z Muscular organ with 4 chambers Z Pumps 5-6 liters blood/minute

3. Chambers of the Heart Left Side Left Side ¤ Oxygenated ¤ Pulmonary veins ¤ Atrium ¤ Mitral valve ¤ Ventricle Right Side Right Side ¤ Unoxygenated ¤ Atrium ¤ Tricuspid valve ¤ Ventricle ¤ Pulmonary arteries

4. Systole and Diastole u Systole: Heart is contracting u Diastole: Heart is relaxed

5. Renin-Angiotensin-Aldosterone ò Renal blood flow decreased ò Sympathetic stimulation causes release of renin ò Renin + plasma angiotensin forms angiotensin I ò Angiotensin I converted in lungs to angiotensin II

6. Renin-Angiotensin-Aldosterone Continued ò Agniotensin II: Produces vasoconstriction Acts directly on kidney to retain sodium & water Stimulates adrenal cortex to secrete aldosterone

7. Cardiotonic-Inotropic Effects ¥ Increase force of myocardial contraction ¥ Causes improved heart’s pumping ability

8. Cardiotonic-Inotropic Drugs u Adrenergic u Digitalis glycosides u Amrinone u Milrinone

9. Inotropic Definition Z Force of myocardial contraction Z Positive inotropic drug: increases force of contractions Z Negative inotropic drug: decreases force of contraction

10. Digitalis Glycosides Z Increase myocardial contractility causing more complete emptying

11. Digitalis Glycosides v Digitoxin Absorption: Absorption: 90-100% Oral v Digoxin Absorption: Absorption: 60-80% Tablet 90-100% Capsule 70-85% Elixir

12. Digitalis Glycosides Continued v Digitoxin Distribution: Distribution: To most body tissues 90% bound to albumin v Digoxin Distribution: Distribution: Throughout the body Binds to skeletal muscle/20-30% to albumin

13. Digitalis Glycosides Continued v Digitoxin Metabolism: Metabolism: Liver - 8% converted to digoxin Excretion: Excretion:Kidneys v Digoxin Metabolism: Metabolism: Small amount in liver & GI flora Excretion: Excretion: Unchanged drug from kidneys

14. Antianginal Drugs Z Organic nitrates: produce vasodilation Z Beta-adrenergic blocking drugs: Inhibits sympathetic stimulation Z Calcium-channel blockers: Prevents Ca moving into cells

15. Antihypertensive Drugs Z Diuretics Z Antiadrenergics Z ACE inhibitors Z Calcium-channel blockers

16. Hypotension and Shock Z Alpha-adrenergic drugs: increase peripheral vascular resistance Z Beta-adrenergic drugs: increase myocardial contractility & heart rate