CARDIOVASCULAR DRUGS!!!!!

CARDIOVASCULAR DRUGS! ! !

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Methyldopa Use? Sympathoplegic, HTN SE? Sedation, positive coombs test

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Reserpine Use? Sympathoplegic, HTN SE? Sedation, depression, nasal stuf iness, diarrhea

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Hydrochlorothiazide Use? Diuretic, HTN SE? Hypo K, Hyperlipidemia, hyperuricemia, lassitude, Hyper Ca, Hyperglycemia

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

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Guanethidine Use? Sympathoplegic, HTN SE? Orthostatic & exercise hypotension, diarrhea, sexual dysfxn

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Nitroglycerin, Isosorbide Dinitrate Use? Vasodilator angina, pulm edema, aphrodisiac/erection MOA? enhancer Releases NO from smooth muscle: increased cGMP relaxation. Veins> Arteries Which does Arteries > Veins? HYDRALAZINE Decreased Preload or Afterload? PRELOAD Toxicity Tachycardia, Flushing, HA, hypotension, Monday Disease decreased tolerance over weekend tach, dizziness and HA on reexposure

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

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

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Beta blockers Use? Sympathoplegic, HTN SE? Impotence , asthma, cardiovascular ef ects (bradycardia, CHF, AV block), CNS ef ects sedation and changes in sleep

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Hydralazine Use? Vasodilator, severe HTN, CHF Mechanism Increased cGMP smooth muscle of Action? relaxation. Arterioles > veins. Reduces AFTERLOAD (Vasodilator!) preload or afterload? SE? Nausea, Headache, Lupus like syndrom e, reflex tachycardia (don t use in agina or C AD !), angina, salt retention Use with beta blocker to avoid tachycardia and with a diuretic to avoid salt retention

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Minoxidil Use? Vasodilator, HTN Mechanis K channel opener, m of hyperpolarizes smooth muscle Action? cel s SE? HAIRY M O NSTER, pericardial effusion, reflex tachycardia, angina, salt retention Use with beta blocker to avoid tachycardia and with a diuretic to avoid salt retention

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

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Hexamethonium Use? Sympathoplegic, HTN SE? Severe orthostatic hypotension, blurry vision, constipation, sexual dysfxn

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Verapamil Use? Calcium Channel Blocker, HTN, angina, arrhythmias, Raynaud s MOA? Blocks Voltage Dependant L type Ca channels, decreasing More cardiac or contractility smooth muscle Cardiac, but also ef ects? vasodilator SE? Dizziness, flushing, Toxicity? constipation, AV block, Nausea Cardiac depression, peripheral edema, flushing, dizziness, constipation

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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! !

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

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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 .

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Diltiazem Use? Calcium Channel Blocker, HTN, angina, arrhythmias, Raynaud s MOA? Blocks Voltage Dependant L type Ca channels, decreasing More cardiac or contractility smooth muscle Somewhere in the middle ef ects? SE? Dizziness, flushing, constipation, AV block, Toxicity? Nausea Cardiac depression, peripheral edema, flushing, dizziness, constipation

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Losartan Use? Angiotensin I Good alternative to Receptor Blocker, what? HTN SE? ACE Inhibitors Fetal renal toxicity, Hyper K

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Nifedipine Use? Calcium Channel Blocker, HTN, angina, Raynaud s MOA? Blocks Voltage Dependant L type Ca channels, decreasing More contractility Cardiac or Smooth muscle vasodilator Smooth Muscle Ef ects? Dizziness, flushing SE? Cardiac depression, peripheral Toxicity? edema, flushing, dizziness, constipation

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CHOLESTEROL DRUGS Which is best for decreased triglycerides? Fibrates Examples? Gemfibrozil, Clofibrate, Bezafibrate, Fenofibrate Which are best for decreasing LDL? Statins MOA? HMG CoA reductase 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

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Anti arrhythmics BIG PICTURE CLASS G eneral M O A Class I Class II Class III Class IV

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Anti arrhythmics BIG PICTURE CLASS G eneral M O A Class I Block FAST sodium channels responsible for phase 0 depolarizationQuinidine, Flecanide, Procainamide Class II Class III Class IV

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Anti arrhythmics BIG PICTURE CLASS G eneral M O A Class I Block FAST sodium channels responsible for phase 0 depolarizationQuinidine, Flecanide, Procainamide Class II Beta Adrenergic Receptor AntagonistsPropranolol, Metoprolol Class III Class IV

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Anti arrhythmics BIG PICTURE CLASS G eneral M O A Class I Block FAST sodium channels responsible for phase 0 depolarizationQuinidine, Flecanide, Procainamide Class II Beta Adrenergic Receptor AntagonistsPropranolol, Metoprolol Class III Prolong action potential with little effect on phase 0 depolarization, mostly via blocking the K repolarizing currentAmiodarone, Sotalol, Ibutilide Class IV

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Anti arrhythmics BIG PICTURE CLASS G eneral M O A Class I Block FAST sodium channels responsible for phase 0 depolarizationQuinidine, Flecanide, Procainamide Class II Beta Adrenergic Receptor AntagonistsPropranolol, Metoprolol Class III Prolong action potential with little effect on phase 0 depolarization, mostly via blocking the K repolarizing currentAmiodarone, Sotalol, Ibutilide Class IV Block slow L type Calcium ChannelsVerapamil, Diltiazem

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Class I Drugs: Broken up by degree of Na channel blockade and ef ect 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 ef ective refractory period, increase QT interval (increased risk of what?) Torsades de points Procainamide Reversible SLE like syndrome

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Class I Drugs: Broken up by degree of Na channel blockade and ef ect on AP duration CLASS IB Drugs MOA? Bold Na channels, but unlike IA s shorten duration of AP and refractory period Uses? Preferential y 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

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Class I Drugs: Broken up by degree of Na channel blockade and ef ect 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.

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Class I 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 flut er 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 ef ects of hypoglycemia Metoprolol Dyslipidemia

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Class I I 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!

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Class IV Drugs MOA? Calcium Channel Blockers: AV node: decreased conduction. Uses? Especial y good for? SVTs Examples? Verapamil and Diltiazem for Anti arrhythmics SE Constipation, flushing, edema, CV ef ects, torsades

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Adenosine MOA Increased K ef lux: hyperpolarization. Drug of choice for which conditions? AV nodal arrhythmias. Short or long acting? Very short (~15 Seconds) Toxicity Flushing, Hypotension, Chest pain

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

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

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