Pharmacology of Lipids and Anticoagulants
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Questions and Answers

Which of the following is NOT a primary mode of treating hypertriglyceridemia?

  • Diet modification
  • Fibric acid derivative intake
  • Niacin supplementation (correct)
  • Regular exercise
  • Besides elevated cholesterol, which risk factor contributes to the development of hyperlipidemia?

  • Family history of early heart disease (correct)
  • Low blood pressure
  • Young age (men under 45, women under 55)
  • High HDL levels
  • What is the primary mechanism of action of HMG-CoA reductase inhibitors (statins)?

  • Inhibiting cholesterol synthesis in the liver (correct)
  • Increasing HDL production
  • Enhancing triglyceride absorption
  • Increasing bile acid secretion
  • Which of the following is a common adverse effect of fibric acid derivatives?

    <p>Gastrointestinal irritation (C)</p> Signup and view all the answers

    Which of the following drugs is classified as an antiplatelet?

    <p>Aspirin (C)</p> Signup and view all the answers

    Niacin is most effective at increasing which component of the lipid profile?

    <p>HDL-C (B)</p> Signup and view all the answers

    What is the primary mechanism of action of heparin?

    <p>Inhibiting thrombin formation (C)</p> Signup and view all the answers

    What is the primary mechanism of action of bile acid sequestrants?

    <p>Binding to bile acids in the intestine for excretion in feces (A)</p> Signup and view all the answers

    What is a common side effect of Niacin?

    <p>Cutaneous flushing (B)</p> Signup and view all the answers

    Which laboratory test is used to monitor the extent of anticoagulation with heparin?

    <p>aPTT (activated Partial Thromboplastin Time) (B)</p> Signup and view all the answers

    What is the antidote for a heparin overdose?

    <p>Protamine sulfate (C)</p> Signup and view all the answers

    For what condition are statins primarily indicated?

    <p>Hypercholesterolemia (D)</p> Signup and view all the answers

    Which of the following is a contraindication for the use of Warfarin?

    <p>Pregnancy (A)</p> Signup and view all the answers

    What is the primary mechanism of action of thrombolytic drugs?

    <p>Dissolving existing clots (C)</p> Signup and view all the answers

    Which of the following is a common adverse effect of thrombolytic therapy?

    <p>Serious bleeding (A)</p> Signup and view all the answers

    Which of the following drugs directly interferes with the synthesis of vitamin K-dependent clotting factors?

    <p>Warfarin (A)</p> Signup and view all the answers

    Which of the following medications is an example of an Angiotensin II Receptor Blocker (ARB)?

    <p>Telmisartan (B)</p> Signup and view all the answers

    What is the primary mechanism by which beta-blockers benefit patients with heart failure?

    <p>Decreasing the heart rate and inhibiting renin release (C)</p> Signup and view all the answers

    Which of these diuretics are most commonly used in the treatment of heart failure?

    <p>Loop diuretics (B)</p> Signup and view all the answers

    What is a common adverse effect associated with combining hydralazine and isosorbide dinitrate?

    <p>Hypotension (B)</p> Signup and view all the answers

    How do positive inotropic agents improve cardiac function?

    <p>By increasing cardiac contractility (C)</p> Signup and view all the answers

    In heart failure, what is the cause of pulmonary edema?

    <p>Blood backing up into veins that take blood through the lungs (C)</p> Signup and view all the answers

    For patients who cannot tolerate ACE inhibitors or ARBs, which combination of drugs is often used in the treatment of heart failure?

    <p>Hydralazine and isosorbide dinitrate (C)</p> Signup and view all the answers

    Which of the following is classified as an aldosterone antagonist?

    <p>Eplerenone (D)</p> Signup and view all the answers

    Which of the following is NOT a recognized adverse effect associated with ACE inhibitors, but is not with angiotensin II antagonists?

    <p>Tachycardia (A)</p> Signup and view all the answers

    What is the primary mechanism of action for alpha-adrenergic blockers like Prazosin?

    <p>Blocking alpha-adrenergic receptors to cause vasodilation (D)</p> Signup and view all the answers

    Which of the following is a class of drugs that is typically reserved for emergency situations due to their direct action on blood vessels?

    <p>Vasodilators (D)</p> Signup and view all the answers

    A patient with pregnancy-induced hypertension might benefit from which centrally acting antihypertensive?

    <p>Methyldopa (C)</p> Signup and view all the answers

    In a hypertensive emergency, which of these is NOT a common intravenous drug used?

    <p>Prazosin (B)</p> Signup and view all the answers

    Which of the following best describes a situation classified as a hypertensive urgency?

    <p>Severe elevation in blood pressure without evidence of target organ damage (A)</p> Signup and view all the answers

    Which class of diuretics acts primarily on the distal convoluted tubules?

    <p>Thiazide diuretics (D)</p> Signup and view all the answers

    What is the term used to describe the percentage of blood that the heart ejects with each contraction?

    <p>Ejection fraction (A)</p> Signup and view all the answers

    A patient is experiencing acute pulmonary edema. Which class of diuretic would be most effective?

    <p>Loop diuretics (B)</p> Signup and view all the answers

    What is the fundamental cause of systolic heart failure?

    <p>Inability of the ventricle to pump effectively (A)</p> Signup and view all the answers

    What is the primary mechanism of action of potassium-sparing diuretics?

    <p>Antagonism of aldosterone in the kidney, leading to sodium and water diuresis (D)</p> Signup and view all the answers

    Which of the following is a common adverse effect associated with thiazide diuretics?

    <p>Hypokalemia (B)</p> Signup and view all the answers

    Which class of drugs acts by blocking calcium channels in smooth muscle?

    <p>Calcium channel blockers (D)</p> Signup and view all the answers

    Which of these medications is an example of an Angiotensin-Converting Enzyme (ACE) inhibitor?

    <p>Captopril (B)</p> Signup and view all the answers

    What is a common adverse effect associated with Angiotensin-Converting Enzyme (ACE) inhibitors?

    <p>Dry cough (B)</p> Signup and view all the answers

    Angiotensin II antagonists primarily act by:

    <p>Preventing the effects of angiotensin II, leading to vasodilation (C)</p> Signup and view all the answers

    What is the primary mechanism by which nitrates increase blood supply to the heart muscle?

    <p>Dilation of the coronary vasculature. (B)</p> Signup and view all the answers

    Which route of nitroglycerin administration provides the most rapid relief from an angina attack?

    <p>Sublingual (A)</p> Signup and view all the answers

    For which condition is Ranolazine primarily indicated?

    <p>Chronic angina, particularly when other treatments have not worked (A)</p> Signup and view all the answers

    Which of the following best describes the role of Low-Density Lipoproteins (LDL) in the body?

    <p>Transport cholesterol to peripheral cells. (B)</p> Signup and view all the answers

    What is the main function of High-Density Lipoproteins (HDL)?

    <p>Carry cholesterol to the liver for breaking down (B)</p> Signup and view all the answers

    What is generally considered an undesirable level of serum cholesterol that is associated with atherosclerosis?

    <p>Above 240 mg/dL (B)</p> Signup and view all the answers

    A patient with chronic angina is prescribed Ranolazine. What does this drug do?

    <p>It inhibits the late phase of sodium current. (D)</p> Signup and view all the answers

    Which of the following indicates healthy lipid levels associated with a reduced risk of atherosclerosis?

    <p>High HDL and low LDL (D)</p> Signup and view all the answers

    Flashcards

    Alpha-adrenergic Blockers

    Drugs that block the action of alpha-adrenergic receptors in small blood vessels, causing vasodilation.

    Vasodilators

    Drugs that directly relax blood vessels, reducing arterial blood pressure.

    Centrally Acting Agents

    Drugs that act on the vasomotor center of the brain, controlling blood pressure centrally.

    Hypertensive Urgency

    A condition characterized by a severe elevation in blood pressure (>180/120 mm Hg) without evidence of target organ damage.

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    Hypertensive Emergency

    A rare, life-threatening condition with extremely high blood pressure (>180/120 mm Hg) and signs of imminent organ damage (stroke, heart attack).

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    Heart Failure (HF)

    A complex, progressive disorder where the heart cannot pump enough blood to meet the body's needs.

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    Ejection Fraction (EF)

    A measurement of the percentage of blood ejected from the heart with each beat, indicating the heart's pumping efficiency.

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    Systolic Heart Failure

    A type of heart failure where the ventricle cannot pump effectively, reducing the heart's ability to deliver blood.

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    Triglycerides

    A type of fat found in the blood, elevated levels are linked to increased risk of heart disease.

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    Hypertriglyceridemia

    A condition characterized by high levels of triglycerides in the blood.

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    Statins

    Drugs that block the enzyme responsible for cholesterol synthesis in the liver.

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    Fibric acid derivatives

    Medicines that help lower triglycerides and raise HDL cholesterol by acting on the liver.

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    Niacin

    A B vitamin, also known as niacin, which helps lower cholesterol and raise HDL.

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    Bile acid sequestrants

    Drugs that bind to bile acids in the gut, preventing their reabsorption and reducing cholesterol levels.

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    Risk Factors for Hyperlipidemia

    A family history of early heart disease, smoking, high blood pressure, low HDL, obesity, diabetes.

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    Treatment for High Triglycerides

    Diet and exercise are the primary modes of treatment to lower triglycerides.

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    Antiplatelet drugs

    Drugs that prevent the formation of blood clots by inhibiting the action of platelets.

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    What are antiplatelets?

    A medication that inhibits the formation of a platelet-rich clot. Examples include aspirin, clopidogrel, ticlopidine, and dipyridamol.

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    Anticoagulant Drugs

    Drugs that prevent the formation of blood clots by interfering with the coagulation cascade.

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    Heparin

    An anticoagulant drug that inhibits the action of clotting factors. Heparin is administered parenterally, prolongs clotting time, inhibits thrombin formation, and is used to prevent venous thrombosis.

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    Antihypertensive drugs

    A type of medication used to treat high blood pressure.

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    Warfarin

    An oral anticoagulant drug that interferes with the synthesis of vitamin K-dependent clotting factors. Warfarin is used to prevent venous thrombosis and pulmonary embolism.

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    Thrombolytic therapy

    They are used for intravenous administration in the treatment of coronary artery thrombosis associated with myocardial infarction. These drugs can cause serious bleeding and arrhythmia. Eg: Streptokinase, urokinase, and tissue type plasminogen activator (t-PA)

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    Hyperlipidemia

    A condition where there is an excess of lipids, specifically cholesterol and triglycerides, in the blood.

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    Low-density lipoproteins (LDL)

    A type of lipoprotein that transports cholesterol to peripheral cells. Excess cholesterol can contribute to atherosclerosis.

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    What is aPTT?

    The test used to monitor the extent of anticoagulation with heparin.

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    What is INR?

    The standard test to monitor the extent of anticoagulation with warfarin.

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    High-density lipoproteins (HDL)

    A type of lipoprotein that collects cholesterol from peripheral cells and takes it to the liver for excretion. High levels of HDL are beneficial.

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    Nitrates

    A medication that dilates the coronary arteries, increasing blood flow to the heart muscle.

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    Ranolazine

    A sodium channel blocker used for the treatment of chronic angina.

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    Nitroglycerin

    A medication that dilates the coronary vasculature, providing increased blood supply to the heart muscle. It is often used for the treatment of angina.

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    Angina

    A condition characterized by chest pain caused by insufficient blood flow to the heart muscle.

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    Angiotensin II Receptor Blockers (ARBs)

    Medicines that block the effects of angiotensin II, a hormone that narrows blood vessels and increases blood pressure. They are often used to treat high blood pressure and heart failure.

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    Aldosterone Antagonists

    A type of medication that blocks the effects of aldosterone, a hormone that regulates salt and water balance in the body. They help reduce fluid retention and improve heart function in patients with severe heart failure.

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    β-Blockers

    Medicines that block the effects of epinephrine (adrenaline) and other hormones involved in the 'fight or flight' response. They slow the heart rate, reduce blood pressure, and improve blood flow to the heart.

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    Diuretics

    Medicines that help remove excess fluid from the body, reducing swelling and pressure. They play a key role in managing heart failure by improving blood circulation and reducing the burden on the heart.

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    Nitrate and Hydralazine Combination

    Venodilators and arterial dilators (respectively) that open up blood vessels, improving blood flow and reducing pressure on the heart. They are particularly helpful in patients with chronic heart failure.

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    Inotropic Drugs

    Medicines that strengthen the heart muscle, making it pump blood more effectively. They are used in severe cases of heart failure when the heart is not able to pump blood adequately.

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    Headache

    A common side effect associated with certain medications, particularly those used in treating heart failure.

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    Hypotension

    A decrease in blood pressure, which can cause feelings of dizziness, lightheadedness, and fainting.

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    What are thiazide diuretics and how do they work?

    Thiazide diuretics, like chlorothiazide and hydrochlorothiazide, work by interfering with the reabsorption of sodium, potassium, and water in the distal convoluted tubules of the kidneys, leading to increased urine production. They are used for treating chronic edema and essential hypertension.

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    What are loop diuretics and what is their main use?

    Loop diuretics, such as furosemide, bumetanide, and ethacrynic acid, are potent diuretics that block the reabsorption of salt and water in the ascending loop of Henle. They are highly effective in treating acute episodes of pulmonary edema due to their strong water-removing action.

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    What are potassium-sparing diuretics and what is their mechanism?

    Potassium-sparing diuretics, including triamterene, spironolactone, amiloride, and triamterene, work by blocking the action of aldosterone in the kidneys. This prevents the reabsorption of sodium and water, leading to increased urine production and potassium retention.

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    What are beta-adrenergic blocking agents and what is their primary effect?

    Beta-adrenergic blocking agents, such as propranolol, atenolol, metoprolol, timolol, and nadolol, work by blocking the action of beta-adrenergic receptors in the body, leading to decreased heart rate and blood pressure. They are often used as first-line therapy for hypertension.

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    What are calcium channel blockers and how do they work?

    Calcium channel blockers, including nifedipine, diltiazem, verapamil, amlodipine, isradipine, and lercanidipine, work by blocking calcium channels in smooth muscle cells, leading to relaxation of blood vessels and reduced blood pressure. They are particularly effective in treating certain types of chest pain (angina).

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    What are ACE inhibitors and what is their primary function?

    Angiotensin-converting enzyme (ACE) inhibitors, like captopril, enalapril, lisinopril, and perindopril, work by blocking the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This reduces blood pressure and helps with sodium excretion by inhibiting the action of aldosterone.

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    What are angiotensin II antagonists and what is their mechanism?

    Angiotensin II antagonists, such as losartan, candesartan, valsartan, irbesartan, and telmisartan, block the action of angiotensin II directly, leading to vasodilation, reduced blood pressure, and increased sodium and water excretion. They are similar to ACE inhibitors in their effects but work at a different target.

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    What is the renin-angiotensin-aldosterone system (RAAS) and what is its role?

    The renin-angiotensin-aldosterone system (RAAS) is a complex hormonal system that plays a crucial role in regulating blood pressure and fluid balance. The system involves several key components, including renin, angiotensin I, angiotensin II, and aldosterone.

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    Study Notes

    Cardiovascular Drugs

    • Antihypertensive drugs, anti-heart failure drugs, antianginal drugs, anti-hyperlipidemic drugs, antiarrhythmic drugs, and antiplatelets, anticoagulants and thrombolytic drugs are all cardiovascular drugs.

    Hypertension

    • Hypertension is high blood pressure.
    • Adults are diagnosed with hypertension when blood pressure is greater than or equal to 140 mmHg systolic pressure, or greater than or equal to 90 mmHg diastolic pressure.
    • Controllable risk factors include obesity, sodium intake, alcohol, lack of exercise and stress.
    • Uncontrollable risks include age, race and heredity.
    • Non-pharmacological treatments include weight reduction, salt restriction, moderation of alcohol use and eating healthy foods.

    Antihypertensive Drugs

    • Diuretics, beta adrenergic blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II antagonists, alpha-adrenergic blockers, vasodilators, and centrally acting agents are antihypertensive drugs.

    Diuretics

    • Diuretics are drugs that promote a loss of sodium ions and water from the body which results in increased urine flow.
    • Different diuretics act at different sites of the nephron in the kidney
    • Diuretics are frequently used for managing abnormal fluid distribution disorders such as hypertension, heart failure, pulmonary edema, cerebral edema, peripheral edema and acute renal failure.
    • Types of diuretics include thiazide diuretics, loop diuretics, K+ sparing diuretics, osmotic diuretics, and carbonic anhydrase inhibitors.

    Thiazide Diuretics

    • Examples like Chlorothiazide and Hydrochlorothiazide interfere with Na, K and water reabsorption in the distal convoluted tubules.
    • They are used to treat chronic edema and essential hypertension.
    • Adverse effects include hypokalemia, hyperglycemia, and postural hypotension.

    Loop Diuretics

    • Furosemide, Bumetanide and Ethacrynic acid interfere with the reabsorption of salt and water in the ascending loop of Henle.
    • These diuretics increase potassium excretion, making them the most potent oral diuretic agents available.
    • They are useful for treating acute episodes of pulmonary edema.
    • Adverse effects like fluid and electrolyte imbalances including hypokalemia.

    Potassium-Sparing Diuretics

    • Triamterene, Spironolactone, Amiloride, and Triamterene block the action of aldosterone in the kidneys which leads to Na and water diuresis and the retention of K.
    • Thiazide or loop diuretics can be combined with K sparing diuretics to prevent K loss.
    • They are used in edema.
    • Adverse effects include hyperkalemia.

    Beta-Adrenergic Blocking Agents

    • Propranolol, Atenolol, Metoprolol, Timolol, Nadolol are examples that block the action of beta-adrenergic receptors (selective and nonselective).
    • They are recommended as a first-line therapy.

    Calcium Channel Blockers

    • Nifedipine, Diltiazem, Verapamil, Amlodipine, Isradipine, Lercanidipine are examples of calcium channel blockers that act by blocking calcium channels in smooth muscle.
    • Reducing or preventing contraction in smooth muscle, they have a vasodilation property.
    • Adverse effects include dizziness, peripheral edema, hypotension, and asystole.

    Angiotensin-Converting Enzyme (ACE) Inhibitors

    • Captopril, Enalapril, Lisinopril, Perindopril block the conversion of angiotensin I to angiotensin II.
    • This prevents the vasoconstrictive effects of angiotensin II and sodium retention caused by aldosterone.
    • Adverse effects include dry cough, taste disturbances, and hypokalemia.

    Renin-Angiotensin-Aldosterone System (RAAS)

    • The RAAS is a system of hormones that regulates blood pressure.
    • It involves the following steps:
    1. Kidney releases renin
    2. Renin converts angiotensinogen from the liver to angiotensin I.
    3. Angiotensin I is converted to angiotensin II in the lungs.
    4. Angiotensin II causes vasoconstriction.
    5. Angiotensin II stimulates the adrenal gland to secrete aldosterone.
    6. Aldosterone increases sodium reabsorption.

    Angiotensin II Antagonists

    • Losartan, Candesartan, Valsartan, Irbesartan, Telmisartan prevent the effects of angiotensin II.
    • This leads to relaxation of smooth muscle, vasodilation, increased renal salt and water excretion, and reduced plasma volume.
    • Two adverse effects of ACE inhibitors, angioedema and cough have not been linked to the use of angiotensin II antagonists.

    Alpha-Adrenergic Blockers

    • Prazosin, Phenoxybenzamine, Phentolamine block the action of alpha-adrenergic receptors in small blood vessels, leading to vasodilation.
    • The main adverse effect is tachycardia.

    Vasodilators

    • Nitroprusside, Hydralazine, Minoxidil directly relax blood vessels, reducing arterial blood pressure.
    • Reserved for emergency situations.

    Centrally Acting Agents

    • Methyldopa, Clonidine act centrally on the vasomotor center of the brain.
    • Clonidine is reserved for patients not controlled by other less toxic antihypertensive agents.
    • Methyldopa is used in pregnancy-induced hypertension.
    • Adverse effects include sedation, drug fever, anemia, and hypotension.

    Hypertensive Emergency

    • A rare and life-threatening situation characterized by severe elevation in blood pressure.
    • Presents with evidence of impending or progressive target organ damage (stroke, myocardial infarction).
    • Immediate lowering of blood pressure with intravenous drugs (nicardipine, nitroprusside, nitroglycerine, phentolamine, esmolol, labetalol, hydralazine, or fenoldopam).

    Anti-heart Failure Drugs

    • Drugs used to treat heart failure aim to increase heart efficiency and/or reduce extra load.
    • Heart failure is a complex, progressive disorder where insufficient blood is pumped by the heart.
    • Main symptoms include dyspnea, fatigue, fluid retention.
    • Ejection fraction (EF) measures the percentage of blood leaving the heart per contraction. Normal ejection fraction is 50% or higher.
    • Two types of heart failure include systolic heart failure (reduced ejection fraction) and diastolic heart failure (preserved or near normal ejection fraction).
    • Causes of heart failure include arteriosclerotic heart disease, myocardial infarction, hypertensive heart disease, valvular heart disease, dilated cardiomyopathy, and congenital heart disease.

    Positive Inotropic Agents

    • Digoxin, β-receptor agonists (dobutamine and dopamine), phosphodiesterase inhibitors (milrinone) enhance cardiac contractility and increase cardiac output.
    • Primarily used intravenously for a short period in acute heart failure (HF) settings.

    Digitalis Glycosides

    • Most digitalis glycosides come from the digitalis (foxglove) plant.
    • Digoxin is most commonly used.
    • Digitoxin seldom used due to long duration of action.
    • Digoxin has a narrow therapeutic index and is available in oral and injectable formulations.

    Pharmacokinetics of Digoxin

    • Digoxin has a large volume of distribution and a long half-life (30-40 hours).
    • Eliminated mainly through the kidneys, requiring dose adjustments in renal dysfunction.

    Therapeutic Uses of Digoxin

    • Digoxin is indicated in patients with severe HF after initiation of ACE inhibitor, β-blocker, and diuretic therapy.
    • In mild to moderate HF, other treatments such as ACE inhibitors, β-blockers, aldosterone antagonists, direct vaso- and venodilators and diuretics may adequately treat the condition without digoxin.

    Adverse Effects of Digoxin

    • Digoxin toxicity is a major concern due to a narrow therapeutic index.
    • Symptoms like anorexia, nausea, and vomiting may indicate toxicity.
    • Hypokalemia, because digoxin usually competes with potassium for the binding site on the Na+/K+-ATPase pump, can also contribute to digoxin toxicity.
    • Treatment for digoxin toxicity includes discontinuation of digoxin, serum potassium level determination and replenishment if indicated.
    • Severe cases require antibodies to digoxin (digoxin immune Fab) to inactivate the drug.
    • Adverse effects may include yellowish vision (xanthopsia), and various cardiac arrhythmias.

    Beta-Adrenergic Agonists

    • Dobutamine and dopamine are beta-adrenergic agonists that improve cardiac performance through positive inotropic effects and vasodilation.
    • They increase calcium ion entry into myocardial cells which results in enhanced contraction.
    • Dobutamine is commonly used over Dopamine as an agent for treating heart failure.
    • Both are administered intravenously for short-term acute HF management.

    Phosphodiesterase Inhibitors

    • Milrinone is a phosphodiesterase inhibitor that increases intracellular calcium and consequently cardiac contractility.
    • Administered intravenously for short-term acute heart failure treatment.

    Antianginal Drugs

    • Antianginal drugs manage angina (chest pain due to insufficient oxygen-rich blood supply to the heart).
    • Angina is a symptom of an underlying condition such as coronary artery disease (CAD), ischemic heart disease (IHD) or coronary artery disease.
    • Common causes of angina include atherosclerotic disease and vascular smooth muscle spasms.
    • Angina can be categorized as stable, unstable, and variant angina.
    • Medications managing chronic stable angina include beta-blockers, calcium channel blockers, nitrates, and a sodium channel blocker (ranolazine).

    Stable Angina

    • Characterized as intermittent, short-lasting burning, heavy or squeezing sensations in the chest, usually relieved promptly by rest or nitroglycerin.

    Unstable Angina

    • Angina episodes characterized by increased intensity, duration, frequency and can be precipitated by progressively less effort.
    • Not relieved by rest or nitroglycerin.

    Prinzmetal or variant angina

    • Uncommon pattern of episodic angina at rest.
    • Caused by spasm of coronary arteries.
    • Responds promptly to coronary vasodilators like nitroglycerin and calcium channel blockers.

    Acute Coronary Syndrome

    • An emergency resulting from acute coronary artery thrombosis caused by plaque rupture and partial or complete occlusion.
    • Untreated acute coronary artery occlusion may result in necrosis of the cardiac muscle (myocardial infarction).

    Antiplatelets, Anticoagulants, and Thrombolytics

    • These drugs prevent and/or treat thrombotic disorders like acute myocardial infarction, pulmonary embolism, acute ischemic stroke and deep vein thrombosis)
    • Platelet aggregation inhibitors decrease formation of platelet rich clots (e.g., aspirin, clopidogrel, ticlopidine, dipyridamole).
    • Anticoagulants either inhibit or interfere with coagulation factors (e.g., heparin, warfarin, others).
    • Thrombolytics dissolve clots (e.g., streptokinase, urokinase, alteplase, reteplase, tenecteplase) available intravenously and used for treatment of coronary artery thrombosis.

    Antihyperlipidemic Drugs

    • Drugs that treat hyperlipidemia (increased lipids like cholesterol and triglycerides in blood).
    • Elevated lipid levels are associated with coronary heart disease (CHD).
    • Lifestyle modifications (like diet and exercise and weight management) and/or medications (HMG-CoA reductase inhibitors (statins), fibrate acid derivatives, and niacin, bile acid sequestrants) can be used to treat elevated lipid levels.

    HMG-CoA Reductase Inhibitors

    • Statins (Atorvastatin, Lovastatin, Pravastatin, Rosuvastatin, Simvastatin) are inhibitors of HMG-CoA reductase.
    • This enzyme is responsible for cholesterol synthesis in the liver.
    • Statins are indicated for patients at high risk of myocardial infarction (MI) and those with high or combined elevated cholesterol and triglycerides.
    • Side effects include myopathy and contraindications in pregnancy, lactation, and children.

    Fibric Acid Derivatives

    • Gemfibrozil, fenofibrate, clofibrate lower serum triglycerides and increase HDL levels.
    • They decrease triglyceride levels by 20% to 50%.
    • Side effects include GI irritation and arrhythmias.

    Niacin (Vitamin B3)

    • Also known as vitamin B3 or pellagra-preventing vitamin,
    • Niacin can reduce LDL-C levels by 10-20% and increases HDL-C levels.
    • The use of niacin to lower triglycerides is in the 20-35% range.
    • Adverse effects include cutaneous flush and itching diarrhea.

    Bile Acid Sequestrants

    • Cholestyramine, Colestipol, and Colesevelam reduce elevated LDL levels by forming an insoluble substance with bile acids that are then excreted.
    • This process prompts the liver to utilize cholesterol for bile production, decreasing cholesterol levels.

    Antiarrhythmic Drugs

    (Class I-IV)

    • Classifications are based on effects on the action potential of cardiac cells and the refractory period.
    • Class I: Sodium channel blockers (e.g., Quinidine, Disopyramide, Procainamide, Lidocaine, Phenytoin, Mexiletine, Flecainide, Propafenone).
    • Class II: Beta-adrenoceptor antagonists (e.g., Propranolol, Metoprolol, Atenolol, Esmolol).
    • Class III: Potassium channel blockers (e.g., Amiodarone, Dronedarone, Dofetilide, Ibutilide, Sotalol).
    • Class IV: Calcium channel blockers (e.g., Verapamil, Diltiazem).

    Cardiac Arrhythmias

    • An arrhythmia is an irregular heartbeat due to defects in impulse generation or conduction.
    • A heart disorder, emotional stress, hypoxia, or electrolyte imbalance are some factors that result in arrhythmias.

    Electrocardiogram (ECG)

    • ECG provides a record of electrical activity in the heart.
    • Proper interpretation of ECG with thorough physical assessment is necessary for determining cause and type of arrhythmia.
    • Abnormal R waves indicate enlarged ventricles, abnormal S-T segments can indicate cardiac ischemia, and abnormal Q-R or Q-T intervals may indicate various cardiac conditions.

    Management of Arrhythmias

    • Pharmacologic management involves drugs acting directly on cardiac cells to inhibit ion channels or alter autonomic inputs.
    • Non-pharmacologic interventions include non-surgical procedures to correct the cause of arrhythmia in a less invasive way such as catheter ablation, pacemaker implants, or defibrillation.

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