Cardiovascular System Meds PDF

1 CARDIOVASCULAR SYSTEM MEDS: Renin-Angiotensin-Aldosterone System (RAAS) Angiotensin Converting Enzyme Inhibitor pg 505 Angiotensin Receptor Blockers (ARBs) pg. 510 (ACE Inhibitor) syllable is – ipril syllable is - artan Mechanism --reduces levels of angiotensin II—dilates blood vessels --blocks ac...

1 CARDIOVASCULAR SYSTEM MEDS: Renin-Angiotensin-Aldosterone System (RAAS) Angiotensin Converting Enzyme Inhibitor pg 505 Angiotensin Receptor Blockers (ARBs) pg. 510 (ACE Inhibitor) syllable is – ipril syllable is - artan Mechanism --reduces levels of angiotensin II—dilates blood vessels --blocks access to receptors in blood vessels, --increases levels of bradykinins—also dilates blood adrenal, and other tissues. of Action vessels, but also causes cough and angioedema --similar effects as the ACE inhibitors, but does not --most are oral, can be given w/ food, once or twice a inhibit Kinase II, so cough and angioedema are less day. Excreted by kidney. common Hypertension Therapeutic Hypertension—safe for asthma patients (c.f. beta blockers), proved to also decrease risk of CV mortality --Slows retinopathy Uses HF & MI HF & MI Nephropathy—so decrease in ESRD Diabetic nephropathy Prevents MI, stroke and death in pt. with CV risk Prevents MI, stroke, and death in pt. with CV risk --First dose hypotension—especially if on diuretic, so Generally well tolerated. Adverse need to lower initial dose or stop diuretics 2- 3 days Dizziness, muscle cramps or weakness, heartburn, Effects --Cough—dry irritating nonproductive, due to Kinase II diarrhea, sensitivity to touch. --Hyperkalemia—rare unless taking K --Renal failure—if have renal condition --Angioedema—can be fatal, increased capillary permeability Specific Drugs captopril—used for high BP, HF, and nephropathy enalapril –used for high BP, HF lisinopril—used for high BP, HF, MI. Active component Diuretics; Other antihypertensive drugs Drug Interactions Drugs that increase K levels; Lithium NSAID Comments Category D (BBW) Causes rebound hypertension if stopped abruptly losartan – used for high BP, stroke prevention & diabetic nephropathy olmesartan—used for high BP only valsartan—used for high BP, HF, MI Not as much an issue Especially used for patients with diabetes Category C in first trimester, and then Category D in second and third trimester Direct Renin Inhibitors pg 515 aliskirin --Only one in this class, oral med --Inhibits the conversion of angiotensinogen into angiotensin I, so suppresses the entire RAAS. --No proof that it is any better than the others. --Used for hypertension --Cough, angioedema and hyperkalemia is less. Aldosterone Antagonists Eplerenone pg. 581 Selective aldosterone receptor blocker, so fewer side effects than spironolactone (diuretic). Used for hypertension and HF. Hyperkalemia 2 Calcium Channel Blockers (CCB) 512 Mechanism Prevents calcium from entering cells, especially at of Action heart & blood vessels, so will decrease HR & myocardial contraction Category C Therapeutic Hypertension Angina pectoris Uses Dysrhythmias Maybe migraines CARDIOVASCULAR SYSTEM MEDS: Other Vasodilators 519 Cardiac Glycosides 582 (wide variety) (also called digitalis drugs) RAAS Inotropic—increases force of Organic nitrates contraction, slows conduction CCBs & increases refractory period; Beta blockers so increases cardiac output Others Absorption variable; Excretion slow so accumulates Hypertension HF is major use Dysrhythmias Reduces symptoms & increase exercise tolerance Adverse Effects Headaches, drowsiness, flushing, fatigue, dizziness, edema. 1 & 2—reflex tachycardia 3 & 4-constipation/dysrhythmia 1.amlodipine not heart 2.nifedipine Postural hypotension and reflex tachycardia Dysrhythmias Anorexia* n/v Diplopia Dysrhythmias hydralazine—use for high 3.verapamil affects heart 4.diltiazem nitroprusside—acts fast, so used in ER for hypertensive emergency minoxidil—used in severe hypertension, but potential serious side effects. digoxin—used less frequently now because not proven to prolong life. Considered second line 5 Classes I—Sodium channel blockers II—Beta adrenergic blockers II—Potassium channel block IV—Calcium channel block V—Others Used less frequently now. I—quinidine adverse effects include CNS, and GI Many drug interactions No grapefruit juice Specific Drugs Many drug interactions. Drug Interactions Grapefruit juice inhibits metabolism so increases Comments toxicity. First line for AfricanAmerican population BP, HF & hypertensive crisis Unique—lupus like syndrome Effective dose is close to the toxic dose. Anorexia*--an early sign of toxicity (watch for it) Many drug interactions. Anti-dysrhythmias 528 Several categories. Both tachy and brady mechanisms. Changes in the EKG Dysrhythmias Organic Nitrates 548 Used for 100s of years. Works directly on smooth muscle to promote dilation of veins, so decrease in O2 demand Angina pectoris (sudden severe pain due to decreased oxygen supply, usually when demand is up) Headache Orthostatic hypotension and reflex tachycardia nitroglycerin Lots of different routes and durations. All hypotensive drugs especially beta blockers. Degrades easily (no light, heat, or moisture). Chemically it is the same as the nitro in explosives