Cardiovascular Drugs PDF

PHARMACOLOGY Cardiovascular Medication CARDIAC CYCLE Drugs Facts about Heart The First heart cell starts to beat as early as four weeks Everyday your heart beats 100 000 times Your heart is no bigger than the size of your fi...

PHARMACOLOGY Cardiovascular Medication CARDIAC CYCLE Drugs Facts about Heart The First heart cell starts to beat as early as four weeks Everyday your heart beats 100 000 times Your heart is no bigger than the size of your fist Each minute your heart pumps 5 liters of blood Happiness helps to lower risk of heart disease. CARDIOVASCULAR SYSTEM Is a closed system of blood vessels, RENIN-ANGIOTENSIN-ALDOSTERONE responsible for delivering oxygenated SYSTEM blood to the tissues Removing waste product from the RAAS system tissues Compensatory system that activates Flows from higher pressure to areas of when BP in kidney fall lower pressure Low BP or poor oxygenation causes Move blood throughout the body the release of renin from juxtaglomerular cells (a group of cell that monitors BP and flow into the BLOOD PRESSURE glomerulus) Pressure system is controlled by specific areas of the brain and various hormones If the pressure becomes too HIGH = Hypertensive If the pressure becomes too LOW = Hypotensive SEVERE LOW BP is called Hypovolemic Shock and it is a life threatening situation. Maintaining BP with normal limits is the main goal of drug therapy Determined both by: 1. Amount of blood your heart pumps 2. Amount of resistance to blood flow in your heart arteries The more blood your heart pumps and KEY COMPONENTS the narrower your arteries, the higher your blood pressure. 1. RENIN: An enzyme secreted by the cholesterol, calcium and other juxtaglomerular cells of the kidney in substances response to low blood pressure, low sodium levels, or SNS stimulation. BLOOD PRESSURE CATEGORY 2. ANGIOTENSIN: A protein produced by the liver, which is converted into Angiotensin 1 by renin. 3. ANGIOTENSIN 1: An inactive precursor that is converted into Angiotensin II primarily by the action of the angiotensin-converting enzyme (ACE) in the lungs. 4. ANGIOTENSIN 2: A potent vasoconstrictor that increases the blood pressure and stimulates the release of aldosterone from the adrenal glands 5. ALDOSTERONE: A hormone that promotes sodium and water retention by the kidneys, which helps increase blood ANTI-HYPERTENSIVE MEDICATIONS pressure. 6. ANTIDIURETIC HORMONES (ADH); Released from the pituitary gland, it also ANGIOTENSIN-CONVERTING- ENZYME helps the kidneys retain water. INHIBITORS (ACEI) ANTIHYPERTENSIVE ANGIOTENSIN 2 RECEPTOR BLOCKER (ARB) WHAT IS HYPERTENSION? High Blood Pressure is a long term force of the blood against your arterial ALPHA BLOCKER wall May eventually cause health problems such as heart disease (Coronary Artery and Cardiovascular Disease). BETA BLOCKER (-olol) ARTERIOSCLEROSIS Beta blockers lower pressure primarily by blocking the sympathetic sumisikip ang wall activation of beta -1 receptors in the A condition where the arteries become heart, narrowed and hardened due to buildup Blocks beta -1 receptors in the heart, of plaque (fats) in the artery wall thereby preventing sympathetic ATHEROSCLEROSIS catecholamines such as norepinephrine and epinephrine from Atherosclerosis is a pattern of the binding. This causes decreased heart disease arteriosclerosis, characterized rate, stroke volume, cardiac output, by development of abnormalities called and blood pressure. lesions in walls of arteries Atherosclerosis is a gradual buildup of plaque in the walls of arteries. Plaque BETA BLOCKER CLASSIFICATION is a sticky substance made of fats,  Non- cardioselective - acts in both B1 Asthma and B2 receptors Sick Sinus Syndrome Cardioselective- Acts selectively on B1 Severe Peripheral Vascular Disease receptors (present in heart) Second or Third degree of Heart Attack Relative: COPD Raynaud Phenomenon Bradycardia Hypoglycemia- prone in diabetics in whom the early and warning symptoms of hypoglycemia may be maske CALCIUM CHANNEL BLOCKER (-ine) Blocked the calcium channels located on vascular smooth muscle cells and cardiac muscle cells. There are 2 main types of calcium \ channel blockers based on their main site of action: ➔ DIHYDROPYRIDINES - BETA BLOCKER SIDE EFFECTS predominately target the calcium channel of blood vessels and cases B Bronchodilation Bradycardia vasodilation to treat hypertension A Arrhythmias ➔ NON-DIHYDROPYRIDINES - predominately target the calcium channel of the heart L Lethargy and causes decreased heart rate and cardiac contraction D Disturbance glucose to treat tachydysrhythmias. metabolism CALCIUM CHANNEL CLASSIFICATION F Fatigue DIHYDROPYRIDINES- ends with “ine” NON-DIHYDROPYRIDINES - have no I Insomnia “ine”. S Sexual Dysfunction DIHYDROPYRIDINES NON-DIHYDROPYRIDI NES H Hypotension Amlodipine Verapamil Nicardipine Diltiazem Nifedipine BETA BLOCKER CLASSIFICATION Nimodipine ABSOLUTE:  Potassium Sparing Felodipine Thiazine CALCIUM CHANNEL BLOCKERS USES Mnemonic: CHASMA CARBONIC ANHYDRASE INHIBITORS (CAI) (-mide) C Cerebral Vasospasm Inhibits the action of the enzyme carbonic anhydrase, the catalyst for H Hypertension the formation of sodium bicarbonate stored as alkaline reserve in the renal A Angina tubules and is important for the excretion of hydrogen. S Supraventricular tachyarrhythmias It slows down the movement of the M Migraine hydrogen ions which leads greater amount of sodium and bicarbonate lost A Atrial flutter, fibrillation in the urine CAI MEDICATION CALCIUM CHANNEL BLOCKERS SIDE EFFECTS ACETAXOLAMIDE SHEDS METHAZOLAMIDE ➔ Steven Johnson Syndrome DORZOLAMIDE ➔ Headache BRINZOLAMIDE ➔ Edema DICLOFENAMIDE ➔ Dizziness ETHOXZOLAMIDE ZONISAMIDE GAPS ➔ Gingival Hyperplasia ➔ Angina CAI INDICATIONS ➔ Palpitations Treatment of glaucoma. Inhibits of ➔ Sleepiness carbonic anhydrase results in decreased secretion of aqueous humor of the eyes. DIURETICS Also used as adjunct to other diuretics Also called water pills, are medications when more intense diuresis is needed designed to increase the amount of Use of diuretics to influence fluid shifts water and salt expelled from the body in pregnant patients is not appropriate. as urine. However, it should not be stopped if To Prevent : (heart failure, liver failure, indicated for specific medical cause tissue swelling (edema), kidney provided that they are made aware of disorder) the possible effects on the fetus. Lactating women should switch to an alternative method of feeding as this drug may have potential effect on the TYPES OF DIURETICS baby. Carbonic Anhydrase Inhibitors LOOP Diuretics CAI PHARMACOKINETICS Osmotic Diuretic  Salicylate, Lithium: increased ROUTE onset peak duration excretion of these drugs oral 1h 2-4h 6-12h sustained-release 2h 8-12h 18-24h oral OSMOTIC DIURETICS This type of diuretic exerts their IV 1-2 15-18 4-5h therapeutic effect by pulling water Into min min renal tubules without loss of sodium, T1/2: 5-6h Only one osmotic diuretic is currently Metabolism: N/A available, MANNITOL (Osmitrol). Excretion: urine MANNITOL; is a sugar that is not well reabsorbed by the tubules and it acts CAI CONTRADICTIONS AND CAUTIONS to pull large amounts of fluid into the Allergy to carbonic anhydrase urines due to osmotic pull exerted by inhibitors, thiazides, antibacterial large sugar molecule. sulfonamides. Prevent severe This also pulls fluid into the vascular hypersensitivity reactions system from ex Chronic non congestive angle-closure glaucoma. Not effectively treated by this drug. Fluid and electrolyte imbalance, renal or hepatic disease, adrenocortical insufficiency, respiratory acidosis, chronic obstructive pulmonary disease (COPD). Could be exacerbated by fluid and electrolyte changes caused by these drugs. Pregnancy and Lactation. can cause potential adverse effects to the fetus and the baby. Routine use of this drug in pregnancy is not appropriate and should be used only when there are underlying pathological conditions. For Lactating women, an alternative method of feeding should be instituted. CAI ADVERSE EFFECTS CNS; Paresthesia, confusion, drowsiness CV; Hypotension GU; Hypokalemia (can precipitate hyperglycemia), increased loss of bicarbonate (can lead to metabolic acidosis) CAI INTEARCATIONS