Cardiovascular Drugs PDF
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Joseph Peter V. Arguillas, MD
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This presentation covers cardiovascular drugs, focusing on different types and their mechanisms of action, uses, and side effects. It details various drug categories like diuretics, sympathoplegics, vasodilators, and calcium channel blockers.
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# Cardiovascular Drugs Joseph Peter V. Arguillas, MD ## Cardiovascular Drugs * Drugs for Hypertension * Drugs for Angina Pectoris * Drugs for Heart Failure * Drugs for Arrhythmia * Drugs for Dyslipidemia ## Drugs Used In Hypertension * Diuretics * Hydrochlorothiazide, Furosemide * Sympathop...
# Cardiovascular Drugs Joseph Peter V. Arguillas, MD ## Cardiovascular Drugs * Drugs for Hypertension * Drugs for Angina Pectoris * Drugs for Heart Failure * Drugs for Arrhythmia * Drugs for Dyslipidemia ## Drugs Used In Hypertension * Diuretics * Hydrochlorothiazide, Furosemide * Sympathoplegics * Clonidine, Prazosin, Metoprolol * Vasodilators * Hydralazine, Minoxidil * Angiotensin Antagonists * Captopril, Losartan * Renin Inhibitors * Aliskeren ## Diuretics * Lower blood pressure by decreasing volume and direct vascular effect * **Two main types of diuretics for hypertension** * 1) Thiazide Diuretics * 2) Loop Diuretics ## Thiazide Diuretics * **Hydrochlorothiazide, Chlorthalidone, Metolazone** * MOA: Inhibits Na/Cl transporter in the Distal Convoluted Tubules * Uses: Hypertension, Heart Failure * SE: Hypokalemic Metabolic Acidosis ## Loop Diuretics * Furosemide, Torsemide, Ethacrynic Acid * MOA: Inhibit Na/K/2Cl transporter in the thick ascending Loop of Henle * Uses: Heart Failure, Pulmonary Edema * Very effective in edematous states and fluid overload * **SE: OH DANG!** * Ototoxicity * Hypokalemia * Dehydration * Allergy to Sulfa * Nephritis * Gout ## Sympathoplegics * Drugs interfere with sympathetic control of cardiovascular function * By reducing the following: venous tone, heart rate, contractile force of the heart, cardiac output and total peripheral resistance. * Indications: * Hypertension * Clonidine, Alpha-1-blockers, Beta Blocks * Pre-eclampsia ## Sympathoplegics * Centrally Acting Alpha 2 Agonist * Clonidine * Methyldopa * Adrenergic Blockers * Alpha Adrenergic Blockers * Prazosin, Doxazosin, Terazosin, Tamsulosin * Beta Adrenergic Blockers * Metoprolol, Propanolol, Atenolol, Nebivolol, Esmolol, Carvedilol ## Centrally Acting Alpha 2 Agonists * Clonidine (Catapres) * Treats high blood pressure by decreasing heart rate and relaxing the blood vessels * SE: Rebound hypertension, dry mouth * Taper before discontinuing to avoid rebound hypertension * Methyldopa (Aldomet) * Most commonly used maintenance medications for **hypertension in pregnancy** * SE: Hemolytic anemia ## Adrenergic Blockers * Alpha blockers * Prazosin, Doxazosin, Terazosin, Tamsulosin, Silodosin, Alfuzosin * Uses: **Benign Prostatic Hyperplasia** - enlarged prostate gland * SE: First dose syncope/Orthostatic hypertension * Tamsulosin: most selective for prostatic smooth muscle * Beta blockers * Metoprolol, Propanolol, Atenolol, Nebivolol, Esmolol, Carvedilol * Uses: Hypertension, Migraine, Glaucoma * SE: Heart Failure, erectile dysfunction * Must not be given in Acute Heart Failure * Can be used in Chronic Heart Failure ## Vasodilators * Medications that open/dilate the blood vessels * Affects the muscles in the walls of the arteries and veins * Prevents muscles from tightening and the walls from narrowing * As a result, blood flows more easily through the vessels * The heart doesn't have to pump as hard and this reduces blood pressure ## Vasodilators * Oral Vasodilators * Hydralazine * Uses: Preeclampsia, Hypertension * SE: **Severe psychiatric depression, suicidal ideation** * Minoxidil * Uses: **Alopecia**, Hypertension * SE: Hirsutism, Angina, Drug Induced Lupus * Minoxidil stimulates hair follicles ## Vasodilators * Parenteral Vasodilators * Nitroprusside * MOA: Relaxes venous and arteriolar smooth muscle by increasing NO → ↑ cGMP → **smooth muscle relaxation** * Uses: Hypertensive emergency, Acute heart failure * SE: Cyanide toxicity, hypotension, headache * **Most effective vasodilator** * Fenoldopam * MOA: Arteriolar vasodilation of afferent and efferent arterioles. Increases renal blood flow * Uses: Hypertensive emergency * SE: Hypotension, Hypokalemia ## Calcium Channel Blockers * Medications that lower blood pressure and treat symptoms such as chest pain and irregular heartbeat * Block the L-type calcium channels in the body * Stops calcium from entering the cells of the heart and the arteries * Calcium causes the heart and arteries to squeeze more strongly * By blocking Calcium, CCBs allow blood vessels to relax and open * Calcium Channel Blockers * 1) Non-dihydropyridine CCB * Verapamil, Diltiazem * 2) Dihydropyridine CCB * Amlodipine, Nicardipine * Common SE: Constipation, Pretibial Edema ## Calcium Channel Blockers * Non-Dihydropyridine CCB * **Verapamil,** * MOA: Cardiac > Vascular * **More cardioselective CCB** * Preferred CCB for arrhythmia * Uses: Supraventricular tachycardia (SVT) * SE: **Gingival hyperplasia (Verapamil)** ## Calcium Channel Blockers * Dihydropyridine CCB * Amlodipine, Nifedipine, Felodipine, Nicardipine * MOA: Vascular > Cardiac * **More selective for blood vessels** * Uses: Hypertension, Angina ## RAAS Antagonist Drugs * Indications: mainly used for hypertension, heart failure, diabetic nephropathy * ACE Inhibitors and ARBs - Teratogens * Contraindications: Pregnancy ## ACE Inhibitors * Captopril, Enalapril, Lisinopril, Benazepril * MOA: inhibits ACE and formation of Angiotensin II, decreased aldosterone secretion * SE: Cough, Angioedema, Teratogenic * Notes: short duration of action: 10 mins * Captopril has a short half-life, requires 2-4x a day administration * 10% of patients experience dry cough * Do not give to patients with bilateral renal artery stenosis since ACE Inhibitors can decrease the GFR if the stenotic kidney.