Pharmacology Week 3 Cardiology Part 2 (SC)

Drugs used in AnginauMedicines to ease chest painuGTN spray (glyceryl trinitrate spray)uWorks by widening blood vessels, letting more blood and oxygen reach your heart.uMedicines to prevent anginauBeta-blockers, Calcium channel blockers, Isosorbide mononitrateuMedicines to reduce further heart probl...

Drugs used in AnginauMedicines to ease chest painuGTN spray (glyceryl trinitrate spray)uWorks by widening blood vessels, letting more blood and oxygen reach your heart.uMedicines to prevent anginauBeta-blockers, Calcium channel blockers, Isosorbide mononitrateuMedicines to reduce further heart problemsuStatins to lower cholesterol, aspirin or other blood thinning medicines to reduce the chance of blood clots developing, medicines to control blood pressure. Arrhythmia-a heart rhythm disorderuAtrial fibrillation is the most common type of arrhythmia. It can cause stroke and heart failure.uhttps://vimeo.com/294263776 Drugs used in Arrhythmias Digoxin-cardiac glycosidesuDigoxin is a cardiac glycoside that increase the force of myocardial contraction and reduces conductivity within the atrioventricular (AV) node.uUsed to treat heart failure and atrial fibrillation Hyperlipidemia-high cholesterol uhttps://www.youtube.com/watch?v=bx99qQoHk5I&t=73s Cholesterol score Reasons for use of drugs n HyperlipidemiauPrevent premature atherosclerosis developmentuLessen the risk of CAD and MIuPrevent unsightly atheroma, xanthelasmasuReduce progression of atheromauCause regression of existing atheromatous plagues Cholesterol lowering medicationsuStatinssuch as simvastatin, atorvastatin, pravastatin, rosuvastatinuFibratessuch as bezafibrateuBile acid sequestrants such as colestipol, cholestyramineuEzetimibeuNicotinic acidderivatives such as Acipimox StatinsuMore effective than other lipid-regulating drugs at lowering LDL-cholesterol concentration but they are less effective in reducing triglyceride concentration.uRecommended for all patients with a total cholesterol : HDL –cholesterol ration > 8 and those with familial hypercholesterolemia. uCaution in patients with hypothyroidism and hepatic impairmentuAvoid in active liver disease and pregnancy and breast-feedinguAdverse effects are: myalgia, myopathy, myositis and rhabdomyolysisuStatins can cause hyperglycaemia and may be associated with the development of diabetes mellitus, particularly in those already at risk of the condition. FibratesuFibrates act mainly by decreasing serum triglycerides, effect on LDL-cholesterol is minimal and HDL-cholesterol usually increases. uThey are recommended for diabetics with a high cardiovascular risk in whom diet, lifestyle modification.uThe fibrate should be introduced as a second agent after a statin or as monotherapy in those who have establishedstatin intolerance. uFibrates may be used as monotherapy or with acipimoxin those with very high serum triglyceride levels (greater than 10 mmol/litre) to reduce the risk of acute pancreatitis; statins are not effective in modifying the pancreatitis risk.uFibrates can cause a deterioration in renal function. This is usually reversible with treatment cessation. uCombination of a fibrate with a statin should be used with caution; the risk of muscle effects (especially rhabdomyolysis) is increased. Bile acid sequestrantsuAct by binging bile acids, preventing their reabsorption; this promotes hepatic conversion of cholesterol into bile acids; the resultant increased LDL receptor activity of liver cells increases the clearance of LDL-cholesterol from the plasma.uEffectively reduce LDL-cholesterol but can aggravate hypertriglyceridaemia.uInterfere with the absorption of fat-soluble vitamins; supplements of vitamins A, D, K, and folic acid may be required when treatment is prolonged.uAdverse effects are mainly gastro-intestinal such as constipation, diarrhoea, nausea, vomiting and gastro-intestinal discomfort. EzetimibeuInhibits the intestinal absorption of cholesterol with a modest effect on lowering LDL-cholesterol, and little effect on other lipoprotein.uWhen used in combination with a statin it may further reduce cardiovascular risk but increase the risk of rhabdomyolysis.uNot recommended as monotherapy. Nicotinic acid derivativesuThe effectiveness of nicotinic acid derivatives in preventing cardiovascular disease has not been demonstrated.uUse should be limited to patients with familial hypercolesterolaemiaunder specialist care.