Cardiac Pharm 3010 PDF

1. Hypertension Pathophysiology: Caused by factors like increased sodium intake, RAAS system dysfunction, aldosterone, and sympathetic nervous system activation. Pharmacology: Treatments include diuretics (loop, thiazide, potassium-sparing), calcium channel blockers, alpha/beta-blockers, vasodilato...

1. Hypertension Pathophysiology: Caused by factors like increased sodium intake, RAAS system dysfunction, aldosterone, and sympathetic nervous system activation. Pharmacology: Treatments include diuretics (loop, thiazide, potassium-sparing), calcium channel blockers, alpha/beta-blockers, vasodilators, and ACE inhibitors. 2. Coronary Artery Disease (CAD) Pathophysiology: CAD arises from atherosclerosis in the coronary arteries due to LDL cholesterol buildup leading to reduced blood flow. Pharmacology: Medications include antiplatelets, anticoagulants, calcium channel blockers, statins, and nitrates. 3. Congestive Heart Failure (CHF) Pathophysiology: A progressive disease where decreased cardiac output fails to meet bodily needs. It involves both left and right-sided heart failure, with symptoms like edema, hepatomegaly, and JVD. Pharmacology: Key drugs include ACE inhibitors, ARBs, vasodilators, diuretics, beta-blockers, and cardiac glycosides like digoxin. 4. Peripheral Arterial Disease (PAD) and Chronic Venous Insufficiency (CVI) PAD Pathophysiology: A chronic obstruction of peripheral arteries leading to partial or total arterial occlusion. Pharmacology: Includes antihypertensives, statins, and antiplatelets. CVI Pathophysiology: Long-term venous insufficiency due to faulty valves. Pharmacology: Steroids, antibiotics, anticoagulants. 5. Anticoagulants and Antiplatelets Anticoagulants: Includes heparin and warfarin, used to prevent clot formation, particularly in post-op patients or those at risk for DVT. Antiplatelets: Includes aspirin and clopidogrel, which prevent platelet aggregation, reducing clot risk. 6. Anemia Pathophysiology: Deficiency in necessary components for normal RBC function leads to reduced oxygen transport. Pharmacology: Iron supplements, vitamin B12, and other medications to manage anemia, with specific focus on treating conditions like iron deficiency or pernicious anemia. 1. Diuretics Loop Diuretics- ends in mide Drugs: Furosemide, Torsemide MOA: Block sodium and water reabsorption in the loop of Henle. Therapeutic Use: Rapid fluid removal, hypertension, heart failure. Complications: Dehydration, hypotension, ototoxicity, hypokalemia, nocturia. Interactions: Digoxin, NSAIDs, additive hypotension effects. Thiazide Diuretics- ends in ide Drugs: Hydrochlorothiazide MOA: Block sodium and water reabsorption in the distal convoluted tubule. Therapeutic Use: First-line treatment for essential hypertension and heart failure. Complications: Dehydration, hypokalemia, hyperglycemia, nocturia. Contraindications: Renal impairment. Potassium-Sparing Diuretics- ends in one Drugs: Spironolactone MOA: Block aldosterone, increasing sodium and water excretion while retaining potassium. Therapeutic Use: Hypertension, edema, heart failure. Complications: Hyperkalemia. Contraindications: Hyperkalemia, kidney or liver disease. Interactions: ACE inhibitors, ARBs. 2. Calcium Channel Blockers- ends in ine Drugs: Nifedipine, Amlodipine MOA: Block calcium channels in blood vessels, leading to vasodilation of vascular smooth muscle. Therapeutic Use: Lower blood pressure. Complications: Reflex tachycardia, orthostatic hypotension, peripheral edema. 3. Beta Blockers- ends in lol Drugs: Metoprolol, Atenolol (Beta 1), Propranolol (Beta 1 & 2), Carvedilol, Labetalol (Alpha & Beta) MOA: Block beta receptors in the heart, reducing heart rate and contractility; block renin release in kidneys. Therapeutic Use: Hypertension, heart failure, arrhythmias. Complications: Bradycardia, decreased cardiac output, orthostatic hypotension, bronchoconstriction (Beta-2), inhibited glycogenolysis (Beta-2). 4. Alpha Adrenergic Blockers Drugs: Prazosin (peripheral), Clonidine (central) MOA: Block alpha-1 receptors on arterioles for vasodilation; central drugs reduce sympathetic outflow. Therapeutic Use: Hypertension. Complications: First-dose orthostatic hypotension (peripheral), rebound hypertension (central). 5. Vasodilators- Drugs: Hydralazine MOA: Relax vascular smooth muscle, reducing blood pressure. Therapeutic Use: Hypertension. Complications: Reflex tachycardia. 6. ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors)- ends in pril Drugs: Captopril, Enalapril, Lisinopril MOA: Block conversion of angiotensin I to angiotensin II, leading to vasodilation and water excretion. Therapeutic Use: Hypertension, heart failure. Complications: First-dose hypotension, dry cough, hyperkalemia, neutropenia, adverse effect: angioedema. 7. ARBs (Angiotensin II Receptor Blockers)- end in sartan Drugs: Losartan MOA: Block angiotensin II receptors, leading to vasodilation and excretion of sodium and water. Therapeutic Use: Hypertension. Complications: Angioedema, hypotension. 8. Cardiac Glycosides Drugs: Digoxin MOA: Positive inotropic effect (increased contraction force), negative chronotropic effect (decreased heart rate). Therapeutic Use: Heart failure, dysrhythmias. Complications: Dysrhythmias (especially with hypokalemia), cardiotoxicity, GI effects (anorexia, nausea), CNS effects (vision changes, halos). 9. Statins (HMG-CoA Reductase Inhibitors)- ends in statin Drugs: Atorvastatin, Simvastatin MOA: Inhibit HMG-CoA reductase, reducing cholesterol production in the liver. Therapeutic Use: Prevention of cardiac events, stroke, and clot formation. Complications: Hepatotoxicity (liver damage), myopathy (muscle pain and tenderness). 10. Nitrates Drugs: Isosorbide Mononitrate MOA: Dilates veins, reducing venous return (preload), which decreases oxygen demand. Therapeutic Use: Prophylaxis of stable angina. Complications: Headache, orthostatic hypotension, reflex tachycardia. 11. Anticoagulants Examples: Warfarin, Heparin, Enoxaparin MOA: Warfarin: Inhibits vitamin K-dependent clotting factors. Heparin/Enoxaparin: Inhibits thrombin and factor Xa. Use: Prevent/treat DVT, PE, stroke in atrial fibrillation. Side Effects: Bleeding, thrombocytopenia. Contraindications: Active bleeding, pregnancy (for warfarin). Monitoring: INR (warfarin), aPTT (heparin). Antidote: Vitamin K (warfarin), protamine sulfate (heparin). 12. Antiplatelets Examples: Aspirin, Clopidogrel MOA: Aspirin: Inhibits thromboxane A2, reducing platelet aggregation. Clopidogrel: Blocks ADP receptors on platelets. Use: Prevention of MI, stroke, stent thrombosis. Side Effects: GI bleeding, hemorrhage. Contraindications: Active bleeding, peptic ulcers. 13. Vitamin B12 (Cyanocobalamin) MOA: Essential for DNA synthesis and red blood cell production. Use: Treat B12 deficiency, pernicious anemia. Side Effects: Rare, may include injection site reactions. Contraindications: Hypersensitivity to B12. Key Interactions Warfarin + Antiplatelets: Increases bleeding risk. NSAIDs + Anticoagulants/Antiplatelets: Heightened risk of GI bleeding. 1. Loop Diuretics (Furosemide) Monitor: Electrolytes (especially potassium and sodium levels). Blood pressure (risk of hypotension). Fluid balance (daily weight checks). Renal function (creatinine levels). 2. Potassium-Sparing Diuretics (Spironolactone) Monitor: Serum potassium (risk of hyperkalemia). Renal function (potassium retention worsens in kidney disease). Blood pressure (for both efficacy and hypotension). 3. Beta-Blockers (Metoprolol, Propranolol) Monitor: Heart rate (watch for bradycardia). Blood pressure (ensure it stays in therapeutic range). Signs of bronchospasm, especially in patients with asthma (for non-selective beta-blockers like propranolol). 4. ACE Inhibitors (Lisinopril) Monitor: Serum potassium (risk of hyperkalemia). Serum creatinine (watch for renal function decline). Cough (common side effect), or signs of angioedema (rare but serious). 5. ARBs (Losartan) Monitor: Serum potassium (risk of hyperkalemia, like ACE inhibitors). Blood pressure (ensure it is effectively controlled). 6. Calcium Channel Blockers (Nifedipine, Verapamil) Monitor: Blood pressure (risk of hypotension). Heart rate (risk of bradycardia for verapamil and diltiazem). Peripheral edema (common with nifedipine). 7. Cardiac Glycosides (Digoxin) Monitor: Serum digoxin levels (narrow therapeutic range). Electrolytes (particularly potassium). Heart rate (watch for bradycardia). Signs of toxicity (visual disturbances, gastrointestinal symptoms). 8. Statins (Atorvastatin, Simvastatin) Monitor: Liver enzymes (ALT/AST) for signs of liver damage. Muscle pain or weakness (early sign of myopathy or rhabdomyolysis). 9. Nitrates (Isosorbide Mononitrate) Monitor: Blood pressure (risk of hypotension). Frequency and severity of headaches (common side effect).