Cardiovascular System Medications PDF

1 Beta-blockers- slow down the heart, so monitor HR as it slows, lowering heart rate CARDIOVASC...

1 Beta-blockers- slow down the heart, so monitor HR as it slows, lowering heart rate CARDIOVASCULAR SYSTEM MEDICATIONS CLASSIFICATION THERAPEUTIC MECHANISM OF ACTION ADVERSE EFFECTS DRUG EXEMPLARS USES/INDICATIONS Angiotensin-conver Hypertension Blocks formation of angiotensin II Related to the effects of vasodilatation captopril (Capoten) ting enzyme (ACE) Heart failure causing: and alterations in blood flow lisinopril (Zestril) inhibitors MI a. vasodilation Generally well tolerated enalapril (Vasotec) Diabetic nephropathy b. excretion of aldosterone, Na & water Serious allergic reactions including fosinopril(Monopril) c. reduction in pathological changes to angioedema blood vessels and heart Hyperkalemia d. results in increase serum potassium. Captopril, moexipril, perindopril: more serious effects Angiotensin II Hypertension Blocks angiotensin II receptors leading Headache, dizziness, syncope, losartan (Cozaar) receptor blockers Heart failure to: weakness irbesartan (Avapro) (ARBs) MI a. vasodilation GI complaints valsartan (Diovan) Diabetic nephropathy b. excretion of aldosterone, Na & water Dry mouth and tooth pain Symptoms of upper respiratory infections and cough Rash, dry skin, alopecia Aldosterone Heart failure post MI Blocks aldosterone receptors in kidney eplerenone (Inspra) antagonists Hypertension leading to: spironolactone a. increased excretion of Na & water (Aldactone) b. reduced blood volume Calcium channel Hypertension 1) Slows movement of calcium into Related to effects on cardiac output Selective for blood blockers (CCBs) Angina smooth muscle cells leading to: CNS effects vessels: Cardiac dysrhythmias a. vasodilation GI effects nifedipine(Procardia) 2) Slows calcium channels in CV effects (bradycardia, peripheral amlodipine(Norvasc) myocardium leading to: edema, and hypotension) a. decreased force of contraction Skin flushing and rash Non-selective for both b. decreased heart rate blood vessels & heart: c. slowed conduction through AV node verapamil (Calan)  2 diltiazem(Cardizem) Alpha1 adrenergic Hypertension Selectively blocks alpha1 adrenergic Extensions of therapeutic effects doxazosin (Cardura) blockers receptors in arterioles leading to: Headache, weakness, dizziness in prazosin (Minipress) a. vasodilation response to hypotension Nausea, vomiting, diarrhea Centrally acting Hypertension Stimulates alpha2 receptors in the brain, clonidine (Catapres) alpha2 agonists which results in relaxation of arteries, vasodilation, slowing of HR, and decreased cardiac output. Cardioselective Hypertension Blocks beta receptors in myocardium Related to blocking of beta1-receptors metoprolol(Lopressor) Beta1 blockers Angina leading to: in SNS atenolol (Tenormin) Heart failure a. decreased force of contraction CNS effects Tachydysrhythmias b. decreased heart rate CV effects MI c. slowed conduction through AV node Pulmonary effects Also blocks beta1 receptors in kidney, GI effects reducing release of renin, angiotensin II GU effects leading to vasodilation Decreased exercise tolerance, hypoglycemia or hyperglycemia. Liver changes Non-selective Beta1 Same as above + Blocks beta1 receptors in myocardium Usually associated with effects on SNS propranolol (Inderal) & Beta2 Blockers Cardiac dysrhythmias and kidney as above and also beta2 GI effects carvedilol (Coreg) receptors in lungs CV effects labetalol (Trandate) Respiratory effects Other effect Vasodilators Hypertensive Centrally acting vasodilator that results Related to changes in BP nitroprusside emergencies in rapid reduction of blood pressure, Cyanide toxicity (Nitropress) preload, & afterload Cardiac glycosides Heart failure Inhibits Na/K/ATPase (enzyme needed Most frequently seen: headache, digoxin Atrial fibrillation for pumping Na ions out of heart cells. weakness, drowsiness, and vision As Na accumulates in the cells, calcium changes ions are released producing: GI upset and anorexia a. increased force of contractions Arrhythmias b. improved stroke volume & CO Digoxin toxicity  3 Also acts to suppress SA – AV node conduction reducing heart rate Diuretics HTN Thiazide Lasix Antilipemic HMG-CoA Hypercholesterolemia Interferes with hepatic enzyme GI effects atorvastatin (Lipitor) reductase Prevention of MIs HMG-CoA to reduce cholesterol CNS effects inhibitors (Statins) precursors. Decreases manufacture of Hepatotoxicity LDL & VLDL Rhabdomyolysis Increases manufacture of HDL Cholesterol Same as above Inhibits intestinal absorption of Mild abdominal pain and diarrhea ezetimibe (Zetia) absorption inhibitor cholesterol secreted in bile and food Headache, dizziness, fatigue, upper respiratory tract infection, back pain, muscle aches and pain Hepatitis (rare) Bile-acid Same as above Binds to bile acids in intestine, causing Headache, anxiety, fatigue, drowsiness colesevelam (Welchol) sequestrants increased excretion of cholesterol. Direct GI irritation: nausea, constipation, aggravation of hemorrhoids Increased bleeding time Vitamin A and E deficiencies Rash Muscle aches and pains Nicotinic acid Same as above Decreases LDL & triglycerides synthesis niacin (Niacin) Fibrates Same as above Decreases triglyceride production and gemfibrozil (Lopid) transport. Increases HDL precursors