Transcript CARDIOVASCULAR DRUGS! - Anything to make this fun

CARDIOVASCULAR DRUGS!!!!!
Methyldopa
• Use?
• SE?
• Sympathoplegic, HTN
• Sedation, positive
coombs test
Reserpine
• Use?
• SE?
• Sympathoplegic, HTN
• Sedation, depression,
nasal stuffiness,
diarrhea
Hydrochlorothiazide
• Use?
• SE?
• Diuretic, HTN
• Hypo-K, Hyperlipidemia,
hyperuricemia,
lassitude, Hyper-Ca,
Hyperglycemia
Clonidine
• Use?
• SE?
• Sympathoplegic, HTN
• Dry mouth, sedation,
severe rebound HTN
Guanethidine
• Use?
• SE?
• Sympathoplegic, HTN
• Orthostatic & exercise
hypotension, diarrhea,
sexual dysfxn 
Nitroglycerin, Isosorbide Dinitrate
• Use?
• MOA?
• Vasodilator—angina, pulm edema,
aphrodisiac/erection enhancer 
• Releases NO from smooth muscle:
increased cGMP  relaxation.
Veins> Arteries
– Which does Arteries > Veins?
– HYDRALAZINE
• Decreased Preload or • PRELOAD
Afterload?
• Tachycardia, Flushing, HA,
• Toxicity
hypotension, Monday Disease—
decreased tolerance over weekend
 tach, dizziness and HA on
reexposure
Prazosin
• Use?
• SE?
• Sympathoplegic, HTN
• Orthostatic hypotension
with 1st dose, dizziness,
headache
Diazoxide
• Use?
• SE?
• Vasodilator, HTN
• Hyperglycemia,
decreased insulin
release, hypotension
Beta blockers
• Use?
• SE?
• Sympathoplegic, HTN
• Impotence , asthma,
cardiovascular effects
(bradycardia, CHF, AV
block), CNS effects—
sedation and changes in
sleep
Hydralazine
• Use?
• Mechanism
of Action?
• Reduces
preload or
afterload?
• SE?
• Vasodilator, severe HTN, CHF
• Increased cGMP  smooth muscle
relaxation. Arterioles > veins.
• AFTERLOAD (Vasodilator!)
• Nausea, Headache, Lupus-like syndrome,
reflex tachycardia (don’t use in agina or
CAD!), angina, salt retention
• Use with beta blocker to avoid tachycardia
and with a diuretic to avoid salt retention
Minoxidil
• Use?
• Mechanism
of Action?
• SE?
• Vasodilator, HTN
• K channel opener, hyperpolarizes
smooth muscle cells
• HAIRY MONSTER, pericardial
effusion, reflex tachycardia, angina,
salt retention
• Use with beta blocker to avoid
tachycardia and with a diuretic to
avoid salt retention
Captopril
• Use?
• Other Examples?
• SE?
• ACE Inhibitor, HTN
• Enalapril, Fosinopril
• Hyper-K, cough,
angioedema, taste
changes, hypotension,
fetal renal damage,
rash, increased renin
Hexamethonium
• Use?
• SE?
• Sympathoplegic, HTN
• Severe orthostatic
hypotension, blurry
vision, constipation,
sexual dysfxn 
Verapamil
• Use?
• MOA?
• More cardiac or
smooth muscle
effects?
• SE?
• Toxicity?
• Calcium Channel Blocker,
HTN, angina, arrhythmias,
Raynaud’s
• Blocks Voltage Dependant Ltype Ca channels,
decreasing contractility
• Cardiac, but also vasodilator
• Dizziness, flushing,
constipation, AV block,
Nausea
• Cardiac depression,
peripheral edema, flushing,
dizziness, constipation
HOW DO YOU TREAT MALIGNANT
HYPERTENSION???
• Three drugs in alphabetical order
– #1: DIAZOXIDE
• MOA?
– K channel opener—hyperpolarizes smooth muscle
– #2: Fenoldopam
• MOA?
– Dopamine1 Receptor Agonist: relaxes vascular smooth muscle
– #3: Nitroprusside
• MOA?
– Increased cGMP via direct NO release
• SE?
– CYANIDE POISONING!!!
Nitroprusside
• Use?
• SE?
• Vasodilator, HTN
• Cyanide Poisoning
(Releases CN!)
WHICH TWO DRUGS ARE THE
HYPERTENSION IN PREGNANCY
SUPERSTAR MEDS?
(Which are ok to use in Pregnancy?)
HYDRALAZINE &
METHYLDOPA
This, on the other hand is NOT safe in pregnancy…. 
Diltiazem
• Use?
• MOA?
• More cardiac or
smooth muscle
effects?
• SE?
• Toxicity?
• Calcium Channel Blocker,
HTN, angina, arrhythmias,
Raynaud’s
• Blocks Voltage Dependant Ltype Ca channels,
decreasing contractility
• Somewhere in the middle
• Dizziness, flushing,
constipation, AV block,
Nausea
• Cardiac depression,
peripheral edema, flushing,
dizziness, constipation
Losartan
• Use?
• Good alternative to
what?
• SE?
• Angiotensin II Receptor
Blocker, HTN
• ACE Inhibitors
• Fetal renal toxicity,
Hyper-K
Nifedipine
• Use?
• MOA?
• More Cardiac
or Smooth
Muscle
Effects?
• SE?
• Toxicity?
• Calcium Channel Blocker, HTN,
angina, Raynaud’s
• Blocks Voltage Dependant L-type
Ca channels, decreasing
contractility
• Smooth muscle—vasodilator
• Dizziness, flushing
• Cardiac depression, peripheral
edema, flushing, dizziness,
constipation
CHOLESTEROL DRUGS
• Which is best for decreased triglycerides?
– Fibrates
– Examples?
• Gemfibrozil, Clofibrate, Bezafibrate, Fenofibrate
• Which are best for decreasing LDL?
– Statins
– MOA?
• HMG CoA reductase inhibitors—inhibit cholestrol precursor:
mevalonate
• Which do patients hate taking because of GI
disturbances?
– Bile Acid Resins: Cholestyramine & Colestipol
• What are two other possible drugs you could use?
– Cholesterol Absorption Blockers (Ezetimibe) and Niacin
Anti-arrhythmics—BIG PICTURE
CLASS
Class I
Class II
Class III
Class IV
General MOA
Anti-arrhythmics—BIG PICTURE
CLASS
General MOA
Class I
Block FAST sodium channels responsible for phase 0 depolarization
Quinidine, Flecanide, Procainamide…
Class II
Class III
Class IV
Anti-arrhythmics—BIG PICTURE
CLASS
General MOA
Class I
Block FAST sodium channels responsible for phase 0 depolarization
Quinidine, Flecanide, Procainamide…
Class II
Beta Adrenergic Receptor Antagonists
Propranolol, Metoprolol…
Class III
Class IV
Anti-arrhythmics—BIG PICTURE
CLASS
General MOA
Class I
Block FAST sodium channels responsible for phase 0 depolarization
Quinidine, Flecanide, Procainamide…
Class II
Beta Adrenergic Receptor Antagonists
Propranolol, Metoprolol…
Class III
Prolong action potential with little effect on phase 0
depolarization, mostly via blocking the K repolarizing current
Amiodarone, Sotalol, Ibutilide…
Class IV
Anti-arrhythmics—BIG PICTURE
CLASS
General MOA
Class I
Block FAST sodium channels responsible for phase 0 depolarization
Quinidine, Flecanide, Procainamide…
Class II
Beta Adrenergic Receptor Antagonists
Propranolol, Metoprolol…
Class III
Prolong action potential with little effect on phase 0
depolarization, mostly via blocking the K repolarizing current
Amiodarone, Sotalol, Ibutilide…
Class IV
Block slow L-type Calcium Channels
Verapamil, Diltiazem
Class I Drugs:
Broken up by degree of Na channel blockade and effect on AP duration
CLASS IA Drugs
• MOA?
– Moderate blockade of Na channels = raise AP threshold and slow AP
upstroke. Also depress slope of phase 4 depolarization.
• Uses?
– Ectopic foci and reentrant rhythms
– Atrial AND Ventricular Arrhythmias
• Examples?
– Quinidine, Amiodarone, Procainamide, Disopyramide
• SE
– Quinidine
• Cinconchism: HA, tinnitus, thrombocytopenia
• Increase AP duration, increased effective refractory period, increase QT
interval (increased risk of what?)
• Torsades de points
– Procainamide
• Reversible SLE-like syndrome
Class I Drugs:
Broken up by degree of Na channel blockade and effect on AP duration
CLASS IB Drugs
• MOA?
– Bold Na channels, but unlike IA’s shorten duration of
AP and refractory period
• Uses?
– Preferentially act on diseased tissue: ischemic or
depolarized Purkinje/ventricular tissue.
– Great post-MI and for dig-induced arrhythmias
• Examples?
– Lidocaine, Mexiletine, Tocainide, Phenytoin?
• SE
– CNS depression/stim and cardiovasc depression
Class I Drugs:
Broken up by degree of Na channel blockade and effect on AP duration
CLASS IC Drugs
• MOA?
– Most potent sodium channel blockers! Decrease upstroke
of AP and conduction velocity everywhere!
– No change in AP duration
• Uses?
– Vtachs that progress to VF and intractable SVT
– LAST RESORT FOR REFRACTORY TACHYARRHYTHMIAS
• Examples?
– Flecanide, Encainide, Propafenone
• SE
– Proarrhythmic, esp post MI: avoid in those with heart
diseaseincreased mortality!
– Prolonged refractory period in AV node.
Class II Drugs
• MOA?
– Beta blockers: decreased cAMP and Ca currents. Decrease slope
of phase 4 depolarization. AV node very sensitive.
• Uses?
– Abnormal pacemakers, Vtach, SVT, slow ventricular rate in a-fib
or a-flutter
• Examples?
– Propranolol, Esmolol, Metoprolol, Atenolol, Timolol
– Which one is super short acting?
• ESMOLOL
• SE
– Impotence , asthma exacerbation, bradycardia, AV block,
CHF,sedation, sleep changes
– Why use with caution in diabetics?
• Mask effects of hypoglycemia
– Metoprolol
• Dyslipidemia
Class III Drugs
• MOA?
– Potassium Channel Blockers: increase AP duration
• Uses?
– used when other drugs fail
• Examples?
– Sotalol, Ibutilide, Bretylium, Amiodarone
– Which is good for Wolf-Parkinson-White?
• Amiodarone
• SE
– Sotalol
• Increased QT Interval—why is this bad?
– Increased risk of torsades de points
• Excessive beta block
– Ibutilide
• Torsades
– Bretylium
• Arrhythmias, hypotension
– Amiodarone
• Pulm fibrosis, corneal deposits, Hepatotoxicity, photodermatitis, Neuro SE, constipation,
bradycardia, heart block, hypothyroid, hyperthyroid
• CHECK PFT’s, LFTs, and TFTs!!
Class IV Drugs
• MOA?
– Calcium Channel Blockers: AV node: decreased
conduction.
– Uses?
• Especially good for?
– SVTs
• Examples?
– Verapamil and Diltiazem for Anti-arrhythmics
• SE
– Constipation, flushing, edema, CV effects,
torsades
Adenosine
• MOA
– Increased K efflux: hyperpolarization.
• Drug of choice for which conditions?
– AV nodal arrhythmias.
• Short or long acting?
– Very short (~15 Seconds)
• Toxicity
– Flushing, Hypotension, Chest pain
Potassium
• MOA
– Decreases ectopic pacers in hypokalemia
• Drug of choice for which conditions?
– Dig toxicity
Magnesium
• Drug of choice for which conditions?
– Torsades and dig toxicity