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7/31/2019 Cardiovascular Drugs1
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CARDIOVASCULAR DRUGS!!!!!
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Methyldopa
Use?
SE?
Sympathoplegic, HTN
Sedation, positive
coombs test
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Reserpine
Use?
SE?
Sympathoplegic, HTN
Sedation, depression,
nasal stuffiness,
diarrhea
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Hydrochlorothiazide
Use?
SE?
Diuretic, HTN
Hypo-K, Hyperlipidemia,
hyperuricemia,
lassitude, Hyper-Ca,Hyperglycemia
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Clonidine
Use?
SE?
Sympathoplegic, HTN
Dry mouth, sedation,
severe rebound HTN
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Guanethidine
Use?
SE?
Sympathoplegic, HTN
Orthostatic & exercise
hypotension, diarrhea,
sexual dysfxn
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Nitroglycerin, Isosorbide Dinitrate
Use?
MOA?
Decreased Preload orAfterload?
Toxicity
Vasodilatorangina, pulm edema,aphrodisiac/erection enhancer
Releases NO from smooth muscle:increased cGMP relaxation.Veins> Arteries Which does Arteries > Veins?
HYDRALAZINE
PRELOAD
Tachycardia, Flushing, HA,
hypotension, Monday Diseasedecreased tolerance over weekend tach, dizziness and HA onreexposure
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Prazosin
Use?
SE?
Sympathoplegic, HTN
Orthostatic hypotension
with 1st dose, dizziness,
headache
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Diazoxide
Use?
SE?
Vasodilator, HTN
Hyperglycemia,
decreased insulin
release, hypotension
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Beta blockers
Use?
SE?
Sympathoplegic, HTN
Impotence, asthma,
cardiovascular effects
(bradycardia, CHF, AVblock), CNS effects
sedation and changes in
sleep
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Hydralazine
Use?
Mechanismof Action?
Reduces
preload orafterload?
SE?
Vasodilator, severe HTN, CHF
Increased cGMP smooth musclerelaxation. Arterioles > veins.
AFTERLOAD (Vasodilator!)
Nausea, Headache, Lupus-like syndrome,reflex tachycardia (dont use in agina or
CAD!), angina, salt retention Use with beta blocker to avoid tachycardia
and with a diuretic to avoid salt retention
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Minoxidil
Use?
Mechanism
of Action?
SE?
Vasodilator, HTN
K channel opener, hyperpolarizes
smooth muscle cells
HAIRY MONSTER, pericardialeffusion, reflex tachycardia, angina,
salt retention
Use with beta blocker to avoidtachycardia and with a diuretic to
avoid salt retention
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Captopril
Use?
Other Examples?
SE?
ACE Inhibitor, HTN
Enalapril, Fosinopril
Hyper-K, cough,
angioedema, tastechanges, hypotension,
fetal renal damage,
rash, increased renin
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Hexamethonium
Use?
SE?
Sympathoplegic, HTN
Severe orthostatic
hypotension, blurry
vision, constipation,sexual dysfxn
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Verapamil
Use?
MOA?
More cardiac orsmooth muscleeffects?
SE?
Toxicity?
Calcium Channel Blocker,HTN, angina, arrhythmias,Raynauds
Blocks Voltage Dependant L-type Ca channels,
decreasing contractility Cardiac, but also vasodilator
Dizziness, flushing,
constipation, AV block,Nausea
Cardiac depression,peripheral edema, flushing,dizziness, constipation
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HOW DO YOU TREAT MALIGNANT
HYPERTENSION???
Three drugs in alphabetical order
#1: DIAZOXIDE
MOA?
K channel openerhyperpolarizes smooth muscle #2: Fenoldopam
MOA?
Dopamine1 Receptor Agonist: relaxes vascular smooth muscle
#3: Nitroprusside MOA?
Increased cGMP via direct NO release
SE?
CYANIDE POISONING!!!
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Nitroprusside
Use?
SE?
Vasodilator, HTN
Cyanide Poisoning
(Releases CN!)
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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.
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Diltiazem
Use?
MOA?
More cardiac orsmooth muscleeffects?
SE?
Toxicity?
Calcium Channel Blocker,HTN, angina, arrhythmias,Raynauds
Blocks Voltage Dependant L-type Ca channels,
decreasing contractility Somewhere in the middle
Dizziness, flushing,
constipation, AV block,Nausea
Cardiac depression,peripheral edema, flushing,dizziness, constipation
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Losartan
Use?
Good alternative to
what?
SE?
Angiotensin II Receptor
Blocker, HTN
ACE Inhibitors
Fetal renal toxicity,Hyper-K
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Nifedipine
Use?
MOA?
More Cardiacor SmoothMuscle
Effects? SE?
Toxicity?
Calcium Channel Blocker, HTN,angina, Raynauds
Blocks Voltage Dependant L-typeCa channels, decreasingcontractility
Smooth musclevasodilator
Dizziness, flushing
Cardiac depression, peripheraledema, flushing, dizziness,
constipation
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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 inhibitorsinhibit cholestrol precursor:mevalonate
Which do patients hate taking because of GIdisturbances? Bile Acid Resins: Cholestyramine & Colestipol
What are two other possible drugs you could use? Cholesterol Absorption Blockers (Ezetimibe) and Niacin
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Anti-arrhythmicsBIG PICTURE
CLASS General MOA
Class I
Class II
Class III
Class IV
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Anti-arrhythmicsBIG PICTURE
CLASS General MOA
Class I Block FAST sodium channels responsible for phase 0 depolarization
Quinidine, Flecanide, Procainamide
Class II
Class III
Class IV
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Anti-arrhythmicsBIG 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
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Anti-arrhythmicsBIG 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
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Anti-arrhythmicsBIG 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
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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
diseaseincreased mortality!
Prolonged refractory period in AV node.
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Class II Drugs MOA?
Beta blockers: decreased cAMP and Ca currents. Decrease slopeof 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
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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 Intervalwhy 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 PFTs, LFTs, and TFTs!!
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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
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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
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Potassium
MOA
Decreases ectopic pacers in hypokalemia
Drug of choice for which conditions?
Dig toxicity
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Magnesium
Drug of choice for which conditions?
Torsades and dig toxicity