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? Vasodilatorangina, 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 (dont 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? Calcium Channel Blocker, HTN, angina, arrhythmias, Raynauds 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

More cardiac or smooth muscle effects? SE?

Toxicity?

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!!!

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? Calcium Channel Blocker, HTN, angina, arrhythmias, Raynauds 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

More cardiac or smooth muscle effects? SE?

Toxicity?

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, Raynauds Blocks Voltage Dependant L-type Ca channels, decreasing contractility Smooth musclevasodilator

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 inhibitorsinhibit 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-arrhythmicsBIG PICTURE
CLASS General MOA Class I

Class II

Class III

Class IV

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

Anti-arrhythmicsBIG PICTURE
CLASS General MOA Class I Block FAST sodium channels responsible for phase 0 depolarization Quinidine, Flecanide, Procainamide Beta Adrenergic Receptor Antagonists Propranolol, Metoprolol

Class II

Class III

Class IV

Anti-arrhythmicsBIG PICTURE
CLASS General MOA Class I Block FAST sodium channels responsible for phase 0 depolarization Quinidine, Flecanide, Procainamide Beta Adrenergic Receptor Antagonists Propranolol, Metoprolol Prolong action potential with little effect on phase 0 depolarization, mostly via blocking the K repolarizing current Amiodarone, Sotalol, Ibutilide

Class II

Class III

Class IV

Anti-arrhythmicsBIG PICTURE
CLASS General MOA Class I Block FAST sodium channels responsible for phase 0 depolarization Quinidine, Flecanide, Procainamide Beta Adrenergic Receptor Antagonists Propranolol, Metoprolol Prolong action potential with little effect on phase 0 depolarization, mostly via blocking the K repolarizing current Amiodarone, Sotalol, Ibutilide

Class II

Class III

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 IAs 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 diseaseincreased 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 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!!

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