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    Cardiovascularagents Cardiovascularagents Presentation Transcript

    • CARDIOVASCULAR AGENTS for use in arrythmia: contraction of ventricle and atrium is not synchronized. Antiarythmia agents will block sodium channel, potassium channel, calcium channel or adrenergic receptor(adreneline,noradrenaline, dopamine). membrane stabilizing agents--aka Class 1 sodium channel blockers The class I antiarrhythmic agents interfere with the sodium channel. Class I agents are divided into three groups (Ia(lengthens action potential), Ib(shortens) and Ic( no effect and increased sodium current depression)--based upon their effect on the length of the action potential.
    • CLASS 1--- Vaughan Williams Classification I-IV • MOA----depresses cardiac conduction and excitabiltity. action potential depends on the opening of sodium ion channels, a blockade of these channels will slow the spread of impulse conduction across the myocardium. mainly for tachycardia. • Side effects: • diarrhea, naseau, dizziness • examples---• lidocaine/Xylocaine • mexiletine/Mextil • procainamide/Pronestyl • quinidine/Quinaglute • tocainide/Tonocard
    • Class II--Beta blockers used after heart attack. moa---- blocks adrenaline and noradrenaline from cardiac cells. Beta-adrenergic blockers reduce heart rate and conduction velocity through the AV node. mainly for atrial dysrythmia. side effects---bronchoconstriction, impotence, fatigue, bradycardia, alopecia, depression examples--atenolol/Tenormin carvedilol/Coreg propanolol/Inderal sotalol/Betapace metaprolol/Lopressor
    • class III---potassium channel blockers moa---prolong the action potential duration (APD) and refractoriness and have been found effective to prevent/suppress cardiac arrhythmias. Cardiac K+ channels are membrane-spanning proteins that allow the passive movement of K+ ions across the cell membrane along its electrochemical gradient. K+ channels affect plateau and repolarization time. side effects---possible pulmonary fibrosis, blue skin deposit, liver damage examples-- amiodarone, bretylium, sotalol, ibutilide
    • class IV---calcium channel blockers calcium allows myosin heads to bind to actin filaments and pull them to get a power stroke. Cardiac muscle requires extracellular calcium ions for contraction to occur.
    • class IV moa--Slow conduction velocity Prolongs the refractory period effective against supraventricular dysrhythmias side effects----bradycardia, hypotension, constipation, headache, dizziness, heart failure consider----keep dilitazem from light examples-dilitazem/Cardizem verapamil/Veralan
    • ACE inhibitorsAngiotensin Converting Enzyme mainly used in congestive heart failure----heart cannot meet oxygen needs for the body. chambers of the heart may respond by stretching to hold more blood to pump through the body or by becoming stiff and thickened. heart muscle walls may eventually weaken and become unable to pump as efficiently. The body keeps high blood pressure by--- the protein renin from kidneys finds protein angiotensinogen(453 amino acids) from the liver and removes first 10 amino acids, this yields angiotensin I(no biological activity). ACE removes another 2 amino acids to yield angiotensin II. This increases blood pressure by increasing the amount of salt and water the body retains. Also a vasoconstrictor. side effects---hypotension, cough, hyperkalemia, headache, dizziness, fatigue, nausea, and renal impairment. examples---benazapril,enalapril, lisinopril, quinapril, ramipril, perinopril, captopril
    • Angiotensin II antagonists for patients who don’t tolerate ACE inhibitors. Angiotensin II is allowed to be made but blocked at receptor site by the drug, yields reduced blood pressure. side effects----dizziness, headache, and/or hyperkalemia examples----losartan, olmesartan, valsartan, irbesartan, eprosartan, telmisartan, candesartan
    • Nitrates used for angina pectoris----coronary blood flow is inadequate for heart oxygen needs. chest pain with exertion. moa----nitrates are converted quickly to nitric acid and yields decreased venous return and reduced ventricular pressure, coronary vessel dilation. side effects----orthostatic hypotension, flushing, nitroglygerin inhalant is flammable, projection liquid from light. examples--isosorbide dinitrated/Isodil isosorbide monomitrate/Imdur nitroglygerin/Nitrostat
    • Vasodilators moa---relax smooth muscle atrerioles, yields decreased vascular resistance. recommend with diuretics and sympathoplegic drugs. side effects----headache, naseau, tachycardia, palpitations examples---minoxidil/Loniten hydralazine/Apresoline fendolapam/Corlopam
    • CNS agents moa----reduce sympathetic outflow from vasomotor center in the brain, yields reduced heart rate, cardiac output, peripheral resistance. side effects----drowsiness, fatigue, fluid retention examples---clonodine/Catapres guanfacine/tenex methyldopa/Aldomet
    • combination drugs moa-----additive effect to lower blood pressure. lower dosages yield less side effects examples-----Lotensin/benazepril&HCTZ Hyzaar/ losartan&HCTZ Avalide/irbesartan&HCTZ