This document discusses cardiovascular drugs used to treat various conditions. It covers drugs that target the heart such as inotropic agents and beta blockers. It also discusses antihypertensive drugs that act on the renin-angiotensin-aldosterone system like ACE inhibitors. The document describes antianginal drugs that reduce oxygen demand or increase oxygen delivery. It provides classifications of antiarrhythmic drugs and drugs used to treat heart failure like digoxin, diuretics, and vasodilators.

1. CARDIVASCULAR DRUGS
By: Maghan Das

2. Maghan Das

3. CARDIOVASCULAR
DISEASE AND DRUGS
 Basic cardiovascular physiology and pathology
depends on the control of heart rate, cardiac
output, blood pressure, blood flow, ionic
composition, RAAS, vascular endothelium,
regulation of tissue perfusion, hypertension,
dislipidaemias, atherosclerosis, blood clotting,
ischaemic heart disease, cardiomyopathies,
cardiac arrhythmias and cardiac failure.
Maghan Das

4.  Cardiovascular drugs: inotropic agents,
b blockers, calcium antagonists, organic
nitrates, anti-arrhythmics, ACE
inhibitors, ATII (=AT1) antagonists,
diuretics, cholesterol lowering drugs,
clot-busters, anti-coagulants, anti-
platelet drugs.
Maghan Das

5. DRUGS TO TREAT
ANGINA PECTORIS
 Angina pectoris refers to a strangling or
pressure like pain caused by cardiac ischaemia.
 It’s a pain syndrome due to induction of an
adverse oxygen supply / demand situation in
portion of myocardium.
 Drugs used exploit two main strategies:
reduction of oxygen demand and increase of
the oxygen delivery to myocardium.
 Three types of anginal attack: stable angina,
unstable angina and variant angina.
Maghan Das

6. ANTI ANGINAL DRUGS
 1) ORGANIC NITRATES: Glyceryl trinitrate
(Nitroglycerin), Isosorbide dinitrate, etc
 2) BETA BLOCKERS: Propranolol, Atenolol,
Metroprolol, Carvedilol, etc
 3) CALCIUM ANTAGONIST: Nifedipine, Diltiazem,
Verapamil
 4) SELECTIVE If- INHIBITORS: Ivabradine
Maghan Das

7. ANTI ARRHYTHMIC DRUGS
Cardiac arrythmias commonly occur in presence of pre-existing
heart disease.
1) CLASS I: Membrane stabilizing drugs; sodium channel
blockers-
CLASS I a- Quinidine, disopyramide
CLASS I b- Lidocaine, Phenytoin
CLASS I c- Propafenone
2) CLASS II: BETA BLOCKERS- Acebutolol, Atenolol,
Esmolol,Metoprolol, Propranolol
3) CLASS III: POTASSIUM CHANNEL BLOCKERS-
Amiodarone, Sotalol
4) CLASS IV: CALCIUM CHANNEL BLOCKERS- Verapamil,
Diltiazem
Maghan Das

8. Maghan Das

9. CLINICAL
CLASSIFFICATION OF
ANTIDYSRHYTHMIC
DRUGS
 I GROUP: (decrease AV conductance, for treatment of
SV tacharrhythmia)- Verapamil
 II GROUP: (for treatment of ventricular
tachyarrhythmia)- Lidocaine (i.v.), Propafenone,
Phenytoin
 III GROUP: (for treating SV and V tachyarrhythmia)-
Amiodarone, Beta blockers
 IV GROUP: (drugs for AV block)- Atropine {M-
cholinolytic}, Ephedrine {indirect adrenomimetics}
 V GROUP: (inhibitors of AV conduction)- Adenosine
[potassium channel opener], Digoxin [cardiac glycoside]
Maghan Das

10. ANTIHYPERTENSIVE DRUGS
 DRUGS AFFECTING RAAS [renin angiotensin
aldosterone system]-
RENIN INHIBITOR: Beta blockers [Propranolol,
Atenolol, etc]
ACE INHIBITORS: Enalapril, Ramipril
ANGIOTENSIN II RECEPTOR [AT1-receptor]
BLOCKERS: Eprosartan, Losartan
ALDOSTERONE ANTAGONIST [ potassium sparing
diuretic ]: Spironolactone
Maghan Das

11. Maghan Das

12.  CALCIUM ANTAGONIST: Nifedipine,
Amlodipine, Diltiazem, Verapamil
 DRUGS DECREASING SYMPATHETIC
ACTIVITY-
BETA BLOCKERS: Nebivolol, Atenolol,
Bisprolol, Pindolol, Carvedilol
ALFA BLOCKERS: Prazosin, Phentolamine
OTHER: Reserpine, clonidine
 DIURETICS: Hydrochlorothiazide, Indapamide,
Furosemide
Maghan Das

13. PERIPHERAL VASODILATORS
 Alfa blockers- Prazosin, Ergotoxine
 Phosphodiesterase inhibitors- Pentoxifylline
 Prostaglandin analogue- [activators of AC] Alprostadil (PG1),
Iloprost (PG2)
 CEREBRAL VASODILATORS:
Nimodipine (calcium antagonist), Naftidrofuryl (5-HT2 receptor
blocker)
Maghan Das

14. DRUGS TO TREAT HEART
FALIURE
 Clinical syndrome that
can result from any
structural or functional
cardiac disorder that
impairs the abilty of the
ventricle to fill with or
eject blood.
Maghan Das

15. Therapeutic Uses of Digitalis Compounds
 Heart Failure
 ↑ inotropy
 ↑ ejection fraction
 ↓ preload
 ↓ pulmonary congestion/edema
 Arrhythmias
 ↓ AV nodal conduction
(parasympathomimetic effect)
 ↓ ventricular rate in atrial flutter
and fibrillation
 Digitalis compounds have historically been used in the
treatment of chronic heart failure owing to their cardiotonic
effect.
 Ex: Digoxin, digitoxin
Maghan Das

16.  To treat CHF:
Ionotropic drugs: Digoxin, Dobutamine
Diuretics: Furosemide, Thiazide
Vasodilators: ACE inhibitors,AT1 antagonist, Nitrate
Beta blockers: Metroprolol
Maghan Das

17. THANK
YOU
Maghan Das