Drugs affecting cardiovascular system

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Drugs affecting cardiovascular system

  1. 1. DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM Lec. No. 10
  2. 2. Cardiovascular agents affect the action of the circulatory system. Most of these agents are highly specialized.
  3. 3. 1-Antihypertensive drugs  A. Diuretics a) Thiazide diuretics: initial therapy in most cases, used in mild to moderate hypertension. b) Loop diuretics: in sever and resistant hypertension and hypertension of renal failure. c) K-sparing diuretics: in hyperaldosteronism.  B. Beta blockers Nonselective: propranolol, timolol, pindolol. Cardio selective (β1 selective): atenolol, esmolol, metoprolol
  4. 4.  C. Calcium channel blockers (CCBs) a) More selective on heart: Verapamil & Diltiazem b) More selective on blood vessels: Nifedipine  D. Drugs affecting angiotensin system 1. Angiotensin converting enzyme inhibitors (ACE Is):  E.g.: Captopril, Alcepril, Enalapril, Lisinopril 2. Angiotensin-1 receptors antagonists (AT-1 antagonists):  E.g.: Saralasin, Losartan
  5. 5. ACE-i. Mechanism of Action VASOCONSTRICTION ALDOSTERONE VASOPRESSIN SYMPATHETIC VASODILATATION PROSTAGLANDINS Kininogen tPA Kallikrein Angiotensinogen RENIN Angiotensin I A.C.E. ANGIOTENSIN II Inhibitor BRADYKININ Kininase II Inactive Fragments
  6. 6. Angiotensin II Receptor Blockers (ARB) RENIN Angiotensinogen Other pathways AT1 Receptor Blockers AT1 Vasoconstriction Angiotensin I ACE ANGIOTENSIN II RECEPTORS Proliferative Action AT2 Vasodilatation Antiproliferative Action
  7. 7.  E. Direct acting vasodilators Nitroprosside Minoxidil Hydralazine Diazoxide
  8. 8.  F. α1 adrenergic blockers: eg. Prazosin HCl  Angina  Heart failure  Diabetes
  9. 9. Possible combinations between some classes of antihypertensive drugs Thiazide diuretics β-blockers Angiotensin receptor antagonists α- blockers Calcium antagonists ACE inhibitors The preferred combinations in the general hypertensive population are represented as thick lines. The frames indicate classes of agents proven to be beneficial in controlled intervention trials
  10. 10. These include:  hypertensive encephalopathy,  cerebral stroke,  severe renal failure. Patient should be hospitalized and reduction of blood pressure should be in hours and not in minutes. Drugs that can be used:
  11. 11. 1. Sublingual nifedipine or captopril 2. Parentral therapy Diuretics (furosemide, bumetanide) I.V. Diazoxid 300 mg I.V. very rapidly. Nitroprusside infusion 2-5mcg/kg/min. according to blood pressure. Beta blocker (propranolol) l-2mg I.V. slowly diluted Nefedipine I.V. diluted 
  12. 12. 2- Drugs used in the treatment of congestive heart failure (CHF) Cardiac glycosides a- Calcium channel blockers e.g amlodipine b- Angiotensin converting enzyme inhibitors e.g.:(Captopril, enalapril ) c- Other vasodilators e.g.:(hydralazine, nitroprusside)
  13. 13.  Cardiac Glycoside  Digitoxin  Digoxin(lanoxin)
  14. 14. 3- Drugs used in the treatment of Arrhythmia Impulse formation, impulse conduction, or a combination
  15. 15. Quinidine. Lidocaine (I.V) Propranolol, Atenolol, Sotalol Amiodarone, Bretylium Verapamil, Diltiazem. Adenosine, Digoxin, Atropine, Adrenalin & Isoprenaline
  16. 16. 4- Drugs used in treatment of Angina: is an acute chest pain that occurs when blood flow is to supply the oxygen required by the heart.
  17. 17.  Short acting Nitrates: 1. Glyceryl Trinitrate (Nitroglycerin) [sublingual /I.V /infusion] 2. Amyl nitrite [inhalation] 3. Isosorbide dinitrate [sublingual]
  18. 18. 1. Long acting Nitrates Isosorbide mononitrate, Isosorbide dinitrate [oral] 2. Beta adrenergic blockers 3. Calcium channel blockers 4. Antiplatelets (aspirin, dipyridamol): used to ↓↓ incidence of coronary thrombosis.
  19. 19. Tolerance for the vasodilating action may develop with continuous exposure to Nitrates without interruption.
  20. 20. 5- Drugs used in the treatment of hyperlipidemia is a condition of high levels of ,
  21. 21. prevent cholesterol synthesis or promote the breakdown of internal cholesterol.
  22. 22. e.g. cholestyramine, colestipol e.g. lovastatin, simvastatin e.g. gemfibrozil, clofibrate
  23. 23. 6- Thrombolytic drugs e.g.: Streptokinase
  24. 24. 7- Anticoagulants . Heparin Warfarin (Caumadin®)

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