6.2 drugs in ischemic heart disease
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This document summarizes drugs used to treat ischemic heart disease conditions like angina pectoris and myocardial infarction. It describes common drug classes like antiplatelet agents, beta blockers, calcium channel blockers, nitroglycerin, and ACE inhibitors. For angina, it discusses stable/unstable types and Prinzmetal's angina. For heart attacks, it covers symptoms and causes. It provides details on several specific drugs, their mechanisms of action, uses, and side effects. It also summarizes antiarrhythmic drugs and their classification/uses for treating arrhythmias.
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6.2 drugs in ischemic heart disease
- 1. Drugs in ischemic heart disease/ D r. S a r o j k s u w a l
- 2. Drugs Used For Angina Pectoris and MI • Antiplatelet agents • Beta-adrenergic blocking agents • Calcium channel blockers • nitroglycerin • Angiotensin-converting enzyme inhibitors
- 3. Angina Pectoris •occurs when the heart muscle is not getting enough blood.
- 4. Types • Stable angina • due to atherosclerosis of coronary arteries • Unstable Angina • due to progressive occlusion of coronary artery • Printzmetal's or variant Angina • due to coronary vasospasm
- 5. Myocardial infarction (MI) •commonly known as a heart attack, •The most common symptom • chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw.
- 6. Cause of MI or Heart Attack blood flow decreases or stops to a part of the heart→ Damage to Heart Muscle (Myocardiu m) Myocardial Infraction or Heart Attack
- 7. Anti Platelets •Aspirin • Prevents platelet aggregation by cyclooxygenase inhibition • subsequent suppression of thromboxane A2. • Low Dose use for the antiplatelet function
- 8. Clopidogrel • Anti Platelet Actions • Also prevents MI and Stroke • inhibits ADP binding to platelet receptor →inhibiting platelet aggregation. • Used for patients with contraindication to aspirin.
- 9. Beta-adrenergic blocking agents • Beta blocker drugs → drugs with “-olol” • blocking the effects of the hormone epinephrine, also known as adrenaline. beta blockers, heart beats more slowly and with less force, reducing blood pressure.
- 10. Adrenergic or Sympathetic Receptors •alpha, and beta receptor
- 13. Classifications •Non selective Drugs • Propranolol •Beta1 selective drugs • Metoprolol • atenolol
- 14. • Metoprolol • Selective beta1-adrenergic blocker that decreases automaticity of contractions • Lipophilic –penetrates CNS • Atenolol • Selectively blocks beta-1 with little or no effect on beta-2 receptors. • Is hydrophilic and does not penetrate CNS. • Propranolol • Nonselective beta-blocker that is lipophilic (penetrates CNS). • Although generally short-acting agent, long-acting preparations also available.
- 15. Uses for beta blockers • High blood pressure • Irregular heart rhythm (arrhythmia) • Heart failure • Chest pain (angina) • Heart attacks • Migraine • Certain types of tremors
- 16. Side effects and cautions • Common side effects • Fatigue • Cold hands or feet • Weight gain • Less common side effects include: • Shortness of breath • Trouble sleeping • Depression Beta blockers generally aren't used in people with asthma because may trigger severe asthma attacks.
- 17. Calcium Channel Blockers •Calcium function as •Cardiac contraction •Smooth muscle contraction •Propagation of cardiac impulse Drugs • Nefidipine • Amlodipine • Verapamil • diltiazem
- 19. nitroglycerins • prevent chest pain (angina • class of drugs known as nitrates. • relaxation of vascular smooth muscle. • Taken oral or sublinguial
- 20. Nursing actionscont’d Educate Patient/Family/Caregivers/Whanau • Medication actions & benefits • Diet (low Na, alcohol, weight reduction) • Smoking cessation • Cholesterol/BP/weight monitoring • Reporting of oedema, SOB, dyspnoea • Exercise program • Cardiac rehab/educator/dietician/case manager/support groups
- 23. Cardiac Action Potential Phase 0-4
- 24. Arrythmia • Is problem with the rate or rhythm of your heartbeat. • means that your heart beats too quickly, too slowly, or with regular or irregular pattern. • due to abnormal generation or conduction of impulses • Electrolyte disturbances, trauma, can cause arrhythmias
- 25. Types of arrythmia • Ventricular • Supraventricular( arterial, SA node , AV node) Patterns a.Tachycardia → increased rate b. Bradycardia → decreased rate c. Fibrillation→ disorganized contractile activity d. Flutter→ very rapid but regular contractions
- 26. Classification of antiarrhythmic drugs • Based on the cardiac cycle (.Vaughan williams classified as follows: )
- 27. Class I Sodium channel Blockers • subdivided into A,B,C • E.g. quinidine , procainamide • also called membrane stabilizing drugs • MOA • bock fast sodium channels → slowing conduction in fast channel tissues(in atrial and ventricular cells, His-Purkinje System)→ stabilize conduction
- 28. Class 1A :procainamide, quinidine • are useful in almost all types of arrhythmias . • useful in atrial fibrillation ,and in ventricular arrhythmias atrial flutter. CLASS 1B DRUGS: Phenytoin, lignocaine • lignocaine Suppresses the electrical activity of the arrhythmogenic tissues • phenytoin is an antiepileptic also useful in ventricular arrhythmias and digitalis –induced arrhythmias. CLASS 1C DRUGS: • Encainide and flecainide are the most potent sodium channel blocker • because of the risk of cardiac arrest ,sudden death and other adverse effects, they are not commonly used.
- 29. Class II : β- adrenergic blocker • Propranolol , esmolol ,acebutolol • use to treat • SVTs, sinus tachycardia, Arterial flutter, fibrillation MOA • slows the channel tissue in SA and AV nodes → decrease rate of automaticity, slow conduction
- 30. Propanol as anti arrhythmic drug • it blocks beta- receptors in heart so it exerts • negative ionotropic effect • negative chronotropic effect • depress atrioventricular conduction • depress automaticity • IT has: • anti arrhythmic effect • anti hypertensive effect • anti angial effect in CVS
- 31. Class III antiarrhythmic Drugs • membrane stabilizing drugs • amiodarone • used for SVTs, VTs, • blocks K+ channels • has also some b adergenic and ca-channel blocking effects
- 32. MOA blocks K+ channel blockers( also blocks Na+ channel) prolongs action potential duration and repolarization impulse at high frequency in cardiac tissue decreased rate of automaticity is reduced
- 33. Class IV antiarrhythmic drugs calcium channel blockers verapamil, diltiazem for SVTs, arterial fibrillation and flutter Blocks calcium channel in cardiac tissue decrease ca- current in SA and AV node decrease conduction , and rate of automaticity slow heart rate
- 35. • Thanks
- 36. Cardio tonic drugs • Cardiac glycosides • naturally occurring drugs ( plant and animal source) • has both good and bad effect on heart • Eg. • digoxin, digitoxin • Uses: • congestive heart failure • Dysrhythmia ( arterial fibrillation, and flutter) • good effects: • increases the force of contraction(ionotropic effect) • decrease heart rate • maintain effective circulation