Educ purpose

1. Related Drug Classification
affecting the
Cardiovascular System

2. Cardiovascular System
• The cardiovascular system
consists of the heart, blood
vessels, and the
approximately 5 liters of
blood that the blood vessels
transport. Responsible for
transporting oxygen,
nutrients, hormones, and
cellular waste products
throughout the body, the
cardiovascular system is
powered by the body’s
hardest-working organ — the
heart, which is only about the
size of a closed fist.

3. Classification of Drugs
• CARDIOTONICS
• ANTI-ANGINALS
• ANTIHYPERTENSIVES

4. CARDIOTONICS
• Cardiotonic agents are drug used to increase the
contractility and output in a hypo dynamic heart
without proportionate increase in 02 consumption
• Commonly used in the treatment of heart failure
(HF)
• Cardiotonic (inotropic) drugs affect the intracellular
calcium levels in the heart muscle, leading to
increased contractility.
• This increase in contraction strength leads to
increased cardiac output , which causes increased
renal blood flow and increased urine production.

5. TYPES OF CARDIOTONICS:
• Cardiac Glycosides
• Phosphodiesterase Inhibitors

6.  used to treat heart and related conditions
 Digoxin (Lanoxin) commonly used drug
 The cardiac glycosides were originally derived
from digitalis purpurea (Common Foxglove)

8.  Digoxin increase intracellular calcium and allows more
calcium to enter myocardial cells during depolarization.
This results to:
1. Increased force of myocardial contraction ( a positive
intropic effect )
2. Increased cardiac output and renal perfusion.
3. Slowed heart rate, owing to slowing of the rate of
cellular repolarization ( a negative chronotropic
effect)
4. Decreased conduction velocity through the
atrioventricular (AV) node

9.  Heart failure (HF)
 Atrial flutter
 Atrial fibrillation
 Paroxymal atrial tachycardia

10.  Digoxin is available for oral and parenteral
administration.
 Oral- 0.75- mg PO
 IV-0.125-0.25 mg IV
 Onset of action -30-120 minutes when take
orally, 5-30 minutes when given intravenously

11.  A serious syndrome that can occur when
digoxin levels are too high
 Normal level-0.5-2.0 ng/ml signs and symptoms
- anoreaxia, malaise, depression, irregular heart
rhythms including heart block, atrial
arrhythmias, and ventricular tachycardia.
 Antidote- digoxin immune Fab (DigilFab)

12.  This drug block the enzyme phosphodiesterase.
This blocking effect leads to an increase in
myocardial cell cyclic adenosine
monophosphate (cAMP), which increases
calcium levels in the cell.

13.  Short-term treatment of HF that has not
responded to digoxin or diuretics alone or that
has had a poor responses to digoxin, diuretics,
and vasodilators .

14.  Intravenous
 (PRIMA OR IV 10Mg/ml inj) dose-50
microgram/kg iv bolus followed by 0.4-1.0
mirogram/kg min infusion

15.  Hypersensivity to phosphosphodiesterase
inhibitors
 Severe aortic or pulmonic vascular disease
 Acute MI

16.  Ventricular arrhythamias (which can progress
to fatal ventricular fibrillation), hypotension,
and chest pain
 GI effects include nausea, vomiting, anorexia,
and abdominal pain
 Thrombocytopenia occurs frequent with
milrinone
 Precipitate from when these drugs are given in
solution with furosemide

17. • Anti-anginal drugs are used primarily to
restore the balance between the oxygen
supply and demand of the heart. These
drugs dilate the coronary vessels to increase
the flow of oxygen to the ischemic regions.
Other than that, they also decrease the
workload of the heart so the organ would
have less demand for oxygen.

18.  It is a pain syndrome due to induction of an
adverse oxygen supply/demand situation in a
portion of myocardium.
 Anti-anginal drugs are used to help restore the
appropriate supply-and-demand ratio in oxygen
delivery to the myocardium.

19. These drugs can work to improve blood delivery
to the heart muscle.
 (1) by dilating blood vessels
(i.e.,increasing the supply of oxygen)
 (2) by decreasing the work of the heart
(i.e.decrasing the demand for oxygen.)

20.  NITRATES
a. Short acting nitrates
Eg: Glyceryl triniterate
(Nitroglycerine)
b. Long acting nitrates
Eg: Isosorbide dinitrate
(sorbitrate)
 BETA-BLOCKERS
Eg: Atenelol, Propanalol
 POTASSIUM CHANNEL
OPENERS
Eg: Nicorandil
 CALCIUM CHANNEL
BLOCKERS
a. Phenly alkamine
Eg: verapamil
b. Benzothiapine
Eg: Diltiazem
c. Dihydropyridines
Eg: Nifidipine.
Amiodipine

21.  Nitrates are drugs that act directly on smooth
muscle relaxation and to depress muscle tone.
 Isosorbide dinitrate (Isordil)
 Isosorbide mononitrate
 nitriglycerin

22.  The nitrates relax and dilate veins, arteries, and
capillaries, allowing increased blood flow
through the vessels and lowering systemic blood
pressure because of a drop in resistance.
 Nitrates decreases the preload and afterload

23.  LONG ACTNG NITRATES
Taken before chest pain begins in situation in
which exertion or stress can be anticipated for
prevention of angina in adults; taken daily for
management of chronic angina
 SHORT ACTING NITRATES
Treatment of acute angina attack, prevention of
anginal attacks.

24.  Isosoribide nitrate- 2.5-5mg SL
5-mg chewable tablet;
5-20 mg PO;
 Nitroglycerin- 5 mcg/min via IV infusion
pump every 3-5 min;
 0.4-mg metered dose sublingual, up to three
dose in 15 min for acute attack

25.  Beta-adrenergic blocker are used to block the
stimulatory effects of the sympathetic nervous
system.
 Eg- Atenelol
Propanalol
Metoprolol

26.  The beta blockers competitively block beta-
adrenergic receptors in the heart and decreasing
the influence of the SNS on these tissue. The
results is a decrease in the excitability of the
heart, a decrease in cardiac oxygen
consumption, and a lowering of blood pressure.

27.  Long-term management of angina pectoris.
 To prevent reinfraction in stable patients 1 to 4
weeks after an MI

28.  Oral- 50-100 mg
 INTRAVENOUS – 5 mg – 15mg

29.  Amlodipine (Norvasc)
 Diltiazem (Cardizem)
 Nicardipine (Cardine)
 Nifedipne
 Verapamil (Calan, Isoptin)

30.  Calcium channel blockers inhibit the movement
of calcium ions across the membranes of
myocardial and arterial muscle cell, altering the
action potential and blocking muscle cell
contraction.
 This will results lose of smooth muscle tone.
Vasodilation, and decreased peripheral resistance
occur
 Decrease the preload and afterload which results
in decreases cardiac workload and oxygen
consumption

31. Treatment of:
 Prinzmetal angina
 Chronic angina
 Effort associated angina
 Hypertension.
 Verapamil is also used to treat cardiac tachy
arrhythmias because it slows conduction more
than the other calcium channel blockers do.

32.  Hypersensitivity
 Pregnancy and location
Caution should be used with:
 Hear block or sick sinus syndrome
 Renal or hepatic dysfunction
 Heart failure.

33.  Potassium channel openers activates the ATP
sensitive potassium channels thereby
hyperpolarising the vascular smooth muscles.
 This results in reduction in vascular tone
 That will lead to a decrease in preload and
afterload
 EG- Nicorandil

34.  Prevention and long term treatment of chronic
stable angina pectoris.
 Reduction in the risk of acute coronary
syndrome in patients in patients with chronic
with stable angina.

35. ANTIHYPERTENSIVES
• Antihypertensives are the drugs that
used to treat hypertension.

36. CLASSIFICATION OF HYPERTENSIVE DRUGS
• Diuretics:
-Loop Diuretics (Furosemide)
-Thiazide Diuretics (Hydrochlorothiazide)
-Potassium Sparing Diuretics
(Spironolactone)

37. • Adrenergic Inhibitors:
-Centrally Acting a-Adrenergic Antagonists
(Clonidine)
-Peripherally Acting a-Adrenergic
Antagonist (Reserpine)
- a-Adrenergic Blockers (Prazocin)
- b-Adrenergic Blockers (Atenelol)

38. • Calcium Channel Blockers (Amlodipine)
• Angiotensin Inhibitors
- Angiotensin-Converting Enzyme
Inhibitors (Captopril)
- Angiotensin II-Receptor Blockers
(Losartan)
- Direct Vasodilators (Nitroglycerin)

39. DIURETICS
• Drugs that increase the production of
urine.
• Loop Diuretics- they inhibit the sodium
and chloride reabsorption in the thick
segment of the ascending limb of the loop of
Henle as well as in the proximal convoluted
tubule and the distal diluting site.

40. • Thiazide Diuretics- these drugs are the firs-line
drugs used to manage essential hypertension
when drug therapy is needed.
• Potassium Sparing Diuretics- not as powerful
as the loop diuretics, but they retain potassium
instead of wasting it.