Pharmacology 181 CHAPTER 25 Cardiovascular Drugs Dr' Jay Shahed

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• Pharmacology 181CHAPTER 25Cardiovascular
  DrugsDr. Jay Shahed

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Categories

• Cardiac Glycosides
• Antiarrhythmics
• Antilipemic
• Antihypertensives
• Vasodilators
• Vasoconstrictors
• Anticoagulants

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Cardiac Glycosides

• Action
• Increases the force of the contractility of the
  myocardium of the heart.
• Increases the efficiency of the heart without
  increasing the Oxygen consumption.
• Decreases heart rate.
• Diuretic effect that reduces edema.
• Increases the cardiac out put.
• Strengthen the heart beat
• Cardiotonic

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Drugs

• Digoxin (Lanoxin)
• Short term treatment.
• Digitoxin (Crystodigin).
• Long term treatment

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Indications

• Congestive Heart Failure
• Used with conjunction of other Antiarrythmic
  drugs
• Atrial flutter, fibrillation.

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Caution

• Digitalization
• Maintain therapeutic dose without reaching toxic
  effect.
• Monitor blood levels and EKG continuously
• Monitor pulse must be less than 60 to continue
  digitalis.
• Avoid OTC medications.

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Side effects

• Anorexia, Nausea, Vomiting
• Abdominal cramps
• Headaches
• Insomnia, confusion
• Fatigue, lethargy,
• Visual disturbances
• Cardiac arrhythmiss.
• Electrolyte imbalance

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Contraindications

• Severe pulmonary disease
• Hypothyroidism
• Acute MI
• Severe heart failure
• Arrhythmias
• Pregnancy and lactation.

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Interactions

• Antacids
• Sulfa, neomycin
• Diuretics, calcium, coticosteroids
• adrenergics.
• Phenbarbital, Phenytoin

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• Antiarrythmic
• agents

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Adrenergic blockers(Beta-Blockers)

• Drugs
• Propranolol (Inderal)
• Atenolol (Tenormin)
• Metoprolol (Lopressor)
• Timolol (Blocadren)

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• Action
• Inhibition of the sympathetic (Adrenergic) nerve
  receptors.
• Membrane stabilizing effect
• Indication
• Arrhythmias
• Migraine headaches
• Chronic angina
• Hypertension.

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Side effects

• Hypotension, Vertigo, syncope
• Bradycardia, Heart block, cardiac arrest
• CNS symptoms (Confusion, dizziness)
• Bronchospasm
• Hypoglycemia
• Impotence.

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Contraindication

• Asthma, COPD
• Fast withdrawal
• Diabetes
• Renal and Hepatic impairment
• Bradycardia, heart block, CHF
• Pediatrics, pregnancy and lactation
• Interactions
• Adrenergics
• Tricyclic antidepressants
• Anticholinergics.

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Calcium channel blockers

• Drugs
• Diltiazem (Cardizem)
• Nifedipine (Procardia, Adalat, Procardia XL)
• Amlodipine (Norvasc)
• Verapamil (Isoptin, Calan)

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Action

• Inhibit the action of calcium in the cardiac
  muscle creating a reduced excitability.
• Coronary arteries dilatation.

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• Indication
• Hypertension
• Angina
• Side effects
• Hypotension
• Edema
• Vertigo
• Bradycardia,
• Abdominal disturbances

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Contraindications

• Heart block
• Heart failure
• Angina
• Children, Pregnancy and lactating.
• Hepatic and Renal disorders

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Interactions

• Antagonist effect
• Lithium
• Salicylates
• Anticoagulants.
• Sulfonamide
• Hypotensive effects
• Diuretics
• ACE inhibitors

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Procainamide

• Action
• Antiarrythmic drug that possesses
• Anticholinergic properties.
• Indication
• Prophylactic therapy
• Side Effect
• Hypotension
• Tachycardia
• Hypersensitivity reaction.
• Blood discrasias
• N/V/D

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• Contraindication
• CHF, Heart Block
• Myasthenia Gravis
• Pregnancy
• R/H disorders.
• Interaction
• Muscle relaxants
• Anticholinergics
• Other cardiac drugs

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Quinidine (Cardioquin)

• Action
• Decreases cardiac excitability and decreasing
  contractility.
• Has Anticholinergic properties.
• Indication
• Prophylactic therapy.

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Side effects

• GI disturbance
• Severe Hypotension
• CNS disturbance
• Vascular collapse
• Asthmatic attacks, Respiratory arrest
• Confusion
• Vision problems
• Hypoglycemia
• Hepatic failure.

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Disopyramide (Norpace)

• Action
• Synthetic drug that inhibits the myocardial
  excitability an conduction
• has Anticholenergic properties
• Side Effects
• Hypotension, dizziness, chest pain
• Edema and weight gain
• Anticholinergic effects
• Dry mouth, blurred vision, constipation, urinary
  retention
• GI disturbances

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• Contraindications
• Glaucoma
• Heart block, CHF
• Hepatic/Renal disorders
• Children, pregnancy, lactation
• Interactions
• Other cardiac drugs
• Oral anticoagulants

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Local Anesthetics

• Lidocaine (Xylocaine)
• Flecainide (Tambocor).
• Tocainide (Tonocard)

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• Action
• Local anesthetic that has an Antiarrythmic
  property of stabilizing the membranes action
  potential.
• Indication
• Lidocaine only
• Premature ventricular contractions (PVC) with
  MIs.
• Side effects
• CNS symptoms Drowsiness, seizure
• Hypotention
• Bradycardia, Heart blocks.
• Respiratory disorders

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• Contraindications
• Respiratory depression
• Heart block
• Children, pregnancy and lactating.
• Interactions
• Other Cardiac drugs.
• Cimetidine

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Antihypertensives Agents.

• Are used to reduce hypertension and control it
  and treat it.
• Etiology
• Unknown (most common)
• Known
• Physiological factors
• Increase blood volume
• CHF, Renal failure
• Increase Resistance
• Vasoconstriction
• Increase CO
• Arrhythmias

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Diuretics

• Drugs
• Hydrochlorothiazide
• Thiazides
• Action
• Increase the elimination of sodium and water from
  the blood.
• Decreases the blood volume
• Side Effect
• Hyperkalemia
• Hyperglycemia

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Beta - Blockers

• Drugs
• Propranolol (Inderal)
• Metoprolol (Lopressor)
• Atenolol (Tenormin)
• Action
• Decreases peripheral resistance by relaxing
  atrial and ventricular smooth muscle.

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Ace - Inhibitors

• Drugs
• Captopril (Capoten)
• Enalapril (Vasotec)
• Benazepril (Lotensin)
• Action
• Angiotensin-converting enzyme inhibitor (causes
  increase in BP)
• Decreases peripheral resistance without
  increasing the output, contractility and rate of
  the heart.

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• Side effects -Severe Hypotension -Renal
  dysfunction -Rash, Photosensitivity -Hyperkalemi
  a. -Dry cough and nasal congestionInteractions
  -Diuretics -Potassium sparing
  diuretics -NSAIDs -Antiacids -Digoxin -Lithium

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• Contraindications
• Renal disorders
• Dialysis
• CHF

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Ca channel blockers

• Drugs
• Nifedapine (Procardia)
• Verapamil (Isoptin)
• Action
• Decreases calcium influx into the cell
• Decreases resistance (Vasodilatation).

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Methyldopa (Aldomet)

• Action
• Centrally active (CNS)
• Adrenergic inhibitor.
• Side effects
• Hypotension and drowsiness
• Anemia
• GI symptoms
• Sexual dysfunction

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• Interactions
• lithium
• Levodopa
• Contraindications
• Hepatic disorders.
• Dialysis patient

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Hydralazine (Apresoline)

• Indication
• Moderate to severe Hypertension.
• CHF
• Action
• Increase CO
• Used in conjunction with a Diuretic or other BP
  medication like Beta-Blocker

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• Side effect -Tachycardia, palpitation -Headache
  and flushing -Orthostatic Hypotension -GI
  effects -Blood abnormalities -Allergic
  reactions (Asthma).
• Contraindication
• Pregnancy

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Coronary Vasodilators

• Action
• Relaxes the walls of the coronary arteries to
  increase the blood flow going to the heart
  muscles.
• Indication
• Angina Pectoris
• Drugs
• Nitroglycerine (Nitrities)
• Isosorbide (Isordil).
• Beta - blockers
• Calcium blockers

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• Side effects
• Headaches
• Postural Hypotention
• Hypersensitivity reactions
• GI disturbance
• Contraindications
• Glaucoma
• Malabsorbtion
• Severe Anemia
• Hypotension

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Antilipemic Agents

• Indications
• Atherosclerosis
• Decrease LDL and Cholesterol
• Drugs
• Lovastatin
• Niacin
• Bile acid sequestrant
• Chlestyramine ( Questran)
• Gemfibrozil ( Lopid)

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• Side Effects
• Constipation
• Increased Calcium excretion
• Headaches
• Dizzines
• Muscle cramping
• Niacin
• Flushing
• Give Aspirin 30 min prior
• Jaundice

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• Interactions
• Immunosuppressive drugs
• With Niacin
• Calcium Blockers
• Beta Blockers
• Potentiate Hypotensive effects
• Contraindications
• Hepatic, Gall Bladder diseases
• Diabetes
• Hypotension
• Pregnant and Lactating.

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Vasoconstrictors

• Indications
• Treatment of shock
• Drugs
• Norepinephrine (Levophed)
• Metraminol Bitartrate ( Aramine).
• Side effects
• CNS disturbance
• Respiratory distress
• Palpitation, Bradycardia
• Tissue necrosis

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Anticoagulants

• Drugs
• Coumarin derivatives
• Warfarin and Coumadin ( Dicumerol ).
• Heparin
• Mechanism
• Prevents Clots from forming
• Prevents further development of preexisting clots

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• Indications
• Venous Thrombosis
• Pulmonary Embolism
• Coronary Heart Disease
• Prophylactically
• Post Surgical
• Valvular Disorder or in aged individuals
• Caution
• Bleeding disorders
• CVA

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Coumarin Derivatives

• Drugs
• Coumadin ( Dicumerol)
• Action
• Alters the effect of Vitamin K resulting in
  improper synthesis of coagulation factor.
• Side effect
• Prolonged bleeding ( Petechie, nosebleed,
  bruising.
• Melana and Hematuria

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Interactions

• Steroids
• Chloral Hydrate and Alcohol
• Disulfiram
• NSAIDS
• Aspirin
• Tricyclic antidepressants
• Thyroid
• Thiazides
• Quinidine

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Caution

• Monitor PT
• Monitor drug blood level

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Heparin

• Action
• Inhibit the activity of fibrin and thrombin
• If too much heparin is given Protamine Sulfate
  can be administered to reduce its effect.
• Side effects
• Major Hemorrhage
• Minor Bleeding ( Petechie, nosebleed, bruising)
• Melana and Hematuria

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• Contraindication
• GI disorders
• Stroke
• Pregnancy
• Blood Dyscriasis
• Interactions
• Aspirin and NSAIDS
• Caution
• Rotate injection site continuously
• Monitor PTT

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Platelet Inhibitor Therapy

• Mechanisms
• Inhibiting clumping of Platelets
• Drugs
• Aspirin
• Dipyridamole ( Persantine)

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Aspirin

• Indication
• MI
• Angina
• Strokes
• Side effect
• GI disturbance
• If taken without food

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Dipyridamole ( Persantine)

• This drug is more effective if used with Coumadin
• Side effects
• GI disorders
• Neurological disturbance
• Contraindications
• Bleeding disorders