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Cardiac System Drugs
Cardiac System Drugs
42
Pharmacology
Professional
11/15/2011

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Term
Clonidine
Definition
Alpha-2 receptor agonist.
Moderate effect
Decr venous tone and PVR.
Often given with methyldopa and diuretic.
Adv Effects: drowsiness, depression, hypertensive crisis if suddenly withdrawn, xerostomia, sexual dysfxn
Term
Methyldopa
Definition
Indirect adrenergic drug, taken up by adrenergic neurons and transformed to methylnorepinephrine which acts as alpha 2 agonist.
Preferred treatment of HTN in pregnancy.
Term
Prazosin
Definition
Alpha 1 blocker
Moderate anti hypertensive effect
Adv effects: postural hypotension, periph edema, urinary freq/incontinence, sex dysfxn
Term
Propanalol
Definition
beta blocker
Decr CO, decr renin release, decr NE release
Term
Labetalol
Definition
alpha/beta blocker.
No change in HR or CO, causes decr in venous tone, PVR.
Highly effective
Adv effects: postural hypotension,
Term
Hydralazine
Definition
Causes arterial vasodilation.
Moderate anti-HTN effect
Incr HR and CO, decr PVR, no post hypotension
Dont give if coronary artery disease, cerebrovascular disease, or collagen disorder.
Adv effect: drug induced lupus
Term
Nitroprusside
Definition
Metabolized by SmM into NO.
High anti-hypertensive effect
Causes large decr in PVR and decr renal blood flow, incr HR
Effect only lasts 5-6 mins.
Met to CN then thiocyanate
Adv effects: accumulation of CN, thiocyanate
Avoid CN accumulation by concurrent dose of sodium thiosulfate or hydroxycobalmin. Treat CN poisioning with B12. Can give with Beta blockers to prevent reflex tachycardia
Term
Minoxidil
Definition
Opens K channels in SmM mem leading to hyperpolarization. Vasodilation limited to arterioles.
High anti-HTN effect
large incr in HR and CO, decr PVR, no post hypotension, works for 24-48 hours.
Adv Effects: salt and water retention, pericardial effusion, tachycardia, HF in people with LV hypertrophy, excessive hair growth (also used for baldness)
Term
Diazoxide
Definition
Opens K channels in SmM mem leading to hyperpolarization.
Used in HTN emergencies and to treat hypoglycemia
Adv effects: salt/water retention, hypertrichosis, hyperglycemia, excessive hypotension leading to stroke
Dont give if DM, compensatory hypertension (aortic stenosis), sulfa drug allergy, coronary disease, impaired cerebral circulation
Term
Nifedipine
Definition
Ca channel blocker
Decr HR and PVR
Tx of HTN
Short acting, not good for long term Tx because causes dangerous reflex tachycardia
High vascular selectivity
Term
Verapamil
Definition
Ca channel blocker
Decr HR, PVR
Good for Tx of HTN
Term
Diltiazem
Definition
Ca channel blocker
Term
Fenoldopam
Definition
D1 dopamine receptor agonist.
Causes vasodilation of renal and mesenteric vasculature and inhibition of Na resorption.
Used for HTN emergencies or to induce controlled hypotension during surgery
Adv effects: tachycardia, hypokalemia, incr intra-ocular pressure (dont give if glaucoma)
Very short acting
Term
Aliskiren
Definition
Competitive inhibitor of renin enzyme.
Adv effects: dizziness, fatigue, hypotension
Dont give in pregnancy
Term
Captopril
Definition
ACE inhibitor and incr bradykinin.
Decr angiotensin II can cause incr renin release.
First choice HTN drug, also used for MI, CHF, Diabetic glomerulonephropathy, hyperaldosteronism
Decr PVR and vascular tone with no effect on CO or HR.
Half life 2 hours
Adv Effects: rare post hypotension, rare angioneurotic edema, dry cough.
Dont give in pregnancy or women of childbearing age, hypovolemia, hypokalemia, ESRF, renal A stenosis, Abdom Aortic stenosis, coronary A disease.
Term
Enalapril/Enalaprilat
Definition
ACE inhibitors, Enalaprilat is the active metabolite of Enalapril. Enalaprilat given IV only and much longer half life.
Term
Losartan
Definition
Angiotensin II receptor antagonist.
No effect on bradykinin or leukotriene met
Main mech is vasodilation and incr Na and water secretion
First choice HTN drug
Adv effects: hypotension, hyperkalemia
Dont use in preg or renal A stenosis
Term
Digoxin (Digitalis)
Definition
Inhibits Na/K pump leading to higher intracellular Na --> Decr Na/Ca exchange --> higher intracellular Ca --> Incr contraction of myocardium.
Also incr Ca entry through voltage gated channels and incr release of Ca from SR
Decr action potential duration.
Digi immune Fab good against Digoxin OD
Adv Effects: mostly cardiac arrythmias, and CNS effects
Used for systolic HF, A flutter and A fib (depression of AV conduction)
Term
Quinidine
Definition
1a: Na channel block (mainly activated Na channes), moderate decr in slope of 0 phase, prolonged repolarization.
Also block K channels and block Ca and alpha-1 at high doses.
Little change in HR. Also anti-malaria
Adv effects: arrythmias, PVTs, decr digitalis CL, N/V/D, thrombocytopenia
Na Lactate treats OD
Dont give in BBB, cardiac failure, long QT, colitis, MG, thrombocytopenic purpura, Torsada de Pointes
Used in A fib or A flutter, SVT, VT, ectopic beats
Term
Procainamide
Definition
1a: Active Na and K channel block, moderate decr in 0 phase slope, prolonged repolarization.
Adv effects: Diarrhea, thrombocytopenia, hypotension, CNS effects, Lupoid syndrome
Used for WPW, SVT and Ventricular Arrhythmias
Term
Lidocaine
Definition
1b: Na channel block (inactive > active), small decr in slope of 0 phase, shortened repolarization
Used for ventricular arrhythmias and digitalis induced arrhythmias.
Adv effects: bradycardia, heart block, hypotension, arrhythmias, CNS effects
Dont give if heart block, A fib, hepatic failure, age >70
Term
Mexilitine
Definition
1b: Na channel block, small decr in 0 phase slope, shortened repolarizaiton.
Lidocaine analog that can be given orally.
For V Tach
Term
Phenytoin
Definition
1b: Inactive Na channel block, small decr in slope of 0 phase, shortened repolarization.
Used as anticonvulsant and digitalis induced arrhrythmias
Term
Flecainide
Definition
1c: Active Na channel and K channel block, marked decr in slope of 0 phase, no affect on repolarization. Depresses cardiac contractility
Used in atrial flutter and SVTs
Adv effects: Ventricular arrhythmias, worsening CHF, visual disturb, CNS effects
Dont give if structural cardiac disease
Term
Amiodarone
Definition
K channel block (prolongs repolarization) and active Na channel block. Increases PR, QRS, and QT. Also causes vasodilation.
Adv effects: hypotension, HF, constipation, hepatitis, CNS effects, pulmonary fibrosis, visual problems, hypothyroidism (contains Iodine), CYP450 block.
Used for A fib, A flutter, V tach, V fib, SVT, arrhythmias from hypertrophic cardiomyopathy.
Term
Ibutilide
Definition
K channel block (prolonging repolariz)
Used in A fib and A flutter
Adv effects: BBB, AV block, torsades de pointes, V tach
Dont give if long QT or V tach
Term
Sotalol
Definition
K channel block (prolonging repolariz) and beta block.
Used in SVT and Ventricular arrhythmias.
Adv effects associated with beta block and can cause torsades de pointes
Term
Verapamil
Definition
Ca channel block (decr slope in phase 0, slower HR and longer PR) causes decr conduction and incr refractoriness. Also causes vasodilation.
Used to treat SVT and A flutter or A fib.
Term
Dilitazem
Definition
Ca channel block (decr slope in phase 0)
Term
Adenosine
Definition
Activates ACh dependent K channels causing hyperpolarization in SA and AV nodes
Used to treat supraventricular tachycardias and works by slowing HR and increasing PR interval.
Adv effects: flushing, dyspnea, chest pain, hypotension, asystole
Drug of choice for paroxysmal SVT
Term
Magnesium Sulfate
Definition
IV admin can prevent torsades de pointes and digitalis induced arrhythmias.
Term
Dobutamine
Definition
Strong beta-1 & weak beta-2 effects resulting in incr CO, BP, & HR, & decr PVR
Used in acute decomp HF, cardiogenic shock (when LV fxn is failing)
Used in low CO and CHF
Adv effects: cardiac arrhythmias, angina, periph vasospasm, HTN
Term
Dopamine
Definition
Activates D1, beta-1 (Int dose), and alpha-1 (high dose).
used in acute decompensated HF, cardiogenic shock, neurogenic and septic shock, helps in poor renal perfusion.
Term
Milrinone
Definition
Phospholipase inhibitor leading to a decr in cAMP and incr intracellular Ca in cardiac muscle. Leads to positive inotrophic effects and periph vasodilation.
Adv effects: hypotension, ventricular arrhythmia, thrombocytopenia.
Used in acute decomp HF or cardiogenic shock.
Term
Carvedilol
Definition
Non selective beta blocker and alpha-1 blocker.
Term
Metoprolol
Definition
Beta blocker, selective for B1
Term
Nesirtide
Definition
vasodilator, activates guanylyl cyclase causing incr in cGMP. Leads to venous and arterial dilation and incr diuresis.
Term
Nicardipine
Definition
Ca channel blocker. These drugs reduce O2 demand by reducing afterload, contractility, and HR. Also incr heart perfusion by coronary A dilation.
High vascular selectivity.
Term
Amyl Nitrate
Definition
Nitrate with duration of about 3-5 mins.
Term
Nitroglycerine
Definition
Reduces O2 demand by reducing preload and incr coronary A perfusion by vasodilation. Acts about 5-10 minutes. Venous dilation more than arterial dilation. Frequent doses can lead to tolerance.
Adv effects: headache, post hypotension
don't give if angina due to ventricular hypertrophy (already have low preload), incr ICP, hyperthyroidism, liver failure, or already taking sidenaphil.
Term
Isosorbide Mononitrate
Definition
Nitrate with duration of 6-10 hours.
Term
Atenolol
Definition
Beta blocker. These drugs decr O2 demand by decr contractility and HR.
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