Katzung Chapter 13 Drugs Used in Heart Failure, Katzung Chapter 11 Antihypertensive Agents, Katzung Chapter 12 Vasodilators and the Treatment of Angina Pectoris, Katzung Chapter 14 Agents Used in Cardiac Arrhythmias

Bisoprolol

Beta adrenergic antagonist, beta 1 selective

Metoprolol

Beta adrenergic antagonist, beta 1 selective

Nebivolol

Beta adrenergic antagonist, beta 1 selective

Carvedilol

Beta adrenergic antagonist, combined beta and alpha antagonists, Lowers blood pressure by reducing vascular resistance without altering cardiac output or heart rate

Enalapril

Angiotensin converting enzyme inhibitor

Lisinopril

Angiotensin converting enzyme inhibitor

Losartan

Angiotensin receptor antagonist

Valsartan

Angiotensin receptor antagonist

Telmisartan

Angiotensin receptor antagonist

Olmesartan

Angiotensin receptor antagonist

Endothelin

Vasoconstrictor

Angiotensin II

Vasoconstrictor, causes the release of aldosterone

Digoxin

Cardiac glycoside, inhibits the Na/K/ATP pump, with increased intracellular calcium that causes an increased interaction between actin and myosin in sarcomere and an increase in the force of cardiac contractility

Furosemide

Diuretic, loop diuretic

Spironolactone

Diuretic, aldosterone antagonist, potassium sparing

Cardiomegaly

Abnormal enlargement of the heart.

Cardiac Remodeling

A group of molecular, cellular and interstitial changes that manifest clinically as changes in size, mass, geometry and function of the heart after injury. The process results in poor prognosis because of its association with ventricular dysfunction and malignant arrhythmias

Systolic Heart Failure

Reduced mechanical pumping action (contractility) with reduced ejection fracture ex. myocardial infarction

Diastolic Heart Failure

Hypertrophy and stiffening of the myocardium, reduced filling and cardiac output

Hydralazine

Relaxes smooth muscle of arterioles and thereby decreases peripheral vascular resistance

Isosorbide dinitrite

Releases nitric oxide in vascular smooth muscle and activates guanylyl cyclase

Propranolol

Beta adrenergic antagonist, non selective

Atenolol

Beta adrenergic antagonist, beta 1 selective

Nadolol

Beta adrenergic antagonist, non selective

Labetolol

Beta adrenergic antagonist, combined beta and alpha antagonists, Lowers blood pressure by reducing vascular resistance without altering cardiac output or heart rate

Prazosin

Alpha 1 adrenergic antagonist, treats hypertension and BPH

Doxazocin

Alpha 1 adrenergic antagonist, treats hypertension and BPH

Verapamil

Calcium channel blockers (L-type channels), has the greatest effect on the heart and may decrease heart rate and cardiac output

Diltiazem

Calcium channel blockers (L-type channels), depresses heart, intermediate effect on heart

Amlodipine

Calcium channel blockers (L-type channels), dihydropiridine, less cardiac depression

Nifedipine

Calcium channel blockers (L-type channels), dihydropiridine, less cardiac depression

Captopril

Angiotensin converting enzyme inhibitor

Triamterene

Diuretic, aldosterone antagonist, potassium sparing

Chlorthalidone

Diuretic, blocks sodium/chloride exchanger in distal convoluted tubule

Hydrochlorothiazide

Diuretic, blocks sodium/chloride exchanger in distal convoluted tubule

Nitroglycerin

Releases nitric oxide in vascular smooth muscle and activates guanylyl cyclase

Tachyphylaxis

Rapidly diminishing response to successive doses of a drug, rendering it less effective

Angina Pectoris

Imbalance between the oxygen requirement of the heart and the oxygen supplied to the heart via the coronary vessels

Classic angina

Oxygen requirement increases during exercise but the coronary blood flow doesn't increase proportionately

Variant angina

Oxygen delivery decreases as a result of coronary vasospasm

Unstable angina

Increase in the character, frequency, duration or precipitating factors of angina, symptoms occur at rest, episodes of increased epicardial coronary artery resistance, small platelet clots, high risk of myocardial infarction and death

Arterial tone

Controls peripheral vascular resistance and thus arterial blood pressure

Venous tone

Controls the amount of venous blood pumped back to the heart

cGMP

Facilitates the dephosphorylation of myosin light chain preventing the interaction of myosin with actin (contraction)

Calmodulin

Binds calcium and activates myosin light chain kinase that phoshorylates myosin light chain producing contraction in cardiac muscle

Coronary Steal Phenomenon

A potent arteriole dilator is given in a situation where there is an obstructed and unobstructed vessel that branch the unobstructed vessel will dilate, decreasing arterial pressure in the area but also decreasing flow into the obstructed vessel and precipitating angina

Esmolol

Beta adrenergic antagonist, beta 1 selective, short-acting

Quinidine

Anti-arrhythmic, blocks activated sodium channels and lengthens the duration of the action potential

Procainamide

Anti-arrhythmic, blocks activated sodium channels and lengthens the duration of the action potential, may cause a lupus erythramatosus-like syndrome

Disopyramide

Anti-arrhythmic, blocks activated sodium channels and lengthens the duration of the action potential, antimuscarinic side effects limit its use

Lidocaine

Anti-arrhythmic, blocks activated and inactivated sodium channels and shortens the duration of the action potential, only given by IV often after an MI

Mexiletine

Anti-arrhythmic, blocks activated and inactivated sodium channels and shortens the duration of the action potential, congener of lidocaine, can be given orally

Flecainide

Anti-arrhythmic, blocks sodium and potassium channels

Propafenone

Anti-arrhythmic, blocks sodium and weak beta-blocker

Amiodarone

Anti-arrhythmic, blocks inactivated sodium channels, lengthens action potential by blocking potassium channels, weak calcium channel blocker, beta-blocker, prolongs QT duration and increases refractory period

Arrhythmias

Cardiac depolarizations that are abnormal in the site of origin, rate or conduction

Asynchronous

Cardiac depolarizations without rhythm

Cardioversion

Tachycardia or other arrhythmia is converted to a normal rhythm using electricity or drugs.

Catheter ablation

Minimally invasive procedure in which the doctor advances a flexible thin tube through the blood vessels to your heart to destroy the tissue that is causing an arrhythmia

Ectopic pacemaker cells

Excitable group of cells that causes a premature heart beat outside the normally functioning SA node of the heart.

Hypokalemia

Increase of pacemaker discharge

Hyperkalemia

Decrease of pacemaker discharge

Reentry

One impulse reenters and excites areas of the heart more than once resulting in a few extra beats or sustained tachycardia

Long QT-related arrhythmias

Delayed repolarization increases the time interval between depolarization and repolarization of the ventricle, can lead to potentially life-threatening arrhythmias, symptoms include fainitng seizures and sudden death

Bretylium

Antiarrhythic, Class III- interferes with normal release of catecholamines

Sotalol

Antiarrhythic, Class III- prolongs action potential and is a non-selective beta blocker

Ibutilide

Antiarrhythic, Class III- enhances inward sodium current

Dofetilide

Antiarrhythic, Class III- blocks a K channel