misc cardiac meds

alpha 1 adrenergic antagonist drugs

tamsulosin (flomax)

what is tamsulosin used for

enlarged prostate - benign prostate hypertrophy

hypertension

what is a side effect of tamsulosin (flomax)

floopy iris syndrome

MOA of alpha 1 adrenergic antagonists

Blockage of alpha-1 adrenergic receptors found in smooth muscle tissue of arterioles, bladder and the prostate gland Results in vasodilation

floppy iris syndrome risk factors

1. male - only one that takes the drug

2. order age

3. tamsulosin is worse than other drugs

what drugs affect the retina

digoxin

digitalis (lanoxin)

what are Digoxin, Digitalis (Lanoxin) used for

arrhythmias like atrial fibrillation, atrial flutter

heart failure - used later when all else has failed

positive ionotrope that inc force of contraction

MOA of digoxin (lanoxin)

potent, selective inhibitor of the active transport Na+ and K+ across cell membranes, by binding to a specific site on the Na+, K+-ATPase = ↑ force of contraction (AKA +inotropic effect); has some additional electrophysiologic actions:

• ↑ tissue perfusion, ↓ edema, (-) chronotropic effect, ↓ sympathetic tone

SAME THING THE RETINA HAS

adverse effects of digoxin (lanoxin)

NARROW THERAPEUTIC INDEX

1. Cardio vascular

2. CNS - vision changes, fatigue, stupor

3. GI

Digoxin toxicity

1. visual - blurred or yellow vision

2. Halos - may be first symptom

3. yellow and green dyschromatopsia

4. send them to get serum blood levels checked

whats the mech of ocular side effects of dig

photoreceptors, muller cells, and RPE all contain the Na/K ATPase

Vaughan –Williams Classification of Sub-Types of Anti-Arrhythmic Agents

1. Type 1 - sodium channel blockers

2. type 2 - beta adrenergic blockers

   1. sympatholytics

   2. OLOL

3. type 3 - block the outward flow of K

4. type 4 - Ca channel blockers

   1. dilating dihydropyridine

      1. amplodopine (Norvasc) —- HTN

   2. non dilating dihydropyridine

      1. Verapamil

      2. Deltiazem -anti arhythmics

whats the type 3 antiarryhthmiac

1. amiodarone (nexterone, Pacerone)

what drug affects the ON

1. amiodarone (nexterone, Pacerone)

1. amiodarone (nexterone, Pacerone, cordarone) MOA

1. K channel blocker

amiodarone PK

1. long half life = 56 (to 83) days

2. we can load this drug - give them a stronger first dose

3. theres no antidote to this tho

adverse effects of amiodarone

1. cardiac = bradycardia

2. extracardiac = major limitation

   1. monitor liver, pulmonary, thyroid function tests, and do eye exams

   2. it accumulates in many tissues

      1. almost all pt have corneal micro deposits

   3. pulmonary fibrosis

   4. abnormal LFTs and hepatitis

      1. AST and ALT tests

   5. corneal microdeposits - seen in almost all pt

   6. optic neuritis

   7. blocks conversion of T4 to T3

amiodarone associated optic neuropathy

1. higher in males

2. higher in pt w longer duration of treatment

3. mean duration of use before visual loss isi ab 9 mo

1. slow progression

2. bilateral sim vision loss

3. w discontinuation of drug some have slow improvement

nitrates MOA

1. one of the most common anti anginal

2. dilates large myocardial arteries = increased blood supply to the heart

   1. SECONDARY mechanism…venous vasodilation is primary mechanism

3. dilation of large veins = pooling of blood in veins = reduced preload (venous return to the heart)

4. All of this = increased blood supply to the heart muscle = decreased O2 consumption due to decreased cardiac work load.

whats an issue w nitro drugs and how do we ocercome this

tolerance

• give them a drug free period

adverse effect of nitrate drugs

1. cerebral ischemia - headache (most common)

what agent are used in gout

1. colchicine

   1. poorly tolerated

2. uricosurics

3. alloprinol (zyloprim)

what are uricosurics drugs

Probenecid (Benemid)

Sulfinpyrazone (Anturane)

• Inhibits re-absorption of UA in renal tubules