Drugs Acting on CVS Part II

Adrenergic Agonists

These agonists increase BP by stimulation of the heart (B1 receptors), constricting peripheral blood vessels (α1 receptors).

Antagonist

Antiadrenergic drugs works by __________ for adrenergic receptor.

Agonist

Antiadrenergic drugs works by inhibit release of adrenergic _______.

Sympathetic

Antiadrenergic agents inhibit the activity of the ___________ nervous system.

Alpha Blockers

Inhibit alpha-1 receptors in smooth muscle.

Alpha Blockers

Relaxes BVs and reduces peripheral resistance, venous return, cardiac output.

Alpha Blockers

Relaxes bladder neck and smooth muscles in the prostate to facilitate better flow in the long term.

Alpha Blockers

Causes reduced salivary flow (dry mouth) and ejaculation on the short term.

Beta Blockers

Agents that block the action of sympathetic nerve stimulation.

Beta Blockers

The main effect is to reduce cardiac activity by diminishing β1 receptor stimulation in the heart.

Beta Blockers

Decreases rate of heart contraction and force of myocardial contraction.

Propranolol

Is a prototype beta blocker.

Beta Blockers

Competitive antagonist at both β1 and β2 receptor. 90-95% bound to plasma protein.

Orally

Beta blockers are administered ______.

1-3 hours

Peak concentration of beta blockers.

3 to 6 hours

Half life of beta blockers.

Alpha-2 Adrenergic Agonists

Medications that “turn on” alpha-2 receptors.

Norepinephrine - Sympathetic

Alpha-2 adrenergic Agonists brake on ______________ release and reduce ___________ outflow from the brain.

Monoamine-depleting Agents

Reduce the amount of monoamine neurotransmitters in nerve endings.

Monoamine-depleting Agents.

Does not block release, but reduce the supply of monoamine neurotransmitters.

Norepinephrine (NE) - Dopamine (DA) - Serotonin (5-HT)

Monoamine neurotransmitters reduced by monoamine-depleting agents (3).

Monoamine-depleting Agents

Dec BP due to lower norepinephrine.

Parkinson

Decreased dopamine = _________ like symptoms.

Vasodilators

Drugs that lower blood pressure, improve the patency of coronary arteries and reduce the work of the heart.

ACE Inhibitors

They block the enzyme Angiotensin-Converting Enzyme, preventing the formation of Angiotensin II in RAAS.

Renin-angiotensin-aldosterone System (RAAS)

Hormone system that regulates long-term blood pressure, blood volume, and sodium balance.

ACE Inhibitors

Drugs that VASODILATE and REDUCE BLOOD VOLUME.

ACE Inhibitors

Side effects: dry cough, angioedema, orthostatic hypotension.

Angiotensin II Antagonists

They prevent Angiotensin II from binding to its receptor.

Angiotensin II Antagonists

Relaxes blood vessels (dilation), aldosterone secretion, well tolerated ACE inhibitors.

Angiotensin II Antagonists

Alternative for patients who cannot tolerate ACE inhibitors (especially cough).

Angiotensin II Antagonists

Still at risk for orthostatic hypotension.

Direct Renin Inhibitors

They inhibit Renin, preventing the formation of Angiotensin I.

Lower

No Angiotensin I → no Angiotensin II → _____ blood pressure.

Aliskiren

(Direct Renin Inhibitors) The only drug in circulation.

Syncope

(Direct Renin Inhibitors) _______ can happen when standing up from the dental chair.

Nitroglycerin

Emergency drugs (for acute angina).

Nitric Oxide

(Nitroglycerin) Donate ______ _____ → widen blood vessels → improve blood flow.

Nitroglycerin

Reflex tachycardia to compensate for low BP. Typically a sudden drop in BP.

Nitroglycerin

Sublingual tablets.

Sildenafil (Viagra)

Do not combine Nitroglycerin with this, as it will cause life threatening hypotension.

Hydralazine

Acts directly on arteriolar smooth muscle to cause relaxation.

Hydralazine

Decreases diastolic pressure more than systolic blood pressure.

No

Is orthostatic hypotension a common effect of hydrazaline?

Hydralazine

Indicated for hypertensive patients with vulnerable renal systems.

Anti-hyperlipidemic Drugs

Reduce blood lipid levels especially cholesterol.

Anti-hyperlipidemic Drugs

These drugs prevent atherosclerosis, heart attack, stroke.

Cholesterol

(Anti-hyperlipidemic Drugs) ___________ plaque narrows arteries and may lead to CVS emergencies.

Lowers

(Anti-hyperlipidemic Drugs) Inhibit HMG-CoA reductase → ______ cholesterol synthesis

Erythromycin - Azole

(Anti-hyperlipidemic Drugs) ____________ and _____ antifungal should be avoided when taking -statins.

Antiplatelet Drugs

Prevents blood clots from forming or enlarging. Blood thinner.

Aspirin

Commonly prescribed antiplatelet drug.

Warfarin - Heparin

Anticoagulants (2).

Anticoagulants

Stop new clots from forming. Blood thinner.