CV Pharm Objectives (bolded)

cardiac output

Heart rate x stroke volume

the overall performance of the heart

- HR controlled by ANS (increased by SNS B1, decreased by PSNS)

preload

volume of blood present before contraction

- increase in preload, increases SV

afterload

Resistance heart must overcome to eject blood

- increase in afterload, decreases SV

stroke volume

The amount of blood ejected from the heart in one contraction

- determined by contractility (dilation and venous return)

starling's relationship

ventricular contraction is proportional to the muscle fiber length

- the more the heart stretches, the more forcefully it contracts allowing adequate BF

peripheral resistance

the opposition to flow that blood encounters in vessels away from the heart

- regulated by constriction/dilation of arterioles

arterial pressure

The pressure of the blood against the arterial walls

- peripheral resistance x cardiac output

RAAS

Renin is released by kidneys in response to decreased blood volume; causes angiotensinogen to split & produce angiotensin I; lungs convert angiotensin I to angiotensin II; angiotensin II stimulates adrenal gland to release aldosterone & causes an increase in peripheral vasoconstriction

Angiotensin II

high activity

- vasoconstriction of arterioles (increase BP)

- release of aldosterone --> Na+ and H2O retention (increase BP)

- hypertrophy and remodeling

renin

converts angiotensinogen to angiotensin I

ACE inhibitors

- reduce levels of Ang II

- cause vasodilation and reduce BV

- introduced after other BP drugs but reduce risk of cardio mortality caused by HTN similar to other drugs

captopril

ACE inhibitor

- used for MI and diabetic neuropathy

lisinopril

ACE inhibitor

- used for MI

ARBs

Angiotensin II Receptor Blockers

- used for HTN, heart failure, diabetic nephropathy

Losartan

ARB

- used for diabetic nephropathy

ARNI

Angiotensin receptor-neprilysin inhibitor

- for heart failure.

Valsartan/Sacubitril

ARNI

- for heart failure

- _____ blocks ang II causing dilation

- _____ blocks breakdown of natriuretic peptides produced in the body

- NOT given to those currently on ARBs or ACE inhibitors

Eplerenone

Selective aldosterone receptor blocker

- ONLY for HTN

calcium channel blockers

agents that inhibit the entry of calcium ions into heart muscle cells, causing a slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation; used to prevent or treat angina pectoris, some arrhythmias, and hypertension

nifedipine

calcium channel blocker

- works in the arterioles

- dihydropyridine

Verapamil and Diltiazem

Class IV: calcium channel blocker (2)

- works in the arterioles and the heart

- decreases velocity of conduction in the heart, prolongs QT interval

vasodilators

medications that cause dilation of blood vessels

- decrease afterload and preload

hydralazine

vasodilator

- works on arterioles

- uses: HTN, hypertensive crisis, and heart failure

minoxidil

vasodilator

- works on arterioles

- uses: severe HTN and hair growth (rogaine)

sodium nitroprusside

vasodilator

- works on arterioles/veins

- used in hypertensive emergencies

hypertension

high blood pressure

- BP > 120/80

heart failure

a chronic condition in which the heart is unable to pump out all of the blood that it receives

- reduced CO, fluid retention, and ventricular dysfunction

Digoxin

cardiac glycoside

- increases force of contraction/cardiac output

- used for heart failure

Spironolactone

potassium-sparing diuretic; aldosterone antagonist (receptor blocker)

- used for heart failure

sotagliflozin

SGLT2 inhibitor

- prevents sugar and sodium absorption in body lowering stress on the heart

- reduces risk of CV death, hospitalization for heart failure, and urgent heart failure visits

dysrhythmias

antidysrhythmic drugs also cause _____

- not used as often

lengthen

many antidysrythmic drugs ____ the PR interval

quinidine

Class IA: sodium channel blocker

- antidysrythmic drug

- decreases conduction in atria, ventricles, and his-purkinje system

lidocaine

class IB: sodium channel blocker

- antidysrhythmic drug

propranolol

class II: B blocker

- antidysrhythmic drug

- effects B1 and B2 receptors

Bretylium

Class III: Potassium channel blocker

- short term therapy

- antidysrhythmic drug

- delays repolarization in the heart, prolongs QT interval

Amiodarone

class III: potassium channel blocker

- antidysrythmic drug

- delays repolarization in the heart, QRS widening, PR/QT lengthening

VLDL

Very Low-Density Lipoprotein, transports triglycerides.

LDL

bad cholesterol

HDL

high density lipoproteins (healthy type of cholesterol)

Statins (HMG-CoA Reductase Inhibitors)

decreased LDL, TG; increase HDL

- MOA: inhibits enzyme needed for cholesterol synthesis

nicotinic acid

decrease LDL and TG; increase HDL

- MOA: decrease VLDL (LDL are byproducts of VLDL)

bile acid sequestrants

Decreases LDL

Increases HDL

No change in TG

fibric acid (fibrates)

Has little to no effect on LDL

Increases HDL

Decreases TG

- MOA: accelerate clearance of VLDL thereby reducing TG

angina pectoris

chest pain, which may radiate to the left arm and jaw, that occurs when there is an insufficient supply of blood to the heart muscle

nitroglycerin

organic nitrate drug used in the treatment of angina

- stable angina: decrease O2 demand by dilating veins

- variant angina: increase O2 supply by relaxing vasospasm

beta blockers

decrease heart rate and dilate arteries by blocking beta receptors

- treats stable angina: decrease O2 demand by decreasing HR

- not used for variant angina

stable angina

chest pain that occurs when a person is active or under severe stress

- exertional angina

- goal of decreasing oxygen demand

variant angina

pain at rest with reversible ST-segment elevation; thought to be caused by coronary artery vasospasm

- goal of increasing oxygen supply

calcium channel

_____ ____ blockers can treat:

- stable angina: decrease O2 demand by dilating arterioles and decreasing HR

- variant angina: increase O2 supply by relaxing coronary vasospams

thrombus

stationary blood clot

fibrin

protein that forms the basis of a blood clot

plasmin

enzyme that dissolves clots

heparin

Helps antithrombin inactivate clotting factors

- suppresses formation of fibrin

- parenteral anticoagulant

- used in hospital and requires lab monitoring

- uses: pregnancy, surgery, MI

Low molecular weight heparins

Helps antithrombin inactive clotting factors

- suppresses formation of fibrin

- parenteral anticoagulant

- used in hospitals/home, does not require lab monitoring

- uses: DVT following hip/knee replacement

warfarin

Oral anticoagulant

- delayed onset of action

- antagonist of vitamin K (required by 4 clotting factors)

- use: prophylaxis of thrombosis

aspirin

Antiplatelet drug

- inhibits COX needed to synthesize thromboxane

adenosine receptor antagonist

Inhibits ADP-stimulated aggregation

- long term antiplatelet maintenance

glycoprotein IIb/IIa receptor antagonist

- antiplatelet drug

- block the final step of aggregation

- long term antiplatelet maintenance

streptokinase

removes thrombi (blood clots)

- made from streptococci

- thrombolytic drug

- use: MI and DVT

Alteplase (tPA)

thrombolytic agent

- removes thrombi (blood clots)

- tissue plasminogen activator

- made in a lab

MI

necrosis of the heart resulting from occlusion of a coronary artery

thrombolytics; antiplatelet

we use _____ and _____ drugs to treat MI