Week 9 & 10 Cardiovascular drugs

Cardiovascular drugs include

1. Atorvastatin (Lipitor)

2. Methyldopa (Aldomet)

3. Prazosin (Minipress)

4. Atenolol (Tenormin)

5. Hydralazine (Apresoline)

6. Verapamil (Calan, Isoptin)

7. Lisinopril (Prinivil)

8. Losartan (Cozaar)

9. Nitroglycein

10. Hydrocholrothiazide (hydrodiuril)

11. Furosemide (Lasix)

12. Spironolactone (aldactone)

13. Mannitol

14. Digoxin (Lanoxin)

15. Potassium

16. Amiodarone (Cordarone)

17. Lidocaine (Xylocaine)

Cholesterol and lipid management drug

1. atorvastatin (lipitor)

Hypertension drugs

• Methyldopa (Aldomet)

• Prazosin (Minipress)

• Atenolol (Tenormin)

• Hydralazine (Apresoline)

• Verapamil (Calan, Isoptin)

• Lisinopril (Prinivil)

• Losartan (Cozaar)

Diuretic medication

• Hydrocholrothiazide (hydrodiuril)

• Furosemide (Lasix)

• Spironolactone (aldactone)

• mannitol

Antiarrhythmic medications

• Amiodarone (Cordarone)

• Lidocaine (Xylocaine)

2 ways to decrease cholesterol

1. decrease production

2. accelerate removal

Atherosclerosis is

buildup of fatty plaque on the arterial wall

A major cause of atherosclerosis is

excess plasma levels of lipoproteins

How can we modify (decrease) lipoproteins in the blood?

1. modify diet

2. drug therapy if dietary changes do not work

VLDL do what

• produced in liver

• deliver triglycerides to adipose tissue and muscle

LDL do what

• by-product of VLDL metabolism

• delivers cholesterol to liver and tissues

HDL do what

removes cholesterol from tissues; has a “good” protective effect

Antilipemics has 2 basic mechansims of drug effect

• suppress lipoprotein formation

• accelerate removal

Do antilipemics remove exisiting plaque?

No

Atorvastatin (Lipitor) drug classification

anti-lipid (HMG- CoA reductase inhibitor)

Atorvastatin (Lipitor) ADR

• mild, transient GI disturbances

• muscle pain

• rash, headache

• sleep disturbances

• increase in serum transaminase levels

• peripheral neuropathy

• lupus-like syndrome

• severe myalgia

• myositis

• muscle weakness

• rhabdomyolysis

Potentially serious side effects from Atorvastatin are

• Myopathies

• Elevations in liver enzymes

What should you know about Atorvastatin?

1. use cautiously in patients who consume large amounts of alcohol or with known liver disease

2. monitor liver function tests

3. drug is contraindicated in pregnancy

4. drugs may enhance the clinical effects of oral anticoagulants

5. do not take with grapefruit juice

Why should you not take grapefruit juice with Atorvastatin?

it inhibits the metabolism of statins and lead to toxic levels

Statins are

highly effective in reducing lipid levels, and are the most prescribed class of anti-lipid drug

Non-drug approaches to HTN

• exercise

• weight reduction

• lower sodium intake

• lower alcohol intake

• reduce stress

• sleep

Groups of drugs used for hypertension

• those that promote salt excretion- diuretics

• those that decrease sympathetic NS activity

• vasodilatos

• Calcium channel blockers

• Angiotensin II inhibitors and related drugs

What type of drugs are most effective at decreasing BP?

drugs that inhibit SNS function

Most common side effect with anti-hypertensives

hypotension

Ganglionic blockers

• decrease BP but they also affect the PAS, can cause widespread side effects

• sometimes used for acute antihypertensive crisis

Drugs that interfere with SNS activity, either centrally or peripherally

• used for mild to moderate hypertension

• good with impaired renal function

• usually used with thiazide diuretic

Methyldopa (Aldomet) drug classification

sympatholytic antihypertensive, alpha 2 adrenergic agonist

Methyldopa (Aldomet) drug action

• central mechanism that reduces sympathetic outflow from brain (medulla)

• reduces amount of NE formed

• result is decreased peripheral resistance

• little or no effect on cardiac output

Methyldopa (Aldomet) ADR

• postural/orthostatic hypotension

• sedation

• depression

• dry mouth

• nasal congestion

• headache

• fever

• decreased WBC and platelets

• hepatic dysfunction

• sexual dysfunction

• Na and water retention if not also receiving diuretic

If pt is on beta blocker you should check pulse rate

Prazosin (Minipress) drug classification

Antihypertensive, alpha 1 adrenergic antagonist

Prazosin (Minipress) drug action

• major action is competitive blockade of the alpha 1 adrenergic receptors

• net result is prevention of the constriction by alpha stimulation

• results in vasodilation and decreased peripheral resistance

Prazosin (Minipress) ADR

• orthostatic hypotension

• dizziness

• syncope

• palpitations

• tachycardia

• headache

• dry mouth

• diarrhea

• peripheral edema

• urinary urgency

• impotence

• “first dose phenomenon”

Atenolol (Tenormin) drug classification

selective beta adrenergic inhibitor (beta blocker)

Atenolol (Tenormin) drug action

• blocks B1 adrenergic receptors

• anti-hypertensive- effect may be d/t decreased HR, force of contraction, depressed renin-angiotensin system or a central action

• anti-anginal- reduction of myocardial oxygen consumption

• anti-arrhythmic- blocks B adrenergic effect in SA node and Purkinje fibers

Atenolol (Tenormin) ADR

• bradycardia, CHF, intensify AV block, hypotension

• can cause bronchospasm, esp in COPD or asthma

• nausea, diarrhea, cramps, fatigue, allergic response

Special information about Atenolol (Tenormin)

1. check apical, radial pulse, and BP before giving

2. used as anti-hypertensive, used in combination with a thiazide diuretic and vasodilator

3. used as an antiarhythmic primarily for supraventricular arrhythmias

4. do not stop abruptly, taper slowly before discontinuing

5. use with caution in patients with CHF, asthma, or diabetes

6. beta blockers also used for migraine prophylaxis, MI prophylaxis, panic attacks, benign essential tremor, and PTSD

What is the drug classification of hydralazine (Apresoline)?

antihypertensive, direct vasodilator

Hydralazine (Apresoline) drug action

has direct action on blood vessels, cause arteriolar vasodilation and increase renal blood flow

Hydralazine (Apresoline) ADR

• hypotension

• headache

• palpitations/tachycardia

• anxiety

• mild depression

• dry mouth

• unpleasant taste in mouth

• N/V

Special information about Hydralazine (Apresoline)

frequent monitoring in early stages of therapy d/t differences in metabolism

What is the drug classification for Verapamil (Calan, Isoptin)?

calcium antagonist, antianginal, antiarrhythmic

Verapamil (Calan, Isoptin) drug action

produce blockade of calcium channels in blood vessels and in heart

Drug effects from Verapamil (Calan, Isoptin)

1. arteriolar dilation and resultant lowering of BP

2. increase in coronary perfusion

3. SA node causes reduction in heart rate

4. decrease in nodal conduction in AV node

5. decrease in force of myocardial contraction

6. inhibition of renin release

Verapamil (Calan, Isoptin) ADR

• bradycardia

• hypotension

• severe tachycardia

• possible nausea

• Abdominal discomfort

• dizziness

• headache

• flushing

• pruritus

• constipation

Special information about Verapamil (Calan, Isoptin)

1. contraindicated in AV block and conditions of reduced myocardial contractility, severe hypotension, and severe CHF

2. diltiazem (cardizem, tiazac) is similar

3. grapefruit juice may increase levels

What drug classifica