Cardiac drugs pt.2 for Taylor

What is the clinical indication for vasopressors?

• used in treatment of shock

• support blood pressure until the underlying cause of shock can be reversed

What are the medications of vasopressors?

• Norepinephrine

• dopamine

• dobutamine

What is the criteria for a hypertensive crisis?

BP (>180/>120)

What is the criteria for a hypertensive urgency?

systolic >220 or diastolic >125 WITHOUT signs or symptoms of acute organ complications (reeducation can be done over several hours or days)

What is the criteria for a hypertensive emergency?

• diastolic >130 WITH acute organ injury signs and symptoms [ex. Diaphoretic, blurred vision, LOC, chest pain, slurred speech, headaches] (requires invasive monitoring and immediate reduction of BP)

What type of drugs are used in the treatment of hypertension?

• Angiotensin-converting enzyme inhibitors

• Angiotensin II - receptor blockers

• Calcium channel blockers

• Beta blockers

• Diuretics

• Adrenergic agents: Centrally acting

• Alpha1-Adrenergic antagonists

• Antiadrenergic agents

• Vasodilators

What do beta blockers end in?

"lol"

What do thrombolytics end in?

"ase"

What are the major body organs affected by hypertension?

• heart

• brain

• kidneys

• eyes

Primary hypertension definiton

(genetic) etiology is unknown, accounts for most cases of hypertension

Secondary hypertension

disease or drug induced, accounts for 10% of all cases

What is the use for diuretics?

• increase in sodium loss

• lowers vascular resistance by reducing plasma volume

• not maintained w/chronic diuretic therapy

All the medications listed for hypertension:

• Angiotensin-converting enzyme inhibitors: (end in “pril”)

◦ captopril

◦ enalapril

• Angiotensin II – receptor blockers: (end in “sartan”)

◦ losartan

◦ valsartan

• Calcium channel blockers: (end in “dipine”)

◦ amlodipine

◦ nicardipine

• Beta blockers: (end in “lol”)

◦ atenolol

◦ labetalol

◦ metoprolol

• Diuretics:

◦ potassium sparing:

▪ amiloride

▪ triamterene

◦ thiazide:

▪ cholothiazide

• Adrenergic agents: Centrally acting (alpha 2 agonists):

◦ clonidine

• Alpha1-Adrenergic antagonists: (end in “osin”)

◦ prazosin

• Antiadrenergic agents:

◦ guanethidine

• Vasodilators:

◦ hydralazine

◦ minoxidil

Angiotensin II – receptor blockers: meds

(end in “sartan”)

◦ losartan

◦ valsartan

Calcium channel blockers: meds

(end in “dipine”)

◦ amlodipine

◦ nicardipine

Beta blockers: meds

(end in “lol”)

◦ atenolol

◦ labetalol

◦ metoprolol

Diuretics: meds

◦ potassium sparing:

▪ amiloride

▪ triamterene

◦ thiazide:

▪ cholothiazide

Adrenergic agents: Centrally acting (alpha 2 agonists): med

◦ clonidine

Alpha1-Adrenergic antagonists: meds

(end in “osin”)

◦ prazosin

Antiadrenergic agents: meds

◦ guanethidine

Vasodilators: meds

◦ hydralazine

◦ minoxidil

Angiotensin-converting enzyme inhibitors: meds

(end in “pril”)

◦ captopril

◦ enalapril

How do ACE1 work to decrease BP?

renin from kidneys acts with angiotensinogen to form angiotensinogen 1

-> angiotensin converting enzyme changes angiotensinogen 1 into angiotensinogen 2

-> angiotensinogen 2 causes vasoconstriction ->ACE1 blocks the conversion ofangiotensinogen 1 to angiotensinogen 2 = decreased SVR & vasodilation

How do Angiotensin II - receptor blockers (ARBs) works o decrease BP?

it is an angiotensinogen 2 receptor agonist and block the receptor sites angiotensinogen 2 tries to bind to, to stop vasoconstriction

How do Calcium channel blockers work to decrease BP?

blocks the influx of calcium into both cardiac and vascular smooth muscle cells to create vasodilation

How do Diuretics work to decrease BP?

thiazides and potassium sparing diuretics increase sodium loss and lowers systemic vascular resistance by reducing plasma volume

How do vasodilators work to decrease BP?

lowers BP by direct relationship of vascular smooth muscle (increase VSM = increased BP, decreased VSM = decreased BP)

Angina definition

chest pain (paroxysmal precordial pain with a feeling of suffocation)

What is an example of a specific medication for Angina?

• Nitrates

◦ Ex. nitroglycerin

What is the most common side effect of septic shock?

Hypotension

What do the 3 vasopressors treat?

Hypotension due to shock

How does Dopamine work?

Increase force of contraction without increasing BP

How does Dobutamine work?

Increase HR & contractility and increases peripheral vasoconstriction

How does Norepinephrine work?

increases peripheral resistance, causing an increase in systolic and diastolic BP

Name the Antithrombitic drug classes

- anticoagulants

- antiplatlets

- thrombolytic (fibrinolytic)

What are the medications of Anticoagulants?

• Heparin

• Enoxaparin sodium

• Dalteparin sodium

• Coumadin

What are the medications of Antiplatelets?

• Aspirin

• Clopidogrel

What are the medications of Thrombolytic (fibrinolytic)?

• Tissue plasminogen activators (tPA)

◦ Alteplase

◦ Retaplase

• Thrombolytic Enzymes

◦ streptokinase

◦ urokinase

◦ anistreplase

(-ase)

tpA is most commonly given for what diagnosis?

Stroke, STEMI