-
Hydralazine - MoA
stimulates NO release
-
Hydralazine - Adverse Effects
- Hypotensive reactions
- activation of RAAS (low pressure)
-
Minoxidil - MoA
- opens K channels
- (hyperpolarize the cell membrane, inhibits depolarization & contraction)
-
Minoxidil - Use
- anti-HTN
- male pattern baldness
-
Minoxidil - Adverse Effect
- Hypotensive reactions
- activation of RAAS
-
what are the HYPOtensive reactions
- Headache, dizzy, anxiety, nausea, vomiting, diarrhea, anemia, dyspnea, edema, nasal congestion (think what happens when you dilates all the bv in your body?)
- reflex tachycardia can occur if Beta-receptors are not blocked or heart conductions are not suppressed
-
Nitroprusside
Nitroglycerin
Diazoxide
- activates guanylate cyclase => increase NO
- parenteral drug
-
Nitroglycerine - Adverse Effects
- Postural hypotensiosn, tachycardia, headache
- Tolerance may develop with prolonged use
- **sudden withdrawal can cause MI**
-
Nifedipine
- Dihydropyridine (-dipine)
- Ca2+ channel blocker
-
Amlodipine
- Dihydropyridine (-dipine)
- Ca2+ channel blocker
-
Nicardipine
- Dihydropyridine (-dipine)
- Ca2+ channel blocker
- more action on coronary vessels
-
Nimodipine
- Dihydropyridine (-dipine)
- Ca2+ channel blocker
- more action on cerebral vessels
-
Nisoldipine
- Dihydropyridine (-dipine)
- Ca2+ channel blocker
- more action on coronary vessels
-
Dihydropyridine - Use
Most effective anti-HTN drug
-
Dihydropyridine - Adverse Effects
- reflex tachycardia
- peripheral edema
- headache, constipation
-
Phenylalkylamines - MoA
- Verapamil
- Ca2+ channel blocker
- most potent in coronary vessel
-
Benzothiazepine - MoA
- Diltiazem
- Ca2+ channel blocker
- most potent in coronary vessel
-
Phenylalkylamines - Use
- Verapamil
HTN & arrhythmia
-
Benzothiazepines - Use
- Diltiazem
HTN & arrhythmia
-
Phenylalkylamines - Adverse Effects
- cardiac conduction disturbanceheadache, constipation
-
Benzothiazepines - Adverse Effects
- Diltiazem
- Cardiac conduction disturbance
- headache, constipation
-
Clonidine
alpha-2 agonist
-
Guanabenze
alpha-2 agonist
-
Guanfacine
alpha-2 agonist
-
Methyldopa
- alpha-2 agonist
- pro-drug (need convert in body to methyl-NE)
-
-
Terazosin
Alpha-1 Blocker
-
Doxazosin
Alpha-1 Blocker
-
Alpha-2 agonist - MoA
- Clonidine, Guanabenze, Guanfacine
- Methyldopa (prodrug)
Stimulates alpha-2 => inhibits pre-synaptic neurotransmitter release
-
Alpha-2 agonist - Adverse Effects
- Clonidine, Guanabenze, Guanfacine
- Methyldopa (prodrug)
- Sedation
- Orthostatic Hypotension
-
Alpha-1 blocker - MoA
- Prazosin, Terazosin, Doxazosin
block alpha-1 => systemic vasodilation
-
Alpha-1 blocker - Adverse Effects
- Prazosin, Terazosin, Doxazosin
- orthostatic hypotension, syncope
- nasal congestion
- headache, palpitation, blurred vision
-
Propranolol - MoA
- Beta-1 & Beta-2 blocker
- decrease sympathetic tone
- decrease HR, CO, RAAS
-
Propranolol - Adverse Effect
- bradycardia
- rebound HTN
- percipitates CHF
- Bronchoconstriction (COPD, asthma)
-
Metoprolol - MoA
- Beta-1 blocker
- decrease HR, CO
- preferred in diabetics
-
Metoprolol - Adverse Effect
Worsens Asthma
-
Labetalol, Carvedilol - MoA
- Beta-1, Beta-2, & alpha-1 blocker
- decrease BP
- best drug for CHF
-
Labetalol, Carvedilol - Adverse Effects
Orthostatic hypotension
-
Beta blocker - Use
- HTN, stable angina, CHF, MI
- thyrotoxicosis, pheochromacytoma (Epi)
- migraine
- not for variable angina
-
Beta blocker - Adverse Effect
- A/V block, acute heart failure (in suppressed heart)
- Abrupt withdrawal of BB can lead to HTN, angina, MI & sudden death
- (chronic inhibition leads to increase beta-receptor sensitivity)
-
ACE inhibitors (-prils) - MoA
- inhibits ACE => decrease AT => vasodilation & decrease sympathetic tone
- also inhibits bradykinin degradation => cough & angioedema
- decrease Pre-load, After-load, RAAS & cardiac remodeling
-
ACE inhibitors (-prils) - Use
- HTN, MI, CHF, cardio hypertrophy
- nephropathy
-
ACE inhibitors (-prils) - Adverse Effects
- Dry Cough
- angioedemaHyperkalemia
- Fetal deformity (teratogen)
- decrease renal functions - avoid in bilateral renal stenosis (dec. renal blood flow)
-
-
-
-
-
-
Angiotensin Receptor (AT-1) Blocker (-sartans) - MoA
- blocks AT-1 receptors
- vasodilates, decrease sympathetic tone
- less side effect than ACEi (no bradykinin effects - cough)
-
Angiotensin Receptor (AT-1) Blocker (-sartans) - Use
HTN, MI, CHF, cardiac hypertrophy
-
Angiotensin Receptor (AT-1) Blocker (-sartans) - Adverse effects
- Hyperkalemia
- fetal deformity (teratogen)
- skin rash
- all the same AE as ACEi except for cough & angioedema
-
Losartan
Angiotensin Receptor (AT-1) Blocker
-
Candesartan
Angiotensin Receptor (AT-1) Blocker
-
Ibersartan
Angiotensin Receptor (AT-1) Blocker
-
Telmisartan
Angiotensin Receptor (AT-1) Blocker
-
Valsartan
Angiotensin Receptor (AT-1) Blocker
-
Aliskiren - MoA
- inhibits renin
- lowers BP
- Renal protective effects
-
Aliskiren - Use
- renal protection in HTN & DM-HTN
- combine with thiazide diuretics
-
Aliskiren - Adverse effects
- Hypotension
- stroke
- angioedema
- hyperkalemia
-
If a patient doesn't not respond well to ACEi & ARB, what do you do next?
- use ACEi & ARBs +diuretics
- commonly seen in some black populations
-
Therapy for HTN
- Diuretics (Thiazide, Loop +K-sparing)
- Vasodilators (Hydralazine, Minoxidil, NG)
- CCB
- ACE inhibitor or ARB
- Alpha & Beta blockers
-
Therapy for Stable Angina
- Nitroglycerin
- Beta-blockers
- CCB
-
Combination Therapy for Angina
- NG + BB
- NG + CCB
- NG + BB + CCB
-
Therapy for CHF
- ACE inhibitor
- Beta blocker
- Diuretics
- Digoxin
- vasodilators
-
Therapy for Stage A CHF
ACE inhibitor
-
Therapy for Stage B CHF
ACE inhibitor + Beta blocker
-
Therapy for Stage C CHF
- ACE inhibitor + Beta Blocker + Diuretics
- other drugs if indicated: digoxin, vasodilators, ARBs
-
Therapy for Stage D CHF
- continue stage C therapy with inotropes
- wait for heart transplant
-
Stage A CHF criteria
high risk, no symptoms
-
Stage B CHF criteria
cardiac remodeling, no symptoms
-
Stage C CHF criteria
CHF symptoms
-
Stage D CHF criteria
refractory
-
Therapy for MI
- NG + Beta Blocker
- CCB can make MI worse
-
Therapy for unstable angina
- NG, CCB
- Beta blocker in unstable angina can make it worse (block beta-2)
-
Digoxin - MoA
- Na/K ATPase inhibitor
- increase intracellular Ca2+ & Na
- increase contractility but not HR
- improve CHF symptoms but doesn't decrease mortality
-
Digoxin - Use
- CHF
- first-line drug for CHF with Atrial Fibrillation
-
Digoxin - Adverse Effect
- small therapeutic index
- vomiting & nausea
- visual disturbances
- AV block & bradycardia
- gynecomastia, delirium
-
Digoxin - Contraindications
- Quinidine, amiodarone, verapamil (increase digoxin conc.)
- Hypokalemia enhances toxicity
-
Treatment of Digoxin toxicity
- mild toxicity - Potassium
- digoxin induced arrhythmia - Lidocaine
- Life threatening toxicity - Digibind
-
Digibind
- monoclonal antibody for digoxin
- used in life threatening toxicity
-
Digitoxin
- same drug as digoxin, except it's LIVER excretion
- used in renal failure patients
-
Acute Heart Failure Therapy
Dobutamine
-
Dobutamine - MoA
- Beta-1 agonist
- increase contractility but not HR
-
Dobutamine - Use
#1 drug in Acute Heart Failure
-
Dobutamine - Adverse Effect
tolerance
-
Dopamine
- dopamine, B1, a1 receptor agonist
- used to maintain hemodynamic in shock
-
Phophodiesterase III inhibitor
- Inamrinone, Milrinone
positive inotropic & vasodilator
-
Nesiritide
- synthetic BNP
- vasodilator & diuretic
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