CV drugs

• 1. statin (avartostatin)
• 2. ezetimibe
• 3. acid binding
• a) nicotinic (Niacin)
• b) bile sequestrants (cholestyramine)
• c) fibric (gemfibrozil)

• 1. liver toxic
• 2. myopathy
• 3. rabdomyolysis
• 4. pregnancy X
• 5. increase warfarin, digoxin

• 1. liver
• 2. respiratory

• 1.liver toxic
• 2. flushing
• 3. hyperglycemia
• 4. gout

• No.
• just do not absorb into circulation.
• mixed with fluid
• do not take with other drugs

same as statin + gallstone

• 1. triglycerides = most
• 2. steroids => atherosclerosis
• 3. phospholipid = build membrane

• 1. Sodium channel blocker (quinindine)
• 2. Beta blocker (propranolol)
• 3. potassium blocker (aminodarone)
• 4. cacium channel blocker (verapamil)
• 5. Others (digoxin & adenosine)

• -abnormalities of conduction or rhythm
• -harmless or deadly

dz, weakness, fainting, decreased exercise tolerance, sob. Skipped beat

• Na & Ca outside cell
• -Na rush inside cell => depolarization
• -Ca rush inside cell => depolarization/contraction

• K inside cell
• -K rush outside cell => back to polarized

• -block Na channel => slow rate of conduction
• (similar to local anesthetics = lidocaine)

• quinidine (protype)
• lidocaine
• phenytoin (dilantin)

• -as slow conduction (rate) => H/B, dz, fainting.
• -new dysrythmias or worsening
• -anticholinergic (dry mouth, urine retention)
• -double digoxin
• -increase risk of heartblock with aminodarone

• -rapid control of Ventricular dysrthymias
• -local anesthetic
• SE = H/B, worsened dysrhythmias, heart block, respiratory (asthmaticus), confusion/sz/lightheadedness, lethargy, blurred vision.
• -toxic if prolong => check level, mus be on cardiac monitor

• 1) reduce automaticity & conduction velocity => reduce heart rate
• 3) reduce contractility =>reduce CO => reduce bp

• -H/B, dz, fainting (same as Na blocker)
• -as also beta 2 (lung) => bronchospasm => asthma and COPD
• -metoprolol = heart block, HF, alter insulin (diabetes), + digoxin => bradycardia
• -propanolol = also tx migraine/ha. Do not give with MAO inhibitor

slow conduction + prolong refractory period (resting) => stablizing dysrhythmias

• aminodarone (K channel blocker)
• => V-tach, A-tach/fib (# v-fib = CPR, defri)
• *also long half life

• - H/B, dz, heart block, HF
• -pulmonary toxic, pneumonia-like synd
• - hepatic
• -photosensitivity
• -increase digoxin/anticoagulant/herbal
• ***IV=continuous EKG

• verapamil
• diltiazem

• -to treat supraventricular dysrhyth only
• same as BAB
• 1) reduce automaticity
• 2) reduce conduction
• 3) reduce contractility
• => prolong refractory period
• * verapamil = slow conduction, dilate coronary arteries (tx angina)
• *Diltiazem = tx vasospastic angina = help coronary arteries relax, HTN, A-fib/flutter

• -H/B, ha
• - increase digoxin (both have effect of slowing conduction)
• -increase level with grapefruit

* diltiazem = AV block, HF, insomnia, photosensitivity

same as BAB & CCC, except that instead of reduce contractility, it increase contractility => dysrhythmias if execess => take apical

• -dysrhythmias if excess
• -interact with many common drugs
• -hypotentsion, HF, anorexia
• -hyperK
• -toxic if pt with hypoK

• -bolus IV to terminate serious A-tach by slowing conduction thru AV and automaticity SA.
• -PSVT = paroxysmal supraventricular tachycardia

meds lower intraocular pressure

Na

• -quinidine => need to reduce digoxin
• -metoprolol, propanolol => + digoxin => increase digoxin=> bradycardia
• -CCC => elevate digoxin

increased CO

• -verapamil = tx angina
• -diltiazem = HTN

• 1) O2 & morphine
• 2) nitrates (nitroglycerin)
• 3) BAB (atenolol)
• 4) CCC (diltiazem?? verapamil)
• 5) thrombolytics (reteplase)
• 6) antiplatelet

sharp pain in heart region, moving to left side of neck, lower jaw, left arm

• -atherosclerosis
• -mitral stenosis
• -MI
• -CAD
• -DM
• -peptic ulcer
• -GERD

banana, kidney bean, spinach, tomatoes, apricot, peanut butter, sweat potato, leafy green

• CABG
• PTCA (areaof narrowing is opened using either balloon cath or laser)

• 1) slow heart rate
• 2) reduce contractility
• 3) dilate vein (so heart can receive less blood =reduced preload)
• 4) lower bp (heart can push blood out of chamber = reduced afterload)

• -dilate coronary arteries
• -SE = H/B, cardiac/resp arrest, sedation, clouded sensorium, euphoria, sz, thrombocytopenia, urine retention
• -Naloxone (Narcan)

• 1) dilate vein => reduce preload returning blood => afterload CO
• 2) dilate coronary artery => more O2 for myocardium, relax spasm

• 1) short = SL, spray, cream = nitroglyeride
• 2) long = oral, patch = isosorbide

• -H/B (may), reflex tachycardia (palpitation or skipped beat) ha, dz, flushing
• -No = viagra, tidalafil (Cialis) => severe hypotension

excessive cardiac suppression

slowed AV conduction => heartblock

• 1) nitroglycerides (short nitrate)
• 2) isosorbide (long nitrate)
• 3) hydralazine (direct)
• 4) nesiritide (IV in ICU only for HF)

* used for chest pain

plaque builup narrowing arteries => a broken piece goes to smaller vessel to lodge => block O2 supply => ischemic

• 1) thrombolytic (reteplase) = dissolve clot by activating plasminogen to bind to fibrin = effective w/in 30 minutes and not later 12 hrs
• 2) antiplatelet = aspirin
• 3) anticoagulant = heparin; glycoprotein IIb/IIIa, ADP receptor blocker
• 4) BAB = effecitve w/in 24 hrs (reduce O2 demand by reduce rate/contractility/bp). H/r watch sx of dysrhyth b/c its ability to slow conduction
• 5) ACE = w/in 1-2 days
• 6) narcotic analgesic (morphine)

• SE = pt with active bleeding
• -NO = consumption of food high K food (interfere with clotting time) eg. leafy green veg, herbal

• 1)digoxin
• 2)diuretic (furosemide)
• 3) ACE (lisinopril - used when pt also has HTN)
• 4) phosphodiesterase (milrinone)
• 5) vasodilator (isosorbide)
• 6) BAB (carvedilol)
• 7) natriuretic peptides (nesiritide - new, IV in ICU, vasodilation => cause severe hypotension)

• -inability of ventricle to pump enough blood for body's demand
• -cause = weakened muscle.
• - can be both, but normally left ventricle

• -decreased contractility => decreased CO =>
• 1) increased preload => lung congestion
• 2) decreased bp =>
• a- increased demand => increased rate => increased workload
• b-decreased flow to kidneys => ADH & renin pathway activated => Na/water retention => increased blood volume => increased bp => increased afterload => increased work

• first choice = mild to moderate
• 1) ACE (esp with HTN which normally the case)
• 2) diuretic
• 3) digoxin (watch serious SE)

• 2nd choice = severe & when 1st not effective =
• 1) phosphodieterase
• 2) vasodilator
• 3) BAB

• 1) preload (stretch)
• 2) contractility (snap back)
• 3) afterload (force of LV to pump against)

1) inhibit Na& K tapse => release Ca => increase force of contraction = increased CO (positive inotropic effect # BAB = negative) => increased UOP => relieve lung congestion & peripheral edema

2)suppress SA & slow conduction AV (watch serious SE = excessive slow heart rate)

• - most dangerous = create dysrhythmias (particularly pt w hypoK) even tho digoxin can also be used for dysrthythmias
• - toxic if overdose (hypo and hyper K). hypoK predispose pt to toxic
• -blurred vision, anorexia, sob, leg muscle cramp

• -inhibit ACE that cause conversion of angiotension I to II
• -diate arterioles & veins => reduce blood volume and bp, peripheral edema
• -prevent pathologic changes in cardiac structure

• -caution in renal failure/insufficiency/DM
• -dry cough
• -hyperK
• -angiodema (swelling of face/trachea/hand)
• -hypotension

• inhibit transport of Na, K & Cl across loop of Henle = blocking NaCl (water) reabsorption => increase UOP => reduce blood volume => reduce bp, edema, congestion
• * K-sparing (spironolactone) = inhibit aldosterone in distal tubule (far from loop => spare K)

• -hypoK (cause lethal dysrhythmias), hypo e-lytes
• -large dose => ototoxicity
• -dehydration,
• -hypotension
• -pancreatitis
• -leukopenia, thrombocytopenia

• -HCTZ
• -act on different part of kidney to incresase UOP => less hypoK

• -HyperK!!! (#furosemide and HCTZ (less)
• -angioedema

• -blocking phosphodiesterase => increase Ca => increaes contraction force (same as digoxin = positive inotropic)
• - vasodilation
• **short term (2-3 days) control of acute HF, toxic => only for pt who not respond to ACE & digoxin
• -SE = ventricular dysrhythmias => EKG monitor

• -act directly on vein to cause vedodilation => reduce venous return (preload) => reduce work for heart
• -dilate coronary arteries => mroe O2 for myocardial tissue
• -SE = hypotension, reflex tachycardia, ha
• -contraindication = viagra

isosorbide (b/c we have to take care of angia first)

• 1) diuretic
• 2) BAB (metoprolol)
• 3) ACE (captopril, lisinopril)
• 4) CCC (diltiazem)
• 5) ARB(losartan)
• 6) direct-acting vasodilator (hydralazine, nitroprusside)