Cardiovascular Drugs Flashcards
Diuretics
Blockade of sodium and chloride reabsorption from the renal tubules; increasing diuresis. Increasing urine and sodium excretion
Hypotensive effect of diuretics
maintained during long term therapy; drugs first decrease extracellular volume and CO. Maintained with long term therapy because of reduced vascular resistance
Thiazide derivatives and related agents
Hydrochlorothiazide (HydroDIURIL) Chlorthalidone
Kinetics of thiazides
Absorbed from a limited absorption site in the small intestine. Most are excreted by the kidneys. Other agents are metabolized or are more highly bound by serum albumin, which prolongs their duration of effect
Pharmacologic effects of thiazides
Initially lower blood pressure by increasing blood volume, over the long term the effect is reduction of arterial resistance
NSAIDs effect on thiazides
action diminished because they block the production of prostaglandins
Centrally acting alpha 2 agonists
Methyldopa (Aldomet) & Clonidine (Catapres)
Methyldopa
MOA: Lower arterial pressure by stimulation of alpha 2 adrenergic receptors
Contraindications of Methyldopa
Active hepatic disease, causes positive Coombs test , hemolytic anemia, Category B and frequently a drug choice in treating hypertension in pregnant women.
Adverse reactions of Methyldopa
CNS- Sedation, fatigue, depression, dry mouth, postural hypotension, headache and weakness
CV-bradycardia
GI-N/V/Distension and constipation
Clonidine (Catapres)
Indicated for hypertension but usually considered a second step drug in conjunction with other agents. Useful with drugs that enhance autonomic reflexes (diuretics or vasodilators)
Contraindications of Clonidine
Rebound hypertension that may occur if the drug is suddenly discontinued; treated by resuming therapy or prazosin
Symptoms that may follow abrupt discontinuation of clonidine include
increase in BP, Heart rate, anxiety, agitation, nervousness, and sweating, due to activation of SNS or down regulation of alpha 2 adrenoceptors
Adverse reactions of clonidine
dry mouth and drowsiness, dizziness, bradycardia, and constipation, are common. May also cause anorexia, nightmares, and impotence. Avoid in patients with mental depression
Beta Blockers
exacerbate hypoglycemia, decrease anxiety
Alpha Blockers
block alpha receptors in blood vessels and allow them to dilate; usually no reflex tachycardia, but do cause peripheral edema
First dose effect with alpha blockers
Can cause marked hypotension and syncope with the first few doses or with rapid increase in dosage
Examples of Alpha Adrenergic Blockers
Prazosin, Terazosin, Doxazosin, Tamsulosin
Vasodilators
3rd step drugs 1. Diuretic 2. Beta Blocker
Vaodilator-Minoxidil
enhances elongation thickening and enhanced pigmentation of fine body hair. (Good to use in people with hypertension and renal disease.
Nitroprusside Sodium (Nipride)
Used in hypertensive urgencies
Viagra (Sildenafil)
Vasodilator
Calcium Channel Blockers MOA
block calcium channels resulting in decreased rate of SA depolarization and decreased heart rate. Decreases the rate of conduction through the AV node
Verapamil
CCB used in tx of supraventricular tachyarrhythmias
Calcium Channel Blockers
Verapamil, Diltiazem, Nifedipine
CCB uses
Angina, Arrthymias, hypertension
Nifedipine side effects
Reflex tachycardia and peripheral edema
Verapamil side effects
Bradycardia; constipation
ACE INHIBITORS; END IN -PRIL; MOA
INHIBIT ANGIOTENSIN I CONVERTING ENZYE DECREASING AVAILABILITY OF ANGIOTENSIN II,PREVENTING THE RELEASE OF ALDOSTERONE; ALSO INHIBIT THE METABOLISM OF BRADYKININ A VASODILATOR
ACE INHIBITORS SIDE EFFECTS
COUGH
ANGIOTENSIN II
MOST POTENT VASOCONSTRICTOR
NO REFLEX TACHYCARDIA WITH
ACE INHIBITORS
DRUG OF CHOICE IN TREATING HYPERTENSION IN THE DIABETIC WITH KIDNEY DISEASE
ACE INHIBITORS
ACE INHIBITORS TREAT
HYPERTENSION, HEART FAILURE, DIABETIC NEPHROPATHY, MYOCARDIAL INFARCTION
