Drugs Acting on the Cardiovascular System Flashcards
Drugs acting on the cardiovascular system
- Drugs affecting blood pressure
- Cardio tonic agents
- Antiarrhythmic agents
- Antianginal agents
- Lipid-lowering agents
- Drugs affecting blood coagulation
- Drugs used to treat anemias
Antihypertensive Agents (List classes)
- Angiotensin-Converting-Enzyme (ACE) Inhibitors
- Angiotensin II-Receptor Blockers
- Calcium Channel Blockers
- Vasodilators
- Other:
a. Diuretic agents
b. Ganglionic blocker
c. Renin inhibitor
d. Sympathetic Nervous System Blockers
i. Beta-blockers
ii. Alpha-and beta-blockers
iii. Alpha-adrenergic blockers
iv. Alpha 1-blockers
v. Alpha 2-agonists
Antihypotensive Agents (List classes)
- Sympathetic adrenergic agonists or vasopressors
2. Alpha-specific adrenergic agents
Cardiotonic (Inotropic) Agents
List classes
- Cardiac glycosides
2. Phosphodiesterase inhibitors
Antiarrhythmic Agents (List classes)
- Class I antiarrhythmics
- class Ia
- class Ib
- class Ic
- Class II antiarrhythmics
- Class IV antiarrhythmics
- Other antiarrhthmics
Antianginal Agents (List classes)
- Nitrates
- Beta-blockers
- Calcium channel blockers
- Piperazineazetamide
Lipid-lowering agents
List classes
- Bile acid sequestrants
- HMG-CoA reductase inhibitors
- Cholesterol absorption inhibitor
- Other:
a. Fibrates
b. Vitamin B
c. Perixisome proliferator receptor alpha activator
Drugs Affecting Blood Coagulation
List classes
- Antiplatelet agents
- Anticoagulants
- Thrombolytic agents
- Other:
a. Low-molecular-weight heparins
b. Anticoagulant adjunctive therapy
c. Hemorrheologic agent
d. C-reactive protein
Drugs used to treat anemias
List classes
- Erythropoiesis-stimulating agents
- Agents used for iron-deficiency anemia
- Agents used for other anemias
a. Agents for megaloblastic anemias
i. Folic acid derivatives
ii. Vitamin B-12
b. Agent for sickle cell anemia
Angiotensin-Converting-Enzyme (ACE) Inhibitors
Definition
(Antihypertensive agent)
- Act in the lungs to prevent ACE from converting angiotensin I to angiotensin II (a powerful vasoconstrictor and simulator of aldosterone release).
- Action leads to a decrease in BP and decrease aldosterone secretion, with resultant slight increase in serum K+ and a loss of serum Na+ and fluid.
Angiotensin-Converting-Enzyme (ACE) Inhibitors
List medications
- Benazepril (Lotensin)
- Captopril (Capoten) P
- Enalapril (Vasotec)
- Enalaprilat (Vasotec IV)
- Fosinopril (Monopril)
- Lisinopril (Prinivil, Zestril)
- Moexipril (Univasc)
- Perindopril (Aceon)
- Quinapril (Accupril)
- Ramipril (Altace)
- Trandolapril (Mavik)
Angiotensin II-Receptor Blockers
Definition
(Antihypertensive agent)
- ARBs selectively bind with angiotensin II receptors in vascular smooth muscle and in adrenal cortex to block vasoconstriction and the release of aldosterone.
- Actions block the BP-raising effects of renin-angiotensin system and lower BP.
Angiotensin II-Receptor Blockers
List medications
(Antihypertensive agent)
- Candesartan (Atacand)
- Eprosartan (Teveten)
- Irbesartan (Avapro)
- Iosartan (Cozaar) P
- Olmesartan (Benicar)
- Telmisartan (Micardis)
- Valsartan (Diovan)
Calcium Channel Blockers
Definition
(Antihypertensive agent)
- Decrease BP, cardiac workload, and myocardial oxygen consumption.
- Inhibit movement of Ca+ ions across the membranes of myocardial and arterial muscle cells, altering the action potential and blocking muscle cell contraction.
- Action depresses myocardial contractility, slows cardiac impulse formation in connective tissues, and relaxes and dilates arteries–causing a fall in BP and decrease in venous return.
Calcium Channel Blockers
List medications
(Antihypertensive agent)
- Amlodipine (Norvasc)
- Diltiazem (Cardizem, Dilacor CR) P
- Felodipine (Plendil)
- Isradipine (DynaCirc)
- Nicardipine (Cardene)
- Nifedipine (Procardia XL)
- Nisoldipine (Sular)
- Varapamil (Calan SR)
Vasodilators
Definition
(Antihypertensive agent)
- Act directly on vascular smooth muscle to cause muscle relaxation, leading to vasodilation and drop in BP.
- Do no block reflex tachycardia that occurs when BP drops.
- Indicated for treatment of severe hypertension that has not responded to other therapy.
Vasodilators
List medications
(Antihypertensive agent)
- Diazoxide (Hyperstat)
- Hydralazine (Apresoline)
- Minoxidil (Loniten)
- Nitroprusside (Nitropress) P
Other: Diuretic Agents
Definition
(Antihypertensive agent)
-Increase excretion of Na+ and H2O from kidney–often first agents tried in mild hypertension.
Other: Diuretic Agents
Thiazide and thiazide-like diuretics
(List medications)
(Antihypertensive agent)
- Bendroflumethiazide (Naturetin)
- Chlorothiazide (Diuril)
- Hydrochlorothiazide (HydroDIURIL)
- Hydroflumethiazide (Saluron)
- Methyclothiazide (Enduron)
- Trichlormethiazide (GENERIC)
- Chlorthalidone (Hygroton)
- Indapamide (Lozol)
- Metolazone (Mykrox, Zaroxolyn)
Other: Diuretic Agents
Potassium-sparing diuretics
(List medications)
(Antihypertensive agent)
- Amiloride (Midamor)
- Spironolactone (Aldactone)
- Triamterene (Dyrenium)
Other: Ganglionic Blocker
Definition
(Antihypertensive agent)
- Occupies cholinergic receptor sites of autonomic neurons, blocking effects of acetylcholine at sympathetic and parasympathetic ganglia.
- Blocking sympathetic system leads to vasodilation, decreased BP, blocking of reflex tachycardia, and release of catecholamines from adrenal gland.
Other: Ganglionic Blocker
List Medications
(Antihypertensive agent)
1. Mecamylamine (Inversine)
Other: Renin Inhibitor
Defninition
(Antihypertensive agent)
- Aliskiren directly inhibits renin, leading to decreased plasma renin activity and inhibiting the conversion of angiotensinogen to angiotensin I.
- This leads to decreased BP, decreased aldosterone release, and decreased Na+ reabsorption.
Other: Renin Inhibitor
List Medications
(Antihypertensive agent)
1. Aliskiren (Tekurna)
Other: Sympathetic Nervous System Blockers
Beta-blockers
(Definition)
(Antihypertensive agent)
-Block vasoconstriction, decrease HR, decrease cardiac muscle contraction, and tend to increase blood flow to kidneys, leading to decrease in release of renin.
Other: Sympathetic Nervous System Blockers
Beta-blockers
(List Medications)
(Antihypertensive agent)
- Acebutolol (Sectral)
- Atenolol (Tenormin)
- Betaxolol (Kerlone)
- Bisoprolol (Zebeta)
- Careolol (Cartrol)
- Metoprolol (Lopressor)
- Nadolol (Corgard)
- Nebivolol (Bystolic)
- Penbutolol (Levator)
- Pindolol (Visken)
- Propranolol (Inderal)
- Timolol (Blocadren)
Other: Sympathetic Nervous System Blockers
Alpha-and beta-blockers
(Definition)
(Antihypertensive agent)
-Useful in conjunction with other agents, and tend to be somewhat more powerful, blocking all receptors in sympathetic nervous system.
Other: Sympathetic Nervous System Blockers
Alpha-and beta-blockers
(List Medications)
(Antihypertensive agent)
- Carvedilol (Coreg)
- Guanabenz (Wytensin)
- Labetalol (Normodyne, Trandate)
Other: Sympathetic Nervous System Blockers
Alpha-adrenergic blockers
(Definition)
(Antihypertenisve agent)
- Inhibit postsynaptic alpha1-adrenergic receptors, decreasing sympathetic tone in vasculature and causing vasodilation, leads to lower BP.
- Also block presynaptic alpha2-receptors, preventing feedback control of norepinephrine release. Resulting in an increase in reflex tachycardia that occurs when BP decreases.
Other: Sympathetic Nervous System Blockers
Alpha-adrenergic blockers
(List medications)
(Antihypertenisve agent)
- Phenoxybenxamine (Dibenzyline)
- Phentolamine (Regitine)
Other: Sympathetic Nervous System Blockers
Alpha1-blockers
(Definition)
(Antihypertenisve agent)
- Block postsynaptic alpha1-receptor sites–decreasing vascular tone and promoting vasodilation, leading to fall in BP.
- (They do not block presynaptic alpha2-receptor sites, and therefore the reflex tachycardia that accompanies fall in BP does not occur).
Other: Sympathetic Nervous System Blockers
Alpha1-blockers
(List Medications)
(Antihypertenisve agent)
- Doxazosin (Cardura)
- Prazosin (Minipress)
- Terazosin (Hytrin)
Other: Sympathetic Nervous System Blockers
Alpha2-agonists
(Definition)
(Antihypertenisve agent)
- Stimulate alpha2-receptors in CNS and inhibit cardiovascular centers, leading to decrease in sympathetic outflow from CNS and resultant drop in BP.
- Associated with many adverse CNS and GI effects.
Other: Sympathetic Nervous System Blockers
Alpha2-agonists
(List Medications)
(Antihypertenisve agent)
- Clonidine (Catapres)
- Guanfacine (Tenex)
- Methyldopa (GENERIC)
Sympathetic Adrenergic Agonists or Vasopressors
definition
(antihypotensive)
- used to treat severe hypotension or shock.
- sympathomimetic drugs react with sympathetic adrenergic receptors to cause effects of a sympathetic stress response: increased BP, increased blood volume, and increased strength of cardiac muscle contraction.
- actions increase BP and may restore balance to cardiovascular system.
Sympathetic Adrenergic Agonists or Vasopressors
list medications
(antihypotensive)
- Dobutamine (Dobutrex)
- Dopamine (Intropin)
- Ephedrine (GENERIC)
- Epinephrine (Adrenalin, Epi-Pen)
- Isoproterenol (Isuprel)
- Metaraminol (Aramine)
- Norepinephrine (Levophed)
- Phenylephrine (Neo-Synephrine)
Alpha-Specific Adrenergic Agents
definition
(antihypotensive)
-midodrine activates alpha-receptors in arteries and veins to produce an increase in vascular tone and an increase in BP.
Alpha-Specific Adrenergic Agents
list medications
(antihypotensive)
1. Midodrine (ProAmatine)
Cardiotonic Agents (definition)
- affect intracellular Ca+ levels in heart muscle, leading to increased contractility.
- increased contraction strength leads to increased cardiac output, which causes increased renal blood flow and increased urine production.
- increased renal blood flow decreases renin release, interfering with effect of renin-angiotensin-aldosterone system, and increases urine output, leading to decreased blood volume.—Result is decrease in heart’s workload and relief of HF.
Cardiotonic Agents (classes)
- Cardiac glycosides
2. Phosphodiesterase Inhibitors
Cardiac Glycosides (definition)
(cardiotonic agent)
-digoxin increases intracellular Ca+ and allows more Ca+ to enter myocardial cells during depolarization–causing the following effects:
-increased force of myocardial contraction (+ inotropic
effect)
-increased cardiac output and renal perfusion
-slowed HR
-decreased conduction velocity through atrioventricular
node
Cardiac Glycosides
list medications
(cardiotonic agent)
1. Digoxin (Lanoxin)
Phosphodiesterase Inhibitors (definition)
(cardiotonic agent)
- blocks the enzyme phosphodiesterase—leads to an increase in myocardial cell cyclic adenosine monophosphate (cAMP), which increases Ca+ levels in the cell.
- increased cellular Ca+ causes stronger contraction and prolongs effects of sympathetic stimulations.
- indicated for short-term treatment of HF that has not responded to digoxin, diuretics, and vasodilators.
Phosphodiesterase Inhibitors
list medications
(cardiotonic agent)
- Inamrinone (Inocor)
- Milrinone (Primacor)
ANTIARRHYTHMIC AGENTS (definition)
- affect the action potential of the cardiac cells by altering their automaticity, conductivity, or both.
- as a result, the can also produce new arrhythmias (proarrhythmic).
ANTIARRHYTHMIC AGENTS (list classes)
- Class I antiarrhythmics
- class Ia
- class Ib
- class Ic
- Class II antiarrhythmics
- Class IV antiarrhythmics
- Other antiarrhthmics
Class I Antiarrhythmics
definition
(antiarrhythmic)
- drugs that block the Na+ channels in the cell membrane during action potential—stabilize the cell membrane by binding to Na+ channels, depressing phase 0 of the action potential and changing the duration of the action potential.
- They are local anesthetics or membrane-stabilizing agents.
- Indicated for treatment of potentially life-threatening ventricular arrhythmias.
- Broken down into 3 subclasses, reflecting how their blockage of Na+ channels affects the action potential.
Class Ia Antiarrhythmics
definition
-Depress phase 0 of action potential and prolong duration of action potential.
Class Ib Antiarrhythmics
definition
-Depress phase 0 somewhat and shorten duration of action potential.
Class Ic Antiarrhythmics
definition
-Markedly depress phase 0, with resultant extreme slowing of conduction—but have little effect on duration of action potential.
Class Ia Antiarrhythmics
list medications
- Disopyramide (Norpace)
- Procainamide (Pronestyl)
- Quinidine (GENERIC)
Class Ib Antiarrhythmics
list medications
- Lidocaine ((Xylocaine) P
2. Mexiletine (Mexitil)
Class Ic Antiarrhythmics
list medications
- Flecainide (Tambocor)
2. Propafenone (Rythmol)
Class II Antiarrhythmics
definition
-Beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential.
Class II Antiarrhythmics
list medications
- Acebutolol (Sectral)
- Esmolol (Brevibloc)
- Propranolol (Inderal) P
Class III Antiarrhythmics
definition
- Blocks K+ channels and slows the outward movement of K+ during phase 3 of action potential, prolonging it.
- They are all proarrhythmic.
Class III Antiarrhythmics
list medications
- Amiodarone (Cordarone) P
- Dofetilide (Tikosyn)
- Ibutilide (Corvert)
- Sotalol (Betapace)
- (Betapace AF)
Class IV Antiarrhythmics
definition
-Blocks the movement of Ca+ ions across the cell membrane, depressing the generation of action potentials and delaying phases 1 and 2 of repolarization, which slows automaticity and conduction
Class IV Antiarrhythmics
list medications
- Diltiazem (Cardizem) P
2. Verapamil (Calan, Covera-HS)
Other Antiarrhythmics: Adenosine & Digoxin
definition
Adenosine: used to convert supraventricular tachycardia to sinus rhythm if vagal maneuvers have been ineffective.
Digoxin: slows calcium from leaving the cell, prolonging the action potential and slowing conduction and HR.
-Effective in treatment of atrial arrhythmias
