Vasodilators Flashcards
Ca channel blocker (4)
DHP: Amilodipine
Non-DHP: Verapamil, Diltiazem, Bepridil
Amilodipine
Ca channel blocker
DHP
Verapamil
Ca channel blocker
Non- DHP
Diltiazem
Ca channel blocker
Non-DHP
Ca channel blocker: MoA
Decrease Ca influx with Ca channel
Vascular effect: Arteriodilation (DHP> Non-DHP)
Cardiac effect: Inhibit L-type Ca channel
(decrease phase 0 depol of SA/AV
(decrease phase 2 of AP in muscle
Decrease HR, conduction, and contractility
(Non-DHP> DHP)
Ca channel blocker: use
Angina, Supraventricular tachycardia, Hypertension
Amilodipine: ADR
Hypotension, Edema, headaches
Verapamil: ADR
Hypotension
Diltiazem: ADR
CHF, AV block, Edema, Headache, Constipation
Ca channel blocker: Contra
Short acting agent
Severe hepatic dysfunction
Hypotension
For non-DHP
Sick sinus syndrome
LV dysfunction
AV block
Ca channel blocker: drug interaction
CYP3A4 inhibitor
Beta blocker
Digoxin (only Verapamil)
Antiarrythmic drug
K-channel openers
Minoxidil
Minoxidil
K channel opener
Minoxidil: MoA
Increase K efflux from vascular smooth muscle
(Hyperpolarize and decrease TPR)
Marked compensatory response (Increase HR, CO, fluid retention)
Minoxidil: use
Refractory/ malignant hypertension
Minoxidoil: ADR
Marked fluid retention
Tachycardia
Pericardial effusion/ Cardiac tamponade
Hypertrichosis
Guanylyl cyclase activator
Nitropruside
Nitropruside
Guanylyl cyclase activator
Nitropruside: MoA
Balanced arterial/venous dilation
Decrease BP, Reflex increase HR
Short half life (min)
IV only (for acute treatment)
Nitropruside: use
Hypertensive emergencies
Acute CHF
MI
Nitropruside: ADR
Acute: Hypotension
Chronic: Thiocyanate/ Cyanidetoxicity
Enzyme that converts Cyanide to Thiocyanate
Rhodunuse
Thiocynate toxicity
Headache
Nausea
Disorientation
Delerium
Cyanide toxicity
CN-cytochrome oxidase
Cytotoxic anoxia
Hypoxia, Convulsion
Respiratory arrest
Organic nitrate
Nitroglycerin
ISDN (Isosorbide dinitrate)
ISMN (Isosorbide mononitrate)
Nitroglycerin
Organic nitrate
Isosorbide dinitrate/ Isosorbide mononitrate
Organic nitrates
Organic nitrates: MoA
More venodilation
@ low dose: venodilation
Decrease CO, Reflex increase of HR/ TPR
@ high dose: venodilation and arteriodilation
Decrease CO, Decrease TPR, Decrease BP, Increase reflex HR
Organic nitrate: Metabolism
Heptaic metabolism
Sublingual
Organic nitrates: use
Angina
CHF
Acute MI
Organic nitrate: ADR
Excessive hypotension (headache, tachycardia, orthostatic hypotension, Angina) Tolerance
Nitric oxide: use
Hypoxic respiratory failure of term/ near-term neonate with pulmonary hypertension
Nitric oxide: ADR
Pulmonary edema
Hypoxia with sudden withdrawal
Nitric oxide excretion
In urine
Hydralazine: MoA
Arterial dilation (decrease TPR, BP, increase reflex HR) Oral
Hydralazine: use
CHF, Hypertension
Hydralazine: ADR
Fluid retention
Tachycardia
+ANA= Lupus like syndrome (in slow acetylators)
no renal involvement, reversible at high dose
Fenoldopam: MoA
D1-receptor agonist
IV, rapid acting
moderate duration
Fenoldopam: use
Hypertensive emergency
Fenoldopam: ADR
Hypersensitivity
Sodium metabisulfite
Tachycardia, Hypotension
PDE inhibitors (3)
Sidenafil
Tadalafil
Vardenafil
Sildenafil
PDE inhibitor
Iadalafil
PDE inhibitor
Vardenafil
PDE inhibitor
PDE inhibitor: MoA
Potentiate NO= increase cGMPr Relax Corpus cavernosum Increase erection Relax lower urinary tract Increase urination
PDE inhibitors: use
Erectile dysfunction
BPH (Tadalafil)
Oral
Hepatic metabolism
PDE inhibitors: ADR
Hypotension
PDE inhibitor: contra
Concurrent organic nitrates (Nitroglycerides, ISDN, ISMN)
Beta blockers
CYP3A4 drugs
ACE inhibitors
Enalapril Lisinopril Captopril Fosinopril "-pril"
“-prils”
ACE inhibitors
ACE inhibitor: use
Hypertension
CHF
Post-MI
Diabetic nephropathy
ACE inhibitor: ADR
Cough Fetopathic potential at last trimester Hyperkalemia Hypotension Hypersensitivity
ACE inhibitor: contra
Pregnancy
Hyperkalemia (Renal disease, K-sparing diuretics, K supplement)
Hypersensitivity
AT-receptor antagonist
Saralasin
Losartan
Valsartan
Saralasin
AT-receptor antagonsit
“-sartan”
AT-receptor antagonist
AT-receptor antagonist: MoA
Competitive antagnoist of AT1 receptor
Decrease aldosterone secretion
Decrease ATII induced vasoconstriction
Decrease neural release of NE= decrease vasoconstrict
Decrease remodeling
Decrease TPR, Decrease Na fluid retention, Decrease BP
AT-receptor antagonist: use
Hypertension
CHF
Post-MI
Diabetics
AT-receptor antagonist: ADR
Getopathic potential Hyperkalemia Hypotension Hypersensitivity (no cough)
AT-receptor antagonist: contra
Pregnancy
Hyperkalemia (Renal disease, K-sparing diuretic, K supplement)
Hypersensitivity
Renin inhibitor
Aliskiren
Aliskiren
Renin inhibitor
Aliskiren: MoA
Inhibit renin
Decrease ATI and ATII
Aliskiren: use
Hypertension CHF Post-MI Diabetic nephropathy (same as ACEi)
Aliskiren: ADR
Cough (less than ACEi) Fetopathic potential at last trimester Hyperkalemia Hypotension Hypersensitivity
Vasodilators and RAA system inhibitors: use
Hypertension
Angina
Ischemia
CHF