CARDIOVASCULAR DRUGS2.pptx

7/30/2019 CARDIOVASCULAR DRUGS2.pptx

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by

Dare Ogunlade, MBChB, FWACP

Lecturer/Consultant Cardiologist

Department of Physiological Sciences

Obafemi Awolowo University, Ile-Ife

CARDIOVASCULAR DRUGS


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CLASSIFICATION

OFCARDIOVASCULAR DRUGS

1.Antihypertensive drugs2.Antiarrhythmic drugs

3.Antithrombotic drugs4.Antianginal drugs

5. Lipid-lowering agents6.Anti heart failure drugs


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ANTIHYPERTENSIVE DRUGS

Antihypertensive drugs are blood pressurelowering agents

They are indicated in the management of

hyper tens ion.


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Classification of Antihypertensive

Drugs

1. Thiazide diuretics

2. Calcium channel blockers (CCBs)

3. Beta blockers(Beta adrenergic receptor

blockers)4. Angiotensin Conversion Enzyme inhibitors

(ACEI)

5. Angiotensin Receptor Blockers (ARBs)

6. Alpha blockers7. Centrally acting drugs

8. Vasodilators


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Antihypertensive DrugsClass Mechanism of

ActionExamples Side-Effects

Thiazide Reduce Na contents of

vascular wall, promote

renal excretion of Na

Hydrochlorothiazide,

bendrofluazide,

polythiazide

Hypokalaemia,

hyponatraemia,

hyperuricaemia,

Hyperglycaemia,

Dyslipidaemia, impotence

CCBs Block calcium channels,vasodilation Nifedipine,amlodipine,Headache, pedal oedema,tachycardia

Beta blockers Non-selective B-blocker Propranolol bradycardia,nighmares,bronchoconstricti

ons

Cardioselective B-blocker Atenolol,metoprolol bradycardia

ACEIs Inhibition of ACE,

vasodilation

Captopril,

lisinopril,enalapril

Cough, angioedema,first

dose hypotension,metallictaste

ARBs Angiotensin II receptorblocker, vasodilation

Valsartan, losartan -

Alpha blockers Alpha adrenergic

blockers

Prazosin,

doxazosin,

First dose hypotension

Centrally actingdrug

False transmitters Methyl dopa Impotence, hepatitis,postural hypotension


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Fixed Drug Combinations

Fixed Drug Combinations: two or more drugswith different mechanisms of action combined in

a fixed dosage.

Example: Moduretic, a combination of

hydrochlorothiazide(50mg) and amiloride (5mg).

Hydrochlorothiazide is a thiazide diuretic while

amiloride is a potassium-sparing diuretic


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Other examples of fixed drug

combinations

Co-diovan: diovan(valsartan) +hydrochlorothiazide

Zestoretic : lisinopril(zestril) +

hydrochlorothiazide Minizide: prazosin + polythiazide

Brinerdin: Reserpine + clopamide +dihydroergocristine


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Choice of antihypertensive

drugs

Hypertension in Blacks is volume dependent.

New cases of hypertension in blacks usually

respond to ;

1.Thiazide diuretics

2. Calcium channel blockers

1& 2 are considered first in initiation of drug therapy

unless there is contraindication or compelling

indications for the use of other antihypertensivemedications.


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ANTIARRHYTHMIC DRUGS

Drugs useful in the treatment

of cardiac

arrhythmias(disorders ofcardiac rhythm)


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Vaughan WilliamsClassifications of Antiarrhythmic

DrugsCLASS CHARACTERISTICS DRUGS

Class I Na channel blockerIa Lengthens AP duration Disopyramide,

procainamide, quinidine

Ib Shortens AP duration Lidocaine, mexiletine,

phenytoinIc No effect on AP duration Flecainade, propafenone,

Class II Beta Blockers Atenolol, propanolol, esmolol

Class III K channel blockers Amiodarone, dronedarone,

sotalol, bretylium

Class IV Calcium channel blockers Verapamil, diltiazem

Others - Digoxin, adenosine


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Examples of Commonly Used

Antiarrhythmic Drugs

1. Digoxin

2. Beta blockers

3. Amiodarone


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Digoxin

Digoxin is a cardiac glycoside

Mechanisms of action

1. Stimulations of parasympathetic discharge-

resulting in decrease heart rate

2. Slow down conduction through atrioventricular

node

3. Inhibition of Na-K ATPase pump- increase

myocardial contractility


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ANTITHROMBOTIC DRUGS Antiplatelets e.g aspirin, clopidogrel, dipyridamole

Low dose aspirin -75mg daily reduces plateletaggregation and is useful in prevention ofcerebrovascular disease in patients withcardiovascular disease e.g hypertension

Anticoagulants e.g Heparin,Warfarin

Warfarin is an oral anticoagulant that is useful inprevention of intramural thrombus formation in patient withdilated cardiac chambers

Fibrinolytic agents e.g streptokinase,tissue plasminogenactivator (tPA), tenecteplase(TNK)

Fibrinolytic agents are useful in indicated in the treatmentof acute myocardial infarction.


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ANTIANGINAL DRUGS

Drugs useful in the management of anginainclude;

1. Nitrates

2. Beta blockers

3. Calcium channel blockers

4. Antiplatelets


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Nitrates

Nitrates include; nitroglycerin, isosorbide dinitrateand isosorbide mononitrate

Mechanism of action: systemic venodilation ,

dilation of epicardial coronary vessels

Indication; myocardial ischaemia


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LIPID-LOWERING AGENTS

Statins : HMG CoA reductase inhibitor

It reduces plasma level of low density

lipoprotein(LDL) cholesterol, a primary risk factor

in coronary artery disease.

It increases plasma level of HDL

Examples include; simvastatin, atorvastatin,

lovastatin, rosuvastatin and fluvastatin


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ANTIHEART FAILURE DRUGS

1. Loop diuretics e.g frusemide2. ACEIs/ARBs

3. Beta blockers e.g bisoprolol, metoprolol, carvedilol

4. Positive inotropes e.g digoxin, dopamine,

dobutamine5. Antiarrhythmic drug e.g digoxin, amiodarone

6. Aldosterone receptor antagonists e.gspironolactone, eplerenone

7. Vasodilators e.g sodium nitroprusside, nitrates8. Anticoagulants e.g warfarin

9. Lipid-Lowering agents e.g statins

10. Oxygen therapy


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CONCLUSION

Cardiovascular drugs are very important inmedical practice.

Although a group of drug may be used to manage

more than one cardiovascular diseases,

combination therapy is the rule.

Mastery of the various groups of drugs with

regards to classif icat ion, mechan isms of

act ion, dosage, ind icat ions,contra ind icat ions, side-effects is

required ofa student in quest for academic

excellence.

Thank you for listening

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