Cardiovascular Agents

Front 1

General Methods of Lowering BP

Back 1

1. relaxing vasc. smooth mm.
2. inhibit RAAS
3. inhibit Ca mediated heart and vasc. smooth mm. contractility
4. inhibit sympathetic activity
5. reduce IV (ECF) volume

Front 2

Examples of Sympatholytic Agents for HTN

Back 2

1. central alpha agonists
2. ganglionic blockers
3. peripheral adrenergic inhibitors
4. peripheral alpha antagonists
5. beta blockers

Front 3

central alpha agonists
1. MOA
2. examples
3. adverse effects
4. therapeutic use

Back 3

1. sympathloytic; central stimulation of alpha 2 receptor reduces symp outflow (dec CO and TPR = dec BP); no impact on lipid profile
2. clonidine, guanabenz, guanfacine
3. sedation, dry mouth, constipation, impotence, brady, withdrawal syndrome
4. minimal due to ADRs, attenuating reflex tachy, pheochromocytoma, withdrawal syndrome, analgesia/anesthesia

Front 4

Methyldopa
1. similar to...
2. adverse effects
3. use in pregnancy

Back 4

1. central alpha agonists (reduces BP by dec CO and SVR)
2. same as central alpha agonists but also parkinsonian, hyperprolactinemia, hepatotoxicity, hemolytic anemia
3. safe in pregnancy

Front 5

ganglionic blockers
1. MOA
2. examples
3. main use
4. Pk

Back 5

1. sympatholytic; symp and parasymp block (vasodilation to reduce BP, bladder/GI atony, cycloplegia, xerostomia, dec sweating)
2. trimethaphan
3. (was) most useful for aortic dissection
4. rapid onset, titrate continuous IV infusion, tolerance develops

Front 6

Peripheral Adrenergic Inhibitors
1. MOA
2. examples
3. effects
4. adverse effects
5. drug interactions

Back 6

1. sympatholytic; depletes and replaces norepi in storage vesicles
2. guanethidine, guanedreal
3. reduces CO and SVR to reduce BP (also reduces preload > dec CO), inhibits responses to postural changes, stimulates Na and water resorption
4. OH, CHF, diarrhea (less w/ guanadrel), NE sensitivity
5. antidepressants, cocaine, amphetamine, PPA

Front 7

Reserpine
1. MOA
2. effect
3. adverse effects

Back 7

1. central and peripheral disruption of NE, DA, and 5HT storage vesicles
2. gradual decline in BP (recovery requires synthesis of new vesicles)
3. OH, brady, Na/H2O ret, sedation, depression, EPS, nassal stuffiness, N/V/D, PUD

Front 8

Peripheral alpha 1 receptor antagonists
1. MOA
2. examples
3. adverse effects
4. therapeutic uses

Back 8

1. selective competitive antagonists in arterioles and veins (reduce BO due to dec TPR)
2. prazosin, doxazosin, terazosin
3. first dose syncope, OH possible but less common than adrenergic inhibitors
4. BPH (tamulosin is 1a selective) + diuretic or beta blocker, no longer fist line anti-HTN med, improve FLP

Front 9

alpha 1 vs. alpha 2 antagonists

Back 9

-alpha 1: peripheral effects, block symp vasoconstriction
-alpha 2: central effects, potentiate sympathetic outflow
-relax bladder/prostate

Front 10

Effects of Beta Blockers

Back 10

1. CV: decreased CO, slow AV conduction, decrease automaticity, decrease renin release, reduce central symp outflow, decrease TPR
2. peripheral vascular effects
3. metabolic effects: less symptoms and response to hypoglycemia, inhibit lypolysis
4. pulmonary effects
5. CNS effects

Front 11

Examples of:
1. beta 1 selective blockers
2. ISA
3. propanol is most . . .
4. combined alpha beta activity
5. nictric oxide activity

Back 11

1. AABBMN: acebutolol, atenolol, betoxolol, bisoprolol, metoprolol, nebivolol
2. PCPA: pentbutolol, carteolol, pindolol, acebutolol
3. lipophilic
4. labetalol, carvedilol
5. nebivolol

Front 12

Therapeutic Uses of Beta Blockers

Back 12

1. hypertension
2. angina
3. arrhythmias (automaticity and AV conduction)
4. post MI
5. heart failure
6. migraine
7. peri-operative
8. essential tremor
9. pheochromocytoma
10. stage fright

Front 13

NHYA Classification of Heart Failure (symptoms and tx)

Back 13

I: asymptomatic, EF <40% (ACEI, BB)
II: symptoms w/ significant activity (ACEI, diuretic, BB, digoxin)
III: symptoms with ADL or minimal activity (diuretic, ACEI, spironolactone, digoxin)
IV: symptoms at rest (diuretic, ACEI, spironolactone, digoxin)
Acute HF: beta agonist, PDE, digoxin

Front 14

Calcium Channel Blockers
1. MOA
2. effects
3. examples

Back 14

1. bind alpha 1 subunit of L type Ca-channels, drugs act from inner side of membrane to reduce Ca++ current
2. relaxation of arterial smooth muscle (dec TPR), negative ionotropic effect (dec contractility), slowed sinus/AV conduction
3. dihydropyridines (nifedipine, nicardipine, amlodipine, felodipine, isradipine, nisolodipine), verapamil, dilitiazem

Front 15

Hemodynamic Effects of CCBs
1. dihydropyridines
2. verapamil
3. dilitiazem

Back 15

1. potent vasodilatation stimulates reflex tachy to negate any negative chronotropic or inotropic effects
2. vasodilation + negative chrono-, ino-, and dromo- tropic effects
3. similar to verapamil

Front 16

Uses of CCBs

Back 16

1. HTN (all equally effective)
2. chronic stable angina (verapamil/diltiazem)
3. vasospastic angina
4. arrhythmia
5. Raynaud's phenomenon
6. no effect on exercise tolerance, lipid profile or electrolytes

Front 17

CCB adverse effects

Back 17

1. HA, flush, peripheral edema (dihydropyridines)
2. contraction of LES
3. constipation (verapamil)
4. bradycardia
5. CHF

Front 18

HTN Therapy
1. first line agents
2. compelling indications

Back 18

1. diuretics, beta blockers, ACEI, alpha beta blockers, ARBs, calcium channel blockers
2. DM, CHF, ISH, MI, CV risk profile