Cardiovascular Pharmacology

Front 1

Hydrochlorothiazide (HCTZ)

Back 1

Class: Thiazide Diuretic

Mech: Works in DCT to block NaCl Txporter. By doing so, it also ↓ Ca2+/Na exchanger, thereby ↑ serum Ca!

Use: Antihypertensive, Diuretic, Hypocalcemia

Toxicities:
Hyper GLUC
Glucose
Lipidemia
Uric Acid
Calcemia
also, hypokalemia (↑ Aldo action in CT)

Front 2

Furosemide

Back 2

Class: Loop Diuretics

Mech: work in Thick Ascending Limb of Loop of Henle to Block Na/K/2Cl (NKCC) Txporter.

Toxicity:
Ototoxicity
Hypokalemia
Gout (↑ Uric Acid)

Front 3

Clonidine

Back 3

Class: Sympathoplegics (α2 agonist)

Mech: Centrally acting α2 agonist. Agonist actions at α2 receptors centrally cause brain to "think" that catecholamine levels are high, ↓ sympathetic outflow from sympathetic nerves and ↓ catecholamine production from adrenal medulla.

Use: Hypertension (rarely), and Opiate Withdrawal

Toxicity: Dry mouth (↓ symp. stim.), and REBOUND HTN if withdrawn

Front 4

Methyldopa

Back 4

Class: Sympathoplegics. Centrally-acting α2 agonist.

Mech: centrally acting α2 agonist binds α2 receptors in CNS --> ↓ sympathetic outflow and ↓ catecholamine synthesis (↓ stim. from brain)

Toxicity: Positive Coombs Test, Sedation

Front 5

Reserpine

Back 5

Class: Sympathoplegic. Monoamine transport blocker (VMAT). Monoamines are then degraded by MAO.

Use: HTN

Toxicity: DEPRESSION, sedation

Front 6

Guanethidine

Back 6

Class: Sympathoplegics. Blocks Na+ ATPase selectively in sympathetic nerve terminals (uptake via uptake 1). ↓ NE release.

Use: Hypertensive emergencies

Toxicity: Severe Orthostatic and exercise Hypotension (body cannot increase sympathetic tone), sexual dysfunction

Front 7

Prazosin

Back 7

Class: Sympathoplegic. α1 receptor antagonist

Mech: α1 receptor antagonist blocks the constriction of vascular smooth muscle.

Use: HTN and BPH

Toxicity: Orthostatic Hypotension (1st dose ONLY), Headache.

Front 8

Beta Blockers

Back 8

Class: Sympathoplegic. Beta adrenergic receptor blockers.

Mech: Block Beta Adrenergic receptors. ↓ HR, ↓ Renin release, ↓ SV, and for those that cross BBB, ↓ sympathetic stimulation in brain

Use: HTN, Angina, Tachycardia, Essential Tremor, Nodal Arrhythmias.

Toxicity: Impotence, CV Depression, Asthma Exacerbation

Front 9

Hydralazine

Back 9

Class: Vasodilator

Mech: ↑cGMP --> sm. muscle relaxation.

Use: HTN (with β-blockers)

Toxicity: Lupus-Like Syndrome, Reflex Tachycardia (↓ with B-blockers), Headache, Angina

C/I: Angina and Coronary Artery Disease (CAD)

Front 10

Minoxidil

Back 10

Class: Vasodilator

Mech: ↑ K+ channel opening --> hyperpolarization of membrane and sm. muscle relaxation

Use: HTN & hair loss (Rogaine)

Toxicity: Hypertrichosis (Rogaine uses S/E to its benefit), Pericardial effusion, Reflex Tachycardia, Angina

Front 11

Nifedipine/Diltiazem

Back 11

Class: Ca Channel Blockers

Mech: Block L-type Ca Channels in vascular smooth muscle and heart.
Sm. muscle: Nifedipine>diltiazem>verapamil
Heart: Verapamil>diltiazem>Nifedipine

Use: HTN, arrhythmias, Raynaud's syndrome, angina and Prinzmetal's angina

Toxicity: Dizziness, Flushing. Verapamil can cause AV Block.

Front 12

Nitroprusside

Back 12

Class: Vasodilators

Mech: Equal Veno and Vasodilator. This means that it dilates arteries=veins. ↓ venous return to heart and ↓ SVR (via arterial vasodilation).

Use: Malignant HTN

Toxicity: Cyanide Toxicity (releases CN)

Front 13

Diazoxide

Back 13

Class: Vasodilators

Mech: Opens K+ Channels --> Vascular muscle Hyperpolarization and Sm. Muscle Relaxation

Use: Malignant HTN

Toxicity: Hyperglycemia (↓ insulin release)

Front 14

ACE Inhibitors

Back 14

Captopril (sulfa Allergy), Enalapril, Fosinopril

Toxicities: Hyperkalemia, Cough, Angioedema, Teratogenic (Fetal Renal Damage)

C/I: Pregnancy and Renal Artery Stenosis (Bilateral especially)
Renal Artery Stenosis because the Renin-Angiotensin system is the only way that the kidneys can maintain GFR

Front 15

Losartan

Back 15

Class: Angiotensin II Receptor Inhibitor

Mech: Angiotensin II Receptor Inhibitor --> ↓ Sm. muscle contraction

Use: HTN, Diuretic

Toxicity: Teratogenic (Fetal Renal Toxicity), Hyperkalemia (Blocks Aldosterone)

Front 16

Goal of Treatment of Angina

Back 16

↓ Myocardial Oxygen Demand (MvO2)
1. Contractility
2. Afterload
3. Heart Size
4. Heart Rate

Front 17

Effect of Nitrates on relative components of Angina Treatment
EDV -->
BP -->
Contractility -->
HR -->
Ejection Time -->
MvO2 -->

Back 17

Effects:
↓ EDV
↓ BP
↑ Contractility (reflex)
↑ HR (Reflex)
↓ Ejection Time
↓ MvO2

Front 18

Effect of β-Blockers on relative components of Angina Treatment
EDV -->
BP -->
Contractility -->
HR -->
Ejection Time -->
MvO2 -->

Back 18

Effects:
↑ EDV
↓ BP (↓ Renin)
↓ Contractility
↓ HR
↑ Ejection Time
↓ MvO2

Front 19

Treatment Strategy for Angina

Back 19

Beta Blockers and Nitrates
Effects on Relevant Components:
± EDV
↓ BP
± Contractility
↓ HR
± Ejection Time
↓↓ MvO2