cardiovascular drugs2.pptx
TRANSCRIPT
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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