Transcript DMAT PA-1 - Keith Conover's Home Page

DMAT PA-1
PHARMACY CACHE
CARDIOVASCULAR AGENTS
Saundra Martino, RpH
ANGIOTENSIN CONVERTING ENZYME
INHIBITORS
•
•
•
LISINOPRIL 20MG TABS
ENALAPRIL 1.25 MG/ ML INJ 2ML
Inhibit conversion of Angiotensin I --------------->
Angiotensin II
(weak vasoconstrictor)
(potent vasoconstrictor)
reduces aldosterone output
(na reabsorption in kidney)
USES:
Congestive heart failure
Hypertension
…..peripheral vasodilation/dec in total peripheral
vascular resistance
dec blood pressure
dec workload on heart
inc renal blood flow
……dec fluid volume/dec water retention
inc in potassium levels
reflex inc in renin secretion
•
KEY FACTS:
chronic cough in up to 39% of patients
first dose may cause profound dec in blood pressure
angioedema—can occur at anytime during treatment esp. with blacks
hyperkalemia>4%
Never use in pregnancy
dec. dose if CrCl<30ml/min
CASCADE: renin--angiotensinogen----angiotensin I---angiotensin II----aldosterone
BETA-BLOCKERS
•
•
•
•
•
ATENOLOL 50MG TABS
METOPROLOL TARTRATE 50MG TABS
METOPROLOL INJ 1MG/ML 5ML
PROPRANOLOL HCL 20MG TABS
PROPRANOLOL INJ 1MG/ML
MULTIPLE MECHANISMS:
dec release of renin from kidneys
dec stimulation of sympathetic NS in heart & vascular smooth
muscle
negative chronotropic effect
negative inotropic effect
some posess antiarrhythmic properties / class II antiarrhythmic
B1 receptors : heart, vascular smooth muscle
B2 receptors: lungs (bronchioles), uterus
dec peripheral vasoconstriction .. Dec bp systolic & diast
olic
dec fluid retention
dec HR both resting & exercise
dec cardiac output
dec in myocardial oxygen demand
inhibit reflex response to orthostatic hypotension
USES:
Angina
Hypertension
Migraine prophylaxis
Tremors
Arrhythmias
Pheochromocytoma
KEY FACTS;
*B1 selective can lose their selectivity at high doses –then block b2 receptors—causes problems in
asthmatics
*Caution use with asthma, COPD, lung disease---may cause bronchospasms
*Caution with diabetics—may cause hypoglycemia
*Slowly wean off over 1-2 weeks abrupt d/c can cause exacerbation of angina, MI, ventricular
arrhythmias
CALCIUM CHANNEL BLOCKERS
•
•
•
•
NIFEDIPINE 10MG CAPS
VERAPAMIL 80MG TABS
VERAPAMIL SR 240MG TABS
DILTIAZEM HCL INJ. 5MG/ML 5ML
USES:
Angina
Hypertension
Supraventricular arrhythmias
Inhibit influx of extracellular calcium across the myocardial & peripheral vascular smooth
muscle membranes---this inhibits contactile process of myocardial smooth muscle
cells --causes relaxation
dilation of coronary & systemic arteries
inc coronary blood flow
Verapamil & Diltiazem depress impulse formation at SA & AV nodes
antiarrhythmics /class IV antiarrhythmics
slows conduction velocity
dec automaticity
depresses SA nodal firing
KEY FACTS:
inc oxygen to myocardial tissue
dec in total peripheral resistance
dec blood pressure
dec afterload
dec heart rate
DIURETICS
•
•
•
HYDROCHLOROTHIAZIDE 25MG TABS
FUROSEMIDE 40MG TABS
FUROSEMIDE INJ 10MG/ML 10ML
USES:
Edema
Hypertension
affect electrolyte transport in kidneys
Thiazide Diuretics
inhibit Na reabsorption at a point distal to Loop Of Henle
get inc excretion of Na & water
dec in total fluid volume
alter carbohydrate metabolism therefore inc in glucose
can inc effectiveness of other antihypertensive agents by
preventing reexpansion of extracellular & plasma volumes
ineffective iif CrCl<,30ml/min
caution with diabetics
can exacerbate hyponatremia & hyperg;lycemia
sulfonamide derivatives-- pho tosensitivity
potassium loss
Loop Diuretics
inhibit Na reabsorption at Loop of Henle
get inc excretion of Na & water
interferes with Mg reabsorption at Loop of Henle
hypomagnesemia
very potent
can exacerbate SLE
ototoxicity with injectable
can cause overdiuresis
orthostatic hypotension, electrolyte imbalances
& volume depletion
can cause hyperglycemia
sulfonamide derivatives…photosensitivity
potassium loss
CARDIAC GLYCOSIDES
•
•
DIGOXIN 0.125MG TABS
DIGOXIN INJ 0.25MG/ML 2ML
Increase myocardial contractility & efficiency
produce positive inotropic effect
produce negative chronotropic effect
inc cardiac output
improve systemic circulation
Improve renal perfusion
reduce edema
effects on electrical activity of heart
dec/slows ventricuar rate
Digoxin ,makes the heart beat stronger with more regular rhythms !!!!!
USES:
Congestive heart failure
Atrial fibrillation
KEY FACTS:
narrow therapeutic index
NITRATES
•
•
•
•
NITROGLYCERIN SL 0.4MG TABS
NITROGLYCERIN TRANSDERM 0.2MG/HR
NITROGLYCERIN INJ. 5MG/ML 10M
ISOSORBIDE 10MG TABS
vasodilation
peripheral veins, peripheral arteries, & coronary arteries
dec blood flow to heart
dec ventricular filling pressures
dec myocardial work—dec oxygen demand
dec in anginal pain
By dec pressure in cardiac tissue facilitate collateral circulation
inc blood distribution to ischemic areas
Tolerance…develops within 24-48 hours
prevent with a nitrate-free period of 8-12 hours
interaction with PDE5 inhibitors—additive vasodilation—potentially fatal hypotension
USES:
relief of anginal pain
dec preload
dec afterload
Decrease workload of heart—dec oxygen demand !!!!!!
CENTRALLY ACTING ALPHA2 AGONIST
•
CLONIDINE 0.1MG TABS
stimulation of alpha2 receptors
inhibitory effect on sympathetic nervous system
dec in heart rate
dec in peripheral resistance
dec in blood pressure
dec cardiac output
dec in stroke volume
USES:
Hypertension
ADHD (attention-deficit hyperac tivity disorder)
abrupt withdrawl after prolonged treatment can lead to hypertensive crisis
Tricyclic antidepressants & beta-blockers enhance potential for hypertensive crisis upon withdrawl
Can cause drowsiness
Can exacerbate depression
DIRECT VASODILATORS
•
HYDRALAZINE 20MG/ML 1ML
USES:
Hypertensive crisis
peripheral vasodil;ator
relaxes arterial smooth muscle
dec peripheral vascular resistance
dec blood pressure (diastolic more than systolic)
reflex autonomic response
inc hr, stroke volume, cardiac output, left ventricular
ejection fraction
inc plasma renin activity
•
•
•
•
•
Dosage adjustments needed in renal impairment
Risk of drug-induced SLE
Never a single agent ---used with diuretic or beta-blocker in hypertensive emergencies
produces reflex tachycardia
Affected by genetic variation