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thedewhub
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Organic Nitrates
- – Decrease myocardial oxygen consumption
- – Used in conjunction with propranolol to reduce
- tachycardia
- – Used for aborting angina attacks; used as prophylaxis
- against predictable attacks
- – Converts to nitric oxide to have effect
- – Can result in reflex tachycardia, venous dilation,
- decreased afterload, increased cardiac force
- – Use is contraindicated with sildenafil (Viagra)
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• Beta antagonists
- – Action by decreasing heart rate and
- contractility
- – Used with organic nitrates to inhibit reflex
- tachycardia
- – Blocks exercise induced tachycardia– Decrease arterial pressure
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Calcium Channel blockers
- – Cardiac vs. smooth muscle selectivity
- – Relaxes vasospasm
- – Decreases heart rate and contractility
- – Side effects bradycardia and AV block
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Heparin
- – LMW heparin – less monitoring, less
- variability in response, longer duration of
- action (better for long distance people)
- – Binds to anti-thrombin III
- – Overdose is treated by protamine sulfate
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• Warfarin
- – Factors affected by warfarin – II, VII, IX, X,
- protein C and S
- – Reversed by vitamin K
- – Not used in pregnancy
- nticoagulant (cont)
-
• Anti-platelet drugs
- – monoclonal antibody
- to IIbIIIa receptor, aspirin (mechanism of
- action, typical drugs)
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• Fibrinolytic (thrombolytic) system –
- – Activators – urokinase, t-PA, streptokinase,
- etc.
- – Inhibitors – aminocaproic acid
- – Abnormal bleeding is the most common side
- effect
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ACE inhibitors
• First line of treatment for HF
-
– • Systolic Dysfunction
- – impaired contractile
- properties
-
• Diastolic Dysfunction
- – inability of the
- heart to fill (decreased compliance,
- reduced relaxation)
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Heart Failure (cont)
- • ACE inhibitors
- – Reduces AngII production
- – Enhances diuretic therapy
- – Should not be used in pregnancy
-
• Phosphodiesterase Inhibitors
- – Milrinone used for short-term support
- – Milrinone bypasses beta1 receptor stimulation
- to produce inotropic activity
-
• Cardiac Glycosides
- – MOA – inhibit Na/K ATPase
- – Use digoxin immune antibody to reverse the effects
-
• Beta-blockers
- – sudden withdrawal may cause
- death – alleviates compensatory increase in
- heart rate and renin release
-
• Vasodilators –
used for reducing afterload
-
• Inotropic drugs
- – Dobutamine has vasodilator properties, stimulates
- adrenergic receptors – useful for immediate drug
- therapy
-
• Treatment for Diastolic Dysfunction -
- controversial
- – Calcium channel blockers
- • Contraindicated in systolic dysfunction
- • Improves relaxation and reduces HR
- • Promotes regression of hypertrophy
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