Pharm II (antianginal/ Antihypertensive agents)
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Name the Ca Channel inhibitors?
What are their general effects?
Nifedipine, Diltiazem, Verapamil
- Smooth muscle relaxation
- Decreases HR, Conduction, and contraction force.
What is a difference between Nitrates and Ca channel Blockers?
Nitrates-- are venous dilators
- Ca channel Blockers--- Arterial dilators
- (note: These can cause a reflex tachycardia)
Which of the Ca channel blockers are DHP (dipine) and which are not?
What are their effects?
What are they used for?
- VERAPAMIL DILTIAZEM are NON-DHP
- - decrease HR
- - Used in Arrythmia and angina
- NIFEDIPINE is DHP
- -increased HR(due to Reflex)
- -Cause Vascular smooth muscle relaxation-- decrease afterload
- - used in HTN and angina
Name the different Dipines (DHP drugs) and their special features.
Amlodipine ---------- no reflex tachycardia
Nicardipine---------- Used in HTN and angina
Nimodipine ---------- This is Cerebral vessel specific, it prevents cerebral vassospasm and ischemia
Nifedipine----- used to treat Raynauds phenonmenon (which is caused by Vasospasm)
K CHANNEL OPENERS
What is their prominate action?
Smooth muscle relaxation of Vascular and Visceral tissues.
What is Ranolazine? What is it used for?
What is Trimetazidine? What is it used for?
It is a Na channel inhibitor. Used for treatment of chronic angina pectoris.
- -Is a drug for angina pectoris.Trimetazidine is an anti-ischemic agent, that improves
- myocardial glucose utilization thus decreasing its O2 dependence.
Conclusions of Antianginal agents
- -Nitrates and CCBs decrease myocardial wall tension whereas, beta blockers decrease the heart rate and
- -Nitrates and Nifedipine have the potential to
- cause reflex tachycardia, but this effect can be prevented by concurrent administration of beta blocker.
What are the Classifications of the Antihypertensives?
- ACE inhibitors
- Angiotensin receptor blockers
- Renin inhibitors
- Beta adrenergic blockers
- Alpha adrenergic blockers
- Central alpha 2 agonists
What are the diuretics that can be used as Antihypertensive agents? Name them
-Thiazides : Chlorothiazides, Metolazone, Indapamide.
-High ceiling diuretics : Furesomide, Bumetanide, Ethacrynic acid
-K sparing diuretics : Spironolactone, Triamterene, Amiloride
What are the Antihypertensive agents that are Vasodilators?
- -Calcium channel blockers :
- - Amlodipine, Nicardipine, Nifedipine.
-Other vasodilators: Hydralazine, Minoxidil, Diazoxide, Nitroprusside, Fenoldopam
Name the Angiotensin Converting Enzyme (ACE) Inhibitors
What is their effect?
Captopril, Lisinopril, Enalapril, Ramipril, Benazepril, Fosinopril
Decreases: Arterial resistance (afterload), Venous tension (preload) and aldosterone secretion.
What are the effects of Angiotension II activation?
- -Increases sympathetic activity
- -Increases Tubular Na/Cl reabsorption
- -Increases Aldosterone secretion
- -Increases arterial vasoconstriction (increases BP)
- -Increases the pituitary release of ADH--> increases water retension
What does ACE enzyme do?
It converts Angiotensin I to Angiotensin II.
It destroys bradykinin which is a Vasodilator
What are the indications for ACE inhibitors?
- -Congestive heart failure (CHF)
- -Left ventricular dysfunction
- -Prevention of nephropathy in diabetes mellitus
What are the Side effects with ACE INHIBITORS?
CHRONIC DRY COUGH**** -- due to increased Bradykinin
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