shosh: cardio drugs

ACE inhibitors

Mask symptoms of hypoglycemia

• Preferentially vasodilates arterioles with a cGMP mediated mechanism
• Drug of choice for hypertension in pregnancy, with methyldopa
• Can cause drug-induced SLE
• Give with a beta blocker to prevent reflex tachycardia

• Opens ATP-dependent K channels in vasculature and pancreatic beta cells
• Prevents insulin release

Blocks DHPR Ca channels in vasculature

• Block L-type Ca channels
• Vasodilation and reduced conduction through the AV node
• Diltiazem works on heart, not vasculature

• Nitroglycerin--causes reflex tachycardia
• Decreases preload
• Spread out doses to prevent tolerance

Nitroprusside--arteriolar and venous dilation, via cGMP

Cyanide poisoning--treat with thiosulfates and nitrites (increase concentration of methemoglobin, which preferentially binds to CN, and keeps it away from the ETC)

Dopamine agonist, relaxes renal vasculature

K channel opener--hyperpolarizes and relaxes vascular SM. Also inhibits insulin release.

Partial beta blockers, contraindicated in angina

• Inhibit HMG CoA reductase
• Cause hepatotoxicity and rhabdomyolysis

• Inhibits VLDL release from the liver, increases HDL
• Side effects include flushing, hyperglycemia, and hyperuricemia

• Prevents cholesterol reabsorption at intestinal brush border
• No major side effects (!!)

• Upregulate lipoprotein lipase, increase triglyceride clearance
• Side effects include myositis, hepatotoxicity, and cholesterol stones

Gs proteins, increase intracellular cAMP, activate PKA. PKA phosphorylates Ca channels and phospholamban, which increase Ca concentration inside the cell, thereby increasing contractility

• Increases Ca concentration in the cardiac cells by inhibiting the Na/K ATPase. Also directly stimulates vagus, which slows heart rate.
• Use to treat CHF and A fib
• Causes blurry yellow vision
• Hypokalemia and quinidine increase toxicity

• Quinidine, procainamide, disopyramide
• Block Na channels in the open conformation, decrease slope of phase zero

• Cinchonism (headache, tinnitus, thrombocytopenia) when used in combination with digoxin.
• Torsades des pointes (quinidine is also a muscarinic antagonist, so can trigger tachycardia)

SLE

• Lidocaine, mexiletine, tocainide
• Block in activated Na channels, and slow Na channels during action potential plateau (shorten plateau)
• Use for ventricular arrhythmias, post-MI

1C antiarrhythmics--last resort drugs, don't use post-MI

• Propranolol, timolol, esmolol, metoprolol, atenolol
• Inhibit adrenergic innervation in the AV node, decrease slope of phase 4 in the action potential

• Drug of choice for SVT
• Can cause impotence, exacerbate asthma, and mask signs of hypoglycemia

Esmolol

Class III antiarrhythmic, and beta blocker

Class III antiarrhythmic

Class III antiarrhythmic

Class III antiarrhythmic

• Class III antiarrhythmic
• Can cause torsades, pulmonary fibrosis, and thyroid dysfunction. Blue-grey deposits in skin

Verapmil, diltiazem--act on AV node

They can cause AV block

• Increases K efflux, hyperpolarizing the cell
• Drug of choice for supraventricular tachycardia
• Very short acting, but causes bronchospasm
• Effects blocked by theophylline

• Blocks endothelin receptors, thereby inhibiting vasoconstriction
• Use to treat pulmonary hypertension

• Alpha 2 agonists, centrally inhibit sympathetic innervation
• Use methyldopa for htn during pregnancy
• Effects are blocked by tricyclic antidepressants

• Acebutalol
• Betaxolol
• Esmolol
• Atenolol
• Metoprolol

• Mixed alpha and beta antagonist
• Decreases peripheral vascular resistance without triggering reflex tachycardia

Phenoxybenzamine