Cardiovascular Meds

Arrhythmias

• Heart attacks sometimes cause damage to the myocardium (heart muscles)

• Irregular heart beats may develop post MI’s• Atrial flutter, palpitations, premature ventricular

contractions (PVC’s) are all common types of arrhythmias

• Goals of meds is to reduce over sensitive heart muscle tissue to contract spastically by reducing cell membrane permeability hence reduced excitability of the myocardium.

Membrane stabilizers for arrhythmias

• Norpace• Lidocaine by IV only to stabilize irreg. hearts

right after an MI in the ER• Procainamide (pronestyl) and quinidine orally

for long term use

Anti-Arrhythmics which prevent neurotransmitter release

• Cordarone and Betapace, orally, can cause dizziness, low blood pressure

Anti arrhythmics which are Calcium blockers

• Calcium ions needed to move across membranes to allow the heart to contract

• Blocking Calcium blocks overly excited hearts post MI’s

• Cardizem and Verapamil, norvasc, procardia,• Can cause hypotension, bradycardia

CHF (congestive heart failure)

• Heart regular BUT too weak for a large body and is failing. Accumulating too much blood but can’t pump it out. Swollen ankles, fatigue, bloating, weakness, dyspnea

• Lanoxin (digitalis) increases the force of heart contractions which helps weak hearts.

• Patients might see green blue halos!!!

ACE inhibitors

• These block the release of a certain enzyme in the kidneys. Angiotensin is the pre-enzyme that it blocks which then blocks renin release hence ACE/angiotensin converting enzyme inhibitors

• Vasotec, monopril,capoten, accupril, Altace,• Side effects; low BP, dizziness, cough,• They do not cause patient to lose potassium and

in fact may cause hyperkaliumia, and they interact with Lithium taking depressive patients

Beta Blockers for MI’s

• Reduce overly sensitive and over active hearts trying too hard to compensate for overload

s like edema, obesity, smoking, arryhthmias,• Heart attack damage, etc.• Block adrenalin receptors in the heart tissue to

relax hearts showing HBP• Toprol, lopressor, tenormin,coreg,Inderal,

corgard:all very commonly used for first line tx of HBP. All cause bradycardia, depression,impotence

Angina care

• No O2 getting to heart tissue therefore heart pain due to poor coronary circulation

• Nitroglycerine:sublingual, spray, patch powerful vasodilator, red in the face as well and dizziness, it’s flammable and protect from sunlight and always taper it off!

• Imdur and Isodil both sublingual and safer to use

Meds for HBP

• Diuretics: increase fluid excretion thus reducing load on sick heart

• Side effect: hypokalium• Don’t take at bedtime or get nocturia• Diuril (Chlorthiazide), Lasi (furosemide),

Hydrodiuril (hydrochlorthiazide), Aldactone (spironolactone), Diazide, Maxide

• All cause hypokalemia EXCEPT spironlactone so take with bananas/OJ

CNS blockers for HBP

• Block adrenalin output by blocking CNS causing its release from the adrenal medulla

• Catapres (clonidine),Aldomet• Dizziness, depression

Peripheral nervous system blockers for HBP

• Allow peripheral vasodilation due to blocking sympathetic nerves

• Cardua, Minipress, Hytrin

Peripheral vasodilators for HBP

• Apresoline (hydralazine)• Minoxidil (Rogaine) also grows hair!• Both block smooth muscle in arterioles hence

lower BP

Combination HBP meds

• Advantage; fewer side effects for they reduce the total dose of each component so safer

• Hyzaar: beta blocker PLUS a diuretic