CARDIVASCULAR DRUGS

By: Maghan Das

Maghan Das

CARDIOVASCULAR DISEASE AND DRUGS

Basic cardiovascular physiology and pathology depends on the control of heart rate, cardiac output, blood pressure, blood flow, ionic composition, RAAS, vascular endothelium, regulation of tissue perfusion, hypertension, dislipidaemias, atherosclerosis, blood clotting, ischaemic heart disease, cardiomyopathies, cardiac arrhythmias and cardiac failure.

Maghan Das

Cardiovascular drugs: inotropic agents, b blockers, calcium antagonists, organic nitrates, anti-arrhythmics, ACE inhibitors, ATII (=AT1) antagonists, diuretics, cholesterol lowering drugs, clot-busters, anti-coagulants, anti-platelet drugs.

Maghan Das

DRUGS TO TREAT ANGINA PECTORIS

Angina pectoris refers to a strangling or pressure like pain caused by cardiac ischaemia.

It’s a pain syndrome due to induction of an adverse oxygen supply / demand situation in portion of myocardium.

Drugs used exploit two main strategies: reduction of oxygen demand and increase of the oxygen delivery to myocardium.

Three types of anginal attack: stable angina, unstable angina and variant angina.

Maghan Das

ANTI ANGINAL DRUGS

1) ORGANIC NITRATES: Glyceryl trinitrate (Nitroglycerin), Isosorbide dinitrate, etc

2) BETA BLOCKERS: Propranolol, Atenolol, Metroprolol, Carvedilol, etc

3) CALCIUM ANTAGONIST: Nifedipine, Diltiazem, Verapamil

4) SELECTIVE If- INHIBITORS: Ivabradine Maghan Das

ANTI ARRHYTHMIC DRUGS

Cardiac arrythmias commonly occur in presence of pre-existing heart disease.

1) CLASS I: Membrane stabilizing drugs; sodium channel blockers-

CLASS I a- Quinidine, disopyramide

CLASS I b- Lidocaine, Phenytoin

CLASS I c- Propafenone

2) CLASS II: BETA BLOCKERS- Acebutolol, Atenolol, Esmolol,Metoprolol, Propranolol

3) CLASS III: POTASSIUM CHANNEL BLOCKERS- Amiodarone, Sotalol

4) CLASS IV: CALCIUM CHANNEL BLOCKERS- Verapamil, Diltiazem

Maghan Das

Maghan Das

CLINICAL CLASSIFFICATION OF ANTIDYSRHYTHMIC DRUGS I GROUP: (decrease AV conductance, for treatment of

SV tacharrhythmia)- Verapamil

II GROUP: (for treatment of ventricular tachyarrhythmia)- Lidocaine (i.v.), Propafenone, Phenytoin

III GROUP: (for treating SV and V tachyarrhythmia)- Amiodarone, Beta blockers

IV GROUP: (drugs for AV block)- Atropine {M-cholinolytic}, Ephedrine {indirect adrenomimetics}

V GROUP: (inhibitors of AV conduction)- Adenosine [potassium channel opener], Digoxin [cardiac glycoside]

Maghan Das

ANTIHYPERTENSIVE DRUGS

DRUGS AFFECTING RAAS [renin angiotensin aldosterone system]-

RENIN INHIBITOR: Beta blockers [Propranolol, Atenolol, etc]

ACE INHIBITORS: Enalapril, Ramipril

ANGIOTENSIN II RECEPTOR [AT1-receptor] BLOCKERS: Eprosartan, Losartan

ALDOSTERONE ANTAGONIST [ potassium sparing diuretic ]: Spironolactone

Maghan Das

Maghan Das

CALCIUM ANTAGONIST: Nifedipine, Amlodipine, Diltiazem, Verapamil

DRUGS DECREASING SYMPATHETIC ACTIVITY-

BETA BLOCKERS: Nebivolol, Atenolol, Bisprolol, Pindolol, Carvedilol

ALFA BLOCKERS: Prazosin, Phentolamine

OTHER: Reserpine, clonidine DIURETICS: Hydrochlorothiazide, Indapamide,

Furosemide

Maghan Das

PERIPHERAL VASODILATORS

Alfa blockers- Prazosin, Ergotoxine

Phosphodiesterase inhibitors- Pentoxifylline

Prostaglandin analogue- [activators of AC] Alprostadil (PG1), Iloprost (PG2)

CEREBRAL VASODILATORS:

Nimodipine (calcium antagonist), Naftidrofuryl (5-HT2 receptor blocker)

Maghan Das

DRUGS TO TREAT HEART FALIURE

Clinical syndrome that

can result from any

structural or functional

cardiac disorder that

impairs the abilty of the

ventricle to fill with or

eject blood.

Maghan Das

Therapeutic Uses of Digitalis Compounds

Heart Failure ↑ inotropy ↑ ejection fraction ↓ preload ↓ pulmonary congestion/edema Arrhythmias ↓ AV nodal conduction

(parasympathomimetic effect) ↓ ventricular rate in atrial flutter

and fibrillation Digitalis compounds have historically been used in the

treatment of chronic heart failure owing to their cardiotonic effect.

Ex: Digoxin, digitoxinMaghan Das

To treat CHF:

Ionotropic drugs: Digoxin, Dobutamine

Diuretics: Furosemide, Thiazide

Vasodilators: ACE inhibitors,AT1 antagonist, Nitrate

Beta blockers: Metroprolol

Maghan Das

THANK YOU

Maghan Das