CARDIVASCULAR DRUGS Sanjukta (2009)

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. ► 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.

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.

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

ANTI ARRHYTHMIC DRUGS Cardiac arrythmias commonly occur in presence of pre- existing heart disease. Cardiac arrythmias commonly occur in presence of pre- existing heart disease. 1) CLASS I: Membrane stabilizing drugs; sodium channel blockers- 1) CLASS I: Membrane stabilizing drugs; sodium channel blockers- CLASS I a- Quinidine, disopyramide CLASS I a- Quinidine, disopyramide CLASS I b- Lidocaine, Phenytoin CLASS I b- Lidocaine, Phenytoin CLASS I c- Propafenone CLASS I c- Propafenone 2) CLASS II: BETA BLOCKERS- Acebutolol, Atenolol, Esmolol,Metoprolol, Propranolol 2) CLASS II: BETA BLOCKERS- Acebutolol, Atenolol, Esmolol,Metoprolol, Propranolol 3) CLASS III: POTASSIUM CHANNEL BLOCKERS- Amiodarone, Sotalol 3) CLASS III: POTASSIUM CHANNEL BLOCKERS- Amiodarone, Sotalol 4) CLASS IV: CALCIUM CHANNEL BLOCKERS- Verapamil, Diltiazem 4) CLASS IV: CALCIUM CHANNEL BLOCKERS- Verapamil, Diltiazem

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]

ANTIHYPERTENSIVE DRUGS ► DRUGS AFFECTING RAAS [renin angiotensin aldosterone system]- RENIN INHIBITOR: Beta blockers [Propranolol, Atenolol, etc] RENIN INHIBITOR: Beta blockers [Propranolol, Atenolol, etc] ACE INHIBITORS: Enalapril, Ramipril ACE INHIBITORS: Enalapril, Ramipril ANGIOTENSIN II RECEPTOR [AT1- receptor] BLOCKERS: Eprosartan, Losartan ANGIOTENSIN II RECEPTOR [AT1- receptor] BLOCKERS: Eprosartan, Losartan ALDOSTERONE ANTAGONIST [ potassium sparing diuretic ]: Spironolactone ALDOSTERONE ANTAGONIST [ potassium sparing diuretic ]: Spironolactone

► CALCIUM ANTAGONIST: Nifedipine, Amlodipine, Diltiazem, Verapamil ► DRUGS DECREASING SYMPATHETIC ACTIVITY- BETA BLOCKERS: Nebivolol, Atenolol, Bisprolol, Pindolol, Carvedilol BETA BLOCKERS: Nebivolol, Atenolol, Bisprolol, Pindolol, Carvedilol ALFA BLOCKERS: Prazosin, Phentolamine ALFA BLOCKERS: Prazosin, Phentolamine OTHER: Reserpine, clonidine OTHER: Reserpine, clonidine ► DIURETICS: Hydrochlorothiazide, Indapamide, Furosemide

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

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.

► 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, digitoxin

► To treat CHF: Ionotropic drugs: Digoxin, Dobutamine Ionotropic drugs: Digoxin, Dobutamine Diuretics: Furosemide, Thiazide Diuretics: Furosemide, Thiazide Vasodilators: ACE inhibitors,AT1 antagonist, Nitrate Vasodilators: ACE inhibitors,AT1 antagonist, Nitrate Beta blockers: Metroprolol Beta blockers: Metroprolol

THANK YOU THANK YOU BY: SANJUKTA GHOSE BY: SANJUKTA GHOSE