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