Week 6: Drugs for Heart Failure, Angina, Coagulation Modifier Drugs, Statins

Heart Failure
specific disease : complex clinical syndrome resulting from
-

vote a any functional & structural

impairment to the ,
specifically ejection of blood OR ventrical filling

control risk factors Obesity & diabetes

-

; HTN , CAD .
.

is unable to DUMP enough blood from ventricles to meet body's metabolic needs
-

⑥ HF coughing SOB dyspnea

-

's pulmonary edema . , ,

⑧ HF 's systemic venous congestion , pedal edema .

jugular venous distension .
ascites .
& hepatic congestion8 .

Classifications of
-

4 Failure :

↳
Class I :
No physical activity limitations

↳ class I :
ordinary physical activity results in fatigue dyspnea ,

↳
class Ii
:
Marked limitation in physical activity

↳
class II :
symptoms @ rest / no physical activity

Cardiac Glycosides
Digoxin llano ✗ in )

NO longer used as first eine tx mortality

-

.
not shown to reduce

MOA

A myocardial contractility 1 positive inotropic effect between SA & AV node cardiac

-

* area .

changes electrical conduction properties of the cells remain in a state of depolarization

> Iv rate of electrical conduction for a longer period & are unable to

↳
prolong refractory period start another electrical impulse .
Which

used in HF & to control ventricular response to to HR & A cardiac efficiency .

*

atrial fibrillation

Adverse Effects

cardio bradycardia tachycardia hypotension

-

:
these are symptoms of anxiety

}
, ,

Headache Confusion convulsions

-

CNS :
. .
fatigue ,

visual :
coloured vision .
halo vision

GI anorexia
:

,
nausea .
vomiting diarrhea ,

Digoxin Toxicity

interactions
-

was 1st Choice drug ,

but not anymore dit adverse effects & drug

contraindicated in pts w/ hypersensitivity to it & ventricular tachycardia or fibrillation

-

therapeutic index (therapeutic dose is close toxic dose)

-

LOW to

Digoxin levels monitored when 1St start taking drug monitor if there
-

are .
When steady . only

is suspicion of toxicity nonadherence , .

& deteriorating kidney fxn .
 LOW potassium OR magnesium levels A potential for toxicity .

Monitor electrolyte levels

-

Pt may be treated WI digoxin immune Fab (digi bind )

↳
Recognizes digoxin as an antigen & forms an antigen antibody complex WI the drug

inactivating the free digoxin

Diltiazem hydrochloride ( card izem )

calcium channel blocker

-

used for temporary control Of rapid ventricular response for Dt Wl atrial fib & .

paroxysmal supra ventricular tactics .

contraindication hypersensitivity pulmonary congestion

-

's acute M1 .
, ,

Angina
Chest pain i
When the supply of oxygen in the blood is insufficient to meet the demands of

requires a large supply of oxygen to meet demands placed on it

ischemia 's
-

poor blood supply to organ .

Chronic stable angina ( classic 1 effort angina ) i

occurs due to artherosclerosis

( pre infarction angina ) WI

-

unstable angina ; most dangerous .

acute coronary syndrome

cardiac ischemia WIO persistent ST segment elevation on ECG & no detectable release

of the enzymes & biomarkers of myocardial necrosis .

Often ends in MI

Vaso Das tic angina ( variant angina ) ; results from spasms from smooth muscle that surrounds

the art hero sclerotic coronary arteries .

↳
occurs @ rest Wto any precipitating cause

>
follows same schedule ,
happens @ same time of day .

Drugs for angina

:
nitrates / nitrites .
b- blockers ,
calcium channel blockers .
Nitrates
Rapid acting forms
-

>
treat acute angina / attacks Available Forms :

↳
sublingual tablets or spray ; Nlnfusion sublingual #

chewable tablets
-

acting forms
-

Long
-

used to prevent anginal episodes

-

>
oralcapsule / tablets

N solutions
-

*
Nitroglycerin

prototypical nitrate transdermal patch #

-

>

>
Large 1St bypass effect moral forms ointments

used for symptomatic + ✗ of ischemic transiingual sprays #

-

>

conditions langina ) *
Bypasses Liver & first-pass effect

>
Oral .
Sublingual .me/-reddOseaerosol

sprayed under tongue ,

IV. & topical

MOA Adverse Effects

cause vasodilation through relaxation Headaches ,

dizziness eotatigue

Of smooth muscles > usually diminishes in intensity & frequency

potent dilating effects on coronary WI continued use

arteries allowing oxygen to ischemic reflex tactics :

when nitrate induced
-

vasodilation

myocardial tissue occurs torabidlb.ws overcompensates &THR

usedfortx & prevention of angina >

huge shift in blood volume toward the systemic

Tolerance venous circulation & away from the

taking nitrates around the orthostatic hypotension

-

occurs in Des

CIOCKORWI long-acting forms

prevented Disallowing a regular nitrate

free period to allow enzyme pathways to

replenish

Nitroglycerin

administered orally blc Of first pass effect

-

Not
-

commonly taken sublingual lb.cl/tTvascUlarity-- quick absorption

Route onset of action peak Action Duration Of Action

IV I -2 mins NIA 3- 5 mins

sublingual 2- 3 mins unknown 30-60 mins .

topical 15 -

60min18 0.5 -

2hr8 3-8 hours .

transdermal 30 -60 mins I -3 hours 8- 12 hours

translingual 2 mins 4- 10min 3- 60min

Hemostasis
process of halting bleeding
>
complex relationship btwn what promotes clot formation OR inhibit coagulation
blood clot
-

Thrombus i a

Embolus thrombus that moves through blood vessels

-

; a .

coagulation system :
cascade WI each activated factor acting as a catalyst that
-

amplifies the next rxn .

Drugs Affecting coagulation

> Results in fibrin ( clot forming ) ① Anticoagulants ; inhibits the action OR formation of

clotting factors ( prevents clot formation )

② Anti platelets ; inhibits platelet aggregation

( prevent platelet plug )

Anticoagulants
Heparin

interfere clotting factors that activate thrombin

-

Usually injected 110 10.000 Units 1 mL )

-

to

always use 1mL Syringes dosing MUST BE EXACT DO NOT ROUND

Toxicity petechia eccnymoses

-

sx ; hematuria ,
Melena , ,

weight heparin8 ( LMWH )

-

LOW molecular

>
enoxapar in cloven OX) & da Heparin (frag min )
↳ more predictable response

C- no ✗ A Darin ( Love nox)

injectable
-

only

prophylaxis
-

commonly used

better than heparin blc no need for monitor & can be given for home tx of DVT
-

DO NOT give heparin + enoxabarin in combination

-

warfarin sodium lcoumad in )

inhibits ✓ it K synthesis by bacteria in GI tract

-

>
inhibit Vit K dependent clotting factors III. V11 , IX. X ) Which are typically synthesized

in the liver .

Most commonly prescribed ORALLY

Dabigatran ( Prada ✗ a) Apixaban ( Eliquis )

direct thrombin inhibitor direct factor ✗ a inhibitor

-
-

prevents stroke & thrombosis in pts anticoagulant used for prophylaxis ( after knee
- -

w/ non valvular atrial fibrillation surgery )

dose dependent on kidney fxn prevents formation of thrombus

-
-

prodrug activated by liver administered PO

- -

Normal dose 150mg bid side effects bruising minor bleed

-

: i
nausea
-

,
,

NO antidote
-

Rivaroxabancxarelto )
direct factor ✗ a inhibitor
-

treats DVT
-

-
+
aspirin to to risk for heart attack

administered PO
-

Antiplatelets
works by inhibiting the enzymes that cause the platelets to clump together

Aspirin ( Acetyl salicylic acid )

18-1
-

Only for

don't use for children WI flu-like sx

-

Clopidogrel ( Plavi × )
only PO
-

ADP inhibitor
-

most widely used .