LECCTURE OF PHARMACOLOGY

MADE BY NURSING ZONE TEAM

L10. Cardiovascular system (CVS) drugs

THIRD YEAR

@Nursing_Zone39

New high blood pressure guidelines 14 Nov, 2017

Oral Rectal
/ Diastolic pressure (mmhg) SC

Hmmmm

Category Systolic

Easy
or Normal
< 120 / 80

or Verity Patient can

Bypasses liver
or Compact

Prehypertension 120 - 129 / 80 administer
Erratic absorption low

Convenient at
grade

compliance Complete
FirstStage
pass effect
1 130 - 139 / 80 - 89

absorption

Sometimes inefficient

Small does

Stage
difficultly 2
in swallowing ≥ 140 / 90

Pain full

Sublingual-Buccal IV IM

BP= CO (cardiac output) x PVR (peripheral vascular resistance)

TI Rapid absorption Rapid

I TI Large volume
E Stability of drug

GBBBEmMgm

Accurate

I K Sustained release
E Higher bioavailability

IX Can’t be retrieved possible

XI Inconvenient Antihypertensive
Expensive
agents
Trained personnel

Small doses only

EXRequires trained personnel Erratic absorption

Can’t be swallowed

Angiotensinogen Kininogen

Renin

3 v
Increased
v

Aliskiren
Angiotensin I Bradykinin s prostaglandin

Angiotensin-converting enzyme (kininase II)

synthesis

Best of luck

Angiotensin II n Inactive metabolites

v ARBS v ACE inhibitors

i v

Vasoconstriction Aldosterone secretion v

Vasodilation e

Spironolactone, eplerenone

v v v

Increased peripheral Increased sodium Decreased peripheral

vascular resistance and water retention e

vascular resistance

s Increased blood pressure e Decreased blood pressure

Subclass M/A Effects Application Toxicities

Oral Rectal SC

Hmmmm

Easy
or converting
Angiotensin- - Chronic heart
- Cough
Inhibits
Arteriolar & - Hyperkalemia
or Verity
enzyme (ACE) inhibitors: failure
Patient can
- Angioneurotic
Captoprilor Compact
ACE Bypasses liver
venous dilation
- Hypertension

edema
administer
Erratic absorption low

Convenient

compliance Complete
Angiotensin receptor
First pass effect - Like ACEI

Blockers (ARBs):

Like ACEI absorption

Like ACEI

Sometimes inefficient
- Intolerant

Losartan

to ACEI Small does
difficultly in swallowing

Pain full

- Hyperkalemia
Reduces

Sublingual-Buccal Inhibits IV IM- Renal

Renin inhibitors enzyme angiotensin
Hypertension impairment
AliskirenRapid absorption activity I & Il and
TI - Potential
of renin I Rapid
Aldosterone

TI Large volume
Stability of drug teratogen

GBBBEmMgm
E

Higher bioavailability
I Accurate K Sustained release
E

Inconvenient
IX Can’t
Competiti be retrieved
- Slows heart
- Chronic heart
possible

XI
BETA BLOCKERS vely Expensive
rate Trained personnel
- Bronchospasm

Small doses only blocks B1 - Reduces blood failure

- Bradycardia
EXRequires trained personnel- Hypertension
Carvedilol Erratic absorption

Can’t be swallowed receptors pressure

- Reduces

cardiac rate
Venodilators:
Blocks - Hypertension

- Verapamil
Ca2+ and output - Angina

- Reduce
Best of luck

- Nifedipine
channel - Arrhythmias

vascular

resistance

Increases

Arteriolar dilators Reduces BP

- Tachycardia
NO Hypertension

Hydralazine & afterload - Fluid retention

synthesis

Subclass M/A Effects Application Toxicities

Oral Rectal SC

Hmmmm

or Easy
Releases - Acute cardiac - Excessive

NO & Reduces blood decompensat hypotension

or Verity
Combined arteriolar
activates Bypasses Patient can
and venodilator: pressure & liver ion - Thiocyanate
or Compact

Nitroprusside guanylyl
absorption low - Hypertensive administer
afterload
Erratic and cyanide

Convenient cyclase emergencies Completetoxicity

compliance
First pass effect

absorption

Sometimes inefficientSelectively Prevent

Blockers
SmallOrthostatic
does
difficultly in swallowingblock a1 sympathetic Hypertension

Prazosin
Adrenoceptors Painhypotension
full

vasoconstriction
Sublingual-Buccal
IV IM
DIURETICS - Hypertension,

- Block Na/CI - Reduce

mild heart
TI Rapid absorption
- Hydrochloro thiazide blood volume
I Rapid
transporter
Failure TI Large volume

Stability of drug

GBBBEmMgm
E

I Accurate - Severe Sustained release

- Frusemide K

E Higher bioavailability

hypertension,

Inconvenient
IX Can’t be retrieved
- Increase Na possible

XI heart Failure

- Spironolactone - Block
Expensive
and decrease K Trained personnel

Small doses only aldosterone excretion - Hypertension,

EXRequires trained personnelheart failure

receptor Erratic absorption

Can’t be swallowed

SYMPATHOPLEGICS,

Reduce central

Activate a2

CENTRALLY ACTING sympathetic Hypertension Sedation

adrenoceptors

Clonidine outflow

Best of luck

Heart Failure (HF)

Oral Rectal SC

Hmmmm

or Easy

• Heartor Verity
isn’t pumping as well (weaker than normal).
Patient can

Bypasses liver to body.
or Compact
• Heart can’t pump enough oxygen & nutrients

Erratic absorption administer

low to pump through

• Heart respond by stretching
Convenient to hold more blood the

body or by becoming stiff & compliance
thickened. Complete
First pass effect

• Heart muscle walls weaken & become unable to pump efficiently. absorption

Sometimes inefficient

• Kidneys respond by causing the body retain fluid (water) & salt. Small does
difficultly in swallowing

• Congestive HF: body becomes congested. Pain full

• Most common causes is coronary artery disease with

Sublingual-Buccal
hypertension. IV IM

• Cardinal symptoms: dyspnea, fatigue, fluid retention.
TI Rapid absorption

Stability of drug
I Rapid TI Large volume

GBBBEmMgm

E

Higher bioavailability
I Accurate K Sustained release
E

Inconvenient
IX Can’t be retrieved possible

XI Expensive Trained personnel

Small doses only

Subclass M/A
EX Requires trained
EffectspersonnelApplication
Erratic absorption
Toxicities

Can’t be swallowed

- Cough

Angiotensin- converting - Chronic heart

Inhibits Arteriolar & - Hyperkalemia

enzyme (ACE) inhibitors: failure

ACE venous dilation - Angioneurotic

Captopril - Hypertension

edema

Best of luck

Angiotensin receptor - Like ACEI

Blockers (ARBs):
Like ACEI - Intolerant Like ACEI

Losartan
to ACEI

Competiti - Slows heart

- Chronic heart - Bronchospasm

BETA BLOCKERS vely rate

failure - Bradycardia
Carvedilol blocks B1 - Reduces blood

- Hypertension

receptors pressure

Subclass M/A Effects Application Toxicities

Oral Rectal SC

Hmmmm

Increases
Arteriolaror Easy
dilators
NO
Reduces BP - Tachycardia
Hypertension
or Verity
Hydralazine & afterload
synthesis Bypasses liver
- Fluid retention
Patient can
or Compact

Erratic absorption low administer

Convenient Releases - Acute cardiac - Excessive

compliance
Reduces blood Complete
Combined First pass effect NO &
arteriolar decompensat hypotension

and venodilator: activates pressure & ion absorption

- Thiocyanate

Sometimes inefficient
Nitroprusside guanylyl afterload and cyanide

- HypertensiveSmall does
difficultly in swallowingcyclase emergencies Pain toxicity

full

Sublingual-BuccalReduced IV IM - Nausea

Ca2+
Increases Chronic - Vomiting
TI Rapid
CARDIAC absorption expulsion &
GLYCOSIDE
cardiac
Rapid symptomatic
Large volume
- Diarrhea
Digoxin increased I contractility TI
E Stability of drug Ca2+

GBBBEmMgm
heart failure
Accurate
I K Sustained release
- Arrhythmias
E Higher bioavailability stored

IX Can’t be retrieved possible

XI Inconvenient - Release Expensive Trained personnel

Small doses only - Acute and

EXRequires preload
nitric trained personnel
& chronic Erratic
heart absorption
- Postural

Can’t be swallowed oxide reduces

Venodilators: failure hypotension

Isosorbide dinitrate (NO) ventricular - Angina - Tachycardia

- Activate Stretch - Headache

guanylyl

cyclase

Best of luck

- Blselective Increases Acute heart

BETA- ADRENOCEPTOR agonist cardiac failure Arrhythmias

- Increases contractility,
AGONISTS: decompensated

CAMP

Dobutamine output

synthesis

‫اﻟﻠﻲ ﺑﺎﻟﻠﻮن دا ﻛﻠﻬﺎ اﻧﺬﻛﺮت ﻓﻮق‬

Signs & Symptoms of

Oral digoxin toxicityRectal SC

Hmmmm

or Easy

or Verity Patient can

• May causes due to narrow TI. Bypasses liver
or Compact

• Early indication of toxicity are usually
Erratic GI low
absorption related administer

Convenient

• GI: compliance Complete

First pass
- Abdominal paineffect - Anorexia - Diarrhea

absorption

Sometimes
- Nausea inefficient - Vomiting

Small does
•difficultly in swallowing
Neurologic:

Pain full

- Blue-yellow color blindness - Blurred vision

Sublingual-Buccal
- Colored dots in vision -IVComa IM

- Confusion - Depression

TI-Rapid
Seizuresabsorption

Stability of drug
I Rapid TI Large volume

GBBBEmMgm

E

Higher bioavailability
I Accurate K Sustained release
E

Inconvenient
IX Can’t be retrieved possible

XI Expensive Trained personnel

Small doses only Arrhythmia

EXRequires trained personnel Erratic absorption

Can’t be swallowed

• Irregular heartbeat (dysrhythmia)

• HR can be irregular or normal (50-100b/min)

- Bradyarrhythmias (<50b/min) = arrhythmias + normal / slow HR

- Tachyarrhythmias (>100b/min) = arrhythmias + rapi d HR

Best of luck

• Symptoms:

- Palpitation (feeling skipped heart beats / fluttering / “flip-flops” /

heart is “running away”)

- Pounding in chest - Dizziness / feeling light-headed

- Fainting - SOB

- Chest discomfort - Weakness / Fatigue (very tired)

Tess

Antiarrhythmic drugs
Oral Rectal SC

Hmmmm

or Easy

or Verity Patient can

Bypasses liver
• Treat disturbances of heart rhythm.
or Compact

• Capable of worsening / causing Erratic the very low
absorption administer

Convenient

arrhythmias. compliance Complete
First pass effect

• Categorized absorption

Sometimes
- Class I (Na+inefficient
channel blockers)

Small does
difficultly
- Class II in swallowing
(Beta adrenoceptor blockers)

Pain full

- Class III (K+ channel blockers)

Sublingual-Buccal
- Class IV (Ca+ channel blockers) IV IM

TI Rapid absorption Rapid

I TI Large volume
E Stability of drug

GBBBEmMgm

Accurate

I K Sustained release
E Higher bioavailability

IX Can’t be retrieved possible

XI Inconvenient
Subclass M/A Effects
Expensive
Application Toxicities
Trained personnel

Small doses only

EXRequires trained personnel

Sodium Erratic absorption

Can’t be swallowed Slows conduction Most atrial and

CLASS 1A : channel

velocity and ventricular Hypotension

- Procainamide (INa)

pacemaker rate arrhythmias

blockade

Terminate
Does not

Best of luck

Sodium ventricular
CLASS 1B :
prolong and

channel tachycardias and Neurologic

- Lidocaine
may shorten symptoms
(INa) prevent ventricular

action potential
blockade fibrillation after

cardioversion

Sodium Supraventricular
Proarrhythmic

CLASS 1C :
channel arrhythmias in
[precipitate

- Flecainide
(INa) patients with
pre-existing

blockade normal heart

arrhythmia]

Subclass M/A Effects Application Toxicities

Oral Rectal SC

Hmmmm
CLASS 2 :
or Easy
or Verity
- Propranolol
Nonselective
competitive
Decreased

heart rate,
cardiac output,
antagonist at Bypasses liver
- Prophylaxis of - Asthma
angina
- Atrial
- Atrioventricular
Block
Patient can
or Compact B-adrenoceptors
and blood
- Acute heart

arrhythmia administer
Erratic absorption low failure

Convenient pressure

compliance Complete
- Sedation
First pass effect

Serious absorption

Sometimes inefficientBlocks IKr, Prolongs action

ventricular Small does
Bradycardia and

difficultly
CLASS 3: in swallowingINa, ICa-L potential
heart

- Amiodarone channels, duration and

arrhythmias andPain full block in

supraventricular diseased heart

Sublingual-Buccal QT interval
B-adrenoceptors

IV arrhythmias IM

TI Rapid absorption - Reduces

Rapid

Stability of drug
I cardiac rate TI Large volume

GBBBEmMgm
Class E
- Hypertension

4:
Higher

bioavailability
Blocks
I Accurate
and output K Sustained release
- Angina
- Verapamil
E Ca2+

Inconvenient
IX Can’t
channel
be retrieved - Arrhythmiaspossible
- Reduce
XI

Expensive
vascular Trained personnel

Small doses only resistance

EXRequires trained personnel Erratic absorption

Can’t be swallowed

‫اﻟﻠﻲ ﺑﺎﻟﻠﻮن دا ﻛﻠﻬﺎ اﻧﺬﻛﺮت ﻓﻮق‬

Antianginal drugs

Best of luck

• Angina: occurs when the coronary arteries supply insufficient

O2 to the myocardium.

• n Heart’s workload by n HR, preload, afterload & force of

myocardial contractility.

• Myocardial O2 demand

• Supply of O2 to the heart

Subclass M/A Effects Application Toxicities

Oral Rectal SC

Hmmmm

or Easy - Release

Verity nitric - Acute and - Postural

NITRATES:or
oxide Bypasses liver
Smooth muscle Patient
chronic heart can
hypotension
or Compact
- Isosorbide dinitrate

(NO) Erratic
relaxation
absorption low failure administer
- Tachycardia

- Nitroglycerin
Convenient - Activate failure

compliance - Angina Complete

- Headache
First pass effect guanylyl

absorption

Sometimes inefficient cyclase

Small does
difficultly in swallowing

Nonselective Decreased - Prophylaxis of

Pain full
- Asthma

BETA BLOCKERS
competitive heart rate, - Atrioventricular
Sublingual-Buccalantagonist at cardiac
- Propranolol
IV output, angina
IM Block
B-adrenoceptors - Atrial - Acute heart
and blood
arrhythmia
TI Rapid absorption pressure
Rapid
failure

Stability of drug
I TI Large volume
- Sedation

GBBBEmMgm
E

Accurate

I K Sustained release
E Higher bioavailability

IX Can’t be retrieved
- Reduces possible

XI Inconvenient
Venodilators: Blocks Expensive
cardiac rate Trained personnel
- Hypertension

Small doses only Ca2+ and output - Angina

- Verapamil EXRequires trained personnel Erratic absorption

Can’t
- Nifedipine be swallowed channel - Reduce - Arrhythmias

vascular

resistance

‫اﻟﻠﻲ ﺑﺎﻟﻠﻮن دا ﻛﻠﻬﺎ اﻧﺬﻛﺮت ﻓﻮق‬

Best of luck

MADE BY NURSING ZONE TEAM

Pharma references

A- Basic and Clinical Pharmacology 13 E Paperback

Bertram Katzung (Author), Anthony Trevor (Author) Publisher: McGraw-Hill Medical; 13 edition
(December 23, 2014)
Language: English
ISBN13:97 0071825054
ISBN 10:0071825053
B. Lippincott Illustrated Reviews: Pharmacology 6th edition (Lippincott Illustrated Reviews Series)
Paperback
Karen Whalen PharmD BCPS (Author) Edition: Sixth, North American.
Edition Language: English. ISBN-13: 978-1451191776 ISBN-10: 1451191774
2. List Essential References Materials (Journals, Reports, etc.) British National Formulary (BNF)