CARDIOVASCULAR DRUGS

Dare Ogunlade, MBChB, FWACP Lecturer/Consultant Cardiologist Department of Physiological Sciences Obafemi Awolowo University, Ile-Ife

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CLASSIFICATION OFCARDIOVASCULAR DRUGS

1. Antihypertensive drugs 2. Antiarrhythmic drugs 3. Antithrombotic drugs 4. Antianginal drugs 5. Lipid-lowering agents 6. Anti heart failure drugs

ANTIHYPERTENSIVE DRUGS
Antihypertensive drugs are blood pressure

lowering agents They are indicated in the management of hypertension.

Classification of Antihypertensive Drugs

1.

2.
3. 4. 5. 6. 7. 8.

Thiazide diuretics Calcium channel blockers (CCBs) Beta blockers(Beta adrenergic receptor blockers) Angiotensin Conversion Enzyme inhibitors (ACEI) Angiotensin Receptor Blockers (ARBs) Alpha blockers Centrally acting drugs Vasodilators

Antihypertensive Drugs
Class
Thiazide

Mechanism of Action
Reduce Na contents of vascular wall, promote renal excretion of Na
Block calcium channels, vasodilation Non-selective B-blocker

Examples
Hydrochlorothiazide,

Side-Effects
Hypokalaemia, hyponatraemia, hyperuricaemia, Hyperglycaemia, Dyslipidaemia, impotence Headache, pedal oedema, tachycardia bradycardia, nighmares,bronchoconstricti ons

bendrofluazide, polythiazide Nifedipine, amlodipine, Propranolol

CCBs Beta blockers

Cardioselective B-blocker

Atenolol,metoprolol

bradycardia
Cough, angioedema,first dose hypotension,metallic taste

ACEIs

Inhibition of ACE, vasodilation

Angiotensin II receptor blocker, vasodilation

Captopril, lisinopril,enalapril

ARBs Alpha blockers Centrally acting drug

Valsartan, losartan Prazosin, doxazosin, Methyl dopa First dose hypotension Impotence, hepatitis, postural hypotension

Alpha adrenergic blockers False transmitters

Fixed Drug Combinations

Fixed Drug Combinations: two or more drugs with different mechanisms of action combined in a fixed dosage. Example: Moduretic, a combination of hydrochlorothiazide(50mg) and amiloride (5mg). Hydrochlorothiazide is a thiazide diuretic while amiloride is a potassium-sparing diuretic

Other examples of fixed drug combinations

Co-diovan:

diovan(valsartan) + hydrochlorothiazide Zestoretic : lisinopril(zestril) + hydrochlorothiazide Minizide: prazosin + polythiazide

dihydroergocristine

Brinerdin: Reserpine + clopamide +

Choice of antihypertensive drugs

Hypertension in Blacks is volume dependent.

New cases of hypertension in blacks usually

respond to ; 1. Thiazide diuretics 2. Calcium channel blockers

1& 2 are considered first in initiation of drug therapy unless there is contraindication or compelling indications for the use of other antihypertensive medications.

ANTIARRHYTHMIC DRUGS
Drugs useful in the treatment

of cardiac arrhythmias(disorders of cardiac rhythm)

Vaughan WilliamsClassifications of Antiarrhythmic Drugs

CLASS
Class I Ia

CHARACTERISTICS
Na channel blocker Lengthens AP duration

DRUGS
Disopyramide, procainamide, quinidine

Ib Ic

Shortens AP duration No effect on AP duration

Lidocaine, mexiletine, phenytoin Flecainade, propafenone,

Class II

Beta Blockers

Atenolol, propanolol, esmolol

Class III

K channel blockers

Amiodarone, dronedarone, sotalol, bretylium Verapamil, diltiazem

Class IV

Calcium channel blockers

Others

Digoxin, adenosine

Examples of Commonly Used Antiarrhythmic Drugs

Digoxin 2. Beta blockers 3. Amiodarone
1.

Digoxin
Digoxin is a cardiac glycoside

Mechanisms of action

Stimulations of parasympathetic dischargeresulting in decrease heart rate 2. Slow down conduction through atrioventricular node 3. Inhibition of Na-K ATPase pump- increase myocardial contractility
1.

ANTITHROMBOTIC DRUGS
Antiplatelets e.g aspirin, clopidogrel, dipyridamole

Low dose aspirin -75mg daily reduces platelet aggregation and is useful in prevention of cerebrovascular disease in patients with cardiovascular disease e.g hypertension
Anticoagulants e.g Heparin,Warfarin

Warfarin is an oral anticoagulant that is useful in prevention of intramural thrombus formation in patient with dilated cardiac chambers
Fibrinolytic agents e.g streptokinase,tissue plasminogen

activator (tPA), tenecteplase(TNK) Fibrinolytic agents are useful in indicated in the treatment of acute myocardial infarction.

ANTIANGINAL DRUGS
Drugs useful in the management of angina

include; 1. Nitrates 2. Beta blockers 3. Calcium channel blockers 4. Antiplatelets

Nitrates
Nitrates include; nitroglycerin, isosorbide dinitrate

and isosorbide mononitrate Mechanism of action: systemic venodilation , dilation of epicardial coronary vessels Indication; myocardial ischaemia

LIPID-LOWERING AGENTS
Statins : HMG CoA reductase inhibitor

It reduces plasma level of low density

lipoprotein(LDL) cholesterol, a primary risk factor in coronary artery disease. It increases plasma level of HDL Examples include; simvastatin, atorvastatin, lovastatin, rosuvastatin and fluvastatin

ANTIHEART FAILURE DRUGS

1. 2. 3. 4. 5. 6. 7.

8.
9. 10.

Loop diuretics e.g frusemide ACEIs/ARBs Beta blockers e.g bisoprolol, metoprolol, carvedilol Positive inotropes e.g digoxin, dopamine, dobutamine Antiarrhythmic drug e.g digoxin, amiodarone Aldosterone receptor antagonists e.g spironolactone, eplerenone Vasodilators e.g sodium nitroprusside, nitrates Anticoagulants e.g warfarin Lipid-Lowering agents e.g statins Oxygen therapy

CONCLUSION
Cardiovascular drugs are very important in

medical practice. Although a group of drug may be used to manage more than one cardiovascular diseases, combination therapy is the rule.
Mastery of the various groups of drugs with

regards to classification, mechanisms of action, dosage, indications, contraindications, side-effects is required of a student in quest for academic excellence.
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