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The Solution(s):
Vasodilator Diuretics Inotropes
The Solution(s):
Vasodilator Diuretics Inotropes
Vasodilators
How do they work?
Mechanism 1:
ACE converts Angiotensin I to Angiotensin II Angio II has effects as shown ACE inhibitors decrease A II
Angiotensin I
ACE
End Results:
Decrease fluid retention, afterload
Angiotensin II
Sympathetic Output Constrict Vascular Smooth Muscle Bradykinin Na+/H20 Retention
Examples:
Enalapril, Captapril
Other Vasodilators:
Mechanism 2:
Direct smooth muscle relaxants Nitrates
Venous dilators Reduce preload Eg: sodium nitropruside
Diuretics
Bottom line: they decrease fluid volumes Four Flavours:
Carbonic anhydrase inhibitors Loop diuretics Thiazide diuretics K+-sparing
Diuretics:
Sites of Action
Carbonic Anhydrase Inhibitors
Eg: Acetazolamide
HCO3Na+ Cl-
Thiazides
Eg: Chlorothiazide
K+ - Sparing
Eg: ?
Loop Diuretics
Eg: Furosemide
Inotropes
Increase force of contraction All increase intracellular cardiac Ca++ concentration Eg:
Digitalis (cardiac glycoside) Dobutamine (-adrenergic agonist) Amrinone (PDE inhibitor)
ATP
ADP + Pi
In
Ca++
Ca++
K+
Digitalis
The solution
Several different classes of drugs All affect cardiac action potentials
Time (Seconds)
Class of Drug
I II III IV
Action
Na+ Channel Blocker -Adrenoreceptor Blocker K+ Channel Blocker Ca++ Channel Blocker
Antianginal Drugs
What is angina? What causes it?
Angina
Problem:
Blood flow to myocardium is insufficient Causes: narrowed artery or arterial spasm
Possible Solutions:
Relax vascular smooth muscle Reduce work of the heart
Angina Drugs
Organic nitrates
Nitroglycerin
Nitrate converted to nitric oxide
-Blockers
Propranolol
Nitrate
Antihypertensive Drugs
Arterial Pressure
~ ~
Cardiac Output
Peripheral Resistance
Arteriolar Radius
Contractility
Antihypertensive Drugs
The Problem:
Sustained diastolic pressure can lead to CHF, infarction, end-organ damage
Possible Solutions:
Mild Htn can be treated with a single drug Severe Htn treated with several drugs, choice of which depends on patient needs
Diuretics
Hydrochlorothiazide, spironolactone
ACE Inhibitors
Captopril
Centrally-Acting Drugs
Clonidine
Vasodilators
Hydralazine
Hypertensive Crisis
BP = 210/150 Drugs that may be used:
Sodium Nitroprusside
Dilates arterial and venous smooth muscle
Diazoxide
vasodilator
Labetolol
- and -blocker Drug of choice
Lipid-Lowering Drugs
The Problem:
High serum levels of cholesterol- and/or triacylglycerol molecules
Solutions:
Decrease lipoprotein synthesis Increase lipoprotein catabolism Increase cholesterol removal
Enzyme
Simvastatin
Inhibits liver enzymes Lipid
Colestipol
Binds to bile salts
THANK YOU