beta blockers Archives - Student Nurse Life

Cardioprotective drugs aim to increase survival and decrease symptoms of cardio-related issues through primary and secondary risk factor prevention. Blood pressure, lipid management, diabetes mellitus and metabolic syndrome are among the targeted concerns. Apart from pharmaceutical therapy, weight management, an increase in physical activity as well as smoking cessation help in providing a total holistic approach for the patient.

Cardioprotective Drugs – Anti-Platelet Therapy

Aspirin 75mg

provides an irriversible anti-thrombotic effect that lasts throughout the whole platelet life, which is between 9-10 days
provides secondary prevention of cardiovascular events (not to be used as primary prevention due to its increased risk of bleeding

Clopidogrel

provides an anti-thrombotic effect which is similar to Aspirin
should be given to patients who are allergic to aspirin
may be combined with Aspirin and administered post coronary stenting or acute coronary syndrome for a year

Prasugrel

should be given to patients unresponsive to Clopidogrel

Cardioprotective Drugs – Beta-Blockers

beta-blockers names end with _lol
reduce blood pressure and oxygen demand by reducing the heart rate and contractility of the heart
reduce symptoms of angina – unless contraindicated, patients with angina requiring regular symptomatic treatment should be prescribed beta blockers
possible side effects include bradycardia, worsening of respiratory symptoms such as in asthma and COPD (switching to beta 1 selective agents may help reduce this)
erectile dysfunction
rebound angina and an increase in cardiac events may be possible if medication is discontinued abruptly

Cardioprotective Drugs – Calcium Channel Blockers

improves angina
non-dihydropyridines such as Verapamil and Diltiazem help lower the heart rate, reducing contractility, heart rate and AV node conduction, but they may worsen heart failure; may cause side-effects such as bradycardia, conduction disturbances and constipation; can be used with beta-blockers in symptomatic patients (but be careful about possible severe bradycardia)
dihydropyridines, including Nifedipine and Amlodipine, may cause side effects such as headaches, flushing and ankle oedema

Cardioprotective Drugs – ACE Inhibitors

helps in treating stable angina pectoris as well as related hypertension, diabetes, heart failure, asymptomatic left ventricular dysfunction or MI injury
may cause a persistent dry cough, causing some patients to have to switch to an ARB instead
rarely causes angioedema

Cardioprotective Drugs – Nitrates

Short-Acting Nitro Glyceral Spray

results in vasodilation
provides pain relief and anti-ischaemia effects
sublingual Nitro Glyceral spray reduces angina pectoris attacks and may also be used in prophylaxis
side effects include headache and flushing, as well as possible orthostatic hypotension
angina unresponsive to nitroglycerin should be assessed as a possible MI or non-cardiac pain

Long-Acting Nitrates

provides relief for symptomatic angina
patient tolerance to oral or transdermal nitrates happens fast, thus, nitrate-free intervals are recommended (eg. nitrate patch should be reduced during the night)
side effects include headache and orthostatic hypotension

Trimatazidine

anti-angina properties
side effects include fatigue and drowsiness

Ivabridine

preserves AV and intraventricular conduction of the myocardium
slows heart rate

Statins

used as primary and secondary preventative measures along with healthy lifestyle changes
lowers lipid levels, inhibiting cellular cholesterol production, reducing LDL cholesterol by up to 40%, thus accounting to a reduction in coronary events
may increase HDL (the ‘good’ cholesterol)
reverses endothelial dysfunction, decreases thrombogenicity and reduces inflammation
stabilise lipid-rich atherosclerotic plaques, making them less vulnerable to become unstable and possible rupture
should be prescribed for all patients with Ischaemic Heart Disease due to their long-term benefits
patients with acute coronary syndrome taking statins are less likely to experience a MI or acute arrhythmias
patients admitted to hospital with acute coronary syndrome should be prescribed statins independently of their LDL level
side effects may include skeletal muscle damage which may be indicated by symptoms, Creatine Kinase level elevation and possibly rhabdomyolysis
OTHER LIPID LOWERING DRUGS include Bile Acid Binding Resins, Fibric Acid derivatives, Nicotinic Acid and Ezetimibe

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Anti-arrhythmic drugs are used to manipulate how the electrical impulses of the heart are generated and conducted, to restore cardiac rhythm to normal where needed, as well as to effect the cardiac cells’ action potential in changing their impulse initiation and conductivity. Unfortunately, most anti-arrhythmic drugs can aggravate or cause new arrhythmias.

The phrase cardiac action potential (AP) refers to the change in voltage across the cell membrane of cardiac cells caused by the movement of ions between the inside and the outside of the cell through ion channels. An action potential happens when different ions cross the neuron membrane.

There are 5 phases in a Cardiac Action Potential:

Phase 4 – resting phase a.k.a. resting membrane potential (when the heart is into diastole)
Phase 0 – opening of the fast sodium channels causing sodium to move into the cell
Phase 1 – initial rapid repolarisation: when fast sodium channels close
Phase 2 – plateau phase caused by calcium moving in and potassium moving out (ST segment in an ECG)
Phase 3 – repolarisation: potassium channels stay open allowing potassium to move out and repolarise the cell; when membrane potential reaches certain level, potassium channels close (T-wave on ECG)

Anti-Arrhythmics, which are classified according to the Vaughn Williams classification, are organised into 4 major classes:

CLASS 1 AGENTS: Fast sodium channel blockers (affect the depolarisation phase)

CLASS 2 AGENTS: Beta-blockers (affect depolarisation)

CLASS 3 AGENTS: Potassium channel blockers (reduce potassium current during the repolarisation phase)

CLASS 4 AGENTS: Calcium Channel Blockers (cause cardiac cells conduction to slow down)

OTHER ANTI-ARRHYTHMICS: Digoxin, Adenosine and Magnesium Sulphate

Class 1 Agents are further sub-divided into 3 types of anti-arrhythmics:

1A Quindine, Procainamide, Disopyramide

1B Lidocaine, Mexiletine

1C Flecanide, Propafenone

Below you can find a collection of videos that can help provide a more visual approach to Anti-Arrhythmic Drugs.

Cardiac Action Potential Animation

Anti-Arrhythmic Drugs Animation

Anti-Arrhythmics

Special thanks to the creators of the featured videos on this post, specifically Youtube Channels Alila Medical Media, MedLecturesMadeEasy