Tag: nitrates

Cardioprotective Drugs – Increasing Survival & Decreasing Symptoms

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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Direct Vasodilators – Anti-Hypertensives in Cardiovascular Pharmacology

Here you can find videos related to direct vasodilators which are anti-hypertensive drugs covered within cardiovascular pharmacology…

Cardiovascular pharmacology deals with the study of the effects of drugs upon the heart or circulatory system. Cardiovascular medicines help to prevent and treat cardiovascular disease, slow the progression of it as well as treat its symptoms whilst providing a better quality of life and increasing life expectancy.

Types of Cardiovascular Drugs include:

  • Anti-Hypertensive Drugs
  • Anti-Angina Drugs
  • Anti-Arrhythmic Drugs
  • Anti-Coagulants
  • Anti-Hyperlipidaemic Drugs

Anti-Hypertensive Drugs are further sub-divided into 4 categories, namely:

Renin-Angiotensin Aldosterone Inhibitors

Adrenergic System Inhibitors

Diuretics

Direct Vasodilators

Below you can find a collection of videos that can help provide a more visual approach to cardiovascular pharmacology, specifically on the Anti-Hypertensive Drugs – Direct Vasodilators.

Nitrates

  • Available as sublingual spray, oral tablets, transdermal patch, and IV preparation.
  • Oral medication can be taken up to 3 times within 5 minute intervals; burning sensation may be experienced (harmless).
  • Sustained release formulas: do not crush and swallow whole; Injection sites should be switched continuously; taper dose over 4-6 weeks to prevent MI.
  • Transdermal patches can lead to patient tolerance. To avoid, remove patch for 4-8 hours, ideally during the night.
  • Nitrates are sensitive to light. Protect from sunlight.
  • INDICATIONS: angina, acute coronary syndrome, for reduction of chest pain and infarct size in MI.
  • ADVERSE EFFECTS: CNS – throbbing headache, dizziness, weakness; CV – hypotension, reflex tachycardia, syncope; GI – nausea, vomiting, incontinence; EENT – pallor, flushing, sweating; methemoglobinemia and cyanosis if administered in high doses.

Calcium Channel Blockers

Nifedipine, Amiodipine, Nicardipine – Dihyropyridines (Anti Hypertensive properties).

Diltaziem, Verapamil – Non-Dihydropyridines (Anti-Arrhythmic properties).

  • Causes a decrease in peripheral resistance, blood pressure and cardiac workload, as well as vasodilation.
  • INDICATIONS: angina pectoris, effort-associated angina, chronic stable angina, unstable crescendo preinfarction angina, essential hypertension.
  • Parenteral administration for treatment of supraventricular tachyarrhythmia, and temporary control of rapid ventricular rate in atrial flutter or atrial fibrillation.
  • ADVERSE EFFECTS: dizziness, light-headedness, headache, fatigue, hypotension, heart block, peripheral oedema, bradycardia, nausea, skin flushing, rash.

Direct Vasodilators: Nitroglycerin and Angina

Direct Vasodilators: Administering Nitroglycerin Sublingual Tablets and Translingual Spray

Calcium Channel Blockers

Special thanks to the creators of the featured videos on this post, specifically Youtube Channels Simple Nursing and Registered Nurse RN

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