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Cardiac Medications Calcium Channel Blockers, Nitrates & Beta Blockers Calcium Channel Blockers Verapamil (Calan, Isoptin) Nifedipine (Procardia) Diltiazem (Cardizem) Amlodipine (Norvasc) Bepridil (Vascor) Felodipine (Plendil) Isradipine (DynaCirc) Mibefradil (Posicor) Nicardipine (Cardene) Nimodipine (Nimotop) Nisoldipine (Sular) Uses Angina Pectoris Hypertension Treatment of SVTD’s Atrial Flutter Atrial Fibrillation PSVT Mechanisms of Action Increase the time that calcium channels are closed Relaxation of arterial smooth muscle but not a great deal on venous smooth muscle - significant afterload effects - little preload effects Slows or inhibits the SA and AV node discharge Slows atrioventricular conduction thus inhibits SVTD’s Reduces inotropy in the heart Reduced wall tensions and lower MVO2 demands Lowers blood pressure due to arterial smooth muscle relaxation Increases AV capture time - prolongs the refractory period of the AV node - thus, there is a negative chronotropic effect Reduced vasospasms of epicardial vessels - reduces Prinzmetal angina Side Effects Bradycardia Hypotension, Syncope Angina Sedation Flushing Fainting & Some Concerns….. Recent evidence in the literature indicates that nifedipine may have arrhythmigenic capabilities Nitrates Nitroglycerin (Niong, Nitrobid) Uses Of Nitroglycerin Treat all forms of angina pectoris usually on an acute basis rather than a prophylactic basis Mechanisms of Action Vasodilate both arterial and venous smooth muscle resulting in reduced preload and afterload Reduces end-diastolic filling pressures Increases blood flow to the endocardial plexus by dilating the epicardials Lowers MVO2 Side Effects Fatigue & Orthostatic hypotension Syncope Headaches Nausea Vomiting Beta Blockers Propranolol (Inderal) non-selective Atenolol (Tenorman) beta-1 selective Pindolol (Visken) non-selective Timolol (Blocarden) non-selective Nadolol (Corgard) non-selective Labetalol (Trandate) non-selective Metaprolol (Lopressor) beta-1 selective Carvedilol (Coreg) non-selective …and many more Beta adrenergic receptors : beta-1 stimulate heart rate increases & increases contractile force beta-2 stimulate bronchodilation and vasodilatation Beta Adrenergic Blockade Causes……. Lowering of the BP inhibit norepinephrine release inhibit vasoconstriction by catecholamines Reduction of Cardiac Output slows electrical conduction velocity reduces sympathetic tone over the heart Inhibition of Renin Release by the Kidneys prevents renin from causing angiotensin I to transform to angiotensin II which acts as a potent vasoconstrictor thus we have permissive vasodilatation Reduced MVO2 Reduction of angina After-load is reduced Longer diastolic filling times resulting in increased heart perfusion Inhibits atrial and ventricular ectopies Beta-blockers are cardioprotective Medical Uses Treatment of : angina hypertension atrial & ventricular dysrhythmias panic attacks migraine headaches reduces the incidence of esophageal bleeding due to varices Side Effects Bronchoconstriction - due to non-selective beta-blockade of beta-2 receptors Inhibition of liver glycogenolysis