1. Drugs to know
1.1. Organic Nitrates
1.1.1. Nitroglycerin
1.1.1.1. MOA: Dilates large myocardial arteries to increase blood supply to the heart.
1.1.1.1.1. Clincial Use: Angina (all forms). May be used prior to exercise to prevent angina (the sole function of Isosorbide dinitrate)
1.1.1.1.2. Special Info: Reduces preload by reducing venous tone. This allows blood pooling in the periphery. Take sublingually; last 2-12hrs
1.1.1.1.3. Side Effects: Hypotension, Rebound tachycardia, bradycardia, cerebral ischemia, contact dermatitis
1.1.2. Isosorbide dinitrate
1.1.2.1. MOA: Dilates large myocardial arteries to increase blood supply to the heart (NOT ACUTELY)
1.1.2.1.1. Clinical Use: Prophylaxis of Angina. Not for acute attack
1.1.2.1.2. Special Info: only last about 1-4 hrs
1.1.2.1.3. Side Effects: Hypotension, Rebound tachycardia, bradycardia, cerebral ischemia, contact dermatitis
1.1.3. How do nitrates cause smooth muscle relaxation?
1.2. Calcium Channel Blockers
1.2.1. Type 1
1.2.1.1. Verapamil
1.2.1.1.1. MOA: Blocks calcium influx. Dilates peripheral arterioles, reduce afterload.
1.2.1.2. Diltiazem
1.2.1.2.1. MOA: Less pronounced heart rate reudction. Reduces afterload by dilating peripheral arteries. Prevents sympathetic coronary artery spasm.
1.2.1.2.2. Clinical Use: Angina and Hypertension
1.2.1.2.3. Special Info: Don't give with beta blockers and digoxin
1.2.2. Type 2
1.2.2.1. Nifedipine
1.3. Beta-Adrenergic Receptor Blockers
1.3.1. Metoprolol
1.3.1.1. MOA: competitive antagonist at beta1 adrenergic receptors (specifically beta1 blockade)
1.3.1.1.1. Clinical Use: HTN, angina, cardiac arrhy., ischemic heart disease, congestive heart failure (CHF)
1.3.1.1.2. Special Info: Metoprolol blocks beta 1 which is almost exclusively expressed in the heart; therefore, it has cardioselectivity!
1.4. Phosphodiesterase Inhibitors
1.4.1. Mechanism for PDE5 Inhibition
1.4.2. Sildenafil
1.4.2.1. MOA: potentiate the physiological response to sexual arousal causing penile erection.
1.4.2.2. Clinical Use: Erectile Dysfunction, Hypertension
1.4.2.3. Special Info: can cross react with PGE 6 in the eye and cause blurred vision
2. Concepts to Know
2.1. Why do we use vasodilator drugs?
2.2. What is the goal of Vasodilator therapy?
2.3. Mechanism of Smooth Muscle contraction
2.4. The "Effect of the Calcium Spark"
2.5. Ischemic Heart Disease (IHD)
2.5.1. Definition
2.5.2. Goal of Therapy for IHD
2.5.3. Pharmacological (Drug) Objective to Provide Treatment
2.5.4. Factors that effect oxygen demand
2.6. Endothelium dependent relaxation of smooth muscle
2.7. Effect of Nitrates on Vascular Beds and Relationship of Vasodilation to the Size of Dose
2.8. The most complicated slide ever!: the cardiac effects of organic Nitrates
2.9. Nitrate Tolerance
2.10. Therapeutic Effects of Calcium Channel Blockers (treating Angina)
2.11. Why don't ppl die when they take Calcium Channel Blockers? Does it not stop the heart from pumping?
2.12. Compensatory Response: Why do we use beta-blockers and diuretics together?
2.13. Phosphodiesterase History
2.14. Pulmonary Arterial Hypertension (PAH)
2.14.1. Definition
2.14.2. How does it occur?
2.14.3. How to treat it? (w/ Vasodilators of course)