Cardiovascular

Drugs
SMF Jantung
Bagian Kardiologi dan Kedokteran
Vaskular
RS Dr. Sardjito FK UGM
Classification of Cardiovascular
Drugs

Inotropic Drugs And Vasopressor

Vasodilator Drugs
Antiadrenergic Drugs
Antiarrhythmic Drugs
Diuretics
Antithrombotic Drugs
Lipid Regulating Drugs
Classification of Cardiovascular
Drugs
Inotropic Drugs And Vasopressor
Cardiac Glycosides (Digitalis)
Sympathomimetic Amines
Phosphodiesterase-3 Inhibitors
Vasopressin
Vasodilator Drugs
Antiadrenergic Drugs
Antiarrhythmic Drugs
Diuretics
Antithrombotic Drugs
Lipid Regulating Drugs
Inotropic Drugs And
Vasopressor
To increase the force of ventricular
contraction when myocardial systolic
function is impaired
Enhance cardiac contraction by increasing
intracellular calcium concentration
 Cardiac Glycosides (Digitalis)

Digitalis extract of foxglove plants, Digitalis

purpurea
Most commonly used: digoxin
Mechanism of action:
mechanical effect: to improve contractility of the
failing heart
electrical effect: to prolong the refractory period
of AV node
Clinical use:
- Inotropic agent to treat HF with reduced LV
function increases the contraction force
- Antiarrhythmic agent of treatment of AF,
atrial flutter and PSVT less common, because
Cardiac Glycosides (Digitalis)
 Sympathomimetic Amines

Inotropic drugs, bind to cardiac 1-receptors

formation of cAMP intracellular
calcium influx force of contraction
Phosphodiesterase-3 Inhibitor

Milrinone: non digitalis, non catecholamines inotropic

agent
positive inotropic actions and vasodilation
Treatment of acute heart failure. Can cause
ventricular arrhythmias short term therapy

Vasopressin
Endogenous antidiuretic hormone
Potent nonadrenergic vasoconstrictor useful
in vasodilatory shock (septic shock)
Beneficial in cardiac arrest ALS
Classification of Cardiovascular
Drugs

Inotropic Drugs And Vasopressor

Vasodilator Drugs
ACE Inhibitors
ARB
Direct acting Vasodilators
Calcium Channel Blockers
Organic Nitrates
Natriuretic Peptides
Phosphodiesterase-5 Inhibitor
 Vasodilator Drugs

Play central role in treatment of HF and

hypertension
HF: triggers compensatory pathways:
Vasodilator Drugs
ACE- Inhibitors
 ACE- Inhibitors
Clinical use: hypertension and heart failure
Adverse effects: hypotension,
hyperkalemia, renal insufficiency, cough
Angiotensin II Type 1 Receptor
Antagonists = ARB
More substantial blockade than ACEinh
Do not affect BK level not producing
cough
ARB
Direct Acting Vasodilators
Hydralazine, Minoxidil, Nitroprusside and
Fenoldopam
Hydralazine:
arteriolar dilation reflex tachycardia
ischemia
combination with Blockers
Minoxidil:
Reflex tachycardia and fluid retention
combination with Blockers and diuretics
Primary indications: treatment of intractable
hypertension, esp in renal failure
Direct Acting Vasodilators
 Calcium Channel Blockers
3 different groups: verapamil, diltiazem and
dihydropyridines
Mechanism of actions:
Augmentation of contractile force in
myocardium and vascular smooth muscle
Calcium Channel Blockers
Calcium Channel Blockers
Organic Nitrates
 Organic Nitrates

Agents:
Short acting
- Tablet nitroglycerin
- Sprays nitroglycerin
Long acting
- Sustained release nitroglycerin, ISDN, ISMN
- Transdermal patch nitroglycerin
- Paste nitroglycerin
Infusion
- Intravenous infusion
Adverse effects: hypotension, reflex tachycardia,
headache, flushing
Precautions: nitrates intolerance
Classification of Cardiovascular
Drugs

Inotropic Drugs And Vasopressor

Vasodilator Drugs
Antiadrenergic Drugs
Central Adrenergic Inhibitors
Sympathetic Nerve-ending
Antagonists
Peripheral -Adrenergic Receptor
Antagonists
-receptor blockers
Antiadrenergic Drugs
Antiadrenergic Drugs
-Receptor Antagonists
 -Receptor Antagonists

Clinical
Uses:
- Ischemic Heart Disease
- Heart Failure
- Hypertension
Classification of Cardiovascular
Drugs

Inotropic Drugs And Vasopressor

Vasodilator Drugs
Antiadrenergic Drugs
Antiarrhythmic Drugs
Diuretics
Antithrombotic Drugs
Lipid Regulating Drugs
Antiarrhythmic Drugs Classification
Antiarrhythmic Drugs Classification
Antiarrhythmic Drugs Classification
Classification of
Cardiovascular Drugs
Inotropic Drugs And Vasopressor
Vasodilator Drugs
Antiadrenergic Drugs
Antiarrhythmic Drugs
Diuretics
Antithrombotic Drugs
Lipid Regulating Drugs
Diuretics

Schematic Diagram of Renal Tubules

Diuretics
Classification of Cardiovascular
Drugs

Inotropic Drugs And Vasopressor

Vasodilator Drugs
Antiadrenergic Drugs
Antiarrhythmic Drugs
Diuretics
Antithrombotic Drugs
Platelet Inhibitors
Anticoagulant Drugs
Lipid Regulating Drugs
Platelet Inhibitors
 Platelet Inhibitors

(1)Sometimes used in combination with warfarin.

(2)If patient has a low risk of stroke, or if warfarin is contraindicated.
(3)When intracoronary stent is implanted.
(4)If PCI undertaken.
(5)Sometimes used in combination with warfarin for recurrent
embolism.
Anticoagulation Drugs
Anticoagulation Drugs

Fondaparinux
UFH
LMWH
Direct
thromb
in
inhibito
r
Anticoagulation Drugs

(6) For hospitalized patients unable to take warfarin.

(7) If undergoing PCI.
(8) Emerging use.
(9) For 36 months after MI if large akinetic segment is present.
Classification of Cardiovascular
Drugs

Inotropic Drugs And Vasopressor

Vasodilator Drugs
Antiadrenergic Drugs
Antiarrhythmic Drugs
Diuretics
Antithrombotic Drugs
Lipid Regulating Drugs
Lipid Regulating Drugs

Major Site of Lipid Regulating Drugs

Lipid-Regulating Drugs