Pharmacology of the Heart

8/13/2019 Pharmacology of the Heart

1/160


2/160

Chapter 12

Cardiovascular

Drugs


3/160

Chapter 12 Topics

Arrhythmias

Congestive Heart Failure

Myocardial Infarction Angina Pectoris

Hypertension

Blood Clotting

Hyperlipidemia


4/160

Learning Objectives

Understand the cardiovascular system

Differentiate arrhythmias, congestive heart

failure, myocardial infarction, anginaand

hypertension

Know the drugsand treatmentof each

separate aspect of heart disease


5/160

Learning Objectives

Recognize anticoagulantand antiplatelet

drugs and know their functions

Discuss strokeand the drugs used to treat it

Identify hyperlipidemiaand explain its role

in heart disease and stroke


6/160

Predetermined Factors for

Cardiovascular Disease

Heredity

Gender

Increasing Age


7/160

Factors Influenced by Lifestyle

Modification

Cigarette Smoking

High Blood Pressure

High Blood Cholesterol Levels

Obesity Diabetes


8/160

Arrhythmias

Variation from normal heart rhythm


9/160

Normal Rhythm

Generated by SA node at a rate of 70-80

beats per minute


10/160

Normal Rhythm

Generated by SA node at a rate of 70-80beats per minute

When the SA node is suppressed ordamaged, it may lead to prematurecontractions resulting in:

Tachycardia, flutter, or fibrilation

ECG records the conduction cycle of theheart


11/160

PrematureVentricular

Contraction


12/160

Abnormal Heart Rhythms

Arrhythmia BPM

tachycardia 150-250

bradycardia 350

prem. atrial cont. variableprem. vent. cont. variable

vent. fibrilation variable


13/160

Abnormal Heart Rhythms

Caused by:

ischemia, infarction, alteration of body

chemicals


14/160


15/160

Pharmaceutical Treatment

Aimed at preventing life-threatening

conditions by restoring normal rhythm

Acts on the myocardium where theimpulses are conducted

Some drugs influence heart rate, others

influence movement of ions (Na and Ca)


16/160

Depressant closes the gate

Stimulant opens the gate


17/160

Membrane Stabilizing Agents

(Class I) Slows the movement of Na ions into

myocardial cells

A stronger signal is needed for actionpotential


18/160

Antiarrhythmic Agents

Membrane-Stabilizing

Agents (Class I)

disopyramide (Norpace)

flecainide (Tambocor)

lidocaine (Xylocaine)

mexiletine (Mexitil)

moricizine (Ethmozine)

Drug L ist


19/160


Membrane-Stabilizing

Agents (Class I)

phenytoin (Dilantin)

procainamide (Procanbid, Pronestyl)

propafenone (Rythmol)

quinidine

tocainide (Tonocard)

Drug L ist


20/160

phenytoin (Dilantin)

Used on resistant arrhythmias

Also used for seizures


21/160


22/160

Beta Blockers Side Effects

Heart depression

Bronchoconstriction

Impotence

Depression

Fatigue

May mask symptoms of hypoglycemia and

cause bradycardia


23/160


24/160

Potassium Channel Blockers

(Class III) Delays repolarization by blocking the flow

of potassium across cell membranes


25/160


Potassium Channel

Blockers (Class III)

amiodarone (Cordarone)

bretylium

Drug L ist


26/160

Calcium Channel Blockers

(Class IV) Prevents movement of calcium to reduce

cell contractility

Relaxes coronary vascular smooth musclecausing vasodilation

Agent of choice for tachyarrhythmias


27/160


Side Effects Bradycardia

Hypotension

Heart block

Cardiac failure

Nausea

Constipation

Headache Dizziness

Fatigue


28/160



(Class IV)

diltiazem (Cardizem, Dilacor XR)

verapamil (Calan, Covera HS, Isoptin,

Verelan)

Drug L ist


29/160

Antiarrhythmic AgentsOther Agents

atropine

digoxin (Lanoxicaps, Lanoxin)

isoproterenol (Isuprel)

Drug L ist


30/160


Most important drug in managing atrial

flutter and fibrilation

Slows ventricular rate and treats cardiacfailure


31/160

Congestive Heart Failure (CHF)

Heart pumps less blood than it receives, so

excess blood pools in the chambers and

stretches the walls of the heart


32/160

Discussion

Why is it dangerous for blood to pool

in the chambers of the heart?


33/160

Discussion

Why is it dangerous for blood to pool

in the chambers of the heart?

Answer:decreased oxygen supply to

tissues; risk of blood clot formation

and movement throughout the body


34/160

CHF

Occurs in 10% of the population over 75

Can result in death through progressive

heart damage or sudden death

Overworking of the heart leads to

cardiomegaly and myocardial hypertrophy


35/160

Causes of Congestive Heart Failure

Primary causes:

Cardiomyopathy

Coronary arterydisease

Hypertension

Secondary causes:

High salt intake

Noncompliance with

treatment

Side effects of drug

therapy

Kidney failure

Stress

Infection and

inflammation

Cigarette smoking

Obesity


36/160

Agents for CHF

Antiarrythmic:


Antidote for digoxin toxicity:

digoxin immune Fab (Digibind)

Drug L ist


37/160


Increases force of contraction

Increases effective refractory period

Affects SA node, causing direct stimulation


38/160

digoxin Dispensing Issues

dig toxicitySystemic accumulation

Symptoms: nausea, vomiting, arrhythmias

Warning!


39/160

Agents for CHFVasodilators

milrinone (Primacor)

nitroprusside (Nitropress)

Drug L ist


40/160

ACE Inhibitors

Inhibits conversion of angiotensin I to

angiotensin II

Lowers blood pressure and lowers the stresson the heart


41/160

ACE Inhibitors Side Effects

Dry, nonproductive cough

Dizziness during first few days


42/160

ACE Inhibitor Dispensing Issues

Stand slowly to prevent orthostatichypotension

Avoid salt substitutes

Do not take potassium supplements

Warning!


43/160

Agents for CHFACE Inhibitors

benazepril (Lotensin)

captopril (Capoten)

enalapril (Vasotec)

fosinopril (Monopril)

lisinopril (Prinivil, Zestril)

Drug L ist


44/160

Agents for CHFACE Inhibitors

moexipril (Univasc)

perindopril (Aceon)

quinapril (Accupril)

ramipril (Altace)

trandolapril (Mavik)

Drug L ist


45/160

Angiotensin II-Receptor Antagonists

Blocks the action of angiotensin II

Works as well as ACE inhibitors with less

coughing and better toleration


46/160

Angiotensin II-Receptor Antagonist

Dispensing Issues

Look-alike and Sound-alike Drugs:losartan (Cozaar)

valsartan (Diovan)

Warning!


47/160

Agents for CHF

Angiotensin II-Receptor Antagonists

Human B-type Natriuretic Peptide (hBNP)

nesiritide (Natrecor)

Drug L ist


48/160

Myocardial Infarction

AKA heart attack

Leading cause of death in industrialized

nations

Heart muscle is deprived of oxygen and

muscle cells die

If healing occurs, scars form, and there isless contractility of the heart muscle


49/160

Causes of MIs

Prolonged decrease in oxygen supply

Occurs if one or more of the 3 major

arteries is narrowed by 70% or more

Risk factors:

History of angina, alcohol consumption,

reduced pulmonary vital capacity, cigarettesmoking, atherosclerosis


50/160

Lifestyle Changes

To reduce the risk of an MI:

Eliminate smoking

Control diabetes Reduce hypertension

Exercise moderately

Achieve and maintain ideal body weight

Decrease alcohol consumption Use aspirin therapy

Reduce dietary cholesterol/triglycerides


51/160

Symptoms of a Heart Attack

Oppressive or burning tightness or

squeezing in the chest

Feeling of choking

Sense of impending doom

Substernal pain with radiations to the neck,

throat, jaw, shoulders, and one or both arms

Pain can last 30 mins to several hours


52/160

Myocardial Drug Therapy

Aimed at allowing the heart to rest and

undergo normal healing

Slow the heart (Beta Blockers)

Reduce blood clot formation (Aspirin

Therapy)


53/160

Beta Blockers Used afteran MI

acebutolol (Sectral)

atenolol (Tenormin)

betaxolol (Kerlone)

bisoprolol (Zebeta)

carvedilol (Coreg)

Drug L ist


54/160


esmolol (Brevibloc)

labetalol (Normodyne, Trandate)

metoprolol (Lopressor, Toprol XL)

nadolol (Corgard)

pindolol (Visken)

Drug L ist


55/160


propranolol (Inderal)

sotalol (Betapace)

timolol (Blocadren)

Drug L ist


56/160


57/160

Angina Pectoris

Chest pain due to imbalance of oxygen

supply and demand

Oxygen demand is related to heart rate,

strength of contraction, and resistance to

blood flow


58/160

3 Types of Angina

Stable

Unstable

Variant


59/160

3 Types of Angina

Stable

Effort-induced pain from physical activity oremotional stress

Relieved by rest

Predictable and reproducible

Unstable

Variant


60/160

3 Types of Angina

Stable

Unstable

Pain occurs with increasing frequency

Diminishes patients ability to work

Has decreasing response to therapy

May signal an oncoming MI

Variant


61/160


62/160

Symptoms of Angina

Severe chest discomfort (heaviness,

pressure, tightness, choking, squeezing)

Sweating

Dizziness

Dyspnea


63/160

Risk Factors for Angina

Advanced age

Coronary artery disease

Hypertension Increased serum glucose levels (diabetes)

Increased serum lipoprotein levels

Obesity Smoking

Type A personality


64/160


65/160

Discussion

Explain why some of these factors

may initiate an angina attack: cold

weather, emotions, heavy meals,hypoglycemia, pain, smoking.


66/160

Discussion

Explain why some of these factors

may initiate an angina attack.

Answer:cold weathertension in the

muscles, possible decrease in blood

flow.


67/160

Nitrates

Most commonly used drugs for angina

Relax vascular smooth muscle and cause

vasodilation Helps with pulmonary edema in CHF

D Li t


68/160

Agents for AnginaNitrates

isosorbide dinitrate (Dilatrate-SR, Isordil) isosorbide mononitrate (Imdur, Ismo)

nitroglycerin (Minitran, Nitrolingual,

Nitrostat)

Drug L ist


69/160

nitroglycerin (Minitran, Nitrolingual,

Nitrostat) Drug of choice for acute attacks

Spray and tablets taken sublingually

May also be used as a prophylaxis

If using a patch, it should not remain on the

skin for a full 24 hours, there needs to be

free time


70/160

nitroglycerins Side Effects

Severe headache

Orthostatic hypotension

Flushing


71/160

nitroglycerin Dispensing Issues

Tablets must be dispensed in the originalamber glass bottle

Medication should be refilled every 3

months and discard any remaining drug

Warning!


72/160

Drug L ist


73/160

Agents for AnginaCalcium Channel Blockers

amlodipine (Norvasc) bepridil (Vascor)

diltiazem (Cardizem, Dilacor XR)

felodipine (Plendil)

isradipine (DynaCirc)

Drug L ist

Drug L ist


74/160

Agents for AnginaCalcium Channel Blockers

nicardipine (Cardene) nifedipine (Procardia)

nisoldipine (Sular)

verapamil (Calan, Covera HS, Isoptin,Verelan)

Beta BlockersTable 12.5

Drug L ist


75/160

verapamil (Covera HS)

Timed-release product designed for bedtime

dose

Drug is pumped out of 2 holes in the tablet Patients may see a ghost tablet in the stool


76/160

Beta Blockers and Angina

Effective in slowing the heart rate,

decreasing myocardial contractility, and

lowering blood pressure


77/160

Hypertension

Product of cardiac output (CO) and total

peripheral resistance (TPR)

Vasoconstriction increases TPR CO has 3 aspects

Preloadblood delivered to the heart

Afterloadshortening of the cardiac muscle

Contractilitycapacity of the muscle to shorten


78/160

Blood Pressure

Systolic Pressure

Measures pressure during the filling of the heart

Cardiac output is a major determining factor


79/160

Blood Pressure

Systolic Pressure

Measures pressure during the filling of the heart

Cardiac output is a major determining factor

Diastolic Pressure

Measures pressure after the heart has emptied

TPR largely determines diastolic pressure


80/160

Staging of Blood Pressure

Category Systolic Diastolic

Normal 100


81/160

Factors Leading to Hypertension

Family history

Cigarette smoking

High fat diet Kidney disease

Decreased pressure

peripherally

Truncal obesity

Adrenal tumor

Medications: OC,corticosteroids,

NSAIDs, nasal

decongestants,

appetite suppressants


82/160

Untreated Hypertension

Cardiovascular disease develops

Enlargement of the heart

Cardiac hypertrophyThickening of the cardiac wall

Cardiac output is reduced

CHF results in cold extremities, edema, andaccumulation of fluid in the lungs


83/160

Untreated Hypertension

Renal insufficiency can occur due to an

increased pressure causing a reduction in

renal blood flow and function

Accelerated cardiac and peripheral vascular

disease can occurHigher the pressure, the greater the risk


84/160

Regimen for Reducing Blood

Pressure Step 1Lifestyle Modifications

Step 2 - Monotherapy

Step 3Add a diuretic

Step 4Add a third agent

i f d i l d


85/160


Pressure Step 1: Modify Lifestyle Factors

High sodium intake to Moderate sodium intake

Excess consumption to Weight reductionof calories

Physical inactivity to Regular aerobic activity

Excess ETOH to Moderate ETOH

Nicotine usage to Nicotine cessation

High stress to Control stress

i f d i l d


86/160


Pressure Step 2: Monotherapy

Use a single drug, usually a diuretic, beta

blocker, ACE inhibitor, angiotensin II-receptorantagonist, or calcium channel blocker

R i f R d i Bl d


87/160


Pressure Step 2: Monotherapy

Use a single drug, usually a diuretic, beta

blocker, ACE inhibitor, angiotensin II-receptorantagonist, or calcium channel blocker

Step 3:

Add a diuretic if it was not the drug used to

begin therapy in Step 2 of the regimen

R i f R d i Bl d


88/160


Pressure Step 4:

Add a third agent that will be synergistic with

the other two in reducing blood pressure

Ph l i A ih i


89/160

Pharmacologic Antihypertensive

Therapies

See Table 12.9 for an overview of the action

of each class of antihypertensive

Drug L ist


90/160

Antihypertensives

Selective Aldosterone Blocker epierenone (Inspra)


ACE Inhibitors

Drug L ist

Drug L ist


91/160

AntihypertensivesAngiotensin II Antagonists

candesartan (Atacand) eprosartan (Teveten)

irbesartan (Avapro)

losartan (Cozaar)

olmesartan (Benicar)

Drug L ist

Drug L ist


92/160

AntihypertensivesAngiotensin II Antagonists

telmisartan (Micardis) valsartan (Diovan)

Beta Blockers

Drug L ist

Drug L ist


93/160

AntihypertensivesCNS Agents

clonidine (Catapres, Catapres-TTS,Duraclon)

guanfacine (Tenex)

methyldopa (Aldomet)

Drug L ist

Drug L ist


94/160

AntihypertensivesAlpha Blockers

alfuzosin (Uroxatral) doxazosin (Cardura)

phentolamine (Regitine)

prazosin (Minipress)

terazosin (Hytrin)

Drug L ist


95/160

terazosin (Hytrin)

Blocks impulses at vascular smooth muscle

Drug L ist


96/160

AntihypertensivesVasodilators

epoprostenol (Flolan) fenoldopam (Corlopam)

hydralazine (Apresoline)

minoxidil (Loniten, Rogaine)

treprostinil (Remodulin)

Drug L ist

Drug L ist


97/160

AntihypertensivesCombination Drugs

amlodipine-benazepril (Lotrel) benazepril-HCTZ (Lotensin HCT)

enalapril-diltiazem (Teczem)

enalapril-HCTZ (Vaseretic)

Drug L ist

Drug L ist


98/160

AntihypertensivesCombination Drugs

irbesartan-HCTZ (Avalide) losartan-HCTZ (Hyzaar)

trandolapril-verapamil (Tarka)

valsartan-HCTZ (Diovan HCT)

Drug L ist


99/160

Blood Clotting

Blood clots are also called thrombi

Develop from abnormalities with:

Blood coagulationBlood flow

Platelet adhesiveness

Vessel walls


100/160

Blood Clotting

Anticoagulants

Prevent clot formation by inhibiting clotting

factors


101/160

Blood Clotting

Anticoagulants

Prevent clot formation by inhibiting clotting

factors Antiplatelets

Reduce risk of clot formation by inhibiting

platelet aggregation


102/160

Blood Clotting

Anticoagulants

Prevent clot formation by inhibiting clottingfactors

Antiplatelets

Reduce risk of clot formation by inhibitingplatelet aggregation

FibrinolyticsDissolve clots already formed

Clotting Cascade


103/160

Clotting Cascade


104/160

Clotting Cascade

If any factor in the cascade is missing,

blood will not clot (hemophilia)


105/160

Venous Thrombi

Usually form in areas of slow blood flow,

surgical or vein injuries, large venous

sinuses, or pockets formed by valves indeep veins

If the clot breaks off, it can travel to the

lung causing pulmonary embolism (PE)


106/160

DVT

Deep vein thrombosis above the knee is the

most serious and may be fatal


107/160


108/160

Laboratory Testing

Certain lab tests must be done on patients

who are on anticoagulant therapy


109/160

Laboratory Testing

Partial thromboplastin time (PTT)

affected by heparin

Prothrombin Time (PT)affected bywarfarin

International Normalized Ration (INR)

Hematocrit

Drug L ist


110/160

Anticoagulant Agents

argatroban bivalirudin (Angiomax)

fondaparinux (Arixtra)

heparin lepirudin (Refludan)

warfarin (Coumadin)

g


111/160


112/160

heparin

Inhibits thrombin formation preventing clots

from forming

Only anticoagulant that does not cross theplacenta

Given for prophylaxis of DVT in

postoperative, bedridden, obese patients,and others


113/160

warfarin (Coumadin)

Prevents production of vitamin

K-dependent clotting factors

Prevents future clots with no effect onexisting clots

Should not be taken with ASA or NSAIDs

Drug L ist


114/160

Antiplatelet Agents

aspirin clopidogrel (Plavix)

ticlopidine (Ticlid)

g

Drug L ist


115/160

Antiplatelet Agents

Glycoprotein Antagonists: abciximab (ReoPro)

eptifibatide (Integrilin)

tirofiban (Aggrastat)

g

Drug L ist


116/160

Fibrinolytic Agents

alteplase (Activase) reteplase (Retavase)

streptokinase (Streptase)

tenecteplase (TNKase)

urokinase (Abbokinase)


117/160

Stroke

The brain is the most oxygen-rich organ

If cerebral circulation is stopped, the brain

runs out of oxygen within 10 seconds, tissuedies and does not regenerate

A stroke is an interruption of oxygen supply

f k


118/160

Types of Strokes

Ischemic Stroke

Cerebral Hemorrhage

f S k


119/160

Types of Strokes

Ischemic Stroke

Results from obstruction of blood flow due to a

thrombus or emboli lodging in the blood vessel

Cerebral Hemorrhage

T f S k


120/160

Types of Strokes

Ischemic Stroke

Cerebral HemorrhageInvolves primary rupture of a blood vessel

Signs: sudden severe headache, stiff neck,

stupor, or a combination of theseEffects are long-lasting and irreversible

S k Ri k F


121/160

Stroke Risk Factors

Modifiable:

Cigarette smoking

Coronary arterydisease

Diabetes

Excessive alcohol

intake

Hyperlipidemia

Hypertension

Obesity

Physical inactivity


122/160

S k M


123/160

Stroke Management

Emphasis is on prevention

Antiplatelet therapy

S k M


124/160

Stroke Management



Anticoagulant therapy

St k M t


125/160

Stroke Management



Anticoagulant therapyFibrinolytic intervention

St k M t


126/160

Stroke Management




Cerebrovascular surgery

St k M t


127/160

Stroke Management





Nonpharmacologic therapy

St k M t


128/160

Stroke Management





Nonpharmacologic therapy

Poststroke management


129/160

A ti l t l t A t


130/160

Antiplatelet Agents

Prevent platelet activation and formation of

platelet plug

Can interfere with platelet aggregation inducedby ADP or

Interfere with synthesis of thromboxane

A ti l t A t


131/160

Anticoagulant Agents

Interfere with the synthesis and activation

of the bloods coagulation factors

May prevent existing clots from expanding Does not reduce existing clots

Fib i l ti A t


132/160

Fibrinolytic Agents

Dissolve existing emboli or thrombi

Indications:

DVTAcute peripheral occlusion

Acute MI with embolization

PECoronary embolus

Drug L ist


133/160

Agents for TIAs andStroke Prevention

aspirin aspirin-dipyridamole (Aggrenox)

clopidogrel (Plavix)

dipyridamole (Persantine)

pentoxifylline (Trental)

ticlopidine (Ticlid)



134/160


Blocks ADP receptors and prevents platelet

adhesion and aggregation

Used to prevent MI and stroke Major side effect is bleeding

Hyperlipidemia


135/160

Hyperlipidemia

High blood cholesterol is a major risk factor

in heart attacks and strokes

Cholesterol is present in animal foodproducts, but not from plant origin

Some cholesterol is good and needed for the

body to function correctly


136/160

Lipoproteins


137/160

Lipoproteins

Packages containing triglycerides,

cholesterol, and carrier proteins

4 types of lipoproteins:Chylomicrons

Very-low-density lipoproteins

Low-density lipoproteinsHigh-density lipoproteins

Lipoproteins


138/160

Lipoproteins

Chylomicrons

90% triglycerides and 5% cholesterol

Absorbed into the lymphatic system Very-low-density lipoproteins

Low-density lipoproteins

High-density lipoproteins

Lipoproteins


139/160

Lipoproteins

Chylomicrons


60% triglycerides and 12% cholesterol

Fatty acids are produced and deposited inadipose tissue

Remnants are changed into LDL

Low-density lipoproteins High-density lipoproteins

Lipoproteins


140/160

Lipoproteins

Chylomicrons


Low-density lipoproteins6% triglycerides and 65% cholesterol

Takes cholesterol to the cells

High-density lipoproteins

Lipoproteins


141/160

Lipoproteins

Chylomicrons


Low-density lipoproteins High-density lipoproteins

5% triglycerides, 25% cholesterol, 50% protein

Remove cholesterol from cells HDL is good cholesterol

Lipoproteins


142/160

Lipoproteins

LDL not used by the cell may be deposited

in the artery walls causing atherosclerosis

Can result in stroke, MI, or limbs lost togangrene

High HDL levels lower the risk of

atherosclerosis

Hyperlipidemia


143/160

Hyperlipidemia

Reduction in the amount of saturated fats

ingested is needed

Total fat intake should not exceed 30% oftotal calories

Goal is to decrease total cholesterol levels,

but specifically LDL levels

HMG CoA Reductase Inhibitors


144/160

HMG-CoA Reductase Inhibitors

Inhibit the enzyme responsible for

cholesterol biosynthesis

Side effects include GI upset and headache These drugs should be taken at night

because most cholesterol is formed at night

Avoid drinking grapefruit juice withinseveral hours of taking statins

HMG-CoA Reductase Inhibitors


145/160

Dispensing Issues

These drugs should be taken at nightbecause most cholesterol is formed at night

Avoid drinking grapefruit juice within

several hours of taking statins

Warning!

Li id L i A t

Drug L ist


146/160

Lipid-Lowering Agents

HMG-CoA ReductaceInhibitors

atorvastatin (Lipitor) fluvastatin (Lescol)

lovastatin (Altocor, Mevacor)

pravastatin (Pravachol)

rosuvastatin (Crestor)

simvastatin (Zocor)

simvastatin (Zocor)


147/160

simvastatin (Zocor)

Take with meals

Report muscle pain accompanied by fever


148/160

Statin Equivalency Chart


149/160

Statin Equivalency Chart

Generic Name Brand Name Equiv. Dose

atorvastatin Liptor 20 mg

rosuvastatin Crestor 5 mgfluvastatin Lescol 160 mg

lovastatin Mevacor 80 mg

pravastatin Pravachol 80 mg

simvastatin Zocor 40 mg

Drug L ist


150/160

Lipid-Lowering AgentsFibric Acid Derivatives

clofibrate fenofibrate (TriCor)

gemfibrozil (Lopid)

fenofibrate (TriCor)


151/160

fenofibrate (TriCor)

Increases the breakdown of VLDLs

Should be used with dietary modification

Primary side effects are GI disturbances

gemfibrozil (Lopid)


152/160

gemfibrozil (Lopid)

Lowers triglyceride and VLDL levels while

increasing HDL levels

gemfibrozils Side Effects


153/160

gemfibrozil s Side Effects

Abdominal pain Vertigo

Diarrhea Headache Nausea Alteration in taste

Vomiting Skin rash

Drug L ist


154/160

Lipid-Lowering AgentsBile Acid Sequestrants

cholestyramine (Questran) colesevelam (WelChol)

colestipol (Colestid)


155/160

niacin (Niacor)

( i i )


156/160

(Vitamin B3)

Inhibits synthesis of VLDL and lowers

triglyceride and LDL levels

May cause extreme skin flushing,preventatives are available

This is the most effective drug to increase

HDL levels

ezetimibe (Zetia)


157/160

ezetimibe (Zetia)

Lowers total cholesterol by inhibiting

absorption in the small intestine

Also increases HDL levels

Drug L ist


158/160

Lipid-Lowering AgentsCombinations

amlodipine-atorvastatin (Caduet) niacin-lovastatin (Advicor)

pravastatin-buffered aspirin (Pravigard

PAC)

Discussion


159/160

Discussion

Name some ways people can lower

their cholesterol levels.

Discussion


160/160

Discussion

Name some ways people can lower

their cholesterol levels.

Answer:Inject less fat, particularly

saturated fat; exercise, take

medications as directed

Documents

Pharmacology of the Heart