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AMSA Education Series Cardiovascular pharmacology M Y 4 M E D I C A L S T U D E N TNature, time and patience are the 3 great physicians!!Let'sbreakitdown,shallwe? YOU SHOULD IDEALLY KNOW THIS (MAKES LIFE EASY!) Sensory (Afferent): The sensory division collects and transports information (touch, pain, pressure, vision, taste, and so on) from the outside (somatic sensory) and inside (visceral sensory) of the body to the CNS. Motor (Efferent) - Somatic: the somatic nervous system controls all voluntary muscle movement and reflex arcs. Motor (Efferent) - Sympathetic & Parasympathetic (ANS): Involuntary Movement - Innervates cardiac and smooth muscleLet'sgetthisbread! ACTION & REACTION Timeforsomegoodol'blocking! ACTION & REACTION! Heart = Beta-1 adrenergic receptors are mainly located in the heart, where they increase the heart rate and contractility, thereby helping the heart pump out more blood. Vascular Smooth Muscle: Beta-2 adrenergic receptors, are found on smooth muscle cells in the walls of blood vessels supplying skeletal muscles and the brain, which leads to vasodilation and increased blood flow to these tissues. Timeforsomegoodol'blocking! BETA BLOCKERS Heart = Slows the heart rate and contractility Vascular Smooth Muscle = Prevents dilation of vessels (causes vasoconstriction of vessels supplying skeletal muscle and the brain --- but it's relatively mild) Other side effects: bronchoconstriction, low blood glucose (less glucagon release) A-M -LOL's = Cardioselective beta blockers (Atenolol, Bisoprolol, Metroprolol)ALPHA-1 BLOCKERS MorebLocking! ALPHA-1 BLOCKERS Two subtypes: Alpha-1 and Alpha-2. Alpha-1 adrenergic receptors are mainly located on the walls of blood vessels, and when stimulated, they cause vasoconstriction, thus decreasing blood flow to tissues. In the eyes, alpha-1 adrenergic receptors also trigger mydriasis, or pupil dilation. In the bladder, they cause sphincter constriction and urinary retention, or holding the urine within the bladder. MorebLocking! ALPHA-1 BLOCKERS Two subtypes: Alpha-1 and Alpha-2 Selective Alpha-1 receptors = doxazosin, prazosin By blocking alpha-1 receptors and inducing vasodilation, these drugs effective in lowering blood pressure, so they are used in cases of hypertension.ONWARDANDFORWARD! ACE Inhibitors ACE inhibitors, or angiotensin-converting enzyme inhibitors, have names that end in "-pril," such as captopril, enalapril, or lisinopril. By inhibiting the action of ACE, they prevent the formation of angiotensin II, lowering its level in the blood. Because there is less angiotensin II in the bloodstream, there is less vasoconstriction, and these medications effectively lower blood pressure. ONWARDANDFORWARD! ARB's - Angiotensin II Receptor Blocker They bind to Angiotensin Receptor-1 on vascular smooth muscles and the adrenal glands, which prevent Angiotensin II from binding to the same receptor. This results in decreased vasoconstriction and decreased aldosterone synthesis (down the line) ARBs ends in “-sartan,” like candesartan, valsartan, and losartan. Arewestillgoingon? Nitrates These drugs are actually prodrugs. This means that it must be converted to its active form called nitric oxide to have the desired effect. After conversion, nitric oxide diffuses into surrounding smooth muscle cells and stimulates guanylate cyclase to increase the concentration of cGMP. Ultimately, this leads to vasodilation of both veins and arteries. However, although they affect both, nitrates dilate veins and venules more than arteries and arterioles. result in decreased blood return. Thus, nitrates primarily reduce preload. This is the amount of blood the heart has to eject with each contraction. On the other hand, nitrates also reduce afterload because arterioles and arteriolar vasodilation reduce systemic vascular resistance. H. The pressure with which the heart must work to expel blood. Comeonnow!really? Calcium Channel Blockers Amlodopine, nimodipine, Verapamil nifedipine Diltiazem Phew!Alldone:) ThanksForlistening!