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- few side effects and are very effective in the treatment of mild to moderate hypertension

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- few side effects and are very effective in the treatment of mild to moderate hypertension

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- act by increasing the volume of urine production by excretion of excess fluids
- common adverse effects: dehydration, orthostatic hypotension, xerostomia

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- common med is Hydrochlorothiazide
- act in the distal tubule inhibiting sodium chloride reabsorption back into the blood allowing for it to be excreted
- lowers BP by 10-15 mm/Hg
- may increase cholesterol and loss of electrolytes
- hypokalemia- requires potassium supplementation
- contraindicated for diabetics because it reduces effect of medication

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Angina is when the demands of the heart exceed the ability of the arteries

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Angina is when the demands of the heart exceed the ability of the arteries

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-90% controlled
-10% uncontrolled

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- relaxes vascular smooth muscles (vasodilation)
- nitroglycerine patches that slowly  releases over 24 hours
- subgingival capsule that quickly gets into the blood stream

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- cardio selective (B1)
- Cardio non-selective (B1 and B2)
- common meds: Atenolol (not for diabetics or asthmatics) and propranolol

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- reduce symptoms not mortality
- drug of choice for Prinzmetal's angina but also for chronic stable angina, hypertension, arrhythmias
- reduce peripheral resistance, decrease force of contraction and decrease contractility

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- used only for prophylaxis and not acute
- may decrease platelet aggregation
- works primarily on small resistance blood vessels in heart

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- anti-platelet (blod thinner)
- inhibits the production of thromboxane A2 (platelet aggregation) preventing blood clot formation
- reduce mortality in unstable angina and stroke patients

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- common med is Furosemide (Lasix)
- located in the loop of henle
- fast acting (within 1 hour)
- hypokalemia- requires potassium supplementation

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- located in the distal tubule where inhibiting sodium reabsorption results in a corresponding potassium
- potassium supplements are not needed
- hyperkalemia can occur so usually paired with a sparing diuretic

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- Thiazide diuretics increase urination

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Angiotensin Converting Enzyme Inhibitors (ACE)

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Angiotensin Converting Enzyme Inhibitors (ACE)

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- inhibits ACE in the lungs reducing the synthesis of angiotensin II (vasoconstrictor)
- preferred drug for diabetics
- adverse effects: dizziness, orthostatic hypertension, xerostomia, persistant caugh
- no NSAIDs
- common meds: "pril" ending Enalapril (Vasotec), Ramapril (Altase)

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- block AII receptors, limiting vasoconstriction (lower BP)
- well tolerated with little to no cough
- no NSAIDs
- common meds: Telmisartan (Miscardis), Valsartan (Diovan)

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- vasodilator
- inhibiting the influx of calcium into the cardiac and smooth muscle by blocking the calcium channels
- side effects: orthostatic hypotension, reflex tachycardia (increased HR due to rapid drop in BP), gingival enlargement
- two types of vasodilators: Dihydropyridines and Non-Dihydropyridines
- common meds: Nifedipine (causes gingival overgrowth), Amlodipine (Norvasc)

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Stage II- 2 or more of the drugs above used

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Stage II- 2 or more of the drugs above used

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- reduce mortality in people with stable angina
- decrease cardiac oxygen demand by reducing HR
- cardios elective (do not cause Bronchoconstriction)
- not for asthmatics and diabetes

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- decrease in contractility, preventing heart from fully pumping blood

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- decrease in contractility, preventing heart from fully pumping blood

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- decrease in cardiac output activate refluxes (increased HR, edema)
- fluid in the lungs

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- Diuretics- Furosemide to reduce the fluid
- cardiac glycoside (Digoxin)- increase the strength of contraction
- Vasodilators (ACE, ARB, CCB)
- Beta-blockers reduce sympathetic stimulation (rest and digest)

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- block sodium entering, preventing transmission of nerve impulse, reducing the rate of depolarization

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- "olol" ending
- treatment of supraventricular arrhythmias
- slows HR, decrease AV node contraction rate, increase AV refractory

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- prolong action potential duration and refractory period
- suppresses ventricular arrhytmias

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- significant affect on cardiac tissue
- decrease AV node conduction velocity and increase its refractory period
- treat supra-ventricular  tachycardia and suppresses AV node conduction

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- goal is to lower LDL and raise HDL
- common meds: "statins" ending, Atrovastatin (Lipitor), Rosuvastatin (Crestor), Simvastatin (Zocor)

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- Novel oral anticoagulants

Dabigatran (Pradaxa)

Rivaroxoben (Xarelto)

Apixaben (Eliquis)

Edoxban (Lixiana, Savaysa)

Betrixaben (Bebyxxa)

- long term management for patients with artificial heart valves and thromboembolic disorders (A-Fib)
- used in conjuction with heparin for the treatment of MI
-Warfarin (Coumadin) needs a medical consult, INR should be within the last 24-72 hours
(normal INR is 1 but for people on Warfarin it should be between 2-3)

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- inhibit platelet aggregation
- common meds: Aspirin 81 mg, clopidogrel (Plavix)- may need a med clearance