Cardiovascular pharmacology
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Scope
- 5% of questions of the boards
Pharmacokinetics
- Potency vs Efficacy: Potency is meaningless, effect of drug per mg. Efficacy is the clinical effectiveness of drug.
- PK is effect of the body on the drug.
- Drug distribution: muscle high in water content. Women have less muscle mass. Older patients have less muscle mass. Elderly women have less total body water. Water soluble drugs are associated with a higher drug effect (eaxample alcohool). Do not diffuse into brain. Very important in beta blockers, they are hydrophilic.
- Lipophilic drugs:Cross into CNS. Lopressor, propranolol
Hydrophilic
- In intravascular space
- Cleared by kidney
- Dont cross blood brain barrier
Atenolol, hadolol, sotalol
Intestinal Metabolism
- grapefruit juice affects intestinal system, but not liver. Intestinal cytochrome CYP3A4. (dihydropiridine CCBs,
lova, simva, cyclosporine, tacrolimus, sildenafil can be affected. May increase drug levels
Hepatic Metabolims
- beta blockers reduce hepatic blood flow, deompensated CHF affects liver blood flow
Know inhibitors\ allopurinal cipr cimet dilt eryth isoiz PPI
Inducers barb carb Know Inducers
Pharmacodynamics
Effect of drug on the body
Drug Drug Interactions
Nitrates with PD5 inhibitors
Digoxin
- Other meds
- Hypokalemia, often dont get dig toxic unless hypok, start on diuretic, then pt becoes dig toxic
- Other drugs