Cardiovascular Pharmacology

At the end of this course, students should be able to: 1. describe electrophysiology of normal cardiac rhythms and mechanism of arrhythmias; 2. enumerate the classes of drugs used in management, with specific drug examples; 3. list basic and clinical pharmacology of drugs used in management; 4. explain pathophysiology of HTN, therapeutic implications and diagnosis; 5. list the basic and clinical pharmacology of the various classes of antihypertensive agents; and 6. describe specific examples of each class of antihypertensive agent.

Hypertension and blood pressure regulation. Aetiology of hypertension. Normal regulation of blood pressure. Postural baroreflex. Renal response to decreased blood pressure, therapeutic implications, diagnosis. Basic pharmacology of antihypertensive drugs in relation to mechanism and site of action, haemodynamic effects, dosage, pharmacokinetics and toxicity, diuretics, sympatholytic drugs, direct vasodilator, and drugs that block production or action of angiotensin. Angina pectoris and anti-anginal Drugs. Pathophysiology of angina, determinants of coronary blood flow and myocardial oxygen supply, specific therapeutic interventions (nitrates, beta blockers, calcium entry blockers). Basic and Clinical pharmacology of anti- anginal drugs. Historical concepts, chemistry, pharmacokinetics, pharmacodynamics, toxicity and tachyphylaxis. Congestive heart failure and Drugs used in Management, pathophysiology of heart failure, pathophysiology of cardiac performance, pathophysiology of the peripheral vasculature in congestive heart failure. Basic and clinical pharmacology of drugs used in congestive heart failure (cardiac glycosides and others like amrinone and beta-adrenergic stimulants), Administration, dosage, interactions, other clinical uses, toxicity, chemistry, pharmacokinetics, pharmacodynamics (mechanical and electrical effects). Cardiac arrhythmias and anti-arrhythmic drugs, electrophysiology of normal cardiac rhythm, mechanisms of arrhythmias. Basic and clinical pharmacology of anti-arrhythmic drugs, classes and types, mechanism of action, specific drugs, pharmacokinetics, pharmacodynamics and extracardiac effects, principles of anti-arrhythmia. Diuretics, renal tubule transport mechanism. Proximal and distal tubules, loop of Henle and collecting ducts. Basic and clinical pharmacology -types (carbonic anhydrase inhibitors, thiazides, loop diuretics, potassium-sparing (aldosterone antagonist), chemistry, pharmacokinetics, pharmacodynamics, clinical indications, dosage, toxicity, contraindications, combination therapy. Drugs that affect water excretion. Mannitol. Clinical pharmacology of diuretics - Oedematous state (CHF, hepatic cirrhosis, nephritic syndrome) non-oedematous states (hypertension, renal potassium wasting), alteration of urinary pH, tract infections, renal failure immunity, immunosuppressive drugs. Drugs used in 79 hyperlipidaemic conditions, Pathophysiology of hyperlipoproteinemia, Normal lipoprotein metabolism review, the hyperlipoproteinemic states (primary hypertriglyceridemia, primary hypercholesterolaemia, deficiency of high-density lipoproteins, secondary hyperlipoproteinemia). Role of elevated serum LDL concentrations in promoting risk of developing cardiovascular disease, protective role of increased serum HDL concentration in decreasing risk, presently accepted values for desirable LDL, HDL and triglyceride concentrations in normal individuals, treatment goals for individuals with hyperlipidaemia. Role of diet and lifestyle, pharmacology of specific drugs used (nicotinic acid, clofibrate, gemfrozil, bile acid-binding resins, sitosterols, neomycin, HMG-CoA reductase inhibitors, dextrothyroxine, probucol), drug combinations. Drugs Acting on blood. Cytopenia and Drugs used in treatment anaemias. Iron deficiency and other hypochromic anaemias, megaloblastic anaemia, basic pharmacology of drugs used in management, iron, cobalamins (B12), folates. Basic pharmacology, clinical indication, mechanism of action, adverse effects and contraindications of the growth factors used in management of cytopenia, including, erythropoietin, G-CSF, GM- CSF and IL-II. thrombosis and thrombolytics, principles of blood coagulation, plasma coagulation factors, regulation of coagulation and fibrinolysis. Basic pharmacology of drugs used to treat thrombosis, types of anti-coagulants (heparin and low molecular weight heparins, coumarins, indandiones), chemistry, pharmacokinetics, mechanism of action, administration and dosage, role of aPTT in heparin monitoring, concept of using INR in management of warfarin therapy. Platelet aggregation inhibitors, drugs that inhibit platelet function, aspirin and related cyclooxygenase inhibitors, imidazole, sulphinpyrazone. Drugs used in bleeding disorders. Vitamin K. Factor VIII. Factor IX. Fibrinogen. Fibrinolysis inhibitors (aminocaproic acid, tranexamic acid).