00:08
We are going to discuss cardiovascular
pharmacology in this component and also in
the next. Not all cardiovascular drugs will
be discussed, of course, because there’s
a huge array of them. But we’re going to
talk about the major drugs that are used every
day for patients with a variety of heart diseases.
00:29
First of all, it’s important to understand
which diseases one would treat with various
drugs. What are the diseases that we are
going to be talking about later in much more
detail? The commonest heart diseases are high
blood pressure or hypertension, coronary artery
disease, heart failure and cardiac arrhythmias -
in other words, electrical short circuits
or abnormalities in the heart. The drugs that
we are going to be discussing can be used
for each of these indications and we are
going to go through three drug or three classes
of drugs.
01:07
Now, it’s important to understand that with
drugs, there is not one effect from the drug.
In fact, drugs have many effects. Unfortunately,
some of those effects are very unpleasant
and they vary from person to person. So, let’s
take a theoretical example - you have Drug
A. You give it to a patient to lower the blood
pressure. Wonderful! The blood pressure comes
down. But, unfortunately, the drug upsets
the patient’s stomach, so that every time
the patient thinks about eating, they get
nauseous. Well clearly, that’s not a good
drug for that patient. Now, it turns out that
there are many drugs for high blood pressure.
So fortunately, we usually can try others
in order to find one that will both take the
patient’s blood pressure down and not cause
indigestion or another side effect. But, since
the drugs work on all tissues, there’s always
the potential for side effects and the side
effects can sometimes be quite serious. They
can cause renal damage. They can cause damage
to the blood cells. And so, one has to be
very careful about drugs, particularly when
you combine them. That’s definitely a chance
for interactions that could lead to problems.
And in fact, very often, these days with
very complicated patients, we often have a
clinical pharmacist who makes rounds with
us in the hospital and makes suggestions about
what drug interactions to avoid and the drugs
that will most likely improve the patient
without causing a lot of side effects.
02:52
Now, the commonest disease in the world is
coronary artery disease. It is the number
one cause for death, not just in North America,
not just in Western Europe, but throughout
the world. It has now moved into the infamous
number one place as the biggest killer of
human beings in the world. There are a number
of related diseases that increase the risk
that one might develop coronary artery disease.
For example, hypertension - high blood pressure
or hyperlipidemia - elevated levels of cholesterol
and other fats in the blood which speed or
initiate the atherosclerotic, or hardening
of the arteries process. So here, you just
see the number of millions of people who
died on the different continents from arteriosclerotic
heart disease.