8 - Cardiovascular Flashcards
List
-categories of antihypertensive drugs (5)
ACE inhibitors + ARBs: -pril, losartan
Beta blockers: propran/labeta/metopr/atenolol
Calcium channel blockers: nifedipine, verapamil, diltiazem
Diuretics: loops, thiazides, potassium-sparing, osmotics
Other: clonidine, hydralazine
What class of drugs: lisinopril, benazepril, enalapril, captopril
ACE inhibitors
What class of drugs: losartan
ARB (angiotensin II receptor antagonist)
What class of drugs: nifedipine, verapamil, diltiazem
CCBs
Lisinopril, Benazepril, Enalapril, Captopril
- MOA
- clinical use
- adverse effects
ACE inhibitors:
1) prevent formation of angiotensin II by inhibiting ACE (angiotensin converting enzyme)
2) block metabolism of bradykinins -> vasodilation
HTN
COUGH
Hypersensitivity reactions, angioedema (swelling of tongue, lips, throat)
Losartan
- MOA
- clinical use
ARB: reduces BP by inhibiting angiotensin II-directed contraction of vascular smooth musc + stimulation of aldosterone secretion
HTN
No cough - often rxd when pts can’t tolerate this SE of ACE inhibitors
Propranolol, Labetalol
- MOA
- clinical use
Non-selective beta1+2 receptor antagonists
Block release of renin from kidneys
HTN
Metoprolol, Atenolol
- MOA
- clinical use
Selective B1 blocker
-less lung/IOP SE
HTN
SE of BBs
- CNS
- CV
- pulmonary
- GI
- reproductive
- other
Disorientation, fatigue, depression Bradycardia, arrhythmia, syncope Dyspnea, wheezing, bronchospasm Nausea, vomiting, diarrhea, ab pain Erectile dysfunction Mask symptoms of hypoglycemia - tachy, tremors
Nifedipine, Verapamil, Diltiazem
- MOA
- clinical use
- adverse effects
CCBs: block L-type Ca2+ channels -> marked decr in intracellular free Ca2+ -> decr smooth muscle contraction (vasodilate)
- all decr peripheral vascular resistance
- V+D more commonly have direct cardiac effects (chronotropism (decr HR -> brady), ionotropism (decr contractility -> worsen heart failure))
HTN
Pts with glaucoma taking Timolol in add’n to V or D are at greater risk for bradycardia, heart failure
Drugs that studies suggest may be rxd for low-tension glaucoma
CCBs - may incr perfusion to optic nerve
*not standard of care
List diuretic drugs + where they work
- loops
- thiazides
- potassium-sparing
- osmostics
Loop: furosemide; thick ascending LOH
Thiaz: hydrochlorothiazide, chlorothiazide; early DCT
K+sparing: spironolactone, triamterene; late DCT + collecting ducts
Osmo: mannitol; entire nephron
Furosemide
- MOA
- clinical use
- adverse effects
Loop diuretic: inhibits Na+/2Cl/K+ cotransporters in thick ascending LOH and incr Ca2+ secretion
HTN
Hypokalemia
Nephrotoxicity
Ototoxicity
Hydrochlorothiazide, Chlorothiazide
- MOA
- clinical use
- adverse effects
Thiazide diuretic: inhibit NaCl reabsorption and decr Ca2+ excretion at early DCT
HTN
Acute transient myopia and acute angle closure glaucoma (both rare)
Spironolactone
- MOA
- clinical use
- adverse effects
Potassium-sparing diuretic: blocks action of aldosterone at late DCT/collecting duct -> incr excretion of Na+ and water + decr passive secr of K+
-also blocks androgen receptors
HTN
Hyperkalemia
Gynecomastia
Anti-androgen effects
Triamterene
- MOA
- clinical use
- adverse effects
Potassium-sparing diuretic: directly blocks ENaCs in late DCT/collecting ducts
HTN
Overall, similar to sprinolactone except no anti-androgen effects
Mannitol
- MOA
- clinical use
- adverse effects
Osmotic diuretic: incr plasma osmolarity -> draws water out of eye (esp vitreous) or brain
HTN, acute angle-closure glaucoma, cerebral edema
Contraindicated in pts with pulmonary edema, dehydration, CHF
All diuretics can cause what ocular SE
Dry eye
Clonidine
- MOA
- clinical use
- adverse effects
CNS alpha2 agonist -> decr SNS outflow, incr PNS tone -> decr vascular resistance, decr HR
HTN
Dry mouth, sedation, impotence, severe rebound HTN
Parent compound of apraclonidine = may decr IOP
Hydralazine
- MOA
- clinical use
- adverse effects
Incr cGMP -> smooth muscle relaxation
Decr afterload by vasodilating arterioles > veins
HTN
Systemic: -compensatory tachy -fluid retention -lupus-like syndrome Ocular: -conj-itis -incr lacrimation
Digoxin
- MOA
- clinical use
- adverse effects
Inhibits Na+/K+ ATPase enzyme -> incr intracellular Ca2+
CHF
Retrobulbar optic neuritis
B/Y color defects
Entopic phenomenon: snowy vision, dimming vision, flickering lights
-due to Na+ channels being blocked in PRs
Amiodarone
- MOA
- clinical use
- adverse effects
Primarily blocks K+ channels (also blocks some Ca2+ and Na+)
Supraventricular and ventricular tachyarrhythmias
Ocular:
-NAION (uncommon)
-whorl keratopathy (common, esp doses >400mg/day)
-anterior sucapsular lens deposits (common at higher doses (600) after 6 mo of tx)
Systemic:
-fatal pulmonary or hepatic toxicity
-thyroid dysfunction
Warfarin
- MOA
- clinical use
- adverse effects
Vit K antagonist -> interferes with clotting factors 2, 7, 9, 10 (vit K-dependent for synth)
Chronic anticoagulation for pts with previous blood clots, mechanical heart valves, or AFib
Discontinue 96-155 hours (4 doses) prior to cataract surgery
Contraindicated in pregnancy, may result in skin necrosis
Cephs are contraindicated in pts taking Coumadin
Clopidogrel
- MOA
- clinical use
- adverse effects
Inhibits ADP receptor on platelet cell membranes (needed for aggregation and clot formation)
RXd after heart attack/stroke to prevent further atherosclerotic events
Risk of bleeding, GI upset, rash
Effects on platelets are irreversible (like aspirin)
Dipyradimole
- MOA
- clinical use
- adverse effects
Inhibits adenosine deaminase and phosphodiesterase -> accum of cAMP + adenosine -> inhibit platelet aggregation, may cause vasodilation
Aggrenox = dipyradimole + aspirin
- most common formulation of dipyr RXd in outpt clinics
- indicated for pts with hx of ischemic stroke
Risk of bleeding
List
-HMG CoA reductase inhibitors (3)
Statins: Lovastatin, Simvastatin, Atorvastatin
Lovastatin, Simvastatin, Atorvastatin
- MOA
- clinical use
- adverse effects
Inhibit HMG-CoA reductase - enzyme used in biosynth of cholesterol
First-line for hyperlipidemia:
- lower LDL + TGs
- raise HDL
Hepatotoxicity
Myopathy
Contraindicated in pregancy/lactation
Gemfibrozil
- MOA
- clinical use
- adverse effects
Fibric acid: binds to peroxisome proliferator receptor (PPAR-alpha) -> incr activity of lipoprotein lipase -> breaks down VLDL
Esp useful for lowering VLDL + TGs
GI disturbances, skin rash, urticaria, myositis
Cholestyramine
- MOA
- clinical use
- adverse effects
Binds bile acids in intestine -> prevents reabsorption
Used with HMG-CoA reductase inhib (statin) to lower LDLs
Constipation, fatty stools
