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KMK Gen Pharm > 8 - Cardiovascular > Flashcards

8 - Cardiovascular Flashcards

1
Q

List

-categories of antihypertensive drugs (5)

A

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

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2
Q

What class of drugs: lisinopril, benazepril, enalapril, captopril

A

ACE inhibitors

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3
Q

What class of drugs: losartan

A

ARB (angiotensin II receptor antagonist)

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4
Q

What class of drugs: nifedipine, verapamil, diltiazem

A

CCBs

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5
Q

Lisinopril, Benazepril, Enalapril, Captopril

  • MOA
  • clinical use
  • adverse effects
A

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)

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6
Q

Losartan

  • MOA
  • clinical use
A

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

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7
Q

Propranolol, Labetalol

  • MOA
  • clinical use
A

Non-selective beta1+2 receptor antagonists
Block release of renin from kidneys

HTN

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8
Q

Metoprolol, Atenolol

  • MOA
  • clinical use
A

Selective B1 blocker
-less lung/IOP SE

HTN

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9
Q

SE of BBs

  • CNS
  • CV
  • pulmonary
  • GI
  • reproductive
  • other
A 
Disorientation, fatigue, depression
Bradycardia, arrhythmia, syncope
Dyspnea, wheezing, bronchospasm
Nausea, vomiting, diarrhea, ab pain
Erectile dysfunction
Mask symptoms of hypoglycemia - tachy, tremors
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10
Q

Nifedipine, Verapamil, Diltiazem

  • MOA
  • clinical use
  • adverse effects
A

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

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11
Q

Drugs that studies suggest may be rxd for low-tension glaucoma

A

CCBs - may incr perfusion to optic nerve

*not standard of care

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12
Q

List diuretic drugs + where they work

  • loops
  • thiazides
  • potassium-sparing
  • osmostics
A

Loop: furosemide; thick ascending LOH

Thiaz: hydrochlorothiazide, chlorothiazide; early DCT

K+sparing: spironolactone, triamterene; late DCT + collecting ducts

Osmo: mannitol; entire nephron

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13
Q

Furosemide

  • MOA
  • clinical use
  • adverse effects
A

Loop diuretic: inhibits Na+/2Cl/K+ cotransporters in thick ascending LOH and incr Ca2+ secretion

HTN

Hypokalemia
Nephrotoxicity
Ototoxicity

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14
Q

Hydrochlorothiazide, Chlorothiazide

  • MOA
  • clinical use
  • adverse effects
A

Thiazide diuretic: inhibit NaCl reabsorption and decr Ca2+ excretion at early DCT

HTN

Acute transient myopia and acute angle closure glaucoma (both rare)

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15
Q

Spironolactone

  • MOA
  • clinical use
  • adverse effects
A

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

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16
Q

Triamterene

  • MOA
  • clinical use
  • adverse effects
A

Potassium-sparing diuretic: directly blocks ENaCs in late DCT/collecting ducts

HTN

Overall, similar to sprinolactone except no anti-androgen effects

17
Q

Mannitol

  • MOA
  • clinical use
  • adverse effects
A

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

18
Q

All diuretics can cause what ocular SE

A

Dry eye

19
Q

Clonidine

  • MOA
  • clinical use
  • adverse effects
A

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

20
Q

Hydralazine

  • MOA
  • clinical use
  • adverse effects
A

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
21
Q

Digoxin

  • MOA
  • clinical use
  • adverse effects
A

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

22
Q

Amiodarone

  • MOA
  • clinical use
  • adverse effects
A

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

23
Q

Warfarin

  • MOA
  • clinical use
  • adverse effects
A

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

24
Q

Clopidogrel

  • MOA
  • clinical use
  • adverse effects
A

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)

25
Q

Dipyradimole

  • MOA
  • clinical use
  • adverse effects
A

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

26
Q

List

-HMG CoA reductase inhibitors (3)

A

Statins: Lovastatin, Simvastatin, Atorvastatin

27
Q

Lovastatin, Simvastatin, Atorvastatin

  • MOA
  • clinical use
  • adverse effects
A

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

28
Q

Gemfibrozil

  • MOA
  • clinical use
  • adverse effects
A

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

29
Q

Cholestyramine

  • MOA
  • clinical use
  • adverse effects
A

Binds bile acids in intestine -> prevents reabsorption

Used with HMG-CoA reductase inhib (statin) to lower LDLs

Constipation, fatty stools

KMK Gen Pharm (9 decks)

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