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pharmacology final ( 1st sem) > B: 17-20 > Flashcards

B: 17-20 Flashcards

1
Q

Ca2+ ch. blockers

A

Dihydropiridines: (selectively acts on coronary, arterioles)
-they bind EC portion of Ca ch Alpha-1 subunit

  • short acting (T1/2= 6 hrs) : Nifedipine, Nimodipin
  • moderate (T1/2= 8-20 hr) : Felodipine, Nitredipin, nisoldipin

long acting (T1/2= 35-50 hr)
Amlodipine,
Manidipin (has duiretic action, inhibit Na, H2o resorption)

Non: (act in heart, coronary, arterioles)
-Bind inner cytoplasmic part of alpha1 subunit

Verapamil, Diltiazem

-NEVER combine with BB bcz cardiac dep, AV block

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2
Q

Dihydropiridines

A

Nifedipine
Amlodipine
Felodipine
Nimodipine

-they bind EC portion of Ca ch Alpha-1 subunit

vascular >> cardiac effect

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3
Q

Dihydropiridines indications

A

HTN
Angina
Arrythmias
Prinzmetal’s angina= vasospastic angina
Peripheral vascular disease
-Subarachnoid hemorrhage (Nimodipine)

Hypertensive emergency
Pregnancy HTN (Nifedipine)
Raynaud’s phenomenom

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4
Q

Which drug should wew give in case of Subarachnoid hemorrhage

A

Nimodipine

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5
Q

Verapamil indications

A

HTN
Angina (atherosclerotic , vasospastic)
Migrane prophylaxis
Anti arrhythmic class IV: AV node arrhythmia

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6
Q

NO releasing agents

A

Hydralazine

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7
Q

Hydralazine MOA, adminstration, duration

A

Induce release of NO from endothelial cells
Mainly arterial vasodil.
Orally active
6-8 h duration

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8
Q

Hydralazine indications

A

HTN
used in combo with isosorbide dinitrate in heart failure

Induces baroreceptor homeostatic compensatory response; must use w duiretic OR BB

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9
Q

Patient with HF and reduced ejection fraction can be given

A

Hydralazine + Isosorbide dinitrate

reduce mortality due to heart failure in African Americans.

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10
Q

Hydralazine side effects

A

Drug induced Lupus at high dose
Tachycardia
Na, H2o retension

causes baro-r homeostatic response ; must be combined with diuretic or BB

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11
Q

Endothelin antagonist

A

Bosentan

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12
Q

Bosentan indications

A

Pulmonary HTN

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13
Q

Bosentan side effects

A

Teratogenic
Hepatotoxicity

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14
Q

PDE-5 inhibitor

A

Sildenafil

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15
Q

Sildenafil indications

A

Erectile dysfunction
Pulmonary HTN

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16
Q

Sildenafil side effects

A

Severe hypotension in combination with Nitrates
Priapism (Prolonges erection)
Blue tinted vision

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17
Q

K sparing diuretics- Aldosteron-R inhibitors

A

Spironolactone
Eplerenone

steroid inhibitors of cytoplasmic Aldosterone-R in Cortical CD

18
Q

Spironolactone . eplerenone duration of action

A

24-72 h

19
Q

Spironolactone indications

A

Hyperaldestronism (primary conns disease, + secondary due to chronic HF , or hepatic cirrhosis)

Hypokalemia caused by other diuretics

Antiadronergic

20
Q

Spironolactone side effects

A

Hyperkalemic metabolic acidosis (decreases exc of K, H ). (increase exc of Na

Anti-adronergic effect (gynecomastia w/ spironolactone use only)

21
Q

ACE inhibitors MOA

A

Inhbition of ACE → ↓ AG-II, ↓ Aldosterone
↑ endogenous vasodilators (Bradykinin)

acts on both arterial and venous ; effectively reduces BP

22
Q

ACE inhibitors names

A

Captopril
Enalapril
Perindopril
Ramipril

23
Q

ACE inhibitors indications

A

HTN
Diabetic nephropathy
Chronic HF (reduced mortality)

Acute coronary syndrome

24
Q

ACE inhibitors side effects

A

Dry cough
Teratogenic
Hyperkalemia
AKI in renal patients

25
Q

ARB’s

A

Losartan
Valsartan
Irbesartan

26
Q

ARB’s indications

A

HTN
Protective of diabetes nephropathy
CHF (reduced mortality)

like ACE-I

27
Q

ARB’s side effects

A

Teratogenic
Hyperkalemia

28
Q

Drug used in Ischemic heart disease (Angina pectoris)

A

Nitroglycerine
Isosorbid-mononitrate / dinitrate
CCB
B blockers (Propranonlol)

Ivabradine (inhibit pacemaker If Na channel in SA node)

Trimetazidine (pFOX inhibitor)- inhibit late Na channel in myocardium

Ranolazine (pFOX inhibitor= partial fatty acid oxidation inhibitor ) - inhibit late Na channel in myocardium

29
Q

Nitrates MOA

A

Release NO in smooth m
NO stimulates guanylyl cyclase
Increased in cGMP
Dephosphorylation of myosin light chain
Smooth muscle relaxation

30
Q

Nitrates effects

A

Vasodilation (venous>>>arterial)
Preload ↓↓
Afterload ↓
Cardiac work ↓
O2 demand ↓

31
Q

Short acting nitrates
How to give
Onset of action
Duration of acation
Indications

A

Nitroglycerin
Sublingual
Onset in 1 min
Lasts 10-20 min

Acute angina, pectoris

Acute coronary syndrome

,Hypertensive emergency,

Acute pulmonary edema

32
Q

Intermediate acting nitrates
How to give
Onset of action
Duration of acation
Indications

A

Nitroglycerin (also isosorbide mononitrate in oral form)
Oral
Slow onset
2-4 h
Angina prophylaxis
Reduced mortalilty in atients with stable angina

33
Q

Long acting nitrates
How to give
Onset of action
Duration of acation
Indications

A

Nitroglycerin
Transdermal patch
Slow
10 h

Angina prophylaxis
Reduced mortalilty in atients with stable angina

34
Q

Isosorbid-dinitrate
Evrything

A

Sublingual
short acting

rapidly denitrated in liver, smooth m to isosorbide mononitrate
20-30 min duration of action

Acute angina pectoris

Acute coronary syndrome

Hypertensive emergency,

Acute pulmonary edema

35
Q

Nitrates side effects

A

Headache
Reflex tachycardia
Cutaneous flushing
Orthostatic hypotension
Syncope
Methemoglobinemia in prolonged high dosage. (rxn with rbc)
Tolerance after 8-10 h; INTERMITTENT treatment !!

36
Q

Nitrates contraindications

A

Systolic BP < 90 mmHg

Right vent. MI (makes it worse because they act on venous side more!!)

Patient took PDE-5 within last 24 h (synergistic relaxation of vascular s.m -> dangerous hypotension, inadequate perfusion to critical organs)

Hypertrophic obstructive cardiomyopathy

37
Q

CCB used to treat angina

A

Nifedipine
Verapamil
Diltiazem

38
Q

B blocker used in angina prophylaxis

A

Propranolol

39
Q

L type Ca channel location

A
  • cardiac
  • skeletal
  • smooth m
  • neurons
  • endocrine cells
  • bone

Blocked by verapamil, DHP

long, large threshold current

40
Q

T type Ca channel location

A

heart

neurons

41
Q

N-type Ca channel location

A
  • neuron
  • sperm (also R-type Ca channel

inhibited by Gaba-pentin

42
Q

pFOX inhibitors

A

Trimetazidine (pFOX inhibitor)- inhibit late Na channel in myocardium

Ranolazine (pFOX inhibitor= partial fatty acid oxidation inhibitor ) - inhibit late Na channel in myocardium

increase efficiency of O2 utilization by shifting heart preferance from fatty acid to glucose.

SE: QT prolongation

pharmacology final ( 1st sem) (15 decks)

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