B: 17-20 Flashcards
Ca2+ ch. blockers
Dihydropiridines: Nifedipine, Amlodipine, Felodipine, Nomidipine
Non: Verapamil, Diltiazem
Dihydropiridines
Nifedipine
Amlodipine
Felodipine
Nimodipine
Dihydropiridines indications
HTN Hypertensive emergency Pregnancy HTN (Nifedipine) Angina Prinzmetal's angina Raynaud's phenomenom Subarachnoid hemorrhage (Nimodipine)
Which drug should wew give in case of Subarachnoid hemorrhage
Nimodipine
Verapamil indications
HTN
Angina
Migrane prophylaxis
Anti arrhythmic class IV
NO releasing agents
Hydralazine
Hydralazine MOA
Induce release of NO from endothelial cells
Mainly arterial vasodil.
Orally active
6-8 h duration
Hydralazine indications
HTN
Induces baroreceptor homeostatic compensatory response
Patient with HF and reduced ejection fraction can be given
Hydralazine + Isosorbide dinitrate
Hydralazine side effects
Drug induced Lupus at high dose
Endothelin antagonist
Bosentan
Bosentan indications
Pulmonary HTN
Bosentan side effects
Teratogenic
Hepatotoxicity
PDE-5 inhibitor
Sildenafil
Sildenafil indications
Erectile dysfunction
Pulmonary HTN
Sildenafil side effects
Severe hypotension in combination with Nitrates
Priapism (Prolonges erection)
Blue tinted vision
K sparing diuretics- Aldosteron-R inhibitors
Spironolactone
Eplerenone
Spironolactone duration of action
24-48 h
Spironolactone indications
Hyperaldestronism
Hypokalemia caused by other diuretics
CHF
Antiadronergic
Spironolactone side effects
Hyperkalemic metabolic acidosis
Anti-adronergic effect
ACE inhibitors MOA
Inhbition of ACE → ↓ AG-II, ↓ Aldosterone
↑ endogenous vasodilators (Bradykinin)
ACE inhibitors names
Captopril
Enalapril
Perindopril
Ramipril
ACE inhibitors indications
HTN
Protective of diabetes nephropathy
CHF (reduced mortality)
Acute coronary syndrome
ACE inhibitors side effects
Dry cough
Teratogenic
Hyperkalemia
AKI in renal patients
ARB’s
Losartan
Valsartan
Irbesartan
ARB’s indications
HTN
Protective of diabetes nephropathy
CHF (reduced mortality)
ARB’s side effects
Teratogenic
Hyperkalemia
Drug used in Ischemic heart disease (Angina pectoris)
Nitroglycerine Isosorbid-mononitrate / dinitrate CCB B blockers (Propranonlol) Trimetaidine Ivabradine
Nitrates MOA
Release NO NO stimulates guanylyl cyclase Increased in cGMP Dephosphorylation of myosin light chain Smooth muscle relaxation
Nitrates effects
Vasodilation (venous>>>arterial) Preload ↓↓ Afterload ↓ Cardiac work ↓ O2 demand ↓
Short acting nitrates How to give Onset of action Duration of acation Indications
Nitroglycerin Sublingual Onset in 1 min Lasts 10-20 min Acute angina, Acute coronary, Hypertensive emergency, Acute pulmonary edema
Intermediate acting nitrates How to give Onset of action Duration of acation Indications
Nitroglycerin Oral Slow 2-4 h Angina prophylaxis Reduced mortalilty in atients with stable angina
Long acting nitrates How to give Onset of action Duration of acation Indications
Nitroglycerin Transdermal patch Slow 8-10 h Angina prophylaxis Reduced mortalilty in atients with stable angina
Isosorbid-mononitrate
Evrything
Sublingual
Rapid acting
30 min duration of action
Acute angina, Acute coronary, Hypertensive emergency, Acute pulmonary edema
Nitrates side effects
Headache Reflex tachycardia Cutaneous flushing Orthostatic hypotension Syncope Methemoglobinemia in high conc. Tolerance after 8-10 h
Nitrates contraindications
Systolic BP < 90 mmHg
Right vent. MI
Patient took PDE-5 within last 24 h
Hypertrophic obstructive cardiomyopathy
CCB used to treat angina
Nifedipine
Verapamil
Diltiazem
B blocker used in angina prophylaxis
Propranolol
