Cardiac Flashcards
Atenolol
Beta Blocker: selective beta 1 adrenoreceptor blocker
Use: angina, hypertension, post MI, off label migraine prophylaxis
How: dose dependent selectivity for Beta 1 blocks catecholamines which leads to reduced renin and aldosterone. Heart rate and contractility slows, while peripheral vasodilation of arterioles – reduced blood pressure
ci: if you already have a slow heart rate or sinus node dysfunction, 2-3 degree heart block, compensated cardiac failure
pregnancy and lactation!
Interactions; may reduce effectiveness of diabetes drugs
NSAIDs will make it less effective at reducing bp
never prescribe with digoxin
se: tiredness, cold extremities, do not stop abruptly
Propranolol
Beta blocker: non selective so will impact the lungs as well
How: reduces heart rate and contractility which decreases overall cardiac output, also leads to bronchoconstriction
uses: angina, hypertension, post MI, anxiety, migraine prophylaxis
ci: asthma, COPD, sinus node dysfunction, already slow heart rate, compensated cardiac failure, 2-3 degree heart block, severe hemorrhage
do not stop abruptly
interaction: same as atenolol
se: Bradycardia, bronchocontriction, blood vessel spasm leading to PVD, blunted hypoglycemia in diabetes and impotence
Lisinopril
Angiotensin Converting Enzyme Inhibitor
use: hypertension, CHF, post MI (within 24hrs), diabetic neuropathy
how: blocks ace from converting angiotensin one to two, which reduces aldosterone secretion and prevents vasoconstriction leading to decrease in bp
ci: angioedema, bilateral renal artery stenosis, pregnancy, use cautiously with lactation
se: dry persistent non productive cough, dizziness, headache, hypotension, hyperkalemia, increased serum Cr, teratogen
Potentially fatal: severe hypotension, angioedema, liver failure
Amlodipine
(dihydropyridine) Calcium Chanel Blocker
use: hypertension, prinzmetal angina, stable angina, raynauds phenomenon
How: blocks voltage type calcium channels of cardiac and vascular sm mm, therefore block inflow of calcium and overall decreased muscle contraction and vasodilation
ci: severe hypotension, shock, aortic stenosis
Interactions; potentiates thiazide diuretic and ACE inhibitors, do not comping with B-Blockers if they have impaired left ventricular function, additive bp lowering effect with Sildenafil, increased effect with grapefruit juice
se: peripheral edema, headache, hypotension, dizziness
Clonidine
Alpha 2 adrenoreceptor agonist
use: hypertension, ADHD (older than 6yo), off label hot sweats, nicotine dependence
how: stimulated Alpha 2 receptors in the brain stem, this reduces outflow from vasomotor centers in medulla which ultimately leads to reduced catecholamine release and vasoconstriction is reduced as well as overall cardiac output
ci: decreased pacemaker activity and conduction issues, pregnancy
interactions: TCAs will decrease effectiveness, may increase toxicity of cyclosporine
se: rebound hypertension if stopped abruptly, bradycardia, sedation, constipation, dry mouth, nausea, vomiting, pruritus, dermatitis, anxiety, somnolence, confusion, drowsiness, dizzy, fatigue, headache, vivid dreams
Valsartan
Angiotensin 2 recepter blocker (ARB)
use: hypertension, heart failure if can’t tolerate an ACE-I, post MI
how: blocks the effects of angiotensin 2 which are: vasoconstriction, vasoconstriction of efferent arterioles, stimulates aldosterone production (increases water and salt retention)
when blocked this amalgamates to things that would lower bp
ci: pregnancy, lactation
interactions: may cause hyperkalemia when paired with potassium sparing diuretics, increased risk of hypovolemia with paired with diuretics
se: dizziness and increased BUN, hyperkalemia (confusion, body weakness, uneven heartbeat, numbness and tingling int he fingers and toes)
Spironolactone
Aldosterone blocker, potassium sparing diuretic
use: hypertension, CHF, edema, hypokalemia, primary hyperaldosteronism
how: competitively binds aldosterone receptors in the distal convoluted renal tubule, increases sodium and water excretion while decreasing potassium excretion. a
also has an anti androgen effect by competitive binding androgen receptors and decreasing testosterone levels through inhibition of 12-20 desmolase
ci: anuria, acute renal insufficiency, impaired renal excretory function, Addison’s disease or tother conditions associated with hyperkalemia
Interactions: do not pair with Valsartan or hyperkalemia can occur, NSAIDs decrease effectiveness
se: gynecomastia, impotence, irregular menses, hyperkalemia, metabolic acidosis, gastric distress and peptic ulcers
Hydrochlorothiazide
thiazide diuretic
use: hypertension, CHF, edema, Nephrolithiasis, osteoporosis in patients with hypercalciuria, nephrogenic diabetes insipidus
how:Inhibits NaCl transporter in the distal tubule, increases excretion of sodium, potassium, chloride and decreases excretion of calcium
this is why it is helpful with calcium type kidney stones
ci: severe hepatic and kidney impairment, addison’s, SULFA DRUG ALLERGY, anuria, preexisting hypercalcemia
Interactions: Carbamazepine may cause hyponatremia, use with alcohol, barbiturates and opioids my enhance diuretic effect t and orthostatic hypotension, may enhance nephrotoxicity of NSAIDs, NSAIDs and corticosteroids may decrease the efficacy
do not pair with glycyrrhiza: may cause potassium depletion
se: hypotension, dizzy, headache, less common are hyponatremiea, volume depletion, hypokalemic metabolic alkalosis, hypercalcemia, hyperuricemia and gout, hyperglycemia, hypersensitivity
Furosemide
Loop diuretic
use: edema related: acute pulmonary edema, CHF, acute renal failure, nephrotic syndrome, hepatic cirrhosis, first line drug for edema of any kind!
hyperkalemia, acute hypercalcemia
hypertension
how: inhibits reabsorption of sodium and chloride in the loop of hence, leads to excretion of water, calcium magnesium, sodium and chloride, potassium and ammonia
reduced uric acid excretion
ci: SULFA DRUG ALLERGY, severe dehydration, hypokalemia, hypernatremia, pre comatose states associated with liver cirrhosis, anuria or acute renal failure, addison’s, pregnant women, lactation
Interactions; glycyrrhiza may increase potassium loss
antagonizes hypoglycemia agent and drugs used for gout, OTOTOXICITY if paired with AMINOGLYCOSIDE ANTIBX especially in renal tox.
similar NSAID and corticosteroid effect to previous drugs..
se: hyperuricemia, hypokalemia, ototoxicity, sulf allergy, sun sensitivity, hypo of the other trace minerals
Nitroglycerin
Nitrate vasodilator
use: angina from CAD, refractory CHF, hypertensive emergencies
how: converted to nitric oxide in the vascular endothelium, NO increases cGMP and this decreases intracellular calcium leading to relaxation of vascular smooth muscle resulting in net vasodilation, increase in coronary bloodflow and decreasing myocardial oxygen demand
ci: acute MI, severe anemia, use of sildenafil in 24 hours, hypersensitivity
Interactions; sildenafil,
se: severe headache, hypotension, reflex tachycardia, transient loss of consciousness
Digoxin
Cardiac glycoside
use: left ventricular systolic heart failure, atrial flutter, fetal tachycardia, SVT
how: postive inotrope –> increase force of myocardial contraction, Na+, K+-ATPase inhibition causing calcium to accumulate inside the cell and increases contractility
decreases heartrate
ci: digitalis toxicity, ventricular fibrillation, obstructive cardiomyopathy
interactions: Hydrastis, Convallaria, Leonurus (other cardiac glycosides), glycyrrhiza may deplete potassium stores leading to digitalis toxicity, hypericum may reduce digoxin effect
hypokalemia with other diuretics, increased digoxin levels with CCBs, ACE-I and quinidine, decreased absorption with antacid use
se: Gi disturbances, arrhythmias, hypokalemia, neurological sx
Amiodarone
Antiarrhythmic cardiac ion channel blocker
use: supra ventricular and ventricular arrhythmias, ventricular tachycardia, a fib
how: blocks K, Na, Ca channels and adrenergic B receptors= prolongs cardiac depolarization, increases refractory period of atrial and ventricular tissue, slows heart rate, increases pr and qt intervals
ci: severe sinus node dysfunction, 2-3 degree heart block, severe bradycardia, shock, pregnancy, lactation, less than 1 year old
interactions; increases levels of digoxin, antiarrhythmics agents, cyclosporine, phenytoin
hypericum may decrease amiodarone levels
photosensitivity
se: pulmonary fibrosis, photosensitivity, heart block, bradycardia, hypotension, hypo or hyper thyroidism, hepatotoxicity, deposits in cornea and skin (smurf skin if IV injection)
Atropine
Anticholinergic
use: antidote for cholinesterase inhibitor poisoning (nerve gas, insecticide), urinary incontinence and ophthalmic solution to produce mydriasis for retinal exam
how: competitive muscarinic receptor, binds M1: sedation, psychosis, M2: tachycardia, vasodilation, M3: decreased GI motility, urinary retention and cycloplegia with mydriasis
ci: glaucome, chronic respiratory disease, sick sinus syndrome, thrytoxicosis, cardiac failure, pyloric stenosis, prostatic hypertrophy, pregnancy and lactation
interactions: do not mix with other anticholinergics
se: same as belladonna
Atorvastatin
HMG-CoA reductase Inhibitor
use: high cholesterol, hyperlipidemia, prevention of atherosclerosis
How: inhibits HMG-CoA which is the first step in cholesterol synthesis in the liver, also increases LDL receptors on the hepatocytes
Ci: hypersensitivity, acute liver disease, elevated serum transaminase, PREGNANCY X, if you are on this drug and able to get pregnant you must use contraception
interactions: increases digoxin levels, fibrates increases risk of rhabdomyolysis, increased norethindrone and ethanol estradiol from OCP, consider when selecting OCP
do not use with red yeast rice extract, grapefruit juice may increase atorvastatin, alcohol may increase hepatotoxicity
se: hepatic enzyme elevations and dysfunction, hypersensitivity, myositis, rhabdomyolysis (increased risk from P450 inhibitors
increased risk for DM
Gemfibrozil
Fibrate
use: hypercholesterolemia
how: stimulates lipoprotein lipase that is responsible for breaking down TG into VLDL and chylomicrons
ci: severe liver or renal disease, primary biliary cirrhosis, gallbladder disease, do not administer with statins for increased risk of rhabdo, pregnancy
interactions: potentiates warfarin
not first or second line treatment for hypercholesterolemia, reserved for TG over 500mg/dL
se: gallstones, gi upset, elevated liver enzyme, potentiates warfarin, myositis, rhabdo
