CARDIAC Flashcards
ACEI/ ARB
MOA, indications/ contradictions, side effects, adverse effects of
ACE
- (prils)
- BLOCK ANGIOTENSIN CONVERTING ENZYME FROM CONVETING ANGIOTENSIS 1 TO ANGIO 2. - a potent vasoconctrictor.
- inihibit the breakdown of bradyknin - a potent vasodilator
ARBS ( SARTANS)
- Block the binding of angiotensis two to its receptors
do not affect bradykinin
used for HTN, chf, MI, LV dysfunction, diebtes, proteinuria
SIDE EFFECTS
- cough, (aces)
- dizzy, hyperkalmiea, elevated renal tests, angioedema
check for renal issues prior
- NOT IN PREGNANCY
CCB
MOA, indications/ contradictions, side effects, adverse effects of
blocking the inward movement of calcium through tht cell membranes of cardiac and smooth muscle cells.
- this results in decreased cardiac muscle contraction
- decreased cardiac conduction
- vasodilation of coronary and peripheral arteries
- decreased cardiac output / hr/ and artery spasm
for arrhytmias - we use verap and ditalizem
for angina - dyhydropryraine ( nifedipine, amlodipine, felodidpine) … verap and ditialzem.
for hyerptension - all of them
pedal edema and headaches ( dihydropryadines and dilitiazem
flushing and dizzy - dyhydrophy
constipation - verapamil
think about age, hf, ami history or renal issues.
dont stop med abruptly .
monitor for hypotension
dont take with grapefruit juice
-
BB
MOA, indications/ contradictions, side effects, adverse effects of
- the workload of heart does down - decreases heart rate
- strengh of conraction goes down
- blocks epi and norepi leading to vasodilation
SIDE EFFECTS
- bradycardia, worsened hf, fatigue, depression, dizzy , decreased hdl, bronchoconstriction, erectile dysfunction
use in caution with DM patients
- can increase insulin resistance and lead to hyperglycemia
can masks symptoms of it
avoid absurptly stopping - increases MI risk
cardioselective beta blocks are
- aten, esm, metop, bisop, nebiv
- better with lung disease and asthma
ALPHA BLOCKER
MOA, indications/ contradictions, side effects, adverse effects of
blocks the alpha 1 adrengeric receptor on vascular smooth muscle and decreases vascular resistance
- may benefit lipis
improves BPH
Doxazoin, PRrazosin, terazosin
ADVERSE EFFECTS - first dose phenominen - hypotension - reflex tachy - hypotension - dizzy, headache, palipiations, priaspism stress inconotinence
STATINS
MOA, indications/ contradictions, side effects, adverse effects of
HMG coa INHIBITORS ( STATINS) prevent production of mevalonate - the building block of cholesterol.
- reduced intrahepatic cholesterol syntehsis
- upregulate expression of LDL receptor gene = more LDL receptors on the liver = lower LDL / trigly and higher HDL.
USED FOR:
- hyperlipidemia
- ASCVD
SIDE EFFECTS - myalgia - myopathy ( rhabdo) - headache - gi elevated LFTS - increased risk for DM/ hyperglycemia
give at night
interactis with gemfibrozil o niacin + statin = increaed risk of rhabdo
Non statin theray of hyperlipidemia
ezetimibe
reduces absorption of cholesterol from intensine
- can be used as monotherapy
- contraindicated with statins in patients with liver disease
- well tolerated
- didnt help with athlerlerslceoris but maybe does now…
non statin therapy of hyperlip
bile acid sequesterants
liver increases production of bile acids using cholesterol
- may decrease other drugs
GI side effects are common
CHOLESTRYAMINE, COLESTIPOL, COLSESEVELAM
non statin therapy
PCSK9 INHIBITORS
AN ENZYMME THAT DEGRADES ldl RECEPTORS ON THE LIVER
- inhibitors bind to pck9 resulting in inhibition of receptor degredation - more LL receptors - lower serum LDL.
shown to derease ASCVD moribdity and mortality
cost is going down but stil expensive
reserved for lipid specialists
NON STATIN
FIBRATES
increases lipoprotein lipase acvitiy - more rapid degredation of triglycersides and LDL
- primary role is hyertryglicerdiemia
common agents:
FENOFIBRATE AND GEMFIBROZIL
dont take gem with statins - will increase the statin and may lead to rhabdo
NON STATIN
NITRATES ( nitroglycerin)
Rapid acting : used for acute angina or for acute prophylaxis
sublingual.
repeat for 5 mins up to 3 times then call 911.
long acting : - oral so significant first pass affect.
- isorbide dinitrate and moninotrate
transdermal
tolerance :
- loss of ability of the smooth muscle to vasodialate
- occurs with continuous exposure
- must have a 12 hour nitrate free interval per day
SIDE EFFECTS
- headache, flushing, dizzy, hypotension, synocope, reflex tachy
INTERACTIONS
- caution with anti - hypertensives
- dont give with pde 5 inhibitors
- anticholinergics ageents may decrease absorption of sublinguqal ( dry mouth)
NON STATIN
DIGOXIN
DIURETICS I
MOA, indications/ contradictions, side effects, adverse effects of diueretics ( know where in the nephron each works)
DIURETICS I
MOA, indications/ contradictions, side effects, adverse effects of diueretics ( know where in the nephron each works)
MOA:
- inhibit NA and CL transport - reduces blood volvume - reduces cardiac output - reduces peripheral resistance
HCTZ
CHLORTHALIDONE
INDAPMINE
CONTRADICTIONS
- renal
- gout
- hypokalamie
- sulfa drug allergy
USES:
- hytertension - usually frst line therapy
- dont increase dosing
edema
adverse effects:
- hypokalemia, dehydration, hyperglycemia, hyperuricemia
hyperlipidemia
impotence
hyponatremia
DIURETICS I
MOA, indications/ contradictions, side effects, adverse effects of diueretics ( know where in the nephron each works)
POTASSIUM SPRARING
SPIRONOLACTONE
- anti - androgen
- good pcos, hiritusium, acne, female hair loss.
caustion in childbearing age,
risk for gynomastia, impotense and libido loss in men.
LOOP DIURETICS
furosemide, toresemide, bumetadine
po or iv
toresemide and bumetadine and high oral bioavilaibity
toresmide has longest duration
risk of hypokalemia, hypcalcimia, hypomagnesium, hyonatremia,
metabllic acidosis
hyperurecemia
ethacrynic acid is non sulfa but higher ototoxic risk
ototoxicity
dont Igive bolus
