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Pharmacology > Cardiac > Flashcards

Cardiac Flashcards

1
Q

What is a strong contraindication for Ca channel blockers?

A

Heart failure

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2
Q

MOA metoprolol

A

Cardio selective beta blocker (b1)

Decreases HR, contractility, and conduction

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3
Q

MOA propanolol

A

Non cardio selective beta blocker

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4
Q

MOA sotalol

A

Non cardio selective beta blocker

Also inhibits potassium channels, working as anti-arrythmic

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5
Q

MOA carvedilol and labetalol

A

Alpha and beta blocker —> potent vasodilation

Decrease resistance, preload and afterload

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6
Q

Which beta blocker can be used for arrythmias?

A

Sotalol

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7
Q

Which beta blockers are used for cardiac ischemia or heart failure?

A

Cardio selective —> metoprolol

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8
Q

Which beta blocker can be used for migraine, tremors, tirotoxicosis, and portal hypertension?

A

Propanolol

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9
Q

Which beta blocker can be used in pregnancy?

A

Labetalol
Carvedilol

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10
Q

When are partial symphathomimetic agonists recommended?

A

Metabolic syndrome (alprenolol)

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11
Q

What are 3 strong contraindications of beta blockers?

A
  • Bradicardia
  • AV block
  • ASTHMA, COPD, COVID, etc.
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12
Q

Which beta blocker can be used in hypertensive emergencies?

A

IV labetalol

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13
Q

Main side effects of cardio selective beta blockers? (3)

A
  • Bradycardia
  • Bradyarrythmia
  • Torsades de pointes (vent. Taquiarrythmia)
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14
Q

Main side effects of NON cardio selective beta blockers?

A
  • Bronchoconstriction
  • Vasoconstriction
  • Hyper or hypo glycemia
  • Bradycardia
  • Higher triglycerides
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15
Q

MOA calcium channel blockers

A

Block type L channels in myocardium and smooth muscle

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16
Q

Types of Ca channel blockers and the difference

A

Dyhydropyridines —> nefidipine, amlodipine
*Act on all smooth muscle = vasodilation

Non-dyhydropyridines —> verapamil, diltiazem
*Act on cardiac muscle = crono, ino, and dromo negative

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17
Q

If a person has a fall risk, which is the antihypertensive category that is most important to AVOID?

A

Ca channel blockers

Risk of orthostatic hypotension

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18
Q

Ca channel blockers (Dihydropyridine) main indications

A
  • Hypertension, including emergency
  • Angina (long acting)
  • Raynaud phenomenon
  • Subarachnoid hemorrhage
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19
Q

Ca channel blockers (non-dihydropyridine) main indications(5)

A
  • Hypertension
  • Supraventricular tachyarrythmia
  • Angina
  • Hypertrophic cardiomyopathy
  • Migraine (verapamil)
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20
Q

What is the strongest contraindication for Ca channel blockers?

A

Acute coronary syndrome

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21
Q

If a patient has acute coronary syndrome, which antihypertensive CAN’T you give?

A

Ca channel blockers

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22
Q

Why can’t more than 1 RAAS system inhibitor be given at a time?

A

High risk of hyperpotassemia

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23
Q

Which medication for hypertension would you give post myocardial infarction?

A

Cardio selective beta blocker

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24
Q

Effects of ACE inhibitors

A

Less vasoconstriction, GFR, aldosterone, reabsorption

More bradykinin = more vasodilation

Less proteinuria and cardiac remodeling

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25
Q

Which hypertensive medication is preferred in diabetics and why?

A

ACE inhibitors (captopril, enalapril)

Nephroprotective

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26
Q

Which antihypertensive class causes a dry cough?

A

ACE inhibitors

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27
Q

CAPTOPRIL mnemonic for side effects

A

Cough
Angioedema
Pemphigus vulgaris
Teratogenic
O hypOtension
Potassium elevation
Renal failure
Increase creatinine
Low GFR

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28
Q

ACE inhibitor main indications

A
  • Hypertension
    *diabetes
  • Heart failure with reduced ejection fraction
  • MI history
  • CKD with proteinuria
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29
Q

When are ARB inhibitors used?

A

If ACE inhibitors were not tolerated (valsartan, losartan)

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30
Q

Which is the prototipic renin inhibitor?

A

Aliskiren

aLISkiREN (LIS RENin)

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31
Q

Which antihypertensives can be used in pregnancy and what is their classification? (4)

A

New Moms Love Hugs:
- Labetalol (alpha and beta blocker)
- Hydralazine (vasodilator)
- Nifedipine (dihydropyridine)
- Methyldopa (alpha agonist)

  • Aliskiren (renin inhibitor)
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32
Q

What can you combine ACE inhibitors with to stabilize K?

A

Thiazide diuretics

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33
Q

Which medication class has rebound hypertension as a clearly described effect?

A

ACE inhibitors

Therefore, start at very small dosis

34
Q

MOA nitrates

A

NO —> increase cGMP —> less intracellular Ca

= smooth muscle relaxation —> vasodilation **VEINS
= less preload

35
Q

Nitrates main indications (5 )

A
  • Acute angina
  • Emergency hypertension
  • Acute coronary syndrome
  • Pulmonary hypertension with edema
  • Chronic heart failure
36
Q

What are important side effects of hydralazine? (2)

A

Reflex tachycardia
Drug-induced lupus

37
Q

Which direct vasodilator is not selective between veins and arteries?

A

Nitroprusside

38
Q

Which beta blocker can be used for glaucoma?

39
Q

Categories of PDE inhibitors

A
  • Nonspecific: theophylline, dipyridamole
  • PDE-5: sildenaFIL, vardenaFIL
  • PDE-4: roflumilast
  • PDE-3: milrinone, cilostazole
40
Q

Which PDE inhibitors are “platelet inhibitors”?

A

Cilostazol
Dipyridamole

41
Q

MOA nonspecific PDE inhibitors

A

—> increased cAMP = bronchial smooth muscle relaxation

42
Q

MOA PDE-5 inhibitors

A

Less cGMP hydrolysis —> more cAMP = vasodilation

Important increased flow in corpus cavernosum, FILls the penis

43
Q

MOA PDE-4 inhibitors

A

Increase cAMP in neutrophils, granulocytes, and bronchi

44
Q

MOA PDE-3 inhibitors

A

Increase cAMP in:
Cardiomyocytes —> + ino and chronotropy
Vascular muscle —> vasodilation

45
Q

How do PDE inhibitors affect platelets?

A

Inhibit their aggregation

46
Q

Which PDE inhibitors are used for erectile dysfunction, prostatic hyperplasia, and pulmonary hypertension?

A

PDE-5 inhibitors

ProsTAtic = TAdalafil

47
Q

Which PDE inhibitors are used for airway? Ex. COPD, asthma

A

Nonspecific (theophylline)

PDE-4 inhibitor (roflumilast)

48
Q

Which PDE inhibitors are used for acute decompensated HF?

A

PDE-3 inhibitors

49
Q

Sildenafil category and main side effects (4H’s)

A

PDE-5 inhibitors

  • Hot and sweaty
  • Headache
  • Heartburn
  • Hypotension
    Cyanopia
50
Q

First-line treatment for hypertension options (3)

A
  • Thiazide diuretics
  • ACE inhibitors or ARBs
  • Dihydropyridine Ca block
51
Q

First-line treatment for hypertension WITH HF options (3)

A
  • Diuretics
  • ACE inhibitors/ARBs
  • Beta blockers ONLY if compensated
52
Q

First-line treatment for hypertension WITH ASTHMA options (4)

A
  • ARBs
  • Ca channel blockers
  • Thiazide diuretics
  • Cardioselective beta blockers
53
Q

How do you prevent reflex tachycardia in a patient taking hydralazine?

A

Add beta blcoker

54
Q

Hypertensive emergency options (5)

A
  • Labetalol
  • Clevidipine
  • Fenoldopam
  • Nicardipine
  • Nitroprusside
55
Q

Angina main medication categories used (2)

A

Nitrates
Beta blockers

56
Q

MOA statins

A

Inhibit HMG-CoA reductase = no conversion to mevalonate —> less cholesterol

Atorvastatin
Simvastatin

57
Q

Main side effects of statins (2)

A

Hepatotoxicity
Myopathy when used with fibrates or niacin

58
Q

Which 2 categories of lipid-lowering agents lower LDL the most?

A

HMG-CoA reductase inhibitors (statins)
PCSK9 inhibitors

59
Q

Which category of lipid-lowering agents lowers TRIGLYCERIDES the most?

60
Q

MOA resins

A

Prevent reabsorption of bile acids in the intestines —> liver uses cholesterol to make more

Cholestyramine
Colestipol
Colesevelam

61
Q

Which lipid-lowering agents can slightly increase triglycerides?

A

Bile acid resins

62
Q

MOA ezetimibe

A

Prevents cholesterol absorption in small intestine

63
Q

Most lipid-lowering agents (increase/decrease) LDL, (increase/decrease) HDL, and (increase/decrease) TG

A

Decrease LDL
Increase HDL
Decrease TG (except bile acid resins)

64
Q

MOA fibrates

A

Activate PPAR-a:
—> upregulate lipoproteic lipase —> TG clearance *MOST EFFECT OF ALL LIPID LOWERING AGENTS
—> induce HDL synthesis

Benzafibrate, fenofibrate, gemfibrozil

65
Q

Statins main side effects (2 )

A
  • MYOPATHY
  • Cholelithiasis
66
Q

MOA niacin

A

Inhibit lipolysis
Reduce hepatic VLDL synthesis
Increases HDL more than others

67
Q

Niacin main side effects (3)

A
  • Flushed face —> give aspirin
  • Hyperglycemia
  • Hyperuricemia
68
Q

MOA PCSK9 inhibitors

A

Inactivate LDL-receptor degradation = more LDL removal

Alirocumab
Evolocumab

69
Q

PCSK9 inhibitors main side effects (2)

A
  • Myalgias
  • Neurocognitive: dementia, delirium
70
Q

MOA cardiac glycosides

A

Inhibit Na/K ATPase —> inhibition of Na/Ca exchange
= increased Ca intracellular
= + inotropic effect and vagus nerve stimulation

= lower HR

DIGOXIN

71
Q

What is digoxin used for? (2)

72
Q

Important digoxin side effects (5)

A
  • Cholinergic: nausea, vomit, diarrhea
  • YELLOW blurry vision
  • Arrhythmias
  • AV block
  • HyperK
73
Q

Antiarrhythmics classes and targets

A

Ia: moderate Na
Ib: weak Na
Ic: strong Na

II: beta blockers
III: K block
IV: Ca block

74
Q

Class I antiarrhythmic medications

A

Ia: Quinidine, PROCainamide, DISOpyramide
“The Queen Proclaims Diso’s pyramid”

Ib: LIDocaine, PHenytoin, MEXIletine
“I’d Buy Liddy’s Phine Mexican tacos”

Ic: Flecainide, Propafenenone
“Can I have Fries, Please?”

75
Q

Class III antiarrhythmic medications

A

AIDS:
Amiodarone
Ibutilide
Dofetilide
Sotalol

76
Q

Class IV antiarrhythmic medications

A
  • Diltiazem
  • Verapamil
77
Q

Which is the best antiarrhythmic post-MI?

A

Class IB - ex. Lidocaine

78
Q

Which antiarrhythmics are contraindicated in structural and ischemic heart disease?

79
Q

Safest and most used antiarrhythmic?

A

Amiodarone, has effects of all classes

80
Q

Important side effect of class III antiarrhythmics?

A

Torsades de pointes (sotalol and ibutilide)

81
Q

With which antiarrhythmic must PFTs, LFTs, and TFTs be checked?

A

Amiodarone
Risk of pulmonary fibrosis, hepatotoxicity, and hypo or hyperthyroidism (has iodine)

Pharmacology (13 decks)

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