Cardiac Flashcards
Thiazide Diuretics
Drugs- hydrochlorothiazide (microzide), chlorthalidone, indapamide, metolazone (zaroxolyn)
MOA- lower BP by increasing sodium and water excretion, decreased CO and renal blood flow
Used as initial therapy
Useful in combo
ADE- hypokalemia, hyperuricemia, hyperglycemia, hyponatremia, hypomagnesemia, hypovolemia
Loop diuretics
Drugs- furosemide, torsemide, bumetanide, etharynic acid
MOA- blocks sodium and chloride reabsorption in the kidneys, decreases renal vascular resistance
ADE- hypokalemia, hypocalcemia, ototoxicity
Used alone or in combo for HTN, CHF, peripheral edema
Potassium sparing diuretics
Drugs- amiloride (midamor), triamterene (dyrenium) inhibit sodium transport in late distal and collecting ducts
Spironolatone (aldactone) and eplerenone (inspra) are aldosterone receptor antagonist
MOA- all reduce potassium, aldosterone antagonist have benefit for improving cardiac remodeling and SHF
Used in combo with loop or thiazides to reduce potassium loss
Also used in PCOS
ADE- hyperkalemia, gynecomastia
Beta blocker
See neuro slides
Acebutolol, atenolol (tenormin), betaxolol, bisoprolol, carvediolol (coreg), esmolol (brevibloc), labetolol (trandate), metorprolol (lopressor, toprol), nadolol (corgard), nebivolol (bystolic), pindolol, propranolol (inderal, innopran)
ACEI
Drugs- benazepril (lotensin), captopril, enalapril (vasotec), fosinopril, lisinopril (prinivil, zestril), moexipril, quinapril (accupril), perindopril, ramipril (altace), trandolapril
MOA- inhibit ACE which converts angiotensin 1 to angiotensin 2, decreases secretion of aldosterone, decrease cardiac preload and after load
Uses- HTN, MI, CHF, CKD, increased risk for CAS
ADE- dry cough, angioedema, increased potassium
Monitor renal function
Tetrogenic
ARBs
Drugs- azilsartan (edarbi), candesartan (atacand), irbesartan (avapro), losartan (cozaar), olmesartan (benicar), telmisartan (micardis), valsartan (diovan)
MOA- blocks Angiotensin 1 receptors and decrease angiotensin 2 production
Can be used as first line for HTN especially in DM, CKD, CHF
ADE- similar to ACEI, but cough and angioedema less likely
Do not give with ACEI or in pregnancy
Renin inhibitor
Drug- aliskiren (tekturna)
MOA- selective renin inhibitor, inhibits renin and acts earlier in the renin angiotensin aldosterone system
Uses- HTN
do not used with ACEI or ARB
ADE- diarrhea, cough and angioedema but less likely
Tetrogenic
CYP3A4 metabolite
CCB
Drugs- amlodpine (norvasc), clevidipine (cleviprex), diltiazem (cardizem, cartia, tiazac), felodipine, isradipine, nicardipine (cardene), nifedipine (adalat, procardia), nisoldipine (sular), verapamil (calan, verelan)
1st line for BP in AA
Subclasses
-diphenylalkylamines- verapamil-slows cardiac conduction and decreased HR for angina, SVT, migraines, clusters
-benzothiazepines- diltiazem-similar to verapamil but less ADE
-dihydropyridines- nifedipine, amlodipine, felodipine, isradipine, nicardipine, nisoldipine, grater affinity for calcium channels, HTN, minimal effect on conduction and HR
MOA- block calcium in the heart and smooth muscles
Uses- HTN in asthma, DM, PVD, angina, afib
ADE- heart blocks, constipation, diltiazem and verapemil should be avoided in CHF or blocks, dizziness, HA, fatigue, peripheral edema
Methyldopa
MOA- alpha agonist
ADE- sedation, drowsiness
Uses- HTN in pregnancy
Vasodilators
Drugs- hydralazine, minoxidil
Reserved for resistant HTN
MOA- produce relaxation of vascular smooth muscles, increase myocardial contraction and can increase HR and oxygen consumption
Can cause angina, MI or CHF
Can increase sodium and water concentrations
Hydralazine- HTN and pregnancy Induced HTN, ADE- HA, tachycardia, nausea, sweating, arrhythmias, angina, lupus like syndrome
Minoxidil can cause body hair growth so can be used for male pattern baldness
HTN crisis
DOC- CCB like nicardipine and clevidipine, nitroglycerin, adrengeruc receptor antagonist like phentolamine, esmolol, labetalol, hydralazine
Carbonic anhydrase inhibitors
Drug- acetazolamide (diamox)
MOA- inhibits carbonic anhydrase in proximal tubules, bicarbonate is released more
Uses- glaucoma, altitude sickness
ADE/ metabolic acidosis, potassium depletion, renal stone forming, drowsiness, paresthesia
Avoid in cirrhosis
Osmotic diuretics
Drugs- mannitol (osmitrol)
MOA- filtered substances undergo little or no reabsorption so results in higher osmolarity in tubular fluid, Limits additional water reabsorption
Not useful for conditions in which sodium retention occurs
Use- maintain urine flow following acute toxic ingestion of substances that can cause ARF, and increased ICP
ADE- dehydration, extracellular water expansion
Sacubitril/valsartan (Entresto)
MOA- combines ARB with neprilysn inhibition and results in increased concentration of vasoactive peptides leading to natriuesis, vasodilation and inhibition of fibrosis
Decrease preload and after load
Uses- use in place of ARB/ACEI in SHF
ADE- similar to ACEI/ARB,
Do not give in hx of angioedem
Ivabradine (corlanor)
Class- hyperpolarization activtated cyclic nucleotide gates channel blocker
MOA- acts slowly on If current in SA node to reduce heart rate without reducing contractility, AV conduction, ventricular repolarization, or blood pressure
Uses- SHF
ADE- bradycardia
Not to be used in pregnancy or BF, with heart blocks or potent 3A4 inhibitors
Vericiguat (verquvo)
Class- soluble guanylate cyclase stimulator
MOA- directly simulates sodium guanylate and signals activation of cGMP to improve left ventricular compliance, vasodilation, reduce inflammation, and prevent hypertrophy and fibrosis
Uses- SHF recently hospitalized and in GDMT
ADE- minimal but due to vasodilators effects, hypotension, anemia, syncope
Contraindicated in pregnancy or BF
Avoid in use with other nitrates or phosphodiesterase inhubutirs
Milirinone
MOA- phosphodiesterase inhibitor that increases cAMP
Results in increase cardiac contractility
Usually given IV for SHF
Dobuatmine and milirinone can be used for intermediate term treatment for OP palliative care
Can also be used for right sided HF and pulmonary HTN
Class 1a anti arrhythmics
MOA- acts by blocking voltage sensitive sodium channels, slows phase 0 depolarization in cardiac myocytes and slows down QRS and QT
Drugs- quinidine, procainamide, disopyramide (norpace)
Uses- quinidine for variety, procainamide for atrial and ventricular, disopyramide for afib or flutter or ventricular
ADE- worsen HF, blurred vision, tinnitus, HA, disorientation, psychosis, hypotension if IV, disopyramide anticholinergic SE
D-D- CYP2D6 for quinidine and disopyramide
Do not use in atherosclerosis or HFrEF
Class 1B antiarrthymics
Drugs- lidocaine (xylocaine), mexiletine
MOA- sodium channel blocker shortens phase 3 repolarization in cardiac myocytes
ADE- worsening ventricular arrhythmia, syncope, dizziness, tremor, ataxia, paresthesia, confusion, seizures, liver failure, n/v, dyspepsia, dysphasia
Uses- alternative for VT VF, used in combo with amiodarone in VT storm
Mexiletine has narrow therapeutic range
D-D- CYP2D6
Class 1C anti arrhythmics
Drugs- flecainide (tambocor) and propafenone (rythmol)
MOA- sodium channel blockers phase 0 depolarization,
ADE- bradycardia, long QT, worsening arrthymias, acute HF, dizziness, hypotension, constipation, HA, tremor, visual disturbances, bronchospasm, liver failure, agranulocytosis, anemia, edema
Uses- af and a flutter, refractory ventricular arrhythmias
Avoid in structural heart disease
Class 2 anti arrhythmics
Beta blockers
Atenolol, esmolol, metoprolol
MOA- inhibit phase 4 depolarization in SA and AV node
Uses- tachy arrhythmia
Class 3 anti arrhythmics
Drugs- amiodarone (cordarone, pacerone), dofertilide (tikosyn), dronedarone (multaq), ibutilide (corvert), sotalol (betapace, sorine)
MOA- potassium channel blocker, prolongs phase 3
-Amiodarone- refractory SVT or ventricular arrhythmias, afib and flutter, ADE- pulmonary fibrosis, neuropathy, hepatotoxicity, corneal deposits, optic neuritis, blue gray skin discoloration, thyroid issues
-dronedarone- similar to amio, better ADE than amio, but liver failure still issue, do not given in symptomatic CHF, or permanent AF due to increase risk of death
-sotalol- also non selective blocker activity, afib, a flutter, refractory paroxysmal SVT, and ventricular arrhythmia, can be used in LVH or CAD, similar ADE to BB, initiate in hospital for QT monitoring
-dofetilide- first line for AF or HF or CAD, must be IP due to risk of proarrhymias
-ibutilide- DOC for chemical conversion of a flutter, IP due to risk of arrhythmias
Class 4 anti arrhythmics
Drugs- diltiazem (cardizem), verapamil (calan, verelan)
MOA- calcium channel blockers, inhibit action potential in SA and AV nodes
ADE- bradycardia, heart block, active HF, peripheral edema; hypotension, dizziness, constipation, gynecomastia, sexual dysfunction, gingival hyperplasia
Uses- atrial arrhythmia, re entrant SVT, reduce ventricular rates in AF or flutter
Other anti Arrhythmia
Digoxin (also for CHF)
Adenosine- decreases automaticity in AV node, IV for converting SVT, flushing, CP, and hypotension, very short DOA
Magnesium sulfate- torsades
Ranolazine- similar to amiodarone, antianginal properties, refractory atrial and ventricular arrhythmias in combination with others