Cardiac

Question 1

Organic ______
- primary drug to tx _____ pectoris

• Cellular MOA:
  • converted to ____ Oxide (NO)
  • NO stimulates guanylate cycles → ↑ in formation of ____
  • cGMP dephosphorylates myosin light chains causes vascular _________

Answer 1

Organic Nitrates:
angina

Nitric
cGMP
RELAXATION

Question 2

Actions of Organic Nitrates to treat angina:

• venous and arterial ______
  • Major effect - ↓ _______
  • Lesser effect - ↓ _______
• Coronary BF
  •dilate large _______ arteries and provide some ↑ O2 supply

Answer 2

dilation
Preload
Afterload

coronary

Question 3

Nitrate Pharmacokinetics:

• Rapid acting = low oral effectiveness due to ____ pass effect
• sublingual Nitroglycerin - tx ____ attacks of angina pectoris
• higher dose oral (swallowed) and transdermal Nitrate = _____ onset and long duration of action

Answer 3

Nitrate Pharmacokinetics:

1st
acute
slow

Question 4

• Nitroglycerin : every form available - IV, sublingual, oral, topical, transdermal (patch)
• Isosorbide dinitrate - sublingual
• Isosorbide mononitrate - oral

Answer 4

Organic Nitrate Drugs

Question 5

Nitrate AVE:

• Nitrate ________ - avoid by needing 8-10 hours Nitrate free period per day

- related to excessive vasodilation:
 • severe \_\_\_\_\_\_\_\_
 • facial flushing
 • hypotension (LBP) - \_\_\_\_\_\_\_\_, weakness
 • orthostatic (\_\_\_\_\_\_\_) hypotension
 • reflex tachycardia - \_\_\_\_\_\_\_\_

Answer 5

tolerance

headache

dizziness
postural
baroreceptor

Question 6

• new drug - less clinical experience
• tx angina
• MOA:
  • ↓ ______ muscle Na+ entry → ↓ Ca+ _____, ↓ cardiac construction → ↓ O2 demand
  • some ↑ _______ BF and O2 supply

-AVE:
 • arrhythmias
 • N/V
 • headache
 • constipation
 • dizziness

Answer 6

Ranolazine

cardiac
overload
myocardial

Question 7

• ends in a”pril”
  • enalaPRIL, captoPRIL, benazePRIL
• MOA:
  • inhibition of _________ II formation
  • block degradation of ________

- AVE:
 • 1st does \_\_\_\_\_\_\_
 • hyperkalemia
 • angioedema
 • Preg Cat. D

• increases survival rates

Answer 7

ACE Inhibitors

angiotensin
bradykinin

hypotension

Question 8

• end in “sartan”
  • valSARTAN, loSARTAN
• MOA: Block ________ II
• AVE: (similar to ACE but not bradykinin)
  • 1st dose ________
  • hyperkalemia
  • Preg Cat. D

Answer 8

Angiotensin Receptor Blockers (ARBs)

angiotensin

hypotension

Question 9

• end in “dipine”
  • amloDIPINE, nifeDIPINE
• MOA: block _-type Ca+ channels in vascular smooth muscle (not in heart)

- AVE:
 • \_\_\_\_ flushing
 • peripheral \_\_\_\_
 • headache
 • dizziness

Answer 9

Ca+ Channel Blockers (CCBs)

L

Facial
Edema

Question 10

• end in “olol” “lol”
  • carvediLOL, propranOLOL, metoprOLOL
• MOA: block b1 receptor causes ↓ HR and ↓ force ________

- AVE:
 • hypotension
 •symptoms of HF: \_\_\_\_\_, SOB, edema, fatigue, cold hands/feet
 • Bradycardia
 • drowsiness
 • depression
 • insomnia
 • bizarre \_\_\_\_\_\_

*abrupt withdrawal can worsen angina

Answer 10

Beta-Blockers

contraction

cough

dreams

Question 11

• primary benefit: ↓ plasma volume
• *Furosemide
• MOA: blocks Na+/__/Cl- transporter in the LOOP of ______ and ↓ Na+ reabsorption

- AVE:
 ~ electrolyte abnormalities (hypokalemia, \_\_\_\_\_\_\_\_\_\_\_)
 • dehydration
 ~ ototoxicity
 • hypotension, \_\_\_\_\_\_\_ 
 ~ caution in Preg

Answer 11

Loop Diuretics

K+
HENLE

hypochloremia

thrombosis

Question 12

• end in “zide”
  • hydrochlorothiaZIDE
• MOA: blocks Na+/Cl- transporter in the _______ CONVOLUTED tubule of the kidney
  • decrease Na+ reabsorption

- AVE:
 • \_\_\_\_\_\_\_\_\_\_
 • dehydration
 • hypotension
 • \_\_\_\_\_\_\_\_\_

Answer 12

Thiazide Diuretics

DISTAL

Hypokalemia

thrombosis

Question 13

• Digoxin (Lanoxin) - reduces symptoms

- MOA: 
 • block Na+ - K+ ATPase in \_\_\_\_\_\_ → cardiotonic drug
 • ↑ CO
   - ↓ sympathetic tone
   - ↓ \_\_\_\_\_ release
   - ↑ \_\_\_\_\_ production - ↓ edema

• AVE:
  • cardiac- bradycardia, ________
  • Non cardiac - anorexia, N/V, fatigue, visual disturbances, halos, yellow/green tinge to objects

Answer 13

Cardiac (Digitalis) Glycoside - Digoxin

Heart

renin
urine

arrhythmias

halos

Question 14

K+ Sparing Diuretics:

• ***Spironolactome
• MOA:
  • block _________ receptors in the collecting duct
  • ↑ plasma __
  • small ↓ plasma ___and volume
• AVE:
  • hyperkalemia
  ~ hormonal effects: gynecomastia (______ of breast tissue), menstrual irregularities, impotence, hirsutism

Answer 14

aldosterone
K+
Na+

swelling

Question 15

Drugs to Tx HF (↓ mortality):

• ___ inhibitors
• _________ rec. blockers (ARBs)
• _-adrenergic rec. bockers
• Vasodilators
• ***Spironolatone

Answer 15

ACE
Angiotensin
B

Question 16

Drugs to Tx HF symptoms

Answer 16

• Diuretics

- Digoxin

Question 17

• Hydralaine
• MOA:
  • direct _________
  • large drop in BP from _______ oxide (NO) or ↓ Ca+
• Not for ____-therapy (tachycardia, Na+ and H20 retention)
  ~ Drug for hypertensive ___________ = Nitroprusside

Answer 17

Direct Vasodilators

vasodilation
Nitrate
mono
emergencies

Question 18

Beta Blocker (-lol)

1st Generation

• non-selective
• Block B1and B2

Answer 18

Propranolol

Question 19

Beta Blocker (-lol)

2nd Generation

• Cardioselective
• Block B1

Answer 19

Metoprolol

Question 20

Beta Blocker (-lol)

3rd Generation

• Mixed Receptor Blockers
• Used in Hypertension, but not first-line drugs
• Block B1, B2, and a1

Answer 20

Carvedilol

Question 21

Are the secondary drug used for hypertension

Adverse effects:
• Fluid retention
• Hypotension, bradycardia, heart attack

Answer 21

Beta-Blocker

Question 22

Primary Drug for Beta Blockers

MOA:

• Prevents excessive sympathetic stimulation to prevent heart muscle failure
• Keeps heart responsive
• Turn off structural remodeling
• Increased survival in HF patients

Answer 22

Carvedilol (B1, B2, and a1)