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USMLE > Cardiac Drugs > Flashcards

Cardiac Drugs Flashcards

1
Q

Hydralazine - mechanism?

A

Increases cGMP –> smooth muscle relaxation. Vasodilates arterioles > veins; afterload reduction

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2
Q

Hydralazine - use? 2+2

A

Acute severe HTN, HF, safe for pregnancy. Given with B-blocker to prevent reflex tachycardia.

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3
Q

Hydralazine - toxicity? (5)

A

Reflex tachycardia, fluid retention, headache, angina, lupus-like syndrome

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4
Q

Diltiazem/verapamil - mech? (4)

A

Block voltage-dependent L-type Ca channels of cardiac and smooth muscle –> decrease muscle contractility in heart
Decrease conduction velocity
Increase ERP
Increase PR interval

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5
Q

Nimodipine - mech?

A

Block voltage-dependent L-type Ca channels of cardiac and smooth muscle –> decrease muscle contractility in vascular smooth muscle

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6
Q

Nimodipine - use? (1)

A

Subarachnoid hemorrhage

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7
Q

Clevidipine - use? (1)

A

Hypertensive urgency or emergency

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8
Q

Diltiazem/verapamil - use? (4)

A

HTN
Angina
AFib/flutter rate control
Prevention of nodal arrhythmias

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9
Q

Clevidipine - mech?

A

Block voltage-dependent L-type Ca channels of cardiac and smooth muscle –> decrease muscle contractility in vascular smooth muscle

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10
Q

Nifedipine - mech?

A

Block voltage-dependent L-type Ca channels of cardiac and smooth muscle –> decrease muscle contractility in vascular smooth muscle

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11
Q

Diltiazem - side fx? (7)

A 
Cardiac depression
AV block 
Peripheral edema, 
Flushing
Dizziness
Constipation
Gingival hyperplasia
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12
Q

Verapamil - side fx? (8)

A 
HYPERPROLACTINEMIA
Cardiac depression
AV block 
Peripheral edema, 
Flushing
Dizziness
Constipation
Gingival hyperplasia
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13
Q

Nitroprusside - use? (1)

A

Hypertensive emergency

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14
Q

Nitroprusside - mechanism?

A

Short acting, increase cGMP via direct release of NO

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15
Q

Nitroprusside - side fx?

A

CN toxicity

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16
Q

Fenoldopam - use? (1)

A

Hypertensive emergency

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17
Q

Fenoldopam - mechanism?

A

Dopamine D1 receptor agonist - coronary, peripheral, renal, and splanchnic vasodilation. Decreases BP and increases natriuresis.

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18
Q

Nitroglycerin - use? (3)

A

Angina, acute coronary synddrome, pulmonary edema

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19
Q

Nitroglycerin - mech?

A

Vasodilate by increasing NO in vasc smooth muscle - increase cGMP and smooth muscle relaxation. Veins more than arteries to decrease preload.

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20
Q

Nitroglycerin - side fx? (4)

A

Reflex tachycardia (tx with B-blockers)
Flushing
Headache
“Monday disease”

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21
Q

Isosorbide dinitrate - use? (3)

A

Angina, acute coronary synddrome, pulmonary edema

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22
Q

Isosorbide dinitrate - mech?

A

Vasodilate by increasing NO in vasc smooth muscle - increase cGMP and smooth muscle relaxation. Veins more than arteries to decrease preload.

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23
Q

Isosorbide dinitrate - side fx (4)?

A

Reflex tachycardia (tx with B-blockers)
Flushing
Headache
“Monday disease”

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24
Q

Isosorbide mononitrate - use? (3)

A

Angina, acute coronary synddrome, pulmonary edema

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25
Q

Isosorbide mononitrate - mech?

A

Vasodilate by increasing NO in vasc smooth muscle - increase cGMP and smooth muscle relaxation. Veins more than arteries to decrease preload.

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26
Q

Isosorbide mononitrate - side fx? (4)

A

Reflex tachycardia (tx with B-blockers)
Flushing
Headache
“Monday disease”

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27
Q

Statins - use (3)

A

Decrease LDL greatly
Increase HDL
Decrease TG

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28
Q

Statins - mech?

A

Inhibit conversion of HMG-CoA to mevalonate, decrease mortality in CAD patients

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29
Q

Statins - side fx? (2)

A

Hepatotoxicity (LFTs)

Myopathy (esp w/ fibrates & niacin)

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30
Q

Cholestyramine - use (3)

A

Decrease LDL
Increase HDL slightly
Increase TG slightly

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31
Q

Colestipol - use (3)

A

Decrease LDL
Increase HDL slightly
Increase TG slightly

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32
Q

Colesevelam - use (3)

A

Decrease LDL
Increase HDL slightly
Increase TG slightly

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33
Q

Cholestyramine - mech

A

Prevent intestinal reabsorption of bile acids; liver uses cholesterol to make more

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34
Q

Colestipol - mech

A

Prevent intestinal reabsorption of bile acids; liver uses cholesterol to make more

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35
Q

Colesevelam - mech

A

Prevent intestinal reabsorption of bile acids; liver uses cholesterol to make more

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36
Q

Cholestyramine - side fx? (2)

A

GI upset

Decreased absorption of other drugs and fat soluble vitamins

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37
Q

Colestipol - side fx? (2)

A

GI upset

Decreased absorption of other drugs and fat soluble vitamins

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38
Q

Colesevelam - side fx? (2)

A

GI upset

Decreased absorption of other drugs and fat soluble vitamins

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39
Q

Ezetimibe - use

A

Decrease LDL

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40
Q

Ezetimibe - mech

A

Prevent cholesterol absorption at small intestine brush border

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41
Q

Ezetimibe - side fx? (2)

A

Rare increase in LFTs

Diarrhea

42
Q

Gemfibrozil - use?

A

Decrease LDL
Increase HDL
Decrease TG greatly

43
Q

Clofibrate - use?

A

Decrease LDL
Increase HDL
Decrease TG greatly

44
Q

Bezafibrate - use?

A

Decrease LDL
Increase HDL
Decrease TG greatly

45
Q

Fenofibrate - use?

A

Decrease LDL
Increase HDL
Decrease TG greatly

46
Q

Gemfibrozil - mech? (2)

A

Upregulate LPL to increase TG clearance

Activates PPAR-a to induce HDL synthesis

47
Q

Clofibrate - mech? (2)

A

Upregulate LPL to increase TG clearance

Activates PPAR-a to induce HDL synthesis

48
Q

Bezafibrate - mech? (2)

A

Upregulate LPL to increase TG clearance

Activates PPAR-a to induce HDL synthesis

49
Q

Fenofibrate - mech? (2)

A

Upregulate LPL to increase TG clearance

Activates PPAR-a to induce HDL synthesis

50
Q

Gemfibrozil - side fx? (2)

A

Myopathy (increased risk with statins)

Cholesterol gallstones

51
Q

Clofibrate - side fx? (2)

A

Myopathy (increased risk with statins)

Cholesterol gallstones

52
Q

Bezafibrate - side fx? (2)

A

Myopathy (increased risk with statins)

Cholesterol gallstones

53
Q

Fenofibrate - side fx? (2)

A

Myopathy (increased risk with statins)

Cholesterol gallstones

54
Q

Niacin (Vit B3) - use?

A

Decrease LDL
Increase HDL (best)
Decrease TG

55
Q

Niacin - mech? (2)

A 
Inhibits lipolysis (hormone-sensitive lipase) in adipose tissue
Reduces hepatic VLDL synthesis
56
Q

Niacin (Vit B3) - side fx?

A

Red flushed face (fix with NSAIDs/long term use)
Hyperglycemia
Hyperuricemia

57
Q

Digoxin - use? (2)

A

HF (increase contractility)

AFib (decrease conduction at AV node and depression of SA node)

58
Q

Digoxin - mech?

A

Direct inhibition of Na/K ATPase to indirectly inhibit the Na/Ca exchanger leading to increase in IC Ca = positive inotropy
Stimulates vagus nerve to decrease HR

59
Q

Digoxin - side fx

A

Cholinergic - nausea, vomiting, diarrhea, blurry yellow vision, arrhythmias, AV block
Hyperkalemia

60
Q

Digoxin - antidote (4)

A

Slowly normalize K+
Cardiac pacer
Anti-digoxin Fab fragments
Mg2+

61
Q

Quinidine - mech? (4)

A

Class IA antiarrhythmic (Na channel blocker)
Increase AP duration
Increase ERP in ventricular AP
Increase QT interval

62
Q

Quinidine - use? (3)

A

Atrial arrhythmias
Ventricular arrhythmias
Re-entrant and ectopic SVT/VTs

63
Q

Quinidine - side fx? (3)

A

Cinchonism (headache, tinnitus)
Thrombocytopenia
Torsades de pointes due to increased QT interval

64
Q

Procainamide - mech? (4)

A

Class IA antiarrhythmic (Na channel blocker)
Increase AP duration
Increase ERP in ventricular AP
Increase QT interval

65
Q

Procainamide - use? (3)

A

Atrial arrhythmias
Ventricular arrhythmias
Re-entrant and ectopic SVT/VTs

66
Q

Procainamide - side fx? (3)

A

Reversible SLE-like syndrome
Thrombocytopenia
Torsades de pointes due to increased QT interval

67
Q

Disopyramide - mech? (4)

A

Class IA antiarrhythmic (Na channel blocker)
Increase AP duration
Increase ERP in ventricular AP
Increase QT interval

68
Q

Disopyramide- use? (3)

A

Atrial arrhythmias
Ventricular arrhythmias
Re-entrant and ectopic SVT/VTs

69
Q

Disopyramide - side fx? (3)

A

Heart failure
Thrombocytopenia
Torsades de pointes due to increased QT interval

70
Q

Lidocaine - mech? (2)

A

Class IB antiarrhythmic (Na channel blocker)
Decrease AP duration
Prefers affect ischemic or depolarized Purkinje and ventricular tissue

71
Q

Lidocaine - use? (2)

A

Acute ventricular arrhythmias (ESP POST MI)

Digitalis-induced arrhythmias

72
Q

Lidocaine - side fx? (2)

A

CNS stimulation/depression

CV depression

73
Q

Mexiletine - mech? (2)

A

Class IB antiarrhythmic (Na channel blocker)
Decrease AP duration
Prefers affect ischemic or depolarized Purkinje and ventricular tissue

74
Q

Mexiletine - use? (2)

A

Acute ventricular arrhythmias (ESP POST MI)

Digitalis-induced arrhythmias

75
Q

Mexiletine - side fx? (2)

A

CNS stimulation/depression

CV depression

76
Q

Flecainide - mech? (3)

A

Significantly prolongs ERP in AV node and accessory bypass tracts
No effect on ERP in Purkinje and ventricular tissue
Minimal effect on AP duration

77
Q

Flecainide - use? (2)

A

SVTs, including AFib

Last resort in refractory VT

78
Q

Flecainide - side fx?

A

Proarrhythmic, especially post-MI (contraindicated)

79
Q

Propafenone - mech? (3)

A

Significantly prolongs ERP in AV node and accessory bypass tracts
No effect on ERP in Purkinje and ventricular tissue
Minimal effect on AP duration

80
Q

Propafenone - use? (2)

A

SVTs, including AFib

Last resort in refractory VT

81
Q

Propafenone - side fx?

A

Proarrhythmic, especially post-MI (contraindicated)

82
Q

B-blockers (-olol) - mech (4)

A

Class II Antiarrhythmics
Decrease SA and AV nodal activity by decreasing cAMP, Ca currents.
Decreases slope of phase 4
AV node is particularly sensitive - increases PR interval

83
Q

B-blockers (-olol) - use (2)

A

SVT

Ventricular rate control for AFib/flutter

84
Q

B-blockers (-olol) - side fx? (5)

A 
Impotence
Exacerbation of COPD and asthma
CV fx (bradycardia, AV block, HF)
CNS fx (sedation)
Mask hypoglycemia
85
Q

Propanolol - side fx?

A

Exacerbate vasospasm in Prinzmetal angina

86
Q

Metoprolol - side fx?

A

Dyslipidemia

87
Q

B-blockers (-olol) - antidote? (3)

A

Saline
Atropine
Glucagon

88
Q

Amiodarone - mech? (5)

A 
Class III Antiarrhythmic - K channel blocker
Increases AP duration
Increases ERP
Increases QT interval
Has Class I - 4 effects
89
Q

Amiodarone - use

A

AFib/Flutter

VT

90
Q

Amiodarone - side fx (7)

A 
Pulmonary fibrosis
Hepatotoxicity
Hypo/hyperthyroidism
Neurologic fx
Constipation
CV effects (bradycardia, heart block, HF)
Check PFTs, LFTs, and TFTs
91
Q

Ibutilide - mech? (4)

A

Class III Antiarrhythmic - K channel blocker
Increases AP duration
Increases ERP
Increases QT interval

92
Q

Ibutilide - use

A

AFib/Flutter

93
Q

Ibutilide - side fx

A

Torsades de pointes

94
Q

Dofetilide - mech? (4)

A

Class III Antiarrhythmic - K channel blocker
Increases AP duration
Increases ERP
Increases QT interval

95
Q

Dofetilide - use

A

AFib/Flutter

96
Q

Dofetilide - side fx

97
Q

Sotalol - mech? (4)

A

Class III Antiarrhythmic - K channel blocker
Increases AP duration
Increases ERP
Increases QT interval

98
Q

Sotalol - use

A

AFib/Flutter

VT

99
Q

Sotalol - side fx

A

Torsades de pointes

Excessive B blockade

100
Q

Adenosine - mech & considerations (2)

A

Shifts K out of cells to hyperpolarize and decrease Ca
Very short acting
Effects blunted by theophylline and caffeine

101
Q

Adenosine - use

A

Diagnosing and abolishing SVT

102
Q

Adenosine - side fx

A 
Flushing
hTN
Chest pain
Sense of impending doom
Bronchospasm

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