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Pharmacology > Cardiac Drugs Part 2 > Flashcards

Cardiac Drugs Part 2 Flashcards

1
Q

Ideal starting agent for HTN

A

Hydrochlorothiazide

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2
Q

MOA: Distal Tubule Diuretics (Thiazides)

A

Inhibits sodium and chloride reabsorption in the distal tubule - increase sodium and water excretion

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3
Q

Avoid Hydrochlorothiazide if they have a past history or at risk for

A

Gout

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4
Q

Thiazide and Loop diuretics increase potassium and sodium loss - what can you do in a hypokalemic state

A

add a K+ sparing diuretic to fix the electrolyte imbalance

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5
Q

Chlorthalidone is

A

a distal tubule diuretic (thiazide)
lower bioavailability than thiazides
HTN

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6
Q

Metolazone is

A

often used together with loop diuretics for the treatment of excess fluid in HF (once every four days - not everyday)
safe to use in states of renal insufficiency

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7
Q

Metolazone is __________ more potent than ________

A

10 times
hydrochlorothiazide

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8
Q

Indapamide is used for

A

HTN and decompensated HF but is uncommonly used

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9
Q

MOA: Loop diuretics

A

Inhibits chloride reabsorption at the Loop of Henle

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10
Q

When using loop diuretics you need to take caution with any _______ loss

A

hearing (ototoxic)

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11
Q

Furosemide is preferred in pts with low _____ and in _______ emergencies.

A

GFR
Hypertensive

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12
Q

MOA furosemide

A

inhibits chloride reabsorption which leads to high potassium loss in urine (need baseline K+ and check every so often)

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13
Q

SE furosemide

A

increases toxicity of ototoxic and nephrotoxic drugs and lithium

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14
Q

Loop diuretics - caution using in pts with _______ allergy

A

sulfa drug

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15
Q

Bumetanide is the _______ potent loop diuretic

A

most potent

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16
Q

Bumetanide had not been reported to have

A

ototoxicity

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17
Q

Large doses of Bumetanide have show to cause

A

severe myalgias (cramps)

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18
Q

MOA torsemide

A

blocks sodium, potassium and chloride carrier in thick ascending loop

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19
Q

SE of torsemide

A

HA and dizziness

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20
Q

MOA K+ sparing diuretics

A

Inhibit potassium secretion and influence sodium excretion in the distal tubule (reduces potassium loss in the urine)

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21
Q

SE of K+ sparing diuretics

A

hyperkalemia

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22
Q

Amiloride
Spironolactone
Triamterene
Eplerenone
Are all example of what class of drugs

A

K+ sparing diuretics

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23
Q

Spironolactone is used for

A

Daily management of edema, prevent acute pulmonary edema
Can be co-prescribed with thiazides

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24
Q

MOA spironolactone

A

aldosterone receptor antagonist –> competes with aldosterone to bind to mineralocorticoid receptor –> preventing sodium reabsorption and potassium excretion

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25
Q

SE of spironolactone

A

gynecomastia
increased risk for digitalis toxicity when co-administered

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26
Q

Spironolactone is contraindicated in

A

pregnancy

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27
Q

Eplerenone is used in

A

edema in HF, resistant HTN, hyperaldosteronism (adrenal gland releasing too much aldosterone)

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28
Q

Eplerenone is considered to have ________ risk of ___________ than spironolactone

A

lower
gynecomastia

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29
Q

Eplerenone is metabolized by

A

CYP

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30
Q

Triamterene is used in

A

HTN and is typically paired with thiazide diuretic

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31
Q

SE of triamterene

A

may turn urine blue
cause crystalluria and cast formation
decrease renal blood flow - caution in pts with renal disease

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32
Q

Acetazolamide is in what class of drugs

A

Carbonic anhydrase inhibitor

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33
Q

MOA of acetazolamide

A

inhibits the enzyme carbonic anhydrase in proximal renal tubule –> promoting renal excretion of sodium, potassium, bicarbonate and water

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34
Q

SE of acetazolamide

A

metabolic acidosis
renal stones
hyperammonemia - causing impairment in cognition

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35
Q

Acetazolamide is contraindicated in

A

pts with sulfa allergy

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36
Q

Acetazolamide is used in

A

prophylaxis of altitude sickness and chronic open-angle glaucome

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37
Q

Drugs that fall in the Osmotic diuretic category

A

mannitol

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38
Q

MOA mannitol

A

Blocking the reabsorption of water by kidney tubules at the glomerulus/ proximal convoluted tubule

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39
Q

Mannitol is used

A

to decreased pressure in the eyes (glaucoma), to lower increased ICP (intracranial pressure) and lithium toxicity

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40
Q

Do not use thiazides in the treatment of

A

hypercalcemia - can exacerbate hypercalcemia by increasing tubular calcium resorption

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41
Q

Enalapril
Captopril
Lisinopril
Are all drugs that fall into what category

A

ACE inhibitors

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42
Q

MOA ACE inhibitors

A

suppress synthesis of angiotensin 2 - suppress aldosterone resulting in natriuresis (more sodium/ more volume voided)

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43
Q

ACE inhibitors are used for treatment of

A

first line HTN in pts with high coronary disease risk, diabetes, stroke, HF, myocardial infarction or chronic kidney disease

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44
Q

_______ levels are not affected when taking ACE inhibitors

A

glucose levels, this is why it is preferred in pts with diabetic nephropathy (renoprotective)

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45
Q

ACE inhibitors decrease

A

peripheral vascular resistance

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46
Q

SE ACE inhibitors

A

first dose Hypotension (body will acclimate)
cough

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47
Q

The IV form of Enalapril is

A

Enalaprilat (which is the prodrug of the oral preperation)

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48
Q

Captopril infrequently causes

A

agranulocytosis or neutropenia (increased risk of infection)

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49
Q

Lisinopril is used to treat

A

HTN and HF

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50
Q

Lisinopril helps slow down ______ and lowers some ______.

A

diabetic kidney disease
lowering of blood sugars

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51
Q

Losartan
Valsartan
Candesartan
Olmesartan
Are all drugs that fall under what category

A

ARBs (angiotensin receptor blocker)

52
Q

SE ARBs

A

dry cough (less common than ACEi)
altered taste
additive effect with antihypertensive drugs

53
Q

MOA of ARBs

A

produce arteriolar and venous dilation and block aldosterone secretion

54
Q

ARBs have shown to help slow effects of

A

diabetic neuropathy

55
Q

Losartan is used

A

for HTN, diabetic neuropathy
good to give in pts who have gout

56
Q

Valsartan is used

A

for treatment of HF and HTN management

57
Q

Olmesartan is used for

A

HTN
significant mean blood pressure reduction

58
Q

What drug is the direct renin inhibitor?

A

Aliskiren

59
Q

MOA Aliskiren

A

Binds tightly with renin and thereby inhibits the cleavage of angiotensinogen into angiotensin 1
metabolized by CYP

60
Q

Aliskiren is used for

A

HTN

61
Q

SE Aliskiren

A

diarrhea at high doses

62
Q

Ambrisentan treats

A

Pulmonary HTN
improves exercise ability

63
Q

MOA Bosentan

A

Non Selectively blocks endothelin receptors

64
Q

MOA Ambrisentan

A

Selectively blocks type A endothelin receptors

65
Q

Bosentan treats

A

Pulmonary HTN

66
Q

Do not use __________ in HF

A

calcium channel blockers

67
Q

MOA calcium channel blockers

A

selectively blocks Ca2+ channels in the myocardium
decreases arterial pressure
decreased heart rate
decreased AV nodal conduction
decreased force of contraction
increased coronary perfusion

68
Q

In calcium channel blockers you need to dose adjust in

A

renal pts

69
Q

Verapamil
Diltiazem
are apart of what drug category

A

non-dihydropyridines (calcium channel blockers)

70
Q

Verapamil is used for

A

stable and vasospastic angina, essential HTN, dysrhythmias

stops the heart from beating too fast - monitor for bradyarrhythmias and heart block

71
Q

Diltiazem is used for

A

stable and vasospastic angina, essential HTN, dysrhythmias
immediate in its actions
monitor for bradyarrhythmias and heart block

72
Q

Nifedipine
Amlodipine
Felodipine
Are drugs that fall into what category

A

Dihydropyridines (calcium channel blockers)

73
Q

Dihydropyridines MOA

A

potent vasodilators
do not alter conduction through AV node

74
Q

Non Dihydropyridines MOA

A

decrease HR, slow AV nodal conduction
antihypertensives

75
Q

Nifedipine is used for

A

HTN, stable and vasospastic angina, migraine, raynaud’s disease

prevents vascular contraction

76
Q

Amlodipine is used for

A

HTN, stable, vasospastic angina

77
Q

Felodipine is used for

A

HTN, stable and vasospastic angina

78
Q

Amlodipine doesn’t need to be

A

monitored because it does not have the potential to cause electrolyte imbalances

79
Q

Isosorbide dinitrate
nitroglycerin
are drugs that fall into what category of drugs

A

Venous Vasodilators

80
Q

Nitroglycerin indications

A

treats chronic angina
severe hypertension

81
Q

Isosorbide dinitrate or monotrate indications

A

HF treatment in black pts incombo with hydralazine
prophylaxis of angina, esophageal spasm

82
Q

MOA of venous dilators

A

converted to nitric oxide in the body –> vasodilation –> decreased cardiac O2 demand

83
Q

Hydralazine
Minoxidil
Diazoxide
Are all drugs that fall under what category

A

Arterial vasodilators

84
Q

Hydralazine is used for

A

essential HTN
used to decrease afterload in HF pts

85
Q

SE of hydralazine

A

SLE syndrome
flushing

86
Q

Minoxidil (rogaine) is used for

A

reserved for pts with severe HTN
stimulant for hair growth

87
Q

Diazoxide is used for

A

acute or malignant HTN
hypoglycemia (inhibits insulin release from the pancreas)

88
Q

MOA minoxidil

A

opens K+ channels in vascular smooth muscle –> K+ flows out –> decreasing cells ability to contract –> arteriolar dilation

89
Q

MOA diazoxide

A

long-acting K+ channel opener –> salt and water retention

90
Q

SE diazoxide

A

excessive hypotension

91
Q

Sodium nitroprusside is a

A

venous and arteriolar vasodilator

92
Q

MOA of sodium nitroprusside

A

breaks down and releases nitric oxide –> activates guanylate cyclase –> catalyzes the production of cyclic GMP –> relaxes smooth muscle of veins and arterioles –> decreasing BP

93
Q

Sodium nitroprusside indications

A

HTN emergencies

94
Q

MOA Digoxin

A

inhibits Na+/K+ ATPase –> promotes calcium influx in myocytes –> increasing contractility increase in vagal tone –> slows SA node firing and AV node conduction

95
Q

Digoxin indications

A

acute decompensated HF, dysrhythmias

96
Q

Digoxin is second line is HF and does not ______ life

A

prolong

97
Q

MOA Milrinone

A

PDE inhibitor –> decreased breakdown of cAMP –> increased cAMP levels –> increased Ca2+ influx in myocytes and vasodilation in vasc sm muscle

98
Q

Milrinone indications

A

short term support for acute hemodynamic and sx relief in pts with HFrEF

99
Q

MOA Dobutamine

A

agonizes B1 receptors - increases HR1

100
Q

Dobutamine is a pressor in states of

A

acute heart failure

101
Q

MOA Ranolazine

A

inhibits late stage of Na+ current –> improvement O2 supply and demand

102
Q

Ranolazine indications

A

stable angina, arrhythmias

103
Q

Phenoxybenzamine MOA

A

irreversible non selective a1 and a2 receptors – decrease vasoconstriction

104
Q

Phenoxybenzamine indications

A

excessive sweating and HTN associated with pheochromocytoma

105
Q

Phentolamine MOA

A

reversible nonselective blockade of peripheral a1 and a2 receptors – decreased vasoconstriction

106
Q

Phentolamine indications

A

Dx and tx of pheo
HTN emergencies

107
Q

Prazosin and Doxasosin are (MOA)

A

selective a1 inhibitors – decreased vasoconstriction

108
Q

Propanolol
timolol
nadolol
are (MOA)

A

Nonselective B1 and B2 inhibition

109
Q

Prazosin and Doxazosin indications

A

HTN
PTSD nightmares

110
Q

Propanolol indications

A

performance anxiety, migraine prophylaxis, postural tremor

111
Q

Nadolol indications

A

HTN and management of chronic angina

112
Q

Pindolol indications

A

HTN

113
Q

Timolol indications

A

chronic glaucoma management

114
Q

Pindolol should be avoided in pts with prior

A

MI/ angina

115
Q

Metoprolol indications

A

HTN, stable and unstable angina, acute MI, supraventricular tachycardia, ventricular tachycardia, chronic stable HF, migraine prophylaxis

116
Q

Atenolol indications

A

HTN, stable and unstable angina, acute MI, supraventricular tachycardia, ventricular tachycardia, chronic stable HF, migraine prophylaxis

117
Q

Nebivolol indications

A

HTN and HF

118
Q

Carvedilol indications

A

chronic stable HF
decreases mortality in pts with prior MI

119
Q

Labetalol indications

A

HTN d/t pheo
HTN emergencies
Preeclampsia

120
Q

Labetalol and Carvedilol (MOA)

A

Non selectively blocks a1 b1 and b2 – peripheral vasodilation

121
Q

SE Carvedilol and Labetalol

A

orthostatic hypertension and dizziness
hypoglycemia

122
Q

Metoprolol
Atenolol
Nebivolol
Are (MOA)

A

selectively inhibits b1 receptors

123
Q

Nebivolol is the most ______ selective of all beta blockers

A

cardio

124
Q

Pindolol MOA

A

partial b1 and b2 agonist

125
Q

Organic nitrates contraindications

A

Coadministration of PDE-5 inhibitors
severe anemia

Pharmacology (7 decks)

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