Cardiac Drugs Part 2 Flashcards
Ideal starting agent for HTN
Hydrochlorothiazide
MOA: Distal Tubule Diuretics (Thiazides)
Inhibits sodium and chloride reabsorption in the distal tubule - increase sodium and water excretion
Avoid Hydrochlorothiazide if they have a past history or at risk for
Gout
Thiazide and Loop diuretics increase potassium and sodium loss - what can you do in a hypokalemic state
add a K+ sparing diuretic to fix the electrolyte imbalance
Chlorthalidone is
a distal tubule diuretic (thiazide)
lower bioavailability than thiazides
HTN
Metolazone is
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
Metolazone is __________ more potent than ________
10 times
hydrochlorothiazide
Indapamide is used for
HTN and decompensated HF but is uncommonly used
MOA: Loop diuretics
Inhibits chloride reabsorption at the Loop of Henle
When using loop diuretics you need to take caution with any _______ loss
hearing (ototoxic)
Furosemide is preferred in pts with low _____ and in _______ emergencies.
GFR
Hypertensive
MOA furosemide
inhibits chloride reabsorption which leads to high potassium loss in urine (need baseline K+ and check every so often)
SE furosemide
increases toxicity of ototoxic and nephrotoxic drugs and lithium
Loop diuretics - caution using in pts with _______ allergy
sulfa drug
Bumetanide is the _______ potent loop diuretic
most potent
Bumetanide had not been reported to have
ototoxicity
Large doses of Bumetanide have show to cause
severe myalgias (cramps)
MOA torsemide
blocks sodium, potassium and chloride carrier in thick ascending loop
SE of torsemide
HA and dizziness
MOA K+ sparing diuretics
Inhibit potassium secretion and influence sodium excretion in the distal tubule (reduces potassium loss in the urine)
SE of K+ sparing diuretics
hyperkalemia
Amiloride
Spironolactone
Triamterene
Eplerenone
Are all example of what class of drugs
K+ sparing diuretics
Spironolactone is used for
Daily management of edema, prevent acute pulmonary edema
Can be co-prescribed with thiazides
MOA spironolactone
aldosterone receptor antagonist –> competes with aldosterone to bind to mineralocorticoid receptor –> preventing sodium reabsorption and potassium excretion
SE of spironolactone
gynecomastia
increased risk for digitalis toxicity when co-administered
Spironolactone is contraindicated in
pregnancy
Eplerenone is used in
edema in HF, resistant HTN, hyperaldosteronism (adrenal gland releasing too much aldosterone)
Eplerenone is considered to have ________ risk of ___________ than spironolactone
lower
gynecomastia
Eplerenone is metabolized by
CYP
Triamterene is used in
HTN and is typically paired with thiazide diuretic
SE of triamterene
may turn urine blue
cause crystalluria and cast formation
decrease renal blood flow - caution in pts with renal disease
Acetazolamide is in what class of drugs
Carbonic anhydrase inhibitor
MOA of acetazolamide
inhibits the enzyme carbonic anhydrase in proximal renal tubule –> promoting renal excretion of sodium, potassium, bicarbonate and water
SE of acetazolamide
metabolic acidosis
renal stones
hyperammonemia - causing impairment in cognition
Acetazolamide is contraindicated in
pts with sulfa allergy
Acetazolamide is used in
prophylaxis of altitude sickness and chronic open-angle glaucome
Drugs that fall in the Osmotic diuretic category
mannitol
MOA mannitol
Blocking the reabsorption of water by kidney tubules at the glomerulus/ proximal convoluted tubule
Mannitol is used
to decreased pressure in the eyes (glaucoma), to lower increased ICP (intracranial pressure) and lithium toxicity
Do not use thiazides in the treatment of
hypercalcemia - can exacerbate hypercalcemia by increasing tubular calcium resorption
Enalapril
Captopril
Lisinopril
Are all drugs that fall into what category
ACE inhibitors
MOA ACE inhibitors
suppress synthesis of angiotensin 2 - suppress aldosterone resulting in natriuresis (more sodium/ more volume voided)
ACE inhibitors are used for treatment of
first line HTN in pts with high coronary disease risk, diabetes, stroke, HF, myocardial infarction or chronic kidney disease
_______ levels are not affected when taking ACE inhibitors
glucose levels, this is why it is preferred in pts with diabetic nephropathy (renoprotective)
ACE inhibitors decrease
peripheral vascular resistance
SE ACE inhibitors
first dose Hypotension (body will acclimate)
cough
The IV form of Enalapril is
Enalaprilat (which is the prodrug of the oral preperation)
Captopril infrequently causes
agranulocytosis or neutropenia (increased risk of infection)
Lisinopril is used to treat
HTN and HF
Lisinopril helps slow down ______ and lowers some ______.
diabetic kidney disease
lowering of blood sugars
Losartan
Valsartan
Candesartan
Olmesartan
Are all drugs that fall under what category
ARBs (angiotensin receptor blocker)
SE ARBs
dry cough (less common than ACEi)
altered taste
additive effect with antihypertensive drugs
MOA of ARBs
produce arteriolar and venous dilation and block aldosterone secretion
ARBs have shown to help slow effects of
diabetic neuropathy
Losartan is used
for HTN, diabetic neuropathy
good to give in pts who have gout
Valsartan is used
for treatment of HF and HTN management
Olmesartan is used for
HTN
significant mean blood pressure reduction
What drug is the direct renin inhibitor?
Aliskiren
MOA Aliskiren
Binds tightly with renin and thereby inhibits the cleavage of angiotensinogen into angiotensin 1
metabolized by CYP
Aliskiren is used for
HTN
SE Aliskiren
diarrhea at high doses
Ambrisentan treats
Pulmonary HTN
improves exercise ability
MOA Bosentan
Non Selectively blocks endothelin receptors
MOA Ambrisentan
Selectively blocks type A endothelin receptors
Bosentan treats
Pulmonary HTN
Do not use __________ in HF
calcium channel blockers
MOA calcium channel blockers
selectively blocks Ca2+ channels in the myocardium
decreases arterial pressure
decreased heart rate
decreased AV nodal conduction
decreased force of contraction
increased coronary perfusion
In calcium channel blockers you need to dose adjust in
renal pts
Verapamil
Diltiazem
are apart of what drug category
non-dihydropyridines (calcium channel blockers)
Verapamil is used for
stable and vasospastic angina, essential HTN, dysrhythmias
stops the heart from beating too fast - monitor for bradyarrhythmias and heart block
Diltiazem is used for
stable and vasospastic angina, essential HTN, dysrhythmias
immediate in its actions
monitor for bradyarrhythmias and heart block
Nifedipine
Amlodipine
Felodipine
Are drugs that fall into what category
Dihydropyridines (calcium channel blockers)
Dihydropyridines MOA
potent vasodilators
do not alter conduction through AV node
Non Dihydropyridines MOA
decrease HR, slow AV nodal conduction
antihypertensives
Nifedipine is used for
HTN, stable and vasospastic angina, migraine, raynaud’s disease
prevents vascular contraction
Amlodipine is used for
HTN, stable, vasospastic angina
Felodipine is used for
HTN, stable and vasospastic angina
Amlodipine doesn’t need to be
monitored because it does not have the potential to cause electrolyte imbalances
Isosorbide dinitrate
nitroglycerin
are drugs that fall into what category of drugs
Venous Vasodilators
Nitroglycerin indications
treats chronic angina
severe hypertension
Isosorbide dinitrate or monotrate indications
HF treatment in black pts incombo with hydralazine
prophylaxis of angina, esophageal spasm
MOA of venous dilators
converted to nitric oxide in the body –> vasodilation –> decreased cardiac O2 demand
Hydralazine
Minoxidil
Diazoxide
Are all drugs that fall under what category
Arterial vasodilators
Hydralazine is used for
essential HTN
used to decrease afterload in HF pts
SE of hydralazine
SLE syndrome
flushing
Minoxidil (rogaine) is used for
reserved for pts with severe HTN
stimulant for hair growth
Diazoxide is used for
acute or malignant HTN
hypoglycemia (inhibits insulin release from the pancreas)
MOA minoxidil
opens K+ channels in vascular smooth muscle –> K+ flows out –> decreasing cells ability to contract –> arteriolar dilation
MOA diazoxide
long-acting K+ channel opener –> salt and water retention
SE diazoxide
excessive hypotension
Sodium nitroprusside is a
venous and arteriolar vasodilator
MOA of sodium nitroprusside
breaks down and releases nitric oxide –> activates guanylate cyclase –> catalyzes the production of cyclic GMP –> relaxes smooth muscle of veins and arterioles –> decreasing BP
Sodium nitroprusside indications
HTN emergencies
MOA Digoxin
inhibits Na+/K+ ATPase –> promotes calcium influx in myocytes –> increasing contractility increase in vagal tone –> slows SA node firing and AV node conduction
Digoxin indications
acute decompensated HF, dysrhythmias
Digoxin is second line is HF and does not ______ life
prolong
MOA Milrinone
PDE inhibitor –> decreased breakdown of cAMP –> increased cAMP levels –> increased Ca2+ influx in myocytes and vasodilation in vasc sm muscle
Milrinone indications
short term support for acute hemodynamic and sx relief in pts with HFrEF
MOA Dobutamine
agonizes B1 receptors - increases HR1
Dobutamine is a pressor in states of
acute heart failure
MOA Ranolazine
inhibits late stage of Na+ current –> improvement O2 supply and demand
Ranolazine indications
stable angina, arrhythmias
Phenoxybenzamine MOA
irreversible non selective a1 and a2 receptors – decrease vasoconstriction
Phenoxybenzamine indications
excessive sweating and HTN associated with pheochromocytoma
Phentolamine MOA
reversible nonselective blockade of peripheral a1 and a2 receptors – decreased vasoconstriction
Phentolamine indications
Dx and tx of pheo
HTN emergencies
Prazosin and Doxasosin are (MOA)
selective a1 inhibitors – decreased vasoconstriction
Propanolol
timolol
nadolol
are (MOA)
Nonselective B1 and B2 inhibition
Prazosin and Doxazosin indications
HTN
PTSD nightmares
Propanolol indications
performance anxiety, migraine prophylaxis, postural tremor
Nadolol indications
HTN and management of chronic angina
Pindolol indications
HTN
Timolol indications
chronic glaucoma management
Pindolol should be avoided in pts with prior
MI/ angina
Metoprolol indications
HTN, stable and unstable angina, acute MI, supraventricular tachycardia, ventricular tachycardia, chronic stable HF, migraine prophylaxis
Atenolol indications
HTN, stable and unstable angina, acute MI, supraventricular tachycardia, ventricular tachycardia, chronic stable HF, migraine prophylaxis
Nebivolol indications
HTN and HF
Carvedilol indications
chronic stable HF
decreases mortality in pts with prior MI
Labetalol indications
HTN d/t pheo
HTN emergencies
Preeclampsia
Labetalol and Carvedilol (MOA)
Non selectively blocks a1 b1 and b2 – peripheral vasodilation
SE Carvedilol and Labetalol
orthostatic hypertension and dizziness
hypoglycemia
Metoprolol
Atenolol
Nebivolol
Are (MOA)
selectively inhibits b1 receptors
Nebivolol is the most ______ selective of all beta blockers
cardio
Pindolol MOA
partial b1 and b2 agonist
Organic nitrates contraindications
Coadministration of PDE-5 inhibitors
severe anemia
