Cardiac Pharm Flashcards
an example of thiazide diuretics
hydrochlorothiazide
MOA of thiazide diuretics
Blocks Na+APTase pumps in upper end of ascending loop of Henle and first segment distal tubule. This will prevent sodium from being pumped out of the filtrate. Water will follow the sodium and be excreted as urine. **may cause hypokalemia.
an example of loop diuretics
furosemide
MOA of loop diuretics
Blocks NA+ATPase pumps along the entire length of ascending loop of Henle; most powerful class of diuretics. **may cause hypokalemia
an example of potassium-sparing diuretic
amiloride and/or eplerenone
MOA of potassium-sparing diuretics
inhibits the Na+ATPase pumps that are indirectly linked to K+/H+ exchange in the distal tubule
MOA of eplerenone
An aldosterone receptor ANTAGONIST. Aldosterone promotes water and Na retention. Blocking an aldosterone receptor leads to diuresis.
an example of an osmotic diuretic
mannitol
MOA of osmotic diuretic
Pulls water into vasculature for elimination via osmosis. Does not depend on BP.
an example of a carbonic anhydrase inhibitor
acetazolamide
Examples of vasodilators (hint: there are 4)
Verapamil
Hydralazine
Nitric Oxide
Nitroprusside
MOA of verapamil
calcium channel blocker
MOA of hydralazine
K+ channel blocker and myosin light chain phosphatase activator
MOA of Nitric Oxide
guanylyl cyclase, myosin light chain phosphatase activator
What is myosin light chain phosphatase?
A substance that DEPHOSPHORALATES the cardiac cell, causing it to relax
What medications are specifically effective in African American patients with htn and HF
hydralazine and nitrates
ACE Inhibitor examples
Aliskiren, captopril and lisinopril
Example of an Angiotensin II receptor blocker (ARB)
losartan
How do ACE inhibitors and ARBs work?
By interfering with the RAAS, causing the body to excrete more urine and decrease blood volume to assist in BP management
Advantage of ACE inhibitors
inhibition of ACE reduces the risk of cardiovascular mortality in hypertensive patients. Are NOT contraindicated with patients who have asthma. Will not cause orthostatic hypotension
examples of antianginal drugs
propranolol and nitroglycerin
MOA of nitroglycerin
Nitroglycerine gets converted to nitric oxide which is a potent vasodilator in the coronary arteries which increases the supply of oxygen.
two medications that can be used in the treatment of cardiac arrest
epinephrine and isoproterenol
How do epinephrine and isoproterenol act to treat cardiac arrest
they act as beta1 agonists in cardiac tissue, increase the SNS activity of the sinoatrial node that can induce myocardial systole (contractions)
what medication prevents the spread of necrosis during an MI
propranolol
how does propranolol prevent spread of necrosis in an MI
propranolol acts as a beta1 antagonist which reduces heart rate, reduces work of the heart, reduces anoxia, and reduces the spread of necrosis
Another treatment to prevent necrosis, other than propranolol?
treat with fibrolytic drugs that dissolve blood clots (ex. TPA)
Examples of fibrolytic drugs
TPA, streptokinase and urokinase
MOA of TPA, streptokinase and urokinase
enzymes that catalyze plasmin formation within a clot that leads to fibrolysis… puts pt at risk for widespread bleeding
What medication is used to treat dysrhythmias?
amiodarone
MOA of amiodarone
amiodarone is a class III potassium channel blocker that is used to control atrial fibrillation and ventricular tachycardia caused by ectopic foci; its effects are also mediated by inhibition of sodium and calcium channels
Why is amiodarone a short term treatment?
AMIODARONE CAN CAUSE TOXIC LUNG, HEART, AND LIVER DAMAGE
Major negative side effect to ace inhibitors and the causation of it
ACE inhibitors also inhibit the enzyme that metabolizes the inflammatory mediator bradykinin > bradykinin along the respiratory airway stimulates an inflammatory condition > stimulates mucous secretion > stimulates a chronic cough
Pro to bradykinin metabolization
bradykinin is beneficial to the heart because it stimulates fibrolysis that reduces the progression of cardiac remodeling > prolonged life in pts with cardiac failure
What is the first line of treatment of patients with fluid overload
diuretics combines with ace inhibitors and/or arbs
MOA of eplerenone
aldosterone receptor antagonist
Usage of eplerenone
reduces symptoms of edema and blocks aldosterone’s role in promoting cardiac remodeling
MOA of tolvaptan
an oral vasopressin antidiuretic hormone receptor antagonist
What does tolvaptan used for
it is used to treat hyponatremia/hypervolemia that is secondary to end-stage HF.
what drug has a positive inotropic effect on the myocardium
digoxin
MOA of digoxin
it blocks the Sodium-Potassium ATPase pump > more sodium in the cell > Sodium-Calcium ATPase pump to work in overtime, excreting sodium from the cell > more calcium inside of the cell > stronger cardiac contractions
