Cardiac Pharmacology Flashcards
What medication inhibits the cellular Na+/K+ ATPase, and what is it’s application?
Digoxin (or Digitalis) and it’s used for Congestive Heart Failure (CHF) and sometimes in Atrial Fibrillation
What class of anti arrhythmic does this drug belong to?
- Sotolol
Class III
What class of anti arrhythmic does this drug belong to?
-Propanol
What is its MOA?
Class II - decreases cAMP and decreases Ca+2 current (slope of phase 4) to prolong PR
What class of anti arrhythmic does this drug belong to?
-Bretylium
Class III
What class of anti arrhythmic does this drug belong to?
-Quinidine
Class I
What is the treatment for primary (essential) HTN?
Thiazides diuretics
ACE inhibitors
ARBs
Dihydropyridine Ca2+ channel blockers
What is the treatment for hypertension with heart failure?
Diuretics
ACE inhibitors/ARBs
Beta-Blockers (compensated HF)
Aldosterone Antagonists (Spironolactone, Eplerenone, Amiloride, Triamterene)
B-Blockers are used cautiously in decompensated HF and contraindicated in cardiogenic shock
What is the treatment of HTN with DM??
Thiazides diuretics
ACE inhibitors/ARBs
Dihydropyridine Ca2+ channel blockers
Beta-blockers
What is the treatment of HTN with asthma?
Thiazides diuretics
ARBs
Dihydropyridine Ca2+ channel blockers
Selective Beta-blockers
- Avoid nonselective BBs to avoid B2-receptor induced bronchoconstriction
- Avoid ACE inhibitors to prevent confusion between drug or asthma-related cough
What medications are used to treat HTN in pregnancy?
Hydralazine
Labetalol
Methyldopa
Nifedipine
What types of Ca2+ channel blockers are there? Name both groups and meds:
Dihydropyridines - Amlodipine, nifedipine, nimodopine, nicardapine
Non-Dihydropyridines: Diltiazam, Verapamil
What are the SEs of Ca2+ channel blockers?
Gingival hyperplasia
Dihydropyridine: peripheral edema, flushing, dizziness
Non-Dihydropyridine: cardiac depression, AV block, hyperprolactinemia (verapamil), and constipation
What is the MOA of hydralazine?
Increases cGMP to promote smooth muscle relaxation. Vasodilator arteries > veins, and thus reduces afterload.
What is the treatment of HTN emergency? What are the MOAs of those 2 drugs?
Nitroprusside- Increases cGMP via direct release of NO. Can cause cyanide toxicity.
Fenoldopam- Dopamine receptor D1 agonist (coronary, peripheral, renal, and splanchnic vasodilation). Decreases BP and increases naturesis. —> SE: tachycardia and hypotension
What is the MOA of nitrates?
Vasodilator of smooth muscle by increasing cGMP via NO. Veins>arteries
Name the drug at hand:
Inhibits the late phase of sodium current therapy reducing diastolic wall tension and oxygen consumption. Does not affect BP. Used for angina refractory to other medical therapies. May cause constipation, dizziness, headache, and nausea.
Ranolazine
Name the drug at hand:
Selective PDE-3 inhibitor. Raises cAMP - in heart, it increases inotropy and chronotropy.
In vascular smooth muscle: inhibits MLCK activity, general vasodilation
Used for short term acute decompensated HF
SEs: Arrhythmias, hypotension
Milrinone
Name the drug at hand:
MOA: Prevents degradation of natiuretic peptides, angiotensin II, and substance P by neprilysin; increases vasodilation, and decreases ECF volume. Used in combination with ARB (valsartan) to treat HFrEF. SE: hypotension, hyperkalemia, cough, and dizziness.
Contraindicated with ACE inhibitors due to angioedema.
Sacubitril
Describe the drug at hand and what are the associated SEs?
Prevent intestinal reabsorption of bile acids, liver must use cholesterol to make more.
Bile acid resins: Cholestyramine, colestipol, colesevelam
SEs: GI upset, decreased absorption of other drugs and fat soluble vitamins
Describe the drug at hand and what are the associated SEs?
Inhibits conversion of HMG-CoA reductase to mevalonate, a cholesterol precursor. Decreases mortality in CVD patients.
HMG-CoA reductase inhibitors- AKA statins.
Atorvastatin, lovastatin, pravastatin
SE: Hepatotoxic (increases LFTs), myopathy (especially when used with fibrates or Niacin)
Describe the drug at hand and what are the associated SEs?
Prevents cholesterol absorption at small intestine brush border.
Ezetimibe
SE: rare increases LFTs and diarrhea.
Describe the drug at hand and what are the associated SEs?
Upregulate LPL—> increases triglyceride clearance. Activates PPAR-alpha to induce HDL synthesis
Fibrates: Gemfibrozil, bezafibrate, fenofibrate
SE: myopathy (increased risk with statins), cholesterol gallstones (via inhibition of 7alpha-hydroxylase)
Describe the drug at hand and what are the associated SEs?
Inactivation of LDL receptor degradation, increasing amount of LDL removed from bloodstream.
PCSK9 inhibitors
SE: myalgias, delirium, dementia, other neurocognitive effects
Describe the drug at hand and what are the associated SEs?
Inhibits lipolysis (hormone sensitive lipase) in adipose tissue; reduces hepatic VLDL synthesis.
Niacin (vitamin B3)
SE: Red, flushed face (decreases by NSAIDs or long term use)
Hyperglycemia
Hyperuricemia
Name the drugs that are in Class 1A - Na+ channel blockers and their SEs:
What potency do they have (weak, moderate, or strong)?
Moderate Na+ channel blockade. Drug and SE: Procainamide - SLE-like syndrome Disopyramide- Heart Failure Quinidine - Cinchonism (tinnitus, deafness, blurred vision, dizziness, N/V)
Name the drugs that are in Class 1B - Na+ channel blockers and their SEs:
What potency do they have (weak, moderate, or strong)?
Weak Na+ channel blockade.
Work best for post MI or because preferentially goes to ischemic tissue:
Mexiletine - Severe GI upset
Lidocaine -
Tocainide - Pulmonary Fibrosis
Phenytoin- hirsutism and gingival hyperplasia
Name the drugs that are in Class 1C - Na+ channel blockers and their SEs:
What potency do they have (weak, moderate, or strong)?
Strong Na+ channel blockade.
Flecainide
Propafenone - also a beta blocker in addition to being Na+ channel blocker
SEs: proarrhythmic, especially post-MI (contraindicated). IC = CI in structural and ischemic heart disease
What beta blockers are partial agonists and antagonists??
Acebutolol
Atenolol
Pindolol
Safe to give to patients that are asmatic, COPD, and diabetes
What beta blockers are also alpha 1 antagonistic?
Labetalol
Carvedalol
Mainly used during hypertensive emergencies
What medication blocks beta receptors and K+ channels?
Sotolol
Prolongs QT interval —> can cause an arrhythmia
Name the drugs that are in Class III K+ channel blockers and their SEs:
Increase AP and ERP, prolong QT interval
Ibutilide
Amiodorone
SEs: Amiodorone - hypothyroidism, hyperthyroidism, corneal deposits, hepatic necrosis, pulmonary fibrosis, blocks cp450, and turn you blue
This medication prolongs slow depolarization (phase IV) by selectively inhibiting certain sodium channels.
Clinical use: chronic stable angina in patients who cannot take beta blockers. Chronic HFrEF.
Name the drug and it’s adverse effects.
Ivabradine
Adverse effects:
Luminous phenomena/visual brightness, hypertension, bradycardia
