cardio Flashcards
tx of HTN in preggos?
hydral
labetalol
methyldopa
nifedipine
DHP CCBs?
amlodipine clevidipine nicardipine nifedipine nimodipine
** act on vascular smooth mm
non-DHP CCBs?
dilt
verapamil
** act on heart
CCB MOA?
block L-type Ca channels –> decreased mm contractility
relative efficacy of CCBs on vascular mm?
amlodipine = nifedipine > dilt > verapamil
relative efficacy of CCBs on heart?
verapamil > dilt > amolidipine = nifedipine
nimodipine is used for?
SAH - prevention of vasospasm
clevidipine is used for?
HTN urgency/emergency
CCB toxicity?
cardiac depression, AV block peripheral edema flushing dizziness constipation gingival hyperplasia
** verapamil –> hyperprolactinemia
hydralazine MOA?
increases cGMP –> smooth mm relaxation (arterioles > veins)
AFTERLOAD reduction
hydralazine uses?
severe HTN (esp acute) HF (use with nitrate)
- safe in preg
- often with BB to prevent reflex tachy
hydralazine SEs?
compensatory tachy fluid retention H/A angina drug-induced lupus
nitroprusside?
increases cGMP via direct NO release
** can cause cyanide toxicity - causes cyanide release
fenoldopam?
D1 receptor agonist –> coronary, peripheral, renal, splanchnic vasodilation
decreased BP, increased natriuresis
** used in HTN emergency
nitrates MOA?
increase NO –> increase cGMP –> vasodilation (veins»_space; arterioles)
PRELOAD reduction
nitrates uses?
angina
ACS
pulm edema
nitrate toxicity?
reflex tachy
hypoT
flushing
H/A
** Monday dz: tolerance during work week from industrial exposure; tachy/dizziness/HA upon reexposure on Monday
what are pindolol and acebutolol?
partial beta agonists
CONTRAINDICATED in angina
statins?
cause large LDL decrease, some TG decrease, some HDL increase
inhib HMG-CoA reductase
SEs: hepatotoxicity, myopathy
bile acid resins?
moderate LDL decrease, slight increase in HDL and TGs
prevent intestinal bile acid reabsorption
SEs: GI upset, decreased drug/fat soluble vitamin absorption
ezetimibe?
moderate LDL decrease
prevents cholesterol absorption at SI brush border
SEs: rare increase in LFTS, diarrhea
fibrates?
large decrease in TGs, small decrease in LDL, small increase in HDL
upreg of LDL –> increased TG clearance
activatio of PPAR-a –> increased HDL synth
SEs: myopathy, cholesterol stones
niacin as lipid tx?
moderate LDL decrease, moderate HDL increase, slight TG decrease
inhibits HSL in adipose, inhibits hepatic VLDL synthesis
SEs: red flushed face (NSAIDs or long term use decrease), hyperglycemia, hyperuricemia
dig MOA?
direct inhib of Na/K ATPase –> indirect inhib of Na/Ca exchg
increased Ca –> positive inotropy
** also stimulates vagus –> decreased HR
dig uses?
HF
Afib (SA depression, decreased AV conduction)
dig toxicity?
cholinergic - N/V/D, yellow blurry vision, arrhythmias, AV block
hyperkalemia
** predisposing factors: renal failure, hypoK, verapamil, amiodarone, quinidine
how does quinidine predispose to dig toxicity?
displaces dig from tissue binding sites
decreases dig clearance
class I antiarrhythmics?
Na channel blockers
decrease phase 0 slope
slow or block conduction
** state dependent
class Ia?
quinidine, procainamide, disopyramide
increase AP length, ERP, QT
used in atrial and vent arrhythmias - esp SVT and VT
class Ia toxicity?
TCP
torsades
quinidine toxicity?
cinchonism
procainamide toxicity?
drug-induced lupus
disopyramide toxicity?
HF
class Ib?
lidocaine, mexilitine
decrease AP duration in ischemic Purkinje and ventricular tissue
used in acute ventricular arrhythmias, dig-induced arrhythmias, post-MI
Ib toxicity?
CNS stimulation/depression
cardiovascular depression
class Ic?
flecainide, propafenone
significant increase in ERP in AV and bypass tracts
used in SVTs, including Afib
class Ic toxicity?
proarrhythmic, especially post MI (CONTRAINDICATED)
class II antiarrhythmics?
BBs
decrease cAMP, Ca –> decrease SA and AV nodes, decrease phase 4 slope
used in SVT, Afib/flutter rate control
BB toxicity?
impotence
COPD/asthma exacerbation
may mask hypoglycemia signs?
metoprolol toxicity?
dyslipidemia
propranolol toxicity?
can exacerbate Prinzmetal angina spasm
tx of BB overdose?
saline
atropine
glucagon
class III antiarrhythmics?
K blockers - amiodarone, ibutilide, dofetilide, sotalol
increase AP duration, ERP, QT
used in Afib, Aflutter, VT
sotalol toxicity?
torsades
excessive beta blockade
ibutilide toxicity?
torsades
amio toxicity?
pulmonary fibrosis hepatotoxicity hypo or hyperthyroidism corneal deposits blue/gray skin deposits, photodermatitis neurologic constipation
class IV antiarrhythmics?
CCBs - verapamil, dilt
decrease conduction velocity, increase ERP, PR interval
used in preventing SVT, Afib rate control
class IV toxicity?
constipation
flushing
edema
adenosine MOA?
increases K efflux –> hyperpolarization - decreases Ca conductance
adenosine use?
dx and abolish SVT
very short acting
** blunted by theophylline and caffeine
adenosine toxicity?
flushing hypoT chest pain sense of impending doom bronchospasm
Mg2+ uses?
torsades
dig toxicity
