Cardio Flashcards
Chlorthalidone
Indapamide
Hydrochlorothiazide
Thiazide-like diuretics
Use Thiazide-like diuretic for
Hypertension
Thiazide like diuretic adverse effects
Hypokalemia, Hyponatriemia- you are losing water and so you will also lose K and Na.
Thiazide-like diuretic contraindication
GFR lower than 30-40 ml/min. or if your patient is not making urine.
How do thiazide-like diuretics work?
inhibit Na Cl symporter in DCT, so it stops Na reabsorption back into body, so you excrete Na, which means you excrete H20.
DCT is where 5% of NA is reabsorbed.
Acetazolaminde
a Carbonic anhydrase inhibitor (CAI) diuretic
How do CAIs work
Inhibit reabsorption of sodium bicarb in PCT, so you excrete NA and H20. blocks where 65-70% NA would be reabsorbed.
When would you use a CAI?
CHF edema, open angle glaucoma or for altitude sickness. Not very effective for CHF edema though and you get metabolic acidosis if you use it for a long time.
Furosemide
Loop Diuretic
How do Loop Diuretics work?
Inhibit Na K Cl co transporter in thick ascending loop of Henle, so Na and water is excreted. Blocks where 25% of your Na would be reabsorbed.
When do you use a Loop Diuretic?
If you have SEVERE edema- pulmonary, CHF, liver cirrhosis, renal disease, etc.
When do you NOT use a Loop Diuretic?
If your pt is not making urine of if they already have electrolyte imbalances
Loop Diuretic side effects?
Pee a lot. can have ototoxicity if you do a rapid infusion, electrolyte imbalances(lose mg, ca). Can get photosensitivity. Can also increase your LDL and TG and lower your HDL. So not a first choice in someone at high risk for MI.
Loop diuretic drug interactions
Lithium, NSAIDS, corticosteroids
Triamterene
K sparing Diuretic
How do Potassium sparing diuretics work?
Inhibits Na reabsorbtoion isn the late DCT and collecting duct, where normally 1-2% of NA would be reabsorbed. It competitively binds to aldosterone receptors and blocks the Na transporter, This allows Na and H20 to be excreted while saving K and H.
When would you use Triamterene?
if you want to lessen the effects of losing K- hypokalemia- for your patients that are already taking thiazide diuretic.
Triamterene side effects
can get photo sensitivity and glucose tolerance. Can also get buildup of K and Cl.
Spironolactone
A potassium sparing diuretic.
When would you use Spironolactone?
If your pt has edema from liver cirrhosis.
Spironolactone side effects
gynecomastia.
Triamterene drug interactions
Lithium and NSAIDS. if taking ACEi, ARBs, B-blockers this can up the chance of getting hyperkalemia.
Spironolactone drug interactions
It is a strong 3A4 inhibitor . Don’t give with exogenous K, trimethoprim, NSAIDS or Lithium. It increases the half life of Digoxin.
Enalapril, Lisinopril, Quinapril
ACE inhibitors
how do ACE inhibitors work?
Inhibits Angiotensin-converting enzyme, which normally converts Angiotensin I to Agtn II, which lowers BP. It also prevents the degradation of bradykinin, which bronchoconstricts and vasodilates
When would you give an ACEi?
For Hypertension, primarily caused by renal artery stenosis. Can also give in HF, Post -MI, high risk Cardio its and for diabetics.
1st dose hypotension is a concern in what drug class?
ACEi
ACE side effects
Cough, Angioedema, acute renal failure if you take it with an NSAID (shuts off blood to glomerulus)
If your pt develops that annoying cough with their ACEi, what can you switch them to?
An ARB
ACEi are less effective in what ethnicity?
African Americans
ACEi pregnancy category
X- black box warning
Losartan, Valsartan
Angiotensin Receptor Blockers, ARBs
How do ARBs work?
They block angiotensin II receptors which dilates that arteries and decreases BP. Works further down the cascade so you do not affect bradykinin (no cough) and some angiotensin receptors will still work (only works on type I, type II still functions)
When would you use an ARB?
Hypertension
When would you use Losartan?
for HTN in its with Diabetic nephropathy and prophylactically for stroke
When would you use Valsartan
for HTN in CHF pts, or HTN post-MI with LVF.
ARB side effects
same as in ACEi, minus the cough and angioedema. So still can get 1st dose hypotension, hyperkalemia, acute renal failure.
ARB pregnancy category
X- black box warning
ARBs are less effective in this population?
African Americans
Amlodipine
CCB- Calcium Channel blocker
How Do CCBs work?
They block Ca by binding to L type Ca channels. In the heart, Ca depolarizes the muscle cell, and in smooth muscle it functions to constrict muscle cell. So by blocking Ca, overall this causes the heart to be hyper polarized and for vasodilation to happen. It decreases Heart force, Heart rate and conduction velocity.
CCBs are ___ antiarrhthmics
Class 4
How does Amlodipine work?
It is a CCB that binds to the N-site of L-type CA channel.
When would you use Amlodipine?
Most useful for HTN where you want maxi vasodilation and little action on the heart. Good for African Americans.
Verapamil
CCB
How does Verapamil work?
it binds to the V site of L-type Ca channel.
When would you use Verapamil?
most useful for angina and arrhythmia. has more heart action and less vasodilation action. good for african americans.
Diltiazem
CCB
How does Diltiazem work?
It binds to the D site of L-type Ca channel
When would you use Diltiazem?
When you want equal HTN and arrhythmia action. Good for African americans.
This type of CCB has the most side effects
Amlodipine. Also has the longest half life.
CCB side effects
Hypotension, MI, peripheral edema, constipation
Do not use CCB in patients with
Hypotension, sinus bradycardia, AV defect or in severe HF. Use caution if pt is on a beta blocker. Watch out for other cytochrome meds- inhibits cytochromes.
Propranolol, Carvedilol, Stalol
All Non selective B1 B2 Betablockers
How do non-selective Beta blockers work?
The inhibit sympathetic stimulation. they prevent NE binding. Have Membrane stabilizing activity and they decrease the action potential propagation.
Non selective Beta blockers ___ antiarrhythmetic
Class II
When would you use Propranolol?
for arrhythmias, angina, MI or HTN.
When would you use Carvedilol?
In HTN or CHF
When would you use Sotalol?
if you have arrhythmia
Non selective Beta blocker side effects
fatigue, bradycardia, depression, hyperglycemia, increased TG. Can mask the sympathetic side effects of hypoglycemia- think of diabetes pts here!
Atenlol, Metroprolol
B1 selective Beta blockers
How do B1 selective Beta blockers work?
Have the same MOA as the non-selectives, they just only work on B1 receptors.
When would you use Atenolol?
HTN, Angine, Arrhythmia, MI if pt also has asthma
When would you use Metorpolol?
CHF, HTN, Angina, Arrhthmia, if pt also has asthma.
Beta blocker contraindications
watch out if asthma, do not use in sinus bradycardia, or LV heart failure, or if to has had MI from coccaine. watch out if also giving a CCB- heart affects can be additive and you can depress it too much.
Nitroglyceride, Isosorbide dinitrate
Organic nitrates
How do organic nitrates work?
they release NO which vasodilator, increase O2 demand on heart and decrease preload and after load. Prevents vasospasm and acts as an anti-inflammatory.
When would you use sublingual or paths Nitroglyceride?
To relieve short term angina
When would you use Isosorbide dinitrate?
long term angina treatment.
organic nitrates are contraindicated in
pts with hypotension, head trauma and cerebral hemorrhage.
Organic nitrate side effects
headache, flushing, nausea, postural hypotension and reflex tachycardia.
Organic nitrate drug interactions
PRE inhibitors (VIAGRA)
How do general Na blockers, Class 1 anti arrhythmic work?
They inhibit NA influx to Block ectopic pacemaker events, prolong diastolic depolarization, increase the refractory period and block extrasystoles. Basically they depresss conduction in depolarized tissues.
general Na blocker side effects
N/V/D
Quinidine, Procainamide
Class 1A na channel blocker, MAO. slightly reduces phase 0, blocks IKr channels and increases QRS and QT.
When would you use a class 1A Na channel blocker?
In Afib, A-flutter, SVT and VT. Its a broad spectrum antiarrrythmetic. can use to maintain sinus rhythm after cardioconversion and to prevent ventricular tachycardia.
Quinidine side effect
enhances digitalis toxicity
Lidocaine
Class 1B Na channel blocker. weakly reduces phase 0, increases EPT and decreases QT
When would you use a class 1B Na channel blocker?
in VT after an MI.
When would you NOT use a class 1B Na channel blocker, Lidocaine?
in SVT- supraventricular tachyarhhythmia
Flecainide and Propafenone
Class 1C Na channel blocker. Strongly reduces phase 0, increases QRS.
When would you use a Class 1C Na blocker?
In life threatening SVT or VT
When can you not use a Class 1C Na channel blocker?
If pt has a hx. of ischemia.
Pracainamide side effects
25-30% of people will get a lupus-like syndrome
Flecainide side effects
Can induce life-threatening VTs that are resistant to tx.
Propanefone side effects
can worsen HF.
Overall, when can you not use a Na channel blocker?
To prevent cardiac arrhythmia post MI
How do Class K blockers work in general?
Bind to and block IKr channels in non-nodal cardiac tissue. This doesn’t allow K to leave, which will delay depolarization of cardiac muscle, increase the Refractory Period ERP and prolong QT
Amiodarone
a class III potassium channel blocker antiarrhythmetic. Has iodine in it- related to thyroxine- so it can block the conversion of T4 to T3.
When would you use amiodarone?
When you need to suppress tachyarrythmias caused by re-entry loops. If you have A-fib, A-flutter. It will maintain a sinus rhythm and tx a-fib.
Amiodarone side effects
Can cause hypo or hyperthyroidism, because it has thyroid function. Can cause gray-blue skin discoloration. Can also cause liver toxicity.
Sotalol
A Class III K channel blocker antiarrhythmics.
When do you use Sotalol?
if your patient has VT or if you want to maintain a sinus rhythm and treat a-fib or a-flutter
Sotalol contraindications?
Asthma. BB warning for torsades
Sotalol side affects?
can actually cause arrhythmia
Hydralazine
used for reflex tachycardia and increased CO
How does Hydralazine work?
It preferentially dilates arteries and arterioles, decreasing preload and afterload
Hydralazine side effects
Headache, N/V, angina, tachycardia. If your pt is a slow acetylateor, they will have a lupus-like syndrome
When would you use hydralazine?
It is especially usefully in African American patients who cannot take ACEi or ARBs. It can also be combine with organic nitrates to decrease pre-load. Its still ultimately to reduce reflex tachycardia and increased CO.
Digoxin
used for severe LV systolic dysfunction- a-fib.
How does Digoxin work?
It inhibits the N K ATPase, increasing the intracellular NA, which leads to less Ca efflux. The free CA floating around will increase contractility. Ultimately, it leads to a more efficient heart.
Digoxin side effects
There can be toxicity with Digoxin use! toxicity can slow AV conduction and give a-fib. GI sx include anorexia and n/v and CNS sx include headache, and seeing halos.
Digoxin precautions
Has a very narrow therapeutic index. Watch out for toxicity.
Tx for digoxin toxicity
Stop or decrease dose. Give K if needed.
Aspirin
An anti-platelt drug.
How does aspirin work?
It is an irreversible inhibitor of COX-A, which is involved in platelet aggregation.
When would you use aspirin (for heart)?
Low dose for life-ling therapy of chronic but stable angina, prevention of CVA, A-fib, PAD, and for an acute MI.
Aspirin side effects
GI bleed. Gout attack. Salicylism (vomiting, tinnitus, vertigo)
What is an aspirin OD?
20-35 tablets of 325mg. Can cause hyperthermia, seizures, coma and death.
Aspirin interactions?
NSAIDs competitively bind for the same site, so do not take within 2 hours of each other.
Aspirin contraindications
if you have hx of bleeding disorder and in children and teens–> Reyes syndrome
Clopidogrel
Antiplatelet drug, a P2Y12 inhibitor Thienopyridine
How do Thienopyridines work?
Creates a change in platelets so that they can no longer hold hands. Does this by inhibiting P2Y12 ADP on the platelet surface. It is a prodrug.
Prasugrel
An anti platelet drug, P2Y12 inhibitor, Thienopyridine
When would you use Thienopyridines?
In acute coronary syndrome- can use with aspirin. Can also use in secondary prevention of noncardioembolitic stroke or TIA, or cardioembolitic stroke.
Clopidogrel side effects?
later onset of action and is associated with less bleeding It is less effective and has shown resistance
Prasugrel side effects?
Increased risk of bleeding in pts getting CABG. Contraindicated in pts over 75, or if you have had a stroke or TIA.
When would you use a low molecular weight thrombin inhibitor?
DVT prophylaxis in surgery or as bridge therapy to warfarin. Need to do platelet counts every other day for a week to be sure the pt is anti coagulated.
When would you use a direct thrombin inhibitor?
Its an anticoagulant that is used in pts with HIT/HITT. Its is parenteral in hospitals.
Warfarin
a vitamin K antagonist anticoagulant.
How does Warfarin work?
It inhibits vitamin K epoxie reductase, preventing conversion of vitamin K to its active form. This inhibits Vitamin K dependent factors- 2, 7, 9, 10 and protein S/C.
When would you use warfarin?
When you need to anti coagulate someone with A-fib or post MI. Can also prevent DVT and can be lifelong for valve replacement people.
INR
Blood is too thick, risk for clotting
INR 4.5-10
Blood is too think, risk for bleeding out
When INR >10
STOP WARFARIN
Warfarin pregnancy category
X
Checking INR on warfarin
Check every 4-12 weeks. INR goal is 2-3, or 2.5-3.5 if you have a prosthetic valve
Exetimibe
A NPC1L1 Inhibitor for hyperchloestermeia
What does Exetimibe do?
Decreases LDL and TG by inhibiting MNPC1L1 in the gut, which decreases the amount of cholesterol the body can absorb.
