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DRUG BRUTE FORCE MEMORIZATION > Cardio > Flashcards

Cardio Flashcards

1
Q

Heparin

A 
Anticoagulant
Surgical anticoag, unstable angina, thromb/isc stroke
Complex with AT
Inhibits factors 10a and 2a
Indirectly inhibits 7a
SE: Bleeding, HIT, osteoporosis, alopecia
IV and subcu
APTT
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2
Q

LMWH

A 
Low molecule weight heparin
Anticoagulant
Prophy/Tx of DVT and ACS
Complex with AT, inhibits 10a and 2a
SE: Bleeding
DO NOT GIVE TO HIT (still cross-rx)
Subcu
Better bioavailability and duration of action than hep
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3
Q

Fondaparinux

A 
Anticoagulant
Management of DVT
Complex with AT, inhibits 10a and 2a
SE: Bleeding
Subcu
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4
Q

Argatroban

A 
Anticoagulant
Management of HIT
Directly inhibits IIa
SE: Bleeding
DO NOT GIVE IN DIC
IV
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5
Q

Bivalirudin

A 
Anticoagulant
Management in HIT
Directly inhibits IIa
SE: Bleeding
IV
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6
Q

Hirudin

A 
Anticoagulant
Management of HIT
DIrectly inhibits IIa
SE: Bleeding
IV
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7
Q

Antithrombin Concentrates

A 
Anticoagulant
DIC, sepsis, thrombophilia, hypercoagulable state
Directly inhibits IIa
NO ADVERSE EFFECTS
IV
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8
Q

Protamine Sulfate

A 
(anti-)Anticoagulant
REVERSAL FOR HEPARIN
SE: Bradycardia, hypotension
IV
Highly basic
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9
Q

Warfarin

A

Oral Anticoagulant
Tx of DVT and a.fib
Comp antag of vit K, factor 2,7,9,10 not synthesized
SE: Bleeding, necrosis
Contras: emergency (hep is faster), high vit K diet, PREGGOS, multiple drug interactions (potential warfarin/inc bleeding)
PT/INR

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10
Q

Vitamin K

A

Oral (anti)Anticoagulant
Hypoprothrombinemia, reverse effects of warfarin
Cofactor in synth of factor 2,7,9,10
SE: Hemolysis

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11
Q

Rivaroxaban

A 
Oral anti-Xa
Oral Anticoagulant
Stroke prevention in a.fib, prophy/tx of DVT
Inhibits factor Xa
SE: Bleeding, liver toxicity
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12
Q

Apixaban

A 
Oral anti-Xa
Oral Anticoagulant
Stroke prevention in a.fib
Inhibits factor Xa
SE: Bleeding, liver toxicity
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13
Q

Dabigatran

A

Oral Anticoagulant
Stroke prevention in a.fib
Inhibits thrombin
SE: Bleeding, liver toxicity

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14
Q

Aspirin

A 
Antiplatelet drug
ACS, stroke, arterial thrombosis
COX inhibitor
SE: bleeding, gastic irritation
PO
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15
Q

Clopidogrel

A 
Antiplatelet drug
ACS, stroke, arterial thrombosis
ADP receptor inhibitor
SE: bleeding, TTP
Prodrug, liver turns it into active metabolite
PO
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16
Q

Prasugrel

A 
Antiplatelet drug
ACS, stroke, arterial thrombosis
ADP receptor inhibitor
SE: bleeding
Better response than plavix, is also a prodrug
PO
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17
Q

Ticagrelor

A 
Antiplatelet drug
ACS, stroke, arterial thrombosis
ADP receptor inhibitor
SE: bleeding
Is not a pro drug, CAN BE USED IN LIVER FAILURE
PO
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18
Q

NSAIDs

A 
Antiplatelet drug
Various diseases
COX inhibitor
Bleeding
PO
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19
Q

Dipyridamole

A 
Antiplatelet drug
Arterial thrombosis, stroke
Phosphodiesterase inhibitor (increases cAMP, blocks platelet aggregation response)
SE: Bleeding
Also a coronary vasodilator
PO
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20
Q

Cilostazol

A 
Antiplatelet drug
Intermittent claudication
Phosphodiesterase inhibitor
SE: hypotension
PO
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21
Q

Abciximab

A 
Antiplatelet drug
ACS/PCI
GPIIb/IIIa inhibitor
SE: Bleeding
IV
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22
Q

Eptifibatide

A 
Antiplatelet drug
ACS/PCI
GPIIb/IIa inhibitor
SE: Bleeding
IV
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23
Q

Tirofiban

A 
Antiplatelet drug
ACS/PCI
GPIIb/IIIa inhibitor
SE: Bleeding
IV
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24
Q

Monteleukast (singulair)

A 
Antiplatelet drug
Asthma and seasonal allergies
Leukotriene receptor inhibitor (dec. vasoconstriction, vascular permeability, inflammatory response)
SE: Hypotension, behavioral changes
PO
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25
Q

Zafirleukast

A 
Antiplatelet drug
Asthma
Leukotriene receptor inhibitor (dec. vasoconstriction, vascular permeability, inflammatory response)
SE: hypotension
PO
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26
Q

Zieuton

A 
Antiplatelet drug
Asthma
Lipoxygenase inhibitor (dec. vasoconstriction, vascular permeability, inflammatory response)
SE: hypotension
PO
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27
Q

Streptokinase

A 
Thrombolytic agent
Thrombolysis, stroke, MI, PE, DVT
Fibrinolytic, activates plasmin
SE: Bleeding
Contra: INTRACRANIAL BLEEDING
IV
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28
Q

Urokinase

A

Thrombolytic agent

Thrombolysis, stroke, MI, PE

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29
Q

tPA

A 
Tissue plasminogen activator
Thrombolytic agent
Thrombolysis, stroke MI
Fibrinolytic, activates plasmin
SE: Bleeding
Contra: INTRACRANIAL BLEEDING
IV
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30
Q

EACA

A 
Epsilon amino caproic acid (AMICAR)
(anti) Thrombolytic agent
Reversal of bleeding
Anti-fibrinolytic, inhibits plasmin
SE: Hypotension
IV
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31
Q

Aprotonin

A 
(anti) Thrombolytic agent
Reversal of bleeding
Anti-fibrinolytic
SE: Graft thrombosis
IV
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32
Q

Ancrod

A 
Thrombolytic agent
Fibrinolytic
SE: allergic rxn
Contra: INTRACRANIAL BLEEDING
IV
Derivative of snake venom
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33
Q

Tranexamic acid

A 
(AMCHA)
(anti) Thrombolytic agent
Reversal of bleeding
SE: retinopathy
IV
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34
Q

Rosuvastatin (Crestor)

A

Anti-hyperlipidemic agent
STATIN
High LDL
Inhibits HMG-COA reductase, SREBP triggered, increased LDL-R expression and LDL CLEARANCE
SE: Muscle myalgia/myopathy, RHABDOMYOLYSIS, hepatitis
Contra: severe liver disease
Decrease LDL, decrease TG, increased HDL
Drug interaction: CYP2C9 inhibitors inc [ ], gemfibrozil decreases OAT2P inc inc [STATIN]
Most potent

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35
Q

Atorvastatin (Lipitor)

A

Anti-hyperlipidemic agent
STATIN
High LDL
Inhibits HMG-COA reductase, SREBP triggered, increased LDL-R expression and LDL CLEARANCE
SE: Muscle myalgia/myopathy, RHABDOMYOLYSIS, hepatitis
Contra: severe liver disease
Decrease LDL, decrease TG, increased HDL
Drug interaction: CYP34A inhibitors (increase risk of SE), GRAPEFRUIT JUICE, gemfibrozil (decreases OAT2P, inc inc [STATIN])

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36
Q

Simvastatin (Zocor)

A

Anti-hyperlipidemic agent
STATIN
High LDL
Inhibits HMG-COA reductase, SREBP triggered, increased LDL-R expression and LDL CLEARANCE
SE: Muscle myalgia/myopathy, RHABDOMYOLYSIS, hepatitis
Contra: severe liver disease
Decrease LDL, decrease TG, increased HDL
Drug interaction: CYP34A inhibitors (increase risk of SE), GRAPEFRUIT JUICE, gemfibrozil (decreases OAT2P, inc [STATIN])

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37
Q

Pravastatin (Pravachol)

A

Anti-hyperlipidemic agent
STATIN
High LDL
Inhibits HMG-COA reductase, SREBP triggered, increased LDL-R expression and LDL CLEARANCE
SE: Muscle myalgia/myopathy, RHABDOMYOLYSIS, hepatitis
Contra: severe liver disease
Decrease LDL, decrease TG, increased HDL
Drug interaction: gemfibrozil (decreases OAT2P, inc [STATIN])
Less rhabdo, no CYP 450, liver/renal excretion

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38
Q

Lovastatin (Mevacor)

A

Anti-hyperlipidemic agent
STATIN
High LDL
Inhibits HMG-COA reductase, SREBP triggered, increased LDL-R expression and LDL CLEARANCE
SE: Muscle myalgia/myopathy, RHABDOMYOLYSIS, hepatitis
Contra: severe liver disease
Decrease LDL, decrease TG, increased HDL
Drug interaction: CYP34A inhibitors (increase risk of SE), GRAPEFRUIT JUICE, gemfibrozil (decreases OAT2P, inc [STATIN])

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39
Q

Fluvastatin (Lescol)

A

Anti-hyperlipidemic agent
STATIN
High LDL
Inhibits HMG-COA reductase, SREBP triggered, increased LDL-R expression and LDL CLEARANCE
SE: Muscle myalgia/myopathy, RHABDOMYOLYSIS, hepatitis
Contra: severe liver disease
Decrease LDL, decrease TG, increased HDL
Drug interaction: CYP2C9 inhibitors inc [ ], gemfibrozil decreases OAT2P inc inc [STATIN]
Least Potent

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40
Q

Cholestyramine

A 
Anti-hyperlipidemic agent
Bile Acid-Binding resin
High LDL
Prevents reabsorption of bile acids, inc. chol 7alpha-hydroxylase, dec. cholesterol, inc. LDL-R, inc. cholesterol clearance
SE: INCREASE TG (can cause pancreatitis)
Contra: TG > 400 mg/dL
Decreases LDL
Interferes with drug absorption (warfarin, phenobarb, digoxin, tetracycline)
OK for kiddos and PREGGOS
Impairs absorption of ADEK
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41
Q

Colestipol

A 
Anti-hyperlipidemic agent
Bile Acid-Binding resin
High LDL
Prevents reabsorption of bile acids, inc. chol 7alpha-hydroxylase, dec. cholesterol, inc. LDL-R, inc. cholesterol clearance
SE: INCREASE TG (can cause pancreatitis)
Contra: TG > 400 mg/dL
Decreases LDL
Interferes with drug absorption (warfarin, phenobarb, digoxin, tetracycline)
OK for kiddos and PREGGOS
Impairs absorption of ADEK
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42
Q

Colesevelam

A 
Anti-hyperlipidemic agent
Bile Acid-Binding resin
High LDL
Prevents reabsorption of bile acids, inc. chol 7alpha-hydroxylase, dec. cholesterol, inc. LDL-R, inc. cholesterol clearance
SE: INCREASE TG (can cause pancreatitis)
Contra: TG > 400 mg/dL
Decreases LDL
No drug interference
OK for kiddos and PREGGOS
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43
Q

Ezetimibine

A 
Anti-hyperlipidemic agent
Inhibitor of Cholesterol Absorption
High LDL
Blocks NPCL1 chol abs. in GI, dec. hepatic chol, inc. LDL-R, inc. LDL clearance
SE: Well-tolerate, flatulance, diarrhea
Dec. LDL
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44
Q

Alirocumab

A

Anti-hyperlipidemic agent
Inhibitors of PCSK9
Hetero FH, high LDL not controlled with max STATIN, STATIN intolerance
Inhibits PCSK9, dec. LDL-R degredation by lysosome, inc. LDL clearance
SE: Unknown, too new
Decreased LDL
Injected subcu q 2 weeks

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45
Q

Evolocumab

A

Anti-hyperlipidemic agent
Inhibitors of PCSK9
Hetero FH, high LDL not controlled with max STATIN, STATIN intolerance
Inhibits PCSK9, dec. LDL-R degredation by lysosome, inc. LDL clearance
SE: Unknown, too new
Decreased LDL
Injected subcu q 2 weeks

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46
Q

Lomitapide

A

Anti-hyperlipidemic agent
Homo FH
Inhibits MTP (TG transfer protein) in GI and liver, dec. production of chylo/VLDL/LDL
SE: Hepatotoxicity
Contra: PREGGOS
Dec. chylo/VLDL/LDL
Drug interaction: is a CYP34A and P-gp inhibitor

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47
Q

Mipomersen

A 
Anti-hyperlipidemic agent
Homo FH
Antisense oligo, specfici for apoB100, inc. expression apoB100, dec. VLDL/LDL
SE: Hepatotoxicity
Contra: mild/mod liver impairment
Dec. VLDL/LDL
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48
Q

Niacin

A

Anti-hyperlipidemic agent
Hypertriglyceridema, high VLDL/LDL, low HDL
Many MoA: dec. lipolysis, inhibits DGAT2/VLDL synthesis, apoC3/inc LPL, inc. apoAI, dec.LP(a)/dec. thrombosis, dec. clots, dec. risk of MI/stroke)
SE: SKIN FLUSHING (tx with NSAIDs), GOUT, PEPTIC ULCERS, heperglycemia, hepatitis
Dec. TG/LDL, inc. HDL
MOST EFFECTIVE DRUG TO RAISE HDLs

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49
Q

Gemfibrozil

A

Anti-hyperlipidemic agent
Hypertriglyceridemia, high VLDL/LDL, low HDL
Dec. apoC3/inc. LPL expression/inc. FFA oxidation/dec. VLDL synthesis/inc.VLDL clearance, APOAI expression/inc.HDL
SE: GALLSTONES, hepatitis, myopathy, RHABDOMYOLYSIS
Contra: severe renal/hepatic disease
Drug interactions: strong protein binder so can knock warfarin/sulfas off, STATINs (inhibits OATP2 which increases [STATIN])

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50
Q

Fenofibrate

A

Anti-hyperlipidemic agent
Hypertriglyceridemia, high VLDL/LDL, low HDL
Dec. apoC3/inc. LPL expression/inc. FFA oxidation/dec. VLDL synthesis/inc.VLDL clearance, APOAI expression/inc.HDL
SE: GALLSTONES, hepatitis, myopathy, RHABDOMYOLYSIS (more common in Gem though)
Contra: severe renal/hepatic disease
Drug interactions: strong protein binder so can knock warfarin/sulfas off

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51
Q

L-NMMA

A

Nitric Oxide Inhibitor
Sepsis-related disorders
Binds arginine binding site in NOA
Non-selective NOS inhibitor

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52
Q

L-NAME

A

Nitric Oxide Inhibitor
Sepsis-related disorders
Binds arginine binding site in NOA
Non-selective NOS inhibitor

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53
Q

7-Nitroindazole

A

Nitric Oxide Inhibitor
Sepsis-related disorders
Binds arginine binding site in NOA
Partiall selective for NOS-1 in vivo

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54
Q

BBS-2

A

Nitric Oxide Inhibitor
Sepsis-related disorders
Inhibits iNOS dimerization
Weakly inhibits nNOS and eNOS

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55
Q

Hemoglobin

A

Nitric Oxide Inhibitor
Sepsis-related disorders
NO scavenger

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56
Q

NO (INOMAX)

A 
NO Donor
ACS
Covalent modification of proteins
SE: vasodilation
Inhalation
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57
Q

Nitroglycerine

A

NO Donor
Pulmonary artery hypertension, exertional/variant/unstable angina
Rxs with vessel wall to increase [NO] in VSMC (causing venodilation)
SE: Orthostatic hypotension, reflex tachy, headache, nitrate tolerance
Contra: systemic hypotension
Sublingual

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58
Q

Hydralazine

A

NO Donor
Resistant/PREGGO Hypertension
NO donor, vasodilator
SE: Headache, nausea, vomiting, hypotension, tachycardia
Contra: long-term use
Drug interactions: NSAIDS REDUCE EFFECTIVENESS
PO

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59
Q

Sildenafil (Viagra)

A 
NO Donor
Hypertension
Phosphodiesterase inhibitor
SE: Hypotension, drug interactions (Nitro)
PO
60
Q

L-Arginine

A 
NO Donor
ACD, vascular disease
NO Donor
SE: Hypotension
PO
61
Q

Captopril

A

Vasoactive peptide
1stline drug in chronic chronic HTN, chronic CHF/a.fib
ACEI
SE: HYPERKALEMIA, rash, DRY COUGH, ANGIOEDEMA, severe stomach pain, chest pain, allergic reaction
Contra: PREGGOS, bilat renal stenosis
Drug interactions: exacerbates hyperK of K sparing drugs
PO
Short half life, multiple daily doses, active metabolites
PREVENTS LV REMODELING

62
Q

Enalapril

A

Vasoactive peptide
1stline drug used in chronic HTN, chronic CHF/a.fib
ACEI
SE: HYPERKALEMIA, rash, DRY COUGH, ANGIOEDEMA, hypotension, severe stomach pain
Contra: PREGGOS, bilat renal stenosis
Drug interactions: exacerbates hyperK of K sparing drugs
PO
Converted to active metabolite, longer onset, longer t1/3, dose 1-2xday
PREVENTS LV REMODELING

63
Q

Losartan

A

Vasoactive peptide
1stline drug used in chronic HTN, chronic CHF (esp if intolerant to ACEI)
Angiotensin receptor inhibitor (ARB)
SE: Diarrhea, insomnia, nasal congestion, HYPERKALEMIA
Contra: PREGGOS (causes renal failure)
Drug Interactions: K sparing drugs, hyperkalemic effects
PO
PREVENTS LV REMODELING

64
Q

Valsartan

A 
Vasoactive peptide
Hypertension, chronic CHF (esp if intolerant to ACEI)
Angiotensin receptor inhibitor (ARB)
SE: stomach pain, nausea
PO
PREVENTS LV REMODELING
65
Q

Icatibant

A 
Vasoactive peptide
Inflammatory responses
Bradykinin receptor inhibitor
SE: stomach pain, nausea
PO
66
Q

Aprotonin

A 
Vasoactive peptide
Inflammation
Kallikrein inhibitor
SE: MI, stroke, kidney failure
IV
67
Q

Desmopressin (DDAVP)

A 
Vasoactive peptide
Bleeding
Vasopressin analogue
SE: headache, stomach pain, nausea
IV
68
Q

Bosentan

A 
Vasoactive peptide
Pulmonary hypertension
Endothelin receptor inhibitor
SE: liver problems, stomach pain, nausea
PO
69
Q

Acetazolamide

A

Diuretic
Carbonic Anhydrase Inhibitor
Weak diuretic agent, inhibits CA in PROXIMAL TUBULE, reducing proximal HCO3 reabsorption
SE: Metabolic acidosis, hypokalemia (acute), CaPO3 stones, drowsiness, fatigue, CNS depression, paresthesia
Contra: cirrhosis
PO
Used in glaucoma, mountain sickness, raise urine pH
Organic ACID transporter

70
Q

Dorzolamide

A

Diuretic
Carbonic Anhydrase Inhibitor
Weak diuretic agent, inhibits CA in PROXIMAL TUBULE, reducing proximal HCO3 reabsorption
SE: Metabolic acidosis, hypokalemia (acute), CaPO3 stones, drowsiness, fatigue, CNS depression, paresthesia
Contra: cirrhosis
PO
Used in glaucoma, mountain sickness, raise urine pH
Organic ACID transporter
Same as acetazolamide by 30x more potent

71
Q

Methazolamide

A

Diuretic
Carbonic Anhydrase Inhibitor
Weak diuretic agent, inhibits CA in PROXIMAL TUBULE, reducing proximal HCO3 reabsorption
SE: Metabolic acidosis, hypokalemia (acute), CaPO3 stones, drowsiness, fatigue, CNS depression, paresthesia
Contra: cirrhosis
PO
Used in glaucoma, mountain sickness, raise urine pH
Organic ACID transporter
Same as acetazolamide, but 5x more potent

72
Q

Dichlorphenamide

A

Diuretic
Carbonic Anhydrase Inhibitor
Weak diuretic agent, inhibits CA in PROXIMAL TUBULE, reducing proximal HCO3 reabsorption
SE: Metabolic acidosis, hypokalemia (acute), CaPO3 stones, drowsiness, fatigue, CNS depression, paresthesia
Contra: cirrhosis
PO
Used in glaucoma, mountain sickness, raise urine pH
Organic ACID transporter
Topic prep for ocular use (avoids systemic effects)

73
Q

Mannitol

A

Osmotic diuretic
Tx or prevention of ARF
Reduce reabsorption of H2O and NaCl in proximal tubule
Contra: CHF, renal failure, pulmonary edema
SE: pulmonary edema, hyponatremia (in impaired renal function), hypernaturemia, nausea, vomiting, headache
No PO, IV only

74
Q

Glycerol

A

Osmotic diuretic
Tx or prevention of ARF
Reduce reabsorption of H2O and NaCl in proximal tubule
Contra: CHF, renal failure, pulmonary edema
SE: pulmonary edema, hyponatremia (in impaired renal function), hypernaturemia, nausea, vomiting, headache
No PO, IV only

75
Q

Urea

A

Osmotic diuretic
Tx or prevention of ARF
Reduce reabsorption of H2O and NaCl in proximal tubule
Contra: CHF, renal failure, pulmonary edema
SE: pulmonary edema, hyponatremia (in impaired renal function), hypernaturemia, nausea, vomiting, headache
No PO, IV only

76
Q

Furosemide

A

Lasix
Loop diuretic
Acute pulmonary edema, HTN, CHF (in renal insufficiency), ARF, CRF, ascites, nephrotic syndrome
Inhibits Na/K/2Cl contransporter in TAL (reduces reabsorption of Na, K, Cl, Mg, Ca, and H2O), also renal vasodilation
SE: HYPOKALEMIA, hypomagnesemia, HYPONUTREMIA, HYPOVOLEMIA, hyperuricemia, metabolic alkalosis, OTOTOXICITY, diarrhea, INCREASED LDL/HDL
PO
Lots of drug interactions; AMINOGLYCOSIDES (ototoxicity), BB, digoxin, NSAIDs, quinidine, sulfas, steroids
Also used to treat hypercalcemia and hyperkalemia
Strong rebound aldosterone, increased Na reabsorption and thus K excretion downstreatm

77
Q

Bumetanide

A

Loop diuretic
Acute pulmonary edema, HTN, CHF (in renal insufficiency), ARF, CRF, ascites, nephrotic syndrome
Inhibits Na/K/2Cl contransporter in TAL (reduces reabsorption of Na, K, Cl, Mg, Ca, and H20), also renal vasodilation
SE: Hypokalemia, hypomagnesemia, hyponutremia, HYPOVOLEMIA, hyperuricemia, metabolic alkalosis, OTOTOXICITY, diarrhea
PO
Lots of drug interactions; aminoglycosides, BB, digoxin, NSAIDs, quinidine, sulfas, steroids
40x more potent, shorter half life, 50% metabolized by liver

78
Q

Torsemide

A

Loop diuretic
Acute pulmonary edema, HTN, CHF (in renal insufficiency), ARF, CRF, ascites, nephrotic syndrome
Inhibits Na/K/2Cl contransporter in TAL (reduces reabsorption of Na, K, Cl, Mg, Ca, and H20), also renal vasodilation
SE: Hypokalemia, hypomagnesemia, hyponutremia, HYPOVOLEMIA, hyperuricemia, metabolic alkalosis, OTOTOXICITY, diarrhea
PO
Lots of drug interactions; aminoglycosides, BB, digoxin, NSAIDs, quinidine, sulfas, steroids
Longer 1/2life than lasix, longer duration, better absorption, 80% metabolized by the liver

79
Q

Ethacrynic acid

A

Loop diuretic
Acute pulmonary edema, HTN, CHF (in renal insufficiency), ARF, CRF, ascites, nephrotic syndrome
Inhibits Na/K/2Cl contransporter in TAL (reduces reabsorption of Na, K, Cl, Mg, Ca, and H20), also renal vasodilation
SE: WORSE SIDE EFFECTS, NEPHROTOXIC AND OTOTOXIC
PO
Lots of drug interactions; aminoglycosides, BB, digoxin, NSAIDs, quinidine, sulfas, steroids
Last resort, only used if sensitivity to others

80
Q

Hydrochlorothiazide

A

Thiazide
HTN, edema dt CHF, hepatic cirrhosis, renal disease, kidney stones
Inhibits apical NaCl cotransport (into cell) in early DCT
SE: HYPOKALEMIA, hyponatremia, hypovolemia, hyperuricemia, hypercalcemia, METABOLIC ALKALOSIS, hypoerglycemia (insulin resistance), hyperlipidemia, hypersensitivity, interstitial nephritis
Drug interactions: anticoags, BB, carbamazepine/chloropropamide, digoxin, NSAIDs, quinidine, steroids
Also used to treat diabetes insipidus

81
Q

Chlorothiazide

A

Thiazide
HTN, edema dt CHF, hepatic cirrhosis, renal disease, kidney stones
Inhibits apical NaCl cotransport (into cell) in early DCT
SE: HYPOKALEMIA, hyponatremia, hypovolemia, hyperuricemia, hypercalcemia, METABOLIC ALKALOSIS, hypoerglycemia (insulin resistance), hyperlipidemia, hypersensitivity, interstitial nephritis
Drug interactions: anticoags, BB, carbamazepine/chloropropamide, digoxin, NSAIDs, quinidine, steroids
1/10 potency, half life of 1.5 hours

82
Q

Metolazone

A

Thiazide
HTN, edema dt CHF, hepatic cirrhosis, renal disease, kidney stones
Inhibits apical NaCl cotransport (into cell) in early DCT
SE: HYPOKALEMIA, hyponatremia, hypovolemia, hyperuricemia, hypercalcemia, METABOLIC ALKALOSIS, hypoerglycemia (insulin resistance), hyperlipidemia, hypersensitivity, interstitial nephritis
Drug interactions: anticoags, BB, carbamazepine/chloropropamide, digoxin, NSAIDs, quinidine, steroids
10x more potent, longer half life, most efficacious in renal insufficiency

83
Q

Indapamide

A

Thiazide
HTN, edema dt CHF, hepatic cirrhosis, renal disease, kidney stones
Inhibits apical NaCl cotransport (into cell) in early DCT
SE: HYPOKALEMIA, hyponatremia, hypovolemia, hyperuricemia, hypercalcemia, METABOLIC ALKALOSIS, hypoerglycemia (insulin resistance), hyperlipidemia, hypersensitivity, interstitial nephritis
Drug interactions: anticoags, BB, carbamazepine/chloropropamide, digoxin, NSAIDs, quinidine, steroids
20x more potent, 1/2 life of 10-22 hours, metabolized by the liver

84
Q

Chlorthalidone

A

Thiazide
HTN, edema dt CHF, hepatic cirrhosis, renal disease, kidney stones
Inhibits apical NaCl cotransport (into cell) in early DCT
SE: HYPOKALEMIA, hyponatremia, hypovolemia, hyperuricemia, hypercalcemia, METABOLIC ALKALOSIS, HYPERGLYCEMIA (insulin resistance), INCREASED LDL/HDL, hypersensitivity, interstitial nephritis, impotence
Contra: HYPOKALEMIA, PREGGOS
Drug interactions: anticoags, BB, carbamazepine/chloropropamide, digoxin, NSAIDs (will decrease prostaglandin effect), quinidine, steroids
Same potency, 1/2life of 44 hours

85
Q

Spironolactone

A

K sparing diuretic/ chronic CHF
Chronic liver disease (tx second to hyperaldosteronisms from cirrhosis), prevent hypokalemia from other drugs, chronic CHF/a.fib
ARB: Blocks aldosterone on collective tubules (dec. Na reabsorption, spares K and H)
SE: HYPERKALEMIA, gynecomastia, hirsutism, menstrual irregularties, testicular atrophy
Drug interaction: ACI (hyperK, cardiac arrhyth), NSAIDs (hyperK), RAS inhibitors
Also used to treat primary hyperaldosteronism
PREVENTS LV REMODELING AND FIBROSIS!

86
Q

Eplerenone

A

K sparing diuretic/ chronic CHF
Chronic liver disease (tx second to hyperaldosteronisms from cirrhosis), prevent hypokalemia from other drugs, chronic CHF/a.fib
Blocks aldosterone on collective tubules (MR receptor)
SE: HYPERKALEMIA
Drug interaction: ACI (hyperK, cardiac arrhyth), NSAIDs (hyperK), RAS inhibitors
NO ANTIANDROGENIC SE
PREVENTS LV REMODELING AND FIBROSIS!

87
Q

Amiloride

A

K sparing diuretic
Prevent hypoK effects of other drugs
ENaC inhibitor: Reduce Na entry across luminal membrane of principal cells of DCT (decreases driving force for K efflux)
SE: HYPERKALEMIA, glucose intolerance in diabetics
Drug interaction: ACEI (hyperK, cardiac arrhyth), NSAIDs (hyperK), RAS inhibitors

88
Q

Triamterene

A

K sparing diuretic
Prevent hypoK effects of other drugs
ENaC inhibitor: Reduce Na entry across luminal membrane of principal cells of DCT (decreases driving force for K efflux)
SE: HYPERKALEMIA, megaloblastic anemia in pts with liver cirrhosis
Drug interaction: ACEI (hyperK, cardiac arrhyth), NSAIDs (hyperK), RAS inhibitors
Liver metabolizes drug, ORGANIC BASE TRANSPORTER

89
Q

Doxycycline

A 
Diuretic
ADH Antagonist
SIADH, hyponutremia
Prevent ADH-induced water reabsorption in principal cells of collecting tubule
SE: Nephrotoxic
Also used in CHF
90
Q

Lithium

A 
Diuretic
ADH Antagonist
SIADH, hyponutremia
Prevent ADH-induced water reabsorption in principal cells of collecting tubule
SE: Nephrotoxic
Also used in CHF
91
Q

Tolvaptan

A

Diuretic
ADH Antagonist
SIADH, hyponutremia
Prevent ADH-induced water reabsorption in principal cells of collecting tubule
SE: Hypernatremia, thirst, dry mouth, hypotension, dizziness
Also used in CHF

92
Q

Conivaptan

A

Diuretic
ADH Antagonist
SIADH, hyponutremia
Prevent ADH-induced water reabsorption in principal cells of collecting tubule
SE: Hypernatremia, thirst, dry mouth, hypotension, dizziness
Also used in CHF, IV available for tx of euvolemic hyponatremia

93
Q

Mozavaptan

A

Diuretic
ADH Antagonist
SIADH, hyponutremia
Prevent ADH-induced water reabsorption in principal cells of collecting tubule
SE: Hypernatremia, thirst, dry mouth, hypotension, dizziness
Also used in CHF

94
Q

Procainamide

A

Anti-arrhythmic
Class IA (intermediate kinetics, prolonged AP)
A and V arrhyth, v.arryth post MI
Blocks Na and K channels, slows upstroke of AP, prolongs QRS, depresses SA/AV
SE: Torsades, hypotension, anticholinergic effects, lupus
PO, IV, IM
t1/2 3-4 hours, renally eliminated, NAPA metabolite

95
Q

Quinidine

A

Anti-arrhythmic
Class IA (intermediate kinetics, prolonged AP)
A and V arrhyth, v.arryth post MI
Blocks Na and K channels, slows upstroke of AP, prolongs QRS, depresses SA/AV
SE: stronger antichol effects, cinchonism (headache, dizziness, tinnitus)
Rarely used b/c severe cardiac effects

96
Q

Disopyramide

A

Anti-arrhythmic
Class IA (intermediate kinetics, prolonged AP)
V arrhyth only
SE: Greatest antichol effects (increases sinus rate and AV conduction), negative inotropic, atropine-like actions
Requires co-admin of drugs that slow conduction

97
Q

Lidocaine

A

Anti-arrhythmic
Class IB (fast kinetics, reduction of AP duration)
V.arrhyth after MI, DRUG OF CHOICE for vtach and v fib after cardioversion
Na channel blockade, dec. AP duration, depression of conduction in depolarized (ischemic) cells
SE: least cardiotoxic class I, neurologic SE dt local anestheic properties
IV only
Extensive first pass liver metabolization, t1/2 is 1-2 hours
Prophy tx not recommended (can increase mortality)

98
Q

Mexiletine

A

Anti-arrhythmic
Class IB (fast kinetics, reduction of AP duration)
V.arrhyth after MI, DRUG OF CHOICE for vtach and v fib after cardioversion
Na channel blockade, dec. AP duration, depression of conduction in depolarized (ischemic) cells
SE: least cardiotoxic class I, neurologic SE dt local anestheic properties
PO
t1/2 is 8-10 hours
Off label use for chronic pain

99
Q

Flecainamide

A

Antiarrhythmic
Class IC (slow kinetics, no effect on AP duration)
Supravent arryth in otherwise normal hearts
Na and K channel blockade, no anticholinergic effects
CONTRA: V.TACH, MI, VENTRICULAR ECTOPY
Well absorbed, t1/2 is 20 hours, eliminated in liver and kidney

100
Q

Propafenone

A

Antiarrhythmic
Class IC (slow kinetics, no effect on AP duration)
Supravent arryth in otherwise normal hearts
Na and K channel blockade, similar to propranolol but with weak BB
SE: arrhythmogenic, sinus bradycardia, bronchospasm (from BB), metallic taste, constipation

101
Q

Propranolol

A

Antiarrhythmic
Class 2
Nonselective BB
Prevents recurrent infarction after MI, a.fib, a.flutter, AV nodal reentry
Inhibits sympathetics, reduce HR and pacemaker current, reduce conduction, decrease catecholamine DAD and EADs
SE: bradycardia, reduced exercise capacity, heart failure, hypotension, AV block, bronchospasm
Contra: sinus brady, partial AV block, asthma, COPD, diabetics
Can mask tachy symptoms of hypoglycemia

102
Q

Esmolol

A 
Antiarrhythmic
Class 2
Cardioselective BB (B1)
Acute supravent tachycardia
IV only
Short half-life
103
Q

Amiodarone

A

Antiarrhythmic
Class 3 (prolongation of AP duration)
PO: recurrent v.tach/v.fib, a.fib
IV: out-of-hospital cardiac arrest, v.tach, v.fib
Blocks K, Na, Ca, B-receptors, prolongs AP refractoriness, slows conduction, suppresses abnormal automaticity, prolongs QT and QRS
SE: bradycardia, heart block, pulmonary FIBROSIS, hepatic toxicity, photodermatiis, blocks T4 to T3 (hypo/hyperthyroidisms)
PO, IV
30-0% bioavailable, lipohilic, accumulates in heart/lung/liver/cornea

104
Q

Dronedarone

A

Antiarrhythmic
Class 3 (prolongation of AP duration)
A.fib, a.flutter
Blocks K, Na, Ca, B-receptors, prolongs AP refractoriness, slows conduction, suppresses abnormal automaticity, prolongs QT and QRS
SE: similar to amiodarone, without thyroid effects
Contra: severe heart failure
t1/2 is 24 hours
Structural analogue of amiodarone, designed to eliminate effects on thyroxine

105
Q

Sotalol

A 
Antiarrhythmic
Class 3 (prolongation of AP duration)
V and supraV arrhyth, maintenance of sinus rhythm in a.fib
Nonselective BB, inhibits delayed rectifier and other K currents
106
Q

Verapamil

A

Antiarrhythmic
Class 4 (Ca channel blockers)
Non-dihydropyridine
1stline HTN, Supravent arrhyth, reentry AV, slows ventricular rate in a.flutter/fib, exertional angina, variant angina
Blocks L-type Ca channels in heart, major effects in slow response tissues (SA/AV node), slows conduction, increases AV node refract, lowers HR, increases PR, vasodilation in periphery
SE: vasodilation, BRADYCARDIA, hypotension, fibrillation, LV dysfunction, CONSTIPATION, lassitude, nervousness, vasodilation, peripheral edema
Contra: Liver dysfunction, CONDUCTION DISTURBANCES, BB (use with caution)
PO
Metabolized in liver

107
Q

Diltiazem

A 
Antiarrythmic
Class 4 (Ca channel blockers)
Non-dihydropyridine
1stlineHTN and angina pectoris
Blocks Ca channels in heart and periphery (vasodilation)
SE: dizziness, headache, edema, BRADYCARDIA
Contra: conduction disturbances
Lower cardioselectivity than verapamil
108
Q

Adenosine

A

Antiarrythmic
Class 4 (Ca channel blockers)
Conversion of paroxysmal supraven tachy to sinus rhyhtm
Increases K conductance, inhibits Ca currents, slows AV node, produces transient cardiac arrest
SE: Flushing and SOB
Contra: theophylline/caffeine (reduces effectiveness), potentiated by dipyridamole
Rapid IV bolus
t1/2 is seconds

109
Q

Magnesium

A 
Antiarrythmic
Class 4 (Ca channel blockers)
Digitalis induced arrhythmias with hypomg
Unknown MoA
IV
110
Q

Potassium

A

Antiarrythmic
Class 4 (Ca channel blockers)
Maintain normal plasma K
Hyperkalemia: depolarizes resting membrane/slows conduction potential
Hypokalemia: decreases K permeability/enhances ectopic automaticity/lengthens AP duration (can lead to EADs)
IV, PO

111
Q

Digitalis

A

Antiarrythmic
Class 4 (Ca channel blockers)
Cardiac glycoside
A.arrhyth, a.flutter, a.fib, acute CHF
Inhibits Na/K-ATPase, increases intracell Ca, causes (+) inotropy, increased AV refract, slows AV conduction
SE: DADs, yellow-green visual disturbances, anorexia, blurred vision, drowsiness, depression
Conta: aminodarone, verapamil, flecainide, hypokalemia/magnesemia
Long t1/2 (40 hours), eliminated by kidney, narrow therapeutic window

112
Q

Nifedipine

A

Dihydropyridine
Ca channel antagonist, blocks L-type Ca channels in VSMC causes vasodilation/decreased contractility
1st line drug for uncomplicated HTN, used in diabetes and hyperlipidemia, anti-anginal
SE: ACUTE TACHY (reflex), headache, PERIPHERAL EDEMA, flushing, bradycardia, heart block, CHF, hypotension

113
Q

Clonidine

A

Antihypertensive
Second line for HTN
a2 agonist (decreases sympathetic outflow from CNS)
SE: SEDATION, DRY MOUTH, bradycardia, DERMATITIS
Drug interactions: CNS depressants
Withdraw slowly to prevent REBOUND HTN

114
Q

Guanfacine

A

Antihypertensive
Second line for HTN
a2 agonist (decreases sympathetic outflow from CNS)
SE: SEDATION, DRY MOUTH, bradycardia, DERMATITIS
Drug interactions: CNS depressants
Longer 1/2life, less chance of rebound HTN

115
Q

Methyldopa

A

Antihypertensive
HTN in PREGGOS
a2-agonist, competes with L-DOPA for DOPA decarboxylase
SE: SEDATION, nightmares, movement disorders, hyperprolactinemia, anemia
Contra: Liver dx
Drug interactions: Levodopa
USED IN PREGGOS!

116
Q

Reserpine

A

Antihypertensive
Resistant HTN
Depletes monoamine from storage vesciles
SE: sedation, diarrhea, DEPRESSION, bradycardia, NASAL CONGESTION
Drug interactions: CNS depressants, MAOIs

117
Q

Phenoxybenzamine

A 
Antihypertensive
Rx for pheo before surg
a-blocker
SE: tachycardia
Non-selective
118
Q

Prazosin

A 
Antihypertensive
2ndline for chronic HTN
a-blocker
SE: HYPOTENSION (first dose), dizziness, headaches, weakness
Deacreases LDL/HDL
119
Q

Terazosin

A

Antihypertensive
2ndline for chronic HTN
a1-blocker
Longer half life

120
Q

Doxazosin

A

Antihypertensive
2ndline for chronic HTN
a1-blocker
Longer half life

121
Q

Propranolol

A

Antihypertensive/Anti-anginal
HTN with angina, MI, or arrhythmia, post MI prophy
Nonselective B-blocker
SE: BRADYCARDIA, impotence, INCREASED TG, DECREASED HDLS, HYPERGLYCEMIA, IMPAIRED EXERCISE TOLERANCE, INCREASED AIRWAY RESISTANCE, INSOMNIA, nightmares, CHRONIC FATIGUE, depression
CONTRA: CARDIOGENIC SHOCK, SINUS BRADY, ASTHMA, SEVERE HF, COPD
Drug interactions: CCB (reduced contractility and conduction)
Lipophilic

122
Q

Nadolol

A

Antihypertensive/Anti-anginal
Long-term angina, post MI prophy
Nonselective B-blocker
SE: BRADYCARDIA, impotence, INCREASED TG, DECREASED HDLS, HYPERGLYCEMIA, IMPAIRED EXERCISE TOLERANCE, INCREASED AIRWAY RESISTANCE
CONTRA: CARDIOGENIC SHOCK, SINUS BRADYCARDIA, ASTHMA, SEVERE HEART FAILURE
Drug interactions: CCB (reduced contractility and conduction)
Longer half life than propranolol, hydrophilic

123
Q

Pindolol

A

Antihypertensive
Long-term angina
Nonselective B-blocker
SE: BRADYCARDIA, impotence, INCREASED TG, DECREASED HDLS, HYPERGLYCEMIA, IMPAIRED EXERCISE TOLERANCE, INCREASED AIRWAY RESISTANCE, INSOMNIA, nightmares, CHRONIC FATIGUE, depression
CONTRA: CARDIOGENIC SHOCK, SINUS BRADYCARDIA, ASTHMA, SEVERE HEART FAILURE
Drug interactions: CCB (reduced contractility and conduction)
Les bradycardia than other BBs
Lipophilic

124
Q

Metoprolol

A

Antihypertensive/Anti-anginal
HTHN, long term angina, post MI prophy, chronic CHF
B1-blocker
SE: BRADYCARDIA, impotence, INCREASED TG, DECREASED HDLS, HYPERGLYCEMIA, IMPARIED EXERCISE TOLERANCE, INSOMNIA, nightmares, CHRONIC FATIGUE, depression
CONTRA: CARDIOGENIC SHOCK, SINUS BRADYCARDIA, ASTHMA, SEVERE HEART FAILURE
Drug interactions: CCB (reduced contractility and conduction)
SOMEWHAT LIPOPHILIC
PREVENTS LV REMODELING

125
Q

Atenolol

A

Antihypertensive/anti-anginal
Chronic HTN, angina, MI, arrhythmia, HF, post MI prophy
B1-blocker
SE: BRADYCARDIA, impotence, INCREASED TG, DECREASED HDLS, HYPERGLYCEMIA, IMPARIED EXERCISE TOLERANCE
CONTRA: CARDIOGENIC SHOCK, SINUS BRADYCARDIA, ASTHMA, SEVERE HEART FAILURE
Drug interactions: CCB (reduced contractility and conduction)
Hydrophilic
Excreted by kidney

126
Q

Labetolol

A

Antihypertensive
Chronic HTN, pheo
Mixed a/B receptor blocker
SE: orthostatic HT, sexual dysfunction, BRADYCARDIA, INCREASED TG, DECREASED HDLS, HYPERGLYCEMIA, IMPAIRED EXERCISE TOLERANCE, INSOMNIA, nigtmares, CHRONIC FATIGUE, depression
CONTRA: CARDIOGENIC SHOCK, SINUS BRADYCARDIA, ASTHMA, SEVERE HEART FAILURE
Drug indications: CCB (reduced contractility and conduction)
Lipophilic

127
Q

Carvedilol

A

Antihypertensive
Chronic HTN, CHF, angina, post MI prophy
Mixed a/B blocker and NO generator
SE: BRADYCARDIA, impotence, INCREASED TG, DECREASED HDLS, HYPERGLYCEMIA, IMPAIRED EXERCISE TOLERANCE, INSOMNIA, nightmares, CHRONIC FATIGUE, depression
CONTRA: CARDIOGENIC SHOCK, SINUS BRADYCARDIA, ASTHMA, SEVERE HEART FAILURE
Drug interactions: CCB (reduced contractility and conduction)
Vasodilator
Lipophilic
PREVENTS LV REMODELING

128
Q

Minoxidil

A

Antihypertensive
Resistant HTN
Vasodilator (similar to hydralazine)
SE: TACHYCARDIA, angina aggravation, fluid retention, nausea, vomiting, sweating, flushing, lupus, hypertrichosis

129
Q

Nitroprusside

A 
Antihypertensive
Acute Hypertensive Crisis (BP >200)
Vasodilator
SE: Nausea, vomiting, muscle twitch, CYANIDE poisoning (from metabolites in long term use)
Immediate onset, brief duration
130
Q

Lisinopril

A

Antihypertensive/Diuretic
1stline drug used in chronic HTN, chronic CHF/a.fib
ACEI
SE: HYPERKALEMIA, rash, DRY COUGH, ANGIOEDEMA
Contra: PREGGOS, bilat renal stenosis
Drug interactions: exacerbates the hyperK effect of K sparing drugs
Water soluble, excreted unchanged by kidney, longer half life, allows 1x daily dosing
PREVENTS LV REMODELING

131
Q

Isosorbide mononitrate

A

Anti-anginal
Exertional angina, variant angina, unstable angina
Reacts with vessel wall to increase [NO] in VSMC (causing venodilation)
SE: Orthostatic hypotension, reflex tachy, headache, nitrate tolerance
Contra: systemic hypotension

132
Q

Isosorbide dinitrate

A

Anti-anginal
Exertional angina, variant angina, unstable angina
Reacts with vessel wall to increase [NO] in VSMC (causing venodilation)
SE: Orthostatic hypotension, reflex tachy, headache, nitrate tolerance
Contra: systemic hypotension

133
Q

Nicardipine

A

Anti-anginal
Exertional angina, variant angina, unstable angina
CCB, blocks influx L-type Ca channels in VSMC, vasodilation and dec. contractility
SE: Bradycardia, heart block, CHF, hypotension, peripheral edema
Contra: advanced heart block, systemic hypotension, CHF
Prevents exercise-induced vasospastic angina

134
Q

Amlodipine

A

Anti-anginal
Exertional angina, variant angina, unstable angina
CCB, blocks influx L-type Ca channels in VSMC, vasodilation and dec. contractility
SE: Bradycardia, heart block, CHF, hypotension, peripheral edema
Contra: advanced heart block, systemic hypotension, CHF
Prevents exercise-induced vasospastic angina

135
Q

Ranolazine

A

Anti-anginal
Stable/exercise induce angina
pFOX inhibitor (inhibits FFA b-ox in cardiac myocytes, encourages glucose met pathway)
SE: Prolongs QT interval
Contra: Long QT syndrome
Drug Interactions: Drugs that prolong QT interval
Prevents exercise-induced myocardial ischemia, less lactic acid accumulation

136
Q

Ivabradine

A

Anti-anginal
Chronic stable angina
If current inhibitor (in SA nodes, slows HR at rest and during exercise)
SE: Bradycardia, heart block, luminous phenomenon
Contra: Sick sinus syndrome
Drug interactions; CCB, verapamil, diltiazem
Prevents exercise-induced myocardial ischemia

137
Q

Niseritide

A

ADCCHF in hospitalized patients
Activates VSM and renal BNP receptors, raises cGMP levels in VSMC and renal epithelial cells
Vasodilation to increase GFR, induces natriuresis (decreases Na reabsorption in distal tubule)
SE: hypotension, ventricular arrhythmias
Contra: Reduced LV filling pressure, systemic hypotension

138
Q

Isoproterenol

A

CHF
B-Adrenergic
Low CO dt acute CHF, cardiogenic shock
Stimulates B receptor to increase myocardial cAMP
SE: arrhythmias, increased O2 consumption, angina
Contra: v. arrhyth, severe PVD

139
Q

Dopamine

A

CHF
B-Adrenergic
Low CO dt acute CHF, cardiogenic shock
Stimulates B receptor to increase myocardial cAMP
SE: arrhythmias, increased O2 consumption, angina
Contra: v. arrhyth, severe PVD

140
Q

Dobutamine

A

CHF
B-Adrenergic
Low CO dt acute CHF, cardiogenic shock
Stimulates B receptor to increase myocardial cAMP
SE: arrhythmias, increased O2 consumption, angina
Contra: v. arrhyth, severe PVD

141
Q

Norepinephrine

A

CHF
B-Adrenergic
Low CO dt acute CHF, cardiogenic shock
Stimulates B receptor to increase myocardial cAMP
SE: arrhythmias, increased O2 consumption, angina, VASOCONSTRICTION
Contra: v. arrhyth, severe PVD

142
Q

Inamrinone

A

CHF
ADCCHF in hospitalized patients (esp on BB)
Inhib. degredation of cAMP, inc. cAMP in cardiac muscle, inhib. degredation of cGMP in VSM, induce vasodilation
SE: arrhythmias, hypotension

143
Q

Milrinone

A

CHF
ADCCHF in hospitalized patients (esp on BB)
Inhib. degredation of cAMP, inc. cAMP in cardiac muscle, inhib. degredation of cGMP in VSM, induce vasodilation
SE: arrhythmias, hypotension

144
Q

LCZ696

A 
ARB
Chronic CHF, esp intolerant to ACEI
Valsartan/sacubitril combo. Blocks AT receptor on VSM, prevents degredation of natriuretic peptides/bradykinin/adrenomedullin (causing vasodilation and reduction of ECF volume via NA excretion)
SE: Hypotension, cough
Contra: systemic hypotension
145
Q

Bucindolol

A

BB
Chronic CHF
Nonselective and a1 blocker
SE: worsening CHF, bradycardia, heart block, depression, bronchospasm, peripheral vasospasm
Contra: acute exacerbation of chronic CHF, asthma, COPD, insulin-dependent diabetes mellitus
PREVENTS LV REMODELING

DRUG BRUTE FORCE MEMORIZATION (7 decks)

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