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First Aid Drugs > Cardio > Flashcards

Cardio Flashcards

1
Q

How to treat essential HTN?

A

ACD: ACEI/ARB, CCB, Diuretics

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2
Q

How to treat HTN from CHF?

A

AAB: ACEI/ARB, aldos-inhib’s (spironolactone), b-blockers (compensated CHF only, C/I’d in cardiogenic shock) + diuretics

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3
Q

How to treat HTN from DM?

A

ACEI/ARB, CCB, diuretics, b-blockers, a-blockers (ACEI are protective against DM nephropathy)

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4
Q

CCBs =

Mech, clin use, toxicity

A

Nifedipine, verapamil, diltiazem, amlodipine

  • block V-dep L-type Ca ch in cardiac/SmM, to reduce m. contractility
  • HTN, angina, arrhythmias (not nifedipine), Prinzmetal’s angina (#1 drug), Raynaud’s
  • cardiac depression, AV block, periph edema, flushing, dizziness, constipation
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5
Q

Ca ch blockers to use in:

  • vascular SmM
  • heart
A
  • amloDIPINE=nifeDIPINE > diltiazem > verapamil

- verapamil > diltiazem > amlodipine=nifedipine (Verapamil=Ventricle)

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6
Q

Hydralazine

mech, clin use, toxicity

A
  • incr’s cGMP -> SmM relaxation; vasodil’s a>v; reduces afterload
  • severe HTN, CHF; 1st line tx for HTN in preg w/ methyldopa; often given w/ b-blocker to prevent reflex tachy
  • compensatory tachy (C/I’d in angina/CAD), fluid retention, N, HA, angina, lupus-like synd
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7
Q

Nitroprusside, nicardipine, clevidipine, labetalol, fenoldopam…use for?

A

Malignant HTN

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8
Q

Nitroprusside =

- used for?

A

Short acting; incr’d cGMP via direct release of NO (can cause cyanide tox bc releases it)
- malig HTN

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9
Q

Nitroglycerin & isosorbide dinitrate

Mech, clin use, toxicity

A
  • vasodil by releasing NO in SmM -> incr’d cGMP and SmM relaxation, dilates v>a, decr’d preload
  • angina, pulm edema
  • reflex tachy, hypotension, flushing, HA, “Monday dz” in industrial re-exposure
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10
Q

-statins

MoA, effect on LDL/HDL/TG, SEs

A
  • inhibit HMG-CoA to mevalonate (choles precursor)
  • VERY low, incr’d, decr’d
  • hepatotox, rhabdymyolysis (myopathy), cog impairments
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11
Q

Niacin (B3)

MoA, effect on LDL/HDL/TG, SEs

A
  • inhib lipolysis in adipose, reduces hepatic VLDL secretion into circ
  • decr’d, incr’d, slightly decr’d
  • red flushed face (give aspirin), hyperglc (acanthosis nigricans), hyperuricemia (gout), hypotension (vasodilatory -> decr anti-HTN meds), hepatitis
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12
Q

Cholestyramine, colestipol, colesevelam

MoA, effect on LDL/HDL/TG, SEs

A
  • bile acid resins; prevents GI reab’n of bile acids, liver must use choles to make more
  • decr’d, slightly incr’d, INCR’d TGs
  • pt’s hate it, tastes bad, GI discomfort, decr’d ab’n of fat-soluble vitamins, CHOLES GALLSTONES
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13
Q

Ezetimibe

MoA, effect on LDL/HDL/TG, SEs

A
  • prevents choles reab’n at SmI brush border
  • decr’d LDL, nothing else
  • rare incr’d LFTs (esp w/ statins), D
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14
Q

Fibrates (gemfibrozil, clofibrate, bezafibrate, fenofibrate)

MoA, effect on LDL/HDL/TG, SEs

A
  • upreg LPL -> incr’d TG clearance (from chylo’s and VLDL)
  • decr’d LDL, incr’d HDL (incr’d apoA1), very decr’d TG
  • myositis (esp w/ statins), hepatotox (incr’d LFTs), choles gallstones
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15
Q

Digoxin
Mech, clin use, SEs
- factors -> more tox
- antidote

A
  • cardiac glycoside; inhib’s Na/K pump -> incr’d IC Ca -> (+) inotropy; also stim’s vagus -> decr’d HR
  • CHF (incr’d contractility), Afib (decr’d SA/AV node conduc)
  • cholinergic (NVD, VanGogh vision), ECG shows incr’d PR, decr’d QT, ST scooping, T inversion, arrhythmia, AV block; hyperK
  • renal failure bc less out, hypoK (competes w/ K to bind pump), quinidine bc displaces digoxin from tissue binding sites
  • KLAM: slowly nl’ize K, lidocaine, anti-digoxin Fab, Mg…also pacemaker
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16
Q

Class IA antiarrhythmics
Drugs
MoA
Used for

A

“the Queen Proclaim’s Diso’s pyramid”

  • Quinidine, procainamide, disopyramide
  • Na ch blocker: interm inhib of phase 0 depol, incr AcP length (QT int)
  • A and V arrhy’s, esp reentrant and ectopic SVT and VT
17
Q

Toxicities of:

  • Quinidine
  • Procainamide
  • Disopyramide
  • All Class IA antiarrhythmics
A
  • cinchonism, HA, tinnitus
  • SLE-like synd
  • HF
  • thrombocytopenia, TdP
18
Q 
Class IB antiarrhythmics
Drugs
MoA
Used for
Toxicities
A

“Lettuce, Tomato, Mayo”

  • Lidocaine, Tocainide, Mexiletine
  • Na ch blockers: wk inhib of phase 0 depol, decr’d AcP length
  • ischemic or depol’d Purk/ventric tissues; acute ventric arrhy’s (esp post-MI), digitalis-induced arrhy’s…anything due to long QT bc here shortens QT
  • local anesthetic, CNS stim’n/depression, CV depression
19
Q 
Class IC antiarrhythmics
Drugs
MoA
Used for
Toxicities
C/I'd in?
A

“More Fries Please”
(Moricizine), Flecainide, Propafenone
- Na ch blocker: strong inhib of phase 0 depol; no change in AcP length
- VT->VF, retractable SVT, for nl struc hearts
- proarrhythmic, esp post-MI (C/I’d), prolongs refractory period in AV node
- struc heart dz and post-MI

20
Q

Class II antiarrhythmics
Ex’s
Mech, clin use, toxicity

A

Metoprolol, propranolol, esmolol, atenolol, timolol (-olol)

  • b-blocker: decr’s SA/AV node act by decr’ing cAMP, decr’ing Ca currents -> suppress abnl pacemakers by decr’ing slope of phase 4
  • VT, SVT, slowing ventric rate during Afib/flutter
  • impotence, more asthma, CV effect (bradycardia, AV block, CHF), CNS effects (sedation, sleep alt’s), may mask signs of hypoglc
21
Q

SEs of:

  • metoprolol; trt overdose w/?
  • propranolol
A
  • dyslipidemia, trt overdose w/ glucagon (incr’s cAMP)

- Prinzmetal’s angina vasospasm

22
Q

Class III antiarrhythmics
Ex’s
Mech

A

“AIDS”

  • Amiodarone, Ibutilide, Dofetilide, Sotalol
  • K ch blocker: incr AcP length/QT; use when other antiarrhythmics fail
23
Q

Toxicities of:

  • Sotalol
  • Ibutilide
  • Amiodarone
  • Remember to check ? when using amiodarone
A
  • TdP, big b-block
  • TdP
  • Pulm fibrosis, hepatotox, hypo/hyperthyroidism (bc is 40% iodine), corneal deposits, skin deposits (blue/gray) -> photodermatitis, neuro effects, constipation, CV effects (bradycardia, heart block, CHF); has class I, II, III, IV effects bc alters lipid membrane
  • check PFTs, LFTs, and TFTs
24
Q

Class IV antiarrhythmics
Ex’s
Mech
Toxicity

A
  • Verapamil, diltiazem
  • CCBs: decr conduc vel, incr’d ERP/PR int, used to prevent nodal arrhythmias (SVT)
  • constipation, flushing, edema, CV effects (CHF, AV block, sinus node depression)
25
Q

Adenosine

  • Used for
  • MoA
  • Duration of action
  • Toxicity
  • Effects blocked by
A
  • antiarrhythmia, SVT (drug of choice!)
  • incr’s K out of cells -> hyperpol of cell and decr’d ICa -> incr time thr AV node
  • Short! ~15s
  • flushing, hypotension, chest pain
  • theophylline, caffeine
26
Q

Mg2+

- Used for?

A

TdP and digoxin toxicity

27
Q

Nifedipine =

- affects

A

dihydropyridine CCB

- Vasc SmM

28
Q

Verapamil =

- affects

A

non-dihydropyridine CCB

- Cardiac m. (V=Ventricles!)

29
Q

Diltiazem =

- affects

A

non-dihydropyridine CCB

- Cardiac m.

30
Q

Amlodipine =

- affects

A

dihydropyridine CCB

- Vasc SmM

31
Q

Fenoldolam =

- use for?

A

D1 R agonist -> vasodil; decr’s BP and incr’s natriuresis

- malig HTN

32
Q

Antianginal tx:

  • decr preload w/
  • decr afterload w/
A
  • nitrates (venodilators)

- b-blockers

First Aid Drugs (13 decks)

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