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Term 4 CRS > Cardio Drugs > Flashcards

Cardio Drugs Flashcards

1
Q

Proximal Tubule fxn and primary transporters

A

fxn:
Reabsorption of Na+/K+/Ca2+/Mg2+ (65%),
NaHC03 (85%),
glucose & amino acids (~100%)
Secretion & reabsorption of organic acids & bases (including most diuretics)
Isosmotic reabsorption of H20

Transporters:
Na+/H+ (NHE3), carbonic anhydrase, acid and base transporters

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2
Q

Thin Descending Loop of Henle fxn and primary transporters

A

fxn: Passive reabsorption of H20
Transporter: Aquaporins

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3
Q

Thick Ascending Loop of Henle fxn and primary transporters

A

fxn:
Active reabsorption of Na+/K+/Cl- (15-25%);
secondary reabsorption of Ca2+ and Mg2+

transporter:
Na+/K+/2Cl- (NKCC2)

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4
Q

Distal Convoluted Tubule fxn and primary transporters

A

fxn:
Active reabsorption of Na+/Cl- (4-8%);
Ca2+ reabsorption under parathyroid hormone control

transporter:
Na+/Cl- (NCC)

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5
Q

Cortical Collecting Duct fxn and primary transporters

A

fxn:
Na+ reabsorption (2-5%);
K+/H+ secretion
H20 reabsorption under vasopressin control

Transporter:
ENaC, K+ channels, H+ transporter, aquaporins

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6
Q

Diuretics act by blocking specific transport functions of the renal tubules, thereby increasing urinary sodium chloride and water losses.

What are the two major clinical uses of diuretics?

A

1.) Edema
2.) Hypertension

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7
Q

Furosemide/Torsemide/Bumetanide are types of _____?

A

Loop Diuretics

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8
Q

Loop Diuretics - MOA

A

• Act in the ascending limb of the loop of Henle
• Block NKCC2 Na+/Cl-/K+ cotransporter

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9
Q

Which type of drug?
Actions:
• Increased urine output
• Increased K+ excretion
• Increased Ca2+ excretion
• Increased Mg2+ excretion
• Increased prostaglandin synthesis
• Decreased renal vascular resistance
• Increased renal blood flow
Adverse effects:
• Ototoxicity, Hyperuricemia, Acute hypovolemia, Hypokalemia, Hypomagnesemia, Allergic reactions

A

Loop Diuretics

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10
Q

Hydrochlorothiazide / Chlorthalidone / Metolazone are which type of drugs?

A

Thiazides

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11
Q

Which medication takes 1-3 wks to produce stable effect

A

Thiazides

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12
Q

Long duration of action: t1/2 = 40-60 h (used to treat
hypertension once daily).

A

Chlorthalidone

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13
Q

Most potent, causes Na+ excretion in advance
kidney failure

A

Metolazone

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14
Q

Which type of drug?
-action:
• Increased Na+ & Cl- excretion
• Increased K+ excretion
• Increased Mg2+ excretion
• Decreased urinary Ca2+ excretion
• Decreased peripheral vascular resistance

-adverse effects:
Hypokalemia, Hyponatremia, Metabolic alkalosis, Hyperuricemia, Hyperglycemia, Hyperlipidemia, Hypersensitivity, Sexual dysfunction

A

Thiazides

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15
Q

Spironolactone and Eplernone are which type of drugs?

A

K+ sparing aldosterone antagonist

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16
Q

Where do thiazides work and what channel do they block?

A

Act in distal convoluted tubule
Blok NCCT (Na+/Cl- co-transporter)

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16
Q

Where do thiazides work and what channel do they block?

A

Act in distal convoluted tubule
Blok NCCT (Na+/Cl- co-transporter)

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17
Q

Where does K+ sparing, spironolactne/Eplernone act and MOA

A

• Act in collecting duct
• Antagonize aldosterone at intracellular cytoplasmic receptor sites (prevents translocation of receptor complex → nucleus)
• Na+ reabsorption & K+ excretion

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18
Q

Amiloride / Triamterene are which type of drugs?

A

K+ sparing, Na+ Channel Inhibitors

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19
Q

Acetazolamide is what type of drug?

A

Carbonic Anhydrase Inhibitor

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20
Q

Where do Carabonic anhydrase inhibitors work and MOA?

A

Works ar proximal tubular epithelial cells
Inhibit CA (Decreases ability to exchange Na+ for H+
> Decreases activity of Na+/K+ ATPase (diuresis)
> HCO3- is retained in lumen)

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21
Q

Where do osmotic diuretics work and MOA?

A

Everywhere
Raise osmotic pressure of the plasma thus draws H2O out of body tissues and produces osmotic diuresis

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22
Q

Mannitol is which type of drug?

A

Osmotic Diuretic

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23
Q

What type of drug is Conivaptan?

A

ADH antagonist

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24
Q

Mechanism behind antihypertensives

A

Decrease cardiac output and/or peripheral resistance

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25
Q

First line agents for Hypertension

A

ACE-inhibitors, ARBs, calcium channel
blockers, thiazide diuretics

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26
Q

Second line agents for hypertension

A

b-blockers, aldosterone antagonists

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27
Q

Captopril / Enalapril / Lisinopril are what type of drugs?

A

ACE Inhibitors

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28
Q

Which antihypertensive drugs are used for diabetics and patients w/ CKD?

A

ACE inhibitors

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28
Q

Which antihypertensive drugs are used for diabetics and patients w/ CKD?

A

ACE inhibitors

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29
Q

Contraindications of ACE inhibitors

A
  1. pregnancy
  2. Pts w/ bilateral renal artery stenosis
    3.) Pts w/ hx of angioedema
30
Q

Losartan / Valsartan are what type of drugs?

A

Angiotension receptor blockers (ARB’s)

31
Q

_____ reduces plasma uric acid levels by inhibiting URAT1 transporter – can be useful in patients with gout

A

Losartan

32
Q

What type of drug is Aliskiren?

A

Renin Inhibitor

33
Q

Verapamil and Diltiazem are which type of drugs?

A

Non-dihydropyridines, Ca2+ channel blockers

34
Q

Nifedipine and amlodipine

A

Dihydropyridine, Ca2+ channel blockers

35
Q

High-doses of short-acting dihydropyridine Ca2+- channel blockers can increase risk of MI
MOA

A

excessive vasodilation & reflex cardiac stimulation

35
Q

High-doses of short-acting dihydropyridine Ca2+- channel blockers can increase risk of MI
MOA

A

excessive vasodilation & reflex cardiac stimulation

36
Q

adverse effects of Verapamil (Ca 2+ channel blocker)

A

Constipation (7%), negative inotropic effects, gingival hyperplasia

37
Q

When is Sprinolactone used as part of first line treatment?

A

In pts w/ hypertension and severe left ventricular dysfunction

(K+ sparing - aldosterone antagonist)

38
Q

When are B-blockers used for first line treatment?

A

Coronary artery disease, heart failure, post MI

39
Q

What type of drug is Propranolol?

A

Non-selective b1 & b2 receptor antagonist

40
Q

What type of drugs are Metoprolol & atenolol (most widely used)?

A

selective b1 receptor antagonist

41
Q

What type of drug is Pindolol

A

Non-selective b1 & b2 partial agonist with intrinsic sympathomimetic activity

42
Q

What type of drugs are Prazosin / Doxazosin?

A

Alpha-1 Blockers (treat BPH)

43
Q

Adverse effect of alpha 1 blockers

A

-Orthostatic Hypotension

44
Q

Which alpha blocker is shown to increase rate of congestive HF

A

Doxazosin

45
Q

Which is the DOC for hypertension in pregnancy?

Which other drug is safe during pregnancy?

A

DOC = Methyldopa
Labetalol

46
Q

What type of drug is Labetalol

A

Mixed alpha and beta blocker

47
Q

What type of drug is Clonidine?

A

partial alpha 2 agonist that acts on presynaptic a2 adrenergic auto receptors

48
Q

What type of drug is methyldopa?

A

alpha 2 agonist

49
Q

What are the adverse effects of Methyldopa (a2 agonist)

A

• Sedation, drowsiness, dizziness, nausea, headache, weakness, fatigue, sexual dysfunction, hypoprolactinemia
• Nightmares, mental depression, vertigo (infrequent)
• Reversible lupus-like syndrome
• Development of positive Coombs test (10-20% patients on long-term treatment (>1 year)). Can result in hemolytic anemia, hepatitis & drug fever

50
Q

Hydralazine / Minoxidil are what type of drugs?

A

Direct Vasodilators

50
Q

Hydralazine / Minoxidil are what type of drugs?

A

Direct Vasodilators

51
Q

Drug used to treat pregnancy-induced hypertension / pre- eclampsia

A

Hydralazine

52
Q

What are the 2 main adverse effects of Hydralazine (direct vasodilator)

A

• Fluid retention & reflex tachycardia are common
• Reversible lupus-like syndrome

53
Q

What are the 2 main adverse effects when taking Minoxidil?

A

• Reflex tachycardia & fluid retention may be severe (combine with loop diuretic & b-blocker)
• Causes hypertrichosis (also used topically to treat male pattern baldness)

53
Q

What are the 2 main adverse effects when taking Minoxidil?

A

• Reflex tachycardia & fluid retention may be severe (combine with loop diuretic & b-blocker)
• Causes hypertrichosis (also used topically to treat male pattern baldness)

54
Q

What type of drug is epoprostenol and purpose?

A

Prostaglandins (synthetic PGI2)
Treatment for pulmonary hypertension

55
Q

What type of drug is bosentan and its purpose?

A

Treatment for pulmonary hypertension

56
Q

What type of drug is sildenafil and purpose?

A

Vasodilators, inhibits PDE-5
Treatment for pulmonary hypertension

57
Q

Which pulmonary hypertension drug is category X for pregnancy?

A

Bosentan

58
Q

Which pulmonary hypertension drugs is contraindicated with the use of Nitric Oxide?

A

Sildenafil

59
Q

What are the adverse effects of Sildenafil?

A

headache, flushing, dyspepsia, cyanopsia

60
Q

Requiement for Hypertensive Emergency

A

• DBP > 150 mmHg (with SBP > 210 mmHg) in otherwise healthy person,
or
• DBP > 120 mmHg in individuals with pre-existing complications (eg, cerebral hemorrhage, aortic stenosis)

61
Q

Avoid abrupt decreases in BP, can lead to which 3 conditions?

A

1.) MI
2.) Stroke
3.) visual changes

62
Q

What are the goals of treatment for Hypertensive Emergency Management?
A.) min-1 hr
B.) 2-6 hrs
C.) 8 - 24 hrs

A

(a) Lower BP by no more than 25 % (within min – 1 h). Appropriate goal is 100-110 mm Hg (DBP)
(b) If stable, followed by further reduction towards goal of 160/100 mm Hg (SBP/DBP) within 2-6 h and gradual reduction to normal over next 8-24 h

63
Q

A rare side effect of Sodium Nitroprusside is Cyanide toxicity. How is this treated?

A

Can be treated with sodium thiosulfate infusion → nontoxic thiocyanate

64
Q

What type of drug is Fenoldopam?

A

Peripheral dopamine-1 (D1) receptor agonist

65
Q

Which drug is particularly beneficial in patients with renal insufficiency? Has a half life of 30 minutes.

A

Fenoldopam

66
Q

Contraindications of Fenoldopam

A

Glaucoma

67
Q

What type of drug is Nicardipine?

A

Calcium channel blocker used for hypertensive emergencies

68
Q

Which drug Inhibits insulin release and can be used to treat hypoglycemia secondary to insulinoma

A

Diazoxide

69
Q

Drug of choice for hypertensive emergencies in patients with cardiac ischemia or angina, or after cardiac bypass surgery

A

Nitroglycerin

70
Q

Often used for aortic dissection or postoperative hypertension

A

Esmolol (B-blocker)

71
Q

What type of drug is Diazoxide?

A

• Arteriolar dilator
• Prevents vascular smooth muscle contraction by opening
K+ channels and stabilizing membrane potential

Term 4 CRS (2 decks)

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