Cardio Drugs Flashcards by Sarah Meadows

Proximal Tubule fxn and primary transporters

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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Thin Descending Loop of Henle fxn and primary transporters

fxn: Passive reabsorption of H20
Transporter: Aquaporins

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Thick Ascending Loop of Henle fxn and primary transporters

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

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

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Distal Convoluted Tubule fxn and primary transporters

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

transporter:
Na+/Cl- (NCC)

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Cortical Collecting Duct fxn and primary transporters

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

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

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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?

1.) Edema
2.) Hypertension

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Furosemide/Torsemide/Bumetanide are types of _____?

Loop Diuretics

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Loop Diuretics - MOA

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

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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

Loop Diuretics

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Hydrochlorothiazide / Chlorthalidone / Metolazone are which type of drugs?

Thiazides

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Which medication takes 1-3 wks to produce stable effect

Thiazides

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

Chlorthalidone

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Most potent, causes Na+ excretion in advance
kidney failure

Metolazone

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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

Thiazides

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Spironolactone and Eplernone are which type of drugs?

K+ sparing aldosterone antagonist

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Where do thiazides work and what channel do they block?

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

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Where do thiazides work and what channel do they block?

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

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

• 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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Amiloride / Triamterene are which type of drugs?

K+ sparing, Na+ Channel Inhibitors

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Acetazolamide is what type of drug?

Carbonic Anhydrase Inhibitor

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Where do Carabonic anhydrase inhibitors work and MOA?

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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Where do osmotic diuretics work and MOA?

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

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Mannitol is which type of drug?

Osmotic Diuretic

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What type of drug is Conivaptan?

ADH antagonist

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Mechanism behind antihypertensives

Decrease cardiac output and/or peripheral resistance

First line agents for Hypertension

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

Second line agents for hypertension

b-blockers, aldosterone antagonists

Captopril / Enalapril / Lisinopril are what type of drugs?

ACE Inhibitors

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

ACE inhibitors

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

ACE inhibitors

Contraindications of ACE inhibitors

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

Losartan / Valsartan are what type of drugs?

Angiotension receptor blockers (ARB’s)

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

Losartan

What type of drug is Aliskiren?

Renin Inhibitor

Verapamil and Diltiazem are which type of drugs?

Non-dihydropyridines, Ca2+ channel blockers

Nifedipine and amlodipine

Dihydropyridine, Ca2+ channel blockers

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

excessive vasodilation & reflex cardiac stimulation

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

excessive vasodilation & reflex cardiac stimulation

adverse effects of Verapamil (Ca 2+ channel blocker)

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

When is Sprinolactone used as part of first line treatment?

In pts w/ hypertension and severe left ventricular dysfunction (K+ sparing - aldosterone antagonist)

When are B-blockers used for first line treatment?

Coronary artery disease, heart failure, post MI

What type of drug is Propranolol?

Non-selective b1 & b2 receptor antagonist

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

selective b1 receptor antagonist

What type of drug is Pindolol

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

What type of drugs are Prazosin / Doxazosin?

Alpha-1 Blockers (treat BPH)

Adverse effect of alpha 1 blockers

-Orthostatic Hypotension

Which alpha blocker is shown to increase rate of congestive HF

Doxazosin

Which is the DOC for hypertension in pregnancy? Which other drug is safe during pregnancy?

DOC = Methyldopa Labetalol

What type of drug is Labetalol

Mixed alpha and beta blocker

What type of drug is Clonidine?

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

What type of drug is methyldopa?

alpha 2 agonist

What are the adverse effects of Methyldopa (a2 agonist)

• 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

Hydralazine / Minoxidil are what type of drugs?

Direct Vasodilators

Hydralazine / Minoxidil are what type of drugs?

Direct Vasodilators

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

Hydralazine

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

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

What are the 2 main adverse effects when taking Minoxidil?

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

What are the 2 main adverse effects when taking Minoxidil?

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

What type of drug is epoprostenol and purpose?

Prostaglandins (synthetic PGI2) Treatment for pulmonary hypertension

What type of drug is bosentan and its purpose?

Treatment for pulmonary hypertension

What type of drug is sildenafil and purpose?

Vasodilators, inhibits PDE-5 Treatment for pulmonary hypertension

Which pulmonary hypertension drug is category X for pregnancy?

Bosentan

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

Sildenafil

What are the adverse effects of Sildenafil?

headache, flushing, dyspepsia, cyanopsia

Requiement for Hypertensive Emergency

• 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)

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

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

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

(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

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

Can be treated with sodium thiosulfate infusion → nontoxic thiocyanate

What type of drug is Fenoldopam?

Peripheral dopamine-1 (D1) receptor agonist

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

Fenoldopam

Contraindications of Fenoldopam

Glaucoma

What type of drug is Nicardipine?

Calcium channel blocker used for hypertensive emergencies

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

Diazoxide

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

Nitroglycerin

Often used for aortic dissection or postoperative hypertension

Esmolol (B-blocker)

What type of drug is Diazoxide?

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