cardio drugs

Question 1

hydralazine

Answer 1

inc cGMP = VSM relaxation
vasodilates arterioles > veins
afterload reduction

for: severe HTN, HF

AE: compensatory tachycardia (contraindicated in angina/CAD), fluid retention, HA, angina, lupus-like syndrom

Question 2

nitroprusside

Answer 2

inc cGMP via direct release of NO
short acting

can cause cyanide toxicity

Question 3

nitroglycerin
isosorbide dinitrate
isosorbide mononitrate

Answer 3

inc NO in VSM = inc cGMP = vasodilation, VSM relxation
dilates veins > arteries
dec preload

for: angina, acute coronary syndrome, pulmonary edema

AE: reflex tachycardia, hypotension, flushing, HA, “monday disease” - loss of tolerance over weekend

Question 4

statins

Answer 4

HMG-CoA reductase inhibitors

dec LDL*, inc HDL, dec TG

AE: hepatotoxicity, myopathy (esp w/ fibrates or niacin)

Question 5

cholestyramine
colestipol
colesevelam

Answer 5

bile acid resins - prevent intestinal reabsorption of bile acids = liver must use cholesterol to synth more

dec LDL, slightly inc HDL, slightly inc TG

AE: GI upset, dec absorption of drugs & fat soluble vit, inc chol content of bile –> cholesterol gallstones

Question 6

ezetimibe

Answer 6

prevent cholesterol absorption at small intestine brush border

dec LDL

AE: rare inc in LFTs, diarrhea

Question 7

gemfibrozil
clofibrate
bezafibrate
fenofibrate

Answer 7

fibrates - upregulate LPL to inc TG clearance, activates PPAR-a to induce HDL synth

dec LDL, inc HDL, dec TG*

AE: myopathy, gallstones

Question 8

niacin

Answer 8

vit B3
(-) lipolysis (hormone sensitive lipase) in adipose tissue
reduces hepatic VLDL synth

dec LDL, inc HDL*, dec TG

AE: flushed face, hyperglycemia, hyperuricemia

Question 9

digoxin

Answer 9

(-) Na/K ATPase = indirect (-) of Na/Ca exchanger = inc intracell Ca = + inotropy
(+) vagus n = dec HR

for: HF (inc contractility), afib (dec conduction @ AV node, depression of SA node)

AE: cholinergic - n/v, diarrhea, blurry yellow vision, arrhythmias, AV block. hyperkalemia

Question 10

quinidine
procainamide
disopyramide

Answer 10

class IA antiarrhythmic - Na channel blocker 
inc AP duration, inc ERP, inc QT

for: arterial & ventricular arrhythmias. esp reentrant & ectopic SVT & VT

AE: thrombocytopenia, torsades de pointes
quinidine - cinchonism
procainamide - reversible SLE-like syndrome
disopyramide - HF

Question 11

lidocaine

mexiletine

Answer 11

class IB antiarrhythmic - Na channel blocker
dec AP duration
preferentially affects ischemic or depolarized purkinje & ventricular tissue

for: acute ventricular arrhythmias, digoxin-induced arrhythmias, post-MI

AE: CNS stimulation/depression, CV depression

Question 12

flecainide

propafenone

Answer 12

class IC antiarrhythmic - Na channel blocker
prolongs ERP in AV node & accessory bypass tracts 

for: SVT, afib

AE: proarrhythmic, esp post-MI
contraindicated in structural & ischemic heart disease

Question 13

metoprolol 
propranolol 
esmolol
atenolol 
timolol 
carvedilol

Answer 13

class II antiarrhythmics - B-blockers 
dec cAMP & Ca currents = dec SA & AV nodal activity
dec slope phase 4 = depress abnml pacemakers 

for: SVT, afib & aflutter rate control

AE: impotence, exacerbation of asthma/COPD, bradycardia, AV block, HF, sedation, sleep alteration, mask signs of hypoglycemia
metoprolol - dislipidemia
propranolol - exacerbate vasospasm of prinzmetal angina

Question 14

amiodarone
ibutilide
dofetilide
sotalol

Answer 14

class III antiarrhythmics - K+ channel blockers 
inc AP duration, inc ERP, inc QT 

for: afib, aflutter, vtach

AE:
sotalol - tordsades, excessive B blockade
ibutilide - torsades
amiodarone - pulmonary fibrosis, heptotoxicity, hypo/hyperthyroidism, gray skin deposits - photodermatitis, neuro effects, constipation, bradycardia, heart block, HF

Question 15

verapamil

diltiazem

Answer 15

class IV antiarrhythmics - non-DHP Ca channel blockers 
dec conduction velocity, inc ERP, inc PR 

for: prevent nodal arrhythmias, rate control in afib

AE: constipation, flushing, edema, HF, AV block, SA node depression

Question 16

adenosine

Answer 16

inc K+ out of cells = hyperpolarization, dec Ca current

for: dx / abolish SVT (stops heart for a few seconds)

AE: flushing, hypotension, CP, sense of impending doom, bronchospasm

Question 17

Mg

Answer 17

for: torsades, digoxin toxicity

Question 18

amlodipine 
clevidipine 
nicardipine 
nifedipine 
nimodipine

Answer 18

dihydropyridine Ca channel blockers

block voltage gated L-type Ca channels on cardiac and smooth muscle = dec m contractility

dihydropyradines = greater effects on VSM
- HTN, angina, raynaud

non-dihydropyridines = greater effects on cardiac m
- HTN, angina, afib, aflutter