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Pharmacology Step 1 > Cardio Drugs > Flashcards

Cardio Drugs Flashcards

1
Q

ACE inhibitors (Angiotensin Converting Enzyme)

A

lisinopril, captopril, enalapril, ramipril

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2
Q

ACE inhibitors MOA, use, AE

A

MOA - inhibit ACE -> decreased AT II -> decreased vasoconstriction, decreased GFR by preventing constriction of efferent arterioles
Use - HTN, HF (decreases mortality), proteinuria, diabetic nephropathy, post MI
AE - cough, angioedema (C/I in C1 esterase inhibitor deficiency), teratogen, increased Creatinine, hyperkalemia, and hypotension

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3
Q

Angiotensin receptor blockers

A

losartan, candesartan, valsartan

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4
Q

Angiotensin receptor blocker MOA, use, AE

A

MOA - selectively block binding of angiotensin II to AT1 receptor; do not increase bradykinin
Use - HTN, HF (decreases mortality), proteinuria, chronic kidney disease
AE - hyperkalemia, decreased GFR, hypotension, teratogen, angioedema

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5
Q

Aliskiren

A

direct renin inhibitor; blocks conversion of angiotensinogen

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6
Q

Calcium Channel Blockers

A

Dihydropyridine (-dipine)
- amlodipine, felodipine, nicardipine, nifedipine, nisoldipine
Nonhydropyridine
-diltiazem, verapamil

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7
Q

MOA, use, AE of dihydropyridine CCB

A

MOA: act on vascular smooth muscle to cause vasodilation
Use: HTN, angina, vasospasm, esophageal spasm, migraine prophylaxis
AE: peripheral edema, flushing, dizziness, constipation, reflex tachycardia

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8
Q

MOA, use, AE of nondihydropyridine CCB

A

MOA - block calcium channels at pacemaker cells
Use - HTN, angina, arrhythmia
AE - cardiac depression (avoid with CHF), AV block, flushing, dizziness, constipation

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9
Q

Minoxidil MOA, use, AE

A

MOA: opens K+ channels and hyperpolarizes smooth muscle (Ca2+ channels stay closed), resulting in relaxation of vascular smooth muscle
Use: severe HTN, topical application for hair loss
AE: hypertrichosis, hypotension, reflex tachycardia, fluid retention/edema

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10
Q

Hydralazine MOA, use, AE

A

MOA - increase cGMP (activate myosin phosphatase -> vasodilation) -> smooth muscle relaxation; vasoldilates arterioles > veins; reduces afterload
Use - severe HTN, HF, safe to use during pregnancy (frequently coadministered with a beta blocker to prevent reflex tachycardia)
AE - compensatory tachycardia (C/I with angina/CAD), fluid retention, HA, angina, lupus-like syndrome

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11
Q

What Abs are found with drug-induced lupus?

A

anti-histone Abs

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12
Q

Nitrates MOA, Use, AE

A

Nitroglycerin, isosorbide dinitrate, isosorbide mononitrate
MOA - vasodilator by increasing NO in vascular smooth muscle -> increase cGMP and smooth muscle relaxation; dilate veins > arteries; decrease preload
Use - angina, acute coronary syndrome, pulmonary edema (pools blood in periphery)
AE - reflex tachycardia, hypotension, flushing, HA
Nitroprusside - cyanide toxicity

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13
Q

What antihypertensive medications should be used in CKD patients?

A

ACE inhibitors or ARBs

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14
Q

What antihypertensive medications should be used in black patients without CKD?

A

thiazide diuretics, CCB

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15
Q

What antihypertensive medications should be used in non-black patients without CKD?

A

thiazide diuretics, CCB, ACE inhibitor or ARB

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16
Q

What antihypertensives should be used in CHF? What should be avoided?

A

Give: ACE inhibitor/ARB, beta blocker, aldosterone antagonist
Avoid: CCB (cause edema), beta blocker (in acute decompensated)

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17
Q

What antihypertensive medications should be used in DM? What should be avoided?

A

Give: ACE inhibitor/ARB (protect against diabetic nephropathy)
Avoid: beta blocker (raise blood sugar)

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18
Q

What antihypertensive medications should be used in post-MI/CAD?

A

thiazide, beta blocker, ACE inhibitor/ARB, CCB (as needed for angina), nitrates (as needed for angina)

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19
Q

What antihypertensive medications should be used in atrial fibrillation?

A

beta blocker, diltiazem/verapamil (control HR)

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20
Q

What antihypertensive medications should be AVOIDED in bradycardia?

A

beta blocker, diltiazem/verapamil (decrease HR)

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21
Q

What antihypertensive medications should be used in BPH?

A

alpha-blocker

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22
Q

What antihypertensive medications should be used in pregnancy? What should be avoided?

A

Use: hydralazine, methyldopa, labetalol, dihydropyridines
Avoid: ACE inhibitors, ARBs

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23
Q

Want antihypertensive medications should be used for migraines?

A

CCB, beta blocker

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24
Q

What antihypertensive medications should be used for essential tremor?

A

propranolol

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25
HMG-CoA reductase inhibitors
statins | lovastatin, pravastain, atrovastatin
26
HMG-CoA reductase inhibitors MOA, effects on LDL, HDL, triglycerides, AE
``` MOA - inhibit conversion of HMG-CoA reductase -> inability to produce de novo cholesterol; increase cell surface LDL receptors LDL: big decrease HDL: slight increase Triglycerides: slight decrease AE - heptatotoxicity, myopathy ```
27
Bile acid resins
cholestyramine, colestipol, colesevelam
28
Bile acid resin MOA, effects on LDL, HDL, triglycerides, AE
MOA: prevent intestinal reabsorption of bile acids LDL: moderate decrease HDL: slight increase Triglycerides: slight increase AE - GI upset, decreased absorption of fat-soluble vitamins, development of cholesterol gallstones
29
Ezetimibe MOA, effects on LDL, HDL, triglycerides, AE
MOA - prevent cholesterol absorption at small intestine brush border LDL: moderate decrease HDL: slight decrease/no effect triglycerides: slight decrease/no effect AE - rare increase in liver function tests, diarrhea
30
Fibrates
Gemfibrozil, Bezafibrate, fenofibrate
31
Fibrate MOA, effect on LDL, HDL, triglycerides, AE
MOA - up regulate LPL -> increase triglyceride clearance LDL - slight decrease HDL - slight increase Triglycerides - big decrease AE - myopathy, cholesterol gallstones, hepatotoxicity
32
Niacin (Vit B3) MOA, effect on LDL, HDL, triglycerides, AE
MOA - inhibits lipolysis in adipose tissue; reduces hepatic VLDL synthesis LDL - moderate decrease HDL - moderate increase (most of all drugs) Triglycerides - slight decrease AE - flushing (decreased by aspirin before or long-term use), hyperglycemia, hyperuricemia
33
What is the effect of Nitrates on EDV (preload), BP, HR, contractility, and myocardial O2 demand?
decrease preload/EDV, decrease BP, increase HR (compensatory), no effect on contractility, decrease myocardial O2 demand
34
What is the effect of beta blockers on EDV (preload), BP, HR, contractility, and myocardial O2 demand?
no effect on preload/EDV, decrease BP, decrease HR, decrease contractility, decrease myocardial O2 demand
35
What is the goal in treating angina?
reducing myocardial O2 demand
36
Ranolazine MOA, use, AE
MOA - inhibits the late phase of sodium current -> reduce diastolic wall tension and O2 consumption (no effect on HR or contractility) Use - angina refractor to other meds AE - constipation, dizziness, HA, N, QT prolongation
37
Na+ channel blockers IA, IB, IC
IA - disopyramide, quinine, procainamide (double quarter pounder) IB - mexiletine, lidocaine, tocainide (mayo, lettuce, tomato) IC - flecainide, propafenone (fries, please)
38
Na+ channel blockers MOA, effects
MOA - decrease slope of phase 0 in mycoytes | Effects - increase effective refractory period (ERP), QT interval, and AP duration
39
Procainamide uses and SE
Wolffe-Parkinson-White (WPW) | SE: drug-induced lupus
40
Quinidine SE
cinchonism, thrombocytopenia, TdP
41
General Uses of Class IA Na+ Channel Blockers
atrial and ventricular arrhythmias, especially re-entrant SVT and VT
42
General Uses of Class IB Na+ Channel Blockers
acute ventricular arrhythmias (esp post MI), digitalis-induced arrhythmias
43
General Uses of Class IC Na+ Channel Blockers
SVTs, including atrial fibrillation (last resort for VT)
44
AE and C/I for Class IC Na+ channel blockers
C/I post MI and ischemic heart disease | AE - proarrhythmic, esp post-MI; toxicity is worse with hyperkalemia
45
Ivabradine MOA, Use, AE
MOA - inhibits funny sodium channels (If) Effects - prolongs phase 4, decreased SA node firing Use - chronic stable angina (when can't take beta blockers), chronic HF AE - luminous phenomena/visual brightness, HTN, bradycardia
46
Beta blockers
metoprolol, propranolol, esmolol, atenolol, timolol, carvedilol
47
Beta blockers MOA
decrease cAMP, decrease Ca2+ current -> suppress abnormal pacemakers by decreasing the slope of phase 4 of the pacemaker cells
48
Beta blockers use in arrhythmias
SVT, ventricular rate control for a fib and a flutter, V tach
49
Beta Blockers AE
exacerbation of COPD and asthma, CV effects (bradycardia, AV block, HF); may mask Sx of hypoglycemia Tx Beta blocker overdose with glucagon
50
Potassium Channel Blockers
Amiodarone, ibutilide, dofetilide, sotalol, bretylium
51
Potassium Channel Blocker MOA & effect
MOA - inhibit phase 3 of the myocyte | Effect - increase AP duration, increase ERP, increase QT interval
52
Clinical Use and AE of Potassium Channel Blockers
Use - a fib, a flutter, V tach; amiodarone can be used for WPW AE - TdP for all
53
AE of amiodarone
pulmonary fibrosis, hepatotoxicity, hyper or hypothyroidism, photo dermatitis, CV effects (bradycardia, heart block, HF)
54
Calcium Channel Blockers
Nondihydropyridine (dihydropyridine have no effect on heart - only blood vessel; use for HTN) Verapamil Diltiazem
55
MOA & effects of CCB
MOA - inhibit phase 0 of pacemaker | Effects - decrease conduction velocity of AV node, increase ERP, increase PR interval
56
Use, AE, and C/I of CCB
Use - prevention of SVT, rate control in a fib AE - constipation, flushing, edema, CV effects (HF, AV block, sinus node depression) C/I - HF, DO NOT combine with beta blockers
57
Adenosine MOA, use, AE
MOA - increase K+ out of cell -> hyper polarizes cell and decreases intracellular calcium -> decreases AV node conduction -> stops heart Use - diagnosing/treating SVT (Effects blunted by theophylline - used for COPD and severe asthma) AE - flushing, hypotension, chest pain
58
When is Mg2+ useful in regards to arrhythmias?
TdP and digoxin toxicity
59
What antihypertensive drug causes first-dose orthostatic hypotension?
alpha 1 blockers (-zosin), clonidine (alpha 2 agonist)
60
What antihypertensive drug causes hypertrichosis?
milnoxidil
61
What antihypertensive drug causes cyanide toxicity?
nitroprusside
62
What antihypertensive drug causes dry mouth, sedation, and severe rebound HTN?
clonidine (alpha 2 agonist)

Pharmacology Step 1 (8 decks)

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