Cardio Drugs Flashcards

Question

Prazosin

Answer 1

ALPHA ADRENERGIC ANTAGONIST MOA: Alpha 1 antagonist - block of alpha-1 mediated sympathetic tone in blood vessels. No reflex tachycardia. Indications: hypertension; it can be used alone or in combination with other antihypertensive drugs Adverse effects: dizziness, orthostatic hypotension, nasal congestion, headache, fluid retention

Answer 2

ALPHA ADRENERGIC ANTAGONIST MOA: Alpha 1 adrenergic receptor antagonist Indications: BPH and optional drug for HTN but its more useful in those patients with both BPH and HTN Adverse effect: dizziness, palpitation, headache, lassitude

Answer 3

ALPHA ADRENERGIC ANTAGONIST MOA: A long acting, nonselective, noncompetitive, alpha receptor blocker; binds covalently to alpha receptors; also inhibits the presynaptic reuptake of released NE, and blocks H-1 histamine, ACh, and serotonin receptors Indications: Pheochromocytoma (increased cortisol); to control episodes of hypertension and sweating, excessive tachycardia can be prevented by a concomitant use of a beta blocker Adverse effects: dizziness, tachycardia, drowsiness, shock, syncope, and postural hypotension

Answer 4

``` ACE INHIBITORS MOA: ACE inhibitor Prevents inhibition of bradykinin T1/2: 2 hours Sulfhydryl-containing ``` Indications: hypertension, heart failure, diabetic nephropathy Contraindication: pregnancy, bilateral renovascular disease, hyperkalemia; NSAIDs Adverse effect: acute renal failure, dry cough, hyperkalemia, skin rash, hypotension, alteration or loss of taste, angioedema

Answer 5

``` ACE INHIBITORS MOA: ACE inhibitor Prevents inhibition of bradykinin T1/2: 11 hours Dicarboxyl-containing ``` Indications: hypertension, heart failure, diabetic nephropathy Contraindication: pregnancy, bilateral renovascular disease, hyperkalemia; NSAIDs Adverse effect: acute renal failure, dry cough, hyperkalemia, skin rash, hypotension, alteration or loss of taste, angioedema

Answer 6

``` ACE INHIBITORS MOA: ACE inhibitor Prevents inhibition of bradykinin T1/2: 11.5 hours Phosphorus containing ``` Indications: hypertension, heart failure, diabetic nephropathy Contraindication: pregnancy, bilateral renovascular disease, hyperkalemia; NSAIDs Adverse effect: acute renal failure, dry cough, hyperkalemia, skin rash, hypotension, alteration or loss of taste, angioedema

Answer 7

``` ACE INHIBITORS MOA: ACE inhibitor Prevents inhibition of bradykinin T1/2: 12 hours Dicarboxyl-containing ``` Indications: hypertension, heart failure, diabetic nephropathy Contraindication: pregnancy, bilateral renovascular disease, hyperkalemia; NSAIDs Adverse effect: acute renal failure, dry cough, hyperkalemia, skin rash, hypotension, alteration or loss of taste, angioedema

Answer 8

ARB MOA: Blocks AT1 receptors (1000x more than AT2), blocking angiotensin 2 activity Indications: hypertension, heart failure, diabetic nephropathy, intolerance to ACE inhibitors( angioedema, cough) Contraindication: Pregnancy; Bilateral renovascular disease; hyperkalemia, NSAIDs, K sparing drugs, concomitant use with Aliskiren in patients with DM Adverse effect: acute renal failure, dry cough, hyperkalemia, skin rash, hypotension, alteration or loss of taste, angioedema (lower incidence of cough and angioedema than ACE inhibitors)

Answer 9

ARB MOA: Blocks AT1 receptors (1000x more than AT2), blocking angiotensin II activity Indications: hypertension, heart failure, intolerance to ACE inhibitors (cough, angioedema) Contraindication: Pregnancy; Bilateral renovascular disease; hyperkalemia, NSAIDs, K sparing drugs, concomitant use with Aliskiren in patients with DM Adverse effect: acute renal failure, dry cough, hyperkalemia, skin rash, hypotension, alteration or loss of taste, angioedema (lower incidence of cough and angioedema than ACE inhibitors)

Answer 10

ARB MOA: Blocks AT1 receptors (1000x more than AT2), blocking angiotensin II activity Indications: hypertension, heart failure, left ventricular dysfunction or failure after MI, intolerance to ACE inhibitors (angioedema, cough) Contraindication: Pregnancy; Bilateral renovascular disease; hyperkalemia, NSAIDs, K sparing drugs, concomitant use with Aliskiren in patients with DM Adverse effect: acute renal failure, dry cough, hyperkalemia, skin rash, hypotension, alteration or loss of taste, angioedema (lower incidence of cough and angioedema than ACE inhibitors)

Answer 11

ARB (Valsartan) + NEPRILYSIN INHIBITOR (Sacubitril) MOA: Lower vascular resistance and increases blood flow Sacubitril: a neutral endopeptidase that degrades vasoactive and natriuretic peptides, bradykinin, and adrenomedullin; prevents metabolism of levels of these peptides, which decreases vasoconstriction, sodium retention, and maladaptive remodeling Valsartan: angiotensin II receptor blocker Indications: treatment of HF with reduced EF Contraindications: pregnancy, K sparing diuretics, NSAIDS, ACE inhibitors (risk of angioedema, African American) Adverse effects: hypotension, hyperkalemia, cough, angioedema

Answer 12

RENIN INHIBITOR MOA: binds the active site of renin and inhibits the cleavage of angiotensin I from angiotensinogen Indications: hypertension, not a drug of first choice; you would use if patient has problems with ACE inhibitor Contraindications: concomitant use with an ACE inhibitor or ARB in DM patients Adverse effects: fetal/neonatal morbidity and mortality; dose-related GI adverse effects

Answer 13

RENIN INHIBITOR + HCTZ MOA: add on therapy for a patient whose BP is not adequately controlled with Aliskiren alone or HCTZ alone may be switched to combination therapy or a patient whose BP is controlled with HCTZ alone but who experiences hypokalemia may be switched to a combination therapy Limitation of use: not indicated for initial therapy Adverse effect: discontinue as soon as pregnancy is detected

Answer 14

OTHER MOA: Increases contractility; slows AV node conduction; increases vagal tone Indication: rate control in atrial fibrillation and systoloc heart failure; control of ventricular rate in chronic atrial fibrillation without systolic heart dysfunction Contraindications: patients with ventricular fibrillation Adverse effects: dose dependent: fatigue and muscle weakness; 2nd or 3rd degree AV conduction block (treat with Atropine), bigeminy, and various arrhythmia

Answer 15

OTHER MOA: Binds to adenosine receptors in the heart; slows conduction time through the AV node; helps block re-entry pathways through the AV node and restore normal sinus rhythm T 1/2 = 10 seconds Indications: PSVT - WPW, AVNRT; diagnosis of unknown SVT Contraindications: 2nd or 3rd degree AV block Adverse effects: facial flushing, light headedness, dyspnea occur occasionally; warn patient before giving adenosine for SVT

Answer 16

OTHER MOA: Muscarinic receptor antagonist; blocks the effects of vagal nerve stimulation; increase HR and AV conduction Indications: useful for bradycardia especially from AV block Adverse Effects: Muscarinic receptor blocking effect such as dryness of mouth, blurred vision, photophobia, and tachycardia

Answer 17

OTHER MOA: prevents influx of calcium into cells via blocking calcium channels Indications: for the treatment of Torsades de pointes even if serum magnesium is normal

Answer 18

Metoprolol Verapamil Digoxin

Answer 19

``` Propafenone Metoprolol Amiodarone Dofetilide Digoxin ```

Answer 20

Metoprolol Verapamil Digoxin

Answer 21

Diltiazem | Adenosine

Answer 22

Lidocaine | Amiodarone

Answer 23

Lidocaine Amiodarone Epinephrine

Answer 24

NITRATE MOA: T 1/2 = 1-4 minutes (short) Low bioavailability Broken down by GST and MtADH2 to release NO and decrease preload Selectively increase collateral blood flow to ischemic areas, stimulates guanylyl cyclase in platelets preventing platelet aggregation Indication: Immediate relief of angina; Drug of choice for acute treatment of angina. Classic effort induced angina pectoria. Vasospastic angina. Unstable angina. CHF associated with acute MI. Control of BP associated with surgical procedures. Dermal patches or slow release for prolonged prophylaxis (tolerance can develop) Contraindications: Type 5 PDE inhibitors; co-administration of Sildenafil; hypotension or uncorrected hypovolemia; increased intracranial pressure; inadequate cerebral circulation Adverse effects: headaches, dizziness, reflex tachycardia (high dose NTG), orthostatic hypotension, tolerance, nausea

Answer 25

NITRATE MOA: Nitrate = increased NO = increase cGMP = increased dephosphorylation = vascular smooth muscle relaxation Bioavailability is highly variable with extensive first pass metabolism Adverse effects: headache

Answer 26

METABOLISM MODIFIER MOA: Reduces sodium influx during ventricular depolarization by blocking a late sodium plateau current caused by sodium channels. Decreased intracellular sodium causes a reduction of intracellular calcium and reduces the contractility Dose-dependent increases QTc by blocking the cadiac K influx; decreased end diastolic flow and improved diastolic coronary flow Indications: Not recommended as a first line therapy for patients with chronic stable angina because of potential risk of QTc prolongation. This is an option for those who can't tolerate any of the traditional agents Adverse effects: QTc prolongation

Answer 27

ANTI-PLATELET MOA: Antiplatelet via PDE inhibition (increases cAMP) and inhibition of adenosine uptake Vasodilator Indications: combined with aspiring to prevent clot formation. An adjunct to coumarin anticoagulant.

Answer 28

Nitrate, beta blockers, calcium channel blockers

Answer 29

Nitrate and beta blockers

Answer 30

Nitrates and calcium channel blockers

Answer 31

NItrates, beta blockers, and calcium channel blocker

Answer 32

Nitrate and calcium channel blockers

Answer 33

Nitrates, beta blockers, and calcium channel blockers

Answer 34

HMG-COA REDUCTASE INHIBITOR MOA: Inhibitors of HMG-CoA reductase; decreases cholesterol synthesis and upregulates LD: Should be given in the evening Absorption enhanced if taken with food Indication: standard protocol to initiate immediately after MI Contraindications: Pregnancy category X, women who are pregnant, lactating or likely to become pregnant Drugs that inhibit or compete for CYP3A4 or CYP2C9, drugs that induce CYP3A4 will reduce lovastatin levels, concomitant use of Amiodarone or Verapamil will cause increased risk of myopathy, and grapefruit juice Adverse effects: Myopathy; rhabdomyolysis, increased risk of DM

Answer 35

HMG-COA REDUCTASE INHIBITOR MOA: Inhibitors of HMG-CoA reductase; decreases cholesterol synthesis and upregulates LD 20% excreted in urine 70% excreted in feces Non-P450 pathways (useful if patient is taking 2nd drug metabolized by P450) T 1/2 = 77 hours Indication: standard protocol to initiate immediately after MI Contraindications: Pregnancy category X, women who are pregnant, lactating or likely to become pregnant

Answer 36

BILE ACID BINDING RESINS MOA: Binds to bile acids in the intestinal lumen and prevents reabsorption; fall in cholesterol will cause reuptake of LDL Indications: For patients with isolated increased in LDL and can be used as a second drug if statin therapy doesn't sufficiently lower LDL levels or in case of statin intolerance Contraindications: homozygous familial hypercholesteremia (lacks LDL-R and PCSK9/ApoB) Adverse Effects: constipation because it stays in the GI tract; prevents reabsorption of fat soluble vitamins (ADEK)

Answer 37

NICOTINIC ACID MOA: Inhibits a hormone sensitive lipase in adipose tissue preventing breakdown of triglycerides to free fatty acids, and the transport of free fatty acids to the liver. Decreases hepatic triglyceride synthesis and inhibits VLDL secretion from the hepatocytes which decreases the production of LDL. ``` Indications: Hypercholesterolemia Severe mixed lipedema Incompletely responsive to diet Most effective agent for increasing HDL levels Combined hyperlipoproteinemia Familial dysbetapoproteinemia ``` Contraindications: Patients with acanthosis nigrans because of it's association with insulin resistance; liver disease, gout, cardiac arrhythmias Adverse effects: harmless cutaneous vasodilation and sensation of warmth after each dose; tachyphylaxis; carbohydrate tolerance may be impaired; nausea and abdominal discomfort

Answer 38

FIBRIC ACID DERIVATIVES MOA: Activation of the nuclear transcription receptor peroxisome proliferator - activated receptor alpha; upregulates apoA-1 and apoA-II and down regulates apoC-III Decrease in VLDL and increase in HDL level Indications: hypertriglyceridemia in which VLDL predominates and in dysbetalipoproteinemia (type III hyperlipoproteinemia). Treatment of hypertriglyceridemia resulting from treatment with viral protease inhibitors Contraindications: patients with hepatic or renal dysfunction, patients with biliary tract disease; interacts with coumarin Adverse effects: arrhythmias, hypokalemia, and high aminotrasnferase or alkaline phosphatase levels

Answer 39

INHIBITORS OF INTESTINAL STEROL ABSORPTION MOA: Blocks cholesterol absorption by enterocytes by inhibiting transport protein NPC1L1; synergistic effects on LDL when combined with statin Indications: hypercholesteremia Contraindications: fibrates - increased plasma levels; cholestyramine - decreased plasma levels Adverse effects: low incidence of reversible hepatic impairment =

Answer 40

PCSK9 INHIBITORS MOA: Inhibit enzyme PCSK9 which prevents destruction of the LDL receptor and facilitates recycling of hepatic LDL receptors, which enhances removal of LDL from the blood Indications: Adjunct therapy to lower LDL in patients with HeFH; atherosclerotic CV disease; they are NOT approved for treatment of hyperlipidemia in statin-intolerant patients without known ASCVD Contraindications: Pregnancy and breast feeding Adverse effects: Nasopharyngitis, flu, allergic reactions; swelling, itching at injection site

Answer 41

MTP INHIBITOR MOA: Binds and inhibits microsomal triglyceride transfer protein (MTP). This inhibits the synthesis of chylomicrons and VLDL. Indications: Hypercholesteremia

Answer 42

APO B-100 INHIBITOR MOA: It's an antisense oligonucleotide targeted to human mRNA for apo B-100 Indications: patients with homozygous familial hypercholesteremia as adjunct to lipid-lowering medications and diet

Answer 43

Indications: Primary hypercholesterolemia and mixed dyslipidemia (Fredrickson type IIa and IIb)

Answer 44

Indications: Primary hyperlipidemia; homozygous familial hypercholesterolemia

Answer 45

Indications: patients where both Niacin XR and Lovastatin is indicated

Answer 46

Indications: patients where both Amlodipine and Atorvastatin is indicated Amlodipine: HTN and CAD Atorvastatin: Prevention of CV disease; heterozygous familial and nonfamilial hypercholesterolemia

Answer 47

ALDOSTERONE ANTAGONIST MOA: Specific antagonist of aldosterone, acting primarily through competitively binding of mineralocorticoid receptors in the collecting tube Indications: treatment of CHF Contraindications: Patients with significant renal impairment; hyperkalemia; not recommended in pregnancy Adverse effect: gynecomastia Major Drug Interactions: NSAIDs and digoxin

Answer 48

HCN CHANNEL BLOCKER MOA: Selective and specific inhibition of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels leading to decreased HR Indications: CHF with EF <35% or you have maximally tolerated doses of beta blockers or have contraindications for beta blockers (last resort) Contraindications: Patients with sick sinus syndrome; CYP3A4 inhibitors Adverse Effects: Luminous phenomena (sensations of brightness in a fully maintained visual field), bradycardia, AV block, headache, blurred vision

Answer 49

``` ACE inhibitors/ARB Beta blockers Aldosterone antagonist Neprilysin inhibitors Ivabradine ```

Answer 50

``` Treat HTN Rate control Reduced edema Reduce MI Increase diastolic relaxation ```