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BECOM > Cardio Drugs > Flashcards

Cardio Drugs Flashcards

1
Q

Procainamide

A

CLASS 1A - Na CHANNEL BLOCKER
MOA:
Class IA: slows phase 0
Class III: prolongs AP

Indication: Most atrial and ventricular arrhythmia (short term because the duration of the action is short)

Adverse effects: Torsade’s de pointes (NAPA metabolite); Lupus syndrome

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2
Q

Quinidine

A

CLASS 1A - Na CHANNEL BLOCKER
MOA:
Class IA: slows phase 0
Class III: prolongs AP

Indication: Atrial, AV junctional and ventricular arrhythmia

Contraindication: Signs of cinchonism (tinnitus, decreased hearing, headache, nausea, vomiting, dysphoria, and visual disturbances)

Adverse effects: Torsade’s de Pointes

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3
Q

Disopyramide

A

CLASS 1A - Na CHANNEL BLOCKER
MOA:
Class IA: slows phase 0
Class III: prolongs AP

Indications: only ventricular arrhythmia

Contraindication: Heart failure

Adverse effects: anti-muscarinic (dry eyes, urinary retention, constipation)

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4
Q

Lidocaine

A

CLASS 1B - Na CHANNEL BLOCKER
MOA:
Class IB: Shortens phase 3 repolarization (decreased QT) B- best for post MI

Indications: Wide TI; ventricular arrhythmia (post-MI); prevention of ventricular fibrillation following cardioversion

Adverse effects: CNS toxicity (SLAP CNS) sleepy, lidocaine, agitation, paresthesia, convulsions, nystagmus, slurred speech

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5
Q

Mexiletine

A

CLASS 1B - Na CHANNEL BLOCKER
MOA:
Class IB: Shortens phase 3 repolarization (decreased QT) B- best for post MI

Indications: Narrow TI; Ventricular arrhythmia

Adverse effects: nausea, vomiting, dyspepsia, CNS

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6
Q

Flecainide

A

CLASS 1C - Na CHANNEL BLOCKER
MOA:
Class IC: Markedly slows phase 0 depolarization
Class III: prolongs AP

Indications: SV arrhythmia with normal hearts; recurrent afib

Contraindications: Pre-existing ventricular tachycardia, ventricular ectopy; Can’t give post MI

Adverse effects: limited use due to prolonged QRS, proarrhythmic effects; use with caution with potent inhibitors of CYP2D6

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7
Q

Propafenone

A

CLASS 1C - Na CHANNEL BLOCKER
MOA:
Class IC: Markedly slows phase 0 depolarization
(Weak) Class II: beta blocking activity

Indications: Atrial arrhythmia

Contraindications: Asthma

Adverse effects: Bronchospasm

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8
Q

Metoprolol

A

CLASS 2 - BETA BLOCKER
MOA: Selective B1 adrenergic antagonist

Indication: Atrial fib/flutter; PAC/PVC; VT; Post-MI

Contraindication: sinus bradycardia, heart block greater than first degree, cardiogenic shock and overt cardiac failure; Prinzmetal/vasospastic angina

Adverse effects: fatigue, dizziness, depression, bradycardia
Sudden discontinuation in patients with IHD - severe angina, MI, and VA are likely

Drug interactions: MAOI, digitalis glycoside, SSRI’s, antipsychotics, antiretroviral drugs, antimalarial and other antiarrhythmics, inhibitors of CYP2D6

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9
Q

Esmolol

A

CLASS 2 - BETA BLOCKER
MOA: Non-selective; Short and fast acting beta blocker; rapidly metabolized by esterases in RBC’s

Indications: Acute arrhythmia during surgery or emergency situations

Contraindication: sinus bradycardia, heart block greater than first degree, cardiogenic shock and overt cardiac failure; Prinzmetal/vasospastic angina

Adverse effects: symptomatic hypotension, dizziness, bronchospasm, nausea

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10
Q

Acebutolol

A

CLASS 2 - BETA BLOCKER
MOA: Non-selective beta blocker with mild intrinsic sympathomimetric activity (partial agonist)

Indications: Tachyarrhythmias, AVNRT, ventricular arrhythmia follow MI

Contraindication: sinus bradycardia, heart block greater than first degree, cardiogenic shock and overt cardiac failure; Prinzmetal/vasospastic angina

Adverse effects: symptomatic hypotension, dizziness, bronchospasm, nausea

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11
Q

Propranolol

A

CLASS 2 - BETA BLOCKER
MOA: Non-selective; completely blocks both beta 1 and beta 2 adrenergic receptors

Indications: HTN; prevention of sudden death/reinfarction post MI; adjunct therapy with alpha blockers for pheochromocytoma; cardiac arrhythmia

Contraindication: sinus bradycardia, heart block greater than first degree, cardiogenic shock and overt cardiac failure; Prinzmetal/vasospastic angina

Adverse effect: fatigue, brochoconstriction, sexual dysfunction, arrhythmia, bradycardia

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12
Q

Atenolol

A

CLASS 2 - BETA BLOCKER
MOA: selective beta 1 receptor blocker

Indications: hypertension; management of hemodynamically stable patients with definite or suspected acute myocardial infarction to reduce cardiovascular mortality

Contraindication: sinus bradycardia, heart block greater than first degree, cardiogenic shock, and overt cardiac failure

Adverse effects: fatigue, bronchoconstriction, sexual dysfunction, arrhythmia

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13
Q

Labetolol

A

CLASS 2 - BETA BLOCKER
MOA: selectively blocks alpha 1 and nonselective B1 and B2 receptors; dose-related falls in blood pressure without reflex tachycardia and without significant reduction in heart rate

Indications: hypertension; second choice for treating hypertension in pregnancy

Contraindication: heart block greater than first degree, cardiogenic shock and overt cardiac failure; Prinzmetal/vasospastic angina

Adverse effects: fatigue, bronchoconstriction, sexual dysfunction, arrhythmia, postural hypotension

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14
Q

Amiodarone

A

CLASS 3 - K CHANNEL BLOCKER
MOA:
Predominantly Class III
Significant Class Ia activity (inactivity state)
Weak class II
Weak class IV
T 1/2 life is 3-10 days (remainder 58 days)

Indications: serious VT - most effective; more often in older patients due to accumulation and toxicity is associated with how long you’re on the drug. Base line testing prior to starting (CXR, PFTs, LFTs, TFTs)

Contraindications: Greater than first degree heart block; Drug interactions with those that inhibit CYP3A4/CYP2C8

Adverse effects: Torsade’s de Pointes; photo dermatitis and gray-blue discoloration, asymptomatic corneal microdeposits, symptomatic bradycardia and heart block, hypothyroidism, abnormal liver function tests and hypersensitivity hepatitis, and fatal pulmonary fibrosis

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15
Q

Dronedarone

A

CLASS 3 - K CHANNEL BLOCKER
MOA:
Predominantly Class III
Significant Class Ia activity (inactivity state)
Weak class II
Weak class IV; (doesn’t contain iodine like Amiodarone)

Indications: atrial fibrillation

Contraindications: patients with acute decompensated or chronic heart failure

Adverse effects: lack pulmonary and thyroid toxicity associated with Amiodarone

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16
Q

Sotalol

A

CLASS 3 - K CHANNEL BLOCKER
MOA:
D-Solatol is class III
L-Sotalol is class II

Indications: Ventricular tachyarrhythmias and atrial fibrillation or flutter

Contraindications: Bronchial asthma; sinus bradycardia

Adverse effects: beta blocker effects; Torsades de Pointes especially with low serum K concentrations; reverse use dependent (less effective at higher HR)

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17
Q

Dofetilide

A

CLASS 3 - K CHANNEL BLOCKER
MOA:
Class III: Pure K+ channel blocker

Indications: Persistent atrial fibrillation

Adverse effects: Torsade de pointes

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18
Q

Ibutilide

A

CLASS 3 - K CHANNEL BLOCKER
MOA:
Class III: K+ channel blocker
Class Ia: Na+ channel blocker

Indication: Drug of choice for chemical conversion of atrial flutter

Contraindications: Oral due to heavy first pass metabolism; initiation in hospital setting due to high risk of arrhythmia

Adverse effects: Torsade de pointes

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19
Q

Verapamil

A

CLASS 4 - Ca CHANNEL BLOCKER (Non-dihydropyridine)
MOA:
Class IV: L-type calcium channel blocker, binds the channels at a different site than diltiazem or dihydropyridines

Indications: Control of ventricular rate in patients with chronic atrial fibrillation/flutter; PSVT, drug of choice for prophylaxis

Contradictions: severe hypotension, 2nd or 3rd degree AV block, cardiogenic shock, severe CHF, sick sinus syndrome (unless has artificial pacemaker), severe LV dysfunction

Adverse effects: constipation, bradycardia, AV conduction block, asystole

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20
Q

Diltiazem

A

CLASS 4 - Ca CHANNEL BLOCKER
MOA:
Class IV: blocks L-type calcium channel (cardiac and vascular)

Indications: control of ventricular rate in atrial fibrillation or flutter; vasospastic and class angina (prophylactic treatment); hypertension

Contraindications: Hypotension, AV block (2nd or 3rd degree) or sick sinus syndrome, acute MI, pulmonary congestion, lactation (excreted in human milk)

Adverse effects: Hypotension, AV conduction block, bradycardia, constipation

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21
Q

Nifedipine

A

CLASS 4 - Ca CHANNEL BLOCKER
MOA:
Class IV: Vascular selective L-type calcium channel blocker; directly dilates peripheral arterioles

Indication: HTN (elderly, African Americans, individuals with decreased renin level), angina of effort, vasospastic angina

Contraindication: Inhibition of P-glycoprotein (Verapamil); inhibition of CYP3A4
Cimetidine- 80% increased in Nifedipine plasma levels

Adverse effects: dizziness, flushing, headache, transient hypotension, peripheral edema, reflex tachycardia

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22
Q

Amlodipine

A

CLASS 4 - Ca CHANNEL BLOCKER
MOA:
Class IV: Vascular selective L-calcium channel blocker; directly dilates peripheral arterioles

Indications: HTN (elderly, African American, individuals with decreased renin levels), angina

Contraindication: Inhibition of P-glycoprotein (Verapamil); inhibition of CYP3A4

Adverse effects: dizziness, flushing, headache, transient hypotension, peripheral edema, reflex tachycardia

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23
Q

Clonidine

A

CNS ACTING A2 ADRENERGIC AGONIST
MOA: Alpha 2 adrenergic agonist; activates the vasomotor center of the brain stem to reduce sympathetic outflow and reduce blood pressure by decreasing TPR, decreasing renal vascular resistance, reducing HR and SV, and increasing parasympathetic tone as well

Indications: hypertension (not recommended for initial treatment)

Contraindications: fluid retention and edema (concurrent therapy with a diuretic is necessary); patients with heart failure with reduced EF;

Adverse effects: dry mouth, dizziness, constipation, orthostatic hypotension, impotence, nausea, GI upset; sudden discontinuation causes hypertension rebound; may potentiate the CNS depressive effects of alcohol, barbiturates or other sedating drugs

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24
Q

Methylodopa

A

CNS ACTING A2 ADRENERGIC AGONIST
MOA: Prodrug; metabolite of alpha-methylnorepinephrine and lowers arterial pressure by false neurotransmission by replacing vascular NE with alpha-methylnorepinephrine, activation of presynaptic alpha 2 receptors in the the brain stem reduces sympathetic outflow, lowering blood pressure, and reduction of plasma renin activity

Indication: hypertension during pregnancy as a replacement for ACE inhibitors or ARBs

Contraindication: Hepatic disease

Adverse effects: transient sedation, depression, hepatotoxicity, hemolytic anemia

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25
Q

Prazosin

A

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

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26
Q

Doxazosin

A

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

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27
Q

Phenoxylbenzamine

A

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

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28
Q

Captopril

A 
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

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29
Q

Enalapril

A 
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

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30
Q

Fosinopril

A 
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

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31
Q

Lisinopril

A 
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

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32
Q

Losartan

A

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)

33
Q

Candesartan

A

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)

34
Q

Valsartan

A

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)

35
Q

Valsartan + Sacubitril

A

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

36
Q

Aliskiren

A

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

37
Q

Aliskiren + HCTZ

A

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

38
Q

Digoxin

A

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

39
Q

Adenosine

A

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

40
Q

Atropine

A

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

41
Q

Magnesium Sulfate

A

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

42
Q

Atrial Flutter

A

Metoprolol
Verapamil
Digoxin

43
Q

Atrial Fibrillation

A 
Propafenone 
Metoprolol 
Amiodarone 
Dofetilide 
Digoxin
44
Q

AV node Re-entry

A

Metoprolol
Verapamil
Digoxin

45
Q

Acute SVT

A

Diltiazem

Adenosine

46
Q

Acute Ventricular Tachycardia

A

Lidocaine

Amiodarone

47
Q

Ventricular Fibrillation

A

Lidocaine
Amiodarone
Epinephrine

48
Q

Nitroglycerin

A

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

49
Q

Isosorbide Dinitrate

A

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

50
Q

Ranolazine

A

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

51
Q

Dipyridamole

A

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.

52
Q

Treatment of angina with no other medical condition

A

Nitrate, beta blockers, calcium channel blockers

53
Q

Treatment of angina with recent MI

A

Nitrate and beta blockers

54
Q

Treatment of angina with asthma/COPD

A

Nitrates and calcium channel blockers

55
Q

Treatment of angina with hypertension

A

NItrates, beta blockers, and calcium channel blocker

56
Q

Treatment of angina with DM

A

Nitrate and calcium channel blockers

57
Q

Treatment of angina with CKD

A

Nitrates, beta blockers, and calcium channel blockers

58
Q

Lovastatin

A

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

59
Q

Pravastatin

A

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

60
Q

Cholestyramine

A

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)

61
Q

Niacine

A

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

62
Q

Gemfibrozil

A

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

63
Q

Ezetimibe

A

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

=

64
Q

Alirocumab

A

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

65
Q

Lomitapide

A

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

Indications: Hypercholesteremia

66
Q

Mipomersen

A

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

67
Q

Simcor (Niacin XR + SImvastatin)

A

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

68
Q

Vytorin (Ezetimide + Simvastatin)

A

Indications: Primary hyperlipidemia; homozygous familial hypercholesterolemia

69
Q

Advicor (Niacin XR + Lovastatin)

A

Indications: patients where both Niacin XR and Lovastatin is indicated

70
Q

Caduet (Amlodipine + Atorvastatin)

A

Indications: patients where both Amlodipine and Atorvastatin is indicated

Amlodipine: HTN and CAD
Atorvastatin: Prevention of CV disease; heterozygous familial and nonfamilial hypercholesterolemia

71
Q

Spironolactone

A

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

72
Q

Milrinone

A

PDE 3

73
Q

Enoximone

A

PDE3

74
Q

Sildenafil

A

PDE5

75
Q

Tadalafil

A

PDE5

76
Q

Ivabradine

A

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

77
Q

Drug Therapy for HF with reduced EF

A 
ACE inhibitors/ARB
Beta blockers 
Aldosterone antagonist 
Neprilysin inhibitors
Ivabradine
78
Q

Drug Therapy for HF with preserved EF

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

BECOM (1 decks)

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