Cardio exam 5 drugs Flashcards
Meds to tx increased preload HF
diuretics
aldosterone antagonists
ANP
Meds to tx increased afterload HF
ACE-I’s
ARBs
Use of loop diuretics in HF
pulmonary edema
decreases volume and causes venodilation
Metabolic changes with loop diuretics
increased Glc/urea
decreased H+/Na+/Mg2+/K+
Toxicity of loop diuretics
ototoxicity
Metabolic changes with thiazide diuretics
decreased K+/Mg2+/Na+/H+
increased Glc/urea/lipids/Ca2+
Side effects of diuretics with HF
overdiuresis electrolyte imbalance (Mg2+/K+) causing arrhythmia
Action and use of nitrates
venous vasodilators
for angina and HF
Problem with nitrate use
tolerance, alternatve every 12 hrs
ACE-I’s/ARBs with HF and beneficial group to use with
decrease preload and afterload
also tx HTN
pts with renal insufficiency (slows progression)
What are ACE-I’s 1st line for?
systolic HF
ARBs with increased K+ or decreased renal fxn
Hydralazine + IDN use and side effect
for pts who cannot use ACE-I’s or ARBs
can cause lupus like syndrome
Side effect of Na+ nitroprusside
cyanide and thiocyanate toxicity
Use of nesiritide
for acute decompensated HF
supresses neurohormonal stimulation
recombinant B type natriuetic peptide
Use of sympathomimetic amines in HF
acute/decompensated HF
Sympathomimetic amines used with HF
dopamine (increases renal fxn)
dobutamine
NE/epi
isoproterenol (increases vasodilation)
Phosphodiesterase inhibitors
amrinone
milrinone
Action of digoxin
increases vagal tone
inhibits Na+/K+ ATPase in sarcolemma (which increases refractory and increases Ca2+ stored in SR)
Dopamine doses and effects
10um/kg/min for peripheral vasoconstriction (alpha1)
Electrolyte imbalances increasing digoxin toxicity
decreased K+/Mg2+
increased Ca2+
Beta blockers increasing survival with HF
metoprolol succinate
bisoprolol
carvedilol
Beta blockers excreted by kidneys (not liver)
atenolol
nadolol
sotalol
carteolol
Benefit of aldosterone antagonists with systolic HF
decreased mortality and morbidity
Side effect of aldosterone antagonists
gynecomastia
hyperkalemia
Drug that decreases mortality perioperatively
beta blockers
Antiarrhythmic not causing QT prolongation
propafenone`
Major characteristics of class IA antiarrhythmics
can cause Torsades discontinuation side effects quinidine (cinchonism) procainamide (lupus) disopyramide (anticholinergic)
Class IB uses
for ventricular arrhythmias
Class IC use
PVC
Side effects of class II antiarrhythmics
bronchoconstriction
AV block
Class III antiarrhythmic toxicities
hyper/hypothyroidism
pulmonary toxicity
bradycardia
hepatic toxicity
Use of sotalol
better efficacy with life threatening pts
beta blockers and K+ channel blocker
Dofetilide uses
for A fib/flutter only
effects only I(kr) K+ current
Dronedarone uses and contraindication
decreases A fib recurrence rates contra in class IV HF or II/III HF with recent hospitalization
Tx for pulseless VT or V fib
CPR + shock, then
epi/vasopressin then
amiodarone (or Mg2+ if Torsades)
What does amiodarone decrease mortality with?
CHF and acute MI
Drug to use post MI
beta blockers
Drugs to use for high risk or VT/VF
defib
amiodarone
sotalol
Drugs causing Torsades
class IA and III antiarrhythmics
Tx for Torsades
Mg2+
Drugs for A fib/flutter
CCBs
beta blockers
digoxin
Drug for PSVT
adenosine
does not effect VT
Drugs decreasing mortality with CHF and MI
beta blockers
ACE-I’s
ACE-I with sulfa allergy
captopril
What do you monitor with ACE-I’s?
serum creatinine and K+ levels
Population with benefit of hydralazine/ IDN
African Americans with class III/IV HF
What is metolazone?
thiazide related
synergistic with loop diuretics for K+ loss
What are tolvaptan/conivaptan?
vasopressin receptor blockers
tx hyponatremia
Action of digoxin on heart (generally)
increased contractility
Use of nicotinic acid
decrease TG mostly, and increase HDL
Side effects of nicotinic acid
increased serum Glc
hyperuricemia
hepatotoxicity
Use of fibrinic acids
decrease TG mostly
Use of ezetimibe
synergistic with statins to decrease LDL
prevents absorption in GI lumen
Drugs to tx increased pulmonary capillary wedge pressure (pulmonary HTN)
natriuetic peptide
vasodilators
Drugs to tx decreased cardiac index
dobutamine
milrinone
Ca2+ sensitizers
Tx unfractionated heparin OD bleeding
protamine sulfate for bleeding
Tx unfractionated heparin thrombocytopenia
direct thrombin inhibitor
LMW heparin inhibits what?
fractor Xa (don’t need to monitor)
Direct thrombin inhibitors
leipuridin
bivalirudin
argatrovban
Tx for 2nd degree AV block
atropine
dopamine
isoproterenol
