Cardio - FA Pharm p312 -319 Flashcards
HTN with HF - rx?
Diuretics, ACE inhibitors/ARBs, β-blockers (compensated HF), aldosterone antagonists.
Which Rx are protective vs DB nephropathy?
ACEI/ARBs
What rx do you avoid in a pt with HTN and asthma
Avoid nonselective β-blockers to prevent β2-receptor–induced bronchoconstriction.
Avoid ACE inhibitors to prevent confusion between drug or asthma-related cough
Name 4 dihydropyridine CCB
Amlodipine, Nimodipine, Nifedipine, Clevidipine
Which CCB assoc with reflex tachy?
Dihydropydrine CCB (“dipines”)
Which CCB act primarily on the heart?
Non dihydropyridines - Verapamil, Diltiazem
Which CCB is used in subarach hemorrhage?
Nimodipine - only one that crosses BBB
Nimo - like dory in Nemo, head doesnt work right
CCB DOC in HTN emergency?
Clevidipine (Clever in an emergency)
Which CCB can cause hyper PRL?
VeRaPamiL (PRL in the word, sort of)
Why is hydralazine freq coadmin with BB?
to prevent reflex tachy
SE of Hydralazine
reflex tachy, fluid retention, headache, angina, SLE-like syndrome
How to Tx a HTN emergency?
Treat with clevidipine, fenoldopam, labetalol, nicardipine, or nitroprusside.
`
Which cardiac parameter is decreased with nitrates?
preload (venous VD >> art VD)
Which cardiac drug is a dopamine D1-R agonist?
Fenoldopam
Which cardiac drug is associated with cyanide tox? Tx for it?
Nitroprusside; Nitrates and thiosulfate (Any nitrate works for CN- poisoning bc will inc metHgb, which will then bind CN-)
4 cardiac Rx used in HTN + pregnancy?
Hydralazine, Labetalol, MethylDopa, Nifedipine
Hypertensive Moms Love Nifedipine
Which cardiac parameter is decreased with Hydralazine?
afterload (art VD>> venous VD)
Which cardiac Rx will increase cGMP?
Nitroprusside, Nitrates –> both inc NO
Hydralazine
In Angina therapy, which Rx will increase ejection time?
BB
Which BB are to be used with caution in angina?
Pindolol and acebutalol - bc they are partial B agonists, and so will have SNS (+)’n –> inc cardiac work and O2 demand
Why does heart rate inc with the use of nitrates in angina?
reflex
What is the goal of antianginal therapy?
Goal is reduction of myocardial O2 consumption (MVO2) by dec 1 or more of the determinants of MVO2: end-diastolic volume, BP, HR, contractility.
Which BB are to be used with caution in angina?
Pindolol and acebutolol are partial β-agonists
Ranolazine MoA
Inhibits the late phase of sodium current thereby reducing diastolic wall tension and oxygen consumption
Ra - Na - late zine blocks late Na channels
used in refractory angina
Which cardiac parameters is not affected by Ranolazine?
it doesn’t affect HR or BP
MoA of Milrinone?
Selective PDE-3 inhibitor.
In cardiomyocytes: inc cAMP accumulation –> inc Ca2+ influx –> inotropy and chronotropy.
In vascular smooth muscle: Inc cAMP accumulation –> inhibition of MLCK activity –> general vasodilation
Use and SE of Milrinone
Used short term in acute decompensated HF
SE/ Arrythmia, hypotension
MoA of Sacubitril?
Prevents degradation of natriuretic peptides, angiotensin II, and substance P by neprilysin;
inc vasodilation, dec ECF volume.
When is Sacubitril used?
Used in combination with an ARB (valsartan) for treatment of HFrEF.
SE of Sacubitril?
Hypotension, hyperkalemia, cough, dizziness
Why is sacubitril CI with ACEIs?
can also cause angioedema
Why are nitrates CI with sildenafil? - bonus Q
Both inc cGMP –> orthostatic hypotension
Which lipid lowering agent upregulates LPL?
Fibrates - gemfibrozil, clofibrate, bezafibrate
Which lipid lowering agent exacerabates gout?
Niacin - causes hyperuricemia
Which lipid lowering agent inhibits hormone sensitive lipase?
Niacin
Bleeding is potential side effect of which lipid lowering agent?
Bile acid resins - due to dec absorption of other drugs, like warfarin, and fat sol vitamins (uworld Q)
Bonus Q - what Tx for Statin induced rhabdomyolysis?
mannitol
What kidney pathology is associated with statins?
Acute tubular necrosis ( break down of musc –> Mgb can plug up kidney –> oxidative damage)
GI discomfort - which lipid lowering agent?
Bile acid resins
What drug blocks chol absorption at SI brush border?
ezetimibe
Which Drug is an antisense oligonucleotide vs apoB100 mRNA?
Mipomersen
Digoxin has a secondary effect on heart rate, separate from contractility - what is it? Mech?
Dec HR by stimulating CN X
Why does digoxin require a loading dose?
Bc has a long half life will take a long time to get to steady state.
Lower dose of digoxin in patients with which comorbidities?
renal failure bc dec excretion - digoxin is renally cleared.
Name 4 drugs that can increase Digoxin Tox - Why?
Verapamil, Amiodarone, Quinidine, Propafenone - bc they displace digoxin from tissue binding sites
VAQuum uP Digoxin
Digoxin tox antidote
anti digoxin Fab fragments, Mg2+, slowly normalize K+ (using insulin, kayexalate, hemodialysis)
Class I anti-arr Rx overall affect which phase of the cardiac cycle?
phase 0
What can increase the chances of toxicity of all class I drugs?
Hyperkalemia
Which anti-arr Rx increase AP duration?
Class III (K ch blockers) and Class Ia (block open active Na channels)
Adenosine affects which phase of cardiac cycle? Mech of action?
phase 4; Inc K+ efflux –> hyperpol and dec Ca current, dec AV node conduction
`Adenosine is used for what disease?
diagnosing, terminating forms of SvT
Which drugs will blunt the affect of Adenosine?
Theophylline, Caffeine
SE of Adenosine
flushing, hypotension, chest pain, sense of impending doom, bronchospasm
`Mg2+ is used in what diseases?
torsades de pointes and digoxin toxicity.
(and pre-eclampsia)
`MoA of Ivabradine
IVabradine prolongs slow depolarization (phase “IV”) by selectively inhibiting “funny” sodium channels (If).
Ivabradine is used for what diseases? SE?
Chronic stable angina in patients who cannot take β-blockers. Chronic HFrEF. (HF with reduced ejection fraction)
Luminous phenomena/visual brightness, hypertension, bradycardia.
Which Anti-arr Rx is associated with gingival hyperplasia ?
Verapamil
Which Anti-arr Rx is associated with “sense of impending doom” as Tox?
Adenosine
Which Anti-Arr Rx will increase PR interval?
BB, CCB
Drug associated with headache, tinnitus?
Quinidine (Cinchonism)
Anti Arr Rx that can lead to reversible SLE like syndrome?
Procainamide
Best class for post MI?
Class Ib - block the inactivated Na channel, tissue post MI is hypoxic, closer to depol, and Na ch is in the inactivated state
Which Anti arr rx is assoc with difficulty breathing, skin and eye issues?
Amiodarone - SE// pulm fibrosis, hyper/hypothyroidism, corneal deposits, blue/grey skin
Which anti Arr rx is a BB that also blocks K channels?
Sotalol
Which anti Arr rx is CI post MI?
Any Class Ic - Flecainide, Proparenone - can be pro-arrythmic
with which anti-Arr Rx will you have to do CBCs?
Class Ia (thrombocytopenia )
Anti -Arr Rx that prolong QT?
Class Ia and III - will lead to Torsades
Disopyramide, ibutilide, Dofetilide, Sotalol, Quinidine, Procainamide
