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Cardio Pharm Flashcards

1
Q

Thiazides MOA

A

” - Block reapsorption of Na+ and Cl- in distal tubule

  • Thiazides secreted at proximal tubule into lumen of nephron, travel to distal tubule
    • Decreases Cardiac Preload”
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2
Q

Thiazides Clinical Uses

A

” - 1st Line for Primary Hypertension

  • Prevention of Kidney Stones
  • Nephogenic Diabetes Inspidius”
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3
Q

Thiazide Contraindications

A

” - Contraindications

  • Sulfa Allergy
  • Severe Hypokalemia
  • Interactions
    • Diabetes Mellitus
    • ACE inhibitors
    • NSAIDs
    • May not work in severe renal disease”
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4
Q

Thiazide Adverse indications

A

” - Electrolyte disturbances – decreased Na, Mg, K, Cl,

  • Hypercalcemia
  • Hyperuricemia (gout patients)
  • Hyperglycemia (diabetics)
  • Increased BUN/Creatinine ratio > 20:1 (dehydration)
  • Cholesterol elevation
  • Idiopathic: thrombocytopenia, pancreatitis”
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5
Q

Loops MOA

A

” - Blocks reabsorption of Na+ and Cl- in thick acending limb of Loop of Henle
- Decreases Cardiac Preload”

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6
Q

Loops Clinical Uses

A

” - 2nd Line for Primary HTN

  • Acute & Congestive Heart Failure
  • Renal/CKD Failure”
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7
Q

Loop contraindication

A

” - Contraindications

- Sulfa Allergy except Ethacrynic Acid”

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8
Q

Loop adverse effects

A

” - Electrolyte disturbances – decreased K, Na, Mg, Cl

  • Hypocalcemia
  • Hyperuricemia (gout patients)
  • Increased glucose (diabetic patients)
  • Increased BUN/Creatinine ratio > 20:1 (dehydration)
  • Ototoxicity
  • Idiopathic: thrombocytopenia, pancreatitis”
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9
Q

Examples of loops

A

” - Bumetanide

  • Furosemide
  • Torsemide
  • Ethacrynic Acid”
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10
Q

Potassium sparing MOA

A

” - Direct inhibition of ENaC in distal convoluted tubule

  • Reduced Na+ reabsopriton and reduced K+ secretion
    • Decrease Cardaic Preload”
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11
Q

Potassium sparing clinical uses

A

” - Hypertension with Hypokalemia

  • Ascites/Edema
  • Additive Effect in Combo with Thiazide or Loop Diuretic”
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12
Q

Potassium sparing adverse interactions

A

” - Contraindications

  • Anuria
  • Hyperkalemia
  • Addison Disease
  • Significant Chronic Kidney Disase (GFR < 45 mL/min)
  • Interactions
    • Hyperkalemia with other diuretics
    • Do not use as monotherapy for hypertension”
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13
Q

Potassium sparing adverse effects

A

” - Hyperkalemia

  • Arrythymias
  • GI Disturbaces”
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14
Q

Contraindicatiosn of potassium spairing

A

amiloride contraindicated in diabetic nephropathy

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15
Q

Sprionolactone MOA

A

” - Competitively binds to aldosterone receptors in late distal convoluted tubule.

  • Inhibits effects of aldosterone leading to decreased Na+ reabsorption & K+ excretion
  • Decreased Mortaility
    • Decrease Cardiac Preload”
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16
Q

Sipironolactone uses

A

” - Hypertension with Hypokalemia
- Ascites/Edema
- Additive Effect in Combo with Thiazide or Loop Diuretic
- Systolic Heart Failure another standard therapy
- Should be considered for pts after MI with acute heart failure”

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17
Q

Contraindications Spironolactone

A

” - Contraindications

  • Anuria
  • Hyperkalemia
  • Addison Disease
  • Interactions
    • Caution in pts with decreased renal function
    • Hyperkalemia with other diruetics”
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18
Q

Spironolactone AE

A

” - Spironolactone: can cause gynecomastia in men & amenorrhea in women
- Eplerenone: use caution with other CYP3A4 inhibitors, & diabetics”

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19
Q

ACE inhibitors MOA

A

” - Inhibits angiotensin converting enzyme, preventing formation of angiotensin II inhibiting downstream effects of RAAS

  • Decreased secretion of aldosterone
    • Decreased Cardiac Afterload & Preload
    • Decreased Cardaic Remodeling”
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20
Q

ACE inhibitor clinical uses

A

” - 1st Line HTN Therapy for

- Diabetes
- Ischemic/Coronary Heart Disease
- Systolic Heart Failure (HFrEF) (mortality benefit)
- History of MI  - Scleroderma"
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21
Q

Contraindications of ACE/ interactions

A

” - Contraindications

  • Pregnancy
  • Not first line or monotherapy for African American patients
  • Other ARBs or direct renin inhibitors
  • C1 esterase inhibitor defiency
  • Aortic Stenosis
  • Interactions
    • NSAIDS (can causes Acute Kidney Injury)
  • Caution with preexisting kidney disease”
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22
Q

AE of ACEI

A

” - Cough - due to bradykinin disruption

  • Hyperkalemia
  • Orthostatic Hypotension
  • Azotemia
  • Skin Rash
  • Decrease GFR
  • Angioedema (Rare) - if occurs switch to ARB however be aware of an 8-10% cross reactivity”
23
Q

ARB MOA

A

” - Antagonist at the angiotensin II receptor, preventing downstream effects of RAAS

  • Decreased sectretion of aldosterone but increased renin secretion
    • Decreased Cardiac Preload & Afterload
    • Decreased Cardiac Remodeling”
24
Q

Clinical Use ARB

A
  • 2nd Line Therapy if ACE Inhibitors aren’t tolerated
25
ARB contraindications
" - Contraindications - Pregnancy - Other ARBs or direct renin inhibitors - C1 esterase inhibitor defiency - Aortic Stenosis - Interactions - NSAIDS (can causes Acute Kidney Injury) - Caution with preexisting kidney disease"
26
ARB adverse effects
" - Hyperkalemia - Angioedema (Rare & Less frequent than ACEIs) - cross reactivity is approx. 8-10% with ACEIs - Azotemia"
27
ACE drugs end with
sartan
28
Direct renin inhibitors MOA
Directly inhibits renin, decreasing plasma renin activity which inhibits the conversion of angiotensinogen to angiotensin I
29
Direct renin inhibitors clinical use
- 3rd Line Therapy if ACE Inhibitors & ARBs aren't tolerated
30
Direct renin inhibitor contraindications
Same as ARBs + P-glycoprotein inhibitors.
31
Direct renin inhibitors AE
" - Hyperkalemia - Diarrhea - Cough (1/3 - 1/2 incidence of ACEI) - Angioedema (Very Rare)" - Aliskiren is long acting, poorly absorbed CYP3A4 toxicity.
32
CCB DHP MOA
" - Bind to & block L- Type Ca2+ channels, primarily in vascular smooth muscle - Causes vascular smooth muscle dilaation & decreased TPR - Decreases Afterload - Negative Inotrope (except amlodipine & felodipine)"
33
CCB DHP clinical uses
" - Hypertension (esp. amlodipine) - Stable Angina (for pts who cant take beta-blockers) - Vasospastic Angina"
34
CCB DHP contraindications
" - Contraindications - Systolic Heart Failure & CHF* - Acute Coronary Syndrome - HOCM - Interactions - Grapefruit juice ( ≥ 1 quart daily) - can increase concentrations of all except amlodipine"
35
Adverse effects of DHP CCB
" - Reflex Tachycardia - Gingival Hyperplasia - Flusing - Dizziness - Periphreal Edema"
36
Which CCB are okay with HFrEF
Amlodipine and Fedipine
37
Non-DHP CCB MOA
" - Bind to & block L- Type Ca2+ channels, primarily in cardiac muscle - Causes decreased cardaic muscle contracitilty, decreases SA node dsicharge rate, decreases AV node conduction - Class IV Anti-Arrhythmic - Decreases Cardiac Output - Decreases Afterload - Negative Inotrope - Negative Dromotrope - Negative Chronotrope"
38
Clinical uses of non-DHP CCB
" - Hypertension - Stable Angina (for pts who cant take beta-blockers) - Vasospastic Angina - Any Type of SVT/AVRT/AVNRT - Atrial Fibrilation - Cardiomyopahty (not dilated)"
39
Contraindications of non-DHP CCB
" - Contraindications - Systolic Heart Failure & CHF - Acute Coronary Syndrome - WPW, Sick Sinus Syndrome, Bradycardia, Severe Heart Block - Interactions - Drug interactions with other CYP450 3A4 - can increase concentrations of cyclosporine, digoxin, lovastatin, simvastatin, tacrolimus, theophylline. - Verapamil > diltiazem - Caution with beta-blockers (due to increased risk of heart block)"
40
Non-DHP CCB adverse effects
``` " - Gingival Hyperplasia - AV Block - Bradycardia - Conduction Disturbances - Heart Failure - Periphereal Edema  - Constipation" ```
41
Which are the non-DHP CCBs and specific AE
" - Verapamil: Adverse Effects - constipation, dizziness | - Diltiazem: Adverse Effects - headache, edema"
42
Cardioselective BB MOA
" - Direct Blocking: β1 - Decreases contractility, AV conduction &refractory time, HR, O2 demand, and Cardiac Remodeling - Prevent Rapid Ventricular Respone in A-Fib - Class II Anti-Arrhythmic: Supress Activity at SA & AV Nodes, Increases Resting Phase - Decrease Preload & Afterload - Negative Chronotrope - Negative Inotrope - Decrease Cardiac Remodeling"
43
Clinical uses of cardioselective BB
" - Arrhythmias - Hypertension: especially post MI/Heart Failure - Chronic Stable Angina with ACEI - HOCM - Acute MI & Acute Coronary Syndromes - Metoprolol: Systolic CHF w/ mortatily benefits"
44
Contraindications of BB cardioselective
" - Contraindications - Pregnancy - Acute Decompensated Heart Failure - Bradycardia, Sick Sinus, WPW - Cardiogenic Shock - Combo with Non-DHP CCBs (precipiate AV Block) - Vasospastic Angina - Peripheral Vascular Disease - Interactions - Psoriasis - Digoxin - CCBs"
45
Adverse effects of cardioselective BB
" - Withdrawal Hypertension (do not abruptly stop) - Heart Block - Bradycardia - Fatigue - Hypoglycemia (may mask symptoms) - Hyperthyroidsim - Cold Extremiteis - Impotence"
46
Which BB are cardioselective?
" - Atenolol - Betaxolol - Bisoprolol - Metoprolol - Esmolol"
47
Noncardioselective BB MOA
" - Direct Blocking: β1 & β2 - Decreases contractility, AV conduction & refractory time, HR, O2 demand, and Cardiac Remodeling - Causes bronchoconstriction & vasoconstricion - Decreases Renin Production - Class II Antiarryhtmic: Increases Resting Phase - Decrease Preload & Afterload - Negative Chronotrope - Negative Inotrope - Decrease Cardiac Remodeling "
48
Noncardioselective BB clinical uses
- Propanolol: Aortic Dissection, CNS Effects
49
Noncardioselective BB contraindications
" - Contraindications - Airway Diseases - Acute Decompensated Heart Failure - Bradycardia, WPW, Sick Sinus, Heart Block - Preganncy - Cardiogenic Shock - Combo with Non-DHP CCBs (precipiate AV Block) - Vasospastic Angina - Peripheral Vascular Disease - Interactions - Psoriasis - Digoxin - CCBs"
50
Noncardioselective BB adverse effects
" - Withdrawal Hypertension (do not abruptly stop) - Bronchoconstriction - Heart Block - Bradycardia - Fatigue - Hypoglycemia (may mask symptoms) - Hyperthyroidsim - Cold Extremiteis - Impotence"
51
Non cardioselective BB meds
Nadolol Propanolol Sotalol
52
Which non cardioselective BB can cross the BBB?
Propanolol
53
Which non-selective cardioselective BB cause torsades
Sotalol

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