Cardio Pharm Flashcards
Difference in -dipine and non-dipine CCB
-dipines best for HTN (vasodilation in periphery)
Dilitazem and verapamil secrease heart conduction and contractility of SA and AV (best for CAD)
Hydralazine
Vasodilation to decrease BP
Decrease afterload for HF
NOT used in CAD
Minoxidil
Prodrug
Vasodilation decreasing BP
Sodium nitroprusside
Vasodilation via nitrous oxide
RAPIDLY decreases BP.
Need continuous BP monitoring
Fenoldopam
Vasodilation
D1 receptor agonist
Start low titrate slow
Don’t give if have gluacoma bc increases IOP
Vasodilators examples
CCB
Hydralazine
Minoxidil
Sodium nitroprusside
Fenoldopam
Thiazide diuretics
-ide
Chlorthalidone
Metolazone
Decreases DCT Na reabsorption
Can cause hypercalcemia
Used in HF
AVOID NSAIDs
Aldosterone receptor antagonist
-one
diuretic
Stop Na reabsorption.
Decreases K secretion
Spironolactone most potent and active on progesterone receptors.
Used in HF
Amiloride, Trimaterene
Epithelial sodium channel antagonists Stop Na reabsorption
Can cause hyperK and kidney stones.
amiloride not metabolized, trimaterene has short 1/2life
NOT good with NSAIDs
Beta blockers
-lol
Decrease HR and BP
CAD
HF med (BCM)
Class II antiarrhtyhmic
What beta blockers are specific to beta-1 receptors
MANBABE
What beta blockers have alpha-1 action
-lol (not -olol)
What beta blocker used for emergency HTN
Labetolol
Alpha-1 receptor agonists
-zosin
Vasodilation
Can cause sudden drop of BP
Alpha-2 receptor agonists
Methyldopa (good in preg)
Clonidine (rebound, goood for HTN in CKD)
Stop NE release to decrease BP
Aprocitentan
Dual endothelin receptor antagonist
TERATOGENIC
Inhibits vasoconstriction
Can cause fluid retension and hepatotoxicity
Statins
Inhibit HMG-CoA reductase
Avoid in liver failure
NOT for preg
Decrease LDL (increases receptors)
Increase HDL
Decrease TG
Take in evening
Ezetimibe
Cholesterol absorption inhibitor.
NOT for liver disease
Decreases LDL (increases receptors)
Decreases TG
Decreases VLDL
Take with statin
PCSK9 inhibitors
-ocumab
Human antibody
Inhibits breakdown of LDL receptors decreasing LDL
SQ injection every two weeks
Niacin
Increases HDL
Decreases TG synthesis
Can cause flush with warm pruritis
Bile acid sequestriants
Col- or Chol-
Bind bile acids in lumen stoping reabsorption.
NOT for diverticulitis
Increase bile acid secreation
Decrease LDL
Increase TG (not good)
Fibrates
-fibr-
Don’t use Gemfibrozil with statin.
Lowers TG
Increases HDL
Fenofibrate lowers LDL too
Omega fatty acids
Fish oils
Omega-3 acid ethyl esters
Icosapent ethyl
Lower TG
Lomitapide
Lowers LDL
Low fat diet necessary
Bempedoic acid
Lowers LDL
Stops cholesterol synthesis causing increased LDL receptors
Inclisiran
Lowers LDL
Prevents PCSK9 production preventing LDL receptor breakdown
Evencumab
Decreases TG
Decreases LDL
Decreases VLDL
Increases lupoprotein lipase by inhibiting ANGLPTL3
Beta blockers in CAD
Decrease effect of norepi reducing myocardial O2 demand
AVOID in cocaine MI
What to avoid with nitrates
PDE5 Inhibitors
Isosorbide
Nitrate
Need regular nitrate free intervals
How many nitros can you give someone with angina before 911
3
Ranolazine
Na channel blocker
CAD
Reserved for pts with failed other treatment
Decreases O2 demand increasing diastolic function
Fibrinolytics
-plase and streptokinase (not in US)
Binds to fibrin clot and catalyzes breakdown.
CAD treatment options
BB
CCB
Nitrates
Na channel blocker
Fibrinolytics
Antiplatelets
Anticoagulants
Antiplatelet example
Cox inhibitors (ASA)
ADP2Y12 receptor antagonists (-grel(or))
PAR-1 antagonist (Vorapaxar)
Glycoprotein IIb/IIIa (Eptifibatide/tirofiban
PDE inhibitors (Cilostazol and dypyridamole)
Aspirin
COX inhibitor
antiplatelet
AVOID in younger than 19 bc Reye’s syndrome.
ADP2Y12 receptor antagonist
-grel or -grelor
antiplatelet
AVOID aspirin>100mg with ticagrelor
Vorapaxar
PAR-1 (thrombin receptor) antagonist
antiplatelet
Eptifibatide
Tirofiban
Glycoprotein IIb/IIIa inhibitors
Antiplatelet
Used with other antiplatelets/anticoagulants in PCI (cath)
Dipyridamole (not for unstable angina)
Cilostazol (not for HF)
PDE inhibitors
Antiplatelet
Anticoagulants
Indirect Thrombin inhibitors
Low molecular weight heparin
Fondaparinux
Warfarin
Direct thrombin inhibitors
Direct oral anticoagulants (DOAC)
Unfractioned heparin
Anticoagulant
Indirect thrombin inhibitor.
Prevents clot from growing while body breaks it down.
Binds to antithrombin blocking Factor Xa
DVT
PE
Low molecular weight heparin
-parin
Binds to antithrombin blocking factor Xa.
Good for DVT in preg
Fondaparinux
Factor Xa inhibitor
Binds to antithrombin
DVT, PE, VTE prophylaxis after ortho and abd surgery
Warfarin
Vitamin K antagonist
TERATOGENIC
affects factors II, VII, IX, X
Narrow range between efficacy and toxicity
AVOID cranberry and vitamin K.
Vitamin K is antidote
Direct thrombin inhibitors
Argatroban used for prophylaxis or treatment of VTE in pts with thrombocytopenia
Bivaliruden blocks catalytic site of thrombin
Direct oral angicoagulants (DOAC)
-xaban directly inhibit factor Xa so less production of thrombin an dprothrombin
Dabigatran is prodrug to treat DVT/PE
HF meds
SGLT2
BB
ARNI
ACEi/ARB
MRA
Loop diuretics
Thiazide diuretics
Vasodilators
Ivabradine
Nesiritide
DIgoxin
Dobutamine
Dopamine
Phosphodiasterase-3 inhibitor
SGLT2i
-flozin
Stops glucose reabsorption in PCT
AVOID in T1D, DKA, and preg
Used in HF
Beta blockers used in HF
Bisoprolol
Carvedilol
Metoprolol
ARNI
Sacubitril/valsartan
Neprilysin inhibitor and ARB
Increased Na and water excretion and vasodilation
Used in HF
Loop diuretcs
-semide
Stop reabsorption of K in ascending loop
Used in HF
AVOID NSAIDs
Vaso and venodilators in HF
Hydralazine decreases peripheral resistance decreasing afterload
Isosorbide dinatrate venodilator causing decreased preload and arteriolar dilator causing decreases afterload
Ivabradine
Blocks HCN Na channel of SA node slowing HR.
Used in HF
Nesiritide
Activates natriuretic peptide causing reduced peload and afterload in acute decompensated HF
Digoxin
Increases contractility in HF
Helps in Afib
Beta-adrenergic agonists
Dobutamine an dopamine
Increase contraction in HF
Phosphodiesterase-3 inhibitor
Increases contraction in HF
DIsopyramide
Quinidine
Procainamide
Calss 1A antiarrhythmics
Blocks FAST Na channels decreasing slope of phase 0 and K channels prolonging repolarization causing QT elongation
Lidocaine
MExiletine
Class 1B antiarrhythmics
Blocks SLOW Na channels in phase 2
Also decreases slope of phase 0
AVOID in 2º and 3º heart block
Flecainide
Propafenone
Class 1C antiarryhthmics
Block FAST Na channels decreasing slope of phase 0.
AVOID in ischemic (post-MI)
Class 2 antiarrthmics
Beta blockers
-lol
Decrease Ca influx at Sa and AV node prolonging phase 4
RATE CONTROL
Amiodarone
Ibutilide
Dronedarone
Dofetilide
Class 3 antiarrhthmics
Block K channels proonging refactory period (phase 3)
RHYTHM CONTROL
Class 4 antiarrhthmics
non-DHP CCB (Verapamil, Dilitiazem)
Blocks Ca channels of SA and AV node in phase 0 and on contractile cells in phase 2]
RATE CONTROL
Adenosine
Slows SA and AV node.
Useful in SVT
Magnesium sulfate
Ca channel blocking slows SA node impluse.
Used in torsades de pointes and digoxin induced arrhthmias
