cardio pharm. Flashcards
hypertension drugs that can be used in pregnancy
hypertensive moms love nifedipine
hydralazine
methyldopa
labetalol
nifedipine
hypertension drugs that cannot be used in pregnancy
ace inhibitor
arbs
what drugs must be used cautiously in decompensated HF
beta blockers
what drugs are contraindicated in cardiogenic shock
beta blockers
hypertension with heart failure
diuretics/ace inhibitors/arbs
minidoxil MOA
opens K+ channels, hyperpolarizing smooth muscle causing relaxation of vascular smooth muscle
hypertrichosis, hypotension, reflex tachycardia, fluid retention/edema
minidoxil side effects
orthostatic hypotension with first few doses
alpha 1 blockers (-zosin)
drug-induced lupus (Anti-histone ab)
hydralazine
minoxidil compensatory responses
marked salt/water retention and marked tachycardia (all others have less compensation)
sudden discontinuation of what drug can cause severe rebound hypertension?
clonidine
pt with second degree AV block + constipation
non-dihydropyridine toxicity (verapamil)
what calcium channel blocker is used in patients with subarachnoid hemorrhage and why
nimodipine to prevent cerebral vasospasm (rmr Nemo)
hyperprolactinemia
verapamil toxicity
gingival hyperplasia
calcium channel blocker toxicity
hydralazine MOA
increases cGMP –> smooth muscle relaxation
does hydralazine affect arterioles or veins
arterioles > veins thus causes decreased afterload
why is hydralazine administered with a beta blocker
to prevent reflex tachycardia
what is contraindicated in CAD and why
hydralazine because it causes compensatory tachycardia which would increased O2 stress on myocardium
what calcium channel blocker can be used in hypertensive emergency
clevidipine
nitroprusside moa
increases cGMP via direct release of NO
venodilator ~ arterioles ( decreases preload and afterloda)
what toxicity can nitroprusside cause
cyanide
fenoldopam MOA
dopamine D1 receptor agonist
coronary peripheral renal splanchnic vasodilation (good for renal failure)
does fendoldopam work on arterioles or veins
arterioles
common side effect of nitrates
headache (vc it vasodilates veins in meninges)
MOA nitrates
increases NO in smooth muscle, increases cGMP and smooth muscle relaxation
venodilator, so decreases preload and thus decreases cardiac work
how do you treat reflex tachycardia
propranolol - beta blockers
explain nitrate tolerance
patients on nitrates need to have a nitrate free period every day to avoid tolerance - usually done at night when patient is sleeping and cardiac work is the least
how do verapamil and diltiazem affect HR?
decrease (inhibit SA and AV nodes)
does minoxidil cause reflex tach?
yes so much so that it must be controlled with beta blockers
dose-dependent rise in HR
hypertension + diabetes drugs
ACE inhibitors or ARBs because they not only lower BP but also slow diabetic nephropathy
statins decrease what the most
LDL
statins upregulate what
LDL receptor
bile acid resins decerease what (cholestyramine)
LDL
what lipid lowering agent has a gritty unpleasant taste
bile acid resins / cholestyramine
what LLA causes decreased absorption of vitamins or other drugs from intestinal tract
bile acid resins/ cholestyramine
hepatotoxicity, rhabdomyolysis/myopathy
side effect of statins
bile acid resins MOA
prevent intestinal reabsorption of bile acids (decreased reabsorption of cholesterol)
statins MOA
competitively inhibit hmg coa reductase (rate limiting enzyme in cholesterol synth) - reduces hmg-coa converstion to malevonate
how do statins affect HDL
increase
how do bile acid resins affect HDL
slightly increase
how do bile acid resins affect triglycerides
slightly increase
how to statins affect triglycerides
decrease
what does ezetimbe reduce
LDL
how does ezetemibe affect HDL/Triglyerides?
no affect
if ezetimibe and statins are given together, what side effect risk is increased
hepatotoxicity
ezetimibe moa
prevent cholesterol reabsorption at small intestine brush border
cutaneous flushing is a common adverse affect of what lipid lowering agent
niacin
what drug do you give if someone has low HDL
niacin
how can you reduce cutaneous flushing due to niacin
pretreatment with aspirin/nsaid
if someone is on niacin, how do you need to adjust the rest of their drugs?
niacin causes hyperglycemia - increase diabetes drugs
niacin potentiates hypertension drugs so decrease dose
fibrates MOA
increases synthesis of lipoprotein lipase by adipocytes via interaction with ppar-alpha protein - increases triglyceride clearance
fibrates decrease what the most
triglycerides
fibrates increase the risk of developing what
choelsterol gallstones
what two lipid lowering agents shouldnt be used together because they both increase risk of choelsterol gallstones and increased risk for mypoathy
statins and fibrates
what lipid lowering agent will exacerbate gouty arthritis
niacin
what lipid lowering agents are teratogenic?
statins (hmg coa reductase inhibitors)
