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Cardio/Renal Flashcards

1
Q 
Antiarrhythmics class 1a
Drug names
A

Quinidine
Procainamide
Disopyramide

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2
Q 
Antiarrhythmics class 1b
Drug names
A

Lidocaine
Mexiletine
(Phenytoin)

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3
Q 
Antiarrhythmics class 1c
Drug names
A

Flecainide

Propafenone

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4
Q 
Antiarrhythmics class 1
Type
A

Na channel blockers

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5
Q 
Antiarryhythmics class 1a
MOA
A

Na channel blockers
Inc. AP duration
Inc. ERP (some K-channel blocking effects).
Prolongs QT interval.

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6
Q 
Antiarrhythmics class 1a
Clinical use
A

Na channel blockers
Atrial/ventricular arrhythmias (AFib, A-flutter; SVT, Vtach)
(esp. re-entrant and ectopic SVT, VT)

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7
Q 
Antiarrhythmics class 1a
Toxicity
A

Na channel blockers.
>Cinchonism (headache, tinnitus; Quinidine).
>SLE-like syndrome (procainamide).
>Heart failure (disopyramide).
>Torsades de pointes (prolonged QT interval).

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8
Q 
Antiarrhythmics class 1b
MOA
A

Na channel blockers
Dec. AP duration (preferential for ischemic or depolarized Purkinje and ventricular tissue).
Dec. ERP.

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9
Q 
Antiarrhythmics class 1b
Clinical use
A 
Na channel blockers.
Ventricular arrhythmias (post-MI)
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10
Q 
Antiarrhythmics class 1b
Toxicity
A

Na channel blockers
CNS stimulation/depression
Cardiovascular depression

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11
Q 
Antiarrhythmics class 1c
MOA
A

Na channel blockers

Markedly prolongs phase 0 depolarization.

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12
Q 
Antiarrhythmics class 1c
Clinical use
A

Na channel blockers
Life-threatening SVTs (atrial fibrillation).
Last resort in refractory Vtach.

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13
Q 
Antiarrhythmics class 1c
Toxicity
A

Na channel blockers

Pro-arrhythmic (CI in post-MI)

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14
Q 
Antiarryhthmics class 2
Type
A

Beta-blockers

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15
Q 
Antiarrhythmics class 2
Drug names
A

Metoprolol, Propanolol
Esmolol, Atenolol
Timolol, Carvedilol

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16
Q 
Antiarrhythmics class 2
MOA
A

B-blockers (B1 antagonists at low doses, atenolol)
Dec. SA/AV node activity (dec. cAMP – dec. Ca – dec. phase 4 slope, dec. depolarization).
Inc. PR interval – dec. conduction through AV node.

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17
Q 
Antiarrhythmics class 2
Clinical use
A

B-blockers
SVT
Ventricular rate control of A-fib and A-flutter.

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18
Q 
Antiarrhythmics class 2
Toxicity
A 
B-blockers.
Impotence.
Exacerbated COPD, asthma.
CVS effects (bradycardia, HF, AV block).
CNS effects (sedation, sleep disturbance).
Can mask hypoglycemic signs.
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19
Q 
Antiarrhythmics class 3
Type
A

K channel blockers

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20
Q 
Antiarrhythmics class 3
Drug names
A

Amiodarone
Ibutilide
Dofetilide
Sotalol

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21
Q 
Antiarrhythmics class 3
MOA
A 
K channel blockers.
Prolongs phase 3 repolarization.
Prolongs AP duration.
Prolongs ERP.
Prolongs QT interval (ventricular contraction).
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22
Q 
Antiarrhythmics class 3
Clinical use
A

K channel blockers.
A-fib, A-flutter
Vtach (amiodarone, sotalol)

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23
Q 
Antiarrhythmics class 3
Toxicity
A

K channel blockers.
Torsades de pointes (sotalol, ibutilide).
B-blockade (sotalol).
>Amiodarone: pulmo fibrosis, hepatotoxicity, hypo/hyperthyroidism (40% iodine); photodermatitis, corneal deposits (acts as a hapten); CNS effects, CVS effects – check LFT, PFT, TFT.

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24
Q 
Antiarrythmics class 4
Type
A

Ca channel blockers (nondihydropyridine)

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25
``` Antiarrhythmics class 4 Drug names ```
Verapamil | Diltiazem
26
``` Antiarrhythmics class 4 MOA ```
``` Ca channel blockers. Prolongs phase 2. Dec. conduction velocity -- slow rise of AP, slow closing of Ca channels. Inc. ERP. Inc. PR interval. ```
27
``` Antiarrhythmics class 4 Clinical use ```
Ca channel blockers Prevents nodal arrhythmias (SVT) Rate control in A-fib
28
``` Antiarrhythmics class 4 Toxicity ```
``` Ca channel blockers Constipation, flushing, edema CVS effects (HF, AV block, sinus node depression) ```
29
Digoxin | Type
Cardiac glycoside
30
Digoxin | MOA
Inhibits Na/K ATPase -- indirect inhibition of Na/Ca exchanger -- Inc. intracellular Ca -- positive inotropy (increases contractility)
31
Digoxin | Clinical use
>HF (inc. contractility). | >A-fib (decr. AV node conduction, depresses SA node).
32
Digoxin | Toxicity, Antidote
>Cholinergic: N/V, diarrhea, changes in color vision (blurry yellow vision), arrhythmias, AV block. >Hyperkalemia (poor prognosis). >Antidote: slowly normalize K; Mg, anti-digoxin Fab fragments.
33
Digoxin | Predisposing for toxicity
Renal failure. Hypokalemia. >Verapamil, Amiodarone, quinidine -- decr. digoxin clearance, displaces digoxin at tissue-binding sites.
34
Calcium channel blockers | Dihydropyridines
Amlodipine, Clevidipine Nicardipine, Nifedipine Nimodipine
35
Calcium channel blockers | Non-dihydropyridines
Diltiazem | Verapamil
36
Calcium channel blockers | MOA
Blocks L-type calcium channels on cardiac and smooth muscle (decrease contractility). >Vascular smooth muscle: amlodipine = nifedipine. >Heart: verapamil > diltiazem > amlodipine = nifedipine.
37
Calcium channel blockers | Clinical use
>Dihydropyridines (except nimodipine): HTN, angina, Raynaud phenomenon. >Nimodipine: SAH (prevents cerebral vasospasm). >Clevidipine: HTN urgency/emergency >NDP: HTN, angina, A-fib/flutter.
38
Hydralazine | MOA
Arteriolar dilator -- reduces afterload. | Inc. cGMP -- smooth muscle relaxation.
39
Hydralazine | Clinical use
Severe HTN, HF. Coadministered w/ B-blocker to prevent reflex tachycardia. Safe in pregnancy.
40
Hydralazine | Toxicity
>Compensatory tachycardia (due to inc. venous return from baroreceptor reflex; CI in angina/CAD). >Fluid retention (sympathetic activation of RAAS). >Lupus-like syndrome.
41
Nitrates | Drug names
Nitroglycerin, isosorbide dinitrate, isosorbide mononitrate
42
Nitrates | MOA
Venous dilator -- reduces preload. | Inc. NO in vascular smooth muscle -- inc. cCMP -- smooth muscle relaxation.
43
Nitrates | Clinical use
Angina, acute coronary syndrome | Pulmo edema
44
Nitrates | Toxicity
``` Reflex tachycardia (response to relative hypotension). >"Monday disease" in industrial exposure: tolerance for vasodilating affect during work week, loss of tolerance over weekend (tachycardia, dizziness, headache upon exposure). ```
45
Calcium channel blockers | Toxicity
Cardiac depression, peripheral edema. AV block (NDPs) Hyperprolactinemia (verapamil) Gingival hyperplasia
46
Mannitol | MOA
Proximal tubule Osmotic diuretic. Inc. tubular osmolarity -- inc. urine flow. Dec. ICP, IOP
47
Mannitol | Clinical use
Elevated ICP, IOP (cerebral edema tx). | Drug overdose.
48
Mannitol | [Toxicity, CI]
>Pulmo edema (rapid rise in volume, overall inc. in hydrostatic pressure in vessels). >CI: anuria, HF. [ex. Pt w/ cerebral edema is given mannitol, so all the fluid in the brain is drawn back into BVs -- rapid inc. in hydrostatic pressure -- pulmo edema]
49
Acetazolamide | MOA
Proximal tubule. Carbonic anhydrase inhibitor. Self-limited NaHCO3 diuresis -- dec. total HCO3 stores.
50
Acetazolamide | Clinical use
Glaucoma. Urinary alkalization, Metabolic alkalosis. Altitude sickness. Pseudotumor cerebri
51
Acetazolamide | Toxicity
``` Hyperchloremic metabolic acidosis (dehydration). NH3 toxicity (SE: urine alkalinization). "ACIDazolamide causes ACIDosis" ```
52
Sulfonamide Loop diuretics | Drug names
Furosemide Bumetanide Torsemide
53
Sulfonamide Loop diuretics | MOA
Thick ascending limb of Henle. Inhibit Na/K/2Cl cotransport. Excess excretion of Na, Cl, H2O -- no hypertonicity of medullary interstitium -- prevents urine concentration. Inc. Ca excretion (paracellular Ca reabsorption w/ Na/K/Cl cotransport).
54
Sulfonamide Loop diuretics | Clinical use
Edematous states (HF, cirrhosis, nephrotic syndrome, pulmo edema). HTN Hypercalcemia
55
Sulfonamide Loop diuretics | Toxicity
Ototoxicity (similar symporters in ear) Hypokalemia Dehydration, Allergy Nephritis, Gout
56
Thiazide diuretics | Drug names
Chlorthalidone | Hydrochlorothiazide
57
Thiazide diuretics | MOA
Distal convoluted tubule. >Inhibits Na/Cl cotransporter -- no Na/Cl reabsorption -- Na/H20 excretion. >Dec. diluting capacity. >Dec. Ca excretion (Ca/Na antiporter exchanges Na from blood w/ reabsorbed Ca -- dec. intracellular Ca during exchange prompts further inc. Ca reabsorption).
58
Thiazide diuretics | Clinical use
HTN, HF Nephrogenic diabetes insipidus Osteoporosis, Idiopathic hypercalciuria
59
Thiazide diuretics | Toxicity
Hypokalemic metabolic alkalosis Hyponatremia, Hypercalcemia (hypocalciuria) Hyperglycemia, Hyperlipidemia, Hyperurecemia
60
K-sparing diuretics | Drug names
Spironolactone, Eplerenone | Triamterene, Amiloride
61
K-sparing diuretics | MOA
Collecting tubules. >Spironolactone, eplerenone: competitive aldosterone receptor antagonists. >Triamterene, Amiloride: Na channel blockers -- block ENaC, w/c drives Na/K pump.
62
K-sparing diuretics | Clinical use
Hyperaldosteronism K depletion HF
63
K-sparing diuretics | Toxicity
Hyperkalemia (maybe arrhythmias). | Endocrine effects w/ spironolactone (gynecomastia, antiandrogen).
64
ACE inhibitors | Drug names
Captopril, Enalapril | Lisinopril, Ramipril
65
ACE inhibitors | MOA
Inhibit ACE -- dec. ATII -- prevent constriction of efferent arteriole -- dec. GFR. Inc. Renin. Prevents bradykinin inactivation (vasodilator).
66
ACE inhibitors | Clinical use
HTN, HF (prevent heart remodelling due to chronic HTN). Proteinuria (no ATII, no vasoconstriction). Diabetic nephropathy -- dec. intraglomerular pressure -- slow GBM thickening.
67
ACE inhibitors | Toxicity
Cough, Angioedema (bradykinin accumulation --vasodilation). Teratogen. Inc. creatinine (due to dec. GFR). Hyperkalemia, Hypotension. *CI in bilateral renal artery stenosis -- renal failure.
68
Angiotensin II receptor blockers (ARBs) | Drug names
Losartan Candesartan Valsartan
69
ARBs | MOA
Blocks binding of ATII to AT1 receptor -- similar effects of ACEi (prevents peripheral vasoconstricting effects of ATII). Dec. GFR, inc. renin. Don't inc. bradykinin.
70
ARBs | Clinical use
For intolerance of ACEi (cough, angioedema). HTN, HF Proteinuria Diabetic nephropathy
71
ARBs | Toxicity
Hyperkalemia Dec. renal function Hypotension Teratogen
72
HMG-CoA reductase inhibitors (-statin) | [Names]
Lovastatin, Simvastatin Pravastatin, Atorvastatin Rosuvastatin
73
HMG-CoA reductase inhibitors | [MOA, effect on lipid levels, toxicity]
>Inhibits conversion of HMG-CoA to mevalonate (cholesterol precursor). >Super dec. LDL, inc. HDL, dec. TGL. >Dec. mortality in CAD >Tox: hepatotoxic, myopathy (esp. w/ fibrates or niacin)
74
Bile acid resins | [Names]
Cholestyramine Colestipol Colesevelam
75
Bile acid resins | [MOA, effect on lipid levels, toxicity]
>Prevents intestinal reabsorption of bile acids -- liver uses cholesterol to make more. >Dec. LDL, slightly inc. HDL. >SE: dec. absorption of other drugs and fat-soluble vitamins
76
Ezetimibe | [MOA, effect on lipid levels]
>Prevents cholesterol absorption at SI brush border. | >Dec. LDL
77
Fibrates | [Names]
Gemfibrozil Clofibrate Bezafibrate Fenofibrate
78
Fibrates | [MOA, effect on lipid levels, toxicity]
>Upregulates LPL -- inc. TG clearance. >Activates PPAR-alpha to induce HDL synthesis. >Super dec. TG, inc. HDL, dec. LDL >SE: myopathy (inc. risk w/ statins), cholesterol gallstones
79
Niacin (B3) | [MOA, effect on lipid levels, SE]
>inhibits lipolysis (HPL) in adipose, reduces hepatic VLDL synthesis. >Inc. HDL, dec. LDL >SE: red, flushed faced (PGs); Hyperglycemia, hyperuricemia

Pharma drugs (12 decks)

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