Cardiology Clues Pharm Flashcards by Andrew Pruett

What are theh Renin-angio system effectors?

ACE inhibitors and ARBs

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What are the ACE inhibitors?

Captopril, Enalapril, Fosinopril, Lisinopril

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What is the MOA of ACE inhibitors?

Inhibits conversion of Ang I to Ang II, decreases Ang II

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What are the Indications for ACE inhibitors?

HTN, CHF, post MI and vasodilation

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What are the adverse effects of ACE inhibitors?

Hyperkalemia, cough, angioedema contraindicated in pregnancy (fetal renal malformations)

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What is the MOA of ARBS?

Ang II blockers:

prevents alpha 1 vasoconstriction from Ang II

prevents aldosterone secretion stimulated by Ang II

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What are the indications for Losartan?

HTN

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What are the adverse effects of Losartan?

Fetal renal toxicity Hyperkalemia

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What are the sympathoplegics?

Metoprolol, Atenolol, Acebutolol, Esmolol, Propranolol, Timolol, Carvedilol, Prazosin, Clonidine, Methyldopa, Hexamethonium, Reserpine, Guanethidine

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What is the MOA of Metoprolol, Atenolol, Acebutolol, Esmolol?

Selective B1-Blockers

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What is the MOA of Propranolol, Timolol?

B1 and B2 Blockers

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What is the MOA of Carvedilol?

Alpha and B-Blocker

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What are the indications for B-blockers

HTN, Angina, MI, Antiarrhythmic

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What are the adverse effects of B-blockers?

Impotence, asthma, bradycardia, AV block, heart failure, sedation, sleep alterations

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What is the MOA of Prazosin?

Alpha 1-Blocker, vasodilation, decreases TPR

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What are the indications for Prazosin?

Pheochromocytoma, HTN

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What are the adverse effects of Prazosin?

Orthostatic Hypotension

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What is the MOA of Clonidine?

Alpha 2 agonist = decreases peripheral resistance

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What are the indications for Clonidine?

HTN Smoking Cocaine Heroin withdraw

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What are the adverse effects of Clonidine?

Drowsiness, dry mouth, and rebound HTN after abrupt withdraw

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What is the MOA of Methyldopa?

Alpha 2 agonist = decreases peripheral resistance

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What are the indications for Methyldopa?

HTN

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What are the adverse of Methyldopa?

Sedation and Hemolytic Anemia (+) Coombs test

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What is the MOA of Hexamethonium?

Nicotinic Ganglionic blocker

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What are the adverse effects of Hexamethonium?

Severe orthostatic hypotension, blurred vision, constipation, sexual dysfunction

What is the MOA of Reserpine?

Prevents the storage of monoamines in synaptic vesicle

What are the indications for Reserpine?

HTN

What are the adverse effects of Reserpine?

Mental depression

What is the MOA of Guanethidine?

Interferes with norepinephrine release

Whata re the indications for Guanethidine?

Severe HTN

What are the adverse effects of Guanethidine?

Contraindicated in patients taking TCA's

What are the Vasodilators?

Hydralazine, Minoxidil, Nifedipine, Verapamil, Nitroprusside, Diazoxide

What is the MOA of Hydralazine?

increases cGMP, smooth muscle relaxation, vasodilates arterioles, afterload reduction

What are the indications for Hydralazine?

Severe HTN, 1st line treatment for HTN in pregnancy

What are the adverse effects of Hydralazine?

Compensatory tachycardia, fluid retention, Lupus like syndrome, contraindicated in Angina/CAD because of compensatory tachy

What is the MOA of Minoxidil?

K+ channel opener, hyperpolarizes and relaxes smooth muscle

What are the adverse effects of Minoxidil?

Hypertrichosis and Pericardial Effusion

What is the MOA of Nifedipine and verapamil?

Ca+ channel antagonists

What are the indications for Nifedipine and verapamil?

HTN, angina, arrhythmia (not Nifedipine) Prinzmetal Angina, Raynaud's

What is the MOA of Nitroprusside?

Direct release of NO, increases cGMP, vasodilator

What are the indications for Nitroprusside?

Hypertensive emergency, CHF, Angina

What are the adverse effects of Nitroprusside?

Cyanide Toxicity, hypotension, short acting

What is the MOA of Diazoxide?

K+ channel opener, hyperpolarizes and relaxes smooth muscle

What are the indications for Diazoxide?

HTN

What are the adverse effects of Diazoxide?

Hypoglycemia (reduces insulin release) and hypotension

What are the HMG-CoA reductase inhibitors?

Lovastatin, Pravastatin, Simvastatin, Atorvastatin, Rosuvastatin

What are the indications for HMG-CoA reductase inhibitors?

Strong decrease LDL Decrease Triglycerides Increase HDL

What are the adverse effects of HMG-CoA reductase inhibitors?

Hepatotoxicity (increase LFT's) Rhabdo

What is the MOA of Niacin?

Inhibits lipolysis in adipose tissue reduces hepatic VLDL secretion into circulation

What are the indications for Niacin?

Decrease LDL and Triglycerides Strong increase HDL

What are the adverse effects of Niacin?

Red flushed face which is decreased by aspirin, hyperglycemia, hyperuricemia

What are the Bile acid resins?

Cholestyramine Colestipol Colesevelam

What is the MOA of Bile Acid resins?

Prevent intestinal reabsorption of bile acids, Liver must use cholesterol to make more

What are the indications for Bile Acid Resins?

Slightly increase HDL and triglycerides Decrease LDL

What are the adverse effects of Acid Resins?

Tastes bad and causes GI discomfort bile decreases absorption of fat soluble vitamins cholesterol gallstones

What are the cholesterol Absorption blockers?

Ezetimibe

What is the MOA of Ezetimibe?

Prevents cholesterol reabsorption at small intestine brush border

What are the indications for Ezetimibe?

Decrease LDL

What are the adverse effects of Ezetimibe?

Rare increase LFT's

What are the Fibrates?

Gemfibrozil, Clofibrate, Bezafibrate, Fenofibrate

What is the MOA of FIbrates?

Upregulate LPL, increase triglyceride clearance

What are the indications for fibrates?

Strong decrease of triglycerides slight decrease of LDL slight increase in HDL

What are the adverse effects of fibrates?

Myositis, hepatotoxicity (increase LFT's) cholesterol gallstones

What is the MOA of Digoxin?

Direct inhibition of Na+/K= ATPase leads to indirect inhibition of Na+/Ca2+ exchanger, positive inotrope, stimulates vagus nerve

What are the indications for digoxin?

CHF (increase contractility) A fib (decrease conduction at the AV node) depression of the SA node

What are the adverse effects of Digoxin?

Cholinergic, ECG: icnrease PR, decrease QT worsened by renal failure Quinidine displaces Digoxin from tissue binding sites

What is the MOA of Nesiritide?

Recombinant BNP, increase in cGMP and vasodilation

What are the indications for Nesiritide?

Acute decompensated heart failure

What are the adverse effects of Nesiritide?

Hypotension

What are the Class IA antiarrhythmic?

Quinidine, Procainamide, Disopyramide

What is the MOA of Class IA antiarrhythmic?

Na+ channel blocker

What are the indications for the Class IA antiarrhythmic?

Increase AP duration, icnrease effective refractory period (ERP) QT interval, affect reentrant and ectopic SVT and ventricular tachy

What are the adverse effects of the Class IA antiarrhythmic?

Quinidine: Cinchonism Procainamide: Torsades de Pointes

What are the Class IB antiarrhythmic?

Lidocaine, Mexiletine, Tocainide

What is the MOA of Class IB antiarrhythmic?

Na+ channel blocker

What are the indications for the Class IB antiarrhythmic?

Decrease AP duration, acute ventricular Arrhythmias, local anesthesia

What are the adverse effects of the Class IB antiarrhythmic?

CNS stimulation and depression Cardiovascular depression Hyperkalemia increases toxicity

What are the Class IC antiarrhythmic?

Flecainide, Encainide, Propafenone

What is the MOA of Class IC antiarrhythmic?

Na+ channel blocker

What are the indications for Class IC antiarrhythmic?

Ventricular tachy progressing to V. fib, last resort

What are the adverse effects of Class IC antiarrhythmic?

Prolongs refractory period in AV node Hyperkalelmia increases toxicity

What are the K+ channel blockers?

Sotalol, Ibutilide, Bretylium, Amiodarone

What is the MOA of the K+ channel blockers?

Increase AP duration, increase effective refractory period (ERP), increase QT interval

What are the adverse effects of the K+ channel blockers?

WPW, Torsades, pulmonary fibrosis, hepatotoxicity, Hypo/hyperthyroidism

What are the Ca2+ channel blockers?

Verapamil, Diltiazem

What is the MOA of the Ca2+ blockers?

Decreases conduction velocity of the AV node, increases ERP and PR interval

What are the indications for the Ca2+ channel blockers?

SVT/ prevent nodal arrhythmias

What are the adverse effects of the Ca2+ channel blockers?

Flushing, edema, constipation, CHF, AV block

What is the MOA of adenosine?

Increase K+ efflux, hyperpolarizes the cell

What are the indications for adenosine?

Dx. and tx. of AV nodal arrhythmias

What are the adverse effects of adenosine?

flushing, hypotension, and chest pain very short acting

What is the MOA of Potassium on the heart?

Depresses ectopic pacemaker in hypokalemia

What are the indications for administering Potassium?

Digoxin toxicity, activated charcoal: binds digoxin in the intestine Digibind: binds to digoxin in the bloodstream

What are the indications from Magnesium?

Effective in Torsades and Dig toxicity

What are the indications of the K+ channel blockers?

a fib, a flutter, Vtach (ami and soto esp)

What are the indications for the Dihydropyridines?

(amlodipine, clevidipine, nicardipine, nifedipine, nimodipine) all of those except nimodipine are for HTN, angina (including prinzmetal angina), and reynauds

What are the indications for the non-dihydropyridines?

verapamil, diltiazem- HTN, angina, a fib/a flutter

Neprilysin

prevents degredations of ANP/BNP