cardiology drugs Flashcards
1
Q
Furosemide: Class
A
Diuretics
2
Q
Furosemide: Subclass
A
Loop
3
Q
Furosemide: Mechanism
A
↓Na/K/2Cl transport in ascending loop of Henle
4
Q
Furosemide: Net Effect
A
↓Volume (↓Preload)
5
Q
Furosemide: Indications
A
Pulmonary Edema, HF
6
Q
Furosemide: Side Effects / Toxicities / Stuff to Know
A
↓K, ↓Mg, ↓BP, resistance, can increase RAAS
7
Q
Furosemide:
A
↓K, hypotension, dehydration, SULFA DRUG!
8
Q
Bumetanide: Indications
A
HF (loop diuretic)
9
Q
Torsemide: Indications
A
HF (loop dieurtic)
10
Q
Hydrochlorothiazide (HCTZ): Subclass
A
Thiazides
11
Q
Hydrochlorothiazide (HCTZ): Mechanism
A
↓NaCl reabsorb, distal convoluted tubule
12
Q
Hydrochlorothiazide (HCTZ): Indications
A
HTN, HF (mild/synergism) good for elderly HTN
13
Q
Hydrochlorothiazide (HCTZ): AE
A
↑Gluc, Ca, lipids, ineffective in renal dysfunction
14
Q
Spironolactone: Subclass
A
K+ Sparing (Aldosterone Inhibitors)
15
Q
Spironolactone: Mechanism
A
Inhibits NaK transporter in collecting duct, inhibits RAAS
16
Q
Spironolactone: Indications
A
HF
↓Cardiac fibrosis, hypertrophy
17
Q
Spironolactone:
A
↑K, gynecomastia, renal dysfunction, low BP
18
Q
Eplerenone: Indications
A
Same as spironolactone: aldosterone antagonist for HF, post MI, causes hyperkalemia and gynecomastia
19
Q
Digoxin: Class
A
Inotropes + Pressors
20
Q
Digoxin: Subclass
A
Cardiac Glycosides
21
Q
Digoxin: Mechanism
A
↓Na/K ATPase in myocytes
Increase intracellular Na, more Na/Ca exchange, more intracellular Ca
22
Q
Digoxin: Net Effect
A
↑Contractility AND ↓AV conduction (sympathetic outflow)
23
Q
Digoxin: Indications
A
HF w/↓EF, SVA Rate Control AND A.Fib w/ rapid response (esp. CHF)
24
Q
Digoxin: Side Effects / Toxicities / Stuff to Know
A
Sympathoinhibition (↓S, ↑PS) AND AV block, bradycardia, small therapeutic window
Seeing yellow!
25
Dopamine: Subclass
Beta agonist
26
Dopamine: Mechanism
Beta activation increases cAMP, increases intracellular Ca
27
Dopamine: Net Effect
Increased contractility
| Symp. Effects: ↑CO, ↑BP
28
Dopamine: Indications
HF with low BP or shock
29
Dopamine: Side Effects / Toxicities / Stuff to Know
Tachycardia, arrhythmias, SCD, hypersensitivity, eosinophilic myocarditis, renal artery dilation at low doses
30
Dobutamine: Mechanism
β1, β2 agonist (cAMP)
31
Dobutamine: Indications
Heart Failure: increases contractility
32
Isoproterenol: Mechanism
β1, β2
33
Isoproterenol: Indications
Bradycardia, heart block
34
Epinephrine: Mechanism
All
35
Epinephrine: Indications
Cardiac arrest
36
Norepinephrine: Mechanism
All but β2
37
Norepinephrine: Indications
HF, peripheral vasodilation
38
Milrinone: Subclass
Phosphodiesterase Inhibitors
39
Milrinone: Mechanism
Indirect β activity: intracellular PDE3 inhibition increases cAMP, increases intracellular Ca
40
Milrinone: Net Effect
↑CO, vasodil.
41
Milrinone: Indications
HF (refractory)
42
Milrinone: Side Effects / Toxicities / Stuff to Know
Vasodilation, arrhythmias, renal, SCD
43
Vasopressin: Subclass
Anti-Diuretic Hormone
44
Vasopressin: Mechanism
↑Renal aquaporins
45
Vasopressin: Net Effect
↑Volume
46
Vasopressin: Indications
Vasodilatory shock
47
Vasopressin: Side Effects / Toxicities / Stuff to Know
↓Na (vaptans prevent this)
48
Captopril (Quick acting): Class
Vasodilators (all ↓BP to some extent)
49
Captopril (Quick acting): Subclass
ACE inhibitors (-april)
50
Captopril (Quick acting): Mechanism
↓Angiotensin converting enzyme, ↓AT-II activity
51
Captopril (Quick acting): Net Effect
A+V dilation (balanced vasodilation) (↓preload + afterload)
| Reverse fibrolysis, remodeling
52
Captopril (Quick acting): Indications
HF, HTN, Post-MI, Kidney Dz in DM
53
Captopril (Quick acting): Side Effects / Toxicities / Stuff to Know
Hypotension, ↑K, renal, angioedema, avoid in pregnancy, persistent cough
54
ARBs
Candesartan, Valsartan, Losartan
| -sartan
55
Candesartan: Mechanism
Block AT-I receptor, ↓AT-II activity
56
Candesartan: Net Effect
A+V dilation
57
Candesartan: Indications
HF, HTN, Kidney Dz in DM
58
Candesartan: Side Effects / Toxicities / Stuff to Know
Hypotension, ↑K, renal, angioedema, avoid in pregnancy. Use in ACEi-intolerance or escape
59
Hydralazine: Subclass
Direct-Acting Vasodilators
60
Hydralazine: Mechanism
?
61
Hydralazine: Net Effect
Arteriole dilation only, not veins!
| Decrease BP, increase sympathetic tone (reflex tach)
62
Hydralazine: Indications
HTN, HF (with nitrate), Ischemic HD, SVA (More benefit in African Americans)
63
Hydralazine: Side Effects / Toxicities / Stuff to Know
Drug-induced lupus, reflex tach, hypotension, headache, flushing, 3/day
64
Minoxidil: Mechanism
↑K channel perm. Relaxes smooth muscle. Is Rogaine!
65
Minoxidil: Net Effect
A dilation only
66
Minoxidil: Indications
Severe/refractory HTN
67
Minoxidil: Side Effects / Toxicities / Stuff to Know
Reflex tach, hair growth (Rogaine), 2x a day, fluid retention
68
Sodium Nitroprusside: Mechanism
↑NO
69
Sodium Nitroprusside: Net Effect
A+V dilation
70
Sodium Nitroprusside: Indications
HTN Emergency, Severe HF
71
Sodium Nitroprusside: Side Effects / Toxicities / Stuff to Know
→Thiocyanate! Renal, blurred vision, tinnitus, rapid effect (wanes in minutes)
72
Fenoldopam: Mechanism
Peripheral dopamine-1 receptor agonist
73
Fenoldopam: Net Effect
A dilation only
74
Fenoldopam: Indications
Severe HTN
75
Fenoldopam: Side Effects / Toxicities / Stuff to Know
Rapid acting, ↑renal perfusion, liver metabolism.
| Increases intraocular pressure: don't use with glaucoma
76
Verapamil, diltiazem Subclass
Calcium Channel Blockers (non dihydropine)
77
Verapamil, diltiazem: Mechanism
Block Voltage-gated L-type calcium channels, ↓Ca influx, ↓intracellular Ca available
78
Verapamil, Diltiazem: Net Effect
↓Contractility,↓AV > SA node
| Decrease afterload.
79
Verapamil, diltiazem: Indications
Ischemic HD, angina, CA spasm, HTN, supraventricular arrhythmias
80
Verapamil, diltiazem: Side Effects / Toxicities / Stuff to Know
Hypotension, bradycardia, edema, constipation, ok in renal failure
Not good in HF, low EF: negative inotropic agents.
V causes constipation, AV block. D causes peripheral edema and CHF
81
Dihydropyridines
-dipine: amlo, felo, nife
Block peripheral L type Ca channeels
82
Dihydropyridines : Indications
HTN, Ischemic HD, angina, CA spasms
83
Dihydropyridines : Side Effects / Toxicities / Stuff to Know
Decreased BP, HA, flushing
| Amlodipine: peripheral edema
84
Nitroglycerin: Subclass
Organic Nitrates
85
Nitroglycerin: Mechanism
Venodilation, decrease preload, CO, BP
86
Nitroglycerin: Net Effect
V dilation only
87
Nitroglycerin: Indications
Ischemic HD, CHF (+Hydralazine), angina, acute coronary
88
Nitroglycerin: Side Effects / Toxicities / Stuff to Know
Many routes. Drug "holiday." vasodilator side effects.
89
Nesiritide: Mechanism
Mimics BNP
90
Nesiritide: Net Effect
A+V dilation
91
Nesiritide: Indications
Refractory HF
92
Nesiritide: Side Effects / Toxicities / Stuff to Know
Bolus dose, expensive
93
Sildenafil: Mechanism
Inhibits cGMP breakdown
94
Sildenafil: Net Effect
Pulm. dilation, specific increase in O2
95
Sildenafil: Indications
Pulm. HTN
96
Sildenafil: Side Effects / Toxicities / Stuff to Know
Viagra. Don't use with Nitrates
97
Clonidine: Class
Antiadrenergic Drugs
98
Clonidine: Subclass
CNS α2 Agonists
With alpha methyldopa, guanabenz, guanfacine
99
Clonidine: Mechanism
↑α2 (↓NE release from presynaptic), ↓sympathetics
100
Clonidine: Net Effect
↓PVR, ↓CO, ↓HR
101
Clonidine: Indications
Refractory HTN
102
Clonidine: Side Effects / Toxicities / Stuff to Know
Rebound HTN (withdrawal phenomenon). α-methyldopa safe in pregnancy
103
Prazosin: Subclass
α 1 Blockers,
With terazosin, doxazosin
104
Prazosin: Mechanism
↓α1
105
Prazosin: Net Effect
Mixed Vasodilation
106
Prazosin: Indications
HTN, BPH
107
Prazosin: Side Effects / Toxicities / Stuff to Know
Orthostatic hypotension, HA, dizziness
108
Phentolamine: Mechanism
↓α1 + ↓α2
With phenoxybenzamine
109
Phentolamine: Net Effect
Mixed Vasodilation
110
Phentolamine: Indications
Pheochromocytoma
111
Phentolamine: Side Effects / Toxicities / Stuff to Know
Reflex tachycardia, arrhythmia, orthostatic hypotension
112
Metoprolol (β1 specific): Subclass
β Blockers (-lol) AND II: Beta Blockers (-lol)
With bisoprolol, carvedilol, esmolol, labetolol
113
Metoprolol (β1 specific): Mechanism
↓β1, slows SA rate, prolongs AV de/repolarization
114
Metoprolol (β1 specific): Net Effect
↓HR, CO, SVR AND ↓HR, CO, SVR by ↓sympathetic
115
Metoprolol (β1 specific): Indications
Ischemic HD, HF AND SVT, VT, PVCs
116
Metoprolol (β1 specific): Side Effects / Toxicities / Stuff to Know
Hypotension, bradycardia, hypoperfusion, fatigue, dizziness, broncho/vasospasm
Don't use for sinus tachy
117
Labetalol: Indications
HTN, Arrhythmias
118
Disopyramide: Class
Antiarrhythmic Drugs
119
Disopyramide: Subclass
Ia: Moderate Na Channel Blockers
With quinidine, procainamide
120
Disopyramide: Mechanism
Block Na channels medium
121
Disopyramide: Net Effect
↑Action potential duration
| Decrease slope of phase 0
122
Disopyramide: Indications
SVT, AF, VT (not used much)
Procainamide for WPW if BP is good
123
Disopyramide: Side Effects / Toxicities / Stuff to Know
Not for Long QT, renal dysfuction, vagolytic symptoms (↓PS outflow)
Procainamide causes lupus like syndrome
124
Lidocaine: Subclass
Ib: Mild Na Channel Blockers
IV, With mexiletine (oral) and phenytoin (anti-seizure)
125
Lidocaine: Mechanism
Block (open) Na channels a bit
126
Lidocaine: Net Effect
Shorten repolarization
127
Lidocaine: Indications
VT, torsade, long QT
128
Lidocaine: Side Effects / Toxicities / Stuff to Know
Use dependence (more effect at ↑HR), confusion dizziness seizures, ↓QT
129
Propafenone: Subclass
Ic: Marked Na Channel Blockers
With flecainide and propafenone
130
Propafenone: Mechanism
Block Na channels a lot
131
Propafenone: Net Effect
Widen QRS
132
Propafenone: Indications
A.Fib, Refractory SVT
133
Propafenone: Side Effects / Toxicities / Stuff to Know
Proarrhythmic (v.tach caused by ↓a.flutter), paresthesias, diplopia, chest pain
134
Amiodarone (↓HR): Subclass
III: K Channel Blockers
With sotalol, dofetilide, amiodarone, ibutilide, dronedarone
135
Amiodarone (↓HR): Mechanism
Blocks K channels, extending refractory period
136
Amiodarone (↓HR): Net Effect
Prolong repolarization (AP duration), prevent reentrant loops
137
Amiodarone (↓HR): Indications
Recurrent VT, A.Fib, A.Flutter
138
Amiodarone (↓HR): Side Effects / Toxicities / Stuff to Know
Cause long QT\torsades
| ~I, II, III, IV, but lots of side effects
139
Sotalol: Side Effects / Toxicities / Stuff to Know
All K blockers: Long QT / Torsades, reverse-use dependence (more effect at ↓HR)
140
Dofetilide: Indications
A.Fib, A.Flutter
141
Dronedarone: Side Effects / Toxicities / Stuff to Know
Dronedarone is like amiodarone minus iodine, but ↑mortality :(
142
Diltiazem: Subclass
IV: Ca Channel Blockers
143
Diltiazem: Mechanism
↓L-type Ca channels
144
Diltiazem: Net Effect
↓AP rise, ↑AV repolarization, ↑SA threshold, ↓HR
145
Diltiazem: Indications
Rate control (A.Fib/Flutter, SVT)
146
Diltiazem: Side Effects / Toxicities / Stuff to Know
Use dependence (more effect at ↑HR), bradycardia, CHF, fatigue, best for black males
147
Adenosine: Subclass
Endogenous Nucleoside
148
Adenosine: Mechanism
Binds adenosine A1 receptor in AV NODE
149
Adenosine: Net Effect
↓SA, AV node conduction
| By decreased cAMP, decreased automaticity
150
Adenosine: Indications
Reentrant SVT
151
Adenosine: Side Effects / Toxicities / Stuff to Know
SA node slowing (↓HR), AV block, asystole, A.fib, bronchospasm
Less than 10s halflife. Not for asthmatics
152
Atropine: Subclass
Anticholinergic
153
Atropine: Mechanism
↓Acetylcholine. Competitve antagonist for muscarinic ach receptors
154
Atropine: Net Effect
↓Parasymp.
155
Atropine: Indications
Symptomatic sinus bradycardia, AV block
156
Atropine: Side Effects / Toxicities / Stuff to Know
Tachycardia, urinary retention, vagolytic
157
Aspirin: Class
Antithrombotics
158
Aspirin: Subclass
Platelet Inhibitors (Arterial)
With dipyridamole, mechanism unknown
159
Aspirin: Mechanism
Irreversibly ↓COX
160
Aspirin: Net Effect
↓aggregation
161
Aspirin: Indications
Ischemic HD, stroke, A.Fib (if warfarin is counterindicated)
162
Aspirin: Side Effects / Toxicities / Stuff to Know
81mg qd, aspirin before NSAIDs
163
ADPr Inhibitors (Thienopyridines): Mechanism and Names
Block P2Y12 receptor, ↓ADP-induced platelet activation
| Ticlodipine, clopidogrel, prasugrel, ticagrelor
164
ADPr Inhibitors (Thienopyridines): Net Effect
```
Ticlodipine inhibits,
Clopidogrel competitively inhibits,
Prasugrel irreversibly inhibits,
Ticagrelor reversibky inhibits ADP receptor.
All prevent clotting.
```
165
ADPr Inhibitors (Thienopyridines): Indications
Unstable angina, MI (NSTEMI and STEMI), post-cardiac cath
166
ADPr Inhibitors (Thienopyridines): Side Effects / Toxicities / Stuff to Know
Long-acting, irreversible, TTP, bleeding, neutropenia (side effects with 1 doesn't rule out other 2) clop and pras are once daily prodrugs, tica is active, 2x a day
167
Gp IIb/IIIa Inhibitors: Mechanism and names
↓Fibrinogen-induced platelet aggregation
Abciximab, an Fab fragment
Eptifibatide, a peptide-based antagonist
Tirofiban, a small molecule inhibitor
168
Gp IIb/IIIa Inhibitors: Net Effect
Functionally 0 platelet activity
169
Gp IIb/IIIa Inhibitors: Indications
Unstable angina, post-coronary intervention (blocks re-stenosis)
170
Gp IIb/IIIa Inhibitors: Side Effects / Toxicities / Stuff to Know
Significant bleeding risk, thrombocytopenia (duh), not long-term solution, IV only
171
Unfractionated Heparin: Subclass
Anticoagulant Drugs (Venous)
172
Unfractionated Heparin: Mechanism
↑Antithrombin-III inactivation of clotting cascade
173
Unfractionated Heparin: Net Effect
Prevention of thrombosis
174
Unfractionated Heparin: Indications
Short term anticoag
175
Unfractionated Heparin: Side Effects / Toxicities / Stuff to Know
Cheap, reversible (protamine), but requires continuous monitoring
176
LMWH (Enoxaparin): Side Effects / Toxicities / Stuff to Know
No monitoring, subQ, x-react with HIT, ↑bioavailability, $$$$, renal
177
Warfarin (Coumadin): Mechanism
↓Vit K carboxylase
178
Warfarin (Coumadin): Net Effect
↓Vit K, inhibits clot formation
179
Warfarin (Coumadin): Indications
Long term anticoag: A.Fib, Post-MI prophylaxis
180
Warfarin (Coumadin): Side Effects / Toxicities / Stuff to Know
Delayed onset, DDI, antidote = vitK
181
Factor Xa Inhibitors: Mechanism and names
Inhibit Factor Xa
| Rivaroxiban (oral), apixaban
182
Factor Xa Inhibitors: Net Effect
Reduces thrombo-embolic risk by inhibiting clot formation
183
Factor Xa Inhibitors: Indications
VTE Tx/prophylaxis, non-valvular A.Fib to prevent stroke, post-op DVT prophylaxis
184
Factor Xa Inhibitors: Side Effects / Toxicities / Stuff to Know
Fondaparinux = IV, Rivaroxaban = oral. >LMWH in VTE prophylaxis
185
Direct Thrombin Inhibitors: Mechanism and name
Block active site of thrombin
| Dabigatran
186
Direct Thrombin Inhibitors: Net Effect
↓Free + clot-bound thrombin
187
Direct Thrombin Inhibitors: Indications
ACS, coronary interventions, heparin-induced thrombocytopenia, stroke prevention in nonvalvular afib
188
Direct Thrombin Inhibitors: Side Effects / Toxicities / Stuff to Know
Irreversible, useful for those with history of heparin-induced thrombocytopenia
189
Dabigatran: Indications
Anticoag for A.Fib, stroke prevention
190
Dabigatran: Side Effects / Toxicities / Stuff to Know
Oral, no DDI or monitoring. GI.
191
Streptokinase: Subclass
Fibrinolytics/Thrombolytics
With urokinase, TPA (tissue plasminogen activator)
192
Streptokinase: Mechanism
↑Plasminogen (directly or indirectly)
193
Streptokinase: Net Effect
Lyses preexisting clots (but ↑risk of hemorrhage)
194
Streptokinase: Indications
Acute MI, other thrombosis, stroke
195
Streptokinase: Side Effects / Toxicities / Stuff to Know
Allergies, indirect activation, hemmorhage
196
Urokinase: Side Effects / Toxicities / Stuff to Know
Originally derived from urine
197
tPA: Side Effects / Toxicities / Stuff to Know
More specific to clots
198
Alteplase: Side Effects / Toxicities / Stuff to Know
tPA derivatives with longer half-lives, can be delivered as bolus
199
Lovastatin: Class
Lipid-Regulating Drugs
200
Lovastatin: Subclass
HMG CoA Reductase Inhibitors (Statins)
With simvastatin (also a prodrug)
And pravastatin, fluvastatin, rosuvastatin, atorvastatin
201
Lovastatin: Mechanism
Competitively inhibit HMG CoA reductase (cholesterol synthesis)
202
Lovastatin: Net Effect
↓Cholesterol synthesis, ↑LDLr activity, ↑LDL clearance, ↓↓LDL
203
Lovastatin: Indications
High cholesterol, post MI tx
204
Lovastatin: Side Effects / Toxicities / Stuff to Know
Hepatic metabolism, dose response plateaus. Side effects: diabetes, myositis, teratogen, hepatitis. Good side effects: ↑NO, ↓vSMC, MMP, inflammation
CYP450, means drug interactions
205
Cholestyramine: Subclass
Bile Acid Sequestrants
With colestipol, colesevelam
206
Cholestyramine: Mechanism
↓Bile acid reabsorption from intestine into liver
207
Cholestyramine: Net Effect
↑LDL clearing to replace bile acids, ↓LDL
208
Cholestyramine: Indications
High cholesterol
209
Cholestyramine: Side Effects / Toxicities / Stuff to Know
Epigastric distress, constipation, muscle aches, interferes with other drugs absorption . Good side effects: ↓blood glucose in T2DM
210
Ezetimibe: Subclass
Cholesterol Absorp. Inhibitor
211
Ezetimibe: Mechanism
↓NPC1 hepatic intracellular cholesterol, increases LDL clearance
212
Ezetimibe: Net Effect
↓LDL
213
Ezetimibe: Indications
High cholesterol
214
Ezetimibe: Side Effects / Toxicities / Stuff to Know
Cholesterol-specific, so diet still important (limit saturated FA)
215
Gemfibrozil: Subclass
Fibrates
With fenpfibrate, clofibrate
216
Gemfibrozil: Mechanism
↑LPL, ↑VLDL/LDL catabolism
217
Gemfibrozil: Net Effect
↓↓TG, ↑Conversion of VLDL, remnant clearance, more HDL
218
Gemfibrozil: Indications
Lipid abnormalities in: (metabolic syndrome/DM + low HDL + high TG)
219
Gemfibrozil: Side Effects / Toxicities / Stuff to Know
GI, gallstones, ↑LDL, ↓libido
Myopathy with statin!
220
Niacin: Subclass
Niacin
221
Niacin: Mechanism
Binds GPCR, decreases cAMP, decrease hepatic secretion of VLDL
222
Niacin: Net Effect
↑↑HDL, ↓TG
223
Niacin: Indications
High cholesterol + TG, low HDL
224
Niacin: Side Effects / Toxicities / Stuff to Know
Flushing, GI (ulcer), hepatitis, gout, hyperglycemia, DM, dry skin
225
dobutamine: side effects
inflammatory eosinophilic myocarditis
226
Rx for homozygous familial hyper lipidemia
Mipomerson: binds apoB mRNA
Lomitapide: prevents lipidations of ApoB
Expensive, risk of cirrhosis
