Cardiology (HTN, Angina, some HF) Drugs

Question 1

HTN w/ Diabetes

Answer 1

ACE inhibitors/ARBs are protective against diabetic neuropathy

Question 2

HTN in pregnancy

Answer 2

Hydralazine, labetalol, methyldopa, nifedipine

Question 3

Ca Channel Blockers - Dihydropyridines

Answer 3

Amlodipine, clevidipine, nicardipine, nifedipine, nimodipine = - dipines
Act on VASCULAR SMOOTH MUSCLE
AE: peripheral edema, flushing, dizziness, gingival hyperplasia

Question 4

Ca Channel Blockers - Nondihydropyridines

Answer 4

Diltiazem, verapamil (verapamil - ventricle = strongest heart drug)
Act on HEART
AE: cardiac depression, AV block, hyperprolactinemia, constipation

Question 5

Ca Channel Blockers - MOA

Answer 5

Block VG (L-type) Ca channels of cardiac/smooth muscle
Decrease muscle contractility

Question 6

Nimodipine CU

Answer 6

subarachnoid hemorrhage (prevents cerebral vasospasm)

Question 7

Clevidipine CU

Answer 7

hypertensive emergency

Question 8

Dihydropyridines CU

Answer 8

(except nimodipine)
HTN, angina (including Prinzmetal), Raynaud phenomenon
VASCULAR SM EFFECTS

Question 9

Non-dihydropyridines CU

Answer 9

HTN, angina, atrial fibrillation/flutter

HEART EFFECTS

Question 10

Hydralazine

Answer 10

Increase cGMP - SM relaxation / vasodilation
ARTERIOLES > Veins
Reduces AFTERLOAD- frequently give w/B blocker to prevent reflex tachycardia
CU: acute severe HTN, HF (w/organic nitrate)
Safe in pregnancy
CI: angina/CAD bc compensatory tachycardia effects
AE: fluid retention, HA, angina, Lupus-like syndrome

Question 11

HTN emergency drugs

Answer 11

Clevidipine/Nicardipine (Dihydropine Ca channel blockers)
Fenoldopam
Nitroprusside
Labetalol

Question 12

Nitroprusside

Answer 12

Direct release of NO to increase cGMP - vasodilation
CU: HTN emergency (short acting)
AE: cyanide toxicity (releases cyanide)

Question 13

Fenoldopam

Answer 13

DA D1 R agonist
Coronary, peripheral, renal and splanchnic vasodilation
Decreases BP, increases natriuresis (Na excretion)
CU: HTN emergency, post-op antihypertensive
AE: hypotension, tachycardia

Question 14

Nitrates

nitroglycerin, isosorbide dinitrate, isosorbide mononitrate

Answer 14

MOA: Increase NO in vascular SM - increase cGMP - SM relaxation/vasodilation
VEINS»»arterioles - decrease PRELOAD
CU: angina, acute coronary syndrome, pulmonary edema
AE: reflex tachycardia (Tx w/B blocker), hypotension, dizziness, flushing, HA
“Monday dz” in industrial exposure (tolerance for vasodilation action develops during work week, but is lost over weekend (increased AE’s))

Question 15

Goal of Antianginal Therapy

Answer 15

Reduction of myocardial O2 consumption (MVO2) by decreasing one or more determinants (end-diastolic volume, BP, HR, contractility)

Best combo antianginal therapy = Nitrates + B-blockers

Question 16

Ranolazine

Answer 16

MOA: inhibits late phase Na current (reduces diastolic wall tension and O2 consumption)
No effect on HR or contractility
CU: Angina refractory to other therapies
AE: constipation, dizziness, HA, N, QT prolongation