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A - USMLE Step 1 Pharm > Cardiology - Pharmacology > Flashcards

Cardiology - Pharmacology Flashcards

1
Q

Hyperlipidemia Drug Classes (5) + Sample Drug

A

1) HMG-CoA Reductase Inhibitors - Statins
2) Resins - Bile Acid Binding - Colestipol + Cholestramine
3) Niacin (B3)
4) Fibric Acid Derivatives - Gemifiozil + Fenofibrate
5) Cholesterol Absorption Blockers - Ezetimibe

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2
Q

HMG-CoA Reductase Inhibitors - Names (3) + Mechanism + Toxicity (4)

A

Names - Lovastatin + Atorvastatin + Simvastatin
Mechanism - Inhibits cholesterol genesis - Increases LDL Receptor Expression
Toxicity - Pregnancy/Breast Feeding + Heptotoxicity (Check ALTs) + Myopathy + CYP450 Interactions

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3
Q

Niacin - Mechanism + Toxicity (3)

A

Mechanism - Inhibits lipolysis and reduces VLDL Synthesis –> Increases HDL
Toxicity - Facial Flushing (PGE Synthesis) + Heptatotoxicity + Hyperuricemia

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4
Q

Bile Acid Resins - Names (2) + Mechanism + Toxicity (5)

A

Names - Colestipol + Cholestramine
Mechanism - Bind bile acid in intestine + decrease re-absorption (cholesterol must be made to make new bile acids) over time effect wanes - Give with statin to preserve effect
Toxicity - Bad Taste + Teratogen + Interferes with intestinal absorption especially of other drugs/vitamins + constipation + bloating

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5
Q

Cholesterol Absorption Block - Names (1) + Mechanism + Toxicity (2)

A

Names - Ezetimibe
Mechanism - Prevents cholesterol absorption
Toxicity - Diarrhea + Increased LFTs

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6
Q

Fibrates - Names (2) + Mechanism + Toxicity (3)

A

Names - Gemifibrozil + Fenofibrate
Mechanism - Increases LDL/TG Clarence - Good for when VLDL is the primary issue
Toxicity - Renal and Liver (LFTs) + Gallstones

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7
Q

Lovastatin - Class

A

HMG-CoA Reductase Inhibitor

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8
Q

Colestipol - Class

A

Bile Acid Resin

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9
Q

Cholestramine - Class

A

Bile Acid Resin

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10
Q

Ezetimibe - Class

A

Cholesterol Absorption Inhibitor

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11
Q

Geifibrozil - Class

A

Fibrate

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12
Q

Fenofibrate - Class

A

Fibrate

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13
Q

Liver LDL Uptake - 3 Results

A

1) Lowers HMG (No new LDL)
2) Increase ACAT (Increase LDL Breakdown)
3) Decrease LDL Receptors

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14
Q

Familial Hypercholesterolemia

A

Failure of the LDL Receptor - No Liver Uptake - None of the 3 Turn-Down Mechanisms Uses (HMG Inhibition + ACAT increase)

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15
Q

Classes of Anti-Arrhythmia Therapy + Mechanism + Prototype Drug (6)

A

1A - Na Channel Blocker - Procainamide
IB - Na Channel Blocker - Lidocaine
IC - Na Channel Blocker - Flecainide
II - Beta Blocker - Propanolol
III - K Channel Blocker - Sotalol + Ibutilide + Amiodarone
IV - Ca-Channel Blocker - Verapamil + Diltiazem

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16
Q

Class IA Anti-Arrhythmia Drugs - Name (3) + Mechanism + Use + Toxicity (5)

A

Name - Procainamide + Disopyramide + Quinidine
Mechanism - Na Channel Blocker - Slows uptake + Increases Action Potential Duration/QT Interval - Intermediate Kinetics
Use - Atrial + Ventricular Arrhythmia - Re-Entry = Key
Toxicity - Reduced Peripheral Resistance + Hypotension + Increased Risk for Early Afterdepolarizations + SLE Like Syndrome
Disopyramide/Quinidine = Anti-Muscarinic

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17
Q

Class IB Anti-Arrhythmia Drugs - Name (2) + Mechanism + Use + Toxicity (2)

A

Name - Lidocaine + Mexiletine
Mechanism - Blocks Na Channel - Rapid + Use Dependent = Preferential for Ischemia Tissue - Decreases AP Duration
Use - Acute Ventricular Arrhythmia + Post MI
Toxicity - Low Toxicity (Cardio and Neuro)

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18
Q

Class IC Anti-Arrhythmia Drugs - Name (2) + Mechanism (1) + Use + Toxicity

A

Name - Flecainide + Propafenone
Mechanism - Na Blocker = Long Acting + Prolongs AV Node Refractory Period
Use - SVT + Wolf-Parkinson-White
Toxicity - Slow Refractory Period = High likelihood of producing a new arrhythmia

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19
Q

Class II Anti-Arrhythmia Drugs - Name (2) + Mechanism + Use + Toxicity (2)

A

Name - Propranolol + Esmolol
Mechanism - Beta Blockers (Esmolol = Rapid) - Slow Conduction + Supress Abnormal Pacemakers (Slower/Weaker Contractions)
Use - SVT + Slowing Ventricular Rate (Especially effective in AV Node) + Decreased Reentry
Toxicity - Impotence + Exacerbation of COPD/Asthma

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20
Q

Class III Anti-Arrhythmia Drugs - Name (3) + Mechanism + Use + Toxicity (3)

A

Name - Sotalol + Ibutilide + Amiondarone
Mechanism - Block IKr - Increase Action Potential Duration - Longer refractory period decreases reentry
Use - Afib/Flutter + Ventricular Tachycardia
Toxicity - Torsades + Excessive Beta-Blockade
Amiodarone = Special = Decreases Phase 4 Slope - Less Torsades Risk but high risk of pumonary firbosis + thyroid disfunction + hepatotoxicity (monitor LFTs)

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21
Q

Class IV Anti-Arrhythmia Drugs - Name (2) + Mechanism + Use + Toxicity (4)

A

Name - Verapamil + Diltiazem (Not NIfedepine)
Mechanism - Block Ca Channels = Shorter AP = Decreased Reentry = Decreased conduction velocity + longer refractory period
Use - Nodal Arrhythmia + AFib
Toxicity - Constipation + Flushing + Edema + AV Block

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22
Q

Adenosine - Mechanism + Use + Toxicity (3)

A

Mechanism - Inhibits AV Node Conduction by activating inward K+ Channels + Inhibiting Ca Channels (Hyperpolarizes)
Use - Super Rapid (10s) with high efficacy)
Toxicity - Flushing + Hypotension + Chest Pain

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23
Q

Verapamil - Arrhythmia Class + Mechanism

A

Class - IV

Mechanism - Ca Channel Blocker

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24
Q

Diltiazem - Arrhythmia Class + Mechanism

A

Class - IV

Mechanism - Ca Channel Blocker

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25
Sotalol - Arrhythmia Class + Mechanism
Class - III | Mechanism - K Channel Blocker
26
Ibutilide - Arrhythmia Class + Mechanism
Class - III | Mechanism - K Channel Blocker
27
Amiodarone - Arrhythmia Class + Mechanism + Special Features
Class - III Mechanism - K Channel Blocker Special Feature - Decreases Phase 4 Slope - Less Torsades Risk but high risk of pumonary firbosis + thyroid disfunction + hepatotoxicity (monitor LFTs)
28
Esmolol - Arrhythmia Class + Mechanism
Class - II | Mechanism - Rapid Beta Blocker
29
Propranolol - Arrhythmia Class + Mechanism
Class - II | Mechanism - Beta Blocker
30
Flecainide - Arrhythmia Class + Mechanism
Class - IC | Mechanism - Slow Na Channel Blocker
31
Lidocaine - Arrhythmia Class + Mechanism
Class - IB | Mechanism - Rapid Na Channel Blocker
32
Mexiletine - Arrhythmia Class + Mechanism
Class - IB | Mechanism - Rapid Na Channel Blocker
33
Quinidine - Arrhythmia Class + Mechanism
Class - IA Mechanism - Intermediate Na Channel Blocker with Long Action Potential Also - Special Anti-Muscarinic AEs
34
Disopyramide - Arrhythmia Class + Mechanism
Class - IA Mechanism - Intermediate Na Channel Blocker with Long Action Potential Also - Special Anti-Muscarinic AEs
35
Procainamide - Arrhythmia Class + Mechanism
Class - IA | Mechanism - Intermediate Na Channel Blocker with Long Action Potential
36
Anti-Arrhythmia Drugs that Increase Action Potential Duration (2) + Impact
IA (Procainamide) III (Amiodarone + Sotalol) Increased Risk of Early Afterdepolarization and Torsades
37
Major HTN Treatment Classes (6) | M2 Only
1) Diuretics 2) Direct Oral Vasodilators (Hydralazine + Minoxidil) 3) Alpha-1 Blockers 4) CNS Symp. Inhibitors (Clonidine) 5) Calcium Channel Blockers 6) RAAS Inhibitors
38
2 Key M2 HTN Points | M2 Only
Never Give RAAS Inhibitors in Pregnancy | Verapamil causes Constipation
39
HTN Treatment in Heart Failure (4)
Diuretics + RAAS Inhibition + B-Blockers (Be Careful) + Aldosterone Antagonists
40
HTN Treatment after an MI (3)
B-Blockers + ACE Inhibitors + ARBs
41
HTN Treatment with Diabetes (4)
RAAS Inhibitors + Ca Channel Blockers + Diuretics
42
Direct Oral Vasodilators for HTN (2) + Adverse Effects | M2 Only
Hydralazine + Minoxidil - For Resistant HTN | Toxicity - Tachycardia + Increased Na/H2O Retention (Vasodilation Activates the RAAS System)
43
Anti-Arrhythmia Treatment - Wolfe-Parkson-White Review | M2 Only
Beta-Blockers + Ca Channel Blockers Alone - Only Slow AV Node Fast Pathway Must Add IC to Slow the Accessory Pathway
44
Heart Failure Drugs - 3 Major Mechanisms | M2 Only
1) Positive Inotropic + 2) Vasodilators (Both Elevate Frank Starling Curve 3) Diuretics - Move you back on the curve
45
Major Classes of Heart Failure Drugs (7) | M2 Only
1) Diuretics 2) RAAS Inhibitors 3) Cardiac Glycosides 4) Sympathomimetics 5) Bipyramides 6) Beta Blockers 7) Special Vasodilators
46
3 Major Cardiac Diuretic Classes + Mechanism + Drug Name | M2 Only
1) Loop Diuretics (Furosimide) 2) Thiazides (HTCZ + Metolazone + Indaparmid 3) K Sparing Diruetics (Amiloride + Spironolactone)
47
Furosemide - Class + Mechanism + Use + Toxicity (3)
Class - Loop Diuretic Mechanism - Inhibits Na/H2O Reabsorption Use - Primarily for Edema + Pulmonary Congestion in HTN + HF Toxicity - Hypokalemia + Metabolic Acidosis + Ototoxicity
48
HTCZ - Class + Mechanism + Use + Toxicity
Class - Thiazide Diuretic (Less Powerful) Mechanism - Best for Na Reduction Use - Anti-HTN + Reduce Afterload Toxicity - Hypokalemia + Metabolic Acidosis + Hypercalemia
49
Metolazone - Class + Mechanism + Use + Toxicity
Class - Thiazide Diuretic (Less Powerful) Mechanism - Best for Na Reduction Use - Anti-HTN + Reduce Afterload Toxicity - Hypokalemia + Metabolic Acidosis + Hypercalemia
50
Indaparmid - Class + Mechanism + Use + Toxicity
Class - Thiazide Diuretic (Less Powerful) Mechanism - Best for Na Reduction Use - Anti-HTN + Reduce Afterload Toxicity - Hypokalemia + Metabolic Acidosis + Hypercalemia
51
Amiloride - Class + Mechanism + Use + Toxicity
Class - K Sparing Diuretic (Aldosterone Inhibitor) Mechanism - Save K + Water - Prevents Aldosterone Remodeling in Heart Use - K Sparing + Anti-Aldosterone Toxicity - Hyperkalemia + High AII + Metabolic Acidosis + Gynocomastia
52
Spironolactone - Class + Mechanism + Use + Toxicity
Class - K Sparing Diuretic (Aldosterone Inhibitor) Mechanism - Save K + Water - Prevents Aldosterone Remodeling in Heart Use - K Sparing + Anti-Aldosterone Toxicity - Hyperkalemia + High AII + Metabolic Acidosis + Gynocomastia
53
Low Renin HTN Treatment | M2 Only
Diuretics = Key = African American HTN
54
ACE Inhibitors - Name (2) Mechanism + Use + Toxicity (3)
Name - Catopril + Enalapril (april) Mechanism - Decrease AI to AII Conversion - Decreases AIII + Increases Bradykinin Use - Stage II-IV CHF to support diuretics by inhibiting cardiac remodeling + decrease symp. activity Toxicity - Teratogenic + Hyperkalemia + Cough and Angioneurotic Edema (From Bradykinin)
55
Angiontensin Receptor Blocker - Name (1) Mechanism + Use + Toxicity (3)
Name - Losartan (sartans) Mechanism -Block AT1 Receptor Use - Alternative to ACE in patients who develop bradykinin cough (no bradykinin effects) - Less Effective Toxicity Teratogenic + Hypokaemia - No Bradykinin Cough
56
Renin Blocker - Name (1) Mechanism + Use + Toxicity | M2 Only
Name - Aliskiren Mechanism -Like ACE Inhibtor Use - Experimental Toxicity - Bradykinin Angioedema + Cough
57
Losartan - Class
ARB
58
Catopril - Class
ACE Inhibitor
59
Enalapril - Class
ACE Inhibitor
60
Aliskiren - Class
Renin Inhibitor
61
Cardiac Glycosides - Name (2) + Mechanism + Effects + Use + Toxicity (4)
Name - Digoxin + Levosimendan Mechanism - Inhibits the Na/K ATPase --> Causes a Na Build-Up in the cell --> Inhibits the NCX from getting Ca out of the cell (no Na gradient in) Effects - Stronger Contraction + Enhances Vagal Tone + Slows AV Conduction Use - CHF (Increase Contractility) + Afib (Slows AV Node Conduction) Toxicity - AV Node Block + Nausea, Vomit + Visual Loss
62
Impact of K+ On Digoxin
Low K+ Increases Digoxin Effect High K+ Decreases Digoxin Effect Important due to small digoxin therapeutic window
63
Digoxin - Class
Cardiac Glycoside
64
Levosimendan - Class
Cardiac Glycoside
65
Bipyrimidiens - Name (2) + Mechanism + Use + Toxicity (3) | M2 Only
Name - Milrinone + Inamrinone Mechanism - Prevent cAMP Breakdown - Increase Contractility Use - CHF - Increase Symp. Activity Toxicity - Bone Marrow Damage (Worst in Inamrinone) + Arrhythmia (Worse in Milrinone) + Liver Toxicity (Both)
66
Milrinone - Class + Special Feature | M2 Only
Class - Bipyrimidien | Special Feature - More Arrhythmia but less bone marrow thrombocytopenia
67
Inamrione - Class + Special Feature | M2 Only
Class - Bipyrimidien | Special Feature - More bone marrow thrombocytopenai but less arrhythmias
68
General Order of CHF Treatment (5) | M2 Only
1) Diuretics 2) ACE/ARB 3) B-Blocker 4) Aldosterone Antagonist + Digoxin if Severe 5) Transplant
69
Special Case Vasodilators for CHF - Name + Use (3)
Nitroprusside - Rapid + Powerful vasodilaterl for Acute Severe Hypotension - SE = Cyanosis Hydalazine - Chronic Failure/HTN in African Americans - SE = Headache Nesiritide - Atrial Peptide Vasodilator - Acute Failure but can cause hypotension
70
Nitroprusside - Class + Use
Class - Emergency Vasodilator | Use - Rapid + Powerful vasodilaterl for Acute Severe Hypotension - SE = Cyanosis
71
Hydralazine - Class + Use
Class - Emergency Vasodilator | Use - Chronic Failure/HTN in African Americans - SE = Headache
72
Nesiritide - Class + Use
Class - Emergency Vasodilator | Use - Atrial Peptide Vasodilator - Acute Failure but can cause hypotension
73
Vasodilators (Angina Treatment) - Approaches (3) | M2 Only
1) Increase Myocardial Perfusion/Oxygenation 2) Decrease Heart Work Rate + O2 Demand (Major Therapy Goal) 3) Increase O2 Extraction from Blood (Not Possible)
74
Nitroglycerin - Mechanism + Types (3) + Use + Toxicity (5)
Mechanism - Increases NO Release with increase smooth muscle cGMP and relaxation Use - Decreae Heart Size and Wall tension during systole (with reflex symp. activation) Types - Short Acting + Long Acting + Sildinafil Toxicity - Flushing + Ortho HTN + Hypotension + Tachycardia + Headache
75
Oral/Sublingual Nitroglycerin - Use + Effects
Use - Instant Angina Vasodilation | Effects - Reduces Pulm. Resistance with no impact on peripheral systemic resistance
76
High Dose Nitroglycerin - Use + Effects
Use - Long Acting + Oral Angina Vasodilation | Effects - Impacts both pulm. systemic resistance (vs. just pulm. in sublingual) + More reflex cardiac stimulation + AEs
77
Sildinafil - Class + Mechanism + Interactions
Class - Phosphodiesterase (PDE5) Inhibitor Mechanism - Vasodilation via cGMP in the penis Interactions - Increases NO and can interact with vasodilators
78
Calcium Channel Blocker - Mechanism + Classes (2) + Names (2 Each)
Mechanism - Block L-Type Calcium Channels - Inhibit Ca Influx in Cardiac + Smooth Muscle Class 1 - DMechanism - Blocks Closed Calcium Channels - Impacts Smooth Muscle more than Cardiac Use - Angina + HTN + Raynouds AE - Less than Non-Dihydro - Flushing + Dizziness + Peripheral Edema + Constipation/Cardiac Depression (But Less) + Reflexive Effects ihydropyridine = = Block Closed Channels Class 2 - Non-Dihydropyridine = Verapamil + Diltiazem = Block Open Channels
79
Dihydropyridine Blockers - Names (2) + Mechanism + Use + Adverse Effects (6)
Names - Nifedipine + Amlodipine Mechanism - Blocks Closed L-Type Calcium Channels - Impacts Smooth Muscle more than Cardiac Use - Angina + HTN + Raynouds AE - Less than Non-Dihydro - Flushing + Dizziness + Peripheral Edema + Constipation/Cardiac Depression (But Less) + Reflexive Effects
80
Non-Dihydropyridine Blockers - Names (2) + Mechanism + Use + Adverse Effects (5)
Names - Verapamil + Diltiazem Mechanism - Blocks Open L-Type Calcium Channels - Impacts Smooth Muscle and Cardiac equally (more cardiac impact than dihydropyridine) Use - AV Nodal Arrhythmia (Afib/Flutter) + Angina + HTN + Migraines AE - More Pronounced - Constipation + Flushing + Dizziness + Peripheral Edema + Cardiac Depression/Hypotension (High Dose)
81
Variant Angina Treament - 2 Methods + 1 Failed Method | M2 Only
Responds to Nitrates + Ca Channel Blockers | No Response to Beta Blockers
82
Anti-Angina Therapy - 2 Major Class
1) Nitrates = Affect Preload - Nifedipine (Dihydropyrimidines Blocker) = Similar 2) B-Blcokers = Affect Afterlod - Verapamil (Non-Dihydropyrimidines Blocker) = Similar
83
Nitrate Angina Therapy Response - First Aid - 4 Points
Affects Preload - Nifedipine = Similar 1) Decrease EDV + BP 2) Reflex Increase in Contractility + HR 3) Decrease Ejection time + Mycoardial O2 Demand
84
B-Blocker Angina Therapy Response - First Aid - 4 Points
Affects Afterload - Verapamil = Similar 1) Increase EDV + Ejection Time 2) Lowers BP + Contractility + HR 3) Lowers Myocardial O2 Demand
85
Verapamil - Class
Non-Dihydropyrimidines - Open L-Type Calcium Channel Blocker
86
Diltiazem - Class
Non-Dihydropyrimidines - Open L-Type Calcium Channel Blocker
87
Nifedipine - Class
Dihydropyrimidines - Closed L-Type Calcium Channel Blocker
88
Amlodipine - Class
Dihydropyrimidines - Closed L-Type Calcium Channel Blocker

A - USMLE Step 1 Pharm (11 decks)

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