Cardiovascular Agents Flashcards
Quinidine
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (2)
Class?
Class IA anti-arrhythmic
Mechanism?
blocks Na channels on cardiac myocyte
Net effect?
prolongs depolarziation, repolarization, increased refractory time = prolonged QT interval
Clinical Uses?
atrial fibrillation, WPW Syndrome, ventricular tachycardia
Side effects?
cardiac arrhythmias
Similar drugs? (2)
procainamide
disopyramide
Lidocaine
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Class
IB Anti-arrhythmic
Mechanism
Blocks Na channels on cardiac myocytes
Net effect
shortened AP, ability for cardiac myocytes be stimulated to contract is diminished
Clinical Uses ventricular arrhythmias (fib + tach)
Side effects?
cardiac arrhythmias
Similar drugs? (1)
Mexiletine
Flecainide
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Class?
Class IC
Mechanism?
Blocks Na channels on cardiac myocyte
Net effect?
Slows rate of cardiac muscle conduction/contraction
Clinical Uses?
Supraventricular arrhythmias
Side effects?
exacerbation or induction of life-threatening arrhythmais; avoid in patients with structurally abnormal hearts (ie decreased EF)
Similar drugs? (1)
Propafenone
B-blockers
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (3)
Class?
Class II anti-arrhythmics
Mechanism?
Blocks b1 receptors on cardiac myocytes
Net effect?
decrease sympathethic input and decreased HR
Clinical Uses?
anti-arrhythmic; only anti-arrhythmic that has ever been shown to IMPROVE mortality post-infarct.
Side effects?
Similar drugs? (3)
Propranolol, Carvedilol, Metoprolol
Sotalol
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (4)
Class?
Class III anti-arrhythmics
Mechanism?
blocks K channels on cardiac myocytes
Net effect?
Prolonged repolarzation, prolonged QT interval
Clinical Uses?
supression of atrial/ventricular arrhytmias
Side effects?
1cardiac arrhythmias
Similar drugs? (4)
ibutilide, dofetilide, amiodarone, dronedarone
“AIDDS”
Verapimil
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (2)
Contraindications?
Class?
Class IV anti-arrhythmic
Mechanism?
Blocks VG Ca channels on SA/AV nodes
Net effect?
slow down spontaneous depolarization + delay repolarization of the myocyte = prolonged PR interval
Clinical Uses? supraventricular tachycardia (ie atrial fibrillation)
Side effects?
hypotension, heart block
Similar drugs?
Diltiazem, Adenosine (SVT only)
nifedipine, nicardipine
Contraindications?
additive effect with other anti-hypertensives
additive toxic effects with b-blockers
reduce doses in patients with renal/hepatic dz or if they’re on nifidepine (due to increased risk of MI)
Pregnancy Class C
Hydralazine
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Contraindications?
Class?
arteriolar vasodilator
Mechanism?
direct relaxation of arteriolar smooth muscle
Net effect?
decreased BP
Clinical Uses?
HTN, heart failure (reduces afterload), pregnancy HTN
Side effects?
drug-induced lupus, reflex tachycardia, GI upset, hypotension
Similar drugs?
Apresoline
Contraindications?
Nifedipine
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (3)
Contraindications?
Class?
Ca channel blockers
Mechanism?
Blocks VG L-type Ca channels on cardiac + VSM
Net effect?
decreased muscle contraction, peripheral vasodilation and decreased myocardial contractility
Clinical Uses?
HTN, Prinzmetal angina, Raynaud disease
Side effects?
bradycardia, heart block, hypotension
Similar drugs?
nicardine, verapamil, diltiazem
Contraindications?
patients with decreased EF bc of the negative inotropic effects
Nitroglycerin
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs?
Contraindications?
Class?
Venodilators
Mechanism?
NO –> cGMP –> dephosphorylation of MLC kinase
Net effect?
relaxation of smooth muscle of veins (reduction in preload), relaxes coronary artery smooth muscles
Clinical Uses?
angina, heart failure, pulmonary edema, HTN
Side effects?
orthostatic hypotension, headache
Similar drugs?
any word with -nitrates
Contraindications?
- additive effects with other anti-hypertensives and vasodilators
- concurrent use with phosphodiesterase inhibitors (sildenafil, tadalafil, vardenafil)
Nitroprusside
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs?
Contraindications?
Class?
Mixed vasodilator
Mechanism?
NO –> cGMP –> dephosphorylation of MLC kinase
Net effect?
VSM relaxation of peripheral veins and arteries, reduced afterload and preload, reduced PVR
Clinical Uses?
HTN crisis, severe HF, cardiogenic shock, controlled hypotension during surgery
Side effects?
CN toxicity
Similar drugs? none
Contraindications?
Additive effects wiht most anti-hypertensives; used with caution in patients with increased intracranial pressure
Captopril
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Contraindications?
Class?
ACE Inhibitor, mixed vasodilator
Mechanism?
inhibits ACE –> decrease AII, increase bradykinin;
Net effect?
decreased PVR and ECVF
Clinical Uses?
HTN, CHF, diabetic nephropathy
decrease mortality in post-MI patients
**Prevents remodeling of the myocardium **
Side effects?
COUGH, ANGIOEDEMA, hyperkalemia, renal failure, hypotension, angioedema
Similar drugs?
Lisinopril
Contraindications?
pts with impaired renal function, renal artery stenosis, use with other diuretics
Losartan
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Contraindications?
Class?
Angiotensin Receptor Blocker (ARB), mixed vasodilator
Mechanism?
blocks AII receptor
Net effect?
decrease PVR + decrease ECVF
Clinical Uses?
HTN, CHF, diabetic nephropathy
Side effects?
Hyperkalemia, renal failure (in renally insufficient patients), hypotension, teratogen
(since ARBs have no effect on bradykinin, there is no effect of cough and angioedema!)
Similar drugs?
Valsartan
Contraindications?
patients with diuretics, renal artery stenosis, mitral/aortic stenosis
Mannitol
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (3)
Contraindications?
Class?
osmotic diuretic
Mechanism?
PCT and descending LOH
Net effect?
increase tubular osmolarity, increase urine outflow, decrease ECVF
Clinical Uses?
volume depletion - decrease intracranial or intraocular pressure
Side effects?
pulmonary edema, GI upset, headache, dehydration
Similar drugs? (3)
Urea, glycerin, isosorbide
Contraindications?
patients with CHF, since it initially causes an expansion of ECVF before renal elimination
Furosemide
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Contraindications?
Class?
loop diuretic, sulfonamide
Mechanism?
inhibits Na/K/2Cl transport in TALH
Net effect?
renal loss of electrolytes and water
Clinical Uses?
volume overload states associated with HF, liver failure, renal failure, HTN, hypercalcemia
Side effects?
Hypokalemia/metabolic alkalosis, ototoxicity, hyperuricemia (gouty attacks)
Similar drugs?
Ethacrynic acid
Contraindications?
patients with sulfa allergies
Acetazolamide
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (3)
Contraindications?
Class?
Diuretic, CA inhibitor
Mechanism?
inhibits carbonic anhydrase in PCT and eye
Net effect?
less bicarb is reabsorbed, more Na/H2O is lost
Clinical Uses?
glaucoma, alkalinize urine in cases of toxin ingestion, high altitude sickness
Side effects?
Hyperchloremic metabolic acidosis, hypokalemia
Similar drugs?
Contraindications?
patients with sulfa allergy
Hydrochlorothiazide
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs?
Contraindications?
Class?
diuretic
Mechanism?
inhibit Na/Cl cotransporter in early DCT
Net effect?
increased secretion of Na/K and decreased secretion of Ca in the urine; lowers BP by 10-15mmHg only
Clinical Uses?
HTN, nephrogenic diabetes insipidus, recurrent kidney stones
Side effects?
Hypokalemia, hyperuricemia, hypercalcemia
Similar drugs?
Contraindications?
additive effects with other anti-hypertensives
patients wiht sulfa-allergies
Notes: this can be inconvenient because it causes intense diuresis
Spironolactone
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Contraindications?
Class?
Diuretic
Mechanism?
- Blocks aldosterone receptors in the late DCT and CCT
- Blocks androgen receptors
Net effect?
- increased renal loss of Na, H2O, and subsequently K
- increase conversion of testosterone to estradiol
Clinical Uses?
primary hyperaldosteronism, volume overload states associated with HF, liver failure, nephrotic syndrome, HTN
**Prevents remodeling of the myocardium **
Side effects?
Hyperkalemia/metabolic acidosis
Gynecomastia
Similar drugs?
Eplerenone (little anti-androgen effect)
Contraindications?
Triamterene
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Contraindications?
Class?
Diuretic
Mechanism?
Blocks Na channels in the DCT
Net effect?
diuresis + decreased K excretion
Clinical Uses?
volume overload states associated with HF, liver failure, and neprotic syndrome, and HTN
Side effects?
Hyperkalemia
Similar drugs?
Amiloride
Contraindications?
none listed
Sildenafil
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Contraindications?
Class?
Phosphodiesterase inhibitor
Mechanism?
blocks cGMP phosphodiesterase inhibitor in the corpus cavernosum of the penis and smooth muscle of pulmonary vasculature
Net effect?
increased blood flow to the corpus cavernosum, vasodilation of the pulmonary vasculature
Clinical Uses?
erectile dysfunction, pulmonary arterial hypertension
Side effects?
Headache, flushing, hypotension
Similar drugs?
Vardenafil, Tadalafil
Contraindications?
patients using nitrates (can cause serious hypotension)
Milrinone
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Contraindications?
Class?
Phosphodiesterase Inhibitor
Mechanism?
blocks phosphodiesterase in cardiac + smooth muscle
Net effect?
increased cAMP –> opening of Ca channel, leading to increased contractility
Clinical Uses?
acute decompensated HF
Side effects?
Nausea, vomiting, cardiac arrhythmias, thrombocytopenia
Similar drugs?
Amrinone
Contraindications?
none
Theophylline
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs?
Contraindications?
Class?
Phosphodiesterase inhibitor
Mechanism?
inhibts phosphodiesterase in bronchial smooth muscle
Net effect?
increased cAMP -> bronchial smooth muscle relaxation -> bronchodilation
Clinical Uses?
acute/chronic asthma
Side effects?
cardiac arrhythmias, anxiety, seizures, GI upset
Similar drugs?
Contraindications?
simultaneous use with cytochrome P450 (since theophylline is metabolized by cytochrome P450, this will result in decreased serum levels)
Nesiritide
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs?
Contraindications?
Class?
natriuretic peptide
Mechanism?
activates guanylate cyclase receptrs on peripheral VSM
Net effect?
increase cGMP -> smooth muscle relaxation, vasodilation, reduction in preload, afterload
Clinical Uses?
acute decompensated heart failure
Side effects?
hypotension, dizziness, nausea, cardiac arrhythmias
Similar drugs?
none
Contraindications?
patients with a systolic BP <90mmHg
Digoxin
Class?
Mechanism?
Net effect?
Clinical Uses?
Side effects?
Similar drugs? (1)
Contraindications?
Class?
cardiac glycoside, Class V anti-arrhythmic drug
Mechanism?
- block Na/K ATPase on cardiac myocyte
- increase parasympathetic outflow of SA/AV node
Net effect?
- increased intracellular Na -> decreased Na/Ca exchanger activity -> increased Ca -> increased contractility
- decrease HR
Clinical Uses?
Heart failure, atrial arrhythmias
Side effects? ECG changes (prolonged PR interval, decreased QT interval, ST segment scooping, T wave inversion), cardiac arrhythmias
Similar drugs?
ouabain
Contraindications?
pts with hypokalemia, renal failure, and quinidine (increases serum levels of digoxin)
Digoxin toxicity can be treated by stopping digoxin therapy or treating with an antibody aganist digoxin
