Cardiovascular agents Flashcards
amiodarone
Brand - Cordarone
Class - Antiarrhythmic
Indication - Atrial fibrillation, Supraventricular arrhythmia, Maintenance of sinus rhythm
Pregnancy: Risk
Contraindication - Severe bradycardia, severe sinus node dysfunction, 2nd- or 3rd-degree AV block, and cardiogenic shock
Black Box - Arrhythmias, hepatotoxicity, proarrhythmic effects, pulmonary toxicity
Counseling - Ensure adequate hydration. Seek medical attention if decreased urination, unusual bruising or bleeding, blistering skin rash, or shortness of breath.
Counseling - use sunscreen, avoid UV, avoid grapefruit juice, report signs or symptoms of cardiac arrhythmias, pulmonary toxicity, or liver toxicity. Multiple drug interactions so inform providers about all medications you are taking; dispense medication guide
MoA - Type III antiarrhythmic that prolongs the effective refractory period of atrial and ventricular tissue by blocking potassium conductance
amlodipine
Brand - Norvasc
Class - Ca2+ channel blocker, antiHTN
Indications - HTN, Stable/variant
MoA: long-acting dihydropyridine calcium-channel bloacking drug with potent arterial and coronary vasodilating properties
Pregnancy - mod risk
Counseling points: Report signs of hypotension or exacerbation of angina w/ initial dosing and dose changes; signs of peripheral edema, fatigue, hypotension, or hepatic dysfunction; avoid alcohol. May cause dizziness, Avoid activities that could be dangerous if dizziness occurs at initiation of therapy. Dizziness may be worse if too much water is lost from the body.
apixaban
Brand - Eliquis
Class - Factor Xa Inhibitor
Indication - Atrial fibrilation, Hip or knee replacement surgery, DVT or PE
Contraindication - Active bleeding
Black Box - Premature discontinuation increases risk of thrombotic events, increased risk of spinal hematoma with spinal puncture or neuraxial anesthesia
Counseling - Seek medical attention if any unexpected bleeding or trouble bleeding, avoid NSAIDS since they increase bleed risk, do not stop taking apixaban without talking to your HCP, stopping early may increase the risk of stroke, especially in patients with atrial fibrilation. Apixaban should be interrupted 24-48 hours in prior to dental and surgical procedures and re-started after homeostasis
MoA - Selective inhibitor of factor Xa, decreases thrombin generation and thrombus development.
atenolol
Brand - Tenormin
Class - Beta-blocker, antihypertensive
Indication - Angina (chronic), HTN, AMI
Pregnancy - Risk
Contraindications: sinus bradycardia, 2nd-/3rd-degree AV block, overt heart failure or cardiogenic shock
Black Box - Avoid abrupt withdrawal
Counseling points: Tk on an empty stomach. Avoid abrupt discontinuation. Report signs/symptoms of bradycardia, hypotension, heart failure, or exacerbation of angina with initial dosing and dose changes. May cause dizziness/drowsiness. Diabetic patients to carefully follow blood sugar levels as β-blockers may mask symptoms of hypoglycemia. Drug may cause sexual side effects, fatigue, and depression.
MoA: cardio selective beta-adrenergic that decreases AV nodal conduction in supra-ventricular tachycardias and blockade of catecholamine-induced dysrhythmias
atorvastatin
Brand - Lipitor
Class - HMG-CoA Reductace Inhibitor
Indication - Hyperlipidemia, Primary and secondary prevention of atherosclerotic cardiovascular disease, Secondary prevention of cardiovascular events in patients with or at high risk for CAD, Familial hypercholesterolemia (homozygous)
Contraindications - Use in breastfeeding, active liver disease, unexplained persistent elevations of serum transaminases
Pregnancy - Contraindicated
Counseling -Avoid excessive alcohol, grapefruit, and grapefruit juice (>1 L/d), does not take the place of lifestyle changes to lower cholesterol levels. Notify prescriber if unexplained muscle tenderness or weakness occurs.
MoA -HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis. A compensatory increase in LDL receptors, which bind and remove circulating LDL-cholesterol, results.
carvedilol
Brand name: Coreg (CR)
Class: Alpha/Beta blocker, antihypertensive
Indications - Heart failure with reduced ejection fraction, HTN, Impaired ventricular function post-MI
MoA: selective alpha1 and nonselective beta-adrenergic blocker that can decrease AV nodal conduction in supra-ventricular tachycardias and blockade of catecholamine-induced dysrhythmia.
Pregnancy - Risk
Contraindications: bronchial asthma, severe sinus bradycardia, 2nd- / 3rd-degree AV block, sick sinus syndrome, overt heart failure, cardiogenic shock, severe hepatic impairment
Counseling points - Tk w/ food. Report signs of heart failure, bradyarrhythmias, bronchospasm, hypotension, syncope, or exacerbation of angina with initial dosing and dose changes. Avoid abrupt discontinuation, may cause rebound HTN. Avoid driving. Diabetic patients should carefully follow blood sugar levels as beta-blockers may mask symptoms of hypoglycemia.
benazepril
Brand - Lotensin
Class - Ace inhibitor, antihypertensive
Indication: HTN
MoA: Competitive ACE-I, also reduces serum aldosterone, leading to decreased Na+ retention, potentiates the vasodilator kallikrein–kinin system, and can alter prostanoid metabolism, inhibit the sympathetic nervous system, and inhibit the tissue renin-angiotensin system.
Pregnancy - Toxic
Contraindications: history of angioedema; anuria; concomitant use with aliskiren (in diabetes) or sacubitril
Counseling points: Avoid pregnancy. Seek medical attention immediately if you experience any facial swelling. Most common adverse effect is dry cough. Use potassium supplements or salt substitutes only under medical supervision. May cause dizziness that may worsen if dehydrated. Take at the same time daily.
chlorthalidone
Brand - Hygroton, Thalitone
Class - Diuretic/“Water pill”
Indication(s): HTN, Edema
MoA: increases Na+ and Cl- excretion by interfering with their reabsorption in the cortical-diluting segment of the nephron.
Contraindications: anuria
Counseling points: Tk in the morning w/ food. Instruct patient to report signs of dyspnea, hypotension, gout, or heart failure. Avoid alcohol (may cause hypotension) and NSAIDs (may decrease effectiveness). This medicine may cause dizziness or blurred vision. Avoid driving
clonidine
Brand - Catapres, Kapvay
Class - Alpha-blocker
Indications - ADHD, HTN
Pregnancy - Risk
Black Box: Epidural Use
Counseling points: Avoid alcohol, CNS depressants. Use caution with driving. May cause nausea, vomiting, insomnia, constipation, fatigue, or dry mouth. Apply patch to hairless area of intact skin on upper outer arm or chest; rotate patch location. If patch loosens during the 7-d wearing, secure adhesive cover. Report signs/symptoms of hypotension, exacerbation of angina peripheral edema, fatigue, hypotension, or hepatic dysfunction with initial dosing and dose changes. Avoid abrupt discontinuation to avoid rebound HTN.
MoA: Clonidine simulates presynaptic alpha2-adrenergic receptors and blocks postsynaptic alpha2-adrenergic receptors in the CNS by activating inhibitory neurons to decrease sympathetic outflow. Clonidine is not a complete agonist, so some of its effects might result from antagonist actions at presynaptic alpha-receptors. These actions reduce peripheral vascular resistance, renal vascular resistance, HR, and BP.
clopidogrel
Brand - Plavix
Class - Platelet Aggregation Inhibitor
Indications - Acute ST segment elevation MI managed medically and non-ST segment elevation MI, Thrombosis prevention in arteriosclerotic vascular disease, following stroke, in peripheral arterial occlusive disease
Contraindication -active bleeding
Black Box: Reduced CYP2C19 function
Counseling Points: Report signs of bleeding, Do not stop therapy abruptly without first talking with prescriber
MoA: Clopidogrel is an antiplatelet agent that prevents platelet aggregation by direct inhibition of ADP binding to receptor sites, inhibiting subsequent activation of the glycoprotein IIb/IIIa complex (irreversible)
digoxin
Brand - Digitek, Digox
Class - Digitalis Glycoside
Indication - Atrial fibrillation, heart failure, Supraventricular tachyarrhythmia
Contraindications - ventricular fibrillation
Counseling -Tk after morning meals (and after evening meals if giving in divided doses). Report signs of bradycardia. Do not discontinue drug suddenly.
MoA - Digitalis glycosides exert positive inotropic effects through improved availability of calcium to myocardial contractile elements, thereby increasing cardiac output in heart failure. Antiarrhythmic actions are caused primarily by an increase in AV nodal refractory period via increased vagal tone, sympathetic withdrawal, and direct mechanisms.
diltiazem
Brand - Cardizem, Cartia XT
Class - Calcium Channel Blocker
Indication - HTN, Stable, chronic angina, Atrial arrhythmia and paroxysmal supraventricular tachycardia
Contraindication - hypotension, 2nd- or 3rd-degree AV block, sick sinus syndrome
Counseling - Report symptomatic hypotension, bradyarrhythmia, peripheral edema, or syncope. This drug is available in multiple brand names with varying properties by brand. Instruct patient to follow administration instructions specific to the prescribed brand with regards to meals and timing. Do not drink alcohol. Administer at same time of day, either morning or evening.
MoA - Calcium-channel-blocking drug that decreases HR, prolongs AV nodal conduction, and decreases arteriolar and coronary vascular tone. It also has negative inotropic properties.
doxazosin
Brand - Cardura (XL)
Class - Alpha1-adrenergic blocker
Indication - Benign prostatic hyperplasia, HTN
Pregnancy - Mod risk
Counseling - Initial dose should be taken with breakfast, particularly with sustained-release products may cause vertigo/dizziness, rise slowly from sitting/lying, may cause syncope in first dose, Report priapism to HCP immediately
MoA - Selectively block postsynaptic alpha1, reduces peripheral resistance through dilation; increase urine flow in BPH by relaxing smooth muscle tone in the bladder neck and prostate
enalapril
Brand - Vasotec
Class - ACE-I
Indications - Heart failure, HTN, Kidney disease (nondiabetic)
Pregnancy - Contraindicated
Contraindications: history of angioedema, concurrent sacubitril
Counseling points: Use K+ supplements only under medical supervision. Report signs of angioedema. May cause dizziness that may worsen if dehydrated. Use caution rising from sitting or lying position, especially when initiating treatment.
MoA: prodrug that is rapidly converted to its active metabolite, enalaprilat, a competitive ACEI. It reduces serum aldosterone, leading to decreased sodium retention, potentiates the vasodilator kallikrein–kinin system, and inhibits the sympathetic nervous system and tissue renin-angiotensin system. The net effect is reduction in total peripheral resistance and BP in hypertensive patients and reduction in elevated afterload in patients with heart failure.
ezetimibe
Brand - Zetia
Class - Antihyperlipidemic, Cholesterol Absorption Inhibitor
Indications - Familial hypercholesterolemia-homozygous, (w/ statin), Mixed hyperlipidemia, Primary hypercholesterolemia
Pregnancy - Unknown, contraindicated in breastfeeding
Contraindications: gallbladder disease, severe hepatic dysfunction
Counseling points: Tk w/ or w/o food and may be taken at the same time as a concurrent statin. In patients receiving a bile acid sequestrant concurrently, ezetimibe should be taken at least 2 h before or 4 h after the bile acid sequestrant is taken.
MoA - Ezetimibe localizes at the brush border of the small intestine and inhibits the absorption of cholesterol, leading to a decrease in the delivery of intestinal cholesterol to the liver. This causes a reduction of hepatic cholesterol stores and an increase in clearance of cholesterol from the blood; this distinct mechanism is complementary to that of statins and of fenofibrate.
fenofibrate
Brand - Antara
Class - Antihyperlipidemic
Indications -Hypercholesterolemia, Hypertriglyceridemia
Pregnancy - limited data
Contraindications - gallbladder disease, severe renal or hepatic dysfunction, nursing mothers
Counseling points: Fenoglide tablets and Lipofen R capsules should be given with food; others can be taken without food. Take 1 h before or 4-6 h after a bile acid binding resin. Products are not interchangeable.
MoA - Fibric acid derivatives activate peroxisome proliferator-activated receptor α (PPARα), which increases lipolysis and elimination of triglyceride-rich particles from plasma by activating lipoprotein lipase and reducing production of apoprotein C-III (an inhibitor of lipoprotein lipase activity). The resulting fall in triglycerides produces an alteration in the size and composition of LDL from small, dense particles to large buoyant particles. These larger particles have a greater affinity for cholesterol receptors and are catabolized rapidly.
furosemide
Brand - Lasix
Class - Diuretic/”Waterpill”
Indications - Edema related to heart failure, renal failure, HTN
Pregnancy Category: Human data suggests low risk for pregnancy. Limited human data (prob compatible) for breastfeeding
Contraindications - anuria
Black Box - Fluid and electrolyte loss
Counseling points: Avoid alcohol, NSAIDs, and UV (wear sunscreen). Report signs of hypotension, decreased urine output, or ototoxicity; severe skin reactions. Eat high-potassium foods, as directed by HCP. Realize drug effects (dizziness/vision) before driving.
MoA -Loop diuretic that is actively secreted via the nonspecific organic acid transport system into the lumen of the thick ascending limb of Henle’s loop, where it decreases sodium reabsorption by competing for the chloride sites on the Na+ -K+ -2Cl- cotransporter
gemfibrozil
Brand - Lopid
Class - Antihyperlipidemic, Fibric Acid
Indication - Coronary arteriosclerosis; prophylaxis, Familial type V hyperlipoproteinemia-Fredrickson type IV hyperlipoproteinemia
Contraindications - concurrent repaglinide or simvastatin, gallbladder disease, severe renal or hepatic dysfunction
Pregnancy - Risk
Counseling - Take 30 min before breakfast and dinner. Instruct patient to report signs/symptoms of rhabdomyolysis, jaundice (yellowing of skin or eyes), or renal failure
MoA - Fibric acid derivatives activate PPAR-α, which increases lipolysis and elimination of triglyceride-rich particles from plasma by activating lipoprotein lipase and reducing production of apoprotein C-III (an inhibitor of lipoprotein lipase activity). Activation of PPAR-α also induces an increase in the synthesis of apoproteins A-I and A-II and HDL-cholesterol.
hydralazine
Brand - Apresoline
Class - Peripheral Vasodilator
Indication - HTN
Pregnancy - Risk
Contraindications - dissecting aortic aneurysm; coronary artery disease; mitral valve rheumatic heart disease
Counseling points: Avoid alcohol, sudden discontinuation of drug; may cause dizziness. Report chest pain, palpitations, signs of tachyarrhythmia, hypotension, agranulocytosis, systemic lupus erythematosus, or hepatotoxicity.
MoA- Hydralazine is a vasodilator that reduces total peripheral resistance by direct action on vascular smooth muscle, with an effect greater on arterioles than on veins.
hydrochlorothiazide
Class - Diuretic/”Waterpill”
Indications - Edema, HTN
Contraindications - concomitant to dofetilide therapy or anuric patients
Counseling points: tk w/ or w/o food. Tk early in the day to avoid nocturia, even if taken more than once/d (bid administration at 8 AM and 2 PM). May cause dizziness. Report signs of hypotension and eat high-K+ foods during therapy; avoid alcohol and NSAIDs.
MoA: Thiazides increase Na + and Cl-excretion by interfering with their reabsorption in the cortical diluting segment of the nephron.
