Sulfonamide associating T/E in 1. Blood 2. Skin

1. Hemolytic anemia 2. Stevens-Johnson syndrome (SJS)

Cardiovascular Drugs Flashcards by Mark Agustin

Which is Systole & Diastole

▪️Contraction:
▪️Relaxation:

▪️Contraction: Systole
▪️Relaxation: Diastole

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What is the Factors for BP?

BP = CO x SVR

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Volume of the blood pump out by the heart per minute [vol/min]

Cardiac Output

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Volume of the blood pumped out by the heart per beat

Strong Volume

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What is stated below

▪️aka: Venous Return, End Diastolic Vol.
▪️ volume of the blood received by the heart at the end of relaxation

Preload

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What is stated below

▪️aka: Afterload
▪️ pressure required for the blood to be ejected by the heart

SVR: Systemic Vascular Resistance

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Drugs: Antihypertensive

▪️↑urinary excretion of Na+ & H2O
▪️Concept:
↑Na, H2O (urine) =↓Na+,H2O (blood)
↓ blood volume
↓ BP

Diuretics

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Classes of Diuretics [Na+ & H2O]

Under Na+: Natriuretics (4)

1.CAIs
2. Loop
3. Thiazides
4. K-Sparing

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SOA (Site of Action) of the ff:

1.CAIs
2. Loop
3. Thiazides
4. K-Sparing

Proximal convoluted Tubule (PCT)
Thick Ascending Limb (TAL)
DCT
Collecting Duct

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Classes of Diuretics (under Na+: Natriuretics)

▪️sulfonamide-like cmpds
▪️Acetazolomide, Dorzolamide, Brinzolamide, Dichlorpenamide

Carbonic Anhydrase Inh. (CAIs)

mide

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Sulfonamide associating T/E in

Blood
Skin

Hemolytic anemia
Stevens-Johnson syndrome (SJS)

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CAIs

▪️Brand Name of Acetazolomide

Diamox

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What is stated below:

▪️1st Line: Open-Angle Glaucoma
▪️Urinary Alkalizer - to make the urine basic
▪️Metabolic alkalosis - clinical effect/use
▪️Acute mountain sickness (swollen head)

CAIs

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Tx for Catamenial Seizure

Acetazolomide [CAIs]

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What Class of Diuretics under (Na+) is stated below:

▪️Aka: High-ceiling Diuretics (↑dose=↑effect)
▪️Ex: Sulfonamides (Furosemide & Bumetanide), Sulfonylurea (Torsemide), Phenoxyacetate (Ethacrynic Acid)
▪️MOA: Natriuretics-in Thick Ascending Limb (LDH)

▪️1° action=Most effective in lowering conc. Na+, K+, Cl- in the blood

▪️Venodilation (veins) = ↓preload=↓BP-If px has HF and Mgt. of acute pulmonary edema (Furosemide)

Loop Diuretics

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What is Metabolic-related T/E of Loop Diuretics

HYPER GLU?

HyperGlycemia
HyperLipidemia
HyperUracemia

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What Class of Diuretics under (Na+) is stated below:

▪️sulfonamide-like cmpds
▪️True Thiazide: benzothiazides, hydrochlorothiazide, chlorothiazide
▪️Thiazide-like: Not Benzothiazides, same MOA (Indopamide, Chlorthalidone, Metolazone)
▪️MOA: Natriuretics-in the DCT
▪️Less effective than loop
▪️May deadline-within 2 weeks

Thiazide Diuretics

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What Class of Diuretics under (Na+) is stated below:

▪️Effects
- Natriuresis (within 2 weeks)
- Vasodilation (beyond 2 weeks)
- (+) enhance Ca2+ reabsoprtion- hypercalcemia
- (+) COX-2 = ↑PGE2

▪️Uses
-1st line: HTN
- Adjuncts: HF
- Nephrolithiasis (kidney stone)

Thiazide Diuretics

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If Thiazide Diuretics take beyond >2 weeks what will happen?

Diuretic Breaking Phenomenon

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1st Line treatment for HTN

CCBs
ACEIs/ARBs
Thiazide

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Tx for Polyuria

Thiazide -> urination

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What Class of Diuretics under (Na+) is stated below:

▪️Effects: (-) Na+ reabsorption, (-) K secretion: ↑K (blood), urine (hyperkalemia)
▪️Mechanism:
- Aldosterone Antagonism: Spironalactone, Eplerenone
- Epithelial Na+ Channel (ENaC) Inh.: Amiloride, Triamterene

Mgt. Diuretic-induced hypokalemia - Mgt. of Hyperaldosteronism
Spironolactone
• Diuretic of Choice: Hepatic Cirrhosis
• PCOS: antiandrogen=antiacne

K-Sparing Diuretics

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What is stated below (under Diuretics)

▪️Creates an osmotic gradient in the H2O permeable sites of the kidney tubule

▪️Mgt. of ICP (Cerebral Edema)

Mannitol

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What is stated below:

▪️plegia: Paralysis
▪️Sympathetic NS
▪️aka: sympatholytics

Sympathoplegics

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What is under the ff: Sympathoplegics 1. Centrally-acting: 2. Peripherally-acting: 3. Ganglionic Blockers: 4. Alpha Blockers: 5. Beta Blockers:

1. Centrally-acting: alpha 2 agonist (MCGG) (MHLN) 2. Peripherally-acting: Adrenal Neuronal Blockers 3. Ganglionic Blockers: obsolete: Hexamethonium, Trimethaphan, Mecamylamine 4. Alpha Blockers: alpha 1 selective (-zosin)- vasodilation 5. Beta Blockers: (-olol, -lol)-Bradycardia

What is stated below: ▪️can relax arteries only ▪️feedback T/E when given as Monotherapy: ->combination - Reflex tachycardia=Beta Blocker - Peripheral Edema=Diuretics|ACEIs| ARBs

Direct Arteriolar Vasodilators

What is stated below: ▪️target both arteries & veins ▪️Ex: Nitrovasodilators (angina) Na Nitroprusside-1st line for HTNsive emergency

Mixed-Acting (under Direct Vasodilators)

2 Classes of CCBs

1. Dihydropyridines (DHPs) 2. Non-DHPs

What class of CCBs are stated below: ▪️-dipine (Amlo-, Felo-) ▪️vasoselective (arteries) = vasodilators ▪️ intrinsically short-acting (except LAL)

Dihydropyridines (DHPs)

What class of CCBs are stated below: ▪️cardioselective (❤️) ▪️Verapamil - most cardioselective ▪️Diltiazem - intermediate, balance effect (heart & arteries) ▪️Intrinsically short-acting

Non-DHPs

What are the intrinsically long-acting CCBs Mnemonics: LAL

Lercanidipine Amlodipine Lacidipine - adverse effect not associated with Reflex Tachycardia and Peripheral Edema

What is the modified long acting CCB drug?

Felodipine XR - not associated: RT, PE

What class of Drugs is stated below: ▪️1st line: HTN (DHPs) ▪️Tx. Angina Pectoris (DHP, Non-DHPs) ▪️Mgt. Arrhythmia (Non-DHPs: Class IV)

Calcium Channel Blocker (CCBs)

What class of Drugs is stated below: ▪️Target RAAS Pathway -RAAS: Renin Angiotensin Aldosterone System ▪️Triggers=Renin Secretion

Angiotensin Antagonist

Drugs -> reduce BV, SVR, which has 2 classes and these are:

1. (-) synthesis of ANG-II 2. (-) action of ANG-II

What Class of Angiotensin Antagonists is stated below: ▪️inhibits the enzymes ▪️I. Renin Inhibitors = Aliskerin ▪️II. ACE Inh. = -pril (prodrugs except Captopril, Lisinopril, Enalapril (IV) ▪️Effects: ANG II: ↓, Bradykinin: ↑

(-) synthesis of ANG-II

What Class of Angiotensin Antagonists is stated below: ▪️target the receptors ▪️Ex. ARBs (Angiotensin II Receptor Blockers) -sartan, saralasin ▪️Uses: - 1st line: ACEIs - 2nd line: ARBs - 1st line: HTN - Base tx components in HF px.

(-) action of ANG-II

What type of Angina Pectoris is stated below: ▪️↑ O2 demand ▪️precipitated by physical exertion/emotional stress

Effort/Classic Angina

What type of Angina Pectoris is stated below: ▪️↓ O2 supply ▪️CA Vasospasm

Prinzmetal/Variant/Vasospastic Angina

Classes (3) Antianginals

1. Nitrovasodilators 2. B-blockers 3. CCBs

What Class of Antianginals stated below: ▪️Aka: organic nitrates ▪️Has 2 effects Dose-dependent 1. Low Dose 2. High Dose ▪️Uses: - Angina Pectoris - Alt. HTNsive emergency, Acute Pulmonary Edema - ISDN: Adjunct-HF- w/ Hydralazine ISDN-Isosorbide Dinitrate

Nitrovasodilators

What Effects/Dose-dependent Nitrovasodilators stated below: ▪️venodilation ▪️= ↓workload =↓stress =↓ O2 demand ▪️For Effort Angina

Low Dose (SL)

What Effects/Dose-dependent Nitrovasodilators stated below: ▪️arteriolar, vasodilation ▪️CA vasodilation=↑O2 supply ▪️For Prinzmetal

High Dose (IV)

What do we called in tolerance throughout therapy

Monday Disease

What Class of Antianginals stated below: ▪️(-) B1: ↓ O2 demand ▪️1st line: For Effort Angina ▪️combined w/ high dose Nitrates (prevents Reflex tachycardia)

Beta Blockers

Class of Antianginals (under CCBs) What class of CCBs is stated below: - ↓O2 demand: Alt. Effort Angina

Non-DHPs (Verapamil, Diltiazem)

Class of Antianginals (under CCBs) What class of CCBs is stated below: - O2 supply: For Prinzmetal =monotherapy

Long-acting DHPs (LAL)

Class of Antianginals (under CCBs) What class of CCBs is stated below: ▪️For Prinzmetal ▪️combined w/ B-blockers ▪️modified release prep.

Short-acting DHPs

What type of Drugs for HF is stated below: To increase the force of myocardial contraction

Inotropic agents

What type of Drugs for HF is stated below: To decrease cardiac wordload

Unloader Meds.

Inotropic Agents (3)

1. Cardiac Glycosides 2. B1 Agonist 3. Dipyridines / PDE-3 Inh.

Drugs for HF (under Cardiac Glycosides) ▪️Block NaKATP ▪️Use: Adjunct-HF, Mgt. Atrial Fibrillation ▪️Toxicology: - requires therapeutic drug monitoring (NTI) - Vtach

Digoxin Digitoxin-withrawn

Specific antidotes for Digoxin: Digoxin-binding antibodies

Digibind Digifab

What class of inotropic agents under Drugs for HF are the ff: 1. Dobutamine, Dopamine - mgt. of acute HF: exacerbation of congestive HF 2. Inamrinone, Milrinone

1. B1 Agonist 2. Dipyridines / PDE-3 Inh.

What are the Unloader Medications ADVaB

1. ACEIs/ARBs 2. Diuretics 3. Vasodilators 4. B-blockers

What class of Drugs in HF is stated below: ▪️1st line: Heart Failure ▪️↓ afterload /or preload ▪️given in combination always ▪️aka. AntiHTNsive

Unloader Medications

What type of unloaders is stated below: ▪️Base tx components ▪️Target RAAS ▪️↓ BV = ↓ preload ▪️↓SVR = ↓ afterload

ACEIs/ARBs

This drug is given for ▪️Vasodilators - Hydralazine + ISDN = (↓ afterload) (low dose: ↓ preload)

For African-American px.

Vasodilators - Ex: -senan -> Bosentan, Tezosentan

Endothelin Antagonists

Drugs for Arrhythmia What class belongs the ff: 1. Na+ Channel Blockers 2. B-blockers 3. K+ Channel Blockers 4. Ca2+ Channel Blockers

1. Class I 2. Class II 3. Class III 4. Class IV

1st line: Digoxin Induced Vtach

Lidocaine

1st line: Torsades de Pointes

MgSO4