Cardiovascular Drugs Flashcards
Which is Systole & Diastole
▪️Contraction:
▪️Relaxation:
▪️Contraction: Systole
▪️Relaxation: Diastole
What is the Factors for BP?
BP = CO x SVR
Volume of the blood pump out by the heart per minute [vol/min]
Cardiac Output
Volume of the blood pumped out by the heart per beat
Strong Volume
What is stated below
▪️aka: Venous Return, End Diastolic Vol.
▪️ volume of the blood received by the heart at the end of relaxation
Preload
What is stated below
▪️aka: Afterload
▪️ pressure required for the blood to be ejected by the heart
SVR: Systemic Vascular Resistance
Drugs: Antihypertensive
▪️↑urinary excretion of Na+ & H2O
▪️Concept:
↑Na, H2O (urine) =↓Na+,H2O (blood)
↓ blood volume
↓ BP
Diuretics
Classes of Diuretics [Na+ & H2O]
Under Na+: Natriuretics (4)
1.CAIs
2. Loop
3. Thiazides
4. K-Sparing
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
Classes of Diuretics (under Na+: Natriuretics)
▪️sulfonamide-like cmpds
▪️Acetazolomide, Dorzolamide, Brinzolamide, Dichlorpenamide
Carbonic Anhydrase Inh. (CAIs)
- mide
Sulfonamide associating T/E in
- Blood
- Skin
- Hemolytic anemia
- Stevens-Johnson syndrome (SJS)
CAIs
▪️Brand Name of Acetazolomide
Diamox
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
Tx for Catamenial Seizure
Acetazolomide [CAIs]
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
What is Metabolic-related T/E of Loop Diuretics
HYPER GLU?
HyperGlycemia
HyperLipidemia
HyperUracemia
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
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
If Thiazide Diuretics take beyond >2 weeks what will happen?
Diuretic Breaking Phenomenon
1st Line treatment for HTN
CCBs
ACEIs/ARBs
Thiazide
Tx for Polyuria
Thiazide -> urination
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
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
What is stated below:
▪️plegia: Paralysis
▪️Sympathetic NS
▪️aka: sympatholytics
Sympathoplegics
What is under the ff:
Sympathoplegics
- Centrally-acting:
- Peripherally-acting:
- Ganglionic Blockers:
- Alpha Blockers:
- Beta Blockers:
- Centrally-acting: alpha 2 agonist (MCGG) (MHLN)
- Peripherally-acting: Adrenal Neuronal Blockers
- Ganglionic Blockers: obsolete: Hexamethonium, Trimethaphan, Mecamylamine
- Alpha Blockers: alpha 1 selective (-zosin)- vasodilation
- 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
- Dihydropyridines (DHPs)
- 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:
- (-) synthesis of ANG-II
- (-) 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
- Nitrovasodilators
- B-blockers
- 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)
- Cardiac Glycosides
- B1 Agonist
- 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:
- Dobutamine, Dopamine - mgt. of acute HF: exacerbation of congestive HF
- Inamrinone, Milrinone
- B1 Agonist
- Dipyridines / PDE-3 Inh.
What are the Unloader Medications
ADVaB
- ACEIs/ARBs
- Diuretics
- Vasodilators
- 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
- Class I
- Class II
- Class III
- Class IV
1st line: Digoxin Induced Vtach
Lidocaine
1st line: Torsades de Pointes
MgSO4