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M4: Pharmacology-Pharmacokinetics > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

1
Q

Which is Systole & Diastole

▪️Contraction:
▪️Relaxation:

A

▪️Contraction: Systole
▪️Relaxation: Diastole

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2
Q

What is the Factors for BP?

A

BP = CO x SVR

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3
Q

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

A

Cardiac Output

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4
Q

Volume of the blood pumped out by the heart per beat

A

Strong Volume

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5
Q

What is stated below

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

A

Preload

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6
Q

What is stated below

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

A

SVR: Systemic Vascular Resistance

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7
Q

Drugs: Antihypertensive

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

A

Diuretics

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8
Q

Classes of Diuretics [Na+ & H2O]

Under Na+: Natriuretics (4)

A

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

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9
Q

SOA (Site of Action) of the ff:

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

A
  1. Proximal convoluted Tubule (PCT)
  2. Thick Ascending Limb (TAL)
  3. DCT
  4. Collecting Duct
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10
Q

Classes of Diuretics (under Na+: Natriuretics)

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

A

Carbonic Anhydrase Inh. (CAIs)

  • mide
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11
Q

Sulfonamide associating T/E in

  1. Blood
  2. Skin
A
  1. Hemolytic anemia
  2. Stevens-Johnson syndrome (SJS)
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12
Q

CAIs

▪️Brand Name of Acetazolomide

A

Diamox

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13
Q

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)

A

CAIs

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14
Q

Tx for Catamenial Seizure

A

Acetazolomide [CAIs]

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15
Q

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)

A

Loop Diuretics

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16
Q

What is Metabolic-related T/E of Loop Diuretics

HYPER GLU?

A

HyperGlycemia
HyperLipidemia
HyperUracemia

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17
Q

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

A

Thiazide Diuretics

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18
Q

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)

A

Thiazide Diuretics

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19
Q

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

A

Diuretic Breaking Phenomenon

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20
Q

1st Line treatment for HTN

A

CCBs
ACEIs/ARBs
Thiazide

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21
Q

Tx for Polyuria

A

Thiazide -> urination

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22
Q

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
A

K-Sparing Diuretics

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23
Q

What is stated below (under Diuretics)

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

▪️Mgt. of ICP (Cerebral Edema)

A

Mannitol

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24
Q

What is stated below:

▪️plegia: Paralysis
▪️Sympathetic NS
▪️aka: sympatholytics

A

Sympathoplegics

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25
Q

What is under the ff:

Sympathoplegics

  1. Centrally-acting:
  2. Peripherally-acting:
  3. Ganglionic Blockers:
  4. Alpha Blockers:
  5. Beta Blockers:
A
  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
26
Q

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

A

Direct Arteriolar Vasodilators

27
Q

What is stated below:

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

A

Mixed-Acting (under Direct Vasodilators)

28
Q

2 Classes of CCBs

A
  1. Dihydropyridines (DHPs)
  2. Non-DHPs
29
Q

What class of CCBs are stated below:

▪️-dipine (Amlo-, Felo-)
▪️vasoselective (arteries) = vasodilators
▪️ intrinsically short-acting (except LAL)

A

Dihydropyridines (DHPs)

30
Q

What class of CCBs are stated below:

▪️cardioselective (❤️)
▪️Verapamil - most cardioselective
▪️Diltiazem - intermediate, balance effect (heart & arteries)
▪️Intrinsically short-acting

A

Non-DHPs

31
Q

What are the intrinsically long-acting CCBs

Mnemonics: LAL

A

Lercanidipine
Amlodipine
Lacidipine

  • adverse effect not associated with Reflex Tachycardia and Peripheral Edema
32
Q

What is the modified long acting CCB drug?

A

Felodipine XR

  • not associated: RT, PE
33
Q

What class of Drugs is stated below:

▪️1st line: HTN (DHPs)
▪️Tx. Angina Pectoris (DHP, Non-DHPs)
▪️Mgt. Arrhythmia (Non-DHPs: Class IV)

A

Calcium Channel Blocker (CCBs)

34
Q

What class of Drugs is stated below:

▪️Target RAAS Pathway
-RAAS: Renin Angiotensin Aldosterone System
▪️Triggers=Renin Secretion

A

Angiotensin Antagonist

35
Q

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

A
  1. (-) synthesis of ANG-II
  2. (-) action of ANG-II
36
Q

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: ↑

A

(-) synthesis of ANG-II

37
Q

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.

A

(-) action of ANG-II

38
Q

What type of Angina Pectoris is stated below:

▪️↑ O2 demand
▪️precipitated by physical exertion/emotional stress

A

Effort/Classic Angina

39
Q

What type of Angina Pectoris is stated below:

▪️↓ O2 supply
▪️CA Vasospasm

A

Prinzmetal/Variant/Vasospastic Angina

40
Q

Classes (3) Antianginals

A
  1. Nitrovasodilators
  2. B-blockers
  3. CCBs
41
Q

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

A

Nitrovasodilators

42
Q

What Effects/Dose-dependent Nitrovasodilators stated below:

▪️venodilation
▪️= ↓workload =↓stress =↓ O2 demand
▪️For Effort Angina

A

Low Dose (SL)

43
Q

What Effects/Dose-dependent Nitrovasodilators stated below:

▪️arteriolar, vasodilation
▪️CA vasodilation=↑O2 supply
▪️For Prinzmetal

A

High Dose (IV)

44
Q

What do we called in tolerance throughout therapy

A

Monday Disease

45
Q

What Class of Antianginals stated below:

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

A

Beta Blockers

46
Q

Class of Antianginals (under CCBs)

What class of CCBs is stated below:

  • ↓O2 demand: Alt. Effort Angina
A

Non-DHPs (Verapamil, Diltiazem)

47
Q

Class of Antianginals (under CCBs)

What class of CCBs is stated below:

  • O2 supply: For Prinzmetal =monotherapy
A

Long-acting DHPs (LAL)

48
Q

Class of Antianginals (under CCBs)

What class of CCBs is stated below:

▪️For Prinzmetal
▪️combined w/ B-blockers
▪️modified release prep.

A

Short-acting DHPs

49
Q

What type of Drugs for HF is stated below:

To increase the force of myocardial contraction

A

Inotropic agents

50
Q

What type of Drugs for HF is stated below:

To decrease cardiac wordload

A

Unloader Meds.

51
Q

Inotropic Agents (3)

A
  1. Cardiac Glycosides
  2. B1 Agonist
  3. Dipyridines / PDE-3 Inh.
52
Q

Drugs for HF (under Cardiac Glycosides)

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

A

Digoxin
Digitoxin-withrawn

53
Q

Specific antidotes for Digoxin:

Digoxin-binding antibodies

A

Digibind
Digifab

54
Q

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
A
  1. B1 Agonist
  2. Dipyridines / PDE-3 Inh.
55
Q

What are the Unloader Medications

ADVaB

A
  1. ACEIs/ARBs
  2. Diuretics
  3. Vasodilators
  4. B-blockers
56
Q

What class of Drugs in HF is stated below:

▪️1st line: Heart Failure
▪️↓ afterload /or preload
▪️given in combination always
▪️aka. AntiHTNsive

A

Unloader Medications

57
Q

What type of unloaders is stated below:

▪️Base tx components
▪️Target RAAS
▪️↓ BV = ↓ preload
▪️↓SVR = ↓ afterload

A

ACEIs/ARBs

58
Q

This drug is given for

▪️Vasodilators
- Hydralazine + ISDN
= (↓ afterload) (low dose: ↓ preload)

A

For African-American px.

59
Q

Vasodilators
- Ex: -senan -> Bosentan, Tezosentan

A

Endothelin Antagonists

60
Q

Drugs for Arrhythmia

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

A
  1. Class I
  2. Class II
  3. Class III
  4. Class IV
61
Q

1st line: Digoxin Induced Vtach

A

Lidocaine

62
Q

1st line: Torsades de Pointes

A

MgSO4

M4: Pharmacology-Pharmacokinetics (50 decks)

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