Cardiovascular drugs Flashcards
thiazides, ACE inhibitors, AngII receptor blockers, dihydropyridine CCB
tx for primary/essential HTN
diuretics, ACE inhib, ARBs, beta blockers, aldosterone antagon
tx for HTN with HF
beta blockers for compensated HF
ACE inhib/ARBs, CCB, thiazides, beta blockers
tx for HTN + DM (protect against diabetic nephropathy)
hydralazine, labetalol, methyldopa, nifedipine
tx for HTN in pregnancy (no ACE-I or ARBs!!)
amlodipine, clevidipine, nicardipine, nifedipine, nimodipine
dihydropyridine CCB- act on vascular smooth m.
diltiazem, verapamil
non dihydropyridine CCB- act on heart smooth m.
CCB used to tx HTN, angina (Prinzmetal’s), Raynaud phenomenon
dihydropyridines (act on vasculature) EXCEPT for nimodipine
CCB used to prevent cerebral vasospasm in SAH
nimodipine
CCB used for HTN urgency or emergency
clevidipine
CCB used to tx HTN, angina, a-fib or atrial flutter
non dihydropyridines
increases cGMP to relax smooth m.
vasodilates arterioles > veins (reduces afterload)
used to tx severe HTN (acute), HF, safe for pregnancy
give w/ beta blocker to block reflex tachy
hydralazine
these drugs are used as tx regimen for…
clevidipine, fenoldopam, labetalol, nicardipine, nitroprusside
HTN emergency
short acting increase in cGMP via direct release of NO
may cause cyanide toxicity
used during HTN emergency
Nitroprusside
D1 agonist causing coronary, peripheral, renal, splanchnic vasodilation - lowers BP, increases natriuresis
used during HTN emergency
fenoldopam
vasodilate by increasing NO in vasc smooth m - increases cGMP & smooth m. relaxation
dilates veins»arteries, lowers preload
used to tx angina, acute coronary syndrome, pulm edema
nitrates: nitroglycerin, isosorbide dinitrate, isosorbide mononitrate
partial beta agonists contraindicated in angina d/t partial increase in HR
pindolol & acebutolol
inhib conversion of HMG CoA to mevalonate (cholest precursor), lowers mortality in CAD pt
lowers LDL***, raises HDL, lowers TG’s
best agents for reducing LDL levels
HMG CoA reductase inhibitors: lovastatin, pravastatin, simvastatin, atorvastatin, rosuvastatin
prevent intestinal reabsorp of bile acids - liver must then use cholest to make more bile acids
lowers LDL, slightly raises HDL, slightly raises TGs
bile acid resins: cholestyramine, colestipol, colesevelam
prevents cholest absorption at sm int brush border
lowers LDL
ezetimibe
upregulate LPL - increased TG clearance
activates PPAR alpha to induce HDL synthesis
lowers LDL, raises HDL, lowers TGs**
the only significant tx to lower TGs
fibrates: gemfibrozil, clofibrate, bezafibrate, fenofibrate
inhib lipolysis via hormone sensitive lipase in adipose tissue, reduces hepatic VLDL synthesis
lowers LDL, raises HDL***, lowers TGs
niacin (B3)
direct inhibition of Na/K ATPase - indirect inhib of Na/Ca exchanger - increased intracell Ca - pos inotropy
stimulates vagus n to lower HR
use: to increase contractil for HF, decreases AV & SA conduction for a-fib
digoxin (cardiac glycoside)
quinidine, procainamide, disopyramide
class IA anti arrhythmics- Na channel blockers
slow/block conduction - slows phase 0 depol, selective to tissue that is frequently depolarized (tachy)
increases AP duration, increases ERF in vent AP, increases QT interval
class IA anti arrhythmics MOA
tx for atrial & ventricular arrhythmias esp re-entrant & ectopic SVT & VT
class IA anti arrhythmics
lidocaine, mexiletine
class IB anti arrhythmics- Na channel blockers
slow/block conduction via slowing phase 0 depol
decreases AP duration, preferential to ischemic or depol Purkinje & ventricular tissue
class IB anti arrhythmics MOA
tx for acute ventricular arrhythmias esp post MI, digitalis induced arrhythmias
class IB anti arrhythmics
flecainide, propafenone
class IC anti arrhythmics- Na channel blockers
slow/block conduction via slower phase 0 depol, selective to tachycardic tissue
prolongs ERP in AV node & accessory bypass tracts
no effect on ERP in purkinje or vent tissues, minimal effect on AP duration
class IC anti arrhythmics MOA
tx for SVTs including a-fib
only as last resort in refractory VT
class IC anti arrhythmics
metoprolol, propanolol, esmolol, atenolol, timolol, carvedilol
class II anti arrhythmics- beta blockers
decrease SA & AV nodal activity by decreasing cAMP & Ca currents, suppress abnormal pacemakers by decr slope of phase 4 (resting potential)
AV node esp sensitive- increased PR interval
class II anti arrhythmic beta blockers MOA
tx for SVT, vent rate control for a-fib & a-flutter
class II anti arrhythmic beta blockers
amiodarone, ibutilide, dofetilide, sotalol
class III anti arrhythmics- K channel blockers
increase AP duration, increase ERP, increase QT
class III anti arrhythmic MOA
tx for a-fib, a-flutter, vent tachy
class III anti arrhythmic amiodarone & sotalol for VT
verapamil, diltiazem
class IV anti arrhythmics- CCB
decrease conduction velocity, increase ERP, increase PR
class IV anti arrhythmics MOA
used to prevent nodal arrhythmias (SVT), control rate in a-fib
class IV anti arrhythmics
increases K exit of cells - hyperpolarizes cell & decreases conduction of Ca
drug of choice to diagnose/abolish SVT
very short acting (15sec)
SE: sense of impending doom
adenosine
effective for torsades de pointe & digoxin toxicity
Mg2+
