Cardiovascular Drugs Flashcards
Inhibits Na/Cl transporter in DCT, increasing reabsorption
Drug for HPN, can decrease BP by 10-15 mmHg
SE: sulfa allergy
Hydrochlorothiazide
Chlorthalidone, Indapamide, Metolazone
Toxicities of HCTZ
Hyper GLUC HyperGLYCEMIA HyperLIPIDEMIA HyperURICEMIA HyperCALCEMIA
Identify Sulfa drugs:
Allergies to these drugs can cause fever, UTI, SJS, hemolytic anemia, thrombocytopenia, agranulocytosis, urticaria
Popular FACTSSS
Probenecid Furosemide Acetazolamide Celecoxib Thiazides Sulfonamide Sulfasalazine Sulfonylureas
Inhibits Na/K/2Cl transporter in TAL of Loop of henle
Causes powerful diuresis and increase Ca excretion
Drug for HPN, Pulmonary edema, Hypercalcemia, ARF
SE: Ototoxicity, Dehydration, Sulfa allergy
Furosemide
Bumetanide, Torsemide, Ethacrynic Acid
Ganglion blocker (nonselective)
Drug previously used for HPN (obsolete)
SE: postural hypotension
Hexamethonium
Nerve terminal blocker (NE, Dopa, Serotonin)
Drug previously used for HPN (obsolete)
Irreversible Vesicular Monoamine Transporter (VMAT) blocker
SE: rebound suicide
Reserpine
Guanethidine
Drugs for BP control in Pheochromocytoma
Phenoxybenzamine
Phentolamine
Labetalol
Carvedilol
Oral Vasodilator
Alters Ca2+ metabolism
Relaxes ARTERIOLAR smooth muscle, decreases Afterload
Drug for HPN, Pre-eclampsia
SE: reflex tachycardia, Drug induced Lupus
Hydralazine
Drugs that can cause lupus
Hydralazine
Isoniazid
Procainamide
Penicillamine
HIPP to have Lupus
Test with Anti-histone
Vasodilator
Opens K channels in Vascular smooth muscle, causing hyperpolarization, muscle relaxation and vasodilation (decreased afterload)
Drug for HPN and ALOPECIA
SE: Reflex tachycardia, Hypertrichosis
Minoxidil
Non-dihydropyridine CCB
blocks voltage gated L-type calcium channels (cardiac>vascular)
Drugs for SVT (in OPD), Arrhythmia
SE: GINGIVAL HYPERPLASIA, heart failure, AV Block, Sinus node depression
Verapamil
Non-dihydropyridine CCB
blocks voltage gated L-type calcium channels (cardiac>vascular)
Drugs for SVT (in OPD), Arrhythmia
SE: REYNAUD’S PHENOMENON, heart failure, AV Block, Sinus node depression
Diltiazem
Dihydropyridine CCB
blocks voltage gated L-type calcium channels (vascular>cardiac)
No cardiodepressant effects
Drugs for HPN, angina
SE: pre-tibial edema, flushing, gingival hyperplasia
Nifedipine
Amlodipine, Felodipine, Nicardipine, Nisoldipine, Israpidine
Vasodilator
Activates guanylyl cyclase, inc cGMP, NO release
Decreases both preload and afterload
Drug for Hypertensive emergency
SE: Cyanide toxicity (to Thiocyanate via Rhodanase)
Nitroprusside
Dopamine 1 agonist
Increases renal blood flow, by ARTERIOLAR vasodilation of afferent and efferent arterioles
Drug for hypertensive emergency
SE: Hypokalemia
Fenoldopam
ACE inhibitor
Inhibits ACE and formation of Angiotensin II
Decreases Aldosterone secretion
Drug for HPN, Heart failure, Post-MI, DM Nephropathy
SE: COUGH, Hyperkalemia, angioedema
Contraindicated in bilateral Renal Artery Stenosis
Captopril
Enalapril, Benazepril, Fosinopril, Lisinopril, Quinapril, Ramipril, Trandolapril
Slows ventricular remodeling and increases survival in heart failure
Delays progression of DM nephropathy (micro to macroalbuminuria)
RENOPROTECTIVE
ACE Inhibitors
ARBs
Drug class that is essential for Heart Failure
Diuretics
Drug class that is essential for MI
Beta blocker
Drug class that is essential for Diabetes
ACE Inhibitor
Or ARB?
Blocks Angiotensin I receptors in vascular smooth muscle and adrenal cortex, dec Aldosterone secretion
Drug for HPN, Heart failure, DM Nephropathy
SE: Teratogen, Hyperkalemia
Given in pxs with ACEi intolerance
Losartan
Candesartan, Valsartan, Irbesartan, Eprosartan, Telmisartan
Pathophysiology of hyperkalemia in ACE I and ARBs
Aldosterone inc K secretion, its inhibition leads to hyperkalemia
Renin antagonist
Prevents conversion of Angiotensinogen to Angiotensin I
Drug for HPN
Aliskiren
Severe hypertension with rapidly progressing end organ damage
Disease?
Malignant hypertension
Target BP for Malignant HPN
Lower BP to 140-160/90-110
Any BP lower than this may cause hypoperfusion of organs
Drugs for Malignant HPN
Vasodilators (Nitroprusside, Fenoldopam, or Diazoxide)
Diuretics
Beta blockers
Ultra short acting nitrate
NO release, inc cGMP
Drug for Cyanide poisoning
SE: Methemoglobinemia
Amyl Nitrite
Cyanide affects which portion of ETC?
Complex IV: Cytochrome Oxidase
Antidote for Cyanide Poisoning
Inhaled Amyl Nitrite
IV Sodium Nitrite
IV Sodium Thiosulfate
Disease caused by occupational exposure to nitrates
Monday Disease
Which does not bypass first pass effect?
Nitroglycerin
ISDN
ISMN
ISMN
Pathophysiology of throbbing headaches in pxs taking nitroglycerin
Menigeal artery vasodilation
Drugs that cause gingival hyperplasia
Verapamil
Cyclosporine (Calcineurin Inhibitor)
Nifedipine
Phenytoin
Very Chaka NgiPin
Cardiovascular drug that causes this paradoxic effect:
reflex increase in HR and contractility
Nitrates alone
Cardiovascular drug that causes this paradoxic effect:
increase in End Diastolic Pressure and Increase in Ejection Time
Beta blocker or CCB Alone
Cardiovascular drugs that causes this paradoxic effect:
decreases HR, Arterial Pressure, End Diastolic Pressure
Nitrate + Beta blocker OR CCB
Decreases ventricular remodeling (cardioprotective)
First line drugs for chronic heart failure
ARBs
ACEI
Drugs that reduce progression of Chronic Heart Failure
Beta Blockers
(Carvedilol, Labetalol, Metoprolol)
Not of value in Acute heart failure
Drugs that inc cAMP, inc intracellular Ca2+, vasodilation
Not for use in chronic failure as they increase morbidity and mortality
Phosphodiesterase inhibitors (Inamrinone, Milrinone)
Drug with no value in CHF
CCB
Drugs that improve survival in heart failure
ABA! Buhay ka pa!
ACE Inhibitors
Beta blockers
ARBs
Class_____ Antiarrhythmics:
Na channel blockers
1
Class_____ Antiarrhythmics:
Beta-adrenoreceptor blockers
2
Class_____ Antiarrhythmics:
K channel blockers
3
Class_____ Antiarrhythmics:
Ca channel blockers
4
Class I__ Antiarrhythmic:
Prolongs AP duration
A
Class I__ Antiarrhythmic:
Shortens AP duration
B
Class I__ Antiarrhythmic:
No effect on AP duration
C
Identify Class IA Antiarrhythmic drugs
QUIN PROtects DIS(o)PYRAMID
Quinidine
Procainamide
Disopyramide
Class IA antiarrhythmic
Drug for Atrial/ventricular arrhythmia esp post MI
SE: lupus-like syndrome
Procainamide
HIPP
Class IA Antiarrhythmic
SE: marked anti-muscarinic effects, heart failure
Disopyramide
Class IA Antiarrhythmic
Drug for malaria
SE: Torsades, Chinconism (headache, vertigo, tinnitus), Autoimmune rxns
Reduces Digoxin clearance
Quinidine
Triad of: Headache Vertigo Tinnitus Seen in pxs taking Quinidine
Cinchonism
Tx for class IA antiarrhythmic induced arrhythmia
Sodium Lactate
Most selective of ischemic tissues among class I antiarrhythmics Little effect on normal cardiac cells, little effect on ECG
IB
Class IB Antiarrhythmics
DOC for ventricular arrhythmia post MI and Digoxin induced arrhythmia
SE: Seizures, Agranulocytosis (in Tocainide)
Lidocaine
Melexitine, Tocainide, Phenytoin
Drugs that cause agranulocytosis
COCO CAPIT Pa! Cotrimoxazole Colchicine Clozapine Aminopyrine PTU Indomethacin Tocainide Phenylbutazone
Depressant of Na current Can slow conduction velocity in atrium and ventricle Drug for refractory arrhythmia SE: increased arrhythmia Contraindicated for Post MI
Flecainide
(Propafenone, Encainide, Moricizine)
C: PROject & FLECs (Flex), Every Morning
Which Class I antiarrhythmic?
All types of arrhythmia
Arrhythmia in acute MI
Procainamide and Amiodarone for WPW
Class IA
Which Class I antiarrhythmic?
Acute Ventricular arrhythmia, esp post MI
Digitalis-induced arrhythmia
Class IB
Which Class I antiarrhythmic?
Refractory Arrhythmia
Class IC
Identify which class of antiarrhythmic drugs: Prolonged PR interval Acts on Phase 4 Cardiac beta blockade Reduction in cAMp
Class II
Class II antiarrhythmic drug
Drug for post MI prophylaxis vs sudden death, thyrotoxicosis
SE: bronchospasm, AV block, Hypotension
Reduces progression of CHF and decrease incidence of potentially fatal arrhythmia
Propranolol
Metoprolol, Timolol
Class II antiarrhythmic
Selective beta 1 blocker
Drug for acute perioperative and thyrotoxic arrhythmia, SVT
SE: bronchospasm
Esmolol
Identify the Beta Blocker:
Nonselective
Propranolol
Timolol
Identify the Beta Blocker:
Beta1 selective
Acebutolol Betaxolol Esmolol Atenolol Metoprolol
A BEAM
Identify the Beta Blocker:
Partial agonist
Pindolol
Acebutolol
Identify the Beta Blocker:
Lacking local anesthetic effect
Timolol
Betaxolol
Identify the Beta Blocker:
Low lipid solubility
Atenolol
Identify the Beta Blocker:
Shortest acting
Esmolol
Identify the Beta Blocker:
Longest acting
Nadolol
Identify the Beta Blocker:
Combined alpha and beta blockade
Carvedilol
Labetalol
Identify which class of antiarrhythmic drugs: Acts on Phase 3 Increase Effective Refractory Period Increased QT interval Most TOXIC & EFFECTIVE
Class III
Identify Class III antiarrhythmic drugs
(D)AIDS Dronedarone Amiodarone Ibutilide Dofetilide Sotalol
Sx of Amiodarone Toxicity
PUtek PAre Tinik Talaga Sa Chicks Pulmonary fibrosis Paresthesia Thyroid dysfunction Tremors Skin deposits Corneal deposits
Identify which class of antiarrhythmic drugs: PR interval is consistently increased AV conduction velocity is decreased and effective refractory period increased Causes a state- and use-dependent selective depression of Calcium currents
Class IV
Why are dihydropiridine CCBs ineffective for arrhythmia?
They evoke compensatory sympathetic discharge which facilitates arrhythmia rather than terminate them
Identify antiarrhythmic drug and class:
Prolongs PR interval
Propranolol, Class II
Verapamil, Class IV
Identify antiarrhythmic drug and class:
Prolongs QT interval
Dofetilide, Class III
Identify antiarrhythmic drug and class:
Prolongs QRS duration
Flecainide, Class IC
Miscellaneous antiarrhythmic drug
Causes marked hyperpolarization and conduction block
Drug for AV nodal arrhythmia, DOC for Paroxysmal SVT
SE: flushing
Adenosine
____________ Ion: depresses ectopic pacemakers
Decrease can cause increased incidence of arrhythmia
Increase can depress conduction and cause reentry arrhythmia
Potassium
____________ Ion: possible MOA is increase in Na/K/ATPase activity
Effective in some cases of Torsades
Similar depressant effects as K on Digitalis-induced arrhythmia
Magnesium
Reduced clearance with quinidine
Arrhythmogenesis increased by HypoK, HypoMg, HyperCal
Digoxin
First line therapy for chronic heart failure
Loop diuretics
Spironolactone
Spironolactone + Eplerenone can reduce mortality in HF
First line drug for ACUTE heart failure
Furosemide
First line drugs for CHRONIC heart failure
ACEi
ARB
Drugs that improve survival in CHF
ACEi/ARB
Beta blocker
Spironolactone
Decreases hospitalizations in CHF
Digoxin
Improves survival in pxs of African-American descent
Hydralazine + ISDN
Drug of choice for arrythmia secondary to Digoxin
Lidocaine
Drugs with Narrow Therapeutic Index
WALA Cyang PaPa, Very Tragic Day Warfarin Aminoglycosides Lithium Amphotericin B Carbamazepine Phenytoin Phenobarbital Vancomycin Theophylline Digoxin
Cardiac glycoside
Inhibits Na/K ATPase, inc intracellular Ca, inc contractility
Drug for heart failure and arrhythmia
SE: Narrow therapeutic window, Arrhythmia, visual changes
Digoxin
Short acting nitrate with shortest onset of action
NO release, inc cGMP, relaxes smooth muscle (esp. Veins)
Drug for Angina, ACS
SE: Headache, Tolerance, reflex tachycardia, orthostatic hypotension
Nitroglycerin
Isosorbide dinitrate, Isosorbide mononitrate
Target BP in hypertensives with no comorbidities?
With DM?
With CKD?
No comorbidities: <125/75
