Cardiovascular Drugs

Question 1

Potassium Channel Blockade

Answer 1

Severe side effects, not typically used

Question 2

Glycosides (Digitalis)

Answer 2

Indicated for Congestive Heart Failure and Atrial Flutter
MOA: Positive inotropic effect from increased Ca2+ release within cardiac muscle
Negative chronotropic effect from calcium ions moving into the muscle and negative dromotropic effect from delaying electrical conduction
(Heart beats stronger and more slowly)
Contraindicated for recent MI, ventricular tachycardia, partial heart block, cardioversion, Ca2+ administration, K+ depletion and renal/hepatic disorders
Narrow therapeutic index and may cause GI distress, visual changes, weakness and irritability, and arrhythmias

Question 3

Quinidine

Answer 3

Indicated for atrial fibrillation, atrial flutter and ventricular tachycardia
MOA: Sodium channel blocker
Cardiac depressant, negative dromotropic effect, negative inotropic effect
Anticholinergic action at AV node prevents slowing from muscarinic agonists (but flutter may be transmitted to ventricles)
Contraindicated for AV block, cardiac failure, glaucoma, urinary retention, abnormal serum K+ levels
Can cause cinchoism, GI distress, tinnitus/decreased hearing, decreased visibility and headache

Question 4

Lidocaine

Answer 4

Indicated for ventricular arrhythmias or after MI
MOA: Sodium channel blocker
Decreases the refractory period of an action potential
No anticholinergic property, has less negative inotropic effect, cardiac output and blood pressure not as decreased

Question 5

Beta Blockers (Propanolol)

Answer 5

Indicated for atrial fibrillation, atrial flutter, pheochromocytoma-caused arrhythmia, hypertension, angina, and to counteract digitalis toxicity. Used for many kinds of dysrhythmias
MOA: Negative chronotropic effect, negative inotropic effect, negative dromotropic effect. Inhibits release of renin.
Contraindicated for asthma, AV block, and persons over 60
May cause GI upset, AV block, and constriction of bronchioles
Must be discontinued slowly, otherwise may cause rebound hypertension, angina, myocardial infarction, or sudden death

Question 6

Calcium Channel Blockers (Verapimil)

Answer 6

Indicated for hypertension, supraventricular tachycardia, angina (Especially used for African Americans with diuretics)
MOA: Ca2+ channel blocker
Negative inotropic effect, negative dromotropic effect, depresses automaticity, creates vasodilation
Contraindicated for congestive heart failure
May cause peripheral edema, dizziness, fatigue, GI upset
Generally considered relatively safe

Question 7

Adrenergic Agents and Anticholinergic Agents

Answer 7

Indicated for cardiac arrest, hypotensive crisis, bradycardia and AV block
MOA: Stimulates beta receptors for positive inotropic effects, positive dromotropic effects and positive chronotropic effect
Or blocks muscarinic slowing
Contraindicated for chronic use, congestive heart failure, angina and hpertension
May cause arrhythmias, headache, anxiety, and hypertension

Question 8

Nitroglycerine (Nitrates, Nitrites)

Answer 8

Indicated for angina
MOA: Forms nitric oxide and relaxes smooth muscle (lowers blood pressure to decrease workload and dilates coronary arteries to increase oxygen availability)
MUST BYPASS THE LIVER–> Administered sublingually, IV (surgery) or topically as an ointment or patch
Contraindicated for glaucoma, head trauma, cerebrovascular hemorrhage
May cause postural hypotension, headache, tachycardia, and GI upset
Must be stored away from light

Question 9

Alpha Blockers (Prazosin)

Answer 9

Indicated for hypertension
MOA: Inhibits epinephrine and norepinephrine from stimulating alpha receptors, thus inhibiting vasoconstriction
May cause postural hypotension, reflex tachycardia

Question 10

Ganglionic Blocker

Answer 10

Indicated for hypertension, but no longer recommended
MOA: Antinicotinic, inhibits sympathetic ganglia to decrease blood pressure by decreasing cardiac ourtput and vasoconstriction
Many side effects

Question 11

Central Nervous System Blockers

Answer 11

Indicated for hypertension
MOA: Unknown
May cause rebound hypertension upon withdrawal, so must be withdrawn slowly and doses must not be missed; sedation, dry mouth, and dizziness.

Question 12

Rauwolfia Alkaloids (Reserpine)

Answer 12

Indicated for hypertension, but not commonly used
MOA: Irreversibly binds to norepinephrine vesicles, depleting their availability in the brain and in the heart
Contraindicated for persons with depression, gastric ulcers, and pregnant women
May cause sedation/psychological depression, GI distress, and nasal congestion

Question 13

Monoamine Oxidase Inhibitors

Answer 13

Indicated for hypertension
MOA: Central nervous system monoamine oxidase is prevented from destroying norepinephrine, sympathetic nervous system initially sees an increase in norepinephrine, followed by a decrease as norepinephrine is replaced by tyrosine, which is usually also destroyed by an enzyme MAO inhibits
Contraindicated for interactions with some foods which increase norepinephrine, persons with depression, persons taking caffeine, alcohol, barbiturates, sedatives, and narcotics, and may cause renal failure
May cause hallucinations, convulsions, hypertension or hypotension, tremors, insomnia, nightmares, GI upset, postural hypotension, and decreased sexual function

Question 14

Direct Peripheral Vasodilators

Answer 14

Indicated for hypertension
MOA: Relaxation of arteriole vessels
Contraindicated for angina, coronary artery disease
May cause headache, nausea, anorexia, and reflex tachycardia due to decreased blood pressure

Question 15

Angiotensin Converting Enzyme (ACE) Inhibitors (Enalapril)

Answer 15

Indicated for hypertension, congestive heart failure, preventative of heart failure after MI, diabetic nephropathy
MOA: Inhibits the angiotensin converting enzymes to prevent vasoconstriction and thus less fluid retention
Contraindicated for pregnancy, hyperkalemia, and patients with depleted blood volume
May cause persistent cough, rash, proteinuria, headache, GI upset, bone marrow depression, and renal damage

Question 16

Angiotensin Receptor Antagonists

Answer 16

Indicated for hypertension
MOA: Prevents angiotensin 2 from from constricting smooth muscle and from stimulating the adrenal cortex
Contraindicated for African Americans
May cause rash, proteinuria, headache, and GI upset

Question 17

Aldosterone Receptor Antagonists

Answer 17

Indicated for hypertension and congestive heart failure
MOA: Blocks aldosterone in the epithelial kidney tissues and in the non-epithelial heart, blood vessels, and brain tissues.
Contraindicated for hyperkalemia and African Americans
May cause diarrhea, increases in liver enzymes and increase in kidney markers

Question 18

Diuretics

Answer 18

Indicated for hypertension
MOA: prevents hypervolemia by decreasing the amount of blood in tissues and increasing NA+ excretion so that water leaves the blood by osmosis, also relaxes smooth muscles
Contraindicated for diabetes, renal or liver disease, and arrhythmias
May cause potassium depletion (leading to arrhythmias) and may aggravate diabetes mellitus

Question 19

Antihypotensive Agents

Answer 19

Indicated for chronic and acute hypotension
MOA: Alpha agonists/pressor agents increase peripheral resistance, beta agonists increase cardiac output
Because these are usually only for hypotensive emergencies, side effects are not considered

Question 20

Antianemic/Hematopoietic Drugs

Answer 20

Indicated for anemia
MOA: Replace missing blood factors (iron, B12, folic acid, red blood cells/whole blood, and erythropoietin
May cause headache, GI upset, teeth staining (iron), increased progression of nerve damage (folic acid), and hepatitis/transfusion reactions (whole blood/components)

Question 21

Mechanical Coagulants (Gelfoam)

Answer 21

Indicated for inability to clot blood, especially during surgery
MOA: Cause platelets to disintegrate

Question 22

Clotting Factors (Thrombin, Platelets)

Answer 22

Indicated for inability to clot blood

MOA: Adding natural hemostatics causes the body to clot blood

Question 23

Vitamin K

Answer 23

Indicated for inability to clot blood

MOA: Used to synthesize prothrombin in the liver

Question 24

Heparin

Answer 24

Indicated for anaphylaxis, venous thrombosis, atrial fibrillation/valve disease, and prevention of coronary thrombosis
MOA: Interferes with conversion of prothrombin to thrombin and conversion of fibrinogen to fibrin, helps prevent mast cell degradation
Contraindicated for oral administration (too large to be absorbed, must be given parenterally), IM injections, bleeding tendencies/ulcers, pregnancy, and severe liver/kidney disease
Will not cross placental barrier

Question 25

Coumarin Derivatives (Warfarin)

Answer 25

Indicated for venous thrombosis, atrial fibrillation/valve disease, and prevention of coronary thrombosis
MOA: Interferes with Vitamin K to prevent prothrombin formation in the liver
Contraindicated for IM injections, bleeding tendencies/ulcers, pregnancy, and severe liver/kidney disease
May be administered orally and will cross placental barrier; 99% plasma protein bound; will affects hepatic metabolism by activating the CP450 system

Question 26

Aspririn

Answer 26

Indicated for venous thrombosis, atrial fibrillation/valve disease, and especially coronary thrombosis
Long-lasting because new platelets must be made
Cannot be substituted with ibuprofen/NSAIDS
Contraindicated for IM injections, bleeding tendencies/ulcers, pregnancy, and severe liver/kidney disease

Question 27

NSAIDS (Ibuprofen)

Answer 27

Indicated for venous thrombosis, atrial fibrillation/valve disease, and prevention of coronary thrombosis
MOA: Has antithrombic effects, but COX-2 agents have prothrombic effects
Not as long-lasting as aspirin; 99% plasma protein bound
Contraindicated for IM injections, bleeding tendencies/ulcers, pregnancy, and sever kidney/liver disease

Question 28

Thrombolytic Drugs (Tissue Plasminogen Activator or rTPA)

Answer 28

Indicated for dissolving clots that have already formed (acute pulmonary embolism, coronary thrombosis, some strokes, deep venous thrombosis, and arterial clots
MOA: Cause plasminogen to convert to plasmin, which dissolves the clot and prevents further clot formation
Contraindicated for bleeding tendencies, cerebrovascular accident older than 2 hours, and tumors
May cause anaphylactic reaction or bleeding tendencies

Question 29

Fibroic Acid Derivatives (Gemfobrozil)

Answer 29

Indicated for high serum lipid concentration
MOA: Inhibits peripheral lipolysis, decreases hepatic triglyceride production
May make statin drugs more toxic, may cause skin flushing, itching, hyperpigmentation, GI distress, cardiac arrhythmias, glucose intolerance, hyperuricemia, liver toxicity, nephrotoxicity, and permanent nerve deafness

Question 30

Niacin/Vitamin B3

Answer 30

Indicated for high serum lipid concentration
MOA: Unknown
May cause skin flushing, muscle pain, and may affect liver function
Often used w/other meds to change lipid profile

Question 31

Bile Sequestrants

Answer 31

Indicted for high serum lipid concentrations
MOA: Binds cholesterol in the intestines with bile acids to prevent absorption
May cause GI distress, interference with GI absorption of other drugs, cardiac arrhythmias, flushing, itching, hyperpigmentation, glucose intolerance, hyperuricemia, liver toxicity, nephrotoxicity, and permanent nerve deafness

Question 32

Statins (HMG-CoA Reductase Inhibitors)

Answer 32

Indicated for high serum lipid concerntration
MOA: Inhibits enzyme necessary for cholesterol production
May cause headache, GI distress, muscle/joint pain, heartburn, and depletion of CoQ10. Possible early cataract formation and abnormal liver function

Question 33

Options for high lipid serum concentration before drug therapy

Answer 33

6 months of dietary and lifestyle changes