Cardiovascular drugs Flashcards
Antiherpertensive medication contraindicated in pregnancy
Losartan
_______increases heart rate in a dose department manner
Minoxidil
- vasodialtor
- causes severe tchycardia that must be controlled with Beta blcokers
Action of nifedipine in response to essential hypertension
decreases calcium influx into smooth muscle
- Prototype L-type calcium channel blocker
- Plasma renin level may increase as a result of the compensatory response
Group of drug groups is most likely to cause postural hypotension
alpha1 - selective receptor blocker
what is the most common manifestation of ACE inhibitor intolerance?
incessant cough
constipation is a common side effect of __________
verapamil
- l-type calcium channels in the colon
prazosin and atenolol both ___________
increase sympathetic outflow from the CNS
________associated with hematologic abnormalities
methyldopa
_______ often cause mild hyperglycemia
Thiazide
Metoprolol and verapamil __________ PR inteval
Increase
- depresseion of calcium dependentd processes in the heart, therefore bradycardia and increased PR interval
used in severe hypertensive emergencies, is short acting and acts on a G-protein coupled receptor, and must be given by IV infusion
Fenoldopam
Very short actig and acts by releasing nitric oxide
Nitroprusside
Hydrochlorothiazide/chlorthalidone
Diuretics
Blocks Na/Cl transported in distal convoluted tubule
Used in hypertension and mild edema
AE: hypokalemia, hyperglycemia, hyperuricemia, hyperlipidemia
Furosemide
Block Na/K/2Cl transporter in thick ascending limb
Used in hypertension, heart failure, edema, hypercalcemia
AE; hypokalemia, hypovolemia, ototoxicity
Clonidine
Agonist at alpha 2 receptors in CNS this results in decreased SANS ouitflow
used in hypertension
AE: sedation, danger of severe rebound hypertension if suddently stopped
Methyldopa
Prodrug converted to methylnorepinephrine in CNS with effects like clonidine
Used in hypertension
AE: sedation, induces hemolytic antibodies
verapamil blocks ___________
P-glycoprotein transporter
Hydralazine
Probably causes release of nitroc oxide by endothelial cells. causes arteriolar dilation
Used in hypertension, also used heart failure in combiantion with isosorbide dinitrate
AE: rachycardia, salt and water retention, lupus-like syndrome
Minoxidil
Prodrug, sulfate metabolite opens K channels, causes arteriolar smooth muscle hyperpolarization and vasodilation
Used in severe hypertension and male pattern baldness
AE: marked tachycardia, salt and water retention, hirsutism
Nitroprusside
Releases, NO from drug molecule
Parenteral
used in hypertensive emergency and acute cardiac decompensation
AE: Excessive hypotension; tachycardia, calt and water retention. Prolonged infusion may cause thocyanate and cyanide toxicity
Diazoxide
K channel opener in smooth muscle, secretory cells
Used in hypertensive emergency and hypoglycemia due to insulin secreting tumors
AE: hyperglycemia, edema, excessive hypotension
Fenoldopam
D1 agonist. causes arteriolar dialtion
Used in hypertensive emergencies
AE: excessive hypotension; tachycardia, salt and water retention, angina
Aliskiren
Renin inhibitor, reduces angiotensin I synthesis
used in hypertension
AE: angioedema, renal impairment
Captopril
ACE inhibitor. reduces angiotensin II synthesis
used in hypertension, diabetes, renal disease, heart failure
AE: cough, hyperkalemia, teratogen
Losartan
Blocks AT1 receptors
Used in hypertension, combination used in heart failure
AR: hyperkalemia, teratogen
Common direct or reflex effect of nitroglycerin
Increased diastolic myocardial fiber tension
- nitroglycerin increases heart rate and venous capacitance and decreases afterload and diastolic fiber tension
- compensatory icnrease in sympathetic discharge
Meningeal vasodialtion can be caused by ____________
nitroglycerin
- Nitrates relax many types of smooth muscle, but the effect on motility on the colon is insignificant
Useful for drugs for the prophylaxis of angina
Verapamil
- CCBs and Beta blockers are generally effective in reducing the number of attacks of angina of effort, and most have durations of 4-8 h
If a beta blocker were to be used for prophylaxis in this patient what is the most probable mechanism
Block of exercise-induced tachycardia
Common adverse effect of nitroglycerin and prazosin
Othostatic hypertension
Drug that can cause methemeglobinemia
amyl nitrite
Drugs in high doses can cause extreme bradycardia
verapamil
which nitroglycerin by inhibiting the metabolism of cGMP
sildenafil
Nitroglycerin, SL
Short-acting nitrates
Releases NO, increases cGMP (cyclic guanosine monophosphate
Used in acute angina pectoris and acute coronary syndrome
AE: tachycardia, orthostaichypotension, headache
nitroglycerin, oral
Intermiediate-acting nitrates
Like Notroglycerin SL, active metabolite dinitroglycerin
used for prophylaxis of angina
ranolazine
Blocks late Na current in myocardium, reduces cardiac work
Used in angina
AE: QT prolongation on ECG, inhibits CYP3A and 2D6
Ivabradine
Blocks pacemaker Na current in myocardium, reduces cardiac work
Ued in heart failure, invesitgaional in angina
AE: excessive bradycaria
Best documented mechanism of beneficial action of cardiac glycosides
An increase in systolic cytoplasmic calcium levels
- It increases calcium by inhibiting Na/K transport by the ATPase sodium pump and indirectly altering Na/Ca exchange
Most likely cause the arrythmogenic effect of digoxin
Increased intracellular calcium
- decreased sympathetic discharge and increased increased extracellular potassium and magnesium reduce digitalis arrhythmogenesis
A common effect of digoxin (at therapeutic blood levels) that can be almost entirely blocked by atropine is
Increased PR interval on ECG
- the parasympathomimetic effeects of digitalis can be blocked by muscarinic blockers such as atropine
- manifestation of slowed AV cinduction
drug shown to reduce mortality in chronic heart failure
Spironolactone
Increases endogenous BNP and also blocks angiotensin receptors
Sacubitril
initial treatment or heart failure f
furosemide
shown to prolong life in patients with chronic congestive failure
Carvedilol
The drug of choice in severe, massive overdose with any cardiac glycoside is __________
digoxin antibody
________– should be avoided to reduce the likelihood of procainamide toxicity
Hyperkalemia
Most effective therapy for procainamide and quinidine toxicity
sodium lactate
- increase sodium current by icnreasing the sodium ion gradient
- reduce drug-receptor binding by alkalinizing the tissue
_____ are most effective against acute thyrotoxic arrhythmias
Beta blockers
effective in both treating and precenting supracentricular AV nodla tachycardias
Calcium channel blockers
________ used in emergency treatment of myocardial infarction arrhythmia is one of the most important
Lidoacaine
_________ very short acting parenteral agent often used for AV nodal arrythmias
adenosine
Longest half-life of all the antiarrythmics
amiodarone
Group 1 antiarryhtmics
Sodium channel blockers
- Group 1A
- both atrial and ventricular arrythmias
- prolongs AP
- block one or more repolarizing K currents
- Group IB
- selectively affect ischemic or depolarized Purkinje and ventricular tissue
- reduce AP
- Group IC
- no effect on ventricular AP duration
- powerful depresants of sodium current
- increase QRS duration of the ECG
Group 2 antiarrhythmics
Beta blockers
- reduction of CAMP
- modest reduction of both sodium and calcium
- the AV node is particularly sensitive
- Prolonged PR interval
- may have some direct local anesthetic (sodium channel blocking)
Group 3 Antiarrythmics
Potassium K channel blockers
Common used in Afib
Prolongs AP
carbonic anhydrase inhibitors
Acetazolamide
diurets useful in the prevention of calcium stones
thiazides
loop diuretics _________urinary calcium excretion and __________blood pressure
Increase
Decrease
Acetazolamide causes ______________
metabolic acidosis
A drug that increases the formation of dilute urine is used to treat SIADH
Tolvaptan