Cardiovascular Drugs Flashcards
[Anti-hypertensive drugs]
What is the formula for blood pressure?
BP = COxSVR
[Anti-hypertensive drugs]
What is the expanded formula for your blood pressure?
BP = HR x SV x SVR
[Anti-hypertensive drugs]
hypertension with comorbid CHF/DM
SE: cough, angioedema, contraindicated in bilateral RAS
Captopril (ACE inhibitors)
-increase bradykinin
ACE inhibitors: “-pril”
captopril, enalapril, benazepril, fosinopril, lisinopril, quinapril, ramipril, trandolapril, moexipril, perindopril, imidapril
[Anti-hypertensive drugs]
used in ACE-inhibitor intolerance
Losartan (ARBs)
ARBs: “-sartan”
losartan, candesartan, valsartan, irbesartan, eprosartan, telmisartan, azilsartan, valsartan
[Anti-hypertensive drugs]
hypertension with comorbid BPH
prazosin (alpha 1 selective adrenergic blockers)
“-osin”
prazosin, doxazosin, terazosin, tamsulosin, silodosin, alfazosin
[Anti-hypertensive drugs]
pre-eclampsia (maintenance medication)
SE: hemolytic anemia (positive coombs test)
methyldopa
[Anti-hypertensive drugs]
pre-eclampsia (acute BP lowering)
SE: reflex tachycardia, drug-induced lupus
hydralazine
[Anti-hypertensive drugs]
hypertensive emergency
SE: hypertrichosis
minoxidil (acts at K channels)
[Anti-hypertensive drugs]
hypertensive emergency
SE: cyanide poisoning
nitroprusside (both arterioles and venous site)
[Anti-hypertensive drugs]
treatment of cyanide poisoning
amyl nitrite
why do patients taking angiotensin antagonists (ACE-Is/ARBs) develop hyperkalemia?
ACE-Is/ARBs reduce aldosterone levels and cause potassium retention
which portion of the electron chain is affected by cyanide?
complex IV (cytochrome oxidase) of the ETC
what is the antidote for cyanide poisoning?
inhaled amyl nitrite + IV sodium nitrite + IV sodium thiosulfate
[Anti-anginal drugs]
used for relief of acute anginal attacks
SE: headache, tolerance
nitroglycerin, ISDN
[Anti-anginal drugs]
used for angina maintenance, VASCULAR> cardiac effect
SE: flushing, edema, gingival hyperplasia
nifedipine
[Anti-anginal drugs]
used for angina maintenance, CARDIAC> vascular effect, vasospastic angina, Raynaud’s phenomenon
*does not cause gingival hyperplasia
diltiazem
[Anti-anginal drugs]
used for supraventricular tachycardia, CARDIAC> vascular effect
SE: gingival hyperplasia
verapamil
drugs that cause gingival hyperplasia
"Nganga Pa Cagat Vampira" nifedipine phenytoin cyclosporine verapamil
why do patients taking nitrates usually experience throbbing headaches?
due to meningeal blood vessel vasodilation
why is calcium-dependent neurotransmission or hormone release not affected by CCBs?
CCBs block L-type calcium channels
other functions use N-, P- and R- types
[drugs for heart failure]
used as positive inotrope for heart failure
SE: arrhythmias (PVC, AVB), yellow visual halos
digoxin (Na-K pump)
[drugs for heart failure]
used as treatment for pulmonary edema in CHF
furosemide
[drugs for heart failure]
used as first line drug for chronic CHF, cardioprotective, renoprotective
ACE inhibitors, ARBs
[drugs for heart failure]
improved survival in CHF (decreases mortality)
ACE inhibitors/ARBs, beta blockers, spironolactone
[drugs for heart failure]
decreases hospitalizations in CHF
digoxin
[drugs for heart failure]
improves survival in CHF patients of African-American descent
hydralazine + ISDN
what drugs have been shown to imrpove survival in cases of heart failure?
“ABA! Buhay ka pa”
ACE inhibitors
Beta blockers
Aldosterone Antagonists
[antiarrhythmic drugs]
treatment of all types of arrhythmias, WPW syndrome
SE: drug-induced lupus
procainamide
antidote of procainamide overdose
Na lactate
[antiarrhythmic drugs]
used for atrial and ventricular arrhythmia
SE: cinchonism (triad: headache, tinnitus, vertigo)
quinidine
[antiarrhythmic drugs]
used for post-MI arrhythmias, digitalis arrhythmias
SE: seizures
lidocaine
[antiarrhythmic drugs]
contraindicated post-MI, refractory arrhythmias
flecainide
[antiarrhythmic drugs]
used for perioperative and thyrotoxic arrhythmias, SVT
esmolol
[antiarrhythmic drugs]
beta blocker, groups 3 activity
SE: dose-dependent torsades de pointes
sotalol
[antiarrhythmic drugs]
most efficacious antiarrhythmic
SE: skin deposits, pulmonary fibrosis, hyper/hypothyroidism
amiodarone (1a activity) - can be used for Wolf Parkinson Wide syndrome
[antiarrhythmic drugs]
used as outpatient managemene of SVT
SE: gingival hyperplasia
verapamil
what are the effects of class 1 antiarrhythmics on action potential duration?
Class 1A: prolongs
Class 1B: shortens
Class 1C: no effect
[antiarrhythmic drugs]
Class 1A drugs
[antiarrhythmic drugs]
Class 1A drugs - prolongs action potential
“QPD - Quezon Police District”
quinidine
procainamide
disopyramide
[antiarrhythmic drugs]
Class 1B drugs
[antiarrhythmic drugs]
Class 1B drugs - shortens action potential
"PLM Tayo" phenytoin lidocaine mexiletine tocainide
[antiarrhythmic drugs]
Class 1C drugs
[antiarrhythmic drugs]
Class 1C drugs - no effect on action potential; contraindicated for post-MI; powerful depressant of Na current
"Please Feed ME" Propafenone Flecainide Moricizine Encainide
Anti-arrhythmics Singh-Vaughan-William Classification Class 1 Class 2 Class 3 Class 4
Anti-arrhythmics
Singh-Vaughan-William Classification
Class 1a, 1b, 1c - Sodium channel blockers (acts of phase 0)
Class 2 - beta blockers (acts on phase 4)
Class 3 - potassium channel blockers
Class 4 - calcium channel blockers
what are the drugs that can cause agranulocytosis?
"CCCAPPIT Me!" clozapine co-trimoxazole colchicine aminopyrine phenylbutazone PTU indomethacin tocainide methimazole
Amiodarone toxicity symptoms
pulmonary fibrosis paresthesias tremors thyroid dysfunction corneal deposits skin deposits
why are dihydropyridine calcium channel blockers not useful as antiarrhythmics?
dihydropyridine CCBs evoke compensatory sympathetic discharge which facilitates arrhythmias rather than terminating them
Anti-arrhythmics Class 1a effect on ECG
Anti-arrhythmics Class 1a effect on ECG:
prolongs PR interval
prolongs QRS duration
prolongs QT interval
Anti-arrhythmics Class 1b effect on ECG
Anti-arrhythmics Class 1b effect on ECG:
no effect on normal cells
Anti-arrhythmics Class 1c effect on ECG
Anti-arrhythmics Class 1c effect on ECG:
prolongs QRS duration
Anti-arrhythmics Class 2 effect on ECG
Anti-arrhythmics Class 2 effect on ECG:
prolongs PR interval
Anti-arrhythmics Class 3 effect on ECG
Anti-arrhythmics Class 3 effect on ECG:
prolongs QT interval
Anti-arrhythmics Class 4 effect on ECG
Anti-arrhythmics Class 4 effect on ECG:
prolongs PR interval
[Diuretics]
- acts on PCT
- used for treatment of glaucoma and mountain sickness
"-zolamide" ACETAZOLAMIDE dorzolamide brinzolamide dichlorphenamide methazolamide
[Diuretics]
adverse SE: NAGMA, hepatic encephalopathy
Carbonic anhydrase inhibitors: "-zolamide" ACETAZOLAMIDE dorzolamide brinzolamide dichlorphenamide methazolamide
[Diuretics]
- acts on TAL
- treatment of pulmonary edema
- most efficacious diuretics
loop diuretics: "FB TE?" FUROSEMIDE bumetanide tosemide ethacrynic acid
MOA: inhibit Na-K-2Cl transporter
[Diuretics]
adverse SE: ototoxicity, HYPOcalcemia, HYPOkalemia
loop diuretics: "FB TE?" FUROSEMIDE bumetanide tosemide ethacrynic acid
MOA: inhibit Na-K-2Cl transporter
[Diuretics]
major site for NaCl & NaHCO3 reabsorption (60-70%);
site of uric acid transport
PCT
[Diuretics]
responsible for a significant % of NaCl reabsorption via Na-K-2Cl transporter
site of Ca and Mg reabsorption
TAL
[Diuretics]
pumps Na and Cl out of the lumen of the nephron via Na-Cl transporter
responsible for 5-8% of Na reabsorption
DCT
[Diuretics]
acts on DCT
Thiazide diuretics: HYDROCHLOROTHIAZIDE chlorthalidone indapamide metolazone bendroflumethiazide hydroflumethiazide methyclothiazide polythiazide quinethazone trichlormethiazide
MOA: inhibit Na-Cl transporter
[Diuretics]
adverse SE if thiazide diuretics
hyperGLUC: hyperglycemia hyperlipidemia hyperuricemia hypercalcemia
[Diuretics]
used for renal Ca stines, nephrogenic DI;
efficacy decreased by NSAIDs
Thiazide diuretics: HYDROCHLOROTHIAZIDE chlorthalidone indapamide metolazone bendroflumethiazide hydroflumethiazide methyclothiazide polythiazide quinethazone trichlormethiazide
MOA: inhibit Na-Cl transporter
[Diuretics]
acts on cortical collecting duct
used for hyperaldosteronism, HPN, HF, hypoK
K-sparing Aldosterone antagonists:
spironolactone
eplerenone
[Diuretics]
adverse effect: gynecomastia, hyperkalemia
K-sparing Aldosterone antagonists:
spironolactone
eplerenone
[Diuretics]
reduces progression of DM nephropathy and reduces mortality in post MI
eplerenone
[Diuretics]
acts on PCT, DCT, and CCD
treatment if rhabdomyolysis and increased ICP, contraindicated in heart failure
adverse SE: transient volume expansion
mannitol
What are the causes of HAGMA?
causes of HAGMA: "MUDPILES" methanol uremia DKA paraldehyde isoniazid, iron lactic acid ethanol, ethylene glycol salicylates
What are the causes of NAGMA?
causes of NAGMA: "HARDUP" hyperalimentation acetazolamide RTA diarrhea ureteral diversion pancreatic fistula
what are the adverse effects associated with loop diuretics?
adverse effects associated with loop diuretics: "OH DANG!" ototoxicity HYPOkalemia dehydration allergy to sulfa nephritis gout
what are the adverse effects of thiazide diuretics?
adverse effects of thiazide diuretics: hyperGLUC: glycemia lipidemia uricemia calcemia
which drugs can cause gynecomastia?
cause gynecomastia: "Sa Dede Co Asset Ko" Spironolactone Digoxin Cimetidine Alcohol Ketoconazole
Anti-hypertensive drugs that can cause depression (usually centrally acting)
“RAMP” Reserpine A2 adrenergic antagonists (Guanabenz, Guanfacine, Clonidine) Methyldopa Propranolol
Cardioselective beta blockers without intrinsic sympathomimetic activity
“MABB” Metoprolol Atenolol Bisprolol Betaxolol
This vasodilator provides myocardial protection via preconditioning by activation of cardiac Katp channels
Nicorandil
Drugs for Pheochromocytoma
“PaPa Loves Cars” Phenoxybenzamine Phentolamine Labetalol Carvedilol
Antihypertensive drugs given during pregnancy
“My Love, Hold Na” Methyldopa Labetalol Hydralazine Nifedipine
Drugs that decrease digitalis clearance
“VAD C Q” Verapamil Amiodarone Diltiazem Cyclosporine Quinidine
Drugs with narrow therapeutic index like digoxin
“Vhaklang To! WALA Cyang PaPa Dai” Vancomycin Theophylline Warfarin Aminoglycosides Lithium Amphotericin Carbamazepine Phenobarbital Phenytoin Digoxin
Drugs that cause agranulocytosis
“Clozap Col Co PAPI To Me” Clozapine Colchicine Cotrimoxazole PTU Aminopyrine Phenybutazone Indomethacine Methinazole Tocainidine
