Cardiovascular Drugs Flashcards by Rhaizza Mae Guerra

[Anti-hypertensive drugs]

What is the formula for blood pressure?

BP = COxSVR

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[Anti-hypertensive drugs]

What is the expanded formula for your blood pressure?

BP = HR x SV x SVR

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[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

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[Anti-hypertensive drugs]

used in ACE-inhibitor intolerance

Losartan (ARBs)

ARBs: “-sartan”
losartan, candesartan, valsartan, irbesartan, eprosartan, telmisartan, azilsartan, valsartan

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[Anti-hypertensive drugs]

hypertension with comorbid BPH

prazosin (alpha 1 selective adrenergic blockers)
“-osin”
prazosin, doxazosin, terazosin, tamsulosin, silodosin, alfazosin

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[Anti-hypertensive drugs]
pre-eclampsia (maintenance medication)
SE: hemolytic anemia (positive coombs test)

methyldopa

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[Anti-hypertensive drugs]
pre-eclampsia (acute BP lowering)
SE: reflex tachycardia, drug-induced lupus

hydralazine

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[Anti-hypertensive drugs]
hypertensive emergency
SE: hypertrichosis

minoxidil (acts at K channels)

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[Anti-hypertensive drugs]
hypertensive emergency
SE: cyanide poisoning

nitroprusside (both arterioles and venous site)

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[Anti-hypertensive drugs]

treatment of cyanide poisoning

amyl nitrite

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why do patients taking angiotensin antagonists (ACE-Is/ARBs) develop hyperkalemia?

ACE-Is/ARBs reduce aldosterone levels and cause potassium retention

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which portion of the electron chain is affected by cyanide?

complex IV (cytochrome oxidase) of the ETC

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what is the antidote for cyanide poisoning?

inhaled amyl nitrite + IV sodium nitrite + IV sodium thiosulfate

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[Anti-anginal drugs]
used for relief of acute anginal attacks
SE: headache, tolerance

nitroglycerin, ISDN

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[Anti-anginal drugs]
used for angina maintenance, VASCULAR> cardiac effect

SE: flushing, edema, gingival hyperplasia

nifedipine

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[Anti-anginal drugs]
used for angina maintenance, CARDIAC> vascular effect, vasospastic angina, Raynaud’s phenomenon
*does not cause gingival hyperplasia

diltiazem

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[Anti-anginal drugs]
used for supraventricular tachycardia, CARDIAC> vascular effect
SE: gingival hyperplasia

verapamil

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drugs that cause gingival hyperplasia

"Nganga Pa Cagat Vampira"
nifedipine
phenytoin
cyclosporine
verapamil

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why do patients taking nitrates usually experience throbbing headaches?

due to meningeal blood vessel vasodilation

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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

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[drugs for heart failure]
used as positive inotrope for heart failure
SE: arrhythmias (PVC, AVB), yellow visual halos

digoxin (Na-K pump)

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[drugs for heart failure]

used as treatment for pulmonary edema in CHF

furosemide

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[drugs for heart failure]

used as first line drug for chronic CHF, cardioprotective, renoprotective

ACE inhibitors, ARBs

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[drugs for heart failure]

improved survival in CHF (decreases mortality)

ACE inhibitors/ARBs, beta blockers, spironolactone

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[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

[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 ```