Cardiovascular drugs Flashcards
Examples of Thiazide diuretics
Hydrochlorothiazide Chlorthalidone Chlorthiazide Indapamide Metolazone
MOA of Thiazide Diuretics
Inhibit Na/Cl transporter in the DCT and reduced excretion of calcium
Side effects of thiazide diuretics
Hypokalemic metabolic alkalosis; Sulfa allergy Hyperglycemia Hyperlipidemia Hyperuricemia Hypercalcemia (HYPER-GLUC)
Examples of Loop Diuretics
Furosemide, Bumetanide, Torsemide, Ethracrynic acid
MOA of Loop Diuretics
Inhibit Na/K/2Cl transporter in the Thick ascending loop of Henle and increased Ca excretion
Loop diuretic which does not trigger sulfa allergy
Ethracrynic Acid
Drugs that irreversibly blocks the vesicular monoamine transporter (VMAT)
Nerve terminal blocker:
GUANETHIDINE
RESERPINE
Side effect of reserpine
Suicidal ideation
A vasodilator that alters intracellular calcium metabolism thus causing relaxation of the arteriolar smooth muscle, decreases afterload
Hydralazine
Drugs that induces Lupus
Hydralazine, Isoniazid, Procainamide, Penicillamine
What is the use of hydralazine in heart failure
when combined with ISDN, more effective in treating acute heart failure in Blacks
Side effect of hydralazine
reflex tachycardia
A hypertensive drug that is used in the treatment of alopecia
Minoxidil
MOA for hypertension: opening of K+ Channels –> hyperpolarization –> vasodilation
Examples of Non-dihydropyridine calcium channel blocker (inhibits voltage-gated L type receptors)
verapamil, diltiazem
Cardiac>vascular
Side effects of non-dihydropyridine receptors blockers
Constipation, Pretibial edema, gingival hyperplasia
Besides its antihypertensive property, what are the other Uses of nondihydropyridine receptors Ca channel blockers
Angina, SVT
Examples of dihydropyridine receptors Ca channel blockers
Amlodipine, felodipine, Nicardipine, Nisoldipine, Isradipine
Vascular>Cardiac
Side effect of dihydropyridine ca channel blockers
Pretibial edema, flushing, constipation
A parenteral vasodilator that relaxes venous and arteriolar smooth muscle (decreasing both preload and afterload)
Nitroprusside
Side effect of Nitroprusside
Cyanide Toxicity
Tx: Inhaled Amyl Nitrite, IV sodium nitrite, IV sodium thiosulfate
What is the side effect for the treatment of the side effect of nitroprusside
Methemglobinemia
Tx: oxygen supplement and methylene blueA
A dopamine agonist which is a parenteral vasodilator
Fenoldopam
Used in hypertensive emergencies
May cause hypokalemia
Anti-hypertensive which is a Renin antagonist
Aliskiren
Treatment for malignant hypertension
Nitroprusside, fenoldopam, diazoxide (vasodilators) plus diuretics (furosemide) and beta-blockers
Ultrashort acting nitrite used in the treatment of cyanide poisoning (MOA: releases NO, increases cGMP and relaxes smooth muscle)
Amyl nitrite
Short-acting nitrite used in the treatment of angina and acute coronary syndromes
Isosorbide dinitrate Isosorbide mononitrate (maintenance)
Side effects of nitrites
Headache
Tolerance (transdermal)
dangerous hypotension when combined with phosphodiesterase (PDE) inhibitors (e.g. sildenafil, vardenafil and tadalafil)
DOC for Prinzmetal’s angina
Diltiazem
Anti-angina drug that can be used in the treatment of raynaud’s phenomenon
Diltiazem
drugs that can cause gingival hyperplasia
Nifedipine, Cyclosporin, Phenytoin, Verapamil
NapaCa Pangit ng gingiVa mo
What drugs can be used in the treatment for migraine and performance anxiety
Beta-blockers
Excessive beta-block blockade will cause what problems?
Bronchospasm, AV block, Heart Failure, CNS sedation
Other side effect: erectile dysfunction
What is the disadvantage in giving beta-blockers in patients with diabetes?
Masks hypoglycemia in Diabetic patients
What drug is a cardiac glycoside which inhibits Na/K ATPase?
Digoxin
Side effects of digoxin
Narrow therapeutic index
arrhythmias - increased by hypokalemia, hypomagnesemia, hypercalcemia
visual changes (remember Van Gogh)
Drugs with narrow therapeutic index
warfarin aminoglycosides lithium amphotericin B carbamazepine Phenobarbital Phenytoin Vancomycin Theophylline Digoxin
treatment for digitalis toxicity
DOC: lidocaine (anti-arrhythmia)
Digibind (digoxin anti-bodies
First line drugs for systolic and diastolic failure
diuretics
furosemide: immediate reduction of pulmonary congestion and edema
Spironolactone and eplerenone: has significant long-term benefits
First line drug for chronic heart failure
angiotensin antagonists
Other than the diuretics, what are the other Drugs useful in acute heart failure
Beta-selective sympathomimetics (Dobutamine and Dopamine)
Should beta-blockers be used in treatment for acute heart failure?
NO. They have no value
What are the beta-blockers which have beta and alpha activity
Carvedilol and Labetalol
What are the phosphodiesterase inhibitors used in the treatment for acute heart failure
Inamirinone and Milrinone
(Note: should not be used in chronic heart failure since they can increase morbidity and mortality
What are the vasodilators that can be used in acute severe failure with congestion
Nitroprusside or Nitroglycerin
What drugs are used in the treatment of CHF in African Americans
Hydralazine and Isosorbide Dinitirate
What is the ECG morphology of Torsade de Pointes
Polymorphic ventricular tachycardia, waxing and waning of QRS complex
What disease is associated with Torsade de Pointes
Long QT syndrome: mutations in the Ik or Ina Channel proteins
Group I antiarrythmics MOA
Sodium channel blockers
- slow or block conduction in ischemic and depolarized cells and slow or abolish abnormal pacemakers wherever these processes depend on sodium channels
- use dependent or state dependent (they selectively depress tissues that is frequently depolarizing or tissue that is relatively deporlarized during rest)
Group IA
Procainamide, Disopyramide, Quinidine
(I am the Queen who Proclaimed Diso’s Pyramid
Group IA effect
prolongs AP duration`
Group IB effect
shorten AP duration
Group IB drugs
Mexiletene, Tocainide, Lidocaine
I buy mexican tacos from Lily
Group IC effect
no effect on AP duration
Group IC drugs
Fleicanide, Propafenone, Encainide, Moricizine
Advantage of IC drugs over group IA and IB
Can be used in Refractory arrhythmia
Side effects of IC drugs
increased proarrhythmic effect (contraindicated for post MI Arrythmia
Drugs that cause agranulocytosis
Colchicine, clozapine, co-trimoxzaole, aminopyrine, phenylbutazone, PTU/methimazole, indomethacin, tocainide
What drug causes cinchonism (headache, vertigo, tinnitus)
Quinidine
What is the beta blocker that is used as post-MI prophylaxis against sudden death and as treatment for thyrotoxicosis
Propranolol
what is the beta-blocker that has class 3 properties
Sotalol
What is the beta blocker used in the treatment of supraventricular arrhythmias?
Esmolol
What is the beta-blocker used in acute perioperative and thyrotoxic arrythmias
esmolol
Class 3 anti-arrythmias
Dofetilide, Ibutilide, Sotalol, Amiodarone
AIDS
What drug is used in the treatment and prophylaxis for atrial fibrillation which has a MOA of selective Ik block?
Dofetilide, Ibutilide
What is a class 3 anti-arrythmic drug that has group 1 activity?
Amiodarone
Dronedarone
What is the mechanism of action of amiodarone
Strong Ik block produces marked prolongation of action potential and refractory period
Group 1 activity slows conduction velocity
Groups 2 and 4 activity confer additional antiarrythmic activity
What is the side effect of amiodarone?
microcrystalline deposits in cornea and skin pulmonary fibrosis paresthesias tremors thyroid dysfunction
What is the MOA of class 4 antiarrythmic drugs
State and use dependent selective depression of calcium currents
What is the ECG findings in class 4 antiarrythmic drugs?
PR interval is consistently prolonged (AV conduction velocity is decreased and effective refractory period increased)
What is the major use of calcium channel blockers in arrythmias?
Convert nodal tachycardia (AV nodal reentry) to normal sinus rhythm
What is an antiarrythmic drug that increases the diastolic Ik of AV node that causes marked hyperpolarization and conduction block; and reduced Ica
Adenosine
What is the drug of choice for paroxysmal supraventricular tachycardia?
Adenosine
What should be checked in patients who will undergo treatment for arrythmia?
Serum potassium
potassium ion depresses ectopic pacemakers including those caused by digitalis toxicity. Hypokalemia is associated with an increased incidence of arrythmia in digitalis toxicity while excessive hypokalemia will depress conduction and can cause reentry arrythmias
What drug can be used in the treatment of torsade de pointes
Magnesium. MOA is poorly understood but possibly it increases Na/K ATPase activity
What are the ECG changes in hyperkalemia? Hypokalemia?
Hyperkalemia: Peak T wave
Hypokalemia: Depressed T wave
what is the drug that is used in the treatment of glaucoma, mountain sickness and edema with alkalosis which inhibits the Na-H antiport in the proximal tubule
ACETAZOLAMIDE, dorzolamide, brinzolamide, dichlorophenamide, methazolamide
(carbonic anhydrase inhibitors)
what are the side effects associated with loop diuretics?
ototoxicity hypokalemia dehydration allergy to sulfa nephritis gout
what are examples of potassium sparing diuretics that inhibits cytoplasmic aldosterone receptor in the cortical collecting ducts?
spironolactone
eplerenone
what are the examples of potassium sparing diuretics that inhibits the epithelial sodium channel in cortical collecting duct?
amiloride
triamterene
what drugs that can cause gynecomastia
Spironolactone digoxin cimetidine alcohol ketoconazole
give examples of diuretics that osmotically retains water in the tubules by reducing reabsorption?
mannitol, glycerin, isosorbide, urea
What are examples of ADH antagonist?
Conivaptan, Lixivaptan
Demeclocycline
Lithium
A tetracycline-derived drug which can also be used as an ADH antagonist
Demeclocycline
Side effect: bone and teeth abnormalities (similar to that of the tetracyclines)
What are the adverse effects of giving fibrates with statins?
Rhabdomyolysis and myopathy
What are examples of lipid-lowering drugs that prevents reabsorption of bile acids by binding them
Cholestyramine, Colesevelam, Colestipol
Why bile acid binders are not given in patients with high triglycerides?
It increases triglycerides and VLDL in patients with high triglycerides?
what drug is used in hypercholesterolemia which inhibits NPC1L1 (a specific transporter in jejunal electrocyte), decreasing intestinal absorption of cholesterol and other phytosterols?
Ezetimibe
What drug is used in hypercholesterolemia which acts as a cholesterol analog, thus decreases absorption of cholesterol and phytosterols?
Sitosterol
Ezetimibe and statins have synergistic LDL-lowering effect, however, it also increases the risk of developing what abnormality?
Hepatotoxicity
What drug is the most effective agent in increasing HDL levels?
Niacin
What drug is given before giving niacin to prevent flushing?
Aspirin
What are the drugs that cause cutaneous flushing
Vancomycin
Adenosin
Niacin
Calcium channel blockers
What is the drug of choice in treating hypertriglyeridemia?
Gemfibrozil, Fenofibrate, Bezafibrate
MOA: activates PPAR alpha and increases expression of lipoprotein lipase and apolipoproteins