Cardiovascular drugs Flashcards by Joanna Rivera

Examples of Thiazide diuretics

Hydrochlorothiazide
Chlorthalidone
Chlorthiazide
Indapamide
Metolazone

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MOA of Thiazide Diuretics

Inhibit Na/Cl transporter in the DCT and reduced excretion of calcium

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Side effects of thiazide diuretics

Hypokalemic metabolic alkalosis; Sulfa allergy
Hyperglycemia
Hyperlipidemia
Hyperuricemia
Hypercalcemia
(HYPER-GLUC)

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Examples of Loop Diuretics

Furosemide, Bumetanide, Torsemide, Ethracrynic acid

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MOA of Loop Diuretics

Inhibit Na/K/2Cl transporter in the Thick ascending loop of Henle and increased Ca excretion

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Loop diuretic which does not trigger sulfa allergy

Ethracrynic Acid

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Drugs that irreversibly blocks the vesicular monoamine transporter (VMAT)

Nerve terminal blocker:
GUANETHIDINE
RESERPINE

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Side effect of reserpine

Suicidal ideation

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A vasodilator that alters intracellular calcium metabolism thus causing relaxation of the arteriolar smooth muscle, decreases afterload

Hydralazine

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Drugs that induces Lupus

Hydralazine, Isoniazid, Procainamide, Penicillamine

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What is the use of hydralazine in heart failure

when combined with ISDN, more effective in treating acute heart failure in Blacks

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Side effect of hydralazine

reflex tachycardia

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A hypertensive drug that is used in the treatment of alopecia

Minoxidil

MOA for hypertension: opening of K+ Channels –> hyperpolarization –> vasodilation

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Examples of Non-dihydropyridine calcium channel blocker (inhibits voltage-gated L type receptors)

verapamil, diltiazem

Cardiac>vascular

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Side effects of non-dihydropyridine receptors blockers

Constipation, Pretibial edema, gingival hyperplasia

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Besides its antihypertensive property, what are the other Uses of nondihydropyridine receptors Ca channel blockers

Angina, SVT

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Examples of dihydropyridine receptors Ca channel blockers

Amlodipine, felodipine, Nicardipine, Nisoldipine, Isradipine

Vascular>Cardiac

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Side effect of dihydropyridine ca channel blockers

Pretibial edema, flushing, constipation

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A parenteral vasodilator that relaxes venous and arteriolar smooth muscle (decreasing both preload and afterload)

Nitroprusside

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Side effect of Nitroprusside

Cyanide Toxicity

Tx: Inhaled Amyl Nitrite, IV sodium nitrite, IV sodium thiosulfate

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What is the side effect for the treatment of the side effect of nitroprusside

Methemglobinemia

Tx: oxygen supplement and methylene blueA

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A dopamine agonist which is a parenteral vasodilator

Fenoldopam
Used in hypertensive emergencies
May cause hypokalemia

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Anti-hypertensive which is a Renin antagonist

Aliskiren

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Treatment for malignant hypertension

Nitroprusside, fenoldopam, diazoxide (vasodilators) plus diuretics (furosemide) and beta-blockers

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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