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Intro To Drugs > Cardiovascular system agents > Flashcards

Cardiovascular system agents Flashcards

1
Q

Hypertension

A

Defined as persistently elevated arterial blood pressure
What do the numbers mean?
BP ≥ 140/90 mm Hg (or)
Currently on antihypertensive therapy
72 million Americans (31% of the US population) have BP ≥ 140/90 mm Hg

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2
Q

Arterial BP

A

pressure in the arterial wall

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3
Q

Hydrochlorothiazide

A

Thiazide Diuretics

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4
Q

Hydrochlorothiazide MOA

A

Inhibit reabsorption of sodium and chloride in the distal tubules 
Increased urinary excretion of sodium and chloride

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5
Q

Hydrochlorothiazide uses

A

Hypertension

Edema

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6
Q

Hydrochlorothiazide adverse effects

A

Hypokalemia, hypochloremic alkalosis, orthostatic hypotension, photosensitivity

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7
Q

Hydrochlorothiazide interactions

A

Loop Diuretics
NSAIDs
Digoxin

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8
Q

Hydrochlorothiazide counseling

A

Take in the morning to avoid increased urination at night

Antihypertensive effects may take several days

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9
Q

Hydrochlorothiazide key points

A

Along with use for the treatment of mild hypertension, thiazides can also be used for edema; however, they often only work for mild edema, and a loop diuretic is often required for more severe edema associated with heart failure.
The 50 mg dose of HCTZ has increased adverse effects without added efficacy and should generally be avoided

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10
Q

Furosemide

A

Loop Diuretics

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11
Q

Furosemide MOA

A

Inhibit reabsorption of sodium and chloride at the thick ascending limb of the loop of Henle 
Increased excretion of sodium, water, chloride, calcium, and magnesium

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12
Q

Furosemide uses

A

Edema

Hypertension

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13
Q

Furosemide adverse effects

A

Electrolyte depletion, hyperuricemia, hypochloremic alkalosis, hypotension, orthostasis, renal function impairment, ototoxicity, skin rash

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14
Q

Furosemide interactions

A

NSAIDs
Aminoglycosides
Digoxin

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15
Q

Furosemide BBwarning

A

May cause profound diuresis with water and electrolyte imbalances. Medical supervision is required

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16
Q

Furosemide counseling

A

Avoid taking before bedtime
With the possibility of hypokalemia there may be a need for additional potassium in the diet; do not change diet without first checking with your healthcare professional
Use caution when getting up suddenly from a lying or sitting position
Be cautious in using alcohol, while standing for long periods or exercising, and during hot weather because of enhanced orthostatic hypotensive effects
Regular monitoring of lab tests (potassium, serum creatinine) and blood pressure is necessary to ensure safe use of the drug and avoid adverse effects

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17
Q

Furosemide key points

A

Commonly used to treat edema

Monitor closely to make sure electrolyte disturbances and hypotension do not occur

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18
Q

Sprionolactone

A

Potassium Sparing Diuretics - Aldosterone Antagonists

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19
Q

Sprionolactone MOA

A

Inhibit aldosterone binding to aldosterone receptors of the distal tubules in the kidney 
Increase sodium chloride and water excretion
NO increase in potassium and/or hydrogen ion excretion

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20
Q

Sprionolactone uses

A 
Edema
Heart failure
HTN
Hyperaldosteronism
Hypokalemia
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21
Q

Sprionolactone adverse effects

A

Hyperkalemia, cramping, diarrhea, gynecomastia, renal dysfunction

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22
Q

Sprionolactone drug interactions

A

Potassium supplements

ACEIs, ARBs

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23
Q

Sprionolactone counseling

A

Avoid ingestion of food high in potassium or use of salt substitutes or other potassium supplements without the advice of your healthcare professional

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24
Q

Sprionolactone key points

A

The use in patients with cirrhosis requires much higher dosing (up to 200 mg daily) than what is recommended in patients with heart failure (max of 50 mg daily)
Monitor patients closely for hyperkalemia and renal dysfunction

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25
Q

Lisinopril, Enalapril

A

Angiotensin-Converting Enzyme (ACE) Inhibitors

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26
Q

Lisinopril, Enalapril MOA

A

Suppression of RAAS
Inhibition of ACE 
Inhibition of the conversion of angiotensin I to angiotensin II

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27
Q

Lisinopril, Enalapril uses

A

HTN
Diabetic nephropathy
Heart failure
s/p MI

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28
Q

Lisinopril, Enalapril adverse effects

A

Hypotension, hyperkalemia, cough, angioedema, increased Scr, renal failure

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29
Q

Lisinopril, Enalapril contraindications

A

pregnancy

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30
Q

Lisinopril, Enalapril interactions

A

Antihypertensive Agents
ARBs, Potassium Sparing Diuretics, Potassium Supplements
Diuretics
NSAIDs

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31
Q

Lisinopril, Enalapril counseling

A

Some lab work will be needed periodically to monitor therapy (potassium, serum creatinine)
Avoid salt substitutes containing potassium
Seek help immediately if swelling in face, lips, tongue, or throat occurs
Women: Notify your physician if pregnancy is suspected

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32
Q

Lisinopril, Enalapril key points

A

Widely used for the treatment of HTN, heart failure, and other CV diseases. There are some potentially fatal adverse effects associated with their use, so appropriate monitoring and patient counseling is necessary

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33
Q

Irbesartan, Losartan, Valsartan

A

Angiotensin II Receptor Blockers (ARBs)

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34
Q

Irbesartan, Losartan, Valsartan MOA

A

Suppression of RAAS
Block the binding of angiotensin II to the AT1 receptor 
Inhibition of the effects of antiotensin II

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35
Q

Irbesartan, Losartan, Valsartan uses

A

HTN
Diabetic nephropathy
Heart failure
s/p MI

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36
Q

Irbesartan, Losartan, Valsartan adverse effects

A

Hypotension, hyperkalemia, angioedema, increased Scr, renal failure
No Cough!!!

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37
Q

Irbesartan, Losartan, Valsartan contraindications

A

pregnancy

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38
Q

Irbesartan, Losartan, Valsartan interactions

A

Antihypertensive Agents
ARBs, Potassium Sparing Diuretics, Potassium Supplements
Diuretics
NSAIDs

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39
Q

Irbesartan, Losartan, Valsartan counseling

A

Some lab work will be needed periodically to monitor therapy (potassium, serum creatinine)
Avoid salt substitutes containing potassium
Seek help immediately if swelling in face, lips, tongue, or throat occurs
Women: Notify your physician if pregnancy is suspected

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40
Q

Irbesartan, Losartan, Valsartan key points

A

Often used in patients intolerant to ACEIs

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41
Q

Aliskiren

A

Direct Renin Inhibitor

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42
Q

Aliskiren MOA

A

Suppression of RAAS
Inhibition of renin 
Inhibition of the conversion of angiotensinogen to angiotensin I

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43
Q

Aliskiren uses

A

HTN

Diabetic nephropathy

44
Q

Aliskiren adverse effects

A

Hypotension, hyperkalemia, angioedema, increased Scr, renal failure

45
Q

Aliskiren contraindications

A

Pregnancy

Concomitant use with ACEI or ARB in patients with DM and/or renal impairment

46
Q

Aliskiren interactions

A

Antihypertensive Agents
ARBs, Potassium Sparing Diuretics, Potassium Supplements
Diuretics
NSAIDs

47
Q

Aliskiren counseling

A

Some lab work will be needed periodically to monitor therapy (potassium, serum creatinine)
Avoid salt substitutes containing potassium
Seek help immediately if swelling in face, lips, tongue, or throat occurs
Women: Notify your physician if pregnancy is suspected

48
Q

selective beta blockers

A

Atenolol

Metoprolol

49
Q

non-selective beta- blockers

A

Carvedilol
Labetolol
Propranolol

50
Q

Atenolol, Metoprolol, Carvedilol, Labetolol, Propranolol MOA

A

Block response to β stimulation

51
Q

Atenolol, Metoprolol, Carvedilol, Labetolol, Propranolol uses

A 
HTN
Heart Failure
s/p MI
Angina
Arrhythmias
Non-cardiovascular: migraine prophylaxis, anxiety, etc
52
Q

Atenolol, Metoprolol, Carvedilol, Labetolol, Propranolol adverse effects

A

Hypotension, bradycardia
Dizziness, fatigue, lethargy, depression, decreased sexual ability
Bronchoconstriction (especially non-selective)

53
Q

Atenolol, Metoprolol, Carvedilol, Labetolol, Propranolol drug interactions

A

Negative Chronotropes - Digoxin, diltiazem, verapamil
Anti-diabetic agents
NSAIDS
Decongestants

54
Q

Atenolol, Metoprolol, Carvedilol, Labetolol, Propranolol counseling

A

Do not abruptly stop taking medication
May mask symptoms of hypoglycemia
Notify your physician if you experience dizziness, lightheadedness, difficulty breathing

55
Q

Atenolol, Metoprolol, Carvedilol, Labetolol, Propranolol key points

A

Very effective for the treatment of many CV diseases
Also used for some off-label uses not associated directly with CV disease
Caution in asthma and COPD

56
Q

non-selective Alpha-1 blockers

A

Doxazosin, Terazosin

57
Q

prostate selective Alpha-1 blockers

A

Tamsulosin, Alfuzosin

58
Q

Doxazosin, Terazosin Tamsulosin, Alfuzosin MOA

A

Antagonists of α₁-adrenergic receptors
Relaxes smooth muscle of the peripheral vasculature
Vasodilation
↓ BP
(also relax smooth muscle of the prostate)

59
Q

Doxazosin, Terazosin Tamsulosin, Alfuzosin uses

A

HTN
Second-line
BPH

60
Q

Doxazosin, Terazosin Tamsulosin, Alfuzosin adverse effects

A

Orthostatic hypotension, dizziness, syncope, headache

61
Q

Doxazosin, Terazosin Tamsulosin, Alfuzosin interactions

A

Antihypertensive agents

62
Q

Doxazosin, Terazosin Tamsulosin, Alfuzosin counseling

A

May cause dizziness and/or drowsiness

Use caution when getting up from a sitting or lying position

63
Q

Doxazosin, Terazosin Tamsulosin, Alfuzosin key points

A

Indicated in HTN but not first-line

64
Q

Clonidine,

A

Alpha-2 Agonists

65
Q

Clonidine MOA

A

Stimulation of α-2 receptors in the brainstem

66
Q

Clonidine uses

A

HTN
Second-line
Other - Alcohol/heroin/nicotine withdrawal, etc.

67
Q

Clonidine adverse effects

A

Orthostatic hypotension, bradycardia
CNS depression, dizziness, drowsiness
Constipation, dry mouth, contact dermatitis
Withdrawal syndrome/rebound hypertension

68
Q

Clonidine interactions

A

Antihypertensive agents
CNS depressants
Beta-blockers

69
Q

Clonidine counseling

A

Do not abruptly stop taking medication
Oral therapy and transdermal therapy may overlap for 1-2 days
Apply transdermal patch weekly to clean hairless area of upper outer arm or chest and rotate sites weekly
Transdermal patch may contain metal – remove prior to MRI

70
Q

Clonidine key points

A

Often used in resistant HTN
High risk of rebound HTN if discontinued abruptly
Transdermal route takes 2-3 days for full therapeutic effect

71
Q

Hydralazine

A

Vasodilator

72
Q

Hydralazine MOA

A

Directly relaxes vascular smooth muscle

73
Q

Hydralazine uses

A

HTN
Heart Failure
Often used in combination

74
Q

Hydralazine adverse effects

A

Tachycardia, angina, headache

Drug-induced lupus-like syndrome

75
Q

Hydralazine counseling

A

Must be taken 3-4 times daily

Be aware of lupus-like symptoms

76
Q

Hydralazine key points

A

Often used in resistant HTN

Patient compliance may be an issue

77
Q

Angina

A

Chest pain or discomfort due to formation of atherosclerotic plaques within the coronary arteries causing decreased blood flow and lack of oxygen supply to the heart

78
Q

Isosorbide mononitrate, Nitroglycerin

79
Q

Isosorbide mononitrate, Nitroglycerin MOA

A

Stimulate cGMP production
Vascular smooth muscle relaxation
Vasodilation

80
Q

Isosorbide mononitrate, Nitroglycerin uses

A 
HTN
Heart Failure
Angina
Pulmonary HTN
Esophageal spastic disorders
81
Q

Isosorbide mononitrate key points

A

Used for long-term treatment of chronic angina

82
Q

Nitroglycerin key points

A

Used for relief of angina attacks only

Store in original container

83
Q

Isosorbide mononitrate, Nitroglycerin adverse effects

A

Hypotension, headache, lightheadedness, syncope, flushing

84
Q

Isosorbide mononitrate, Nitroglycerin interactions

A

Antihypertensive agents

Phosphodiesterase Inhibitors – AVOID/CI within 24 hours

85
Q

Isosorbide mononitrate, Nitroglycerin counseling

A

Headaches may occur - aspirin or APAP may be used to relieve pain
Extended-release tablets/capsules, sublingual tablets, transdermal patch

86
Q

Isosorbide mononitrate, Nitroglycerin key points

A

Nitrate-free interval

Angina

87
Q

Dihydropyridine MOA

A

Inhibit movement of calcium ions across cell membranes
Relaxation of coronary vascular smooth muscle
Vasodilation

88
Q

Dihydropyridine uses

A

HTN
Angina
Pulmonary HTN

89
Q

Dihydropyridine adverse effects

A

Hypotension, dizziness, lightheadedness, flushing, headache

Peripheral edema

90
Q

Dihydropyridine drug interactions

A

Antihypertensive agents

CYP3A4 inhibitors/inducers

91
Q

Dihydropyridine counseling

A

Notify physician if swelling of the hands and feet occur

92
Q

Dihydropyridine key points

A

Used primarily for HTN

Also in angina

93
Q

Arrhythmias

A

An irregular heart rhythm, or an abnormality in the timing or pattern of the heartbeat, causing the heart to beat too rapidly, too slowly, or irregularly

94
Q

Amiodarone MOA

A

↓HR

blocks Na channels, K channels, Ca channels, and Beta-receptors

95
Q

Amiodarone uses

A

Arrhythmias

96
Q

Digoxin MOA

A

Inhibits Na/K ATPase 

↑ intracellular Na and stimulation of Na/Ca exhange

97
Q

Digoxin uses

A

Arrhythmias

Heart failure

98
Q

Amiodarone adverse effects

A

Bradycardia, hypotension

Blue/grey skin discoloration, hyper/hypothyroidism, liver toxicity, pulmonary toxicity

99
Q

Amiodarone interactions

A 
Negative chronotropes (↓HR)
Drugs that prolong QT interval
Digoxin (reduce digoxin dose 50%)
Warfarin (reduce warfarin dose 50%)
100
Q

Digoxin adverse effects

A

GI toxicity
Visual disturbances
Cardiac toxicity

101
Q

Digoxin interactions

A 
Amiodarone, Dronedarone (reduce digoxin dose 50%)
Diuretics
Negative chronotropes (↓HR)
102
Q

Amiodarone counseling

A

Sunscreen

Monitor PFTs, TFTs, LFTs

103
Q

Amiodarone key points

A

Most commonly used anti-arrhythmic agent

104
Q

Digoxin counseling

A

Notify physician if any signs of toxicity occur

105
Q

Digoxin key points

A

Often used in symptomatic HF

Narrow therapeutic index

Intro To Drugs (13 decks)

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