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PCM1 > CRS Drugs > Flashcards

CRS Drugs Flashcards

1
Q

Captopril

A

ACE Inhibitor

Inhibits conversion of Angiotensin I to Angiotensin II

First line treatment for Hypertension, particularly for patients with DM & CKD.

AE: Cough, Hyperkalemia, Angioedema, Acute Renal Failure (in pt with bilat renal art stenosis), rash, fever, altered taste.

Contraindications: Pregnancy, bilat renal art stenosis, hx of angioedema.

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2
Q

Enalapril

A

ACE Inhibitor

Inhibits conversion of Angiotensin I to Angiotensin II

First line treatment for Hypertension, particularly for patients with DM & CKD.

AE: Cough, Hyperkalemia, Angioedema, Acute Renal Failure (in pt with bilat renal art stenosis), rash, fever, altered taste.

Contraindications: Pregnancy, bilat renal art stenosis, hx of angioedema.

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3
Q

Lisinopril

A

ACE Inhibitor

Inhibits conversion of Angiotensin I to Angiotensin II

First line treatment for Hypertension, particularly for patients with DM & CKD.

AE: Cough, Hyperkalemia, Angioedema, Acute Renal Failure (in pt with bilat renal art stenosis), rash, fever, altered taste.

Contraindications: Pregnancy, bilat renal art stenosis, hx of angioedema.

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4
Q

Losartan

A

Angiotensin Receptor Blocker (ARB)

Blocks Angiotensin II receptors.

First line treatment for Hypertension as an alternative to ACE Inhibitors.

AE: Hyperkalemia, Angioedema, Acute Renal Failure (in pt with bilat renal art stenosis), rash, fever, altered taste.

Contraindications: Pregnancy, bilat renal art stenosis

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5
Q

Valsartan

A

Angiotensin Receptor Blocker (ARB)

Blocks Angiotensin II receptors.

First line treatment for Hypertension as an alternative to ACE Inhibitors.

AE: Hyperkalemia, Angioedema, Acute Renal Failure (in pt with bilat renal art stenosis), rash, fever, altered taste.

CI: Pregnancy, bilat renal art stenosis

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6
Q

Aliskiren

A

Renin Inhibitor

Inhibits Renin from converting Angiotensinogen into Angiotensin I

Alternative agent in treating hypertension.

AE: Hyperkalemia, Angioedema, Acute Renal Failure (in pt with bilat renal art stenosis), rash, fever, altered taste.

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7
Q

Verapamil

A

Calcium Channel Blocker. Non-dihydropyridine.

Blocks channels in both cardiac & vascular smooth muscle.

Used to treat angina, supraventricular tachyarrhythmias, hypertension, migraine, cerebral vasospasm.

Arrhythmias: Class IV, negative inotrope, negative chronotrope, negative dromotrope. Slow Phase 0 of SA node (inc PR). More effective against atrial arrhythmias.

AE: Constipation, negative inotropic effects, gingival hyperplasia, transient hypotension, CNS effects.

CI: pt with b blockers, 2nd or 3rd degree AV block, severe left vent diastolic dysfunction, digoxin, dofetilide, statins.

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8
Q

Diltiazem

A

Calcium Channel Blocker. Non-dihydropyridine.

Blocks channels in both cardiac & vascular smooth muscle.

Used to treat angina, supraventricular tachyarrhythmias, hypertension, cerebral vasospasm.

Arrhythmias: Class IV, negative inotrope, negative chronotrope, negative dromotrope. Slow Phase 0 of SA node (inc PR). More effective against atrial arrhythmias.

AE: Negative inotropic effects.

CI: Concomitant b blockers, 2nd or 3rd degree AV block, severe left vent diastolic dysfunction, digoxin, dofetilide, statins.

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9
Q

Amlodipine

A

Calcium Channel Blocker. Dihydropyridine.

Blocks channels in vascular smooth muscle leading to coronary & peripheral vasodilation.

AE: High doses can increase risk of MI (excess vasodilation causes reflex cardiac stimulation). Hypotension, peripheral edema, dizziness, headache, fatigue, gingival hyperplasia, flushing.

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10
Q

Nifedipine

A

Calcium Channel Blocker. Dihydropyridine.

Blocks channels in vascular smooth muscle leading to coronary & peripheral vasodilation.

AE: High doses can increase risk of MI (excess vasodilation causes reflex cardiac stimulation). Hypotension, peripheral edema, dizziness, headache, fatigue, gingival hyperplasia, flushing.

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11
Q

Furosemide

A

Loop Diuretic

Blocks Na/Cl/K cotransporter in ascending Loop of Henle.

Increases excretion of K, Ca, Mg. Increases renal blood flow, prostaglandin synthesis. Decreases renal vascular resistance.

AE: Ototoxic, hypokalemia, hypomagnesemia, allergic reactions.

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12
Q

Torsemide

A

Loop Diuretic

Blocks Na/Cl/K cotransporter in ascending Loop of Henle.

Increases excretion of K, Ca, Mg. Increases renal blood flow, prostaglandin synthesis. Decreases renal vascular resistance.

AE: Ototoxic, hypokalemia, hypomagnesemia, allergic reactions.

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13
Q

Bumetanide

A

Loop Diuretic

Blocks Na/Cl/K cotransporter in ascending Loop of Henle.

Increases excretion of K, Ca, Mg. Increases renal blood flow, prostaglandin synthesis. Decreases renal vascular resistance.

AE: Ototoxic, hypokalemia, hypomagnesemia, allergic reactions.

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14
Q

Hydrochlorothiazide

A

Thiazide Diuretic

Blocks Na/Cl cotransporter in distal tubule.

Increases excretion of K, Mg. Decreased excretion of Ca.

Useful in edema caused by mild-moderate HF, pre-menstrual edema, Diabetes insipidus.

First line treatment in htn with no co-morbidities. Second line in htn with all comorbidities except HF and MI.

AE: Metabolic alkalosis, hyperuricemia, hyperglycemia, hyperlipidemia, hypersensitivity, sexual dysfunction.

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15
Q

Chlorthalidone

A

Thiazide Diuretic

Blocks Na/Cl cotransporter in distal tubule.

Increases excretion of K, Mg. Decreased excretion of Ca.

Useful in edema caused by mild-moderate HF, pre-menstrual edema, Diabetes insipidus.

First line treatment in htn with no co-morbidities. Second line in htn with all comorbidities except HF and MI.

AE: Metabolic alkalosis, hyperuricemia, hyperglycemia, hyperlipidemia, hypersensitivity, sexual dysfunction.

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16
Q

Metolazone

A

Thiazide Diuretic

Blocks Na/Cl cotransporter in distal tubule.

Increases excretion of K, Mg. Decreased excretion of Ca.

Useful in edema caused by mild-moderate HF, pre-menstrual edema, Diabetes insipidus.

First line treatment in htn with no co-morbidities. Second line in htn with all comorbidities except HF and MI.

AE: Metabolic alkalosis, hyperuricemia, hyperglycemia, hyperlipidemia, hypersensitivity, sexual dysfunction.

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17
Q

Spironolactone

A

Aldosterone Antagonist (K sparing diuretic)

Aldosterone receptor antagonist in collecting tubule.

AE: Gastric upset & ulcers, antiandrogen effects, hyperkalemia, nausea lethargy + mental confusion.

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18
Q

Eplerenone

A

Aldosterone Antagonist (K sparing diuretic)

Aldosterone receptor antagonist in collecting tubule.

AE: Gastric upset & ulcers, antiandrogen effects, hyperkalemia, nausea lethargy + mental confusion.

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19
Q

Amiloride

A

Na Channel Inhibitor (K sparing Diuretic)

Blocks Na/K exchanger in collecting tubule.

Not efficacious alone, can prevent K loss associated with loop diuretics & thiazides.

AE: Hyperkalemia, leg cramps, GI upset, dizziness, pruritus, headache, visual changes.

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20
Q

Acetazolamide

A

Carbonic Anhydrase Inhibitor

Inhibit Carbonic Anhydrase in proximal tubule.

Cause metabolic acidosis, increases urinary pH.

AE: Metabolic acidosis, hyponatremia, hypokalemia, crystalluria, malaise, fatigue, depression, headache, GI upset, drowsiness paresthesia.

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21
Q

Mannitol

A

Osmotic Diuretic

Raises plasma osmotic pressure, draws H2O out of tissues and promotes diuresis. Does not directly affect Na excretion.

Increases urine flow in patients with renal failure. Reduce increased ICP & cerebral edema.

AE: Tissue dehydration, extracellular water expansion, don’t give in CHF or Pulmonary Edema.

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22
Q

Conivaptan

A

ADH Antagonist

Antagonist at ADH V1 and V2 receptor (collecting tubule). Decreases H2O reabsorption.

Used in euvolemic & hypervolemic hyponatremia, SIADH and some cases of CHF.

Potent inhibitor of CYP3A4.

AE: Infusion site reactions, thirst, Afib, GI & electrolyte disturbances, Nephrogenic Diabetes Insipidus.

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23
Q

Propranolol

A

Non-selective B blocker.

Used as add-on therapy to first-line agents in primary prevention patients. First-line therapy in patients with CAD, HF, post-MI.

Arrhythmia: Class II. Reduce incidence of arrhythmia after MI. Control of ventricular and supraventricular tachycardia.

AE: Bradycardia, hypotension, CNS effects.

CI: Acute CHF, severe bradycardia, heart-block, severe hyperactive airway disease.

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24
Q

Metoprolol

A

Selective B1 blocker

Used as add-on therapy to first line agents in primary prevention patients. First-line therapy in patients with CAD, HF, post-MI.

Arrhythmia: Class II. Reduce incidence of arrhythmia after MI. Control of ventricular and supraventricular tachycardia.

AE: Bradycardia, hypotension, CNS effects.

CI: Acute CHF, severe bradycardia, heart-block, severe hyperactive airway disease.

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25
Q

Atenolol

A

Selective B1 blocker

Used as add-on therapy to first line agents in primary prevention patients. First-line therapy in patients with CAD, HF, post-MI.

Arrhythmia: Class II. Reduce incidence of arrhythmia after MI. Control of ventricular and supraventricular tachycardia.

AE: Bradycardia, hypotension, CNS effects.

CI: Acute CHF, severe bradycardia, heart-block, severe hyperactive airway disease.

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26
Q

Pindolol

A

Non-selective B1 & B2 partial agonist

Used as add-on therapy to first line agents in primary prevention patients. First-line therapy in patients with CAD, HF, post-MI.

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27
Q

Prazosin

A

A1 antagonist

Lower PVR and arterial BP. No long-term tachycardia. Causes Na & H2O retention.

Side effect profile means they are used to treat BPH less than HTN.

AE: Orthostatic hypotension, short-term reflex tachycardia, dizziness, drowsiness, headache, lack of energy, nausea, palpitations.

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28
Q

Doxazosin

A

A1 antagonist

Lower PVR and arterial BP. No long-term tachycardia. Causes Na & H2O retention.

Side effect profile means they are used to treat BPH less than HTN.

AE: Orthostatic hypotension, short-term reflex tachycardia, dizziness, drowsiness, headache, lack of energy, nausea, palpitations.

Can increase rate of Congestive HF (specific to doxazosin)

29
Q

Labetalol

A

Mixed a and b blocker

Safe in pregnancy. Does not cause reflex tachycardia.

Can be used to treat hypertensive emergency.

AE: Orthostatic hypotension. Contraindicated in COPD, asthma, 2nd or 3rd degree AV block or bradycardia.

30
Q

Clonidine

A

Central A2 agonist

Acts on presynaptic a2 autoreceptors, reduces central sympathetic outflow.

Doesn’t lower Renal Blood Flow & GFR. Manage hypertension.

AE: Rebound hypertension with abrupt withdrawal (don’t use with b blockers). Drowsiness, dry mouth, dizziness, headache, sexual dysfunction.

31
Q

Methyldopa

A

Central A2 agonist

Acts on presynaptic a2 autoreceptors, reduces central sympathetic outflow.

Doesn’t lower Renal Blood Flow & GFR. Manage hypertension. SAFE IN PREGNANCY.

AE: Rebound hypertension with abrupt withdrawal (don’t use with b blockers). Drowsiness, dry mouth, dizziness, headache, sexual dysfunction. NIGHTMARES, mental depression, vertigo, reversible lupus like syndrome, positive Coombs test, hemolytic anemia, hepatitis, drug fever.

32
Q

Hydralazine

A

Direct Vasodilator

Directly vasodilates arterioles. Produces reflex tachycardia, increases plasma renin. Used as last-line hypertension therapy.
Treat PREGNANCY induced hypertensive emergencies.

AE: Fluid retention, reflex tachycardia, reversible lupus-like syndrome, headache, nausea, sweating, flushing, used with b blocker & thiazide.

33
Q

Minoxidil

A

Direct Vasodilator

Directly vasodilates arterioles. Produces reflex tachycardia, increases plasma renin. Used as last-line hypertension therapy.

AE: Fluid retention, reflex tachycardia, used with b blocker & loop diuretic. Hypertrichosis (can be used to treat baldness)

34
Q

Epoprostenol

A

Synthetic PGI2

Lowers peripheral, pulmonary & coronary resistance. Used in pulmonary HTN, given by continuous infusion.

AE: Flushing, headache, jaw pain, diarrhea, arthalgia.

35
Q

Bosentan

A

Nonselective endothelin receptor blocker.

Blocks ETa and ETb responses to endothelin. Extremely unsafe in pregnancy (cat X).

36
Q

Sildenafil

A

Phosphodiesterase Inhibitor

Increases cGMP, relaxes smooth muscle.

AE: Headache, flushing, dyspepsia, cyanopsia.

Contraindication: Nitrates

37
Q

Sodium Nitroprusside

A

IV Vasodilator

Prompt vasodilation of peripheral arterial & venous SM. Reflex tachycardia.

Treat hypertensive crisis.

AE: Hypotension, goose bumps, abdominal cramping, nausea, vomiting, headache. Cyanide toxicity can be treated with Sodium Thiosulfate.

38
Q

Fenoldopam

A

Peripheral D1 agonist

Evokes arteriolar dilation. Maintains or increases renal perfusion as lowers BP.

Safe for all hypertensive emergencies, particularly beneficial in pt with renal insufficiency.

Contraindication: Glaucoma

39
Q

Nicardipine

A

Calcium Channel Blocker

Evokes reflex tachycardia. IV infusion for hypertensive emergency.

40
Q

Nitroglycerin

A

Vasodilator through guanylyl cyclase activation

More effect on veins than arteries.

DOC for hypertensive emergencies in patients with cardiac ischemia & angina.

AE: Hypotension

41
Q

Diazoxide

A

K channel opener

Prevents SM contraction and thus opens K channels.

AE: Hypotension, reflex tachy, Na & H2O retention.

Inhibits Insulin release & treats hypoglycemia secondary to insulinoma.

42
Q

Phentolamine

A

Reversible non-selective alpha blocker

DOC for patients with catecholamine related emergencies.

43
Q

Esmolol

A

B1 selective blocker

Short-acting.

Treat aortic dissection or post-op htn. IV treatment of acute arrhythmias in surgery or emergency situations.

44
Q

Sacubitril

A

Neprilysin Inhibitor

Given together with Valsatran: ARNI

Prevents breakdown of BNP, bradykinin, Ag II

AE: Hypotension, Hyperkalemia, Teratogenic, worsens renal function, Cough

CI: Hx of angioedema with ACEI or ARB. Concomitant use of ACEI or ARB. Concomitant use of Aliskiren.

45
Q

Isosorbide Dinitrate

A

Direct Vasodilator

Treatment of HFrEF. Used concurrently with Hydralazine in pt who cannot tolerate ACEI/ARB or African American pt.

CI: PDE5 inhibitors.

46
Q

Dapagliflozin

A

SGLT2 Inhibitor

Decrease Glucose reabsorption in prox tubule –> inc Glucose in urine.
Mechanism of help in HFrEF unclear. Most effective in pt with DM2.

AE: UTI, volume depletion, inc serum creatinine, hyperkalemia, hypermagnesemia, hyperphosphatemia, hypotension.

47
Q

Digoxin

A

Cardiac Glycoside

Inhibits Na/K ATPase leading to indirect inhibition of Na/Ca exchanger, leading to higher intracellular Ca.

Positive inotrope. Negative chronotrope. Negative dromotrope. Treat HF with afib.

AE: Arrhythmias, anorexia nausea & vomiting, headache, fatigue, confusion, blurred vision, altered color perception, halos around dark object.

Predisposing factors: Hypokalemia, quinidine/verapamil/amiodarone.

CI: Diastolic (HFpEF) or right-sided HF, uncontrolled HTN, bradyarrhythmias.

48
Q

Vericiguat

A

Soluble guanylate cyclase stimulator

Vasodilator, decreases heart fibrosis/hypertrophy/inflammation. Increases renal blood flow.

AE: Hypotension, dizziness, nausea, abdominal discomfort, diarrhea, syncope.

CI: PDE5 inhibitors

49
Q

Ivabradine

A

If current inhibitor

Decreases rate of SA/AV node depolarization, thus decreasing HR.

AE: Bradycardia, afib, sinus arrest, QT prolongation/Torsade de pointes.

CI: HFpEF, decompensated HF, Arrhythmia, heart block, hypotension & bradycardia, liver failure, use of CYP3A4 inhibitors (verapamil, diltiazem)

50
Q

Inamrinone

A

PDE3 inhibitor

Increases myocardial cAMP. Positive inotrope. Systemic & Pulmonary vasodilator. Short term therapy for patients with intractable HF.

51
Q

Milrinone

A

PDE3 inhibitor

Increases myocardial cAMP. Positive inotrope. Systemic & Pulmonary vasodilator. Short term therapy for patients with intractable HF.

52
Q

Dopamine

A

Stimulates adrenergic & dopaminergic receptors.

Increases renal blood flow, cardiac stimulation.

Treat cardiogenic shock which persists after adequate fluid replacement.

53
Q

Dobutamine

A

A1, B1, B2 agonist.

At therapeutic levels predominantly stimulates B1, potent inotrope with little chronotrope effect. Increases CO in acute treatment of HF.

54
Q

Glucagon

A

Gs stimulator

Similar effects to b-agonists without the need of functioning b receptors.

Used as cardiac stimulant in managing b-blocker overdose.

55
Q

Quinidine

A

Class IA Antiarrhythmic

Blocks fast inward Na channels. Slows phase 0 (inc QRS). Blocks K channels (Class 3 activity). Slows phase 3 (inc QT).

Suppress Supraventricular & Ventricular arrhythmias.

CYP2D6, CYP3A4, and P-glycoprotein inhibitor.

AE: Arrhythmias (Torsade De Pointes), SA/AV block, asystole, nausea, vomiting, diarrhea, thrombocytopenic purpura. VTach. Cinchonism (blurred vision, tinnitus, headache, psychosis)!, a-adrenergic blocker, antimuscarinic. Increase [digoxin].

CI: Complete heart block!, prolonged QT interval, hx of torsade de pointes, incomplete heart block, decomp HF, myocarditis, severe myocardial damage.

56
Q

Procainamide

A

Class IA Antiarrhythmic

Blocks fast inward Na channels. Slows phase 0 (inc QRS). Blocks K channels (Class 3 activity). Slows phase 3 (inc QT).

Suppress Supraventricular & Ventricular arrhythmias.

Metabolized by CYP2D6 and acetylated to NAPA.

AE: Reversible lupus-like syndrome!, asystole, ventricular arrhythmias, CNS effects, hypotension, weak anticholinergic effects.

CI: Hypersensitivity, complete heart block, 2nd degree AV block, Lupus, Hx of torsade de pointes, HF, hypertension.

57
Q

Disopyramide

A

Class IA Antiarrhythmic

Blocks fast inward Na channels. Slows phase 0 (inc QRS). Blocks K channels (Class 3 activity). Slows phase 3 (inc QT).

Suppress Supraventricular & Ventricular arrhythmias.

Strong antimuscarinic. Stronger negative inotrope than other Class IAs. Peripheral vasoconstrictor.

AE: Antimuscarinic effects (dry mouth, urinary retention, blurred vision, constipation). Hypotension, cardiac failure without pre-existing myocardial dysfunction.

58
Q

Lidocaine

A

Class IB Antiarrhythmic

Block fast inward Na channels. Slows phase 0 (inc QRS). Shortens phase 3 (dec QT).

Acute treatment of ventricular arrhythmias. Treatment of digoxin arrhythmias.

IV only

AE: Drowsiness, slurred speech, agitation. Arrhythmias. Toxic doses: convulsions, coma.

59
Q

Mexiletine

A

Class IB antiarrhythmic

Block fast inward Na channels. Slows phase 0 (inc QRS). Shortens phase 3 (dec QT).

Management of ventricular arrhythmias.

IV or oral. Orally active lidocaine derivative.

AE: Drowsiness, slurred speech, agitation. Arrhythmias. Toxic doses: convulsions, coma. GI side effects.

60
Q

Flecainide

A

Class IC anti-arrhythmic

Markedly depresses Phase 0 (inc QRS). Prominent effects even at normal heart rate.

Treat severe ventricular & supraventricular arrhythmias, & prevent paroxysmal afib.

AE: Negative inotrope, CNS effects, GI effects, Arrhythmias & Vtach

CI: CHF, Structural Heart Disease!

61
Q

Propafenone

A

Class IC Antiarrhythmic

Markedly depresses Phase 0 (inc QRS). Prominent effects even at normal heart rate. Also has b-blocking activity.

Treat severe ventricular & supraventricular arrhythmias, & prevent paroxysmal afib.

AE: Negative inotrope, CNS effects, GI effects, Arrhythmias & Vtach

CI: CHF, Structural Heart Disease!, COPD

62
Q

Amiodarone

A

Class III Anti-arrhythmic

Has Class I, II, and IV effects, but III predominant.

Manage Vent & Supravent arrhythmias. DOC for Acute VTach refractory to shock. Low doses maintain normal sinus rhythm in afib.

Oral & IV. Very high VD and half-life, effects and AE may take 6 weeks to be achieved.

AE: Interstitial Pulmonary Fibrosis!, Blue Skin!, Av block, arrhythmias.

CI: Concomitant use of Digoxin, theophylline, warfarin, quinidine. Bradycardia, SA/AV block, hypotension, resp failure.

63
Q

Sotalol

A

Class III antiarrhythmic

Also a potent non-selective B-blocker.

Treat life-threatening vent arrhythmias. Maintain sinus rhythm in pt with afib and aflutter who are currently in sinus rhythm.

AE: Same as b-blockers, Torsade De Pointes, arrhythmias (lowest rate of adverse effects).

CI: Renal impairment

64
Q

Dofetilide

A

Class III anti-arrhythmic

Potent and pure K channel blocker. Prolong Phase 3 (inc QT). Phase 3 unaltered.

Convert Afib & Aflutter to normal sinus rhythm. Maintain normal sinus rhythm in pt with chronic afib/flutter.

AE: Vtach, Torsade De Pointes, CNS effects, chest pain.

65
Q

Adenosine

A

Nucleoside (P1 receptor agonist)

High doses: Decreased conduction velocity & prolongs refractory period. Enhances K conductance, hyperpolarizes AV node.

DOC for abolishing acute supraventricular tachycardia.

AE: Flushing, burning, chest pain, hypotension, bronchoconstriction in asthmatics.

66
Q

Magnesium

A

Functional Ca antagonist

Treat Torsade De Pointes, Digoxin arrhythmia, prophylaxis of arrhythmia in acute MI

67
Q

Atropine

A

Anti-muscarinic

Treat bradyarrhythmias by decreasing vagal tone

68
Q

Ranolazine

A

Na channel blocker

Blocks Na current of Na/Ca exchanger, decreases intracellular Ca level.

Produces myocardial relaxation and reduces myocardial O2 demand.

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