CV Flashcards
Which diuretics are highly efficient at moving large volumes of fluids (ie in HF)?
Loop diuretics
Furosemide
Torsemide
Bumetanide
Ethacrynic acid
How are loop diuretics usually used?
To treat edema
SYMPTOMATIC relief of HF, not first line antihypertensive)
Side effects of loop diuretics
HYPOkalemia - my require K+ supplementation
HYPOnatremia
HYPOcalcemia
HYPERuricemia
Which loop diuretics are contraindicated in patients with sulfa allergies?
Furosemide
Torsemide
Bumetanide
Ethacrynic Acid is OK (not a sulfa)
Which loop diuretic has the highest risk of ototoxicity
Ethacrynic acid
How are thiazides used?
To treat HTN, or to enhance antihypertensive actions of other drugs
Can be used for edema/MILD fluid retention in HF, but they are better as antihypertensives than they are at diuresis
What are the three thiazide diuretics?
HCTZ (Microzide)
Chlorothiazide (Diuril)
Metolazone (thiazide-related)
HCTZ and Chlorothiazide are contraindicated in patients with…
Sulfa allergy
Anuria
Anuria is a contraindication for…
Loop and thiazide diuretics
They’re gonna make you pee a lot, and if you CAN’T pee, you’re gonna be in trouble
Is metolazone contraindicated in patient’s with sulfa allergies?
Not contraindicated but use with CAUTION
Side effects of thiazide diurectics
HYPOkalemia HYPOnatremia HYPERuricemia Hypercholesterolemia Hyperglycemia ED
What should you monitor in patients on thiazides?
BP/orthostatic
Electrolytes
Renal function
Loops and thiazides may precipitate _____ at high doses
Gout
How are aldosterone antagonists and potassium sparing diuretics used?
Overall weak diuretic effect, used in combo with other diuretics to eliminate need for K+ supplementation)
Used to treat edema, HF (not first line for HTN)
What are the contraindications for aldosterone antagonists and potassium sparing diuretics?
HYPERKALEMIA
Anuria
Severe, progressive kidney disease/dysfunction
Use with caution with ACE-Is/ARBs
Which drugs are aldosterone antagonists?
Spironolactone (Aldactone)
Eplerenone (Inspra)
Which drugs are direct inhibitors of Na+ flux (used as potassium sparing diuretics)?
Triamterene (Dyrenium)
Amiloride
Major side effect of potassium sparing diuretics and aldosterone antagonists
Hyperkalemia (DUH)
Monitor potassium, BP, and renal function in these patients
Which HTN drugs are best for reducing mortality AND improving Sx of HF?
ACEIs (ie Lisinopril)
BBs (ie Metoprolol)
Which drugs are good at improving Sx of HF but do not reduce overalls mortality?
Loop diuretics
Contraindications for ACEIs and ARBs
Angioedema
Pregnancy
MOA for ACEIs
Block angiotensin converting enzyme and stop formation of angiotensin II
—> lower preload and afterload
Which drug is considered first-line in all patients with diabetes, CKD, and HFrEF?
ACEIs and ARBs
Can be used to treat HFrEF, HTN, STEMI
SE of ACEIs
DRY COUGH Orthostatic hypotension Hyperkalemia Angioedema Rash
Monitor: electrolytes, renal function, BP
MOA for beta blockers
ß-adrenergic antagonists —> negative chronotropy, negative inotropy, and reduced CO
Decrease mortality rate s/p MI, stable class II and III HF
How are beta blockers used?
To treat angina, HFrEF, and HTN (not first line but useful)
When are beta blockers contraindicated?
Severe bradycardia
2nd/3rd degree AV block
Uncompensated HF
SBP <100
Cardiogenic shock
Which beta blockers are non-selective?
Propranolol
Nadolol
Timolol
SE of NON-selective BBs
BRONCHOSPASM WORSEN CHF Raise lipids Impaired glucose tolerance FATIGUE Decreased libido/impotence Depression Insomnia
Which beta blockers are cardioselective?
Acebutolol
Atenolol
Metoprolol
Nebivolol
What happens to side effects when you used cardioselective BBs instead of non-selective?
They are reduced but not eliminated
Can raise lipids
Which beta blockers have intrinsic sympathomimetic activity?
Acebutolol
Pindolol
What is the biggest caution when using beta blockers?
Avoid abrupt withdrawal - can precipitate acute coronary events and severe increases in BP
What drug should you consider if you put your patient on an ACE and they can’t handle the cough?
Angiotensin Receptor Blocker (ARB) - the “sartans”
MOA for ARBs
Block angiotensin II from binding to AT1 receptors —> reduced preload and afterload
How are ARBs used?
To treat HFrEF, HTN, STEMI
Considered first-line in all patients with diabetes CKD, HFrEF
Effects of Digoxin
(+) Inotropy, (-) Chronotropy, increased CO
How is Digoxin used?
To treat mild to moderate HFrEF, a fib
Side effects of Digoxin
Arrhythmias
HA
Fatigue
Drowsiness
Digoxin has a narrow margin of safety, especially in patients with…
Reduced renal clearance and hypokalemia
Monitor ECG, electrolytes, renal function, and serum digoxin concentrations
What is considered to be “pre-hypertension”?
120-139 SBP or 80-89 DBP
What is considered to be stage 1 hypertension?
140-159 SBP or 90-99 DBP
What is considered to be Stage 2 hypertension?
≥160 SBP or ≥100 DBP
Lifestyle mods recommended to patients with HTN
Smoking cessation Salt restriction DASH Diet Exercise/physical activity Weight management
What are considered to be the four first line meds for HTN?
HCTZ, ACEIs, ARBs, CCBs
Which first line HTN meds are more effective in black patients?
HCTZ, CCB
Which HTN meds are more effective in non-black patients?
ACE-I, BBs
Which HTN meds are first line for patients with CKD?
ACE/ARBs
MOA for CCBs and how are they used?
(-) inotropy, relax smooth muscles (esp vascular)
Used to treat HTN, vasospastic angina
When are CCBs contraindicated?
SA or AV node abnormalities
BB
HF
Which type of CCBs are more potent vasodilators?
Dihydropyridines - ex: Nifedipine and other dipines
Cause arterial smooth muscle relaxation and decrease in PVR
SE of dihydropyridines
Short acting CCBs - may cause mild to moderate reflex tachycardia, may see SA, flushing, or PERIPHERAL EDEMA
Long-acting CCBs - usually only cause EDEMA
Which drugs are non-dihydropyridines?
Verapamil and Diltiazem
Less vasodilation effect, (-) inotropy, (-) chronotropy
SE of non-dihydropyridines
Constipation
Bradycardia
SA dysfunction
Heart block
Monitor BP, HR, edema
How do alpha blockers work?
Decrease vasoconstriction and reduce peripheral vascular resistance
Used to treat HTN in patients with BPH
Which drugs are alpha blockers?
Prazosin
Doxazosin
Terazosin
Non-selective: Phenoxybenzamine
Major side effect of alpha blockers
Orthostatic hypotension (first dose phenomenon)
Others: fatigue, weakness, nasal congestion, and HA
MOA for central alpha agonists?
Reduce sympathetic vasoconstriction and total peripheral vascular resistance
Used to treat refractory HTN (not first line)
What drugs are central alpha agonists?
Clonidine Methyldopa (recommended for use in pregnancy)
SE of central alpha agonists
Sedation/drowsiness
Xerostomia
Orthostatic hypotension
What should you warn patients about when taking central alpha agonists
Avoid abrupt withdrawal - can precipitate hypertensive crisis
What patient ed should you provide with sublingual nitro?
SE: orthostatic hypotension, THROBBING HA, tachycardia
Take one dose every 5 min for up to 3 doses —> call EMS if not improved after first dose
What drug is preferred for treatment of vasospastic (Prinzmetal) angina?
CCBs
When is nitro contraindicated?
Within 24 hours of Sildenafil
HCM
RV infarction
What are the different antianginal options?
Rapid-acting nitrates (ie Nitroglycerin) for acute angina or prophylaxis
Long-acting nitrates (ie Isosorbide dinitrate) for long term management of chronic stable angina
BBs/CCBs for long term management of chronic stable angina, sometimes unstable angina
