CV meds Flashcards
May cause hypokalemia, myositis, and is hepatotoxic
Gemfibrozil
This antihypertensive should not be used in raynaud’s or peripheral vascular disease
Atenolol
Concommitant alcohol use results in severe hypotension. This medication is also potentitated by aspirin
Nitroglycerin
In hypothyroidism, this medication must be decreased. In hyperthyroidism and high fever, this medication dosage should be lowered
Digoxin
Inotropic and chronotropic medication that is a class II antiarrhythmic
Beta-blockers (atenolol, propranolol)
This medication should not be abruptly stopped because of risk of rebound hypertension and tachycardia. It s also contraindicated in asthma, AV blocks, and severe bradycardia
Carvedilol (beta-blocker)
Hydrochlorothiazide
i. ) Clinical Use
ii. ) Mechanism
a. ) HTN
b. ) CHF & Edema
c. ) Urolithiasis prevention & idiopathic hypercalciuria
d. ) Nephrogenic Diabetes Insipidus
a. ) Thiazide diuretic that acts in the DISTAL tubules & Ascending loop of henle. b. ) Increases sodium & potassium excretion c. ) Decreases hypercalciuria
Hydrochlorothiazide
iii. ) Side Effects
iv. ) Contraindications
a.) Hyponatremia, Hypokalemia, Hypomagnesemia
b.) Hyperglycemia
c.) Hyperlipidemia
d.) Hyperuricemia (imparied renal function)
e.) Hypercalcemia
Mneumonic = HyperGLUC + hypoM(i)NK
**Sulfa drug allergies
a. ) Anuria b. ) Electrolyte imbalances c. ) Sulfa allergies d. ) hepatic failure e. ) SLE f. ) DM
Hydrochlorothiazide
v. ) Interactions
vi. ) Monitoring Parameters
a. ) Supplement with minerals (Mg, K)
b. ) Avoid large calcium doses (to prevent hypercalcemia)
c. ) Interferes with anticoagulants
d. ) Potentiates digoxin and lithium toxicity
e. ) Interferes with oral hypoglycemics
f. ) NSAIDs decrease effects
a.) Monitor Calcium levels
This medication should not be given to people with ventricular arrhythmias but is used clinically in atrial fibrillation
Digoxin
This antihypertensive may also be used to treat urolithiasis because it reduces hypercalciuria
Hydrochlorothiazide
Carvedilol
i. ) Clinical Use
ii. ) Mechanism
a. ) Mild-to-Severe Heart failure (left ventricular dysfunction)
a. ) Non-selective Beta-Blocker
Carvedilol
iii. ) Side Effects
iv. ) Contraindications
a. ) Fatigue
b. ) Hypotension, dizziness
c. ) Hyperglycemia
d. ) Weight gain
e. ) Diarrhea
a. ) Asthma b. ) AV block c. ) Severe bradycardia d. ) Severe hepatic dysfunction
Carvedilol
v.) Interactions
vi.) Monitoring Parameters
v. ) Interactions
a. ) Inhibited by Fluconazole, Ketoconazole, NSAIDs & Sulfonamides
b. ) Serum levels increased by Clonidine and Cimetidine
vi. ) Monitoring Parameters
* *do NOT abruptly withdrawal Beta blockers -> rebound hypertension and tachycardia
Class III antiarrhythmic with some Class I and Class II effects
Amiodarone
Class I = Sodium Channel Blockers
Class II = Beta-blockers
Class III = Potassium Channel Blockers
Nitroglycerine
i. ) Clinical Use
ii. ) Mechanism
i. ) Clinical Use
a. ) Angina
b. ) Acute MI & Hypertensive Crisis (IV)
c. ) CHF
d. ) Topically applied for Raynaud’s syndrome
ii. ) Mechanism
a. ) Releases Nitric Oxide causing vasodilation
Nitroglycerine
iii. ) Side Effects
iv. ) Contraindications
iii. ) Side Effects
a. ) Postural Hypotension
b. ) Reduced efficacy over time
c. ) Reactive Tachycardia
d. ) Increased Oxygen consumption
iv. ) Contraindications
a. ) Discontinue if Blurry Vision or a Dry Mouth Occurs
b. ) Severe Anemia (because oxygen consumption is increased)
c. ) Glaucoma
d. ) Hypotension (because it vasodilates and may lower BP)
e. ) Hypertrophic Cardiomyopathy
Nitroglycerine
v.) Interactions
v. ) Interactions
a. ) Concommitant alcohol use results in severe hypotension
b. ) Potentiated by aspirin
c. ) Hypotension with calcium channel blockers and sildenafil (viagara)
d. ) Interferes with heparin
e. ) N-acetylcysteine helps reduce nitrate tolerance
***Titrated Withdrawal to prevent rebound angina
Amiodarone
i. ) Clinical Use
ii. ) Mechanism
i. ) Clinical Use
a. ) Serious ventricular arrhythmias
b. ) Chemical cardioversion of atrial fibrillation
* *Not a 1st line antiarrhythmic because of significant toxicity
ii. ) Mechanism
a. ) class III antiarrhythmic (potassium channel blocker) but it also mimics class I (sodium channel blockers) and class II (beta-blockers) meds
b. ) Delays depolarization in the SA node
Amiodarone
iii. ) Side Effects
iv. ) Contraindications
v. ) Interactions
a. ) Has a very long half-life
b. ) May alter thyroid function
iii. ) Side Effects
a. ) Hypotension, Bradycardia, CHF
b. ) Pulmonary Fibrosis
c. ) Hepatoxicity
d. ) Hypothyroidism/Hyperthyroidism (Amiodarone is 40% iodine by weight)
e. ) Skin deposits (grey/blue) resulting in photodermatitis
f. ) Corneal Deposits
iv. ) Contraindications
a. ) Sinus-node dysfunction
b. ) Second- or third-degree AV block
c. ) Bradycardia causing syncope
d. ) Breastfeeding
Amiodarone
v.) Interactions
a. ) Has a very long half-life
b. ) May alter thyroid function
Antihypertensive that reduces the efficacy of salbutamol and salmeterol
Propranolol
Contraindicated with glaucoma, and should be discontinued at the onset of blurry vision and/or dry mouth
Nitroglycerin
Side effects is most notably affecting the thyroid because 40% of its molecular weight is iodine. Therefore administration of this medication requires vigilant monitoring of thyroid function
Amiodarone (anti-arrhythmic)
Antihypertensive and chronotropic that enhances the effects of digitalis
Atenolol
Spironolactone
i. ) Clinical Use
ii. ) Mechanism
i. ) Clinical Use
a. ) Hyperaldosteronism
b. ) Hypokalemia
c. ) CHF with edema (can be paired with ACE inhibitor)
d. ) Hirsutism
ii. ) Mechanism
a. ) Potassium-sparing Aldosterone Receptor Antagonist in the distal renal tubules
b. ) Increases sodium and water excretion while sparing potassium
This cholesterol medication potentiates warfarin and increases the risk of myopathy when combined with statins
Gemfibrozil
Used to treat bradycardia, uveitis, and hyperhydrosis
Atropine (Muscarinic Antagonist)
Can be applied topically for Raynaud’s Syndrome because it increase nitric oxide release and subsequent vasodilation
Nitroglycerin
Spironolactone
iii. ) Side Effects
iv. ) Contraindications
iii. ) Side Effects
a. ) Hyperkalemia leading to arrhythmias
b. ) Gynecomastia & Antiandrogen effects
iv. ) Contraindications
a. ) Renal Impairment & Anuria
b. ) Hyperkalemia
Spironolactone
v. ) Interactions
vi. ) Monitoring Parameters
v. ) Interactions
a. ) Avoid potassium supplements & other potassium-sparing diuretics
vi. ) Monitoring Parameters
a. ) Potassium levels
Atropine
i. ) Clinical Use
ii. ) Mechanism
i. ) Clinical Use
a. ) Bradycardia & Heart Block
b. ) Uveitis
c. ) Hyperhydrosis
d. ) Organophosphate poisoning (components of insecticides)
e. ) PUD
ii. ) Mechanism
a. ) Muscarinic (Acetylcholine) Antagonist
*Acetylcholinesterase inhibitors (excess acetylcholine) cause the following symptoms: Diarrhea, Urination, Miosis, Bronchospasms, Bradycardia, Excitation of skeletal muscles, Lacrimation, Sweating, & Salivation.
Because Atropine is a muscarinic antagonist, it can be used as the antidote to AchE inhibitors, or for conditions such as bradycardia and hyperhydrosis
Atropine
iii. ) Side Effects
iv. ) Contraindications
iii. ) Side Effects
a. ) Dry mouth/eyes
b. ) Blurred vision & Photophobia (Mydriasis)
c. ) Confusion & hallucinations (CNS excitability)
d. ) Tachycardia & Ventricular fibrillation
iv. ) Contraindications
a. ) Closed-Angle Glaucoma (causes mydriasis)
b. ) IHD
Atropine
v.) Interactions
Antidotes
v. ) Interactions
a. ) Counteracts bradycardia drugs
Antidotes: physostigmine & pilocarpine
This cardiovascular medication inhibits Na-K pump in myocardial cells that corresponds with an increase in intracellular calcium and a longer action potential
Digoxin
Lisinopril
i. ) Clinical Use
ii. ) Mechanism
i. ) Clinical Use
a. ) HTN
b. ) CHF
c. ) Prevention of Diabetic Nephropathy
ii. ) Mechanism
a. ) ACE inhibition - Suppresses the synthesis of Angiotensin II (vasoconstrictor) & prevents the breakdown of bradykinin (a potent vasodilator)
This antihypertensive medication interferes with anticoagulants and potentiates lithium and digoxin
Hydrochlorothiazide
Lisinopril
iii. ) Side Effects
iv. ) Contraindications
iii.) Side Effects
a.) Cough, Angioedema, Proteinuria, Taste Changes (taste loss & metallic), Hypotension, Pregnancy problems (fetal renal damage), Rash, Increased Potassium (hyperkalemia), Lower angiotensin II
Mnemonic = CAPTOPRIL
iv. ) Contraindications
a. ) Angioedema
b. ) Bone marrow suppression
c. ) Renal artery stenosis
d. ) Pregnancy
e. ) Hyperkalemia
Lisinopril
v. ) Interactions
vi. ) Monitoring Parameters
v. ) Interactions
a. ) Increases Digoxin and Lithium levels and and their respective toxicities
b. ) High risk of hyperkalemia with potassium-sparing diuretics
vi. ) Monitoring Parameters
a. ) Potassium levels
This antihypertensive is metabolized by the P450 enzyme pathway
Amlodipine
This antihypertensive agent may be passed along to baby during breastfeeding.
Clonidine
This antihypertensive medication can also be used in nephrogenic diabetes insipidus
Hydrochlorothiazide
Lovastatin/Atorvastatin
Clinical Use
ii.) Mechanism
Clinical Use
a.) Hypercholesterolemia & Atherosclerosis
ii. ) Mechanism
a. ) HMG CoA reductase inhibitor -> mostly lowers LDL; variable effect on HDL
Lovastatin/Atorvastatin
iii. ) Side Effects
iv. ) Contraindications
iii. ) Side Effects
a. ) Inhibits CoQ10 formation & Myalgia
b. ) Elevated liver enzymes
c. ) Headaches
d. ) Photosensitivity
e. ) Hepatitis
iv. ) Contraindications
a. ) Liver & Kidney Disease
b. ) PUD
c. ) Pregnancy & Lactation
d. ) Poorly managed diabetes
This antihypertensive is contraindicated in metabolic acidosis, pheochromocytoma, raynaud’s, bradycardia, and CHF
Atenolol
Lovastatin/Atorvastatin
v. ) Interactions
vi. ) Monitoring Parameters
v. ) Interactions
a. ) Niacin = synergistic (sustained release increases toxicity though)
b. ) CoQ10 needed (to prevent its depletion)
c. ) Increases OCP levels
d. ) Potentiates digoxin & warfarin
vi. ) Monitoring Parameters
a. ) Liver enzymes (baseline, 6 weeks, 12 weeks)
b. ) Slit lamp to monitor for cataracts
c. ) Creatine phosphokinase if myalgia occurs
**should be taken at night because highest cholesterol production is between midnight and 5 am
Hypertensive medication that causes hyperglycemia, hypercalcemia, hyperuricemia, and hyperlipidemia
Hydrochlorothiazide
Contraindicated in Liver/Kidney Disease, Pregnancy/Lactation, PUD, and poorly managed diabetes.
Liver enzymes should be monitored at baseline, 6 weeks, and 12 weeks while on this medication
Atorvastatin
HMG-CoA Reductase inhibitor
Atorvastatin
Potently reduce triglycerides but is not as strong as niacin (but better tolerated)
Gemfibrozil
Class III antiarrhythmic.
Amiodarone
Class III = Potassium Channel Blockers. Work to delay depolarization of the SA Node, thereby slowing the heart rate and/or cardioverting the heart (atrial fibrillation or serious ventricular dysrrhythmia)
Phenylephrine
i. ) Clinical Use
ii. ) Mechanism
i.) Clinical Use
a.) Mydriatic Agent (eye drops)
b.) Hemorrhoids (symptomatic relief by decreasing swelling)
c.) Increase blood pressure (without affecting heart rate) -> septic shock
d.) Decongestant *nasal spray
(substitute to pseudoephedrine in cases where pseudoephedrine’s positive chronotropy & inotropy is a concern)
(oxymetazolin is a more commonly used nasal spray)
Controversial about whether or not it is an effective decongestant. There has been a push to use it to reduce the abuse of pseudoephedrine
ii. ) Mechanism
a. ) Selective Alpha-1 adrenergic receptor agonist
Phenylephrine
iii. ) Side Effects
iv. ) Contraindications
iii. ) Side Effects
a. ) HTN & Reflex Bardycardia
iv. ) Contraindications
a. ) Glaucoma (when using eye drops for mydriasis)
b. ) Prostatic Hyperplasia
Phenylephrine
v.) Interactions
a.) Extensively metabolized by MAO
Side effect of this antihypertensive is peripheral edema and reflexive tachycardi
Amlodipine
Digoxin
i. ) Clinical Use
ii. ) Mechanism
i. ) Clinical Use
a. ) CHF
b. ) Atrial fibrillation/flutter
ii. ) Mechanism
a. ) Cardiac glycoside = inhibits cardiac Na/K ATPase
b. ) Positively Inotropic (increases contractility) & Negatively Chronotropic (decreases heart rate)
* *makes the heart beat more efficienctly
This anti-arrhythmic is not used as a first line anti-arrhythmic because of its significant toxicity: pulmonary fibrosis, hepatotoxicity, thyroid problems, and skin deposits
Amiodarone
Digoxin
iii. ) Side Effects
iv. ) Contraindications
iii. ) Side Effects
a. ) Anorexia, Fatigue, Nausea/Vomiting (stimulates the vagus nerve)
b. ) Yellow-green halo in vision
c. ) Bradycardia & Arrhythmias
d. ) Gynecomastia
e. ) Loss of libido
iv. ) Contraindications
a. ) Hypokalemia, hypo- or hypercalcemia, hypomagnesemia
b. ) Ventricular arrhythmias
c. ) Kidney failure
d. ) Severe Carditis
Digoxin
v.) Interactions
v. ) Interactions
a. ) Toxicity is potentiated by potassium- and magnesium-depleting substances: Diuretics, Steroids, Glycyrrhiza
- **has a narrow therapeutic window
- ** recirculates in enterohepatic cycle (toxicity is thereby cumulative)
This anti-hypertensive medication should not be used in people with sulf drug allergies or in people with SLE
Hydrochlorothiazide
A non-selective phosphodiesterase inhibitor that also inhibits TNF-alpha & leukotriene synthesis often used in intermittent claudication
No major side effects, contraindications, or interactions
Pentoxifylline
This medication requires the practitioner to monitor calcium levels
Hydrochlorothiazide
This medication has reduced efficacy over time but can be given with N-acetylcysteine to help reduce the body’s tolerance to this medication
Nitroglycerin
Increases the incidence of gallstones
Gemfibrozil
This cardiovascular medication causes photodermatitis and corneal microdeposits
Amiodarone
Nitroglycerin cannot be used with what HTN related meds?
Calcium channel blockers and sildenafil (viagara)
Pentoxifylline
i. ) Clinical Use
ii. ) Mechanism
i. ) Clinical Use
a. ) Primarily used in Intermittent Claudication caused by Peripheral Arterial Disease
b. ) Multi-infarct Dementia
c. ) Alcoholic & Non-alcoholic Steatohepatitis
d. ) Sickle-cell anemia
e. ) Endometriosis
ii. ) Mechanism
a. ) Non-selective phosphodiesterase inhibitor
b. ) Inhibits TNF-alpha
c. ) Inhibitis Luekotriene synthesis
This antihypertensive prevents the excretion of lithium thereby potentiating its toxicity. This medication also competes with aspirin for renal excretion and therefore may cause aspirin toxicity
Furosemide
This medication suppresses the synthesis of Angiotensin II & prevents the breakdown of bradykinin
Lisinopril / Captopril / Ramipril
Angiotensin II = vasoconstrictor
Bradykinin = potent vasodilator
N-acetylcysteine can be taken as an adjunct to this medication to prevent tolerance
Nitroglycerin
Contraindicated in Sinus Node Dysfunction, 2nd/3rd Degree Heart Blocks, Bradycardia, & Breastfeeding. This medication also has a very long half-life
Amiodarone (anti-arrhythmic)
Gemfibrozil
i. ) Clinical Use
ii. ) Mechanism
i.) Clinical Use
a.) Reduce Triglycerides (strong, but not as strong as niacin), VLDL, LDL
b.) Modest increase in HDL
Hyperlipidemia Type III & IV
ii. ) Mechanism
a. ) Fibrate (increases the clearance of triglycerides by activating PPARa)
What medication is contraindicated in diabetes because it blunts the sympathetic response to hypoglycemia (sweating, agitation, tachycardia) and thereby masks severe hypoglycemic episodes
Atenolol
Gemfibrozil
iii. ) Side Effects
iv. ) Contraindications
v. ) Interactions
a. ) Potentiates Warfarin
b. ) Concomitant use with statins increases risk of myopathy
iii. ) Side Effects
a. ) GI distress
b. ) Increased incidence of gallstones
c. ) Hypokalemia
d. ) Myositis
e. ) Hepatotoxicity
iv. ) Contraindications
a. ) Liver disease
b. ) Biliary tract disease
c. ) Pregnancy
Gemfibrozil
v.) Interactions
v. ) Interactions
a. ) Potentiates Warfarin
b. ) Concomitant use with statins increases risk of myopathy
This antihypertensive causes hyponatremia, hypokalemia, hypomagnesemia, and hyperglycemia
Hydrochlorothiazide
This cardiovascular medication recirculates in the enterohepatic cycle and has a narrow therapeutic window with a long half-life (40 hours). Toxicity is a concern. The antidote is potassium, and antibodies against the medication.
Digoxin
This medication may cause an AV block, arrhythmia, yellow blurry vision, gynecomastia, and loss of libido.
Digoxin
Selective beta-1 blocker that is less likely to cause bronchospasms because it does not have an affinity for beta-2 receptors (responsible for keeping bronchial system open) in the lungs
Atenolol
Digoxin
i. ) Clinical Use
ii. ) Mechanism
i. ) Clinical Use
a. ) CHF (increases contractility)
b. ) Atrial Fibrillation (decreases SA & AV node conduction)
ii. ) Mechanism
a. ) Cardiac Glycoside = Positive Inotrope, Negative Chronotrope
b. ) Inhibits NA-K transport into myocardial cells causing an increase in intracellular sodium. Sodium is then exchanged with an influx of calcium. Higher calcium levels result in a prolonged action potential
Digoxin
iii. ) Side Effects
iv. ) Contraindications
iii. ) Side Effects
a. ) AV block
b. ) Arrhythmias
c. ) Blurry Yellow Vision
d. ) Diarrhea, Nausea, Vomiting
iv. ) Contraindications
a. ) AV block
b. ) Cardiomyopathy
c. ) Hypokalemia, Hypercalcemia
Digoxin
v.) Interactions
a. ) Digoxin has a very long half-life (40 hours). 75% of digoxin is bioavailable, the other 20-40% is protein bound
b. ) Toxicity is potentiated by potassium-depleting substances (furosemide, corticosteroids, thiazides, glycyrrhiza)
This blood pressure medication increases Digoxin & Lithium levels in the blood
Lisinopril / Captopril / Ramipril
This beta-blocker does not cross the BBB
Atenolol
It is less likely to have CNS side effects, in comparison to propranolol which does cross the BBB
This antihypertensive should not be used in severe coronary artery disease because it may further reduce cardiac output (negative inotropic activity
Amlodipine
Used in hyperaldosteronism, hypokalemia, and CHF or cirrhosis with edema
Spironolactone
This medication can be used to treat CHF.
Increases sodium and water excretion while reabsorbing potassium in the distal renal tubules
Spironolactone
Primarily used in Intermittent Claudication caused by peripheral arterial disease but may also be used in sickle-cell anemia, NASH, endometriosis, and multi-infarct dementia
Pentoxifylline
May cause gynecomastia, loss of libido, and electrolyte imbalances: hypokalemia, hypercalcemia, hypomagnesemia
Digoxin
This medication potentiates digoxin and warfarin. It may also cause cataracts, myalgia, and increase OCP levels
Atorvastatin
Anti-hypertensive contraindicated in aortic stenosis
Amlodipine
Anti-hypertensive agent that may cause insomnia, nightmares, and vivid dreams
Propranolol
