CV Pharm II Flashcards by Kate Leavens

How do Angiotensin II receptor antagonists ARB’s work?

Block type I angiotensin II receptors on blood vessels and the heart

How well did you know this?

Not at all

Perfectly

What drugs are in the ARB class of anti hypertensives?

Valsartan, Irbessartan, Valsartan

How well did you know this?

Not at all

Perfectly

When are ARBs indicated?

HTN, congestive heart failure

How well did you know this?

Not at all

Perfectly

What is the MOA of ARBs?

i. Vasodilator
ii. Down regulate sympathetic adrenergic activity
iii. Promote renal excretion of sodium and water
iv. Inhibit cardiac and vascular remodeling

How well did you know this?

Not at all

Perfectly

When are ARBs CI?

Pregnancy
Bilateral renal artery stenosis

How well did you know this?

Not at all

Perfectly

how do ACE inhibitors work?

i. Vasodilator
ii. Down regulate sympathetic adrenergic activity
iii. Promote renal excretion of sodium and water
iv. Inhibit cardiac and vascular remodeling

How well did you know this?

Not at all

Perfectly

What are ACEI used for?

HTN
Edema
CHF

How well did you know this?

Not at all

Perfectly

What are some of the AEs of ACE inhibitors?

Dry cough
Angioedema
Hyperkalemia
Hypotension

How well did you know this?

Not at all

Perfectly

Which drugs are from the class of ACE inhibitors?

Lisinopril, Ramipril

How well did you know this?

Not at all

Perfectly

When are ACE inhibitors CI?

Pregnancy
Bilateral renal artery stenosis

How well did you know this?

Not at all

Perfectly

Which drugs are in the Beta Blocker class of anti hypertensives?

Atenolol, Metoprolol, Carvedilol, Propranolol

How well did you know this?

Not at all

Perfectly

Which beta blocker is B-1 selective?

Atenolol, Metoprolol

How well did you know this?

Not at all

Perfectly

Which beta blockers affects B1 and B2 receptors?

Carvedilol
Propranolol

How well did you know this?

Not at all

Perfectly

What drugs act as an alpha and beta adrenergic blocker?

Carvedilol

How well did you know this?

Not at all

Perfectly

What is the advantage of using atenolol or metoprolol, a beta-1 blocker only?

Less bronchoconstriction than agents that bond to B-2 receptors

How well did you know this?

Not at all

Perfectly

How do B-1 blockers work?

Selective sympatholytic agent
Causes decreased HR and output
Decreases renin release

How well did you know this?

Not at all

Perfectly

What are the AEs of beta blockers?

May worsen CHF
Bradycardia
Cold extremities
Reduced exerces capacity
Fatigue
Hypotension
Impotence

How well did you know this?

Not at all

Perfectly

What are the other uses for propranolol?

i. Migraine prophylaxis
ii. Hyperthyroidism
iii. Benign essential tremor

How well did you know this?

Not at all

Perfectly

What is one of the SEs of propranolol?

Bronchoconstriction so CI in asthma or COPD pts

How well did you know this?

Not at all

Perfectly

Which population should you be cautious of prescribing of beta blockers?

Diabetics, may mask the tachycardia associated with hypoglycemia

How well did you know this?

Not at all

Perfectly

What are the CIs of beta blockers?

Sinus bradycardia
Partial AV block

How well did you know this?

Not at all

Perfectly

What black box warning is associated with beta blockers?

Increased risk of angina pectoris and MI with abrupt discontinuation

How well did you know this?

Not at all

Perfectly

Which drugs are Calcium Channel blockers?

Dihydropyridine : Amlodipine
Nondihyropyridine : Diltiazem, Verapamil

How well did you know this?

Not at all

Perfectly

What is the MOA of CCBs?

i. Calcium channel antagonist which reduces calcium influx into cardiac cells
ii. Vascular smooth muscle relaxation : vasodilatioin
iii. Decreased myocardial force generation (negative inotropy)
iv. Decreased HR (negative chronotropy)

How well did you know this?

Not at all

Perfectly

What are some of the uses for CCB?

HTN Angina Arrhythmias

What are some of the AEs of CCBs?

Dizziness Peripheral edema Hypotension Nausea Fatigue

What are CIs for prescribing CCBs?

Preexisting bradycardia Conduction defects or systolic function HF

Which hypertensive drug class should not be given together with CCBs?

Beta Blockers

What is the MOA of Clonidine?

Centrally acting alpha-2 agonist

What are some of the AEs of Clonidine?

Sedation Dry mouth Bradycardia **Orthostatic hypotension** Impotence Edema

What is the prototype anti-angina drug?

Nitroglycerine

How does nitroglycerin work?

Releases nitrous oxide into smoooth muscle causing relaxation

What situation is nitroglycerin best used in?

Acute angina due to its rapid onset

What are the AEs of nitroglycerin?

Postural hypotension HA

What is Digoxin used for?

Congestive HF

How does Digoxin work?

Decreased HR Increases contractility Makes heart beat more efficiently

What are some of the side effects of digoxin?

i. Cardiac arrhythmia : atrial tachycardia and AV block ii. Bradycardia iii. Fatigue iv. N/V v. changes in mood and mental alertness vi. Vision changes - yellow/green vision

What do you need to be careful of when prescribing digoxin?

It has a very narrow therapeutic window so levels need to be checked frequently

What is the effect of amiodarone on CYP450?

Inhibits 2C9, 2D6, and 3A4/5/7 significantly

When is amiodarone used?

Tacharrhythmias

What effect does amiodarone have on digoxin’s pharmacokinetics?

Doubles half-life, so cut dose in half

What is the interaction of amiodarone with warfarin?

Potentiates it, inceases risk of bleeding

What are the different types of diuretics?

i. Loop diuretics ii. Thiazide diuretics iii. Potassium sparing diuretics

What is the order of strength for the different diuretics from strongest to weakest?

i. Loop diuretics ii. Thiazide diuretics iii. Potassium sparing diuretics

What is the loop diuretic?

Furosemide

How do loop diuretics work?

They alter sodium transport in the loop of Henle

What is furosemide used for?

i. HTN ii. Edema iii. Pulmonary edema iv. Ascites v. CHF

What are some of the AEs of furosemide?

i. Hypokalemia ii. Hyperuricemia iii. Electrolyte imbalances iv. Ototoxic

How do thiazide diuretics work?

They act on the distal tubules to increase NaCl excretion i.e. inhibit sodium and chloride reabsorption

What is the prototype of thiazide?

Hydrochlorothiazide

What are uses for hydrochlorothiazide?

i. HTN ii. Edema iii. Diuresis

What are the AEs of hydrochlorothiazide?

i. Hypertriglyceridemia ii. Electrolyte imbalances iii. Decreased glucose tolerance

What are the CIs of hydrochlorothiazide?

i. Cannot be taken with sulfonamide ii. Cannot be taken with quinidine

How do potassium sparing diuretics work?

They act as antagonists to aldosterone, therefore stopping aldosterone from retaining sodium

What are the potassium sparing diuretics?

Spironolactone Triamterene

What are the AEs of potassium sparing diuretics?

i. Hyperkalemia ii. Metabolic acidosis iii. Impotence iv. Gynecomastia

What is the prototype cholesterol lowering medication?

Statin Drugs : Atorvastatin, Simvastatin

How do statin medications work?

It inhibits the enzyme HMG CoA reductase, which is the enzyme invovled in cholesterol synthesis

What is the indication for statin medications?

i. Dyslipidemia ii. Prevention of complications of atherosclerosis

What nutrient is depleted by statin medications?

CoQ10

Which cholesterol molecule does statin medications have the greatest impact upon?

Lowering LDL

What are some of the AEs of statins?

i. Increase LV enzymes ii. Nasopharyngitis iii. Arthralgia iv. Diarrhea v. Hyperglycemia and diabetes **vi. Black box warning : Rhabdomyolysis**

What are the CIs for statins?

i. Active LV disease ii. Pregnancy / lactation

Which drugs interact with statins?

i. Gemfibrozil, Niacin ii. CCBs iii. Azole anti-fungals iv. Amiodarone v. Erythromycin vi. Grapefruit juice

What action does Gemfibrizol have on lipids?

Lowers VLDL and triglyceride levels

What are some of the SEs of Gemfibrizol?

Cholelithiasis Rhabdomyolysis which combined with statins Nausea

What is the MOA of Terazosin?

Selective A-1 antagonist that causes vasodilation by blocking the binding of norepinephrine to the smooth muscle receptors.

When should Terazosin not be used?

Heart failure and angina

Terazosin AEs

Dizziness Nasal Congestion Orthostatic hypotension HA Edema

What is hydralazine used for?

Acute HTN emergencies due to its direct vasodilating effects

What are some AEs of hydralazine?

HA Flushing Tachycardia Angina Lupus-like syndrome (rare)

What is different about effect of Isosorbidemononitrate?

Longer onset and duration of action than nitroglycerin

How does carvedilol act?

Non specific alpha/beta1 blocker

When is carvedilol indicated?

Congestive HF

What type of Anti-arrhythmic is Flecainide?

Sodium Channel Blocker

What type of arrhythmia is Flecainide used for?

Life threatening supraventricular tachyarrythmias

What can Flecainide cause?

Increased risk of sudden death in pts with prior MI or sustained ventricular arrthmias

What is the action of Colesevelam?

Bile acid sequestrant : binds bile acids in intestine to prevent absoprtion

What are the common SEs of Colesevelam?

Abdominal Pain and constipation

What other conditions is Colesevelam used in?

DMII

What is the action of ezetimibe?

Inhibits cholesterol absorption in small intestine

SEs of ezetimibe

Rhabdomyolysis, diarrhea, pancreatitis, URI symptoms

What medications should not be taken with Ezetimibe?

1. Gemfibrozil 2. Cyclosporine 3. Fenofibrate in a pt with cholelithiasis 4. Statin those with severe LV disease

CI of Digoxin

It is potentiated by potassium loss, therefore CI with diuretics