CV_Pharm Flashcards
Essential Hypertension - Tx?
- Diuretics
- ACE inhibitors
- Angiotensin II Receptor Blockers (ARBs)
- Calcium channel blockers
CHF - Tx?
- Diuretics
- ACE inhibitors/ARBs
- β-blockers (compensated CHF)
- K+ sparing diuetics
(β-blockers must be used cautiously in decompensated CHF, & are contraindicated in cardiogenic shock)
Diabetes Mellitus - Tx?
- ACE inhibitors / ARBs
- Calcium channel blockers
- Diuretics
- β-blockers
- α- blockers
4 Calcium channel blockers?
Nifedipine, Verapamil, Diltiazem, & Amlodipine
CC-blockers - MOA?
Block voltage-dependent L-type calcium channels of cardiac & smooth muscle & thereby reduce muscle contractility
Vascular SM – Amlodipine = Nifedipine > Diltiazem > Verapamil
Heart – Verapamil > Diltiazem > Amlodipine = Nifedipine
(Verapamil = Ventricles)
CC-blockers - Clinical uses?
- Hypertension
- Angina
- Arrhythmias (not nifedipine)
- Prinzmetal’s angina
- Raynaud’s
CC-blockers - Toxicity?
- Cardiac depression
- AV block
- Peripheral edema
- Flushing
- Dizziness
- Constipation
Hydralazine - MOA?
- ↑cGMP → smooth muscle relaxation
- Vasodilates arterioles > veins
- Afterload reduction
Hydralazine - Clinical uses?
- Severe hypertension
- CHF
- First-line therapy for hypertension in pregnancy, w/ methyldopa
- Frequently co-administered w/ a β-blocker to prevent reflex tachycardia
Hydralazine - Toxicity?
Compensatory tachycardia (contraindicated in angina/CAD)
- Fluid retention
- Nausea
- Headache
- Angina
- Lupus-like syndrome
Commonly used drugs for Malignant Hypertension?
Nitroprusside, Nicardipine, Clevidipine, Labetalol, & Fenoldopam
Nitroprusside - MOA?
↑cGMP via direct release of NO
short-acting
Nitroprusside - Toxicity?
Can cause cyanide toxicity (releases cyanide)
Fenoldopam - MOA?
- Dopamine D1 receptor agonist – coronary, peripheral, renal, & splanchnic vasodilation
- ↓BP
- ↑Natriuresis
Nitroglycerin - MOA?
- Vasodilate by releasing nitric oxide in smooth muscle, causing ↑ in cGMP & smooth muscle relaxation
- Dilate veins»_space; arteries
- ↓ preload
Nitroglycerin - Clinical uses?
- Angina
- Pulmonary Edema
Nitroglycerin - Toxicity?
- Reflex tachycardia
- Hypotension
- Flushing
- Headache
- “Monday disease” in industrial exposure: development of tolerance for the vasodilating action during the work week & loss of tolerance over the weekend results in tachycardia, dizziness & headache upon re-exposure
Goal of anti-anginal therapy?
Reduction of myocardial O2 consumption (MVO2) by decreasing 1 or more of the determinants of MVO2:
- end-diastolic volume
- blood pressure
- heart rate
- contractility
- ejection time
Which of the calcium-channel blockers is most similar to Nitrates?
Which is most similar to β-blockers?
Nitrates = Nifedipine
β-blockers = Verapamil
3 Class 1A anti-arrhythmic drugs?
Effect on AP duration?
Quinidine, Procainamide, Disopyramide
↑ AP duration
(also ↑ QT interval)
“A Queen Proclaims Diso’s pyramid”
3 Class 1B anti-arrhythmic drugs?
Effect on AP duration?
Lidocaine, Mexiletine, Tocainide
↓ AP duration
“I’d Buy Leyla’s Mexican Tacos”
also: “IB is Best post-MI”
2 Class 1C anti-arrhythmic drugs?
Effect on AP duration?
Flecainide, Propafenone
No effect on AP duration
“IC is Contraindicated in structural heart disease & post-MI”
List the Class 1 anti-arrhythmics groups in order of sodium-channel binding strengths (A, B, & C)
1C > 1A > 1B
(this is why 1C anti-arrhythmics exhibit use-dependence & build up their effect in tachyarrhythmias – but over time this can cause too great a delay in conduction speed, eventually promoting a new arrhythmia)
(1B have less affinity for sodium receptors & are more selective for ischemic myocardium — thus useful post-MI)
Which Class 1 anti-arrhythmic groups demonstrate the most & least use dependence?
1C = Most use dependence
1B = Least use dependence
