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CVPR > CVPR Cardiovascular pharmacology > Flashcards

CVPR Cardiovascular pharmacology Flashcards

1
Q

Primary HTN AKA

A

Essential hypertension

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2
Q

Drugs to treat primary hypertension

4 listed

A
  • Thiazide diuretics
  • ACE inhibitors
  • Angiotensin II receptor blockers (ARBs)
  • Dihydropyridine Ca channel blockers
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3
Q

Drugs to treat hypertension with HF

5 listed

A
  • Diuretics
  • ACE inhibitors
  • ARBs
  • Β-blockers cautiously in decompensated HF
  • Aldosterone antagonists
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4
Q

Β-blockers in HF

A

Β-blockers must be used cautiously in decompensated HF and are contraindicated in cardiogenic shock

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5
Q

Β-blockers in cardiogenic shock

A

Contraindicated in cardiogenic shock

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6
Q

HF and ARBs

A

May be combined with the neprilysin inhibitor Sacubitril

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7
Q

Drugs to treat hypertension with diabetes mellitus

5 listed

A
  • ACE inhibitors
  • ARBs
  • Ca channel blockers
  • Thiazide diuretics
  • Selective β-blockers
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8
Q

ARBs and ACE inhibitors and diabetes

A

ARBs and ACE inhibitors are protective against diabetic nephropathy

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9
Q

Drugs to treat hypertension with asthma

A
  • ARBs
  • Ca channel blockers
  • Thiazide diuretics
  • Selective β-blockers
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10
Q

Β-blockers and asthma

A

Avoid nonselective β-blockers to prevent the blockade of β2-receptor-induced bronchodilation

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11
Q

ACE inhibitors and asthma

A

Avoid ACE inhibitors to prevent confusion between drug or asthma-related cough

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12
Q

Drugs to treat HTN in pregnancy

4 listed

A
  • Hydralazine
  • Labetalol
  • Methyldopa
  • Nifedipine
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13
Q

Nmeumonic for drugs to treat HTN in pregnancy

A

He likes My Neonate

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14
Q

Classes of Ca channel blockers

A
  • Dihydropyridines
  • Non-dihydropyridines
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15
Q

Dihydropyridines site of action

A

Vascular smooth muscle

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16
Q

Non-dihydropyridines site action

A

Act on heart

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17
Q

List of dihydropyridines

5 listed

A
  • Amlodipine
  • clevidipine
  • nicardipine
  • nifedipine
  • nimodipine

(dihydropyridines act on smooth muscle)

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18
Q

List of non-dihydropyridines

A
  • Diltiazem
  • Verapamil
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19
Q

Mechanism of action dihydropyridines

A

Block voltage-dependent L-type Ca channels of cardiac and smooth muscle → ↓ muscle contractility

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20
Q

Ca channel blockers affinity

A
  • Vascular smooth muscle: amlodipine = nifedipine > diltiazem > verapamil
  • Heart: verapamil > diltiazem > amlodipine = nifedipine
  • Verapamil = ventricle
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21
Q

Clinical uses of dihydropyridine (except nimodipine)

3 listed

A
  • HTN
  • Angina (including prinzmetal)
  • Raynaud phenomenon
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22
Q

Clinical uses of nimodipine

A

Subarachnoid hemorrhage (prevents cerebral vasospasm)

23
Q

Clinical uses of nicardipine and clevidipine

A

Hypertensive urgency or emergency

24
Q

Clinical use of non-dihydropyridines

A
  • HTN
  • Angina
  • Atrial fibrillation/flutter
25
Q

Adverse effects of non-dihydropyridines

A
  • Cardiac depression
  • AV block
  • Hyperprolactinemia
  • Constipation
  • Gingival hyperplasia
26
Q

Adverse effects of dihydropyridines

A
  • Peripheral edema
  • Flushing
  • Dizziness
27
Q

What is hyperprolactinemia?

A

Hyperprolactinemia is a condition in which a person has higher-than-normal levels of the hormone prolactin in the blood. The main function of prolactin is to stimulate breast milk production after childbirth, so high prolactin levels are normal in pregnancy

28
Q

Hydralazine mechanism

A

↑cGMP → smooth muscle relaxation

Vasodilates arterioles > veins Afterload reduction

29
Q

Clinical use of hydralazine

A

Severe HTN (particularly acute) HF (with organic nitrate)

Frequently coadministered with a β-blocker to prevent reflex tachycardia

30
Q

Hydralazine and pregnancy

A

Safe to use during pregnancy

31
Q

Adverse effects of hydralazine

5 listed

A
  • Compensatory tachycardia (contraindicated in angina/CAD)
  • Fluid retention
  • Headache
  • SLE-like syndrome
32
Q

Drugs to treat HTN emergency

A
  • Clevidipine
  • Fenoldopam
  • Lebetalol
  • Nicardipine
  • Nitroprusside
33
Q

Nitroprusside mechanism of action

A

Short-acting ↑cGMP via direct release of NO

34
Q

Fenoldopam mechanism of action

A
  • Dopamine D1 receptor agonist
  • Causes coronary, peripheral, renal and splanchnic vasodilation
  • Resulting in ↓BP and ↑natriuresis
35
Q

Fenoldopam clinical uses

A
  • HTN emergency
  • Also used postoperatively as an antihypertensive
36
Q

Adverse effects of Fenoldopam

A

Can cause hypotension and tachycardia

37
Q

List of nitrates

A
  • Nitroglycerin
  • Isosorbide dinitrate
  • Isosorbide mononitrate
38
Q

Nitrates mechanism of action

A

Vasodilate by ↑NO in vascular smooth muscle → ↑cGMP causing smooth muscle relaxation Dilates veins >> arteries ↓ preload

39
Q

Clinical use of nitrates

3 listed

A

Angina

Acute coronary syndrome

Pulmonary edema

40
Q

Adverse effects of nitrates

A
  • Reflex tachycardia (treat with β-blockers)
  • Hypotension
  • Flushing
  • Headache
  • “Monday disease”
41
Q

Treatment of reflex tachycardia caused by nitrates

A

Treat with β-blockers

42
Q

What is “Monday disease”?

A

Development of tolerance for the vasodilating action during the work week and loss of tolerance over the weekend resulting in tachycardia, dizziness, headache upon rexposure

43
Q

Nitrates contraindications

A

Right ventricular infarction

44
Q

What is the goal of antianginal therapy

A

Goal is reduction of myocardial O2 consumption (MVO2) by ↓ 1 or more of the determinants of MVO2

45
Q

What are the determinants of MVO2?

A
  • End-diastolic volume
  • BP
  • HR
  • Contractility
46
Q

Nitrates effect on end-diastolic volume

A

↓

47
Q

β-blockers effect on end-diastolic volume

A

No effect or ↑

48
Q

Nitrates + β-blockers effect on end-diastolic volume

A

No effect or ↓

49
Q

Nitrates effect on BP

A

↓

50
Q

β-blockers effect on BP

A

↓

51
Q

Nitrates + β-blockers effect on BP

A

↓

52
Q

dihydropyridines for Hypertensive urgency or emergency

A

nicardipine and clevidipine

53
Q

Hydralazine contraindications

A

contraindicated in angina/CAD

54
Q

Nitroprusside adverse effects

A

can cause cyanide toxicity

CVPR (93 decks)

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