CVPR Cardiovascular pharmacology Flashcards
Primary HTN AKA
Essential hypertension
Drugs to treat primary hypertension
4 listed
- Thiazide diuretics
- ACE inhibitors
- Angiotensin II receptor blockers (ARBs)
- Dihydropyridine Ca channel blockers
Drugs to treat hypertension with HF
5 listed
- Diuretics
- ACE inhibitors
- ARBs
- Β-blockers cautiously in decompensated HF
- Aldosterone antagonists
Β-blockers in HF
Β-blockers must be used cautiously in decompensated HF and are contraindicated in cardiogenic shock
Β-blockers in cardiogenic shock
Contraindicated in cardiogenic shock
HF and ARBs
May be combined with the neprilysin inhibitor Sacubitril
Drugs to treat hypertension with diabetes mellitus
5 listed
- ACE inhibitors
- ARBs
- Ca channel blockers
- Thiazide diuretics
- Selective β-blockers
ARBs and ACE inhibitors and diabetes
ARBs and ACE inhibitors are protective against diabetic nephropathy
Drugs to treat hypertension with asthma
- ARBs
- Ca channel blockers
- Thiazide diuretics
- Selective β-blockers
Β-blockers and asthma
Avoid nonselective β-blockers to prevent the blockade of β2-receptor-induced bronchodilation
ACE inhibitors and asthma
Avoid ACE inhibitors to prevent confusion between drug or asthma-related cough
Drugs to treat HTN in pregnancy
4 listed
- Hydralazine
- Labetalol
- Methyldopa
- Nifedipine
Nmeumonic for drugs to treat HTN in pregnancy
He likes My Neonate
Classes of Ca channel blockers
- Dihydropyridines
- Non-dihydropyridines
Dihydropyridines site of action
Vascular smooth muscle
Non-dihydropyridines site action
Act on heart
List of dihydropyridines
5 listed
- Amlodipine
- clevidipine
- nicardipine
- nifedipine
- nimodipine
(dihydropyridines act on smooth muscle)
List of non-dihydropyridines
- Diltiazem
- Verapamil
Mechanism of action dihydropyridines
Block voltage-dependent L-type Ca channels of cardiac and smooth muscle → ↓ muscle contractility
Ca channel blockers affinity
- Vascular smooth muscle: amlodipine = nifedipine > diltiazem > verapamil
- Heart: verapamil > diltiazem > amlodipine = nifedipine
- Verapamil = ventricle
Clinical uses of dihydropyridine (except nimodipine)
3 listed
- HTN
- Angina (including prinzmetal)
- Raynaud phenomenon
Clinical uses of nimodipine
Subarachnoid hemorrhage (prevents cerebral vasospasm)
Clinical uses of nicardipine and clevidipine
Hypertensive urgency or emergency
Clinical use of non-dihydropyridines
- HTN
- Angina
- Atrial fibrillation/flutter
Adverse effects of non-dihydropyridines
- Cardiac depression
- AV block
- Hyperprolactinemia
- Constipation
- Gingival hyperplasia
Adverse effects of dihydropyridines
- Peripheral edema
- Flushing
- Dizziness
What is hyperprolactinemia?
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
Hydralazine mechanism
↑cGMP → smooth muscle relaxation
Vasodilates arterioles > veins Afterload reduction
Clinical use of hydralazine
Severe HTN (particularly acute) HF (with organic nitrate)
Frequently coadministered with a β-blocker to prevent reflex tachycardia
Hydralazine and pregnancy
Safe to use during pregnancy
Adverse effects of hydralazine
5 listed
- Compensatory tachycardia (contraindicated in angina/CAD)
- Fluid retention
- Headache
- SLE-like syndrome
Drugs to treat HTN emergency
- Clevidipine
- Fenoldopam
- Lebetalol
- Nicardipine
- Nitroprusside
Nitroprusside mechanism of action
Short-acting ↑cGMP via direct release of NO
Fenoldopam mechanism of action
- Dopamine D1 receptor agonist
- Causes coronary, peripheral, renal and splanchnic vasodilation
- Resulting in ↓BP and ↑natriuresis
Fenoldopam clinical uses
- HTN emergency
- Also used postoperatively as an antihypertensive
Adverse effects of Fenoldopam
Can cause hypotension and tachycardia
List of nitrates
- Nitroglycerin
- Isosorbide dinitrate
- Isosorbide mononitrate
Nitrates mechanism of action
Vasodilate by ↑NO in vascular smooth muscle → ↑cGMP causing smooth muscle relaxation Dilates veins >> arteries ↓ preload
Clinical use of nitrates
3 listed
Angina
Acute coronary syndrome
Pulmonary edema
Adverse effects of nitrates
- Reflex tachycardia (treat with β-blockers)
- Hypotension
- Flushing
- Headache
- “Monday disease”
Treatment of reflex tachycardia caused by nitrates
Treat with β-blockers
What is “Monday disease”?
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
Nitrates contraindications
Right ventricular infarction
What is the goal of antianginal therapy
Goal is reduction of myocardial O2 consumption (MVO2) by ↓ 1 or more of the determinants of MVO2
What are the determinants of MVO2?
- End-diastolic volume
- BP
- HR
- Contractility
Nitrates effect on end-diastolic volume
↓
β-blockers effect on end-diastolic volume
No effect or ↑
Nitrates + β-blockers effect on end-diastolic volume
No effect or ↓
Nitrates effect on BP
↓
β-blockers effect on BP
↓
Nitrates + β-blockers effect on BP
↓
dihydropyridines for Hypertensive urgency or emergency
nicardipine and clevidipine
Hydralazine contraindications
contraindicated in angina/CAD
Nitroprusside adverse effects
can cause cyanide toxicity
