CVS Flashcards
Name of vasodilators ?
Na-nitroprusside
hydralazine
minoxidil
diazoxide
fenol-dopam
374
M/A of Na nitroprusside ?
Release NO + Direct stimulation to enzyme
= activate guanyl cyclase
= inc cAMP
= relax vascular smooth muscle
= dilate A & V
= dec PVR
= dec Venous return
375
classification of anti-anginal drugs ?
384
nitroglycerin drugs name ?
GTN
isosorbide di-nitrate
amyl nitrite
which nitroglycerin for unstable angina ?
GTN
which one for stable angina ?
Isosorbide di nitrate
which beta blocker in angina ?
propranolol
atenolol
metoprolol
which CCB in angina ?
cardio & vessel selectuve
adjuvent drugs in angina ?
anti-platelet & anti-coagulant
common anti-HTN + anti-angina ?
CCB + Beta blocker
how to avoid extensive 1st pass metabolism of GTN ?
sublingual / transdermally as patch disc / ointment
angina pain kemon ?
sudden severe stabbing agenising radiating to neck jaw thumb
main molecular action of salbutamol ?
2nd messenger activate kore
drug of choice in angina ?
organic nitrate
M/A of GTN ?
387
A/E of GTN ?
throbbing type of headache
postural hypotension
tachycardia
nitrate tolerance
inc ICP
pallor
dizziness
restlessness
feeling of throbbing headache ?
mathay haturi diye bari marar moto
actions of GTN ?
dec preload
dec afterload
inc coronary vasodilation
why throbbing headache?
streching of the pain sensitive tissue around the meningeal arteries resulting in inc pulsation and accompanies the local vasodilation
389
indication of organic nitrate ?
Angina
HF
Formulations of GTN ?
oral
parental
inhalation
suppository/ointment
what is nitrate intolrance ?
389
an atteenuation / total loss hemodynamic and anti-ischemic effects during continuous nitrate medication
how to prevent nitrate tolerance ?
it can be overcome by providing a daily nitrate free intervel to restore sensitivity to the drug
this intervel is typically 10-12 hrs usually at night
procedure of taking GTN ?
TO avoid postural hypotension
GTN should be taken in lying position
legs should be raised above the head to restore venous return
merits of using sublingual GTN ?
in case of throbbing headache β Pt - split out kore dibe
molecular mechanism of GTN ?
388
demerits of spray in Throbbing H ?
kichu korar nai
barbar ulcer korle - ulcer hote pare
can beta blokcer cause coronary perfusion ?
NO
they cannot cause coronary vasodilation
reflex tachycardia by GTN can be minimize by whichdrug ?
beta blocker
beta blockers in Angina M/A ?
binds with beta1 on heart
dec HR dec FOC
dec cardiac work
less O2 demand
releif on angina pain
CCB in angina ?
dec afterload
cardiac failure e heart er kon kon function impair hoy ?
venous pressure +
capillary filtration + = edema
cardiac output -
BP -
RBF -
renin +
angiotension 2 +
Na water retention +
drugs used in HF ?
397
Reduction of preload which drugs ?
diuretics
nitrates
SGLT-2 empagliflozin
both after & pre load reduction ?
ACEi
ARB
Beta blokcer
spironolcatione
reduction of afterload which drug ?
vasodilators
stimulation of myocardium which drugs ?
digoxin
digitoxin
reduction of heart rate ?
ivabradine
397
Digoxin toxicity when develops ?
serum D level >2ng/ml
Digoxin A/E ?
Anorexia
vomiting
gynecomastia
visual distrubance
color vision
cardiac - bradycardia AV conduction defect
ventricular fibrilation
bigeminy
trigeminy
403
which drugs increase HR ?
β
Ξ²-agonists: Epinephrine, Isoproterenol, Dobutamine
β
Anticholinergics: Atropine, Glycopyrrolate
β
Sympathomimetics: Ephedrine, Amphetamines
β
Phosphodiesterase Inhibitors: Milrinone, Theophylline
β
Calcium Channel Blockers (DHPs): Nifedipine, Amlodipine (reflex tachycardia)
most common sign of digoxin toxicity ?
β GI symptoms (nausea, vomiting, anorexia) β Most common early sign of digoxin toxicity.
@usmlereviews
which metabolic drugs dec HR ?
thyroxin
glucagon
digoxin HR baray naki komay ?
komay
which factors precipitate D T ?
hypokalemia
hypomagnesemia
hypercalcemia
management of digoxin toxicity ?
stop the drug
correct electrolyte imbalance
K supplement
anti-arrythmatic drug ?- phenytoin lidocain
Digoxin er sathe dibo kon drug ?
ACEi
ARB
spironolactone
dibo na kon drug ?
K loosing diuretics
loop d
t diuretics
beta blokcers
M/A of digoxin ?
401
Digoxin + BEta blocker ???
more bradycardia
Heart block
Digoxin + CCB ?
D toxicity
ACEi effect on CCF ?
407
Anti-arrhythmic drugs name ?
410
which CCB in arthymia ?
verapamil
deltiazem
which K channel blocker ,
amiodarone
dronedarone
which Na channel blocker ?
quinidine
lidocaine
In case of heart rate is increase , when i will call it tachycardia and when arrhythmia?
β
Tachycardia = HR >100 bpm (can be normal or abnormal)
β
Arrhythmia = Irregular or abnormal rhythm, may include tachycardia but also bradycardia, fibrillation, flutter, blocks
π Example:
- Sinus tachycardia β Normal rhythm, HR >100 bpm (fever, exercise, stress)
- Atrial fibrillation β Arrhythmia (irregularly irregular rhythm, rapid HR)
- Ventricular tachycardia β Both tachycardia & arrhythmia (abnormal rhythm + HR >100 bpm)
@usmlereviews
which beta blockers ?
esmolo
stenolol
sotaolol
pindolol
propranolol
in Arrhythmia HR bare naki kome ?
HR - irregular
when postural hypotension in ACEi ?
initial dose
what is arrythmia ??
β Arrhythmia = Abnormal heart rhythm (irregular rate, conduction, or impulse formation).
which beta blocker is used in angina ?
propranolol
atenolol
what is corrected by digoxin in HF ?
respiratory distress
edema
tachycardia
cardiomegaly
mechanical mechanism of digoxin ?
401
12-2-2025
11.28AM
inc cardiac contractility
inc CO
dec residual blood
dec diastolic pressure and size
dec cardiac congestion
enhance complete ventricular emptying = dec ventricular size
Minoxidil use let alone HTN >
Vasodilation
alopecia
is propranolol is given in a asthmatic and diabetic patient ?
π« Propranolol (Non-selective Ξ²-blocker) AVOID in:
β
Asthma β Blocks Ξ²β, causes bronchospasm
β
Diabetes β Masks hypoglycemia symptoms (blocks tremor, tachycardia)
π Safer alternatives:
- Asthma β Cardioselective Ξ²β blockers (Metoprolol, Atenolol)
- Diabetes β Cardioselective Ξ²β blockers OR Ξ±/Ξ² blockers (Carvedilol)
@usmlereviews
urine of diabetic nephropathy ?
β
Albuminuria (Early marker) β Microalbuminuria (30-300 mg/day) β Progresses to macroalbuminuria (>300 mg/day)
β
Glucose (if uncontrolled DM)
β
Kimmelstiel-Wilson nodules (histology, not urine)
β
Casts: Hyaline (early), Waxy, granular (late CKD)
β
Ξ²β-microglobulin, NAG enzyme (Tubular damage markers)
π Dx: Urine albumin-to-creatinine ratio (UACR), 24h urine protein
π Tx: ACEi/ARB (βProteinuria, slows progression)
@usmlereviews
which one has larger half life ?
lisinopril
how ACEi dec preload and afterload ?
no vasoconstriction = dec preload
bradykinin +++ ===== dec preload
aldosteroine -
no retention of Na & H2O
edema β
afterload βββ
which drugs used in compensation of reflax tachycardia and postural hypotension ?
β Drugs to compensate Reflex Tachycardia & Postural Hypotension:
π For Reflex Tachycardia (due to vasodilation, e.g., DHP CCBs, nitrates):
- Ξ²-blockers (e.g., Metoprolol, Propranolol) β βHR, βcontractility
- Non-DHP CCBs (Verapamil, Diltiazem) β βHR, βAV conduction
π For Postural Hypotension (due to Ξ±-blockers, autonomic dysfunction):
- Fludrocortisone β βNaβΊ retention, βBP
- Midodrine (Ξ±β-agonist) β Vasoconstriction, βBP
- Droxidopa (NE precursor) β βBP in neurogenic hypotension
@usmlereviews
advantages of sublingual GTN ?
rapid onset
avoid 1st pass metabolism
driect go to systemic circulation
short duration of action
highly lipid soluble
less chance of A./E
ASHORT duration of action
vasoconstrictor drug name ?
Vasoconstrictors:
Phenylephrine Norepinephrine Epinephrine Vasopressin (ADH) Angiotensin II
cardiotropic drugs name ?
Cardiotropic Drugs:
Digoxin Dobutamine Milrinone Isoproterenol Dopamine
drugs that decrease HR ?>
Here are 5 drugs that decrease heart rate (negative chronotropes):
- Metoprolol (Beta-blocker)
- Atenolol (Beta-blocker)
- Diltiazem (Calcium channel blocker)
- Verapamil (Calcium channel blocker)
- Digoxin (Cardiac glycoside)
11.47AM
