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Drugs Flashcards

0
Q

NS B blockade: eg, indications

A
  • eg: propranolol, nadolol, timolol
  • indications: angina, HTN, arrhythmias
  • phasing out for more specific drugs, lipophilic -> CNS defects
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1
Q

B1 blockade: eg, effects, indication,

A
  • eg: MEAN B.
  • effects: decrease HR, contractility, AV conduction velocity, renin release
  • indication: CV indications; post MI, essential HTN
  • esmolol: short acting IV only
  • note* B2 in high doses
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2
Q

Vasodilation B blockade

A
  • eg: carvadelol, lebatelol VERY COMMONLY used
  • MOA: a/B blockade
    > vasodilation A1 mediated
  • Nebivilol B1 selective (increased NO -> vasodilation)
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3
Q

B-blockers adverse effects (B1 and B2)

A
  • B1: bradycardia, hypotension, worsening of acute HF
  • B2: bronchospasm, masking of hypoglycemia, hyperglycemia, PVD exacerbation, impotency
  • CNS: fatigue, depression, decreased exercise tolerance
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4
Q

B-blockade contraindications (3) consideration(2)

A
  • abrupt cessation
  • risk of unopposed activation
  • severe bradycardia or AV block
  • cardiogenic shock or worsening HF
  • varian angina
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5
Q

A-antagonist specific agents (a1 and NS a1,2)

A

A1 a,b and d specific eg: terazosin, doxazosin, prazosin (reversible a 1a,b and d)

  • BPH
    eg: NS a1,2 antagonists:
  • phentolamine, phenoxybenzamine
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6
Q

A1 antagonism Sx/Cind

A 
Sx
- orthostatic HTN
- reflex tachy
- nasal congestion 
Cind
- elderly (falls) 
- additive hypotension with other hypotensives 
- start low titrate up 
- less effect at bed time
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7
Q

A2 specific agonists (eg, ind)

A

Clonadine
- ind: hypertensive emergency/urgency and intractable HTN
Methyldopa
- ind: prodrug for HTN in pregnancy

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8
Q

A2 agonism Sx and considerations

A

Adverse effects

  • CNS sedation and depression
  • hypotension, bradycardia, orthostasis, rebound HTN
  • GI, drymouth
  • Methyldopa: hepatitis, hemolytic anemia
  • as always avoid in elderly and abrupt discontinuation
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9
Q

Pressors and inotropes (eg and use)

A

pressors: maintain perfusion in hypotensive PTs.
- epi:
- norepi:
- phenylepi: a1 only
- dopamine (also inotropic)
- dobutamine (inotropic only)

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10
Q

Pressors and inotropes Sx (4)

A
  • tachycardia
  • dysrhythmia
  • peripheral ischemia
  • hypotension (dobutamine)
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11
Q

Atropine: CV pharmacology

A
  • MOA: M2 blockade
  • CV indication: acute symptomatic bradycardia (not for cardiac arrest)
  • Sx: anti ACh
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12
Q

Epinephrine MOA (low/high dose)

A
  • low dose: B1, B2 > a1 agonism

- high dose: a1 > B1,B2 agonism

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13
Q

Isoproteronol

A
  • B1, B2 agonism
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14
Q

Norepi MOA

A
  • B1, a1
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15
Q

Phenylepherine MOA

A
  • a1 agonism
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16
Q

a1, a2, B1, B2 receptor actions

A
  • a1: vasoconstriction
  • a2: decrease sympathetic outflow
  • B1: increase HR
  • B2: vasodilation
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17
Q

Chemical cardiac stress test

A
  • dobutamine
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18
Q

Class I antidysrhythmic useful for pharm cardioversion of Afib and Aflutter
- 3 classic Sx

A
  • quinidine
  • risk of toursades
    1. Toursades, tinnitus, cinchonism
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19
Q

Trt for toursades

A
  • Mg
  • unknown mechanism
  • also used for resistant VT/VF and Digoxin toxicity
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20
Q

Trt for dig toxicity

A
  • Mg

- arrythmias caused by digoxin toxicity: phenytoin

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21
Q

Class I antidysrhythmic

A
  • Na channel blockade

- quinidine, procainamide, dyspirimine

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22
Q

Class II antidysrhythmics

A
  • beta blockade: reduces Ca influx during phase 0, (slow current channels) and decreases automaticity (phase 4) esp in SA/AV nodes
  • reduces nodal reentry tachydysrhythmias; reduces AV node conduction velocity and increases ERP
  • metoprolol, propranolol et al
  • not or use in acute HF: better for prevention (doesn’t terminate)
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23
Q

Na/K pump inhibitor

A

In crease in intracellular Na -> increase calcium influx -> increase contractility

  • positive inotrope/negative chronotrope, slows SA/AV conduction increase absolute refractory period
  • Sx: GI, arrythmias, yellow halos (dig Abs)
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24
Q

First line drug for SVT

A
  • adenosine
  • cAMP mediated Ca influx -> inhibits AV/SA node; essentially restarts the heart by induction of 3rd degree block but it’s 1/2 life is 10 ~ sec
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25
Q

Cass IV antidysrhythmic used as first line foratrial dysrhythmias. It may cause HF, hypotension or AV block

A

Verapamil/Diltiazam

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26
Q

Class III antidysrhythmic convert atrial flutter conversion and Risk

A
  • ibutalide: prolongs APD

- Sx: toursades de points

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27
Q

Class III antidysrhythmic used in atrial and atrioventricular dysrhythmias. Sx

A
  • Sotalol: atrial and ventricular arrythmias
  • B blocking: proarrhythmic
  • prolongs QT interval
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28
Q

First line for venticular dysrhythmias, biphasic 10/53 day 1/2 life

A
  • amniodarone
  • class III K channel blocking; also, Na, Ca, and B blocking
  • prolong QT interval
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29
Q

Class III antidysrhythmic

A
  • bretylin
  • Sotalol
  • ibutalide
  • amniodarone
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30
Q

Class Ib antidysrhythmic

A
  • phenytoin/lidocaine: prolongs ERP but shortens APD
  • for ventricular dysrhythmias
  • CNS effects, liver damage, CHF
  • CIND: elderly
  • primarily effects diseased/ischemic myocardium **
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31
Q

Class Ia antidysrhythmic (3)

A
  • Na channel blockade (phase 0 decrease slope) k channel (phase 4 increase)
  • dysopyramide (ACh effects)
  • procainamide (SLE)
  • quinidine (Torsades)
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32
Q

SLE induction

A
  • procainamide

- hydralazine

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33
Q

Drugs that are associated with increased survival in HF PTs. (5)

A
  • ACEIs
  • B-blockers (carvedilol, metoprolol, bisprolol)
  • spironolactone
  • ARBs
  • hydralazine + nitrates
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34
Q

Steps in managing systolic HF with drugs

A
  1. Loop diuretic
  2. Add ACEIs
  3. Add B-blocker
  4. Add spironolactone (K sparing)
  5. Add digoxin
  6. Add ARB, hydralazine, nitrite
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35
Q

Diastolic HF management

A
  • control HTN, HR and ischemic heart disease

- avoid inotropes

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36
Q

Recombinant natriuretic peptide used in acute decompensating HF to decrease pre and after load

A
  • Nesiritide
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37
Q

Arteriolar vasodilator used in combo with other nitrates in PTs who cannot tolerate ACEis

A

Hydralazine

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38
Q

ARBs and ACEIs

A
  • both inhibit the renin-angiotensin pathway
  • ARBs don’t screw with bradykinin (less cough or edema)
  • ACEis contra indicated in preggers - fetal injury
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39
Q

Drugs that decrease arteriolar vasoconstriction, ANP release and NaCl resorb
- inhibits bradykinin breakdown

A
  • ACEis

- decrease afterload AND preload

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40
Q

Sx: cyanide poisoning

A
  • Na Nitroprusside
  • rare, more commonly hypotension is only Sx due to vasodilation MOA (NO)
  • contraindicated in pregnancy
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41
Q

Drugs of acute decompensating HF

A
  • NO
  • Na Nitroprusside
  • phosdi inhibitors (Milrinone)
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42
Q

K sparing drugs for HF (3) MOAs and Sx

A
  • spironolactone: aldosterone antagonist
  • amiloride and Triamterene: blocks Na channel in DCT
    > Na/K/H exchanger is inhibited
  • hyperkalemia and acidosis
43
Q

Diuretic location of action: PCT, DLOH, ALOH, DCT

A
  • PCT: Carbonic anhydrase inhibitors and osmotic diuretics
  • descending: osmotic diuretics
  • ascending LOH: loop diuretics
  • DCT: thiazide diuretics K sparing
44
Q

HF: drugs effecting vascular tone

A
  • NO donors
  • ACEis
  • ARBs
  • hydralazine
  • Nesiritide
  • B-blockers
45
Q

Vasodilators used in acute decompensating HF

A 
- Nitroglycerin
    > Sx: HA, hypotension 
- Na Nitroprusside 
    > hypotension, cyanide poisoning 
    > contraindication for prego
46
Q

Drugs that decrease preload and afterload

A
  • ACEis: block activation of bradykinin (prils)
    > inhibit conversion angiotensin II
  • ARBs: don’t interfere with bradykinin
47
Q

ACEis: MOA, effects, Sx

A
  • inhibition of conversion to angiotensin I
  • increase pre and afterload, inhibition of bradykinin
    > decreases arteriolar vasoconstriction, NaCl resorption and ADH
  • Catopril prototypical ACEi
  • Sx: cough and angioedema (most serious), hypokalemia
    > fetal injury
    > renal insufficiency
48
Q

ARB

A
  • same effect as ACEis, except doesn’t inhibit upstream bradykinin act
  • Losartan, valsartan
  • second line to ACEi
49
Q

Hydralazine

A
  • arteriolar vasodilator: decrease after load
  • unknown mechanism
  • often used in conj with nitrates
50
Q

HF drug used for PTs who cannot tolerate ACEi

A
  • hydralazine
  • arteriovasodilator
  • used in conj with nitrates
51
Q

IV only recombinant BNP

A
  • Nesirtide
  • continuous IV infusion in acute decompensating HF
  • may be associated with worse outcomes in renal failure and potentially worsen HF mortality
52
Q

Steps in treating systolic dysfunction HF (5 + other)

A

1: loop diuretic
2. ACEi
3. B blocker
4. K sparing (spironolactone)
5. Digoxin
Other: hydralazine + nitrate

53
Q

Treating diastolic HF control and Rx

A
  • control HTN
  • control HR
  • control ischemia
  • Rx: B blocker, Ca channel blocker, ACEi, ARB
  • AVOID INOTROPES like digoxin
54
Q

B blockade important mechanism in HF

A
  • attenuates cytotoxicity and signaling effect of catecholamines by upregulation of B1 receptors
  • ** improves myocardial remodeling **
  • carvedilol, metoprolol, bisprolol, (improve survival) esp when added to ACEi
55
Q

Digoxin indication in CHF

A
  • only used in cases of CHF with Afib

- it’s actually a fifth line drug for CHF

56
Q

Indications in acute decompensating HF

A
  • O2
  • loop diuretic (furosemide)
  • vasodilator (NO,nitro prusside)
  • inotrope (dobutamine, Milrinone)
  • morphine reduces preload and pain
57
Q

Milrinone

A
  • Phosphodiesterase inhibitor -> increases cAMP and thus is a + inotrope
  • acute decompensating HF
58
Q

Furosemide

A
  • loop diuretic
  • hypovolemia, hypokalemia
  • acidosis (due to lack of Na for the Na/H pump)
  • first line in acute decompensating HF
59
Q

Bumetinide

A
  • loop diuretic
  • hypovolemia, hypokalemia
  • acidosis (due to lack of Na for the Na/H pump)
  • first line in acute decompensating HF
60
Q

Spironolactone

A
  • aldosterone inhibitor (K sparing hence hypERkalemia)
61
Q

Amiloride

A
  • k sparing DCT diuretic

- not assoc with increased survival

62
Q

Triamterene

A
  • K sparing DCT diuretic
63
Q

ACEi interactions (3)

A
  • potassium supplements, K sparring diuretics

- NSAIDs

64
Q

Losartan

A
  • ARBi

- 2nd line to ACEi

65
Q

Ideal antiarrythmic drug

A
  • increases ERP, decreases RRP and adjusts QTc (no effect on a/p duration)
66
Q

Class I antidysrhythmic effects on A/P

A
  • a: moderate Na channel block -> prolongs phase 0 and pushes back phase 3
  • b. slight Na block -> slightly prolonged phase 0 with early repolarization
  • c. Significant Na block -> sig prolonged phase 0 with UNAFFECTED repolarization
67
Q

Quinidine: ind, mech (3), Sx due to mech

A
  • class 1a antiarrythmic: chemical cardioversion**
  • Na/K channel blocker/alpha blocker/ACh blocker
    > Na/K blockade: increase ERP/APD **
    > alpha blockade: reflex tachy/hypoTN
    > anti-ACh: increase AV node condxn
68
Q

Procainamide: Compaired to quinidine

A
  • similar to quinidine: less anti-ACh; more SA/AV nodal depression
  • ganglion blocker
  • less QTc prolonging
69
Q

Dysopyramide compared to quinidine

A
  • similar to quinidine: more pronounced anti-ACh effects
70
Q

Indication for phenytoin

A
  • ventricular arrythmias esp. Caused by digoxin toxicity
71
Q

Class IC antidysrhythmics: eg, ECG effect, ind

A
  • flecainide
  • propafone (B block and Ca blocker)
  • prolongs QRS but NOT QT
  • Sx: flecainide - higher risk of arrythmias
  • for atrial and ventricular dysrhythmias
72
Q

Ibutalide indication and sig risk

A
  • atrial flutter conversion

- Rick of toursades

73
Q

Flecainide, propafone

A
  • class 1C antidysrhythmic
74
Q

Junctional dysrhythmias and mechs (3)

A
  • PJC: enhanced automaticity
  • junctional rhythm: normal automaticity
  • accelerated junctional rhythm: enhanced automaticity
75
Q

Ventricular dysrhythmias/ mechs (5)

A
  • PVC: DAD
  • accelerated idioventricular rhythm: enhanced auto
  • Vtach: reentry
  • toursades: EAD
  • Vfib: reentry
76
Q

Atrial dysrhythmias and mechs (5)

A
  • PAC: DAD
  • Atrial tach: reentry
  • MAT: DAD
  • a flutter: reentry
  • Afib: reentry
77
Q

Nitrate MOA

A
  • forms free radical NO -> vasodilation (organic nitrates may dilate coronary arteries)
  • NO mediated cGMP also inhibits PLT aggregation
78
Q

Organic nitrates: eg, effect

A
  • nitroglycerin, isosorbide dinitrate/mononitrate
  • mostly Venodilators (decrease preload)
  • superior efficacy in variant angina
79
Q

Na Nitroprusside: MOA, effect, indication, Sx

A
  • veno/arteriodilation
  • decreased pre/afterload
  • for HTN emergency/ decomp HF NOT for angina
  • cyanide/thiocyanate tox, coronary steal
80
Q

NGT: MOA, 1/2 life, indication

A
  • organic nitrate
  • 1/2 life 5 minutes
  • high first pass: sublingual/transdermal patch
81
Q

Isosorbide dinitrate: MOA, 1/2 life, use

A
  • organic nitrate
  • 1/2 life: 1 hr
  • oral dose 1-3 x daily
  • tolerance to nitrates: tachyphylaxis (24 hrs)
    > nitrate free period of 8-12
    > body compensates with increase in vascular tone and Na retention
82
Q

Isosorbide mononitrate: MOA, 1/2 life, use, consideration

A
  • organic nitrate
  • 1/2 life: 4 hrs
  • 1-2 x daily
  • tolerance to nitrates: tachyphylaxis (24 hrs)
    > nitrate free period of 8-12
    > body compensates with increase in vascular tone and Na retention
83
Q

Nitrate Sx, interactions, Cind

A
  • HA, orthostasis, reflex tachy
  • PDE-5 inhibitors
  • contraindication: sildenafil, vardenafil, tadalafil
84
Q

1st line monotherapy for stable angina (hr parameters)

A
  • B blocker
  • decrease HR, contractility and BP
  • doesn’t improve myocardial O2 supply (may be worse for variant)
  • HR target parameters: resting HR 50-60 BPM, exercise > 100
85
Q

Ca channel blockers in angina

A
  • dihydropyrimidine/nondihydropyridine
  • arterial dilation, decrease in contractility and HR
  • may increase blood flow via coronary arteries (superior efficacy in variant angina)
86
Q

Dihydropyridines

A
  • bind to N site
  • peripheral action
  • amlodipine (common), felodipine
  • primarily Anti-HTN but can be used for stable angina
87
Q

Non-dihydropyridines

A
  • Ca channel blocker that binds to V and D sites
  • cardiac activity
  • Diltiazam and verapamil
  • stable angina, ACS (symptom relief), Afib/Flutter
88
Q

Calcium channel blockers + beta blockers, dig or amniodarone

A
  • bradycardia

- additive hypotension with other anti-HTN

89
Q

Partial FA oxidase inhibitor

A
  • ranolazine
  • 5th line anti-anginal agent
  • QT prolongation cyp3a4 substrate
90
Q

Anti-ischemia algorithm for stable angina

A
  1. Blocker
  2. Long acting nitrate (mono nitrate) or long acting CCB
  3. Substitute 2nd line
    • symptoms with BB and LA nitrate -> add ranolazine
91
Q

Variant angina algorithm

A
  • SL NTG for acute trt
  • 1st line prophylaxis: long acting CCB
  • NO B blockers
92
Q

Anti-HTN drug causes Hirsutism

A

Minoxidil

- peripheral vasodilator: act ATP mod K channels

93
Q

PPAR activator

A
  • fibrinates
  • gemfibrozil et al
  • can cause upper right quadrant pain due to gall stone formation
94
Q

A drug that can substantially raise your trigs due to increase of LpL, and decrease VLDL

A
  • niacin
95
Q

Diuretic contraindicated in hyperuricemia

A
  • thiazide diuretics
96
Q

B blocker contraindicated in angina

A
  • Acebutilol

> it has sympathomimetic activity and may exacerbate

97
Q

Trt of HTN in polycystic kidney disease

A
  • ACEi

- mech of HTN: cyst impair glomeruli perfusion -> renin release -> ace system act

98
Q

Amlodipine

A
  • vascular Ca channel blocker
  • ## it’s vasodilating effect experts negative inotropy
99
Q

Anti-HTN drug for hair loss

A

Minoxidil

100
Q

Nitrate tolerance

A
  • tachyphylaxis

- take 8-12 hr drug holidays

101
Q

Anti-HTN drug known for causing dyslipidemia

A
  • B blockers: metoprolol
102
Q

Treatment of Wolff-Parkinson-White syndrome that can result in V fib

A
  • digoxin
103
Q

Tinnitus chinconism (QT)

A
  • quinidine
104
Q

Anti-arrhythmic with class I-IV effects and toxicity

A
  • amniodarone

- PFT, LFT

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