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Pharmacology > Drugs for the treatment of CHF, HTN, angina and HLD > Flashcards

Drugs for the treatment of CHF, HTN, angina and HLD Flashcards

1
Q

Digoxin MOA

A

Inhibits the Na/K ATPase at the potassium binding site (less Na so more Ca) to increase contractility. Reduces HR (decreases SNS tone which prevails in CHF). Increases CO in the failing heart.

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2
Q

Digoxin Main Effect

A

Positive Inotrope for CHF.

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3
Q

Digoxin Side Effects

A

Narrow margin of safety. Earliest sign of toxicity is GI upset. CNS effects. Cardiac arrhythmias are the most common and most dangerous: Bigeminy.

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4
Q

Treatment of Digoxin toxicity

A

Discontinue or reduce amount of digoxin. Moderate toxicity: oral/IV potassium. Severe: Digitalis immune Fab with potassium.

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5
Q

increased Digoxin toxicity

A

Hypokalemia (loops/thiazides and diarrhea)

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6
Q

Phosphodiesterase Inhibitors MOA

A

Inhibit cAMP phosphodiesterase to increase cAMP leading to more calcium influx and stronger contraction with significant vasodilation.

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7
Q

Inamrinone

A

Phosphodiesterase Inhibitor

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8
Q

Milrinone

A

Phosphodiesterase Inhibitor

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9
Q

Phosphodiesterase Inhibitors Indication

A

Acute heart failure. Increases CO as a last ditch effeort

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10
Q

Drugs that Reduce CHF mortality

A

Aldosterone antagonists, beta blockers, ACE-I and ARBs

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11
Q

Dopamine Indications

A

Severe refractory CHF. At a moderate dose will bind beta 1 receptors in the heart. IV only.

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12
Q

Dobutamine (Dobutrex)

A

Beta-1 agonist that is a positive inotrope (less tachycardia). Decreases filling pressure and increases oxygen consumption. IV only.

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13
Q

Diuretics Used for CHF

A

Spironolactone and Eplerenone (aldosterone antagonists). Reduces mortality rate in CHF. Decreases venous pressure to decrease edema and cardiac size.

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14
Q

DOC for CHF

A

ACE inhibitors (-prils). Reduces mortality.

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15
Q

ACE inhibitors MOA

A

“-prils” Inhibits ACE to stop conversion of angiotensin I to angiotensin II. Decreases afterload (Less angio II induced vasoconstriction) and decreases preload (less aldosterone) decreases cardiac remodeling.

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16
Q

ACE inhibitor Side Effects

A

Dry cough and angioedema due to increases in bradykinin.

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17
Q

Angiotensin II receptor blockers (ARB) MOA

A

“-sartans” Block the binding of angiotensin II to the AT1 receptor.

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18
Q

Beta-Blockers and CHF

A

Decreases renin secretion, attenuates catecholamine effects, decreases HR, stops cardiac remodeling. Decreases mortality. Only use in the early stages due to negative inotropic effect. Carvedilol and metoprolol.

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19
Q

Vasodilators used for CHF

A

Sodium nitroprusside (nitropress), Isosorbide dinitrate, hydralazine (SLE causing). Decrease preload, afterload and cardiac remodeling.

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20
Q

DOC for HTN

A

Thiazides

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21
Q

Adverse effects of thiazides

A

Reduced glucose tolerance

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22
Q

Thiazide contraindication

A

Diabetes

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23
Q

Clonidine

A

Centrally acting sympatholytic.

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24
Q

Methyldopa

A

Centrally acting sympatholytic

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25
Q

Centrally acting sympatholytic MOA

A

Bind alpha 2 adrenergic receptors to decrease neurotransmitter release and decrease peripheral SNS activity.

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26
Q

Centrally acting sympatholytic Effects

A

Decrease SNS outflow

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27
Q

DOC for HTN in pregnancy

A

Methyldopa

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28
Q

Methyldopa Side effects

A

Hemolytic anemia

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29
Q

Prazosin

A

Alpha-adrenergic Antagonist

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30
Q

Terazosin

A

Alpha-adrenergic Antagonist

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31
Q

Doxazosin

A

Alpha-adrenergic Antagonist

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32
Q

Alpha-adrenergic Antagonist Indications

A

Useful for treating HTN in men with BPH

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33
Q

Alpha-adrenergic Antagonist Side Effects

A

First dose phenomenon

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34
Q

Timolol

A

Non-selective Beta Blocker

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35
Q

Propanolol

A

Non-selective Beta Blocker

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36
Q

Nadolol

A

Non-selective Beta Blocker

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37
Q

Metoprolol

A

Beta 1 blocker

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38
Q

Atenolol

A

Beta 1 blocker

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39
Q

Nebivolol

A

Beta 1 blocker

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40
Q

Acebutolol

A

Beta 1 blocker

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41
Q

Beta Blocker effects

A

Decrease CO, renin secretion and SNS tone.

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42
Q

Beta Blocker Indications

A

Reduces mortality in CHF. Angina, Post-MI, Migraines.

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43
Q

Beta Blocker side effects

A

Blocks insulin release and inhibits recovery from hypoglycemia.

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44
Q

Beta Blocker contraindications

A

DM, asthma, heart block and end stage CHF

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45
Q

Carvedilol

A

Alpha and Beta Blocker

46
Q

Labetalol

A

Alpha and Beta Blocker

47
Q

Alpha and Beta Blocker MOA

A

Vasodilation without the reflex tachycardia or renin release

48
Q

Labetalol Indications

A

HTN emergencies. Acute and maintenance use in pregnancy.

49
Q

Carvedilol Inditations

A

HTN and CHF especially post-MI

50
Q

Alpha and Beta Blocker Side effects

A

Hepatotoxicity (especially labetalol)

51
Q

Vasodilator side effects

A

Reflex tachycardia, HA, fluching, palpitations. Long term lead to fluid retention.

52
Q

Hydralazine

A

Vasodilator that acts through NO.

53
Q

Hydralazine side effects

A

Lupus is slow acetylators

54
Q

Sodium Nitroprusside

A

Vasodialtor that acts through NO. Emergency HTN, IV only.

55
Q

Sodium Nitroprusside adverse effects

A

Metabolized by thiocyanate and causes cyandide accumulation

56
Q

Minoxidil MOA

A

Vasodilator that opens potassium channels to cause hyperpolarization and smooth muscle relaxation.

57
Q

Fenoldopam

A

D1 receptor agonist. Mainly effects the renal vasculature.

58
Q

Nifedipine

A

CCB dihydropine. Strongest vasodilatory effects so increases HR

59
Q

Verapamil

A

CCB with the strongest cardiac effects leading to a decreased HR

60
Q

Diltiazem

A

CCB with vasodilatory and cardiac effects.

61
Q

CCB contraindications

A

CHF. don’t use along with a nitrate.

62
Q

DOC for HTN in DM

A

ACE-I

63
Q

-prils

A

ACE-I

64
Q

DOC for HTN in CKD

A

ACE-I

65
Q

DOC for HTN in CHF

A

ACE-I

66
Q

ACE-I adverse effects

A

Increased bradykinin leading to dry cough and angioedema

67
Q

-sartans

A

ARBs

68
Q

ARBs MOA

A

Block the effects of angiotensin II without effecting Bradykinin (no cough or angioedema). Similar to ACE-I

69
Q

DOC For Acute Anginal Attack

A

Nitrates

70
Q

Nitrate indications

A

Acute use in classic and vasospastic. Long term maintenance in classic angina.

71
Q

Nitrate Side effects

A

Throbbing head aches

72
Q

Nitrate contraindications

A

Don’t use with sildenafil

73
Q

Monday’s disease

A

Frequent exposure to nitrates builds up tolerance. Not effective for long term treatment

74
Q

CCB indications

A

Treatment of HTN and angina

75
Q

Beta blockers and Angina

A

Decrease cardiac workload to decrease oxygen demand. Only useful in classic angina

76
Q

Ranolazine Indications

A

Refractory angina

77
Q

Sildenafil (viagra)

A

Phosphodiesterase type 5 inhibitor

78
Q

Sildenafil (viagra) Adverse effects

A

Blue visual disturbances

79
Q

Sildenafil (viagra) Contraindications

A

Use with an alpha blocker, nitrate or grapefruit juice

80
Q

Vardenafil (levitra)

A

Phosphodiesterase type 5 inhibitor. More selective for PD5 and faster onset of action.

81
Q

Tadalafil (cialis)

A

Phosphodiesterase type 5 inhibitor. More selective for PD5. Longer duration of action.

82
Q

Statin MOA

A

Structural analog for HMG-CoA reductase. Blocks de novo synthesis of cholesterorl in the liver causing and increase in high affinity LDL receptors which will decrease plasma levels.

83
Q

DOC for Decreasing LDL

A

Statins

84
Q

Statin effects

A

Decreases LDL and triglycerides while increasing HDL. Decreases CRP, lipoprotein oxidation and platelet aggregation. Increases NO production and plaque stability.

85
Q

Statin adverse effects

A

Increased LFTs (caution in patients will existing liver problems). Muscle pain that can lead to rhabdomyolysis.

86
Q

Statin Contraindications

A

pregnancy, Grapefruit juice.

87
Q

Statin drug interactions

A

gemfibrozil will inhibit their metabolism

88
Q

Chlestyramine

A

Bile acid binding resin

89
Q

Colestipol

A

Bile acid binding resin

90
Q

Colesevelam

A

Bile acid binding resin

91
Q

Bile acid binding resin MOA

A

inhibits bile acid reabsorption. Decrease LDL. No effect on familial hypercholesteremia

92
Q

Bile acid binding resin Side effects

A

Constipation and bloating. Impairs the absorption of fat soluble vitamins and other drugs.

93
Q

Niacin MOA

A

Inhibits VLDL secretion and increases HDL

94
Q

Niacin adverse effects

A

Cutaneous vasodilation due to prostaglandins (aspirin first)

95
Q

Gemfibrozil

A

Fibric Acid Derivative

96
Q

Fenofibrate

A

Fibric Acid Derivative

97
Q

Fenofibric acid

A

Fibric Acid Derivative

98
Q

Fibric Acid Derivative MOA

A

PPAR-alpha ligand receptor to upregulate LPL genes. Decrases Triglycerides.

99
Q

Fibric Acid Derivative Side effects

A

Gall stones

100
Q

Ezetimibe MOA

A

Blocks intestinal absorption of cholesteral. Synergistic with statins.

101
Q

Alirocumab

A

PCSK9

102
Q

Evolocumab

A

PCSK9

103
Q

PCSK9 MOA

A

Antibodies that inhibit LDL receptor breakdown. Given as a subcutaneous injection.

104
Q

Treatment of HTN with Angina

A

Beta-blocker

105
Q

Treatment of HTN post-MI

A

Beta blocker

106
Q

Treatment of HTN with asthma

A

CCB

107
Q

Treatment of HTN with DM

A

ACEI

108
Q

Treatment of HTN with CKD

A

ACEI

109
Q

Treatment of HTN with BPH

A

Alpha blocker

110
Q

Treatment of HTN with migraines

A

Beta blocker

Pharmacology (24 decks)

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