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

Question 1

Digoxin MOA

Answer 1

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.

Question 2

Digoxin Main Effect

Answer 2

Positive Inotrope for CHF.

Question 3

Digoxin Side Effects

Answer 3

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

Question 4

Treatment of Digoxin toxicity

Answer 4

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

Question 5

increased Digoxin toxicity

Answer 5

Hypokalemia (loops/thiazides and diarrhea)

Question 6

Phosphodiesterase Inhibitors MOA

Answer 6

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

Question 7

Inamrinone

Answer 7

Phosphodiesterase Inhibitor

Question 8

Milrinone

Answer 8

Phosphodiesterase Inhibitor

Question 9

Phosphodiesterase Inhibitors Indication

Answer 9

Acute heart failure. Increases CO as a last ditch effeort

Question 10

Drugs that Reduce CHF mortality

Answer 10

Aldosterone antagonists, beta blockers, ACE-I and ARBs

Question 11

Dopamine Indications

Answer 11

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

Question 12

Dobutamine (Dobutrex)

Answer 12

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

Question 13

Diuretics Used for CHF

Answer 13

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

Question 14

DOC for CHF

Answer 14

ACE inhibitors (-prils). Reduces mortality.

Question 15

ACE inhibitors MOA

Answer 15

“-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.

Question 16

ACE inhibitor Side Effects

Answer 16

Dry cough and angioedema due to increases in bradykinin.

Question 17

Angiotensin II receptor blockers (ARB) MOA

Answer 17

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

Question 18

Beta-Blockers and CHF

Answer 18

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.

Question 19

Vasodilators used for CHF

Answer 19

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

Question 20

DOC for HTN

Answer 20

Thiazides

Question 21

Adverse effects of thiazides

Answer 21

Reduced glucose tolerance

Question 22

Thiazide contraindication

Answer 22

Diabetes

Question 23

Clonidine

Answer 23

Centrally acting sympatholytic.

Question 24

Methyldopa

Answer 24

Centrally acting sympatholytic

Question 25

Centrally acting sympatholytic MOA

Answer 25

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

Question 26

Centrally acting sympatholytic Effects

Answer 26

Decrease SNS outflow

Question 27

DOC for HTN in pregnancy

Answer 27

Methyldopa

Question 28

Methyldopa Side effects

Answer 28

Hemolytic anemia

Question 29

Prazosin

Answer 29

Alpha-adrenergic Antagonist

Question 30

Terazosin

Answer 30

Alpha-adrenergic Antagonist

Question 31

Doxazosin

Answer 31

Alpha-adrenergic Antagonist

Question 32

Alpha-adrenergic Antagonist Indications

Answer 32

Useful for treating HTN in men with BPH

Question 33

Alpha-adrenergic Antagonist Side Effects

Answer 33

First dose phenomenon

Question 34

Timolol

Answer 34

Non-selective Beta Blocker

Question 35

Propanolol

Answer 35

Non-selective Beta Blocker

Question 36

Nadolol

Answer 36

Non-selective Beta Blocker

Question 37

Metoprolol

Answer 37

Beta 1 blocker

Question 38

Atenolol

Answer 38

Beta 1 blocker

Question 39

Nebivolol

Answer 39

Beta 1 blocker

Question 40

Acebutolol

Answer 40

Beta 1 blocker

Question 41

Beta Blocker effects

Answer 41

Decrease CO, renin secretion and SNS tone.

Question 42

Beta Blocker Indications

Answer 42

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

Question 43

Beta Blocker side effects

Answer 43

Blocks insulin release and inhibits recovery from hypoglycemia.

Question 44

Beta Blocker contraindications

Answer 44

DM, asthma, heart block and end stage CHF

Question 45

Carvedilol

Answer 45

Alpha and Beta Blocker

Question 46

Labetalol

Answer 46

Alpha and Beta Blocker

Question 47

Alpha and Beta Blocker MOA

Answer 47

Vasodilation without the reflex tachycardia or renin release

Question 48

Labetalol Indications

Answer 48

HTN emergencies. Acute and maintenance use in pregnancy.

Question 49

Carvedilol Inditations

Answer 49

HTN and CHF especially post-MI

Question 50

Alpha and Beta Blocker Side effects

Answer 50

Hepatotoxicity (especially labetalol)

Question 51

Vasodilator side effects

Answer 51

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

Question 52

Hydralazine

Answer 52

Vasodilator that acts through NO.

Question 53

Hydralazine side effects

Answer 53

Lupus is slow acetylators

Question 54

Sodium Nitroprusside

Answer 54

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

Question 55

Sodium Nitroprusside adverse effects

Answer 55

Metabolized by thiocyanate and causes cyandide accumulation

Question 56

Minoxidil MOA

Answer 56

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

Question 57

Fenoldopam

Answer 57

D1 receptor agonist. Mainly effects the renal vasculature.

Question 58

Nifedipine

Answer 58

CCB dihydropine. Strongest vasodilatory effects so increases HR

Question 59

Verapamil

Answer 59

CCB with the strongest cardiac effects leading to a decreased HR

Question 60

Diltiazem

Answer 60

CCB with vasodilatory and cardiac effects.

Question 61

CCB contraindications

Answer 61

CHF. don't use along with a nitrate.

Question 62

DOC for HTN in DM

Answer 62

ACE-I

Question 63

-prils

Answer 63

ACE-I

Question 64

DOC for HTN in CKD

Answer 64

ACE-I

Question 65

DOC for HTN in CHF

Answer 65

ACE-I

Question 66

ACE-I adverse effects

Answer 66

Increased bradykinin leading to dry cough and angioedema

Question 67

-sartans

Answer 67

ARBs

Question 68

ARBs MOA

Answer 68

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

Question 69

DOC For Acute Anginal Attack

Answer 69

Nitrates

Question 70

Nitrate indications

Answer 70

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

Question 71

Nitrate Side effects

Answer 71

Throbbing head aches

Question 72

Nitrate contraindications

Answer 72

Don't use with sildenafil

Question 73

Monday's disease

Answer 73

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

Question 74

CCB indications

Answer 74

Treatment of HTN and angina

Question 75

Beta blockers and Angina

Answer 75

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

Question 76

Ranolazine Indications

Answer 76

Refractory angina

Question 77

Sildenafil (viagra)

Answer 77

Phosphodiesterase type 5 inhibitor

Question 78

Sildenafil (viagra) Adverse effects

Answer 78

Blue visual disturbances

Question 79

Sildenafil (viagra) Contraindications

Answer 79

Use with an alpha blocker, nitrate or grapefruit juice

Question 80

Vardenafil (levitra)

Answer 80

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

Question 81

Tadalafil (cialis)

Answer 81

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

Question 82

Statin MOA

Answer 82

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.

Question 83

DOC for Decreasing LDL

Answer 83

Statins

Question 84

Statin effects

Answer 84

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

Question 85

Statin adverse effects

Answer 85

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

Question 86

Statin Contraindications

Answer 86

pregnancy, Grapefruit juice.

Question 87

Statin drug interactions

Answer 87

gemfibrozil will inhibit their metabolism

Question 88

Chlestyramine

Answer 88

Bile acid binding resin

Question 89

Colestipol

Answer 89

Bile acid binding resin

Question 90

Colesevelam

Answer 90

Bile acid binding resin

Question 91

Bile acid binding resin MOA

Answer 91

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

Question 92

Bile acid binding resin Side effects

Answer 92

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

Question 93

Niacin MOA

Answer 93

Inhibits VLDL secretion and increases HDL

Question 94

Niacin adverse effects

Answer 94

Cutaneous vasodilation due to prostaglandins (aspirin first)

Question 95

Gemfibrozil

Answer 95

Fibric Acid Derivative

Question 96

Fenofibrate

Answer 96

Fibric Acid Derivative

Question 97

Fenofibric acid

Answer 97

Fibric Acid Derivative

Question 98

Fibric Acid Derivative MOA

Answer 98

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

Question 99

Fibric Acid Derivative Side effects

Answer 99

Gall stones

Question 100

Ezetimibe MOA

Answer 100

Blocks intestinal absorption of cholesteral. Synergistic with statins.

Question 101

Alirocumab

Answer 101

PCSK9

Question 102

Evolocumab

Answer 102

PCSK9

Question 103

PCSK9 MOA

Answer 103

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

Question 104

Treatment of HTN with Angina

Answer 104

Beta-blocker

Question 105

Treatment of HTN post-MI

Answer 105

Beta blocker

Question 106

Treatment of HTN with asthma

Answer 106

CCB

Question 107

Treatment of HTN with DM

Answer 107

ACEI

Question 108

Treatment of HTN with CKD

Answer 108

ACEI

Question 109

Treatment of HTN with BPH

Answer 109

Alpha blocker

Question 110

Treatment of HTN with migraines

Answer 110

Beta blocker