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Cardiology is my friend > ♥ ♡ DRUGS - let's stare deeply into each other's eyes ♡ ♥ > Flashcards

♥ ♡ DRUGS - let's stare deeply into each other's eyes ♡ ♥ Flashcards

1
Q

According to JNC7, what’s the main firstline drug to start your average hypertension patient on?

A

THIAZIDE diuretic

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2
Q

Name the drug class that contains propranolol, atenolol, and metoprolol.

A

Beta blockers

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3
Q

Name the drug class that contains prazosin, terazosin, and doxazosin.

A

Alpha blockers

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4
Q

Name the drug class that contains lisinopril and enalapril.

A

ACE inhibitors

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5
Q

Name the drug class that contains losartan.

A

ARBs (angiotensin receptor blockers)

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6
Q

Name the drug class that contains nifedipine, verapamil, and diltiazem.

A

CCBs (calcium-channel blockers)

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7
Q

Name two central or alpha-2 agonists.

A

clonidine

methyldopa

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8
Q

Name two direct vasodilators.

A

hydralazine

minoxidil

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9
Q

What’s the class of diuretics that works on the proximal tubule? Example drug of this class, please.

A

Carbonic anhydrase inhibitors

acetazolamide

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10
Q

Where along the nephron does hydrochlorothiazide work?

A

Distal tubule

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11
Q

Where along the nephron does bumetanide work? Name 3 other drugs of this type.

A

Loop diuretics work at the ascending loop of Henle. Also furosemide, torsemide, and ethacrynic acid.

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12
Q

What class of diuretics works in the collecting duct? Name 3 examples of this type of drug.

A

potassium-sparing diuretics
~spironolactone
~amiloride
~triamterene

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13
Q

Are you really going to ever use acetazolamide for hypertension or CHF? What are the indications?

A

No. Carbonic anhydrase inhibitors are used for chronic glaucoma and altitude sickness.

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14
Q

What is the first-line drug for an acute angina attack?

A

nitroglycerin/isosorbide dinitrate

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15
Q

What is the first-line treatment drug class used long-term for CLASSIC angina (not vasospastic)?

A

Beta blockers

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16
Q

What drug class is third-line treatment for angina? Meaning, if beta blockers cannot be tolerated or if nitrate + BB is not enough.

A

CCBs - only the dihydropyridines (which would be nifedipine, amlodipine)

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17
Q

Name 2 anti-platelet medications.

A

aspirin

clopidogrel

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18
Q

Name 3 anti-coagulants.

A

heparin
warfarin
dabigatran

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19
Q

Which anti-coagulant works by directly inhibiting thrombin?

A

dabigatran

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20
Q

Name a vitamin K antagonist.

A

warfarin

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21
Q

Which anti-coagulants CAN and CANNOT be used in pregnancy?

A

heparin: YES. It is BIG and negatively charged and does NOT cross the placenta. Heparin = Happy baby.
warfarin: NO, do NOT use in pregnancy! Pregnancy category X! Warfarin = WAR on the baby!

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22
Q

Name 2 thrombolytics.

A

alteplase (tPA)

streptokinase

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23
Q

Out of all the drugs we are learning this time, this one has the narrowest therapeutic window and has the highest chance of toxicity/dose-related adverse effects. It’s given for severe left systolic HF. What is it?

A

digoxin

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24
Q

Name 3 adrenergic agonists.

A

epinephrine
dopamine
dobutamine

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25
Q

What are the indications for dopamine?

A

Dopamine is the drug of choice for cardiogenic shock.

Also used in severe CHF.

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26
Q

Name a synthetic B1 receptor agonist that is used in acute CHF.

A

dobutamine

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27
Q

What are the effects of a B1 receptor agonist?

A

increase HR and contractility = increase cardiac output

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28
Q

According to JNC7, what is the firstline drug of choice for hypertension in patients with chronic kidney disease?

A

ACEi/ARB
NOT thiazides
(thiazides don’t work as well in patients with poor renal function, because thiazides need to be excreted to the tubule and then they work on the luminal side of the cell. If you can’t excrete very well then you won’t get much of the drug available.)

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29
Q

What is the difference between selective and non-selective beta blockers? Give an example of each type.

A

Nonselective means that the drug works on both B1 and B2 adrenergic receptors, so will have both heart and lung effects.
Selective means that it works mainly on B1 receptors, in the heart.
propranolol is NONSELECTIVE
atenolol and metoprolol are SELECTIVE

30
Q

What is the indication for alpha blockers?

A

Hypertension. Can also be used in CHF.

31
Q

What are the indications for ACEi/ARB?

A

Hypertension, especially in pts with CKD
CHF
Post-MI

32
Q

What antihypertensives are to be used in black patients, according to JNC?

A

thiazides, CCBs

33
Q

What are the indications for central/a2 agonists?

A

Used to treat HTN that has not responded to 2+ other drugs.

Also, good in HTN + CKD because they do not decrease renal blood flow.

34
Q

When would you use hydralazine?

A

Used to treat moderately severe HTN, and usually administered in combo with a beta blocker (to balance the reflex tachycardia) and a diuretic (to reduce sodium retention)
Also, hydralazine is used as monotherapy in pregnancy-induced HTN.

35
Q

What is the mechanism of action of thiazides?

A

decrease reabsorption of Na+

36
Q

What is the main drug of choice for CHF?

A

loop diuretics

37
Q

What’s the main adverse effect of spironolactone that patients don’t like?

A

gynecomastia

38
Q

What diuretic works not by decreasing sodium reabsorption but by decreasing H2O reabsorption? What are the indications for this diuretic?

A

mannitol

  1. increased intracranial pressure
  2. acute renal failure
39
Q

What are the indications for aspirin?

A

prophylactic for TIA, pre-MI, post-MI, current MI

40
Q

What is the mechanism of action of heparin?

A

binds to (thereby enhancing activity of) antithrombin III -> rapid inactivation of coagulation factors

41
Q

What is the indication for dabigatran?

A

Prevention of stroke & systemic embolism in patients with atrial fibrillation

42
Q

TRUE or FALSE:

INR must be monitored with use of dabigatran

43
Q

What is the only oral anticoagulant? What are its indications?

A

Warfarin

  1. Used to prevent the progression or recurrence of acute DVT or PE after initial heparin treatment
  2. Used prophylactically in acute MI, prosthetic valves, and chronic afib.
44
Q

What test is used to monitor warfarin therapy?

A

prothrombin time

45
Q

What are the indications for thrombolytics?

A

MI
massive PE
acute ischemic stroke (tPA within 3 hours of symptom onset)

46
Q

TRUE or FALSE

Digoxin can be used in right sided and diastolic HF.

A

FALSE.

Only left systolic

47
Q

According to JNC8, what are the initial HTN drugs to be used in nonblack patients, including with DM?

A

start with thiazide, CCB, or ACEi/ARB

48
Q

According to JNC8, what are the initial HTN drugs to be used in black patients, including with DM?

A

start with thiazide or CCB (NOT ACEi/ARB)

49
Q

According to JNC8, what are the initial HTN drugs to be used in CKD patients?

A

include or start with ACEi/ARB

50
Q

What antihypertensive class of drugs is also prophylactic for migraines?

51
Q

What BB MUST NOT be given to patients with COPD or asthma? Why?

A

propranolol!
It is a non-selective BB, meaning that it blocks both beta 1 and beta 2 receptors => slows/turns down heart but ALSO stops B2-mediated vasodilation in the lungs, meaning that bronchoconstriction is highly likely!

52
Q

What might be some unwanted side effects of BB in men?

A

decreased libido, impotence

BBs are Bad for Boners (sorry)

53
Q

What are the indications for BB?

How are they used in HTN?

A

Since BB decrease the O2 requirements of the heart muscle, they are good for angina, post-MI, and CHF.
They are used for HTN in post-MI patients.

54
Q

Should you give a patient their first dose of prazosin and walk away?

A

NO - the first dose of an alpha-blocker is EXTREMELY likely to produce an orthostatic response (syncope!) and reflex tachycardia

55
Q

What are the indications for alpha blockers and why?

A
  1. used to treat CHF (decrease preload and afterload because they relax both arterial and venous smooth muscle)
  2. used to treat HTN
56
Q

What is a common side effect of ACEi and why?

A

COUGH

Because ACEi also inhibits the breakdown of bradykinin, and bradykinin causes bronchoconstriction

57
Q

What must be monitored when taking ACEi?

A

potassium levels - danger of hyperkalemia

58
Q

What group responds well to CCBs?

A

black hypertensive patients

59
Q

What CCB should not be used in a patient with CHF?

A

verapamil and diltiazem should not be used in a patient with CHF

60
Q

What are the indications for minoxidil?

A

severe to malignant HTN that has not responded to other drugs

61
Q

What ions are lost and which are kept when thiazide diuretics are used?

A

Lost: Na+, K+, Mg2+
Kept: Ca2+

62
Q

What are the adverse effects of thiazides?

A
  1. hyperuricemia (gout!)
  2. hyperglycemia
  3. hyperlipidemia
63
Q

What ions are lost and what ions are kept when loop diuretics are used?

A

Lost: Na+, K+, Ca2+, Mg2+
Kept: none

64
Q

What ions are lost and what ions are kept when potassium-sparing diuretics are used?

A

Lost: Na+
Kept: K+

65
Q

What is a common side effect of nitroglycerin?

66
Q

What type of medication cannot be taken along with nitroglycerin?

A

Phosphodiesterase-5 inhibitors (sildenafil/Viagra)

67
Q

Which types of angina are nitrates effective for?

A

ALL 3 TYPES
classic/stable
unstable
variant

68
Q

Why is nitroglycerin taken sublingually?

A

Because it has an extremely high first pass metabolism

69
Q

What is the INR goal for warfarin therapy?

70
Q

Ototoxicity is an adverse effect of what?

A

loop diuretics

71
Q

Long-acting nitroglycerin patch: leave it on for 1 week after an angina attack and then remove.
TRUE or FALSE?

A

FALSE.
Tolerance to nitro builds very quickly; need a 12 hr window EVERY NIGHT without patch. Wear patch during day, take off at night.

72
Q 
For general venous occlusion issues, what class of drugs?
For general arterial occlusion issues, what class of drugs?
A

Venous: anticoagulants/antithrombotics

Arterial: antiplatelet

Cardiology is my friend (2 decks)

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