Drugs - Randomized

Question 1

Fenoldopam (type, class, MOA, physiological effect, indications, and side effects)

Answer 1

TYPE: antihypertensive CLASS: Misc. MOA: selective D1-receptor (DA) antagonistPHYSIOLOGIC EFFECT: decreases TPR with increased renal blood flowINDICATION: acute treatment for severe HTNSIDE EFFECTS: flushing, hypotension, headache, nausea

Question 2

Atenolol (type, class, MOA, physiological effect, indications, and side effects)

Answer 2

TYPE: AntihypertensiveCLASS: sympatholiticMOA: β receptor agonistPHYSIOLOGIC EFFECT: decreases BP, renin release, and sympathetic outflow from the brainINDICATIONS: decrease myocardial O2 demand to lessen angina, HFSIDE EFFECTS: fewer CNS effects than nonselective β-blockers, hypotension, bradycardia

Question 3

Lidocaine (type, class, MOA, physiological effect, indications, and side effects)

Answer 3

TYPE: antiarrhythmic CLASS: IBMOA: Na channel blocker. Inhibits influx of Na through fast Na channelsPHYSIOLOGIC EFFECT: Purkinje fibers - depress automaticity; higher affinity for ischemic tissue. Suppresses spontaneous depolarization in ventricles by blocking reentryINDICATIONS: Acute treatment of ventricular arrhythmia from MI; suppress ventricular tachycardiaSIDE EFFECTS: neurotoxicity including seizures

Question 4

Aldosterone Blockade

Answer 4

Ex.. Spironolactone, eplerenoneadd-on therapy to ACEI/ARB and β-blockers for HFSpironolactone has estrogenic effects and can cause gynecomastia

Question 5

Low Molecular Weight Heparin (LMWH)

Answer 5

Ex: enoxaparin, dalteparin, tinzaparinalternative to UFH

Question 6

Statins in order of potency, physiologic effect, and side effects

Answer 6

Lovostatin, Pravastatin, Simvastatin, Fluvastatin, Atorvastatin, ResuvastatinPHYSIOLOGIC EFFECT: LDL lowering and modest HDL raising and triglyceride lowering effectsSIDE EFFECTS: myalgias and possible blood sugar raising, memory impairment

Question 7

Drug classes with proven mortality benefit for HF patients

Answer 7

1. β-blockers2. ACEI’s or ARBs3. Aldosterone antagonists4. hydralazine/isosorbide dinitrate combo

Question 8

Nitroglycerin (type, class, MOA, physiological effect, indications, and side effects)

Answer 8

TYPE: anti-anginalCLASS: nitrateMOA: activates GC which raises cGMP and lowers intracellular Ca in SMPHYSIOLOGIC EFFECT: increases venous capacitance; decreases arteriole resistance; redistributes blood to ischemic areaINDICATIONS: angina attack and prophylaxis, HF, HTN emergencySIDE EFFECTS: transient dizziness, hypotension, flushing, severe headaches but tolerance occurs

Question 9

Metoprolol (type, class, MOA, physiological effect, indications, and side effects)

Answer 9

TYPE: antiarrhythmicCLASS: II MOA: β-1 adrenergic receptor antagonist (β-blocker)PHYSIOLOGIC EFFECT: reduces HR and lessens contractility INDICATIONS: treatment and prophylaxis of PSVT; prevent recurrent MI in pt recovering from MI; decrease myocardial O2 demand to lessen angina, HFSIDE EFFECTS: fewer CNS effects than nonselective beta blockers, hypotension, bradycardia

Question 10

Sodium Nitroprusside (type, class, MOA, physiological effect, indications, and side effects)

Answer 10

TYPE: antihypertensiveCLASS: vasodilatorMOA: direct action relaxing arterioles and venules via NOPHYSIOLOGIC EFFECT: peripheral vasodilation - lowers preload and afterloadINDICATIONS: hypertensive emergency, acute MI, aortic dissection, HFSIDE EFFECTS: hypotension, tachycardia, cyanide toxicity

Question 11

Drug classes for symptomatic relief, but nor mortality benefit in HF patients

Answer 11

1. Vasodilators2. Loop Diuretics3. Nitrates4. Digoxin5. Inotropes/infusion therapy

Question 12

Esmolol (type, class, MOA, physiological effect, indications, and side effects)

Answer 12

TYPE: antiarrhythmicCLASS: IIMOA: β-blockerPHYSIOLOGIC EFFECT: reduces HR and lessens contractibility INDICATIONS: short-term control of sinus, tachycardia, PSVT, and ventricular rate in pt with atrial fibrillation/flutterSIDE EFFECTS: AV block and cardiac arrest

Question 13

Quinidine (type, class, MOA, physiological effect, indications, and side effects)

Answer 13

TYPE: antiarrythmicCLASS: IA MOA: Na channel blocker. Also blocks K channels. Decreases phase 0 depolarizationPHYSIOLOGIC EFFECT: decrease myocardial CV, excitability, and contractibility. Prolongs AP INDICATIONS: Atrial arrhythmias, PSVT, WPW SIDE EFFECTS: Torsades de pointes, cinchonism, thrombocytopenia, anticholinergic effects

Question 14

Hydrochlorothiazide (type, class, MOA, physiological effect, indications, and side effects)

Answer 14

TYPE: antihypertensive CLASS: diuretic MOA: inhibits Na reabsorption in distal tubulesPHYSIOLOGIC EFFECTS: lowers plasma and ECF volume, thus decreasing workload on heart and TPRINDICATIONS: first therapy for managing HTN; HFSIDE EFFECTS: hypokalemia, sexual dysfunction, hyperglycemia/lipidemia

Question 15

Heparin (UFH)

Answer 15

ancillary to fibrinolytic therapy. Used for high risk embolization Pts after STEMI

Question 16

Loop Diuretics

Answer 16

Ex. furosemide, torsemide, bumetanideimprove renal performance to remove excess salt and H2O retention- provides symptomatic relief, but no proven mortality benefit

Question 17

ending for all ACE inhibitors

Answer 17

-pril

Question 18

Amidarone (type, class, MOA, physiological effect, indications, and side effects)

Answer 18

TYPE: antiarrhythmicCLASS: IIIMOA: Blocks Na, K, and Ca channels; blocks beta-1 receptorsPHYSIOLOGIC EFFECT: properties of all 4 classes of antiarrhythmic drugsINDICATIONS: atrial and ventricular arrhythmiasSIDE EFFECTS: Torsades de pointes, pneumonitis, pulmonary fibrosis

Question 19

Diltiazem (type, class, MOA, physiological effect, indications, and side effects)

Answer 19

TYPE: antihypertensiveCLASS: vasodilatorMOA: Ca-channel blockerPHYSIOLOGIC EFFECT: prevent vascular SM contractionINDICATIONS: arrhythmia, Prinzmetal’s anginaSIDE EFFECTS: edema, constipation, flushing, and dizziness

Question 20

Fibrates physiologic effect and side effects

Answer 20

PHYSIOLOGIC EFFECT: HDL raising, TG lowering, modest LDL benefitSIDE EFFECTS: myopathy, especially in combo with statins

Question 21

Fibrinolytics

Answer 21

Ex: Alteplase, reteplase, tenecteplase, streptokinaseMOA: converts proenzyme plasminogen to plasmin

Question 22

ending for all ARBs

Answer 22

-sartan

Question 23

Hydralazine/Isosorbide Dinitrate

Answer 23

used in African American pts in combo with ACEI/ARB therapySIDE EFFECTS: dizziness, headache, and lupus-like syndrome at high doses

Question 24

PCSK9 normal function, PCSK9 inhibitors physiologic effect and side effects

Answer 24

NORMAL F(x): binds the LDL receptor and facilitates it’s degradationPHYSIOLOGIC EFFECT: monoclonal Ab that lowers LDLSIDE EFFECTS: nasopharyngitis, injection site rxns, joint pains

Question 25

Losartan (type, class, MOA, physiological effect, indications, and side effects)

Answer 25

TYPE: antihypertensiveCLASS: ARBMOA: antagonizes angiotensin II receptorsPHYSIOLOGIC EFFECT: lowers TPR, reduces plasma volumeINDICATIONS: HF and diabetic neuropathy SIDE EFFECTS: acute renal failure; NO angioedema and coughing associated with ACE inhibitors

Question 26

Nifedipine (type, class, MOA, physiological effect, indications, and side effects)

Answer 26

TYPE: antihypertensiveCLASS: vasodilatorMOA: Ca-channel blockerPHYSIOLOGIC EFFECT: prevent vascular SM contractionINDICATIONS: arrhythmia, Prinzmetal’s anginaSIDE EFFECTS: edema, constipation, flushing, and dizziness

Question 27

Digoxin (type, class, MOA, physiological effect, indications, and side effects)

Answer 27

TYPE: antiarrhythmicCLASS: Misc.MOA: inhibits the Na/K-ATPasePHYSIOLOGIC EFFECT: Increased intracellular Na followed by greater Ca influx and greater contractionINDICATIONS: Antrial fibrillation (first-line with HF or sedation); SVTSIDE EFFECTS: N&V, mental status change, vision color and EKG changes

Question 28

Procainamide (type, class, MOA, physiological effect, indications, and side effects)

Answer 28

TYPE: antiarrythmicCLASS: IAMOA: Na channel blocker; also blocks K channels. Decreases phase 0 depolarizationPHYSIOLOGIC EFFECT: decrease myocardial CV, excitability, and contractibility. Prolongs AP INDICATIONS: refractory ventricular fibrillation; pulseless ventricular tachycardiaSIDE EFFECTS: SLE like symptoms

Question 29

Niacin physiologic effect and side effects

Answer 29

PHYSIOLOGIC EFFECT: LDL lowering, good HDL and TG effectsSIDE EFFECTS: flushing (most common reason for discontinuation) and hepatotoxicity