E3: Cardiovascular Pharm Flashcards
What are Loop diuretics used for?
- Used to move an large volume of fluid
- Treats edema, and alt agent for HTN
What kind of drugs are Furosemide, Torsemide, Bumetanide, and Ethacrynic acid?
Loop diuretic
What is the contraindication to loop diuretics?
Anuria
- Furosemide, torsemide, and Bumetanide have sulfa hypersensitivity
What is the main concern with Ethacrynic acid?
Ototoxicity
What are the side effects of Loop diuretics?
- Hypokalemia, hyponatremia, hypocalcemia, and hyperuricemia
- May precipitate gout at high doses
What kind of drugs are HCTZ, chlorothiazide, and Metalazone?
Thiazide diuretics
What is the use of thiazide diuretics?
- Treated edema and mild fluid retention in HF
- Treated HTN, enhances antihypertensive actions of other drugs
What are the contraindications to thiazide diuretics?
- Anuria
- Don’t use in patients with sulfa allergies (Metalazone less so, but still use caution)
What are the side effects of thiazide diuretics?
- Hypokalemia, hyponatremia, hyperuriecemia, hypocholesterolemia, hyperglycemia, and ED
- May precipitate gout at high doses
What kind of drugs are spironolactone and eplernone?
potassium sparing diuretic- aldosterone antagonist
What kind of drugs are Triamterene and Amiloride?
Potassium sparing diuretic - direct inhibitors of Na flux
What is the use of potassium sparing diuretics?
- Overall weak diuretic effect, used in combination with other diuretics
- Treats Edema and HF, alt agent for HTN
What is the contraindication for all potassium sparing diuretics?
Hyperkalemia
What are the contraindications of the direct inhibitors of Na flux potassium sparing diuretics?
Anuria, severe progressive kidney disease/dysfunction
What are the side effects of potassium sparing diuretics?
Hyperkalemia
What medications are used to reduce mortality and improve symptoms in heart failure?
-ACE inhibitor, BB, and loop diuretic
What is the MOA of ACE-I?
-Blocks angiotensin converted enzyme and stops formation of AT II
What is the use of ACE-I?
- Treats HFrEF, HTN, and STEMI
- Decreases preload and afterload
What are the contraindications of ACE-I?
Angioedema, pregnancy
What are the side effects of ACE-I?
Dry cough, orthostatic hypotension, hyperkalemia, angioedema, and rash
What is considered first line in all patients with DM, CKD, and HFrEF?
ACE-I and ARBs
What is the use of beta blockers?
- Decreased chronotropy, inotropy, and cardiac output
- Treates angina, HFrEF, and HTN
- decrease mortality rate s/p MI, stable class II and III HF
What are the contraindications of beta blockers?
- Severe bradycardia
- 2nd and 3rd degree AV block
- uncompensated HF
- SBP <100
- cardiogenic shock
What are the side effects of non-selective beta blockers?
-Bronchospasm, worsen CHF, raise lipids, impaired glucose tolerance, fatigue, decreased libido, depression, and insomnia
What are the non selective beta blockers?
Propranolol, nadolol, and time lol
What are the cardioselective Beta blockers?
Acebutolol, Atenolol, metoprolol, Nebivolol
What are the beta blockers with intrinsic sympathomimetic activity?
Acetubolol and Pindolol
What do you need to keep in mind when taking a patient off Beta blockers?
-You must avoid abrupt withdrawal because it can precipitate acute coronary events and severe increases in BP
If a patient taking an ACE-I comes in complaining of a cough, what should you do?
Reassure them that a cough a common with an ACE-I, or switch them to an ARB if the cough is too bothersome
What is the MOA of ARBs?
Blocks angiotensin II from binding to AT1 receptor
What is the use of ARBs?
- Treats HFrEF, HTN, and STEMI
- decreases preload and afterload
What are the contraindications to ARBs?
Angioedema and pregnancy
What are the side effects of ARBs?
Orthostatic hypotension, Hyperkalemia
What are the uses of Digoxin?
- Increase contractility, decrease chronotropy, and increase cardiac output
- treats mild to moderate HFrEF and atrial fibrillation
What are the side effects of Digoxin?
- Arrhythmias, headache, fatigue, drowsiness
- Narrow margin of safety, monitor closely, especially patients with reduced renal clearance and hypokalemia
What is the first line treatment of hypertension?
-Lifestyle modifications!! Smoking cessation, salt restriction, diet, exercise, weight management
What are the first line medications for HTN?
-HCTZ, ACE-I, ARB, and CCB
What medications are preferred for HTN in black patients?
HCTZ and CCB
What medications are preferred for HTN in non-black patients?
ACE-I and BB
What medications are preferred for HTN in patients with CKD?
ACE-I, ARB
What is the drug titration strategy in HTN?
-Maximize first medication before adding a second
OR
-add a second medication before reaching maximum dose of first medication
OR
-Start with two medication classes separately or as a fixed dose combination
What is the use of CCBs?
- Decrease inotropy, relax smooth muscles
- Treats HTN and vasospastic angina
What do the dihydropyridine CCBs do?
Potent vasodilators that cause arterial smooth muscle relaxation and decrease PVR
What kind of drug is Nifedipine?
Dihydropyridine CCB
What are the side effects of dihydropyridine CCBs?
Short acting CCBs may cause mild to moderate reflex tachycardia, flushing, and peripheral edema
-Long acting usually only cause edema
What do the Non-dihydropyridines do?
Less vasodilation, decreases inotropy and chronotropy
What kind of drugs are Verapamil and Diltiazem?
Non-dihydropyridine CCBs
What are the side effects of non-dihydropyridine CCBs?
Constipation, bradycardia, SA node dysfunction, heart block
What are the contraindications for non-dihydropyridines?
SA or AV node abnormalities , BB, and HF
What is the use of alpha blockers?
- Treats HTN and BPH
- Decrease vasoconstriction and reduce PVR
What are the selective alpha blockers?
Prazosin, doxazosin, and terazosin
What is the non-selective alpha blocker?
Phenoxybenzamine
What are the side effects of alpha blockers?
-Orthostatic hypotention (first dose phenomenon), fatigue, weakness, nasal congestion, and headache
When are alpha blockers first line for HTN?
When there is concomitant BPH
If you are treated a patient with resistant hypertension with an ACE-I and CCB but his blood pressure is still not controlled, what should you consider adding?
BB
What is the use of alpha agonists?
- Treats refractory HTN
- Reduce sympathetic vasoconstriction and total peripheral vascular resistance
What kind of drugs are clonidine and Methyldopa?
Central acting alpha agonists
*** Methyldopa is safe in pregnancy
What are the side effects of alpha agonists?
-Sedation, xerostomia, Orthostatic hypotension
What should you monitor in a patient taking Methyldopa?
CBC, liver enzymes, and Coombs test
What is the most appropriate pharmacologic treatment for stable angina?
Sublingual nitro PRN
What are the side effects of nitro?
Orthostatic Hypotension, tachycardia, throbbing headache
What is the dosage of SL nitro?
Take 1 dose ever 5 minutes for up to 3 doses, and if it does not improve call EMS
What is the use of antianginals?
- Decrease cardiac workload, decrease preload and afterload
- treat acute angina or prophylactically
What kind of drug is Isosorbide Dinitrate?
A long acting nitrate used in the long term management of chronic stable angina
What are the contraindications to nitrates?
Do not use within 24 hours of sildenafil
-HCM or RV infarction
