Exam 1 shuffled Flashcards
1
Q
Aminocaproic acid
A
Bleeding treatment, inhibits plasminogen activation to encourage clotting. Oral
2
Q
What anticoagulant is very good in combination?
A
Dipyridamole
3
Q
Nebivolol*
A
Beta 1 blocker (for HTN, angina AND heart failure). Decreases CO and renin and increases NO production causing vasodilation. This reduces negative effects of heart remodeling. AE: Bradycardia, fatigue, decreased libido, sudden cessation can cause angina, MI, or death!
4
Q
Fenoldopam
A
Parenteral agent (Vasodilator for HTN). MOA: Peripheral dopamine-1 receptor agonist to increase renal blood flow. increases IOP–avoid in glaucoma, send note to ER
5
Q
Thiazide Diuretics. MoA, Therapeutic uses, pharmacokinetics, AE, net change in absorption/secretion:
A
antiHTN, and heart failure med. MOA: inhibits Na/Cl cotransporter in the distal convoluted tubule, causing Na,Cl, K, and water excretion (retains Ca). lowers peripheral resistance. THERAPEUTIC USES: htn, heart failure, hypercalciuria (excess Ca in urine), kidney stone prevention. PHARMACOKINETICS: oral, effects in 1-3 weeks, kidney! excreted. AE: K depletion (can cause arrhythmias), hyponatremia, hyperuricemia (causes gout), orthostatic hypotension, Hypercalcemia (excess Ca can mess with glucose uptake), Hyperlipidemia, rare sulfa hypersensitivity. NET CHANGE: excretion of Na, K, urine; retention of Ca++
6
Q
What is effective treating HTN in patients with angina or diabetes?
A
Ca channel blockers (-Pine –zem -mil)
7
Q
What HTN treatment is good for Diabetes and asthma patients because beta blockers are bad for them?
A
Ca channel blockers (vasodilator for HTN and angina)
8
Q
Doxazosin
A
Alpha blocker (for HTN). MOA: Relaxes arterial and venous smooth muscle. Rarely used by itself because of tolerance. can cause peripheral edema
9
Q
Losartan
A
Angiotensin-2-receptor blockers (for HTN and heart failure) MOA: Reduces water retention; decreased preload and afterload for increased CO. AE: hyperkalemia when used with K-sparing diuretics, rash, fever, Fetotoxic
10
Q
Carvedilol
A
non-selective beta blocker (for HTN, angina, AND heart failure). MOA: Decreases CO and renin. This reduces negative effects of heart remodeling. Not for asthmatics! AE: Bradycardia, fatigue, decreased libido, sudden cessation can cause angina, MI, or death!
11
Q
Cilazapril
A
ACE inhibitor (for HTN and heart failure). MOA: Decreases angiotensin II and increases bradykinin, reducing water retention. AE: dry cough. hyperkalemia when used with K-sparing diuretics, rash, fever, Fetotoxic
12
Q
Pentoxifylline
A
Sickle cell anemia treatment. Improves erythrocyte flexibility and reduces viscosity
13
Q
Azilsartan
A
Angiotensin-2-receptor blockers (for HTN and heart failure) MOA: Reduces water retention; decreased preload and afterload for increased CO. AE: hyperkalemia when used with K-sparing diuretics, rash, fever, Fetotoxic
14
Q
What is the most common diuretic used in HTN?
A
Thiazide Diuretics ( Chlor Inda- -Zone)
15
Q
What can cause decreased libido?
A
Beta blockers
16
Q
What drugs do you want to avoid in kidney failure?
A
Thiazide diuretics, Gemfibrozil and Fenofibrate (fibrates)
17
Q
Propafenone
A
Class 1C Antiarrhythmic (Na channel blocker) Markedly slows phase 0 depolarization in ventricular muscle fibers. AE can/does interfere with normal heart beat, Dizziness, blurred vision, HA, nausea…… slows down rise in action potential. Absorbed orally, long half-life. UNIQUE: good for atrial fibrillation
18
Q
How do Diuretics help in HF?
A
They relieve pulmonary congestion and peripheral edema. Decreased venous return reduces cardiac workload and oxygen demand.
19
Q
What should you not give to people that have had brain, eye, or spinal surgery?
A
Heparin
20
Q
What drugs are good for atrial flutter?
A
Verapamil. (also for atrial fibrillation): Metoprolol, Digoxin
21
Q
Captopril
A
ACE inhibitor (for HTN and heart failure). MOA: Decreases angiotensin II and increases bradykinin, reducing water retention. AE: dry cough. hyperkalemia when used with K-sparing diuretics, rash, fever, Fetotoxic
22
Q
What angina treatment does NOT produce much orthostatic htn?
A
Calcium channel blockers
23
Q
Enalapril
A
ACE inhibitor (for HTN and heart failure). MOA: Decreases angiotensin II and increases bradykinin, reducing water retention. AE: dry cough. hyperkalemia when used with K-sparing diuretics, rash, fever, Fetotoxic
24
Q
Simvastatin (Zocor)
A
HMG COA Reductase inhibitor. MOA: analogs of HMG (cholesterol precursor). Stabilizes plaque, causes LDL to go into cells and prevents VLDL secretion. Less effective in familial hypercholesterolemia because they lack LDL receptors. Excretion through bile and feces. AE: elevated liver enzymes, disintegration of muscle (rare), increased warfarin levels. not for pregnant or nursing or children.
25
What treats mountain sickness?
CAI diuretics.
26
Benazepril (Lotensin)
ACE inhibitor (for HTN and heart failure). MOA: Decreases angiotensin II and increases bradykinin, reducing water retention. AE: dry cough. hyperkalemia when used with K-sparing diuretics, rash, fever, **Fetotoxic**
27
Alteplase
Thrombolytic Agent. MOA: converts plasminogen > plasmin cleaves fibrin. AE: bleeding. UNIQUE: "fibrin selective", administer within 3 hours of ischemic stroke.
28
Esmolol
Beta 1 blocker (for HTN and angina) and Class II antiarrhythmic. MOA: Decreases CO and renin and increases NO production causing vasodilation. MOA 2:Inhibits phase 4 depolarization in SA and AV nodes. IV emergency arrhythmias AE: Bradycardia, fatigue, decreased libido, sudden cessation can cause angina, MI, or death!
29
Moexipril
ACE inhibitor (for HTN and heart failure). MOA: Decreases angiotensin II and increases bradykinin, reducing water retention. AE: dry cough. hyperkalemia when used with K-sparing diuretics, rash, fever, **Fetotoxic**
30
What is treatment for classic angina?
Effort-induced angina is treated with rest or nitroglycerin and also beta blockers (especially metoprolol and atenolol)
31
Dabigatran (Pradaxa)
Direct thrombin inhibitor (anticoagulant). Prodrug. Tx prevent stroke in pts with atrial fibrillation. First oral anticoagulat since warfain. AE: bleeding
32
What 3 drug types are used to treat HTN in combination?
Thiazide diuretic, beta blocker, and ACE inhibitor or Angiotensin-2-receptor blocker
33
Ticagrelor
Platelet aggregation inhibitor. MOA blocks ADP receptors, prevents fibrinogen binding to glycoprotein receptor. plasma protein bound, P450 metabolism, renal/fecal elimination. AE: prolonged bleeding, life-threatening Thrombotic thrombocytopenic purpura. UNIQUE: is not irreversible so it's good for surgery
34
Atorvastatin (Lipitor)
HMG COA Reductase inhibitor. MOA: analogs of HMG (cholesterol precursor). Stabilizes plaque, causes LDL to go into cells and prevents VLDL secretion. Less effective in familial hypercholesterolemia because they lack LDL receptors. Excretion through bile and feces. AE: elevated liver enzymes, disintegration of muscle (rare), increased warfarin levels. not for pregnant or nursing or children.
35
Which anticoagulant can be reversed with vit K?
Warfarin
36
What hormone can induce cardiac hypertrophy?
Angiotensin II
37
What are the most commonly used HF diuretics?
Loop diuretics
38
Hydrochlorothiazide (HCTZ)
Thiazide diuretic, antiHTN, and heart failure med. MOA: inhibits Na/Cl cotransporter in the distal convoluted tubule, causing Na,Cl, K, and water excretion (retains Ca). lowers peripheral resistance
39
What can cause ototoxicity?
Loop diuretics
40
Bisoprolol
Beta 1 blocker (for HTN and angina). MOA: Decreases CO and renin and increases NO production causing vasodilation. AE: Bradycardia, fatigue, decreased libido, sudden cessation can cause angina, MI, or death!
41
Terazosin (Hytrin)
Alpha blocker (for HTN). MOA: Relaxes arterial and venous smooth muscle. Rarely used by itself because of tolerance. can cause peripheral edema
42
What are the 2 basic mechanisms for arrhythmias?
Disturbances in impulse formation or conduction
43
Potassium
Other Antiarrhythmic Drugs. proper dose balances K gradients
44
What do Chylomicrons do?
They transport dietary lipids from gut to adipose tissue and liver
45
Methazolamide
Carbonic Anhydrase Inhibitors (diuretic). MOA: CAI affects proximal convoluted tubule, TREATS glaucoma, mountain sickness. AE: metabolic acidosis, renal stones, drowsiness, paresthesia. NET CHANGE: excrete Na, K, HCO3- (bicarb), urine.
46
Tirofiban
Platelet aggregation inhibitor. MOA blocks ADP receptors, prevents fibrinogen binding to glycoprotein receptor. UNIQUE: IV only
47
Eptifibatide
Platelet aggregation inhibitor. MOA blocks ADP receptors, prevents fibrinogen binding to glycoprotein receptor. UNIQUE: IV only
48
Ticlopidine
Platelet aggregation inhibitor. MOA irreversibly blocks ADP receptors, prevents fibrinogen binding to glycoprotein receptor. plasma protein bound, P450 metabolism, renal/fecal elimination. AE: prolonged bleeding, life-threatening Thrombotic thrombocytopenic purpura. UNIQUE: prodrug, can inhibit P450
49
What drugs are good for atrial fibrillation?
Propafenone, Amiodarone, Dofetilide, Diltiazem. (also for Atrial flutter): Metoprolol, Digoxin
50
Cholestyramine
Bile acid sequestrant. Binds biles a/s in small intestine, causing liver to use cholesterol to make bile acids. increases LDL receptors. excreted in feces. AE: GI disturbances, impair absorption of vit ADEK, and other drugs. UNIQUE: relieves pruritis caused by accumulation of bile acids in patients with biliary obstruction.
51
Which meds do NOT produce peripheral edema?
Diuretics, Beta blockers, ACE inhibitors, ARBs, Aliskiren (renin inhibitor)
52
What is the criteria for a hypertensive emergency? What symptoms are there?
210/150 or 210/130 if they have pre-existing conditions. Severe HA, confusion, apprehension, blurred vision
53
Gemfibrozil
Fibrate. MOA: prevents bile acids/salts from going to liver so liver makes bile a/s from cholesterol instead. causes genes to make proteins responsible for lipoprotein structure/function, resulting in decreased triglyceride and increased HDL. Also lowers LDL PHARMICOKINETICS: oral, albumin bound, excreted in urine. AE: Gallstones, voluntary muscle inflammation, warfarin increase. bad for liver/kidney/gallbaldder disease
54
What are the steps of the Renin-Angiotensin-Aldosterone System?
Angiotensinogen (renin>) Angiotensin 1 (ACE>) angiotensin 2, which stimulates vasoconstriction and aldosterone secretion (Na retention increases blood volume)
55
Niacin
increases HDL by inhibiting lipolysis in adipose tissue, lowering blood triglycerides. Helps reverse endothelial cell dysfunction. Great for familial hyperlipidemias. Excreted in urine. AE: intense cutaneous flush and feeling of warmth (helped via aspirin), nausea, inhibits secretion of uric acid which can cause gout.
56
What can cause arrhythmia?
Ischemia/hypoxia, pH imbalances, autonomics, electrolyte imbalance, stretching/scarring of cardiac tissue drug toxicity
57
What drug is contraindicated in pts with glaucoma?
Fenoldopam (Vasodilator for HTN).
58
Class IV antiarrhythmics are what?
Ca blockers
59
Metolazone
Thiazide diuretic, antiHTN, and heart failure med. MOA: inhibits Na/Cl cotransporter in the distal convoluted tubule, causing Na,Cl, K, and water excretion (retains Ca). lowers peripheral resistance
60
Disopyramide
Class 1A Antiarrhythmic (Na channel blocker) Slows phase 0 depolarization in ventricular muscle fibers. Similar AE as cholinergic blocker: Dry mouth, urine retention, blurred vision, constipation
61
What do LDLs do?
Transport cholesterol to peripheral tissues for incorporation into cell membranes and steroids. also deliver cholesterol to artery wall.
62
What are the 4 endogenous inhibitors of coagulation?
Protein C, protein S, antithrombin III, tissue factor pathway inhibitor
63
Argatroban
Direct thrombin inhibitor (anticoagulant). Parenteral, liver metabolized
64
Torsemide
Loop Diuretic, antiHTN, and heart failure med. MOA: Inhibits Na/K/2Cl cotransporter in ascending loop of Henle, causing Na, K, Ca, and water excretion. lowers peripheral resistance. Treats acute pulmonary edema of heart failure, hypercalcemia and hyperkalemia. AE: Ototoxicity, Hyperuricemia (causes gout), acute hypovolemia, hypomagnesemia. NET CHANGE: excrete Na+, K+, Ca++, urine
65
Quinidine
Class 1A Antiarrhythmic (Na channel blocker) Slows phase 0 depolarization in ventricular muscle fibers. UNIQUE: Absorbs quickly orally, CP450 metabolized. AE: arrhythmia, GI disturbances, blurred vision. Other: increases digoxin, displaces from tissue-binding sites.
66
What drugs are good for AV Nodal reentry
| (supraventricular tachycardia)?
Metoprolol, Verapamil, Digoxin
67
What drug can cause metabolic acidosis?
CAI diuretics.
68
What can cause cardiac depression?
Calcium channel blockers (in the case of angina treatment)
69
Perindopril
ACE inhibitor (for HTN and heart failure). MOA: Decreases angiotensin II and increases bradykinin, reducing water retention. AE: dry cough. hyperkalemia when used with K-sparing diuretics, rash, fever, **Fetotoxic**
70
What drugs are good for ventricular fibrillation?
Amiodarone, epinephrine, lidocaine
71
Darbepoetin
Anemia treatment during renal disease, HIV, or cancer. Not for acute anemia. HTN may result
72
What drugs work on the ascending loop of Henle?
Loop diuretics
73
Nisoldipine
Calcium channel blocker (vasodilator for HTN and Angina). MOA: Dilates arteries by blocking inward Ca to prevent muscle contraction. Has natural diuretic effect. Short half life. can cause peripheral edema.
74
Telmisartan
Angiotensin-2-receptor blockers (for HTN and heart failure) MOA: Reduces water retention; decreased preload and afterload for increased CO. AE: hyperkalemia when used with K-sparing diuretics, rash, fever, **Fetotoxic**
75
What drugs work in the distal convoluted tubule?
Thiazide diuretics
76
Eicosapentaenoic acid
Omega-3 Fatty Acids for hyperlipidemia
77
Diltiazem
Calcium channel blocker (vasodilator for HTN and Angina). and Class IV Antiarrhythmic. MOA: Dilates arteries by blocking inward Ca to prevent muscle contraction. Has natural diuretic effect. Short half life. can cause peripheral edema. UNIQUE: favorable side effect profile. MOA 2: Inhibits AP in SA and AV nodes in phase 4 to prevent spontaneous depolarization, prolongs refractory period. UNIQUE: contraindicated depressed cardiac function. good for atrial fibrillation and acute supraventricular tachycardia
78
Chlorthalidone
Thiazide diuretic, antiHTN, and heart failure med. MOA: inhibits Na/Cl cotransporter in the distal convoluted tubule, causing Na,Cl, K, and water excretion (retains Ca). lowers peripheral resistance
79
What is reserved for advanced HF?
Spironolactone (although Eplerenone has fewer side effects)
80
Eplerenone (Inspra)
“Potassium-Sparing” Diuretic, antiHTN, (also for heart failure). MOA: inhibits aldosterone receptors in collecting tubule, causing Na/water excretion (retains K/H). lowers peripheral resistance; relieves edema and cardiac workload. PHARMACOKINETICS: Metabolized by P450 system into active metabolite, Highly bound to plasma proteins. AE: gynecomastia (in men), menstrual irregularities. NET CHANGE: excrete Na, urine. Retain K
81
What are the most common causes of resistant HTN?
Poor compliance, alcoholism, NSAIDS/antidepressants, insufficient dose, similar MOA.
82
What drugs do you give in a hypertensive emergency?
Nitroprusside, Fenoldopam or Nicardipine (Ca channel blocker).
83
What drug class should be avoided in HF?
Calcium channel blockers because they decrease heart contraction.
84
Why are beta blockers helpful in HF?
They decrease sympathetic activity, reduce water retention, vasoconstriction, high bp, high workload, and cardiac remodeling. NOT good for acute HF.
85
Dipyridamole
Platelet aggregation inhibitor. MOA increases cAMP, which decreases Thromboxane A2 and clot formation. Very good in combination, poor alone
86
Rivaroxaban (Xarelto)
Factor Xa Inhibitor (anticoagulant), oral. does not have variable activity. tx hip/knee surgery, renal eliminated.
87
Amlodipine (Norvasc)
Calcium channel blocker (vasodilator for HTN and Angina). MOA: Dilates arteries by blocking inward Ca to prevent muscle contraction. Has natural diuretic effect. can cause peripheral edema. UNIQUE: has a long half life
88
Aliskiren
Renin inhibitor (for HTN), MOA: decreases blood volume. metabolized by p450 system. AE: Cough (not like ace inhibitors, though), hyperkalemia. NOT for pregnancy
89
Reteplase
Thrombolytic Agent. MOA: converts plasminogen > plasmin cleaves fibrin. AE: bleeding. UNIQUE: "fibrin selective", administer within 3 hours of ischemic stroke.
90
An LDL higher than ____ plus additional risk factor prompts drug therapy
160
91
Clevidipine
Calcium channel blocker (vasodilator for HTN and Angina). MOA: Dilates arteries by blocking inward Ca to prevent muscle contraction. Has natural diuretic effect. can cause peripheral edema. Short half life
92
Dronedarone
Class III Antiarrhythmic (K Channel blocker) Prolongs phase 3 repolarization in ventricular muscle fibers. They prolong the AP and refractory period. AE: ventricular tachyarrhythmias. UNIQUE: shorter half life, fewer side effects.
93
Propranolol
non-selective beta blocker (for HTN, angina) and Class II antiarrhythmic. MOA: Decreases CO and renin. Not for asthmatics! MOA 2: Inhibits phase 4 depolarization in SA and AV nodes. Reduces sudden arrhythmic death after MI. AE: Bradycardia, fatigue, decreased libido, sudden cessation can cause angina, MI, or death!
94
Which drug can develop tolerance?
Alpha 1 blockers (-sin)
95
Nifedipine (Procardia)
Calcium channel blocker (vasodilator for HTN and Angina). MOA: Dilates arteries by blocking inward Ca to prevent muscle contraction. Has natural diuretic effect. Short half life. can cause peripheral edema.
96
Lovastatin
HMG COA Reductase inhibitor. MOA: analogs of HMG (cholesterol precursor). Stabilizes plaque, causes LDL to go into cells and prevents VLDL secretion. Less effective in familial hypercholesterolemia because they lack LDL receptors. Excretion through bile and feces. AE: elevated liver enzymes, disintegration of muscle (rare), increased warfarin levels. not for pregnant or nursing or children.
97
Flecainide
Class 1C Antiarrhythmic (Na channel blocker) Markedly slows phase 0 depolarization in ventricular muscle fibers. AE can/does interfere with normal heart beat, Dizziness, blurred vision, HA, nausea...... slows down rise in action potential. Absorbed orally, long half-life.
98
What is the least appropriate drug for acute HF?
Beta blockers
99
What can cause gynecomastia and menstrual irregularities?
Potassium-sparing diuretics
100
Warfarin (Coumadin)
Other anticoagulant. MOA: inhibits vitamin K epoxide reductase, preventing vit K regeneration. PHARMACOKINETICS: 99% albumin bound. Other protein-binding drugs can displace Warfarin, increasing its concentration. AE: bleeding. not for pregnancy!
101
What do VLDLs do?
Deliver triglycerides to peripheral tissue and are transformed into LDLs as triglycerides are removed
102
What drug class has a greater affinity for open sodium channels?
IA and IC antiarrhythmics. Weird note: can cause blurred vision
103
What is the first line therapy for increased LDL?
HMG CoA reductase inhibitors (statins)
104
Irbesartan
Angiotensin-2-receptor blockers (for HTN and heart failure) MOA: Reduces water retention; decreased preload and afterload for increased CO. AE: hyperkalemia when used with K-sparing diuretics, rash, fever, **Fetotoxic**
105
Docosahexaenoic acid
Omega-3 Fatty Acids for hyperlipidemia
106
What is the treatment for damaged myocardial cells or non-SA node automaticity?
Since they depolarize the heart sooner, blocking Na or Ca channels is good
107
Ibutilide
Class III Antiarrhythmic (K Channel blocker) Prolongs phase 3 repolarization in ventricular muscle fibers. They prolong the AP and refractory period. AE: ventricular tachyarrhythmias. UNIQUE: risk of proarrhythmia, 6-10 hr half life, adjust dose if there is renal insufficiency.
108
Ramipril
ACE inhibitor (for HTN and heart failure). MOA: Decreases angiotensin II and increases bradykinin, reducing water retention. AE: dry cough. hyperkalemia when used with K-sparing diuretics, rash, fever, **Fetotoxic**
109
Trandolapril
ACE inhibitor (for HTN and heart failure). MOA: Decreases angiotensin II and increases bradykinin, reducing water retention. AE: dry cough. hyperkalemia when used with K-sparing diuretics, rash, fever, **Fetotoxic**
110
What can be used to prevent migraines and cluster HA?
Beta blockers
111
Erythropoietin
Anemia treatment during renal disease, HIV, or cancer. Not for acute anemia. HTN may result
112
Clonidine
Centrally acting alpha-2 agonist (for HTN). MOA: Lowers CO. UNIQUE Used when 2 or more HTN drugs have failed. Food for renal disease. AE: all mild: sedation, dry mouth, constipation, rebound hypertension, peripheral edema
113
How can Diabetes Insipidus be treated with diuretics?
Polyuria (peeing) and polydipsia (thirst) treated with diuretics (huh?!). Thiazide diuretic reduces plasma volume causing a drop in glomerular filtration rate. Promoting reabsorption of Na and water
114
What is the most effective treatments for elevated triglycerides?
Diet and exercise, niacin and fibric acid derivatives.
115
Aspirin
Platelet aggregation inhibitor. MOA: inhibits Cox-1. (platelet activation > arachidonic acid [Cox-1>] Prostaglandic H2 > Thromboxane A2 > clot formation). rapid effect that lasts platelet life. Tx prophylactic stroke or MI. AE: hemorrhagic stroke, GI bleeding.
116
What drug is poisonous if given orally?
Nitroprusside (Vasodilator for HTN and heart failure).
117
Procainamide
Class 1A Antiarrhythmic (Na channel blocker) Slows phase 0 depolarization in ventricular muscle fibers. UNIQUE: AE: lupus-like rash in 20-30% pts, some GI disturbances, CNS problems
118
Dobutamine
Beta agonist (for heart failure). MOA: Increases contraction of heart increased protein kinase increases Ca influx. AE: risk of angina or arrhythmias
119
Metoprolol
Beta 1 blocker, Class II Antiarrhythmic (for HTN, angina AND heart failure). Decreases CO and renin and increases NO production causing vasodilation. This reduces negative effects of heart remodeling. AE: Bradycardia, fatigue, decreased libido, sudden cessation can cause angina, MI, or death! MOA 2: Inhibits phase 4 depolarization in SA and AV nodes. most common beta blocker for arrhythmias. UNIQUE: preferred in angina treatment.... good for atrial flutter, atrial fibrillation
120
Pitavastatin
HMG COA Reductase inhibitor. MOA: analogs of HMG (cholesterol precursor). Stabilizes plaque, causes LDL to go into cells and prevents VLDL secretion. Less effective in familial hypercholesterolemia because they lack LDL receptors. Excretion through bile and feces. AE: elevated liver enzymes, disintegration of muscle (rare), increased warfarin levels. not for pregnant or nursing or children.
121
What can diuretics treat?
Hypertension, Hypercalcemia (loop diuretics), Diabetes insipidus (Thiazide diuretics reduce glomerular filtration rate)
122
Felodipine
Calcium channel blocker (vasodilator for HTN and Angina). MOA: Dilates arteries by blocking inward Ca to prevent muscle contraction. Has natural diuretic effect. Short half life. can cause peripheral edema
123
Where is the nephron impermeable?
In the ascending loop of Henle and distal convoluted tubule
124
Minoxidil
Vasodilator (for HTN). MOA: opens K channels that hypopolarize smooth muscle. can cause reflex heart stim, causing problems. Used topically to treat baldness
125
What are atheromas?
Accumulation of macrophages, collagen, fibrin, and calcium.
126
Deficiency of folic acid can lead to what?
Megaloblastic anemia
127
Tenecteplase
Thrombolytic Agent. MOA: binds to fibrin, plasminogen > plasmin cleaves fibrin.
128
What are the 3 compensatory responses in HF?
Increased sympathetic activity (increased CO, increased venous return), renin-angiotensin system activation (increase BP), and myocardial hypertrophy (bad compensation). Note that higher BP can lead to pulmonary edema.
129
What is cholesterol goals (total, LDL, HDL)?
Less than 200 total. 130 or less for LDL, 60+ for HDL
130
Nadolol
non-selective beta blocker (for HTN, angina). MOA: Decreases CO and renin. Not for asthmatics! AE: Bradycardia, fatigue, decreased libido, sudden cessation can cause angina, MI, or death!
131
How is anemia treated?
Iron, folic acid, Vitamin B12, Erythropoietin and Darbepoetin (these two treat anemia involved in renal disease, HIV, cancer)
132
Eprosartan
Angiotensin-2-receptor blockers (for HTN and heart failure) MOA: Reduces water retention; decreased preload and afterload for increased CO. AE: hyperkalemia when used with K-sparing diuretics, rash, fever, **Fetotoxic**
133
Which drugs can be used during pregnancy?
Methyldopa (alpha 2 agonist), Hydralazine (vasodilator for HTN and HF), Labetalol for severe HTN
134
Candesartan
Angiotensin-2-receptor blockers (for HTN and heart failure) MOA: Reduces water retention; decreased preload and afterload for increased CO. AE: hyperkalemia when used with K-sparing diuretics, rash, fever, **Fetotoxic**
135
Class Ia antiarrhythmics are what?
Na blockers. They slow conduction, prolong AP, and increase refractory period. Phase 0
136
CAI Diuretics. MoA, Therapeutic uses, AE, net change in absorption/secretion:
MOA: CAI affects proximal convoluted tubule, reduces Na/Cl/bicarb reabsorption, excretes water/K/some Na. TREATS glaucoma, mountain sickness. AE: metabolic acidosis, renal stones, drowsiness, paresthesia. NET CHANGE: excrete Na, K, HCO3- (bicarb), urine
137
Prasugrel
Platelet aggregation inhibitor. MOA irreversibly blocks ADP receptors, prevents fibrinogen binding to glycoprotein receptor. plasma protein bound, P450 metabolism, renal/fecal elimination. AE: prolonged bleeding, life-threatening Thrombotic thrombocytopenic purpura. UNIQUE: prodrug, can inhibit P450
138
Mexiletine
Class 1B Antiarrhythmic (Na channel blocker) Shortens phase 3 repolarization in ventricular muscle fibers. UNIQUE: often used after MI.
139
Desirudin
Direct thrombin inhibitor (anticoagulant)
140
Dopamine
Beta agonist (for heart failure). MOA: Increases contraction of heart increased protein kinase increases Ca influx. AE: risk of angina or arrhythmias
141
What drugs should NOT be used in pregnancy?
Aliskiren (renin inhibitor for HTN), ACE inhibitors (for HTN and HF), Angiotensin II receptor blockers (for HTN and HF), Warfarin (anticoagulant), -statins (HMG COA reductase inhibitor)
142
Heparin
Other anticoagulant. MOA binds to antithrombin III to quickly (within minutes) inactivate thrombin and factor Xa. High molecular weight protein. Tx deep vein thrombosis and pulmonary embolism. Good for surgery. Does not cross the placenta. parenterally. Excreted in urine. AE:Bleeding, hypersensitivity, thrombocytopenia. contraindicated in recent surgery of brain, eye, or spinal cord.
143
```
What drug class AE?:
Flushing, Constipation, Dizziness, Headache, Fatigue, Hypotension, Peripheral edema (not from water retention but from vessels leaking), cardiac depression
```
Ca channel blocker (vasodilator for HTN and Angina)
144
What is the only NSAID that irreversibly exhibits antithrombotic efficacy?
Aspirin
145
What drug can reduce effect of loop diuretics?
NSAIDs
146
Digoxin Shortens refractory period in ____ and prolongs refractory period in ____
Digoxin Shortens refractory period In MYOCARDIAL CELLS and prolongs refractory period in THE AV NODE
147
What do LMWH/antithrombin III complex inactivate what?
Factor Xa, (does not include thrombin)
148
Nitroglycerin
Organic Nitrate (for angina) MOA: Increases NO and cGMP (both for dilation). rapid onset, liver inactivates drug so it's given sublingual or patch. AE: tachycardia, orthostatic hypertension, HA from brain vasodilation, tollerance requires "nitrate-free interval" UNIQUE: Tx classic angina
149
Potassium-sparing Diuretics. MoA, Therapeutic uses, pharmacokinetics AE, net change in absorption/secretion:
MOA: inhibits aldosterone receptors in collecting tubule, causing Na/water excretion (retains K/H). lowers peripheral resistance; relieves edema and cardiac workload. PHARMACOKINETICS: Metabolized by P450 system into active metabolite, Highly bound to plasma proteins. AE: gynecomastia (in men), menstrual irregularities. Gluten intolerance. NET CHANGE: excrete Na, urine. Retain K
150
Fenofibrate (Tricor)
Fibrate. MOA: prevents bile acids/salts from going to liver so liver makes bile a/s from cholesterol instead. causes genes to make proteins responsible for lipoprotein structure/function, resulting in decreased triglyceride and increased HDL. Also lowers LDL PHARMICOKINETICS: oral, albumin bound, excreted in urine. AE: Gallstones, voluntary muscle inflammation, warfarin increase. bad for liver/kidney/gallbaldder disease
151
Protamine
Bleeding treatment, FISH SPERM! antagonizes heparin.
152
What do HDLs do?
Secreted by liver and intestine. They return idle cholesterol, even from atheroma, back to liver
153
Urokinase
Thrombolytic Agent. MOA: directly cleaves plasminogen into plasmin cleaves fibrin. Tx pulmonary emboli
154
Colesevelam
Bile acid sequestrant. Binds biles a/s in small intestine, causing liver to use cholesterol to make bile acids. increases LDL receptors. excreted in feces. AE: GI disturbances, impair absorption of vit ADEK, and other drugs.
155
What are the 2 systems that control BP? Which is more long-term?
Baroreceptors and sympathetic system and Renin-Angiotensin-aldosterone system. RAA is long-term
156
What drugs are good for Acute ventricular tachycardia?
Acute ventricular tachycardia is common death cause after MI. Lidocaine, amiodarone
157
Fosinopril
ACE inhibitor (for HTN and heart failure). MOA: Decreases angiotensin II and increases bradykinin, reducing water retention. AE: dry cough. hyperkalemia when used with K-sparing diuretics, rash, fever, **Fetotoxic**
158
What HTN drug is good for severe/malignant HTN that doesn't respond to other drugs?
Minoxidil
159
How do platelet inhibitors work?
They either (3):1. inhibit cyclooxygenase-1 2. block glycoprotein or 3. block ADP receptors
160
Class Ib antiarrhythmics are what?
Na blockers. They shorten repolarization to decrease the duration of AP
161
Methyldopa
Centrally acting alpha-2 agonist (for HTN). MOA: Lowers CO. UNIQUE: can be used in pregnancy, AE: Drowsiness, peripheral edema
162
What is definition of HTN?
Higher than 120/80 in either systolic/diastolic
163
Nitroprusside (Nitropress)
Parenteral agent (Vasodilator for HTN and heart failure). UNIQUE: MoA: increases cGMP, > NO increases to cause rapid vasodilation. very short half life. Poisonous if taken orally (converts to cyanide)
164
Dalteparin
Low Molecular Weight Heparins (LMWH) (anticoagulant)
165
Lisinopril
ACE inhibitor (for HTN and heart failure). MOA: Decreases angiotensin II and increases bradykinin, reducing water retention. AE: dry cough. hyperkalemia when used with K-sparing diuretics, rash, fever, **Fetotoxic**
166
What drugs work on the proximal convoluted tubule?
CAIs
167
Prazosin (Minipress)
Alpha blocker (for HTN). MOA: Relaxes arterial and venous smooth muscle. Rarely used by itself because of tolerance. can cause peripheral edema
168
Bivalirudin
Direct thrombin inhibitor (anticoagulant)
169
Hydroxyurea
Sickle cell anemia treatment. Increase fetal Hb. Prevents painful crises. AE bone marrow suppression can result
170
Colestipol
Bile acid sequestrant. Binds biles a/s in small intestine, causing liver to use cholesterol to make bile acids. increases LDL receptors. excreted in feces. AE: GI disturbances, impair absorption of vit ADEK, and other drugs.
171
Fluvastatin
HMG COA Reductase inhibitor. MOA: analogs of HMG (cholesterol precursor). Stabilizes plaque, causes LDL to go into cells and prevents VLDL secretion. Less effective in familial hypercholesterolemia because they lack LDL receptors. Excretion through bile and feces. AE: elevated liver enzymes, disintegration of muscle (rare), increased warfarin levels. not for pregnant or nursing or children.
172
Verapamil
Calcium channel blocker (vasodilator for HTN and Angina). And Class IV Antiarrhythmic. MOA: Dilates arteries by blocking inward Ca to prevent muscle contraction. Has natural diuretic effect. Short half life. can cause peripheral edema. UNIQUE: Least selective calcium channel blocker..... MOA 2: Inhibits AP in SA and AV nodes in phase 4 to prevent spontaneous depolarization, prolongs refractory period. UNIQUE: contraindicated depressed cardiac function. Good for atrial flutter and AV Nodal reentry
173
What drugs can increase Digoxin toxicity? 5
VQuATE verapamil, quinidine, amiodarone, tetracycline erythromycin, tetracycline. These all increase Digoxin concentration
174
Rosuvastatin (Crestor)
HMG COA Reductase inhibitor. MOA: analogs of HMG (cholesterol precursor). Stabilizes plaque, causes LDL to go into cells and prevents VLDL secretion. Less effective in familial hypercholesterolemia because they lack LDL receptors. Excretion through bile and feces. AE: elevated liver enzymes, disintegration of muscle (rare), increased warfarin levels. not for pregnant or nursing or children.
175
Mannitol (Osmitrol)
Osmotic diuretic. MOA Carries water with it as it filters through glomerulus. used to prevent acute renal failure and in treatment of increased intracranial pressure.
176
What drugs work in the collecting tubule and duct?
Potassium-sparing diuretics (aldosterone inhibitors)
177
What are the two strategies of treating angina?
Decrease oxygen demand of the HEART by decreasing cardiac work, or increase oxygen delivery to heart.
178
Enoxaparin
Low Molecular Weight Heparins (LMWH) (anticoagulant)
179
Inamrinone
Inotrope (for heart failure). MOA: this phosphodiesterase inhibitor causes increase of cAMP, increases Ca. Long-term use increases mortality, so it's short term via IV
180
Acetazolamide (Diamox)
Carbonic Anhydrase Inhibitors (diuretic). MOA: CAI affects proximal convoluted tubule, TREATS glaucoma, mountain sickness. AE: metabolic acidosis, renal stones, drowsiness, paresthesia. NET CHANGE: excrete Na, K, HCO3- (bicarb), urine. UNIQUE systemic dose is good for angle closure (and glaucoma)
181
With which diuretics must you monitor the heart?
Thiazide diuretics because loss of K
182
Isosorbide mononitrate (Imdur, Ismo)
Organic Nitrate (for angina) MOA: Increases NO and cGMP (both for dilation). rapid onset, liver inactivates drug so it's given sublingual or patch. AE: tachycardia, orthostatic hypertension, HA from brain vasodilation, tollerance requires "nitrate-free interval"
183
Valsartan
Angiotensin-2-receptor blockers (for HTN and heart failure) MOA: Reduces water retention; decreased preload and afterload for increased CO. AE: hyperkalemia when used with K-sparing diuretics, rash, fever, **Fetotoxic**
184
Apixaban (Eliquis)
Factor Xa Inhibitor (anticoagulant)
185
Amiodarone
Class III Antiarrhythmic (K Channel blocker) Prolongs phase 3 repolarization in ventricular muscle fibers. They prolong the AP and refractory period. AE: ventricular tachyarrhythmias. UNIQUE: shows ALL classes of actions, therapy of choice for atrial fibrillation. PHARMACOKINETICS: half life of several weeks. AE: interstitial pulmonary fibrosis, GI problems, blue skin, NAION and whorl keratopathy. good for atrial fibrillation and acute ventricular tachycardia and ventricular fibrillation
186
What drugs are good for Acute Supraventricular tachycardia?
Adenosine, Diltiazem.
187
Abciximab
Platelet aggregation inhibitor. MOA: blocks ADP receptors, prevents fibrinogen binding to glycoprotein receptor. Expensive
188
What are some examples of combination therapy? What toxicities can occur?
niacin with cholestyramine (for type II hyperlipidemia). Statin with bile acid-binding agent (lowers LDL). liver and muscle toxicity.
189
Digoxin
Inotrope (for heart failure) and antiarrhythmic. MOA: increases Ca by inhibiting Na/K pump, increase CO reduces heart rate. PHARMACOKINETICS: long half-life,narrow therapeutic index, never used alone, accumulates in muscle. Use ACE inhibitors/diuretics before Digoxin. AE: arrhythmia, toxicity especially with from decreased K levels. HA, fatigue, blurred vision, altered color, halos. MOA 2: shortens refractory period in myocardial cells and prolongs refractory period in AV node. good for atrial flutter, atrial fibrillation, and AV nodal rentry
190
Lepirudin
Direct thrombin inhibitor (anticoagulant). IV administered. AE: patient can develop antibodies that will slow renal elimination.
191
Spironolactone (Aldactone)
“Potassium-Sparing” Diuretic, antiHTN, (also for heart failure). MOA: inhibits aldosterone receptors in collecting tubule, causing Na/water excretion (retains K/H). lowers peripheral resistance; relieves edema and cardiac workload. PHARMACOKINETICS: Metabolized by P450 system into active metabolite, Highly bound to plasma proteins. AE: gynecomastia (in men), menstrual irregularities. NET CHANGE: excrete Na, urine. Retain K. UNIQUE: used for advanced HF
192
What is the drug of choice for reducing acute pulmonary edema of heart failure?
Loop Diuretics (Bu Eth Fur Tor)
193
Bumetanide
Loop Diuretic, antiHTN, and heart failure med. MOA: Inhibits Na/K/2Cl cotransporter in ascending loop of Henle, causing Na, K, Ca, and water excretion. lowers peripheral resistance. Treats acute pulmonary edema of heart failure, hypercalcemia and hyperkalemia. AE: Ototoxicity, Hyperuricemia (causes gout), acute hypovolemia, hypomagnesemia. NET CHANGE: excrete Na+, K+, Ca++, urine
194
Isosorbide dinitrate (Dilatrate-SR, Isordil)
Organic Nitrate (for angina and heart failure). MOA: Increases NO and cGMP (both for dilation). rapid onset, liver inactivates drug so it's given sublingual or patch. AE: tachycardia, orthostatic hypertension, HA from brain vasodilation, tollerance requires "nitrate-free interval"
195
What drug class has a greater affinity for inactivated sodium channels?
IB Antiarrhythmics
196
Dofetilide
Class III Antiarrhythmic (K Channel blocker) Prolongs phase 3 repolarization in ventricular muscle fibers. They prolong the AP and refractory period. AE: ventricular tachyarrhythmias. UNIQUE: risk of proarrhythmia, 6-10 hr half life, adjust dose if there is renal insufficiency. good for atrial fibrillation
197
Which antiarrhythmics are useful for emergency treatment
Class IB antiarrhythmics
198
Loop Diuretics. MoA, Therapeutic uses, AE, net change in absorption/secretion:
MOA: Inhibits Na/K/2Cl cotransporter in ascending loop of Henle, causing Na, K, Ca, and water excretion. lowers peripheral resistance. Treats acute pulmonary edema of heart failure, hypercalcemia and hyperkalemia. AE: Ototoxicity, Hyperuricemia (causes gout), acute hypovolemia, hypomagnesemia. NET CHANGE: excrete Na+, K+, Ca++, urine
199
Hydralazine
Vasodilator (for HTN and heart failure). MOA: Increases NO. can cause reflex heart stim, causing problems. pregnant ok!
200
What is the order of therapy for HF?
ACE inhibitors or ARBs, then Beta blocker, then diuretics and digoxin
201
Quinapril (Accupril)
ACE inhibitor (for HTN and heart failure). MOA: Decreases angiotensin II and increases bradykinin, reducing water retention. AE: dry cough. hyperkalemia when used with K-sparing diuretics, rash, fever, **Fetotoxic**
202
all hyperlipidemic drugs require what?
diets low in saturated and trans fat
203
Which drug class is indicated in pts with all stages of left ventricular failure?
ACE inhibitors
204
Sotalol
Class III Antiarrhythmic (actually non-selective beta-blocker) Prolongs phase 3 repolarization in ventricular muscle fibers. Lowest rate of AE
205
Which platelet aggregation inhibitors are prodrugs that can inhibit the P450 system?
Clopidogrel, prasugrel, and ticlopidine. NOT Ticagrelor
206
What drugs work on the descending loop of Henle?
Osmotic diuretics
207
What can treat male pattern baldness?
Minoxidil
208
What should you avoid in HF?
NSAIDs, alcohol, calcium-channel blockers, high dose beta-blockers and some antiarrhythmic drugs
209
Fondaparinux
Factor Xa Inhibitor (anticoagulant), Subcutaneous. does not have variable activity. tx hip/knee surgery, renal eliminated.
210
Ethacrynic acid
Loop Diuretic, antiHTN, and heart failure med. MOA: Inhibits Na/K/2Cl cotransporter in ascending loop of Henle, causing Na, K, Ca, and water excretion. lowers peripheral resistance. Treats acute pulmonary edema of heart failure, hypercalcemia and hyperkalemia. AE: Ototoxicity, Hyperuricemia (causes gout), acute hypovolemia, hypomagnesemia. NET CHANGE: excrete Na+, K+, Ca++, urine
211
Class III antiarrhythmics are what?
K blockers
212
Which vasodilators are used in HF?
Hydralazine, isosorbide dinitrate, isosorbide mononitrate, nitroprusside
213
Long-term use of what drugs increase mortality?
The phosphodiesterase inhibitor c and c
214
Describe abnormal impulse conduction:
Instead of branching symmetrically, a block on one side can cause a delay because of retrograde impulses
215
Olmesartan
Angiotensin-2-receptor blockers (for HTN and heart failure) MOA: Reduces water retention; decreased preload and afterload for increased CO. AE: hyperkalemia when used with K-sparing diuretics, rash, fever, **Fetotoxic**
216
Lidocaine
Class 1B Antiarrhythmic (Na channel blocker) Shortens phase 3 repolarization in ventricular muscle fibers. UNIQUE: Also local anesthetic, large therapeutic index. Good for acute ventricular tachycardia and ventricular fibrillation
217
What is the only diuretic that causes hyperosmolar (concentrated) urine
Thiazide diuretics (Chlor Inda- -zone)
218
Streptokinase
Thrombolytic Agent. MOA: activates plasminogen > plasmin cleaves fibrin. AE: bleeding, immune response. UNIQUE: use within 4 hours of MI
219
Furosemide (Lasix)
Loop Diuretic, antiHTN, and heart failure med. MOA: Inhibits Na/K/2Cl cotransporter in ascending loop of Henle, causing Na, K, Ca, and water excretion. lowers peripheral resistance. Treats acute pulmonary edema of heart failure, hypercalcemia and hyperkalemia. AE: Ototoxicity, Hyperuricemia (causes gout), acute hypovolemia, hypomagnesemia. NET CHANGE: excrete Na+, K+, Ca++, urine
220
What drug do you want to avoid with cirrhosis?
CAI diuretics.
221
What is used to treat sickle cell?
Hydroxyurea (increases fetal hb levels),
222
Milrinone
Inotrope (for heart failure). MOA: this phosphodiesterase inhibitor causes increase of cAMP, increases Ca. Long-term use increases mortality, so it's short term via IV
223
What drug can cause NAION and whorl keratopathy?
Amiodarone (class III but is complex)
224
Magnesium
Other Antiarrhythmic Drugs. MOA unknown
225
What is the antiarrhythmic of choice for atrial fibrillation and is more widely prescribed?
Amiodarone (class III but is complex)
226
NO and prostacyclin inhibit what?
Platelet aggregation
227
Adenosine
Other Antiarrhythmic Drugs. MOA: activates inward K current and inhibits Ca current. This causes hyperpolarization. also inhibits AV conduction. less effective w/ caffeine. AE: flushing, SOB, chest burning. Good for acute supraventricular tachycardia.
228
Atenolol
Beta 1 blocker (for HTN and angina). MOA: Decreases CO and renin and increases NO production causing vasodilation. AE: Bradycardia, fatigue, decreased libido, sudden cessation can cause angina, MI, or death! UNIQUE: preferred in angina treatment
229
Pravastatin
HMG COA Reductase inhibitor. MOA: analogs of HMG (cholesterol precursor). Stabilizes plaque, causes LDL to go into cells and prevents VLDL secretion. Less effective in familial hypercholesterolemia because they lack LDL receptors. Excretion through bile and feces. AE: elevated liver enzymes, disintegration of muscle (rare), increased warfarin levels. not for pregnant or nursing or children.
230
What is treatment for rest angina?
Vasodilators and ca channel blockers
231
What is used in severe HTN during pregnancy?
Labetalol or hydralazine
232
Ezetimibe
Cholesterol Absorption Inhibitor (in the small intestine), reduces hepatic cholesterol stores and increases clearance of cholesterol from blood. Very long half life (22 hours). Bad for hepatic insufficiency. biliary and renal excretion.
233
Nicardipine
Calcium channel blocker (vasodilator for HTN and Angina). MOA: Dilates arteries by blocking inward Ca to prevent muscle contraction. Has natural diuretic effect. can cause peripheral edema. UNIQUE: long half life, tx hypertensive emergency.
234
Indapamide
Thiazide diuretic, antiHTN, and heart failure med. MOA: inhibits Na/Cl cotransporter in the distal convoluted tubule, causing Na,Cl, K, and water excretion (retains Ca). lowers peripheral resistance
235
Isradipine
Calcium channel blocker (vasodilator for HTN and Angina). MOA: Dilates arteries by blocking inward Ca to prevent muscle contraction. Has natural diuretic effect. Short half life. can cause peripheral edema.
236
What is the 1st line therapy for treating HF, HTN patients with chronic renal disease, and patients with increased risk for coronary artery disease
ACE inhibitors (for HTN and HF)
237
Class II antiarrhythmics are what? What do they do? Which drugs?
Beta blockers. Diminish automaticity in phase 4. Propranolol, metoprolol, Esmolol.
238
What are the 2 goals of HF treatment?
Reducing symptoms and slowing progression, managing acute episodes of decompensated failure
239
Clopidogrel (Plavix)
Platelet aggregation inhibitor. MOA irreversibly blocks ADP receptors, prevents fibrinogen binding to glycoprotein receptor. plasma protein bound, P450 metabolism, renal/fecal elimination. AE: prolonged bleeding, life-threatening Thrombotic thrombocytopenic purpura. UNIQUE: prodrug, can inhibit P450
240
Ranolazine (Ranexa)
Sodium channel blocker (for angina). MOA: Inhibits late phase of Na current to improve diastolic function. used for chroinic angina
241
What is becoming more widely used than medications for arrhythmias?
Implantable defibrillators (basically pacemaker 2.0)
242
Acebutolol
Beta 1 blocker (for HTN and angina). MOA: Decreases CO and renin and increases NO production causing vasodilation. AE: Bradycardia, fatigue, decreased libido, sudden cessation can cause angina, MI, or death!
243
Labetalol
non-selective beta blocker (for HTN, angina). MOA: Decreases CO and renin. Not for asthmatics! AE: Bradycardia, fatigue, decreased libido, sudden cessation can cause angina, MI, or death!
