First Semester Test 2 CCB/ARB/Cardiac Flashcards
CCB Chart
Calcium Channel Blockers (CCBs) - Non-Dihydropyridines (Non-DHPs)
Verapamil - ADRs: Constipation, arrythmias, HA, Dizzyness, Peripheral Edema, AV block, Hypotension, Sinus Bradycardia
Diltiazem - ADRs: Above + Rhinitis
Actions: Peripheral & Coronary Vasodilation, negative inotrope/chronotrope/dromotrope, regulate O2 supply /demand
Use: AFIB/Flutter, Paroxysmal Supraventricular tachycardia, HTN (DHP preferred), Myocardial ischemia/angina
Class 4 Antiarrythmic
VD the Non-DHP CCB
CCBs - Dihydropyridines (DHPs)
Amy - Amlodipine
Needs - Nifedipine
No - Nicardipine
Friends - Felodipine
In - Isradipine
Niche - Nimodipine
Novels - Nisoldipine
Cleveland - Clevidipine
Dipine, Dipine, Calceeem!
CCB - DHP - Specs/Actions/ADRs
Actions: Peripheral Vasodilation
Specifics: HTN, Myocardial Ischemia (Non-DHP preferred), Helps, with O2 supply but not demand
ADRs: Peripheral Edema, Flushing, Palpations, Reflex tachycardia, Hypotension, Dizziness, Fatigue, Exacerbation of Angina, Precipitating Arrhythmias
AADs - Class 1 Sodium Channel blockers - 1A
Double - Disopyramide - Negative inotrope
Quarter - Quinidine - Antimalerial also
Pounder - Procainamide - Cleared renally, most used
Actions: Increased duration of refractory period, slows conduction rate, treat Atrial & ventricular arrhythmias
AADs - Class 1 Sodium Channel blockers - 1A ADRs
Disopyramide - Anticholinergic effects, exacerbate HF, increase Digoxin tox (negative inotrope)
Quinidine - Vertigo, Tinnitus, GI disturbances, Hemolytic Anemia, Hepatitis (not used anymore)
Procainamide - Hypotension, Lupus-like syndrome, agranulocytosis (need good renal)
All can cause new Arrhythmias
AADs - Class 1 Sodium Channel blockers - 1B
Lettuce - Lidocaine - IV or IM, Acute Ventricular arrhythmias
Mayo - Mexiletine - PO, Long Duration
Actions: Ventricular arrhythmias, slows conduction rate
ADRs: CNS toxicity (Paresthesia, Confusion, Seizures, Tremor, GI upset)
AADs - Class 1 Sodium Channel blockers - 1C
Pickles - Propafenone - Mild Beta Blocking
Fries - Flecainide - Eliminated via kidney & liver
Actions: Slows conduction rate
ADRs: Conduction abnormalites, HF exacerbation, Metalic Taste, Constipation
AADs - Class 2 (Beta Blockers)
Esmolol - Acute Arrhythmias
Actions: Heart Rate Control
ADRs: Bronchospasm, AV block, Exercise intolerance, Cardiac Depression, Hypotension, Sexual Dysfunction
AADs - Class 3 (Potassium Channel Blockers) Agents/Actions
SADDI
Sotalol - V. Arrhythmia, AFIB, Renal Clear, Blocks K &B (weakly)
Amiodarone - Wide Use, Class 1,2,& 4 electrophysiological properties, Many DDIs
Dofetilide - Treatment/prophylaxis of AFIB, Must start inpatient
Dronedarone - Also blocks Ca/Na, strong CYP3A4 interactions
Ibutilide - Acute AFIB, Blocks K/Na/B
Actions: Delay repolarization, Increase action potential & refractory period, Used for Atrial and Ventricular arrhythmias
AADs - Class 3 (Potassium Channel Blockers) ADRs/DDIs
Sotalol:
ADRs: Torsades de Pointes, Cardiac Depression, Bradycardia, Bronchospasm
DDIs: No significant DDIs
Amiodarone:
ADRs: Pulmonary Fibrosis, Hepatic dysfunction, Grey-Blue skin, Corneal Deposits, Hyper/hypothyroidism
DDIs: Many
Dofetilide:
ADRs: Torsades de Pointes, Pro-arrhythmia
DDIs: HCTZ & Verapamil
Dronedarone:
ADRs: GI intolerance
DDIs: Strong CYP3A4 interactions
Ibutilide:
ADRs: Torsades de Pointes
AAds - Class 4 (Non-DHP CCB)
Verapamil : DDI with Digoxin, Dofetilide, Simvastatin, and Lovastatin
Diltiazem : IV or PO
Not preferred for Rate Control, Use for PTs with restrictive airway disease
Actions: Slows conduction in AV node, Increase Refractory period
ADRs: Constipation (more w/verapamil), Hypotension, Heart Block, Exacerbation of HF
Renin, Angiotensin, Aldosterone, System (RAAS) - Angiotensin Converting Enzyme (ACE) Inhibitors
-Prils
Lisinopril
Enalapril
Quinapril
Captopril
Ramipril
Benazopril
Fosinopril
Moexipril
Perindopril
Trandolapril
RAAS - ACE inhibitors - Use/Actions/ADRs
Use: HTN Post MI, Left Vent Systolic Dysfunction/Systolic HF, CKD
Actions:
DEC TPR/BP DEC Na/H20 retention
DEC H20 Ingestion DEC Arterial pressure
INC Compliance of Large Arteries DEC Proteinuria
ADRs: Dry Cough, Hyperkalemia, Acute Renal, Angioedema, Teratogenic. Hypotension
Can cause AKI when starting or changing therapy/dose
Reduced efficacy in African Americans, they have low renin HTN
RAAS - Angiotensin Receptor Blockers (ARBs)
-Sartan
Losartan - Lowers uric acid good for Gout
Valsartan
Olmesartan
Irbasartan
Candesartan
Telmisartan
Eprosartan
Azilsarton
Reduced efficacy in African Americans as they have low renin HTN
RAAS - ARBs - Use/Action/ADRs
Use: HTN Post MI/Heart Failure, CKD, Intolerance to ACE inhibitors
Actions: Same as ACE inhibitors
DEC TPR/BP DEC Na/H20 retention
DEC H20 Ingestion DEC Arterial pressure
INC Compliance of Large Arteries DEC Proteinuria
ADRs: Hyperkalemia, Acute Renal, Angioedema, Teratogenic, Hypotension
RAAS - Angiotensin Receptor - Neprilysin Inhibitor (ARN)
Ernesto (sacubitril/valsartan) - CHF with reduced Ejection Factor
Actions: Vasodilation, Natriuresis, ADR effects, Diuresis, Inhibited Pathogenic GF/Fibrosis
Diuretics - Loop
Fuck - Furosemide
The - Torsemide
Big - Bumetanide
Exam - Ethacrynic Acid (only non-sulfa, only a concern in sulfa anaphylaxis)
Use: HTN, CHF, Pulmonary Edema, Edema, Good in Renal
Actions: Inhibit Na/K/Cl symporter (more ions in lumen), also more Mg and Ca
ADRs: Hypo K/Ca/Mg/Volemia/Tension, Ototoxicity
Diuretics - Thiazide
How - Hydrochlorothiazide
Can - Chlorthalidone
I - Indapamide
Continue - Chlorothiazide
Memorizing - Metolazone - Ok for CKD
Use: HTN, CHF, Edema
Actions: Inhibit Na/Cl (more Na/Cl in Lumen)
ADRs: Hypo K/Ca/Mg/Glycemia/Volemia/Tension
Sulfa in all, only avoid in anaphylaxis
Diuretics - Potassium Sparing
Aldosterone Antagonists - Reduce Na/H2O absorption increase K absorption
Spirinolactone
Eplerenone
ADRs: Hyperkalemia, Impotence (steroid related), DDI’s E>>S
Na Channel Blockers - Inc NA in Lumen, Dec K in Lumen
Amiloride
Triamterene
ADRs: Hyperkalemia
SEAT!
Cardiac - Nitrates
**Isosorbide Mononitrate**
Isosorbide Dinitrate - For Angina
Nitroglycerin/
Actions: Smooth muscle relaxation (Vasodilation), Dec Preload & Afterload
ADRs: HA, Flushing, Rash, Dizziness, Sweating, Hypotension, Reflex Tachy, Methemoglobinemia (Blue dude), PDE-5 interactions
Cardiac - PDE-5 Inhibitors
**Vardenafil **
Avanafil - Smooth Muscle Relaxation/vasodilation (INC cGMP)
Tadalafil - /
Sildenafil /
Use: ED, BPH, Pulmonary Arterial HTN
ADRs: Nitrate interactions, Blue/Green Halos
VATS -afil
Cardiac - Direct Vasodilators
Alpha 1 Blockers
CCBs
Cardiac - Others
Hydralazine - Use for HTN, HF
Actions: Dec BP/Vascular Resistance, Vasodilation of smooth muscle
ADRs: HA, Flushing, Dizziness, Palpations, Angina, Sinus Tach, Hypotension, Peripheral Edema, Fluid Retention
Minoxidil - Use for Severe drug-resistant HTN
Actions: Dec BP/Vascular Resistance, Vasodilation of smooth muscle
ADRs: Hypotension, Sinus Tach, Hypertrichosis, Angina, HA, Peripheral Edema, Fluid Retention
Nitroprusside - Use in Hypertensive emergency, Acute CHF
Actions: Liberate No, Dec Preload & Afterload
ADRs: Hypotension, Methemoglobinemia, Cyanide tox
