Lesson 2 Flashcards
Diuretics used for hypertension
Hydrochlorothiazide
Chlorthalidone
Indapamide
Metolazone
Microside
Thiazides SE
Hypokalemia
Hypomagnesemia
Hypercalcemia
Hyperuricemia
Hyperglycemia
Hyperlipidemia
Beta Blockers MOA
negative inotropic, chronotropic action
Beta Blocker (Cardio Selective at Low Dose) Examples
Atenolol
Betaxolol
Bisoprolol
Metoprolol
Beta Blocker (Intrinsic Sympathomimetic Activity
Acebutolol
Carteolol
Penbutolol
Pindolol
Beta blockers with extensive first pass metabolism
Propranolol
Metoprolol
Beta Blocker with long half-life, renal excretion
Atenolol
Nadolol
SE Beta Blocker
Hypotension
Bradycardia
Heart failure
Heart block
Bronchospasm
Peripheral vasoconstriction and Intermittent claudication
ACE inhibitors examples
Captopril
Ramipril
Enalapril
Imidapril
It blocks conversion of angiotensin I to angiotensin II
It blocks the degradation of bradykinin—angioedema
It is given once daily except captopril (2-3x a day)
Angiotensin Converting Enzyme (ACE) Inhibitors
It blocks angiotensin type (AT 1) receptor.
It is contraindicated in pregnancy.
Angiotensin II Receptor Blockers
Examples of Angiotensin II Receptor Blockers
Losartan
Valsartan
Candesartan
Irbesartan
Valsartan
It blocks voltage sensitive calcium channels in cardiac and smooth muscles.
Calcium Channel Blockers
2 Classes of Calcium Channel Blockers
Non dihydropyridine
Dihydropyridine
Non dihydropyridine Examples
Diltiazem
Verapamil
Dihydropyridine Examples
Nifedipine
Felodipine
Amlodipine
Non dihydropyridine SE
Bradycardia
AV Block
Heart Failure
Constipation
Dihydropyridine SE
Dizziness
Headache
A1 Receptor Blockers
Prazosin
Terazosin
Doxazosin
It is reserved for patients with BPH
A1 Receptor Blockers
A1 Receptor Blockers SE
First-dose phenomenon - Orthostatic hypotension (dizziness, faintness,
syncope)
Sodium and water retention
Centrally acting/A2 agonist
Methyldopa
Clonidine
Guanabenz
Guanfacine
Presynaptic A2 agonist—-negative feedback—Dec. NE release
Centrally Acting A2 Agonist
The activity of methyldopa is due to stimulation of central alpha adrenoreceptors by methyldopamine and methylnorephinephrine
Centrally Acting A2 Agonists SE
- Sedation, dry mouth, depression
- Sodium and water retention (esp. methyldopa)
- Rebound hypertension (esp. clonidine)
It depletes NE and blocks transport of NE into its storage vesicles.
Reserpine
Reserpine SE
Sodium and fluid retention
Parasympathetic effect (nasal congestion, diarrhea, bradycardia),
Depression
It increases HR and renin release ( should be given with beta blocker and a diuretic)
Vasodilators (Direct Arteriolar)
Examples of Vasodilators
Hydralazine - for eclampsia
Methyldopa - for chronic HTN in pregnant patients
Minoxidil
Side Effects of Hydralazine
Lupus-like reaction (rash, arthralgia; reversible)
Side effects of Minoxidil
Hypertrichosis (overgrowth of hair)
It depletes and inhibits the release of NE
Postganglionic Sympathetic Inhibitors
Postganglionic sympathetic inhibitors Examples
Guanethidine
Guanadrel
Postganglionic Sympathetic Inhibitors SE
Orthostatic Hypotension
Primary Agents:
Diuretics
Beta Blockers
ACE Inhibitors
Angiotensin II Receptor Blockers
Calcium Channel Blockers
Alternatives for HTN Treatment:
A-Blockers
A2 Agonists
Adrenergic Inhibitors
Drugs for Hypertensive Urgency
Oral: Captopril, Clonidine, Labetalol
Drugs for Hypertensive Emergency
IV Nitroprusside
Nitroglycerin
Nicardipine
Felodopam
Labetalol or Hydralazine
It is a chest pain due to decreased blood flow to the heart or due to an inadequate supply of oxygen to the heart muscle.
The pain is typically severe and crushing, and it is characterized by a feeling of pressure and suffocation just behind the breastbone.
Angina Pectoris
Angina can accompany or be a precursor of a:
Heart Attack
2 Main Types of Angina
Exertional Angina
Vasospastic Angina
It is caused by increased physical exertion.
- Most common type
- Due to atherosclerosis of the coronary artery
Exertional Angina
Exertional Angina is also called:
Chronic Stable Angina
Classic Angina
Typical Angina
Effect-induced Angina
It is caused by vasospasm of the coronary artery.
Vasospastic Angina
Vasospastic Angina is also called:
Rest Angina
Variant
Prinzmetal
Angina treatment to increase O2 delivery
Nitrates
Vasodilators
Ca blockers
Angina treatment to decrease O2 demand
B-Blockers
Ca Blockers
It is the most widely used drug of this class (Nitrates)
Nitroglycerin
Nitroglycerin routes
Sublingual
Buccal
Spray
Patch
Types of Nitrates
Nitroglycerin
ISDN
ISMN
ISDN meaning and route
Isosorbide dinitrate
Oral / Sublingual
ISMN meaning and route
Isosorbide Mononitrate
Oral
It is converted to nitric oxide (NO)—this increase cGMP—–smooth muscle relaxation—-vasodilation—-venodilation and arterial dilation—decrease oxygen demand—therefore dilation of coronary artery.
Nitrates
Drugs for Acute Attack (Angina)
Nitroglycerin - Sublingual, Buccal, Spray
ISDN - Sublingual
Drugs for Prophylaxis (Angina)
Nitroglycerin - patch
ISDN - oral
ISMN - oral
Note:
- The nitrates undergo extensive first pass metabolism
-Tolerance (have 8-12-hour nitrate free interval)
Nitrates SE
Postural hypotension
Reflex tachycardia
Headache
Flushing
- Also known as coronary artery disease (CAD)
- Lack of oxygen and decreased or no blood flow to the heart due to coronary artery narrowing or obstruction
Ischemic Heart Disease
Ischemic Heart Disease may present as:
Acute MI
Unstable angina
Chronic stable angina
Variant angina
It is the beta blocker most widely used in the treatment of angina.
Propranolol
Antagonize or reverse the effects of sympathetic activation caused by exercise and other physical or mental exertions thereby decreasing HR, contractility and BP which reduces myocardial oxygen demand.
Beta Blockers
Beta Blockers are effective as mono therapy and in combination with:
Nitrates
Calcium Channel Blockers
Agents of choice for variant or Prinz metal angina
Calcium Channel Blockers
It is a chronic progressive condition that affects the pumping power of your heart muscles.
It specifically refers to the stage in which fluid builds up around the heart and causes it to pump inefficiently.
Congestive Heart Failure
It is the inability of the heart to pump sufficient blood to meet the metabolic needs of the body.
Heart Failure
Common Causes of Heart Failure
Atherosclerosis
Arteriosclerosis
Myocardial ischemia and infarction, Hypertension
Valvular stenosis
Regurgitation
First Line Therapies for Heart failure
Cardiac Glycosides (Digoxin, Digitoxin, Others (Deslanoside, Ouabain)
The major side effect of cardiac glycosides
Hypokalemia
It is the method of dosage with cardiac glycosides that rapidly produces effective drug level.
Digitalization
Daily dosage of glycoside that maintains effective drug levels in the blood.
Maintenance
It is a problem with the rate or rhythm of your heartbeat. It means that your heart beats too quickly, too slowly, or with an irregular pattern.
Arrhythmia
Heart beats faster than normal
Tachycardia
Heart beats too slowly
Bradycardia
The most common type of arrhythmia, which causes an irregular and fast heartbeat.
Atrial fibrillation
Tachycardia[ atrial or ventricular] beats/min
150 - 250
Atrial flutter beats/min
200 - 350
Atrial Fibrillation beats/min
greater than 350
Ventricular Fibrillation characteristic rate
Uncoordinated Contraction
Premature contraction of aorta characteristic rate
Variable
Premature contractions of the ventricles characteristic rate
Variable
Bradycardia beat/min
Less than 50
It is the most serious arrythmia ; can result in cardiac arrest and death.
Ventricular fibrillation
Signs and Symptoms of Arrhythmia
Palpitations
Irregular pulse
Dizziness
Syncope
Heart failure
Chest pain
How is arrhythmia diagnosed?
Through Electrocardiogram (ECG)
Class I of Antiarrhythmic drugs (Sodium Channel Blockers)
Class 1A:
- Procainamide
- Quinidine
- Disopyramide
Class II Antiarrhythmic drugs (Beta blockers)
Propranolol
Esmolol
- for patients with AF
Class III Antiarrhythmic drugs (Potassium Channel Blockers)
Bretylium
Sotalol
Ibutilide and doletilide
Amiodarone
Class IV Antiarrhythmic drugs (Calcium Channel Blockers)
Verapamil
Diltiazem
Miscellaneous antiarrhythmics drugs:
Adenosine
Magnesium Sulfate
Non-Pharmacologic treatment for Arrhythmia
Defibrillation
Pacemaker
this is a specific type of abnormal heart rhythm that can lead to sudden cardiac death… a polymorphic ventricular tachycardia
torsades de pointes
a good enzyme in the heart
cGMP - Cyclic Guanosine Monophosphatase
S/Sx of Heart Failure
Dyspnea
Orthopnea
Fatigue
Cough
Lipid Solubility of Digoxin
Medium
Lipid Solubility of Digitoxin
High
Half-Life of of Digoxin
Short
Half-life of Digitoxin
Long
Digoxin Excretion
Renal
Digitoxin Excretion
Hepatic
Cardiac Glycosides Interactions
- Diuretics
- ACE Inhibitors
- Beta Blockers
- Diuretics
Types of Arrhythmia / Commonly Occurring Arrhythmia
Tachycardia
Atrial Flutter
Atrial Fibrillation
Ventricular Fibrillation
Premature Contraction of Aorta
Premature Contraction of Ventricles
Bradycardia
Uses and SE of Procainamide
- All types: AF, VT
- Hypotension, Lupus
SE of Quinidine
Cinchonism, GI Upset, Torsades de pointes
SE of Disopyramide
Antimuscarinic (dry mouth, blurred vision, hot and flushed skin, dry skin, inc. intraocular pressure)
Uses of Class II Beta Blockers (Propranolol, Esmolol)
For patients with AF
Uses and SE of Bretyllium
- Refractory Post-MI, VF
- Arrhythmia, Hypotension
Uses and SE of Sotalol
- Oral
- Torsades, Bradycardia, Asthma
Uses and SE of Ibutilide and Doletilide
- Atrial Fibrillation
- Torsades
Uses and SE of Amiodarone
Most effective
Blocks Na, Ca, K channels and B receptors
VT (1st line)
- Corneal deposits, Hypothyroidism, Pulmonary Fibrosis
Uses and SE of Verapamil
Atrial Fibrillation (1st line)
IV, Oral
- Hypotension
