Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology Exam II > Medications > Flashcards

Medications Flashcards

1
Q

Hydrochlorothiazide

A

Thiazide Diuretic

Indications: antihypertensives (reduce blood volume, cardiac output, and peripheral resistance)

AE: hypokalemia, hyperglycemia, hyperuricemia, diuresis, hyperlipidemia; AE increase with age

CI: GFR <30

Caution: renal function declines with age; diabetics (increased uric acid and insulin resistance)

Interactions: steroids, NSAIDs, class IA or III antiarrythmics that prolong QT interval (induce torsades de pointes with hypokalemia), probenecid and lithium, and digoxin

dose in morning to prevent nocturia

more common

monitor electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Chlorthalamide

A

Thiazide Diuretic

Preferred! 1.5 - 2 times more effective than hydrochlorothiazide

Indications: antihypertensives (reduce blood volume, cardiac output, and peripheral resistance)

AE: hypokalemia, hyperglycemia, hyperuricemia, diuresis, hyperlipidemia; AE increase with age

CI: GFR <30

Caution: renal function declines with age; diabetics (increased uric acid and insulin resistance)

Interactions: steroids, NSAIDs, class IA or III antiarrythmics that prolong QT interval (induce torsades de pointes with hypokalemia), probenecid and lithium, and digoxin

dose in morning to prevent nocturia

more common and more effective

monitor electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Metalozone

A

Thiazide Diuretic

Indications: antihypertensives (reduce blood volume, cardiac output, and peripheral resistance)

AE: hypokalemia, hyperglycemia, hyperuricemia, diuresis, hyperlipidemia; AE increase with age

CI: GFR <30

Caution: renal function declines with age; diabetics (increased uric acid and insulin resistance)

Interactions: steroids, NSAIDs, class IA or III antiarrythmics that prolong QT interval (induce torsades de pointes with hypokalemia), probenecid and lithium, and digoxin

dose in morning to prevent nocturia

monitor electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Indapamide

A

Thiazide Diuretic

Indications: antihypertensives (reduce blood volume, cardiac output, and peripheral resistance)

AE: hypokalemia, hyperglycemia, hyperuricemia, diuresis, hyperlipidemia; AE increase with age

CI: GFR <30

Caution: renal function declines with age; diabetics (increased uric acid and insulin resistance)

Interactions: steroids, NSAIDs, class IA or III antiarrythmics that prolong QT interval (induce torsades de pointes with hypokalemia), probenecid and lithium, and digoxin

dose in morning to prevent nocturia

monitor electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Furosemide

A

Loop Diuretic

50% bioavailability of oral medication; only give half of IV dose

Indications: antihypertensives and treat symptoms of heart failure and edema

MOA: prevent reabsorption of Na and Cl in the kidneys, reduce renal vascular resistance and increase renal flow

AE: hypokalemia, hypo Ca, hypo Mg (can cause arrhythmias), excessive diuresis (hyponatremia, hypotension, renal insufficiency), reflex activation of RAAS, hypouricemia

Caution: diuresis continues despite dehydration; watch for drugs that aggravate hyperglycemia, dyslipidemias, and hyperuricemia; watch kidney function with ARBs or ACE-I

Interactions: aminoglycosides, NSAIDs, class IA or III antiarrhythmics, probenacid

Monitor: electrolytes and renal function

IV used in Acute Heart Failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Torsemide

A

Loop Diuretic

100% oral bioavailability

Indications: antihypertensives and treat symptoms of heart failure and edema

MOA: prevent reabsorption of Na and Cl in the kidneys, reduce renal vascular resistance and increase renal flow

AE: hypokalemia, hypo Ca, hypo Mg (can cause arrhythmias), excessive diuresis (hyponatremia, hypotension, renal insufficiency), reflex activation of RAAS, hypouricemia

Caution: diuresis continues despite dehydration; watch for drugs that aggravate hyperglycemia, dyslipidemias, and hyperuricemia; watch kidney function with ARBs or ACE-I

Interactions: aminoglycosides, NSAIDs, class IA or III antiarrhythmics, probenacid

Monitor: electrolytes and renal function

IV used in Acute Heart Failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Bumetamide

A

Loop Diuretic

100% oral bioavailability

Indications: antihypertensives and treat symptoms of heart failure and edema

MOA: prevent reabsorption of Na and Cl in the kidneys, reduce renal vascular resistance and increase renal flow

AE: hypokalemia, hypo Ca, hypo Mg (can cause arrhythmias), excessive diuresis (hyponatremia, hypotension, renal insufficiency), reflex activation of RAAS, hypouricemia

Caution: diuresis continues despite dehydration; watch for drugs that aggravate hyperglycemia, dyslipidemias, and hyperuricemia; watch kidney function with ARBs or ACE-I

Interactions: aminoglycosides, NSAIDs, class IA or III antiarrhythmics, probenacid

Monitor: electrolytes and renal function

IV used in Acute Heart Failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Ethacrynic Acid

A

Loop Diuretic

Indications: antihypertensives and treat symptoms of heart failure and edema

MOA: prevent reabsorption of Na and Cl in the kidneys, reduce renal vascular resistance and increase renal flow

AE: hypokalemia, hypo Ca, hypo Mg (can cause arrhythmias), excessive diuresis (hyponatremia, hypotension, renal insufficiency), reflex activation of RAAS, hypouricemia

Caution: diuresis continues despite dehydration; watch for drugs that aggravate hyperglycemia, dyslipidemias, and hyperuricemia; watch kidney function with ARBs or ACE-I

Interactions: aminoglycosides, NSAIDs, class IA or III antiarrhythmics, probenacid

Monitor: electrolytes and renal function

IV used in Acute Heart Failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Amiloderone

A

Potassium Sparing Diuretic

Indications: antihypertensive

MOA: inhibits sodium transport at late distal and collecting ducts

AE: hyperERkalemia, especially in those with severe renal impairment, or those receiving potassium sparing drugs (ACE-I, ARBs, K supp, and NSAIDs

Interactions: ACE-I – may increase risk of hyperkalemia

Monitor: electrolytes and renal function

not very effective at diuresis; sometimes used with thiazides and loops to prevent K loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Triamterene

A

Potassium Sparing Diuretic

Indications: antihypertensive

MOA: inhibits sodium transport at late distal and collecting ducts

AE: hyperERkalemia, especially in those with severe renal impairment, or those receiving potassium sparing drugs (ACE-I, ARBs, K supp, and NSAIDs

Interactions: ACE-I – may increase risk of hyperkalemia; Indomethacin – decrease in renal function when combined with triamterene; Cimetidine: increases bioavailability and decreases clearance of triamterene

Monitor: electrolytes and renal function

not very effective at diuresis; sometimes used with thiazides and loops to prevent K loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Spironolactone

A

Aldosterone Antagonist/ Potassium Sparing Diuretic

better outcomes in patients with heart failure!

aldosterone antagonist, diminish cardiac remodeling in HF

Indications: anithypertensives and prevent remodeling in patients with heart failure

MOA: modulate vascular tone and cause diuresis (increase NaCl excretion, decrease K+ excretion)

AE: hyperkalemia, especially with impaired renal function, ACE, ARBs, direct renin inhibitors, K sup, K salts subs, NSAIDs); gynecomastia or breast tenderness; menstrual irregularities, hirsutism

Caution: elderly, diabetics (increased risk of hyperkalemia), and patients with poor renal function

Interactions: ACE-I, ARBs, NSAIDs, Digoxin (increased plasma concentration of spironolactone), K supplements

Discontinue: K > 5.5 mEq/L, worsening renal function

Monitor: check K at baseline and after week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Eplerenone

A

Aldosterone Antagonist/ Potassium Sparing Diuretic

aldosterone antagonist, diminish cardiac remodeling in HF

Indications: anithypertensives and prevent remodeling in patients with heart failure

MOA: modulate vascular tone and cause diuresis (increase NaCl excretion, decrease K+ excretion)

AE: hyperkalemia, especially with impaired renal function, ACE, ARBs, direct renin inhibitors, K sup, K salts subs, NSAIDs); gynecomastia or breast tenderness; menstrual irregularities, hirsutism

Caution: elderly, diabetics (increased risk of hyperkalemia), and patients with poor renal function

Interactions: ACE-I, ARBs, NSAIDs, Digoxin (increased plasma concentration of spironolactone), K supplements; CYP34A substrate – do not use eplerenone with strong 3A4 inhibitors (increase eplerenone plasma concentrations)

Monitor: check K at baseline and after week

Discontinue: K > 5.5 mEq/L, worsening renal function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Nadolol

A

Beta Blockers: Non-selective without ISA

Indication: Antihypertensive- Block B1 and B2; Class II Antiarrhythmics - Inhibit AV nodal conduction by slowing AV nodal conduction and prolonging AV nodal refractoriness

AE: bradycardia, heart block, heart failure, dyspnea, bronchospasm, fatigue, dizziness, lethargy, depression, decreased libido, erectile dysfunction, hyper/hypoglacemia (watch in diabetics), hypokalemia, hyperlipidemia

Caution: Heart Rate <60, respiratory disease, abrupt discontinuation – rebound hypertension or ischemic syndrome (taper), may mask signs of hypoglycemia, hypokalemia with diuretic use

CI: hypersensitivity, sinus node dysfunction (okay with pacemaker), severe sinus bradycardia, heart block, cardiogenic shock, acute decompensated heart failure, asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Propanolol

A

Beta Blockers: Non-selective without ISA

Indication: Antihypertensive- Block B1 and B2; Class II Antiarrhythmics - Inhibit AV nodal conduction by slowing AV nodal conduction and prolonging AV nodal refractoriness

MOA: Block B1 and B2

AE: bradycardia, heart block, heart failure, dyspnea, bronchospasm, fatigue, dizziness, lethargy, depression, decreased libido, erectile dysfunction, hyper/hypoglacemia (watch in diabetics), hypokalemia, hyperlipidemia

Caution: Heart Rate <60, respiratory disease, abrupt discontinuation – rebound hypertension or ischemic syndrome (taper), may mask signs of hypoglycemia, hypokalemia with diuretic use

CI: hypersensitivity, sinus node dysfunction (okay with pacemaker), severe sinus bradycardia, heart block, cardiogenic shock, acute decompensated heart failure, asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Timolol

A

Beta Blockers: Non-selective without ISA

Indication: Antihypertensive- Block B1 and B2; Class II Antiarrhythmics - Inhibit AV nodal conduction by slowing AV nodal conduction and prolonging AV nodal refractoriness

MOA: Block B1 and B2

AE: bradycardia, heart block, heart failure, dyspnea, bronchospasm, fatigue, dizziness, lethargy, depression, decreased libido, erectile dysfunction, hyper/hypoglacemia (watch in diabetics), hypokalemia, hyperlipidemia

Caution: Heart Rate <60, respiratory disease, abrupt discontinuation – rebound hypertension or ischemic syndrome (taper), may mask signs of hypoglycemia, hypokalemia with diuretic use

CI: hypersensitivity, sinus node dysfunction (okay with pacemaker), severe sinus bradycardia, heart block, cardiogenic shock, acute decompensated heart failure, asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pindolol

A

Beta Blockers Non-selective with ISA

Indication: Antihypertensive- Block B1 and B2; Class II Antiarrhythmics - Inhibit AV nodal conduction by slowing AV nodal conduction and prolonging AV nodal refractoriness

MOA: Block B1 and B2

AE: bradycardia, heart block, heart failure, dyspnea, bronchospasm, fatigue, dizziness, lethargy, depression, decreased libido, erectile dysfunction, hyper/hypoglacemia (watch in diabetics), hypokalemia, hyperlipidemia

Caution: Heart Rate <60, respiratory disease, abrupt discontinuation – rebound hypertension or ischemic syndrome (taper), may mask signs of hypoglycemia, hypokalemia with diuretic use

CI: hypersensitivity, sinus node dysfunction (okay with pacemaker), severe sinus bradycardia, heart block, cardiogenic shock, acute decompensated heart failure, asthma; not with ACS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Carteolol

A

Beta Blockers Non-selective with ISA

Indication: Antihypertensive- Block B1 and B2; Class II Antiarrhythmics - Inhibit AV nodal conduction by slowing AV nodal conduction and prolonging AV nodal refractoriness

AE: bradycardia, heart block, heart failure, dyspnea, bronchospasm, fatigue, dizziness, lethargy, depression, decreased libido, erectile dysfunction, hyper/hypoglacemia (watch in diabetics), hypokalemia, hyperlipidemia

Caution: Heart Rate <60, respiratory disease, abrupt discontinuation – rebound hypertension or ischemic syndrome (taper), may mask signs of hypoglycemia, hypokalemia with diuretic use

CI: hypersensitivity, sinus node dysfunction (okay with pacemaker), severe sinus bradycardia, heart block, cardiogenic shock, acute decompensated heart failure, asthma; not with ACS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Penbutolol

A

Beta Blockers Non-selective with ISA

Indication: Antihypertensive- Block B1 and B2; Class II Antiarrhythmics - Inhibit AV nodal conduction by slowing AV nodal conduction and prolonging AV nodal refractoriness

AE: bradycardia, heart block, heart failure, dyspnea, bronchospasm, fatigue, dizziness, lethargy, depression, decreased libido, erectile dysfunction, hyper/hypoglacemia (watch in diabetics), hypokalemia, hyperlipidemia

Caution: Heart Rate <60, respiratory disease, abrupt discontinuation – rebound hypertension or ischemic syndrome (taper), may mask signs of hypoglycemia, hypokalemia with diuretic use

CI: hypersensitivity, sinus node dysfunction (okay with pacemaker), severe sinus bradycardia, heart block, cardiogenic shock, acute decompensated heart failure, asthma; not with ACS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Atanolol

A

Beta Blockers Selective without ISA

Indication: Antihypertensive - block B1, Heart Failure (good for patients with HF and hypotension);Class II Antiarrhythmics - Inhibit AV nodal conduction by slowing AV nodal conduction and prolonging AV nodal refractoriness

AE: bradycardia, heart block, heart failure, dyspnea, bronchospasm, fatigue, dizziness, lethargy, depression, decreased libido, erectile dysfunction, hyper/hypoglacemia (watch in diabetics), hypokalemia

Caution: Heart Rate <60, respiratory disease, abrupt discontinuation – rebound hypertension or ischemic syndrome (taper), may mask signs of hypoglycemia, hypokalemia with diuretic use

CI: hypersensitivity, sinus node dysfunction (okay with pacemaker), severe sinus bradycardia, heart block, cardiogenic shock, acute decompensated heart failure; Not with ACS

use low doses only; can use with asthma, COPD, peripheral vascular disease, but avoid non-selective with these patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Metoprolol

A

Beta Blockers Selective without ISA

Indication: Antihypertensive - block B1 only, Heart Failure (good for patients with HF and hypotension); Class II Antiarrhythmics - Inhibit AV nodal conduction by slowing AV nodal conduction and prolonging AV nodal refractoriness

AE: bradycardia, heart block, heart failure, dyspnea, bronchospasm, fatigue, dizziness, lethargy, depression, decreased libido, erectile dysfunction, hyper/hypoglacemia (watch in diabetics), hypokalemia

Caution: Heart Rate <60, respiratory disease, abrupt discontinuation – rebound hypertension or ischemic syndrome (taper), may mask signs of hypoglycemia, hypokalemia with diuretic use

CI: hypersensitivity, sinus node dysfunction (okay with pacemaker), severe sinus bradycardia, heart block, cardiogenic shock, acute decompensated heart failure; Not with ACS

use low doses only; can use with asthma, COPD, peripheral vascular disease, but avoid non-selective with these patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Emolol

A

Beta Blockers Selective without ISA

Indication: Antihypertensive - block B1 only; Class II Antiarrhythmics - Inhibit AV nodal conduction by slowing AV nodal conduction and prolonging AV nodal refractoriness

AE: bradycardia, heart block, heart failure, dyspnea, bronchospasm, fatigue, dizziness, lethargy, depression, decreased libido, erectile dysfunction, hyper/hypoglacemia (watch in diabetics), hypokalemia

Caution: Heart Rate <60, respiratory disease, abrupt discontinuation – rebound hypertension or ischemic syndrome (taper), may mask signs of hypoglycemia, hypokalemia with diuretic use

CI: hypersensitivity, sinus node dysfunction (okay with pacemaker), severe sinus bradycardia, heart block, cardiogenic shock, acute decompensated heart failure; Not with ACS

use low doses only; can use with asthma, COPD, peripheral vascular disease, but avoid non-selective with these patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Betaxolol

A

Beta Blockers Selective without ISA

Indication: Antihypertensive - block B1 only; Class II Antiarrhythmics - Inhibit AV nodal conduction by slowing AV nodal conduction and prolonging AV nodal refractoriness

AE: bradycardia, heart block, heart failure, dyspnea, bronchospasm, fatigue, dizziness, lethargy, depression, decreased libido, erectile dysfunction, hyper/hypoglacemia (watch in diabetics), hypokalemia

Caution: Heart Rate <60, respiratory disease, abrupt discontinuation – rebound hypertension or ischemic syndrome (taper), may mask signs of hypoglycemia, hypokalemia with diuretic use

CI: hypersensitivity, sinus node dysfunction (okay with pacemaker), severe sinus bradycardia, heart block, cardiogenic shock, acute decompensated heart failure; Not with ACS

use low doses only; can use with asthma, COPD, peripheral vascular disease, but avoid non-selective with these patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Bisoprolol

A

Beta Blockers Selective without ISA

Indication: Antihypertensive - block B1 only; Class II Antiarrhythmics - Inhibit AV nodal conduction by slowing AV nodal conduction and prolonging AV nodal refractoriness; Heart Failure (not FDA approved)

AE: bradycardia, heart block, heart failure, dyspnea, bronchospasm, fatigue, dizziness, lethargy, depression, decreased libido, erectile dysfunction, hyper/hypoglacemia (watch in diabetics), hypokalemia

Caution: Heart Rate <60, respiratory disease, abrupt discontinuation – rebound hypertension or ischemic syndrome (taper), may mask signs of hypoglycemia, hypokalemia with diuretic use

CI: hypersensitivity, sinus node dysfunction (okay with pacemaker), severe sinus bradycardia, heart block, cardiogenic shock, acute decompensated heart failure; Not with ACS

use low doses only; can use with asthma, COPD, peripheral vascular disease, but avoid non-selective with these patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Acebutolol

A

Beta-blocker: Selective with ISA

Indication: Antihypertensive - block B1 only; Class II Antiarrhythmics - Inhibit AV nodal conduction by slowing AV nodal conduction and prolonging AV nodal refractoriness

AE: bradycardia, heart block, heart failure, dyspnea, bronchospasm, fatigue, dizziness, lethargy, depression, decreased libido, erectile dysfunction, hyper/hypoglacemia (watch in diabetics), hypokalemia

Caution: Heart Rate <60, respiratory disease, abrupt discontinuation – rebound hypertension or ischemic syndrome (taper), may mask signs of hypoglycemia, hypokalemia with diuretic use

CI: hypersensitivity, sinus node dysfunction (okay with pacemaker), severe sinus bradycardia, heart block, cardiogenic shock, acute decompensated heart failure; Not with ACS

ISA beta blockers are not recommended for patients with previous acute coronary syndrome (ACS)

use low doses only; can use with asthma, COPD, peripheral vascular disease, but avoid non-selective with these patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Labetolol

A

Beta Blocker with Vasodilation Properties

Indication: Antihypertensive; Class II Antiarrhythmics - Inhibit AV nodal conduction by slowing AV nodal conduction and prolonging AV nodal refractoriness

MOA: Blocks a1, B1 and B2

AE: bradycardia, heart block, heart failure, dyspnea, bronchospasm, fatigue, dizziness, lethargy, depression, decreased libido, erectile dysfunction, hyper/hypoglacemia (watch in diabetics), hypokalemia

Caution: Heart Rate <60, respiratory disease, abrupt discontinuation – rebound hypertension or ischemic syndrome (taper), may mask signs of hypoglycemia, hypokalemia with diuretic use

CI: hypersensitivity, sinus node dysfunction (okay with pacemaker), severe sinus bradycardia, heart block, cardiogenic shock, acute decompensated heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Carvedilol

A

Beta Blocker with Vasodilation Properties

Indication: Antihypertensive, Heart Failure (most BP lowering HF BB; but more dizziness and hypotension); Class II Antiarrhythmics - Inhibit AV nodal conduction by slowing AV nodal conduction and prolonging AV nodal refractoriness

MOA: Blocks a1, B1 and B2

AE: bradycardia, heart block, heart failure, dyspnea, bronchospasm, fatigue, dizziness, lethargy, depression, decreased libido, erectile dysfunction, hyper/hypoglacemia (watch in diabetics)

Caution: Heart Rate <60, respiratory disease, abrupt discontinuation – rebound hypertension or ischemic syndrome (taper), may mask signs of hypoglycemia, hypokalemia with diuretic use

CI: hypersensitivity, sinus node dysfunction (okay with pacemaker), severe sinus bradycardia, heart block, cardiogenic shock, acute decompensated heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Nebivolol

A

Beta Blocker with Vasodilation Properties

Indication: Antihypertensive; Class II Antiarrhythmics - Inhibit AV nodal conduction by slowing AV nodal conduction and prolonging AV nodal refractoriness

MOA: Block B1 and B2, and has NO activity

AE: bradycardia, heart block, heart failure, dyspnea, bronchospasm, fatigue, dizziness, lethargy, depression, decreased libido, erectile dysfunction, hyper/hypoglacemia (watch in diabetics)

Caution: Heart Rate <60, respiratory disease, abrupt discontinuation – rebound hypertension or ischemic syndrome (taper), may mask signs of hypoglycemia, hypokalemia with diuretic use

CI: hypersensitivity, sinus node dysfunction (okay with pacemaker), severe sinus bradycardia, heart block, cardiogenic shock, acute decompensated heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Nifedipine

A

Calcium Channel Blocker - Dihydropyridine

MOA: dilate the arterioles by blocking the movement of calcium into smooth muscle cells preventing their contraction, and causing relaxation and dilation; greater affinity for vascular calcium channels than calcium channels in the heart

AE: bradycardia, peripheral edema, headache, flushing, gingival hyperplasia, reflex tachycardia

CI: Hypersensitivity, reduced ejection fraction

Caution: contaminant use with Beta Blockers – can cause heart block

most have short half-lives, so extended release is preferred

will not help heart failure, but will not hurt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Amlodipine

A

Calcium Channel Blocker - Dihydropyridine

MOA: dilate the arterioles by blocking the movement of calcium into smooth muscle cells preventing their contraction, and causing relaxation and dilation; greater affinity for vascular calcium channels than calcium channels in the heart

AE: bradycardia, peripheral edema, headache, flushing, gingival hyperplasia, reflex tachycardia

CI: Hypersensitivity

Caution: contaminant use with Beta Blockers – can cause heart block

Safe to use in patients with heart failure/reduced ejection fraction

Long-half life; no extended release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Verapamil

A

Calcium Channel Blocker - Non -
dihydropyridine

MOA: dilate the arterioles by blocking the movement of calcium into smooth muscle cells preventing their contraction, and causing relaxation and dilation; affects both vascular and heart calcium channels

AE: bradycardia, heart block, constipation, peripheral edema, headache, flushing, may worsen HF

CI: sinus node dysfunction, severe sinus bradycardia (pacemaker okay), heart block, afib/flutter associated with accessory bypass tract

Caution: heart rate <60, contaminant use with Beta Blockers – can cause heart block
hypersensitivity, reduced ejection fraction

most have short half-lives, so extended release is preferred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Diltiazem

A

Calcium Channel Blocker - Non -
dihydropyridine

MOA: dilate the arterioles by blocking the movement of calcium into smooth muscle cells preventing their contraction, and causing relaxation and dilation; affects both vascular and heart calcium channels

AE: bradycardia, heart block, constipation, peripheral edema, headache, flushing, may worsen HF

CI: sinus node dysfunction, severe sinus bradycardia (pacemaker okay), heart block, afib/flutter associated with accessory bypass tract

Caution: heart rate <60, contaminant use with Beta Blockers – can cause heart block
hypersensitivity, reduced ejection fraction

most have short half-lives, so extended release is preferred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Linsinopril

A

ACE-I

most common

Indication: antihypertensive

MOA: inhibit conversion of angiotensin I to angiotensin II; lowers output of SNS, increases vasodilation of smooth muscle, and lowers retention of sodium and water

AE: hyperkalemia, especially when starting or increasing dose and with NSAID use; persistent dry cough; reduced GFR and serum creatine (monitor); acute renal failure; angioedema

Absolute CI: pregnancy, bilateral renal artery stenosis, history of angioedema

Relative CI: unilateral renal artery stenosis, renal insufficiency, hypotension (go slow), hyperkalemia (greater than 5 mEq/L)

Caution: baseline hyperkalemia, NSAIDs, can potentially cause declined renal function

Dosage Adjustments: renal impairment, elderly, volume depleted, diuretic therapy

Monitor: electrolytes (K+), GFR and serum creatine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Fosinopril

A

ACE-I

uncommon

Indication: antihypertensive

MOA: inhibit conversion of angiotensin I to angiotensin II; lowers output of SNS, increases vasodilation of smooth muscle, and lowers retention of sodium and water

AE: hyperkalemia, especially when starting or increasing dose and with NSAID use; persistent dry cough; reduced GFR and serum creatine (monitor); acute renal failure; angioedema
Absolute CI: pregnancy, bilateral renal artery stenosis, history of angioedema

Relative CI: unilateral renal artery stenosis, renal insufficiency, hypotension (go slow), hyperkalemia (greater than 5 mEq/L)

Caution: baseline hyperkalemia, NSAIDs, can potentially cause declined renal function

Dosage Adjustments: renal impairment, elderly, volume depleted, diuretic therapy

Monitor: electrolytes (K+), GFR and serum creatine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Moexipril

A

ACE-I

uncommon

Indication: antihypertensive

MOA: inhibit conversion of angiotensin I to angiotensin II; lowers output of SNS, increases vasodilation of smooth muscle, and lowers retention of sodium and water

AE: hyperkalemia, especially when starting or increasing dose and with NSAID use; persistent dry cough; reduced GFR and serum creatine (monitor); acute renal failure; angioedema

Absolute CI: pregnancy, bilateral renal artery stenosis, history of angioedema

Relative CI: unilateral renal artery stenosis, renal insufficiency, hypotension (go slow), hyperkalemia (greater than 5 mEq/L)

Caution: baseline hyperkalemia, NSAIDs, can potentially cause declined renal function

Dosage Adjustments: renal impairment, elderly, volume depleted, diuretic therapy

Monitor: electrolytes (K+), GFR and serum creatine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Trandolapril

A

ACE-I

uncommon

Indication: antihypertensive

MOA: inhibit conversion of angiotensin I to angiotensin II; lowers output of SNS, increases vasodilation of smooth muscle, and lowers retention of sodium and water

AE: hyperkalemia, especially when starting or increasing dose and with NSAID use; persistent dry cough; reduced GFR and serum creatine (monitor); acute renal failure; angioedema

Absolute CI: pregnancy, bilateral renal artery stenosis, history of angioedema

Relative CI: unilateral renal artery stenosis, renal insufficiency, hypotension (go slow), hyperkalemia (greater than 5 mEq/L)

Caution: baseline hyperkalemia, NSAIDs, can potentially cause declined renal function

Dosage Adjustments: renal impairment, elderly, volume depleted, diuretic therapy

Monitor: electrolytes (K+), GFR and serum creatine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Benazepril

A

ACE-I

Indication: antihypertensive

MOA: inhibit conversion of angiotensin I to angiotensin II; lowers output of SNS, increases vasodilation of smooth muscle, and lowers retention of sodium and water

AE: hyperkalemia, especially when starting or increasing dose and with NSAID use; persistent dry cough; reduced GFR and serum creatine (monitor); acute renal failure; angioedema

Absolute CI: pregnancy, bilateral renal artery stenosis, history of angioedema

Relative CI: unilateral renal artery stenosis, renal insufficiency, hypotension (go slow), hyperkalemia (greater than 5 mEq/L)

Caution: baseline hyperkalemia, NSAIDs, can potentially cause declined renal function

Dosage Adjustments: renal impairment, elderly, volume depleted, diuretic therapy

Monitor: electrolytes (K+), GFR and serum creatine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Captopril

A

ACE-I

Indication: antihypertensive

MOA: inhibit conversion of angiotensin I to angiotensin II; lowers output of SNS, increases vasodilation of smooth muscle, and lowers retention of sodium and water

AE: hyperkalemia, especially when starting or increasing dose and with NSAID use; persistent dry cough; reduced GFR and serum creatine (monitor); acute renal failure; angioedema

Absolute CI: pregnancy, bilateral renal artery stenosis, history of angioedema

Relative CI: unilateral renal artery stenosis, renal insufficiency, hypotension (go slow), hyperkalemia (greater than 5 mEq/L)

Caution: baseline hyperkalemia, NSAIDs, can potentially cause declined renal function

Dosage Adjustments: renal impairment, elderly, volume depleted, diuretic therapy

Monitor: electrolytes (K+), GFR and serum creatine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Enalapril

A

ACE-I

Indication: antihypertensive

MOA: inhibit conversion of angiotensin I to angiotensin II; lowers output of SNS, increases vasodilation of smooth muscle, and lowers retention of sodium and water

AE: hyperkalemia, especially when starting or increasing dose and with NSAID use; persistent dry cough; reduced GFR and serum creatine (monitor); acute renal failure; angioedema

Absolute CI: pregnancy, bilateral renal artery stenosis, history of angioedema

Relative CI: unilateral renal artery stenosis, renal insufficiency, hypotension (go slow), hyperkalemia (greater than 5 mEq/L)

Caution: baseline hyperkalemia, NSAIDs, can potentially cause declined renal function

Dosage Adjustments: renal impairment, elderly, volume depleted, diuretic therapy

Monitor: electrolytes (K+), GFR and serum creatine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Perindopril

A

ACE-I

Indication: antihypertensive

MOA: inhibit conversion of angiotensin I to angiotensin II; lowers output of SNS, increases vasodilation of smooth muscle, and lowers retention of sodium and water

AE: hyperkalemia, especially when starting or increasing dose and with NSAID use; persistent dry cough; reduced GFR and serum creatine (monitor); acute renal failure; angioedema

Absolute CI: pregnancy, bilateral renal artery stenosis, history of angioedema

Relative CI: unilateral renal artery stenosis, renal insufficiency, hypotension (go slow), hyperkalemia (greater than 5 mEq/L)

Caution: baseline hyperkalemia, NSAIDs, can potentially cause declined renal function

Dosage Adjustments: renal impairment, elderly, volume depleted, diuretic therapy

Monitor: electrolytes (K+), GFR and serum creatine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Quinapril

A

ACE-I

Indication: antihypertensive

MOA: inhibit conversion of angiotensin I to angiotensin II; lowers output of SNS, increases vasodilation of smooth muscle, and lowers retention of sodium and water

AE: hyperkalemia, especially when starting or increasing dose and with NSAID use; persistent dry cough; reduced GFR and serum creatine (monitor); acute renal failure; angioedema

Absolute CI: pregnancy, bilateral renal artery stenosis, history of angioedema

Relative CI: unilateral renal artery stenosis, renal insufficiency, hypotension (go slow), hyperkalemia (greater than 5 mEq/L)

Caution: baseline hyperkalemia, NSAIDs, can potentially cause declined renal function

Dosage Adjustments: renal impairment, elderly, volume depleted, diuretic therapy

Monitor: electrolytes (K+), GFR and serum creatine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Ramipril

A

ACE-I

Indication: antihypertensive

MOA: inhibit conversion of angiotensin I to angiotensin II; lowers output of SNS, increases vasodilation of smooth muscle, and lowers retention of sodium and water

AE: hyperkalemia, especially when starting or increasing dose and with NSAID use; persistent dry cough; reduced GFR and serum creatine (monitor); acute renal failure; angioedema

Absolute CI: pregnancy, bilateral renal artery stenosis, history of angioedema

Relative CI: unilateral renal artery stenosis, renal insufficiency, hypotension (go slow), hyperkalemia (greater than 5 mEq/L)

Caution: baseline hyperkalemia, NSAIDs, can potentially cause declined renal function

Dosage Adjustments: renal impairment, elderly, volume depleted, diuretic therapy

Monitor: electrolytes (K+), GFR and serum creatine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Aliskren

A

Direct Renin Inhibitor

Indication: Antihypertensive

MOA: directly inhibits Renin

AE: hyperkalemia, hypotension

CI:with ACE-I or ARB in diabetics, pregnancy

Caution: severe renal impairment, deteriorating renal function, renal artery stenosis

Monitor: K+, GFR and serum creatine

Interactions: ACE-I, ARB, cyclosporine, any potassium supplements, furosemide concentration decreased, ketoconazole increases aliskirin levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Doxazosin

A

Alpha 1 Blocker

Indication: hypertension

MOA: block alpha 1 receptors

AE: first dose – syncope, dizziness, palpitations; orthostatic hypertension

CI: hypersensitivity

not for monotherapy for hypertension

may cause increase in cardiovascular events

used in really resistant patients as a back-up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Prazosin

A

Alpha 1 Blocker

Indication: hypertension

MOA: block alpha 1 receptors

AE: first dose – syncope, dizziness, palpitations; orthostatic hypertension

CI: hypersensitivity

not for monotherapy for hypertension

may cause increase in cardiovascular events

used in really resistant patients as a back-up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Terazosin

A

Alpha 1 Blocker

Indication: hypertension

MOA: block alpha 1 receptors

AE: first dose – syncope, dizziness, palpitations; orthostatic hypertension

CI: hypersensitivity

not for monotherapy for hypertension

may cause increase in cardiovascular events

used in really resistant patients as a back-up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Clonidine

A

Alpha 2 Agonist

common; tablet and patch

Indication: occasionally used for resistant hypertension

MOA: reduce sympathetic outflow (NE); enhance parasympathetic activity, reducing heart rate, cardiac output, and total peripheral resistance

AE: transient sedation initially, vision disturbances, sedation (avoid other sedatives), orthostatic hypotension, dry mouth, muscle weakness

CI: hypersensitivity

discontinuation results in severe rebound hypertension, so it much be tapered

if on a beta blocker, taper it before starting clonidine – too much PNS activity

clonidine withdrawal – too much SNS activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Methyldopa

A

Alpha 2 Agonist

Indication: occasionally used for resistant hypertension

MOA: reduce sympathetic outflow (NE); enhance parasympathetic activity, reducing heart rate, cardiac output, and total peripheral resistance

AE: transient sedation initially, vision disturbances, sedation (avoid other sedatives), hepatotoxicity, peripheral edema, hemolytic anemia, orthostatic hypotension

CI: hypersensitivity, concurrent use of MAO inhibitor, hepatic disease, pheochromocytoma

first line hypertensive treatment in pregnancy

tolerance may occur after 2-3 mo; increase dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Guanfacine

A

Alpha 2 Agonist

Indication: occasionally used for resistant hypertension

MOA: reduce sympathetic outflow (NE); enhance parasympathetic activity, reducing heart rate, cardiac output, and total peripheral resistance

AE: transient sedation initially, vision disturbances, sedation (avoid other sedatives)

CI: hypersensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Gaunabenz

A

Alpha 2 Agonist

Indication: occasionally used for resistant hypertension

MOA: reduce sympathetic outflow (NE); enhance parasympathetic activity, reducing heart rate, cardiac output, and total peripheral resistance

AE: transient sedation initially, vision disturbances, sedation (avoid other sedatives)

CI: hypersensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Resperpine

A

Peripheral Sympathetic Inhibitor

Indication: hypertension

MOA: reduces sympathetic tone and peripheral resistance; depletes NE from nerve endings

AE: gastric ulceration, depression, sexual side effects, orthostatic hypotension, nasal congestion, fluid retention, peripheral edema, diarrhea, increased gastric secretion

CI: hypersensitivity, peptic ulcer disease, ulcerative colitis, history of depression, history of ECT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Isosorbide Nitrate/Hydralazine

A

Direct Vasodilators

Indication: resistant hypertension

MOA: relax smooth muscles in arterioles and activate baroreceptors

AE: tachycardia

CI: hypersensitivity, increased cranial pressure

cause reflex tachycardia and fluid retention; use beta blockers and diuretics too

use caution and review use and monitoring before prescribing for hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Hydralazine

A

Direct Vasodilators

Indication: resistant hypertension

MOA: relax smooth muscles in arterioles and activate baroreceptors

AE: tachycardia, lupus-like syndrome

CI: hypersensitivity

cause reflex tachycardia and fluid retention; use beta blockers and diuretics too

use caution and review use and monitoring before prescribing for hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Minoxidil

A

Direct Vasodilators

Indication: resistant hypertension

MOA: relax smooth muscles in arterioles and activate baroreceptors

AE: tachycardia, edema, hypertrichosis

CI: hypersensitivity, pheochromocytoma

cause reflex tachycardia and fluid retention; use beta blockers and diuretics too

use caution and review use and monitoring before prescribing for hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Sacubitril/Valsartan

A

ARB/Neprilysin Inhibitor

Indication: Heart Failure

MOA: ACE-I/ARB Combo; Sacubitril increases natriuretic peptides (involved in diuresis) by preventing their breakdown, but causes increase in AT II; Valsartan blocks AT II’s receptor

AE: new; theoretical risk of increasing peptides associated with Alzheimer’s

NEW - don’t be the first, don’t be the last!

may improve HF outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Hydralazine + Isosorbide Dinitrate

A

Heart Failure – for patients intolerant to ACE-I or ARBs; or African Americans

MOA: Nitrates – venous vasodilation, reducing preload; Hydralazine – direct arterial smooth muscle relaxation, reducing afterload

AE: hypotension, headache, tachycardia, lupus; often poorly tolerated

CI: concomitant use of sildenafil, tadalalfil, vardenafil (increase risk of hypotension)

56
Q

Azilsartan

A

Angiotensin Receptor Blockers

Indications: hypertension; heart failure (improves symptoms and outcomes/heals the heart)

MOA: block angiotensin II from binding to angiotensin receptor

AE: hyperkalemia, renal function deterioration, angioedema, hypotension/syncope

Absolute CI: pregnancy, bilateral renal artery stenosis, history of angioedema

Relative CI: unilateral renal artery stenosis, renal insufficiency, hypotension (go slow), hyperkalemia (greater than 5 mEq/L)

Dose Adjustments: renal impairment, elderly, volume depleted, diuretic therapy

Monitor: electrolytes (K+), GFR and serum creatine

57
Q

Candesartan

A

Angiotensin Receptor Blockers

Indications: hypertension; heart failure (improves symptoms and outcomes/heals the heart)

MOA: block angiotensin II from binding to angiotensin receptor

AE: hyperkalemia, renal function deterioration, angioedema, hypotension/syncope

Absolute CI: pregnancy, bilateral renal artery stenosis, history of angioedema

Relative CI: unilateral renal artery stenosis, renal insufficiency, hypotension (go slow), hyperkalemia (greater than 5 mEq/L)

Dose Adjustments: renal impairment, elderly, volume depleted, diuretic therapy

Monitor: electrolytes (K+), GFR and serum creatine

58
Q

Irbesartan

A

Angiotensin Receptor Blockers

Indications: hypertension; heart failure (improves symptoms and outcomes/heals the heart)

MOA: block angiotensin II from binding to angiotensin receptor

AE: hyperkalemia, renal function deterioration, angioedema, hypotension/syncope

Absolute CI: pregnancy, bilateral renal artery stenosis, history of angioedema

Relative CI: unilateral renal artery stenosis, renal insufficiency, hypotension (go slow), hyperkalemia (greater than 5 mEq/L)

Dose Adjustments: renal impairment, elderly, volume depleted, diuretic therapy

Monitor: electrolytes (K+), GFR and serum creatine

59
Q

Losartan

A

Angiotensin Receptor Blockers

Indications: hypertension; heart failure (improves symptoms and outcomes/heals the heart)

MOA: block angiotensin II from binding to angiotensin receptor

AE: hyperkalemia, renal function deterioration, angioedema, hypotension/syncope

Absolute CI: pregnancy, bilateral renal artery stenosis, history of angioedema

Relative CI: unilateral renal artery stenosis, renal insufficiency, hypotension (go slow), hyperkalemia (greater than 5 mEq/L)

Dose Adjustments: renal impairment, elderly, volume depleted, diuretic therapy

Monitor: electrolytes (K+), GFR and serum creatine

60
Q

Olmesartan

A

Angiotensin Receptor Blockers

Indications: hypertension; heart failure (improves symptoms and outcomes/heals the heart)

MOA: block angiotensin II from binding to angiotensin receptor

AE: hyperkalemia, renal function deterioration, angioedema, hypotension/syncope

Absolute CI: pregnancy, bilateral renal artery stenosis, history of angioedema

Relative CI: unilateral renal artery stenosis, renal insufficiency, hypotension (go slow), hyperkalemia (greater than 5 mEq/L)

Dose Adjustments: renal impairment, elderly, volume depleted, diuretic therapy

Monitor: electrolytes (K+), GFR and serum creatine

61
Q

Telmisartan

A

Angiotensin Receptor Blockers

Indications: hypertension; heart failure (improves symptoms and outcomes/heals the heart)

MOA: block angiotensin II from binding to angiotensin receptor

AE: hyperkalemia, renal function deterioration, angioedema, hypotension/syncope

Absolute CI: pregnancy, bilateral renal artery stenosis, history of angioedema

Relative CI: unilateral renal artery stenosis, renal insufficiency, hypotension (go slow), hyperkalemia (greater than 5 mEq/L)

Dose Adjustments: renal impairment, elderly, volume depleted, diuretic therapy

Monitor: electrolytes (K+), GFR and serum creatine

62
Q

Valsartan

A

Angiotensin Receptor Blockers

Indications: hypertension; heart failure (improves symptoms and outcomes/heals the heart)

MOA: block angiotensin II from binding to angiotensin receptor

AE: hyperkalemia, renal function deterioration, angioedema, hypotension/syncope

Absolute CI: pregnancy, bilateral renal artery stenosis, history of angioedema

Relative CI: unilateral renal artery stenosis, renal insufficiency, hypotension (go slow), hyperkalemia (greater than 5 mEq/L)

Dose Adjustments: renal impairment, elderly, volume depleted, diuretic therapy

Monitor: electrolytes (K+), GFR and serum creatine

63
Q

Eprosartan

A

Angiotensin Receptor Blockers

Indications: hypertension; heart failure (improves symptoms and outcomes/heals the heart)

MOA: block angiotensin II from binding to angiotensin receptor

AE: hyperkalemia, renal function deterioration, angioedema, hypotension/syncope

Absolute CI: pregnancy, bilateral renal artery stenosis, history of angioedema

Relative CI: unilateral renal artery stenosis, renal insufficiency, hypotension (go slow), hyperkalemia (greater than 5 mEq/L)

Dose Adjustments: renal impairment, elderly, volume depleted, diuretic therapy

Monitor: electrolytes (K+), GFR and serum creatine

64
Q

Felodipine

A

Calcium Channel Blocker - Dihydropyridine

MOA: dilate the arterioles by blocking the movement of calcium into smooth muscle cells preventing their contraction, and causing relaxation and dilation; greater affinity for vascular calcium channels than calcium channels in the heart

AE: bradycardia, peripheral edema, headache, flushing, gingival hyperplasia, reflex tachycardia

CI: Hypersensitivity, reduced ejection fraction

Caution: contaminant use with Beta Blockers – can cause heart block

most have short half-lives, so extended release is preferred

will not help heart failure, but will not hurt

65
Q

Digoxin

A

Indications: heart failure; add digoxin for patients who are symptomatic despite optimized ACE I and Beta Blocker and Diuretic, or if concomitant Afib – digoxin slows rate (beta blockers are better)

MOA: binds to Na+ and K+ ATP pumps, leading to incrased intracellular Na concetnrations; more intracellular Ca is then available during systole; regulates heart rate (slows); Neurohormonal (RAAS, SNS) modulation – may be related to restoration of baroreceptor

Antiarrhythmic - vagal stimulation (PNS), direct AV nodal inhibition, prolongs AV node refractoriness

Digoxin Toxicity: fatigue, weakness, CNS effects (confusion, delirium, psychosis), GI effects (nausea, vomiting, anorexia), visual disturbances (halos, photophobia, color perception problems – red-green or yellow-green vision), cardiac effects (arrhythmias, ventricular tachycardia and fibrillation, AV node block, and sinus bradycardia) – increased with electrolyte disturbances (hypo K, hyper Ca, hypo Mg)

Many Interactions

digoxin conc <1.2 ng/mL – no adverse effect on survival

digoxin conc >1.2 ng/mL – increased relative risk of mortality

desired concentration range = 0.5 - 0.9 ng/mL; preferably at or less than 0.8 ng/mL

slow onset of action – need loading dose in emergent situations

Adjust Dose: age, renal function, weight, risk for toxicity, indication (HF vs arrhythmia)

routine monitoring of serum drug concentrations not required, but recommended if there are changes in renal function, there is suspected toxicity, or after addition or

66
Q

Nitroglycerin

A

Vasodilator

Indication: Acute Heart Failure (IV)

MOA: acts as source of NO (induces smooth muscle relaxation in arterial and venous system)

AE: hypotension (especially Nesiritide – long half-life)

CI: if cardiac filling depends on venous return, shock

67
Q

Nitroprusside

A

Vasodilator

Indication: Acute Heart Failure (IV)

MOA: venous and arterial dilator

AE: hypotension (especially Nesiritide – long half-life)

CI: if cardiac filling depends on venous return, shock

68
Q

Nesiritide

A

Vasodilator

Indication: Acute Heart Failure (IV)

MOA: venous and arterial dilation, antagonizes RAAS

AE: hypotension (especially Nesiritide – long half-life)

CI: if cardiac filling depends on venous return, shock

69
Q

Dobutamine

A

Inotropic Agent

adrenergic receptor agonist, drug of choice, not as effective if on BB, causes vasodilation

70
Q

Dopamine

A

adrenergic receptor agonist; use: low systolic BP, cardiogenic shock; dose dependent effects

71
Q

Milrinone

A

phosphodiesterase III inhibitor, vasodilation, limited use

72
Q

Atrovastatin

A

High Intensity Statin

Indication: Hypercholesterolemia; reduces risk of ASCVD

MOA: inhibit HMG-CoA, a rate-limiting enzyme in cholesterol biosynthesis, reducing LDL

Common AE: constipation, abdominal pain, diarrhea, dyspepsia, nausea - but mostly well-tolerated

Serious AE: elevations in liver function (monitor LFTs) and liver toxicity (LFT elevations > 3X upper limit of normal), myopathy, rhabdomyolysis

may increase risk of getting diabetes mellitus

CI: NEVER in pregnant women

Discontinue: serum transaminase levels (liver function) rise to 3X upper limit of normal; signs or symptoms of myopathy

check dosage if patients have renal function issues

Interactions: drugs that inhibit metabolism: cyclosporine and gemfibrozil (statins metabolized by cytochrome p-450s)

maximum effect on lipids at 4-6 weeks - follow-up and check cholesterol levels/adherence at this time

Monitor: liver enzymes (LFTs) at baseline and as clinically indicated after; Creatinine Kinase in patients at risk for myopathy or complaining of muscle pain, weakness, tenderness, or brown urine; check for symptoms of myopathy at 6-12 weeks

Re-challenge intolerance after 2-4 weeks except in patients with Rhabdomyolysis

73
Q

Fluvastatin

A

Statin

fewer interactions; consider in re-challenges

Indication: Hypercholesterolemia; reduces risk of ASCVD

MOA: inhibit HMG-CoA, a rate-limiting enzyme in cholesterol biosynthesis, reducing LDL

Common AE: constipation, abdominal pain, diarrhea, dyspepsia, nausea - but mostly well-tolerated

Serious AE: elevations in liver function (monitor LFTs) and liver toxicity (LFT elevations > 3X upper limit of normal), myopathy, rhabdomyolysis

may increase risk of getting diabetes mellitus

CI: NEVER in pregnant women

Discontinue: serum transaminase levels (liver function) rise to 3X upper limit of normal; signs or symptoms of myopathy

check dosage if patients have renal function issues

Interactions: drugs that inhibit metabolism: cyclosporine and gemfibrozil (statins metabolized by cytochrome p-450s)

maximum effect on lipids at 4-6 weeks - follow-up and check cholesterol levels/adherence at this time

Monitor: liver enzymes (LFTs) at baseline and as clinically indicated after; Creatinine Kinase in patients at risk for myopathy or complaining of muscle pain, weakness, tenderness, or brown urine; check for symptoms of myopathy at 6-12 weeks

Re-challenge intolerance after 2-4 weeks except in patients with Rhabdomyolysis

74
Q

Lovastatin

A

Low Intensity Statin

Indication: Hypercholesterolemia; reduces risk of ASCVD

MOA: inhibit HMG-CoA, a rate-limiting enzyme in cholesterol biosynthesis, reducing LDL

Common AE: constipation, abdominal pain, diarrhea, dyspepsia, nausea - but mostly well-tolerated

Serious AE: elevations in liver function (monitor LFTs) and liver toxicity (LFT elevations > 3X upper limit of normal), myopathy, rhabdomyolysis

may increase risk of getting diabetes mellitus

CI: NEVER in pregnant women

Discontinue: serum transaminase levels (liver function) rise to 3X upper limit of normal; signs or symptoms of myopathy

check dosage if patients have renal function issues

Interactions: drugs that inhibit metabolism: cyclosporine and gemfibrozil (statins metabolized by cytochrome p-450s)

maximum effect on lipids at 4-6 weeks - follow-up and check cholesterol levels/adherence at this time

Monitor: liver enzymes (LFTs) at baseline and as clinically indicated after; Creatinine Kinase in patients at risk for myopathy or complaining of muscle pain, weakness, tenderness, or brown urine; check for symptoms of myopathy at 6-12 weeks

Re-challenge intolerance after 2-4 weeks except in patients with Rhabdomyolysis

75
Q

Pravastatin

A

Low Intensity Statin

not metabolized by cytochrome 450

fewer interactions; consider in re-challenges

Indication: Hypercholesterolemia; reduces risk of ASCVD

MOA: inhibit HMG-CoA, a rate-limiting enzyme in cholesterol biosynthesis, reducing LDL

Common AE: constipation, abdominal pain, diarrhea, dyspepsia, nausea - but mostly well-tolerated

Serious AE: elevations in liver function (monitor LFTs) and liver toxicity (LFT elevations > 3X upper limit of normal), myopathy, rhabdomyolysis

may increase risk of getting diabetes mellitus

CI: NEVER in pregnant women

Discontinue: serum transaminase levels (liver function) rise to 3X upper limit of normal; signs or symptoms of myopathy

check dosage if patients have renal function issues

Interactions: drugs that inhibit metabolism: cyclosporine and gemfibrozil (statins metabolized by cytochrome p-450s)

maximum effect on lipids at 4-6 weeks - follow-up and check cholesterol levels/adherence at this time

Monitor: liver enzymes (LFTs) at baseline and as clinically indicated after; Creatinine Kinase in patients at risk for myopathy or complaining of muscle pain, weakness, tenderness, or brown urine; check for symptoms of myopathy at 6-12 weeks

Re-challenge intolerance after 2-4 weeks except in patients with Rhabdomyolysis

76
Q

Pitavastatin

A

Statin

not metabolized by cytochrome 450

Indication: Hypercholesterolemia; reduces risk of ASCVD

MOA: inhibit HMG-CoA, a rate-limiting enzyme in cholesterol biosynthesis, reducing LDL

Common AE: constipation, abdominal pain, diarrhea, dyspepsia, nausea - but mostly well-tolerated

Serious AE: elevations in liver function (monitor LFTs) and liver toxicity (LFT elevations > 3X upper limit of normal), myopathy, rhabdomyolysis

may increase risk of getting diabetes mellitus

CI: NEVER in pregnant women

Discontinue: serum transaminase levels (liver function) rise to 3X upper limit of normal; signs or symptoms of myopathy

check dosage if patients have renal function issues

Interactions: drugs that inhibit metabolism: cyclosporine and gemfibrozil (statins metabolized by cytochrome p-450s)

maximum effect on lipids at 4-6 weeks - follow-up and check cholesterol levels/adherence at this time

Monitor: liver enzymes (LFTs) at baseline and as clinically indicated after; Creatinine Kinase in patients at risk for myopathy or complaining of muscle pain, weakness, tenderness, or brown urine; check for symptoms of myopathy at 6-12 weeks

Re-challenge intolerance after 2-4 weeks except in patients with Rhabdomyolysis

77
Q

Rosuvastatin

A

High Intensity Statin

fewer interactions; consider in re-challenges

Indication: Hypercholesterolemia; reduces risk of ASCVD

MOA: inhibit HMG-CoA, a rate-limiting enzyme in cholesterol biosynthesis, reducing LDL

Common AE: constipation, abdominal pain, diarrhea, dyspepsia, nausea - but mostly well-tolerated

Serious AE: elevations in liver function (monitor LFTs) and liver toxicity (LFT elevations > 3X upper limit of normal), myopathy, rhabdomyolysis

may increase risk of getting diabetes mellitus

CI: NEVER in pregnant women

Discontinue: serum transaminase levels (liver function) rise to 3X upper limit of normal; signs or symptoms of myopathy

check dosage if patients have renal function issues

Interactions: drugs that inhibit metabolism: cyclosporine and gemfibrozil (statins metabolized by cytochrome p-450s)

maximum effect on lipids at 4-6 weeks - follow-up and check cholesterol levels/adherence at this time

Monitor: liver enzymes (LFTs) at baseline and as clinically indicated after; Creatinine Kinase in patients at risk for myopathy or complaining of muscle pain, weakness, tenderness, or brown urine; check for symptoms of myopathy at 6-12 weeks

Re-challenge intolerance after 2-4 weeks except in patients with Rhabdomyolysis

78
Q

Sivastatin

A

Statin

not metabolized by cytochrome 450

fewer interactions; consider in re-challenges

Indication: Hypercholesterolemia; reduces risk of ASCVD

MOA: inhibit HMG-CoA, a rate-limiting enzyme in cholesterol biosynthesis, reducing LDL

Common AE: constipation, abdominal pain, diarrhea, dyspepsia, nausea - but mostly well-tolerated

Serious AE: elevations in liver function (monitor LFTs) and liver toxicity (LFT elevations > 3X upper limit of normal), myopathy, rhabdomyolysis

may increase risk of getting diabetes mellitus

CI: NEVER in pregnant women

Discontinue: serum transaminase levels (liver function) rise to 3X upper limit of normal; signs or symptoms of myopathy

check dosage if patients have renal function issues

Interactions: drugs that inhibit metabolism: cyclosporine and gemfibrozil (statins metabolized by cytochrome p-450s)

maximum effect on lipids at 4-6 weeks - follow-up and check cholesterol levels/adherence at this time

Monitor: liver enzymes (LFTs) at baseline and as clinically indicated after; Creatinine Kinase in patients at risk for myopathy or complaining of muscle pain, weakness, tenderness, or brown urine; check for symptoms of myopathy at 6-12 weeks

Re-challenge intolerance after 2-4 weeks except in patients with Rhabdomyolysis

79
Q

Ezetimibe

A

Cholesterol Absorption Inhibitor

Indication: sometimes recommended for hypercholesterolemia

MOA: inhibits cholesterol absorption in the small intestine, preventing delivery to liver, causing an increase in cholesterol clearance from the blood

AE: similar to placebo, possible increase in transaminases

CI: similar to placebo, possible increase in transaminases

primary used in combination with a statin when adequate reductions in cholesterol is not achieved, in patients that are intolerant to statins, or when patients can only tolerate moderate intensity statins

80
Q

Alirocumab

A

PCSK9 Inhibitor

Indications: sometimes recommended for hypercholesterolemia

MOA: inhibits binding of PCSK9 to LDL receptors on hepatocytes; LDL receptors are not degraded and stay to clear LDL from circulation

AE: well tolerated, injection site reactions, flu, common cold, itching, serious allergic reaction

new; don’t know long-term effects

expensive ($14,000/year)

consider as add-on for familial hypercholesterolemia

81
Q

Evolocumab

A

PCSK9 Inhibitor

Indications: sometimes recommended for hypercholesterolemia

MOA: inhibits binding of PCSK9 to LDL receptors on hepatocytes; LDL receptors are not degraded and stay to clear LDL from circulation

AE: well tolerated, injection site reactions, flu, common cold, itching, serious allergic reaction

new; don’t know long-term effects

expensive ($14,000/year)

consider as add-on for familial hypercholesterolemia

82
Q

Cholestyramine

A

Bile Acid Sequesterants (Resins)

Indications: not generally recommended for hypercholesterolemia

MOA: bind to bile acids I the gut, which are then excreted; hepatic cholesterol converts to bile, more LDL receptors are made to make-up for loss of cholesterol inside of the liver, cholesterol is removed from the blood

AE: nausea, constipation, bloating, flatulence, may worsen elevated triglycerides, impair absorption of fat soluble vitamins (remains in GI tract, so AE remain here)

Interactions: may prevent absorption of other drugs; take 1 hour before or 4 hours after other medications

Dosing: start low and go slow

only hypercholesterolemia treatment recommended for pregnant women

usually with a statin

reduce CHD events in patients with CHD

83
Q

Colesevelam

A

Bile Acid Sequesterants (Resins)

less likely to cause AE

Indications: not generally recommended for hypercholesterolemia

MOA: bind to bile acids I the gut, which are then excreted; hepatic cholesterol converts to bile, more LDL receptors are made to make-up for loss of cholesterol inside of the liver, cholesterol is removed from the blood

AE: nausea, constipation, bloating, flatulence, may worsen elevated triglycerides, impair absorption of fat soluble vitamins (remains in GI tract, so AE remain here)

Interactions: may prevent absorption of other drugs; take 1 hour before or 4 hours after other medications

Dosing: start low and go slow

only hypercholesterolemia treatment recommended for pregnant women

usually with a statin

reduce CHD events in patients with CHD

84
Q

Colestipol

A

Bile Acid Sequesterants (Resins)

Indications: not generally recommended for hypercholesterolemia

MOA: bind to bile acids I the gut, which are then excreted; hepatic cholesterol converts to bile, more LDL receptors are made to make-up for loss of cholesterol inside of the liver, cholesterol is removed from the blood

AE: nausea, constipation, bloating, flatulence, may worsen elevated triglycerides, impair absorption of fat soluble vitamins (remains in GI tract, so AE remain here)

Interactions: may prevent absorption of other drugs; take 1 hour before or 4 hours after other medications

Dosing: start low and go slow

only hypercholesterolemia treatment recommended for pregnant women

usually with a statin

reduce CHD events in patients with CHD

85
Q

Niacin ER, IR, or SR

A

Nicotinic Acid

Indication: generally not recommended for Hypercholesterolemia

MOA: inhibits fatty acid release from adipose tissue and inhibits fatty acid and triglyceride production in liver cells

AE: flushing (IR), itching, gastric distress, headache, hepatotoxicity (SR), hyperglycemia, hyperuremia

reduce flushing by taking aspirin or NSAID 30 min prior; take with food; start at low dose

also known as vitamin B3, but the lipid treatment is a higher dose than the nutritional supplement

86
Q

Fenofibrate

A

Fibric Acid Derivatives

Indications: generally not recommended for Hypercholesterolemia

MOA: work by activating PPAR-alpha, which leads to destruction and removal of triglycerides and causes an increase in HDL production

AE: nausea, diarrhea, flatulence, fatigue, gallstones, myositis, hepatitis

CI: gallbladder disease, liver dysfunction, or severe kidney dysfunction

Interactions: increase risk of rhabdomyolysis with statin, increase risk of bleeding with warfarin

most effective triglyceride lowering drug; decrease by 20-50%

max effect 2 weeks for Fenofibrate and 3-4 weeks for gemfibrozil

87
Q

Gemfibrozil

A

Fibric Acid Derivatives

Indications: generally not recommended for Hypercholesterolemia

MOA: work by activating PPAR-alpha, which leads to destruction and removal of triglycerides and causes an increase in HDL production

AE: nausea, diarrhea, flatulence, fatigue, gallstones, myositis, hepatitis

CI: gallbladder disease, liver dysfunction, or severe kidney dysfunction

Interactions: increase risk of rhabdomyolysis with statin, increase risk of bleeding with warfarin

most effective triglyceride lowering drug; decrease by 20-50%

max effect 2 weeks for Fenofibrate and 3-4 weeks for gemfibrozil

88
Q

Lovaza

A

Omega 3 Fatty Acid

AE: eructation (burping), dyspepsia, taste perversion

Indication: generally not recommended for hypercholesterolemia

MOA: reduced synthesis and increased clearance of triglycerides

Caution: hypersensitivity to fish/shellfish

Interactions; anticoagulant or antiplatelet agents (may increase risk of bleeding and hemorrhagic stroke)

89
Q

Vascepa

A

Omega 3 Fatty Acid

AE: arthralgia

Indication: generally not recommended for hypercholesterolemia

MOA: reduced synthesis and increased clearance of triglycerides

Caution: hypersensitivity to fish/shellfish

Interactions; anticoagulant or antiplatelet agents (may increase risk of bleeding and hemorrhagic stroke)

90
Q

Epanova

A

Omega 3 Fatty Acid

AE: diarrhea, nausea, abdominal pain or discomfort

Indication: generally not recommended for hypercholesterolemia

MOA: reduced synthesis and increased clearance of triglycerides

Caution: hypersensitivity to fish/shellfish

Interactions; anticoagulant or antiplatelet agents (may increase risk of bleeding and hemorrhagic stroke)

91
Q

Omtrya

A

Omega 3 Fatty Acid

AE: eructation (burping), dyspepsia, taste perversion

Indication: generally not recommended for hypercholesterolemia

MOA: reduced synthesis and increased clearance of triglycerides

Caution: hypersensitivity to fish/shellfish

Interactions; anticoagulant or antiplatelet agents (may increase risk of bleeding and hemorrhagic stroke)

92
Q

Lomitapide

A

Microsomal Transfer Protein Inhibitor

Indication: generally not recommended for hypercholesterolemia

MOA: oral inhibitor of microsomal triglyceride transfer protein; prevents assembly of Apo-B lipoproteins, ultimately reducing LDL

AE: GI side effects (low fat diet may reduce), elevation in liver enzymes and hepatic fat, hepatotoxicity

CI: NEVER in pregnancy

Interactions: strong and moderate cytochrome P-450 3A4 inhibitors, warfarin, lovastatin, simvastatin

available only through the Risk Evaluation and Mitigation Strategy program (REMS)

metabolized extensively by CYP450

93
Q

Quinidine

A

Class IA Antiarrhythmic

intermediate potency

IV

MOA: blocks sodium from entering cardiac cell, making it harder to depolarize

AE: proarrhythmic, increased risk of death (consult)

94
Q

Procainamide

A

Class IA Antiarrhythmic

intermediate potency

IV

MOA: blocks sodium from entering cardiac cell, making it harder to depolarize

AE: hypotension, torsades due pointes, proarrhythmic, increased risk of death (consult)

95
Q

Disopyramide

A

Class IA Antiarrhythmic

intermediate potency

IV

MOA: blocks sodium from entering cardiac cell, making it harder to depolarize

AE: proarrhythmic, increased risk of death (consult)

96
Q

Lidocaine

A

Class IB Antiarrhythmics - lowest potency, minimal effect on conduction velocity at normal heart rates

IV

MOA: blocks sodium from entering cardiac cell, making it harder to depolarize

AE: proarrhythmic, increased risk of death (consult)

97
Q

Mexiletine

A

Class IB Antiarrhythmics - lowest potency, minimal effect on conduction velocity at normal heart rates

IV

MOA: blocks sodium from entering cardiac cell, making it harder to depolarize

AE: GI distress, tremor, dizziness, fatigue, seizures (if dose too high)

98
Q

Flecainide

A

Class IC Antiarrhythmics - greatest potential for slowing ventricular conduction

Conversion to Sinus Rhythm, Maintenance of Sinus Rhythm

oral

MOA: blocks sodium from entering cardiac cell, making it harder to depolarize

AE: dizziness, blurred vision, HF exacerbation, proarrhythmic, increased risk of death (consult)

99
Q

Propafenone

A

Class IC Antiarrhythmics - greatest potential for slowing ventricular conduction
oral

Conversion to Sinus Rhythm, Maintenance of Sinus Rhythm

MOA: blocks sodium from entering cardiac cell, making it harder to depolarize

AE: dizziness, blurred vision, proarrhythmic, increased risk of death (consult)

100
Q

Amiodarone

A

Potassium Channel Blockers (also has CCB and BB activity)

Class III Antiarrhythmic (technically can work as all four classes); Ventricular Rate Control (second-line)

Conversion to Sinus Rhythm, Maintenance of Sinus Rhythm

MOA: blocks potassium from leaving cardiac cell, slowing repolarization

AE: IV: hypotension, sinus bradycardia
Oral: blue-gray skin, photosensitivity, corneal microdeposits, pulmonary fibrosis, pulmonary toxicity, hepatotoxicity, sinus bradycardia, hypo or hyperthyroidism, peripheral neuropathy, weakness, AV block, exacerbated arrhythmias

101
Q

Dafetilide

A

Potassium Channel Blockers

Class III Antiarrhythmic

Conversion to Sinus Rhythm and Maintenance of Sinus Rhythm

MOA: blocks potassium from leaving cardiac cell, slowing repolarization

AE: torsades de pointes, hospitalize for initiation, correct potassium first, proarrhythmic, death

102
Q

Dronedarone

A

Potassium Channel Blockers

Class III Antiarrhythmic

Maintenance of Sinus Rhythm

MOA: blocks potassium from leaving cardiac cell, slowing repolarization

AE: diarrhea, asthenia, n/v abdominal pain, bradycardia, GI distress, hepatotoxicity, worsening HF, increased risk of stroke, arrhythmias, death

CI: do not use in severe HF-increase death by 2X!

103
Q

Ibutilide

A

Potassium Channel Blockers

Class III Antiarrhythmic

Conversion to Sinus Rhythm

MOA: blocks potassium from leaving cardiac cell, slowing repolarization

104
Q

Soltolol

A

DOES NOT WORK AS BB - FOR ARRHYTHMIAS

Potassium Channel Blockers

Class III Antiarrhythmic

Maintenance of Sinus Rhythm

MOA: blocks potassium from leaving cardiac cell, slowing repolarization

AE: sinus bradycardia, AV block, fatigue, torsades de pointes, hospitalize for initiation, do not abruptly discontinue, monitor QT, proarrhythmic, death

105
Q

Adenosine

A

Non-class Antiarrhythmic - drug of choice for PVST

IV Push

MOA: causes direct AV node inhibition

AE: chest pain (not ischemia), flushing, shortness of breath (bronchospasm possible), sinus bradycardia, AV block

Interactions: dipyridamole and carbamazepine = increase response to adenosine

successful in 90-95% of patients

extremely short half-life: 10 seconds
must administer very quickly

106
Q

Warfarin

A

Anticoagulant

107
Q

Fondaparinux

A

Indirect Xa Inhibitor

Anticoagulant

108
Q

Rivaroxaban

A

Direct Xa Inhibitor

Anticoagulant

109
Q

Apixaban

A

Direct Xa Inhibitor

Anticoagulant

110
Q

Lepiruidin

A

Direct Thrombin Inhibitor
Anticoagulant
IV
No longer in use

111
Q

Bivalirudin

A

Direct Thrombin Inhibitor
Anticoagulant
IV

112
Q

Desirudin

A

Direct Thrombin Inhibitor
Anticoagulant
SubQ

113
Q

Aragatroban

A

Direct Thrombin Inhibitor
Anticoagulant
IV

114
Q

Unfractionated Heparin

A

Anticoagulant

115
Q

Dalteparin

A

Low Molecular Weight Heparin

116
Q

Enoxaparin

A

Low Molecular Weight Heparin

117
Q

Asprin

A

Antiplatelet

118
Q

Dipyridamole

A

antiplatelet that is expensive, but sometimes added to aspirin

119
Q

Clopidogrel

A

P2Y12 Inhibitor

120
Q

Prasugrel

A

P2Y12 Inhibitor

121
Q

Ticagrelor

A

P2Y12 Inhibitor

122
Q

Congrelor

A

P2Y12 Inhibitor

123
Q

Abciximab

A

Glycoprotein IIb/IIIc Receptor Inhibitors

124
Q

Eptifbatide

A

Glycoprotein IIb/IIIc Receptor Inhibitors

125
Q

Tirofiban

A

Glycoprotein IIb/IIIc Receptor Inhibitors

126
Q

Alteplase

A

Fibrin Specific Fibrinolytic

127
Q

Reteplase

A

Fibrin Specific Fibrinolytic

128
Q

Tenecteplase

A

Fibrin Specific Fibrinolytic

129
Q

Streptokinase

A

Fibrin Non-Specific Fibrinolytic

130
Q

Urokinase

A

Fibrin Non-Specific Fibrinolytic

131
Q

Nitroglycerin

A

Short-Acting Nitrates

132
Q

Nitroglycerin ER

A

Long-Acting Nitrates

133
Q

Isosorbide dinitrate

A

Long-Acting Nitrates

134
Q

Isosorbide Mononitrate

A

Long-Acting Nitrates

135
Q

Ranolazine

A

Treats Angina

Pharmacology Exam II (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions