Mod 2- Cardiovascular

Question 1

Nitrates

Answer 1

Nitroglycerin
MOA: directly dilates veins
Indication: acute angina and HF
SE/AE: h/a,orthostatic hypotension
Dosing: 0.4mg q5min for 3 doses
Contraindicated if of sildenafil, vardenafil or tadlafil; or if suspected right ventricular myocardial infarction
Treat hypotension with fluids

Question 2

Beta Blockers

Answer 2

Propan-
Metopr-
Labeta- olol
MOA: block beta receptors- decreases heart workload
Indication: angina; HTN, HF, AMI, dysrhythmias, migraines, anxiety
SE/AE: fatigue, bradycardia, hypoglycemia
BB: abrupt discontinuation can cause cardiac events
Propanolol- highest risk for bronchoconstriction
First line for angina prevention
Carvedilol is primarily used for HF
Safest BP med during pregnancy

Question 3

Ranolazine

Answer 3

MOA: unknown- decreases O2 demand
Indication: angina prevention
SE/AE: QT prolongation

Question 4

Sodium Channel Blockers (class 1a)

Answer 4

Procainamide
Slows cardiac conduction
Indication: arrhythmia
BB: lupus like syndrome, blood dyscrasias, proarrythmic effects

Question 5

Sodium Channel Blockers (class 1b)

Answer 5

Lidocaine
MOA: slows cardiac conduction
Indications: arrythmias
SE/AE: CNS effects
Contraindicated for WPW and certain heart blocks

Question 6

Sodium Channel Blockers (class 1C)

Answer 6

Flecainide; Propafenone
MOA: slows cardiac conduction
Indications: arrhythmia
BB: Proarhythmic effects- possible increased mortality

Question 7

Class 2 antiarrythmics

Answer 7

Beta blockers

Question 8

Potassium blockers- Class 3 antiarrythmics

Answer 8

Amiodarone
MOA: prolongs repolarization
Indications: Arrhythmias
SE/AE: bradycardia, hypotension, hepatotoxicity; pulmonary toxicity; skin sensitive to light
BB: pulm toxicity; hepatotoxicity; proarrythmic effects
Not safe for pregnancy
Avoid grapefruit juice
Lasts in body for several months

Question 9

Calcium channel Blockers: class 4 antiarrythmics

Answer 9

Cardizem

Question 10

Adenosine

Answer 10

MOA: decreases automaticity and slows conduction
Indications: tachydysrhythmia treatment and diagnostics
Patients must be on cardiac monitor
Onset in a few seconds
Chemical conversion

Question 11

Cardiac Glycosides- Digoxin

Answer 11

MOA: increased effects of calcium resulting in increased contractility
Indication: dysrhythmias and HF with reduced EF
SE/AE:: n/v; visual disturbances; bradycardia
Antidote for toxicity is digoxin-immune fab

Question 12

Heparin

Answer 12

MOA: indirectly inhibits thrombin
Indication: treatment and prevention of thromboembolic events
SE/AE: hemorrhage; HIT
Reversed with protamine sulfate
Considered safe during pregnancy
Enoxaparin is another drug in this class
Monitor aPTT

Question 13

Warfarin

Answer 13

Vitamin K antagonist
MOA: decreases production of vitamin K clotting factors
Onset is 12-72 hours
Monitor PT and INR- INR should be 2-3 on warfarin
Reversed with vitamin k
Interacts with many meds
Patients cannot increase their vitamin k intake

Question 14

Dabigatran (praxada)

Answer 14

Direct thrombin inhibitors
MOA: directly inhibits thrombin
Indication: DVT PE and prevention of clots with afib
SE/AE: GI upset
BB: abrupt discontinuation increases risk of thromboembolic events
Argatroban- for HIT; is also in this class

Question 15

Factor Xa inhibitors: Rivaroxaban Apixaban

Answer 15

MOA: inhibits factor Xa
Indications: treats DVT, PE and prevention of Afib clots
BB: abrupt discontinuation can lead to thromboembolic events
Reversed with factor Xa

Question 16

Aspirin

Answer 16

MOA: COX inhibition causes suppression of platelet aggregation- irreversible for the life of the platelet (7-10 days)
Indications: prevention of thombotic events, stokes, MI, ACS and more
SE/AE: GI bleeding

Question 17

Tirofiban (aggrastat)

Answer 17

Glycoprotein IIb/IIa inhibitors
MOA: inhibits these glycoproteins resulting in inhibition of platelet aggregation
Indication: prevention of patients having an MI
IV only- considered an antiplatelet

Question 18

Clopidogrel; Ticagrelor

Answer 18

ADP receptor antagonists
MOA: blocking ADP receptors resulting in decreased platelet aggregation
Indications: prevention of thrombotic events in patients having an AMI and reduce risk for hx of MI, stroke, atherosclerosis
Often given with aspirin
Considered an antiplatelet

Question 19

Thrombolytics

Answer 19

Alteplase; reteplase; tenecteplase
MOA: initiates fibrinolysis
Indications: AMI, CVA, PE
IV only
SE/AE: intracranial hemorrhage
High risk

Question 20

Tranexamic Acid

Answer 20

MOA: inhibits fibrinolysis, inhibits plasmin
Indications: bleeding with associated menstruation, trauma and more

Question 21

Antihypertensives: 1st Line

Answer 21

ACEI/ARB; Thiaszide Diuretics; Calcium Channel Blockers

Question 22

ACE-Inhibitors

Answer 22

Lisinopril, captopril
MOA: inhibit angiotensin 1 to angiotensin 2
Indications: HTN, ACS, CKD, stroke prevention, HF
SE/AE: kidney injury, angioedema, cough, hyperKalemia
Captopril can cause neutropenia
Teratogenic

Question 23

ARB

Answer 23

Losartan, Valsartan
MOA: inhibits angiotensin two receptors
Indications: kidney disease
SE/AE: kidney injury and hyperkalemia
Less likely to have cough and angioedema vs ACEI
Teratogenic

Question 24

Thiazide Diuretic

Answer 24

Hydrosholorthiazide; chlorthalidone
MOA: blocks reabsorption of sodium and chloride
Indications: HTN and edema
Most prescribed class of diuretics

Question 25

Calcium channel blockers- dihydropyridines

Answer 25

Amlodipine; Nicardipine- dihydropyridines- do not affect HR
MOA: inhibits calcium resulting in relaxation of vascular smooth muscle and vasodilation
Indications: angina and HTN
Used a first line for african american

Question 26

Calcium channel blockers- non-dihyropyridines

Answer 26

Verapamil; diltiazem
MOA: relaxation of vascular smooth muscle and vasodilation and also decrease cardiac cellular excitability and contractility
Indications: angina, afib, HTN, SVT
SE/AE/ dysrhythmias
Contraindications: 2nd and 3rd degree AV blocks, SSS, hypotension
Not first line for HTN

Question 27

Hydralazine

Answer 27

Direct vasodilators
MOA: directly dilates arteries
Indications: HF, hypertensive urgency, HTN
SE/AE: lupus like syndrome, refles tachy and hypotension
Very common to get headache
Isosorbide dinitrate is another vasodilator that is often given together along with bidil as well

Question 28

Sodium Nitroprusside

Answer 28

MOA: directly dilate arteries and veins
Indications: acute HF and acute HTN
SE/AE: cyanide toxicity and hypotension
IV only

Question 29

Clonidine Methyldopa: alpha two agonist

Answer 29

MOA: stimulates alpha two adrenergic receptor reducing sympthetic stimulation
Indications: hypertension
SE/AE: drowsiness
Clonidine often used PRN
Methyldopa is considered safe during pregnancy

Question 30

Aliskiren

Answer 30

Renin blocker
MOA: inhibits renin
indications: HTN
Alternative agent; never first line
Teratogenic

Question 31

Doxazosin prazosin

Answer 31

Alpha one adrenergic antatgonists
MOA: inhibits alpha one receptors
indications: BPH and HTN
SE/AE: orthostatic hypotension and reflex tachy
Tamsulosin is alpha 1 agonist used only for BPH

Question 32

HF dose of carvedilol

Answer 32

Much lower than hypertensive dose

Question 33

Phosphodiesterase Inhibitor

Answer 33

Amrinone; milrinone
MOA: inhibiting phosphodiesterase resulting in increased contractility and vasodilation
Indications: HF with reduced EF
SE/AE: dysrhythmias and hypotension
Parenterally only

Question 34

Sacubitril-valsartan (entresto)

Answer 34

MOA: inhibits neprilysin which increases vasodilation plus blocks the RAAS
Indication: heart failure
Also referred to as an ARNI
Not safe during pregnancy

Question 35

Bidil

Answer 35

Isosorbide dinitrate- hydralazine
MOA: dilates veins and arteries
Indications: HF with reduced EF
SE/AE: hypotension and headache

Question 36

Dobutamine

Answer 36

MOA: beta one agonist
Indications: acute decompensated HF
IV only
Considered vasopressor but not vasoconstrictor

Question 37

Epinephrine/norepinephrine - vasopressor

Answer 37

Vasopressors; alpha and beta-adrenergic activation

Question 38

Phenylephrine- vasopressor

Answer 38

Alpha adrenergic activation

Question 39

Dopamine- vasopressor

Answer 39

Low dose: dopaminergic activation- increased flow to kidneys
Medium Dose:; dopaminergic and beta-adrenergic activation
High Dose: alpha adrenergic activation

Question 40

Isoproterenol/dobutamine- Vasopressor

Answer 40

Beta adrenergic activation (does not cause vasoconstriction)

Question 41

Vasopressors

Answer 41

MOA: activate according receptors
Indication: shock
SE/AE: tachycardia palpitations
BB: IV extravasation- give phentolamine to treat/ give through central line

Question 42

Loop Diuretics

Answer 42

Bumetanide; furosemide
MOA: blocks reabsorption of sodium and chloride in loop of henle
Indications: edema r/t HF, liver failure, kidney failure, alternative for hypertension
SE/AE: ototoxicity
BB: fluid and electrolyte imbalances
Most potent diuretics

Question 43

Potassium Sparing Diuretics (aldosterone antagonist): Examples; MOA; indications; SE/AE

Answer 43

Spironolactone
MOA: blocks aldosterone
Indications: HTN, edema, HF
Caution with drugs that increase potassium

Question 44

Osmotic Diuretic: examples, MOA, indications

Answer 44

Mannitol
Interferes with water reabsorption in the kidneys, acts as hypertonic solution
Indications: reduction of ICP and IOP, increase diuresis related to renal failure

Question 45

Antidiuretic Hormone: MOA, indications; off-label use

Answer 45

Decreases urine output and vasoconstriction
Indication: shock and cardiac arrest
Off label: Diabetes Insipidous

Question 46

Carbonic Anhydrase Inhibitor: Examples, MOA, Indications

Answer 46

Drug: Acetazolamide
MOA: increased renal excretion of sodium, potassium, bicarbonate and water
Indications: Glaucoma, acute mountain sickness