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Pharmacology > Pharm 2 (GI, antihyperlipidemics, Cardiovascular) > Flashcards

Pharm 2 (GI, antihyperlipidemics, Cardiovascular) Flashcards

1
Q

Sodium Bicarbonate
Aluminum Hydroxide
Calcium Carbonate
Magnesium hydroxide

A

Antacids

Tx - GERD, peptic ulcers, dyspepsia

AE - Hypokalemia & can affect absorption, bioavailability, or urinary excretion of other drugs

  • AH - Constipation, hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures
  • CC - Hypercalcemia, acid rebound, gas/bloating
  • SB - metabolic acidosis, excess NaCl absorption, gas
  • MH - Diarrhea, hyporeflexia, HoTN, cardiac arrest
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2
Q

Cimetidine
Ranitidine
Famotidine
Nizatidine

A

H2 blockers = reversibly block histamine H2-receptors = ↓H+ secretion by parietal cells

Tx - GERD, peptic ulcer, dyspepsia, gastritis

AE - C = potent inhibitor of cytochrome P-450, antiandrogenic effects (prolactin release, gynocomastia, impotence, ↓ libido in males), crosses BBB (confusion, dizziness, headaches) & placenta
- C&R = ↓ renal excretion of creatinine

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3
Q 
Omeprazole
Lansoprazole
Esomeprazole
Pantoprazole
Dexlansoprazole
Rabeprazole
A

Proton Pump Inhibitors = Irreversibly inhibit H+/K+ ATPase in stomach parietal cells

Tx - GERD, peptic ulcer, dyspepsia, gastritis, hyper-secretory disease (Zollinger-Ellison), NSAID & H. pylori associated ulcers

AE - ↑ risk of C. dif infection, pneumonia, hip fractures;
- ↓ serum Mg w/ long-term use

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4
Q

Bismuth

Sucralfate

A

Mucosal protective agent - bind to ulcer base, provide physical protection & allow HCO3- secretion to reestablish pH gradient in the mucous layer

Tx - ↑ ulcer healing, travelers’ diarrhea (bismuth)

AE - Bismuth - Blackening of stool & tongue

Bismuth subsalicylate also usee as antidiarrheal

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5
Q

Misoprostol

A

Mucosal protective agent - PGE1 analog = ↑ production & secretion of gastric mucous barrier, ↓ acid production

Tx - Prevent NSAID-induced peptic ulcers

 - maintenance of a PDA
 - also used to induce labor (ripens cervix)

AE - Diarrhea, cramping
CI - women of childbearing potential (abortifacient)

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6
Q

Octreotide

A

Somatostatin receptor agonist (long-acting) = ↓ gut motility

Tx - acute variceal bleeds

 - acromegaly, VIPoma, carcinoid tumors
 - secretory diarrhea

AE - Nausea, cramps, steatorrhea

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7
Q

Magnesium hydroxide
Magnesium citrate
Polyethylene glycol
Lactulose

A

Osmotic laxatives - provide osmotic load to draw water out (into the intestinal lumen)

Tx - Constipation

AE - Diarrhea, dehydration (may be abused by bulimics)

Lactulose also Tx - hepatic encephalopathy since gut flora degrade it into metabolites (lactic & acetic acid) that promote nitrogen excretion as NH4+

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8
Q

Infliximab

A

Monoclonal Ab (mouse/human chimeric) to TNF-α

Tx - Moderate to severe IBD (UC, CD), RA, ankylosing spondylitis, psoriasis

AE - Infection (including reactivation of latent TB), fever, HoTN

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9
Q

Sulfasalazine

Balsalazine

A

Sulfapyridine (antibacterial) & 5-ASA (anti-inflammatory), activated by colonic bacteria

Tx - UC & CD

AE - Malaise, nausea, sulfonamide toxicity, reversible oligospermia

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10
Q

Ondansetron

A

Antiemetic (central acting) - 5-HT3 antagonist; ↓ vagal stimulation;

Tx - control vomiting Post-op & in chemotherapy

AE - headache, constipation
- Prolonged QT

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11
Q

Metoclopramide

A

Prokinetic & antiemetic - D2 receptor antagonist; ↑ resting tone, contractility, LES tone, motility (does not influence colon transport time)

Tx - Diabetic & post-op gastroparesis, antiemetic

AE - ↑ parkinsonian effects (restlessness, drowsiness, fatigue, depression, nausea, diarrhea)
CI - Small bowel obstruction, Parkinson disease
RxI - digoxin & diabetic agents

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12
Q

Bethanechol

A

Prokinetic agent - Muscarinic receptor (M3) agonist

Tx - GERD, gastroparesis

AE - cholinergic side effects

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13
Q

Neostigmine

A

Prokinetic agent - AChE inhibitor

Tx - non-obstructive urinary retention, abdominal distension

AE - Cholinergic side effects

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14
Q

Erythromycin

A

Prokinetic agent - Motilin receptor agonist

Tx - gastroparesis

AE - Erythromycin mediated side effects

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15
Q

Methylcellulose

Psyllium

A

Bulk-forming laxative (fiber) - adds fecal bulk & retains water (must take w/ water)

Tx - constipation, minimize straining, prior to surgical/endoscopical procedures

AE - gas/bloating

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16
Q

Glycerin

Mineral oil

A

Surfactant/Stool-softening Laxative = coat stool w/ oil & penetrate w/ water & lipids

Tx - constipation, minimize straining, prior to surgical/endoscopical procedures

AE - nutrient malabsorption

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17
Q

Senna
Castor Oil
Phenophthalein

A

Stimulant Laxative = stimulate ENS, induce leaky mucosa, inhibit sodium uptake by the gut

Tx - constipation, minimize straining, prior to surgical/endoscopical procedures

AE - GI irritation

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18
Q

Lubiprostone

A

Laxative - Chloride Channel Activator (Prostaglandin derivative)

Tx - Chronic constipation

AE - N,V,D

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19
Q

Loperamide

A

Anti-diarrheal, opioid agonist = ↑ segmental contractions & ↓ peristaltic contractions (↑ absorption ↓ movement)

Tx - Diarrhea (IBS)

AE - Constipation
low to no ability to cross BBB

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20
Q

Diphenoxylate

A

Anti-diarrheal, opioid agonist = ↓ GI perception of GI distension

Tx - diarrhea

AE - CNS effects, Atropine-like effects

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21
Q

Kaolin & Pectin

A

Antidiarrheal; Add fecal bulk & absorb toxins
Kaolin = Magnesium aluminum silicate
Pectin = non-digestible sugar

Tx - Diarrhea

AE - constipation

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22
Q

Bismuth subsalicylate

A

Antidiarrheal agent - Absorb toxins & inhibit prostaglandin synthesis in intestines

Tx - nonspecific & travelers’ diarrhea

AE - Salicylate toxicity

Also used as a mucosal protective agent

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23
Q

Scopolamine

A

Antiemetic - Muscarinic (M1) antagonist

Tx - Motion sickness

AE - Antimuscarinic effects

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24
Q

Dimenhydrinate

A

Antiemetic - Histamine (H1) antagonist

Tx - Motion Sickness

AE - Drowsiness

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25
Q

Aprepitant

A

Antiemetic - NK1 antagonist

Tx - Chemotherapy related nausea/vomiting
- 2nd/3rd choice due to AE

AE - Fatigue, dizziness, diarrhea
CYP3A4 interactions

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26
Q

Prochlorperazine

A

Antiemetic - M1D2H1 antagonist

Tx - Severe nausea & vomiting
- 2nd/3rd choice due to AE

AE - Extrapyramidal (D), Drowsiness (H), Anticholinergic (M)

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27
Q

Lorazepam

A

Antiemetic - GABA agonist

Tx - Anxiety/chemotherapy

AE - drowsiness

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28
Q

Nabilone

A

Antiemetic - Cannabinoid agonist

Tx - chemotherapy

AE - dysphoria, sedation, increased appetite (can be beneficial if trying to ↑ caloric intake)

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29
Q

Dexamethasone

A

Antiemetic - Glucocorticoid agonist

Tx - Post-op & chemotherapy
- ↑ effectiveness of 5-HT antagonists (ondansetron, Alosetron etc.)

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30
Q

Tegaserod

A

Laxative - 5-HT4 agonist

Tx - chronic idiopathic constipation
- IBS-constipation predominant

AE - GI, cardiovascular, CNS
- not available for general use

31
Q

Alosetron

A

5-HT3 antagonist = relieve pain & ↓ motility

Tx - IBS-diarrhea prodominant in Women**

AE - constipation, ischemic colitis (fatal)

32
Q

Mesalamine-

- Pentasa
- Asacol
- Rowasa 7 Canasa
A

5-ASA (aminosalicylate) = inhibit IL-1, TNF-α, NF-kB, COX; free radical scavenger

Tx - Ulcerative colitis

33
Q

Prednisone
Prednisolone
Hydrocortisone

A

Glucocorticoids - suppress inflammatory cytokines (TNF-α, IL-1), chemokines (IL-8), adhesion molecules & signal transduction molecules (NOS, PLA2, COX-2, NF-kB)

Tx - Moderate to severe active IBD

AE - Glucocorticoid Adverse Effects

34
Q

Azathioprine

6-mercaptopurine

A

Antimetabolites - Inhibition of purine synthesis
= ↓ proliferation of immune cells

Tx - Maintenance of remission of IBD

AE - N,V, bone marrow suppression

35
Q

Methotrexate

A

Antimetabolite - Inhibit DHFR = impair immune cell proliferation

Tx - Maintenance of remission of Crohn’s disease

AE - Bone marrow depression (uncommon at low doses)

36
Q 
Lovastatin
Pravastatin
Simvastatin
Atorvastatin
Rosuvastatin
A

Inhibit HMG-CoA reductase = inhibit conversion of HMG-CoA to mevalonate (a cholesterol precursor) = ↓ de novo cholesterol synthesis = cells upregulate LDLr & ↑ uptake of LDL = ↓↓↓ LDL, ↓ Triglycerides, ↑ HDL

Tx - Familial combined hyperlipoproteinemia

 - Familial hypercholesterolemia
 - Familial ligand-defective apoB

AE - GI effects, hepatotoxicity (↑ LFTs)
- rhabdomyolysis (esp. w/ fibrates & niacin)

37
Q

Cholestyramine
Colestipol
Colesevelam

A

Bile acid resins - Prevent cholesterol absorption at small intestine brush border = ↑ liver bile acid synthesis
= ↓ plasma cholesterol (↓ LDL, slightly ↑ HDL & Trig)

Tx - Familial hypercholesterolemia
- impaired bile-salt absorption mediated diarrhea

AE - Tastes bad & causes GI discomfort (Pt hate it)
- Cholesterol gallstones, ↓ ADEK absorption

38
Q

Niacin (Vit B3)

A

Inhibits lipolysis in adipose tissue; reduces hepatic VLDL synthesis (↓↓ LDL (&VLDL), ↑↑ HDL, ↓ Trig)

Tx - all hypercholesterolemias & hypertriglyceridemias
   Primary chylomicronemia
   Familial hypertriglyceridemia
   Familial dysbetalipoproteinemia
   Familial combined hyperlipoprotemia
   Familial hypercholesterolemia
   Familial ligand-defective apoB

AE - Cutaneous flust (↓ by aspirin or long-term use), hyperglycemia (acanthosis nigricans), hyperuricemia (exacerbates gout)

39
Q

Gemfibrosil
Clofibrate
Fenofibrate
Bezafibrate

A

Fibrates = Upregulate LPL to ↑ Trig clearance; + PPAR to induce HDL synthesis ( ↓ LDL, ↑ HDL, ↓↓↓ Trig)

Tx - Primary chylomicronemia, Familial combined hyperlipoproteinemia, Familial hypertriglyceridemia, Familial dysbetalipoproteinemia

AE - Myositis (↑ risk w/ statins), Hepatotoxicity (↑ LFTs), cholesterol gallstones (esp. w/ bile acid resins)

40
Q

Ezetimibe

A

Prevent cholesterol absorption at small intestine brush border = ↓↓ LDL & total cholesterol

Tx - Familial combined hyperlipoproteinemia, Familial hypercholesterolemia, Familial ligand-defective apoB

AE - rare ↑ LFTs, diarrhea

41
Q

Class I Antiarrhytmics

A

Na+ channel blockers

  • Slow or block (↓) conduction (esp. in depolarized cells)
  • ↓ slope of phase 0 depol
  • ↑ threshold for firing in abnormal pacemaker cells

Are state dependent = selectively depress tissue that is frequently depolarized (e.g. tachycardia)

Hyperkalemia causes ↑ toxicity for all class I drugs

42
Q

Quinidine
Procainamide
Disopyramide

A

Class IA antiarrhytmics - Na+ channel blockers (moderate)
↑ AP duration, ↑ ERP, ↑ QT interval

Tx - Atrial & ventricular arrhytmias; especially re-entrant & ectopic SVT & VT

AE - Torsades de pointes; thrombocytopenia

  - Cinchonism (headache, tinnitis) - Quinidine
  - reversible SLE-like syndrome - procainamide
  - Heart failure - Disopyramide
43
Q

Lidocaine
Mexiletine
-Phenytoin can fall into this category

A

Class IB antiarrhythmics - Na+ channel blockers (mild)
↓ AP duration; preferentially affect ischemic or depolarized Purkinje & ventricular tissue

Tx - Acute ventricular arrhythmias (esp. post-MI)
- digitalis-induced arrhythmias

AE - CNS stimulation/depression, CV depression

IB is Best post-mi

44
Q

Flecainide

Propafenone

A

Class IC antiarrhythmics - Na+ channel blockers (strong)
Significantly prolongs refractory period in AV node
(minimal effect on AP duration)

Tx - SVTs, including atrial fibrillation
- only as last resort in refractory VT

AE - Proarrhythmic, especially post-MI
CI - structural & ischemic heart disease

45
Q 
Metoprolol
Propranolol
Esmolol
Atenolol
Timolol
Carvedilol
A

Class II antiarrhythmics - β-blockers
↓ SA & AV node activity (by ↓ cAMP, ↓ Ca+ currents); Suppress abnormal pacemakers by ↓ slope of phase 4

Tx - SVT, slows ventricular rate during A Fib & Flutter

AE - Impotence, exacerbation of COPD & asthma

  - CV (bradycardia, AV block, CHF)
  - CNS effects (sedation, sleep alterations)
  - may mask the signs of hypoglycemia
  - Dyslipidemia (metoprolol)
  - propranolol can exacerbate vasospasm in Prinzmetal agina

CI - cocaine users (risk of unopposed α-adrenergic receptor agonist activity)

Treat overdose w/ glucagon

*ONLY antiarrhytmic drugs found to be clearly effective in preventing sudden cardiac deaths in Pt w/ prior MI

46
Q

Amiodarone, (Dronedarone)
Ibutilide
Dofetilide,
Sotalol

A

Class III antiarrhytmics, K+ channel blockers
↑ AP duration, ↑ ERP, ↑ QT interval

Tx - A Fib & Flutter, Ventricular Tachycardia (A, S)
- used when other antiarrhytmics fail

AE - Sotalol - TdP, excessive β-blockade

  - Ibutilide - TdP
  - Amiodarone - *pulmonary fibrosis (lethal interstitial pneumonitis), hepatotoxicity, hypo/hyperthyroidism, corneal deposits, Blue/gray skin deposits, photodermatitis, neurologic effects, constipation, Cardiovascular (bradycardia, heart block, CHF)   - Remembert ro checn PFTs, LFTs, & TFTs

Amiodarone has Class I, II, III & IV effects, and alters the lipid membrane

47
Q

Verapamil

Diltiazem

A

Class IV antiarrhythmic - Ca2+ channel blocker
↓ conduction velocity, ↑ ERP, ↑ PR, ↓ SA automaticity

Tx - Prevention of nodal arrhytmias (e.g. SVT), rate control in atrial fibrillation

AE - Constipation, flushing, edema, CV effects (CHF, AV block, sinus node depression)

48
Q

Adenosine

A

Other antiarrhythmic - ↑ K+ out of cells = hyperpolarize the cell and ↓ Ica = ↓ firing rate
-Very short acting (~15 seconds)

Tx - DoC in Dx/abolishment of SVT

AE - flushing, HoTN, chest pain

Effects blocked by theophylline & caffeine

49
Q

Magnesium

A

Other antiarrhythmic

Effective in TdP & digoxin toxicity

50
Q

Hydralazine

A

Arterial Vasodilator - ↑ cGMP = smooth muscle relaxation
Vasodilates arterioles > veins = afterload reduction

Tx - Severe HTN, CHF

 - 1st line tx for HTN in pregnancy (w/ methyldopa)
 - frequently coadministered w/ a β-blocker to prevent reflex tachycardia

AE - Compensatory tachycardia = CI in angina/CAD

  - fluid retention, nausea, headache, angina
  - Lupus-like syndrome
51
Q

Sodium Nitroprusside

A

Short acting for Hypertensive emergency
↑ cGMP via direct release of NO = ↓ preload & afterload

Can cause cyanide toxicity (releases cyanide)

52
Q

Fenoldopam

A

Dopamine D1 receptor agonist
=coronary, peripheral, renal & splanchnic vasodilation

Tx - hypertensive emergency
- ↓ BP & ↑ natriuresis

53
Q

Nitroglycerin
Isosorbide dinitrate
Isosorbide mononitrate

A

Vasodilate by ↑ NO in vascular smooth muscle = ↑ cGMP & smooth muscle relaxation

Dilate veins&raquo_space; arteries = ↓ preload

Tx - angina, acute coronary syndrome, pulmonary edema

AE - reflex tachycardia (tx w/ β-blocker), HoTN, flushing, headache
“Monday disease” in industrial exposure = development of tolerance during the week & loss of tolerance over weekend = tachycardia, dizziness & headache upon reexposure

54
Q

Digoxin

A

Direct inhibition of Na/K ATPase leads to indirect inhibition of Na/ca exchanger = ↑ Ca = positive inotropy
-also stimulates vagus nerve = ↓ HR

Tx - CHF (↑ contractility); A Fib (↓ conduction at AV node & depression of SA node)

AE - Cholinergic (N,V,D, blurry yellow vision)

  • ECG = ↑ PR, ↓ QT, ST scooping, T-wave inversion, arrhythmia, AV block
  • Can lead to hyperkalemia, which indicates poor Px

Antidote = Slowly normalize K+, cardiac pacer, anti-digoxin Fab fragments, Mg2+

55
Q

-Minoxidil

A

Arterial Vasodilator - Katp channel opener = relaxes arteriole smooth muscle cells (NO effect on veins)

Tx - oral use only for severe, refractory HTN
- in combo w/ diuretics & B-blockers

AE - Fluid & salt retention; Reflex ↑ myocardial activity; hypertrihosis

CV effects = ↓ BP, ↑ CO, ↑ blood flow to renal, heart, skin, skeletal muscle, GI, CNS

56
Q

-Aliskiren

A

Binds directly to catalytic site of renin = inhibits conversion of angiotensinogen in ANG1

Tx - Mono- or combotherapy for HTN
- demonstrated efficacy in lowering BP when used in combo w/ thiazide, ACEI, ARB or CCB

AE - hyperkalemia
CI - Pregnancy

57
Q

-Reserpine

A

Rauwolfia Alkaloids = blocks transport of NE into storage granules = depletes NE at sympathetic nerve endings

Tx - most effective w/ thiazide diuretic (mitigate Na/H2O retention)
- rarely used in HTN because of perceived side affects

AE - sedation, depression, ↓ CO, orthostatic HoTN
- ↑ parasympathetic activity = nasal stuffiness, ↑ gastric acid secretion, diarrhea, bradycardia

58
Q
  • Inamrinone

- Milrinone

A

Phosphodiesterase Inhibitors - Inhibit PDE3 = ↑ cAMP (due to ↓ degradation) = ↑ myocardial contractility, accelerate myocardial relaxation; balance arterial & venous dilation; ↓TPR, PVR, LV &RV filling pressure = ↑CO

Tx - short-term circulation support in advanced CHF

short T1/2 = must be given IV

59
Q
  • Propanolol
  • Metaprolol
  • Pindolol
  • Labetalol
A

β-adrenergic receptor antagonists
= ↓ BP, varying degrees of ↓ HR, may ↓ renin

Tx - 1st line for compelling indications of CAD, Left ventricular dysfunction w/ HTN
- Addon for uncomplicated HTN & HTN w/ diabetes

+ w/ migraine, tachyarrhythmia, high-normal HR/tachycardia, hyperthyroidism (symptoms), essential tremor, Pre-op HTN

AE - can ↑ bronchospasm

60
Q
  • Spironolactone

- Eplerenone

A

Aldosterone receptor antagonists - competitively inhibit aldosterone binding MRs = ↓ Na uptake, ↓ K loss

Tx - Add-on for RHTN, & HTN w/ CAD, L ventricle dysfunction

+ Low-normal K - used in combo w/ thiazide to balance K, chronic kidney disease (early stages)
- high-normal K (including end stage kidney disease)

61
Q
  • Prozosin
  • Doxasin
  • Terazosin
A

α1-adrenergic receptor antagonists

Tx - HTN monotherapy, or w/ diuretic

+ ↓ LDL, TG & total cholesterol

AE -mild reflex tach, sexual dysfunction, orthostatic HoTN
- mild tolerance develops to antihypertensive effect

62
Q
  • Clonidine

- α-methyldopa

A

α2 selective agonists
= ↓ central sympathetic outflow = ↓ BP

Tx - transdermal formulation useful for labile HTN, Pt prone to early morning BP surges, hospitalized Pt who can’t take medication by mouth

  • optimally used w/ diuretic to diminish fluid retention
  • limited by anticholinergic effects & can cause rebound HTN when stopped

α-methyldopa - used in gestational HTN & chronic HTN in pregnancy
= fewer anticholinergic side effects but hepatotoxicity & + direct Coomb’s test

63
Q

Mannitol

A

Osmotic diuretic = ↑ tubular fluid osmolarity, producing ↑ urine flow, ↓ intracranial/intraocular pressure

Tx - Drug overdose

 - ↑ intracranial/intraocular pressure
 - prophylaxis for acute renal failure

AE - pulmonary edema, dehydration
CI - anuria, CHF

64
Q

Acetazolamide

A

Carbonic anhydrase Inhibitor - causes self-limited NaHCO3 diuresis & ↓ total-body HCO3- stores

Tx - Glaucoma
- urinary alkalinization, metabolic alkalosis, altitude sickness, pseudotumor cerebri

AE - hypercholoremic metabolic acidosis, parasthesias, NH3 toxicity, sulfa allergy, renal stones
CI - cirrhosis

65
Q

Furosemide

Bumetamide

A

Sulfonamide Loop diuretic - inhibit NKCC in thick ascending loop; abolish hypertonicity of medulla, preventing concentration of urine. Stimulates PGE release; ↑ Ca excretion (loops lose calcium)

Tx - Edematous states (CHF, cirrhosis, nephrotic syndrome, pulmonary edema), HTN, hypercalcemia

AE - Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa), Nephritis (interstitial), Gout (OH DANG!)

66
Q

Ethacrynic acid

A

Phenoxyacetic acid derivative loop diuretic - essentially same action as furosemide

Tx - diuresis in patients allergic to sulfa drugs

AE - OH DANG; can cause hyperuricemia = never use to treat gout

67
Q

Hydrochlorothiazide
Chlorthalidone
Metolazone
Indapamide

A

Thiazide diuretics - Inhibit NCC in early distal tubule.
↓ diluting capacity of the nephron; ↓ Ca excretion

Tx - HTN, CHF, idiopathic hypercalciuria, nephrogenic diabetes insipidus, osteoporosis

AE - hypokalemic metabolic alkalosis, hyponatremia

  - hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia (hyperGLUC)    - sulfa allergy
68
Q

Amiloride

Triamterene

A

Block Na channels in late distal tubule & collecting ducts
=K+ sparing agents

Tx - hyperaldosteronism, K+ depletion, CHF, HTN
- in combo w/ loop diuretics/thizides to prevent hypokalemia

AE - Hyperkalemia (can lead to arrhythmias), glucose tolerance & photosensitization

69
Q

Spironolactone

Eplerenone

A

Competitive aldosterone receptor antagonists in cortical collecting tubule = ↓ Na uptake = natriuresis
= K+ sparing agents

Tx - Hyperaldosteronism, K+ depletion, CHF, HTN
- prevention of L. ventricular remodeling & fibrosis, prevention of sudden cardiac death…

AE - Hyperkalemia (can lead to arrhythmias),
- spironolactone = endocrine effects (gynocomastia, antiandrogen effects…)

70
Q

Captopril
Lisinopril
Fosinopril
Enalapril

A

ACEI - ↓ AngII = ↓ GFR by preventing constriction of efferent arterioles. Levels of renin ↑ as a result of loss of feedback inhibition. Inhibition of ACE also prevents inactivation of bradykinin (a potent vasodilator)

Tx - HTN, CHF, proteinuria, diabetic nephropathy

 - prevent unfavorable heart remodeling as a result of chronic HTN
 - 1st line/add=on for uncomplicated HTN
 - 1st line tx for diabetes, chronic kidney disease, CAD, LV dysfunction & ischemic shock

AE - Cough, Angeioedema, Teratogen, ↑ Creatinine (↓gfr), Hyperkalemia & Hypotension (Captopril’s CATCHH)

CI - bilateral renal stenosis (because ACEI will further ↓ GFR = renal failure)

71
Q

Losartan
Valsartan
Candesartan

A

ARB (Angiotensin Receptor 1 blockers) = block AT1R = ↓ ANGII effects = ↓ vasoconstriction, aldosterone & Na/H2O retention

Tx - 1st line/add-on in uncomplicated HTN

 - 1st line Tx for diabetes, chronic kidney disease, CAD, LV dysfunction   - commonly used as an alternative for pt w/ intolerance to ACEI

+ Low-normal K, prediabetes
- High-normal K, hyperkalemia, volume depletion

CI - pregnancy & bilateral renal artery stenosis

72
Q

Nifedipine
Amlodipine
Felodipine
Nimodipine

A

Dihydropyridine Ca channel blockers - Block voltage-dependent L-type Ca channels w/ vasodilation to negative ionotropy = 10:1

Tx - HTN, angina (incl. Prinzmetal), Raynaud phenomenon
- nimodipine = subarachnoid hemorrhage (prevents cerebral vasospasm)

AE - Cardiac depression, AV block, peripheral edema, flushing, dizziness, hyperprolactinemia & constipation

73
Q

Verapamil

Diltiazem

A

NDHP Ca channel blockers - block voltage-dependent L-type Ca channels w/ 1:1 vasodilation to negative ionotropy

Tx - Hypertension, angina, A fib/flutter

AE - Cardiac depression, AV block, peripheral edema, flushing, dizziness, hyperprolactinemia & constipation

Pharmacology (6 decks)

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