Pharm 3 Cardio Flashcards

Question

Conivaptan

Answer 1

- Non peptide v1 & v2 adh rec antagonists | - ↑ urine output ↓ resorption water

Answer 2

Anti-platelt - PDE3 inhib → ↑ cAMP - TX intermittent claudication

Answer 3

- Tetracycline antibiotic - Used to produce Diabetes Insipidus - Uncouple v2 receptor - Lower toxicity than lithium

Answer 4

Uncouples v2 from adenylyl cyclase

Answer 5

-CardOut ↑ in CHF; Not in normal pt: ↓HR -Use for atrial arrhythmias -Inhibits Na/K ATPase -↑ contractility, ↑ free Ca ↑intra Na -K counters Digitalis;Digitalis counters K -Mg and K ↓ toxicity -Hockey Stick Config -Narrow Marg of Saftey: L ADV EFF: arrhythmias, CNS, and skin irrit DO NOT USE CARDIOVERISON C/I: WPW syndrome

Answer 6

Enhance toxicity: - ↓ Renal Clearance & ↓ VD: - -(quinidine, amiodarone, verapamil, diltiazem, captopril) - ↑ GI Absorption Reduce Toxicity: -↓ GI absorption: Cholestyramine ↓ absorption QUINIDINE: ↑ plasma levels displaces from protein DIURETICS: cause hypokalemia= ↑toxicity ELDERLY: ↑ levels b/c hypochloridia/↓ Clearance INFANTS: ↑ Dose Hypothyroid: ↓renal CL  ↑ plasma levels Use: Lidocaine, Phenytoin or Propranolol for intox

Answer 7

-Inodilator or bipyridine -Inhibit PDE, ↑ cAMP -↑ Ca influx -Vasodilatory -ACUTE: ↑ CardOut CHRONIC: ↓ survival Toxicites -Arrhythmias, thrombocytopenia, nausea USE FOR ACUTE HEART FAILURE

Answer 8

-Inodilator or bipyridine -Inhibit PDE, ↑ cAMP -↑ Ca influx -Vasodilatory ACUTE: ↑ CardOut CHRONIC: ↓ survival Toxicites -Arrhythmias, thrombocytopenia, nausea USE FOR ACUTE HEART FAILURE

Answer 9

``` -Sympathomimetic USE: Severe refractory CHF & Post op heart -↑ Cardiac Output ↑ RBF -↓ p. resistance -↑ Na excretion -Can treat shock -IV Admin ```

Answer 10

- Calcium Sensitizers - ↑ calcium sensitivity w/out ↑ tissue calcium - Inhibit PDE III - Sensitizes troponin-C

Answer 11

- Sympathomimetic - Selective B1 - Less Tachycardia - ↑ O2 consumption - Reduced filling pressure - IV admin

Answer 12

- Analog of BNP - Acute Tx of decompensated CHF - Causes ↓ Pulm Wedge Press - Improves Dyspnea and Fatigue - Lack of tolerance (unlike Nitroglycerin) MONITOR BP, hypotension

Answer 13

-Dangerous in severe CHF -↓ mortality rates class II and III CHF USED in Diastolic Dysfunction & cardiomyopathy Benefits - Attenuation catecholamines - ↑ beta receptors - ↓ HR ↓ Remodeling - Antiarrhythmic effect (UNIQUE)

Answer 14

- Used in CHF helps with preload after load - IV for HTN emergencies (↑ infusion = ↓ BP & visa versa) - Vasodilator Art and Veins (veins > arteries) - ADVERSE: Excessive Hypotension - Metabolized to thiocyanate: CYANIDE POISONING - Can cause metabolic acidosis - Sodium Nitrite → methemeglobin → Tx CN poisoning

Answer 15

``` -ORAL: chronic HPT Tx-Vasodilator- peripheral (via NO) -Relax ARTERIOLE smooth muscle (NO VEINS) -↑ HR, Card Output, Left Vent Eject Fraction -SAL: chronic HPT Tx -given in combo w/ diuretics and BB -Use for short term -esp. effective w/ AFRICAN AMERICAN ``` -SLE in slow acetylators **May induce ANGINA and MI in pts w/ CAD

Answer 16

-Class IA antiarrythmic/ Like Quinidine -Shorter Duration of Action & IV use -Affected by slow/fast acetylators -Same Adv Effect Quin: Torsdae de Pointes ADV EFFECT: SLE & ↑ ANA -DO NOT USE in complete AV block -USE in ventricular and supraventric TACHY

Answer 17

Class IA antiarrythmic--open & inactive Na chan - Myocardial Depress: ↓automaticity&response - ↑ Diastolic Threshold: slow Ca rise rate - ↑ APD & ERD: PREVENTS REENTRY - Block K+: ORAL; First pass - Block M Rec, ekg changes, ↑SA/AV block - LOW Ther INDEX: C/I- Av block,thrbocyto - Cardiac TOXIC;paradox tachy, SYNCOPE, Torsade de Pointes, Diarrhea Cinchonism - ↑ pt time, Phenytoin ↑ metab, ↑K=↑Toxicity - ↑ effect of paralyzing agents

Answer 18

-Class IA inhibitor, Different Structure than Quinidine -Reduces Cardiac Index -Use for premature ventricular & vent tach -Increases ERP, elect threshold, decrease velocity -Toxicity -Torsdade de Pointes, Neg Inotropic effect -Anticholinergic effect DO NOT USE IN SICK SINUS SYNDROM USE FOR VENTRICULAR TACHYCARDIA

Answer 19

- Class Ib- antiarrhythmic & anesthetic - Binds inactivated channels - Decreases APD, Shortens ERP - Block slow Na Window Currents - NO depressant on contractility - NO VAGAL blocking - IV only, NO use for Supravent arrythmia - Toxicity - CNS Depression, Hypotension Convulsion - Bradycardia * *Least negative inotropic

Answer 20

- Class Ib - Similar to lidocain - Also relieves pain in diabetic neuropathy - Toxicity - CNS - Tremor - Blurred - Lethargy CAN BE USED ORALLY

Answer 21

-Class Ib -Binds active and inactive NA channels -Antiepileptic drug -Used with digitalis toxicity -Shortens ERP: depression myocar automaticity Toxicity -Nystagmus, ataxia, slurred speech, confusion -Elevated glucose levels -Fever Rash Blood dyscrasia -Drug Interaction -Warfarin, Disulfiram inhibit the metabolism -Induces P450, inhibits folate dihydro reduct

Answer 22

-Class IC- binds to ALL Na channels -No effect APD, ANS -QRS widening, shorten AP perkinje -No first pass Toxicity -BLURRED VISION, Proarrythmic effect C/I -Pre ex AV block -CHF or cardio genic SHOCK *use for life threat ventric arrhythmias, prevent PSVT

Answer 23

-Class IC similar to Flecainide -Structurally similar to beta blockers -Use in hospital with monitoring RESERVED FOR LIFE THREATENING

Answer 24

- Class III anti-arrhythmic - Life threat vent arrhythmia & atrial flutt/fib - Blocks K, Binds to inactivated Na, Calcium blocking, - Causes peripheral vasodilation (alpha block) - LARGE half life - Causes bradycardia, heart block, pulm fibrosis - Deposits in tissues cornea, Thyroid dysfunc - Ventricular Arrhythmias * ** NO TORSADES DE POINTES***

Answer 25

- Nonselective beta blocker Class II l-isomer - Prolongs action potent Class III d-isomer - USED in ventricular and supraventricular - CAUSES torsades de pointes

Answer 26

- Class III - USED: Rapid Conversion atrial fib/flutter - Promotes Na influx through hslow channels - Increases Length of action potential - DOES NOT alter bp, hr or QRS

Answer 27

- Class III - USED: Conversion and Maintenance atrial fib - Effective supraventricular arrhythmia - Blocks Potassium channels - NO NEGATIVE INOTROPIC ACTIVITY - ORAL - Toxicity - Arrhythmias,TORSADE DE POINTES - Influenza Syndrome, Resp Tract Infect

Answer 28

-Class IV Verapamil- --Blocks slow cardia Ca, slows AV node, --Supraventricular Tachycardia (Rentry Type) --Minimal tox after ORAL --Constipation **avoid w/ beta blockers** Diltiazem - -Inhibits influx extracell Ca, reduces HR - -Increases exercise capacitance, improve perfus - -Treat paroxysmal supraventricular tach, atrial fib/flutter, Prinzmetal, follow ANGIOPLASTY -affect arteries more than veins

Answer 29

-DOC for PSVT and for WPW syndrome -Slows conduction AV node, interrupts Rentry -Atropine doesn’t affect but *Caffeine does -Enhace K conductance, inhib of cAMP Ca -SHORT ACTING: IV ONLY -Flushing, loss of breath, burn chest, hypotension C/I: -Sick sinus syndrome -AV Block

Answer 30

-Mechanism UNKOWN -Effective even with normal Mg levels USES: -Digitalis induces arrhythmia -TORSADE DE POINTES -Management of Seizures

Answer 31

- Careful b/c insufficient and excess are both PRO ARRHYTHMIC - Use to normalize K pool - Effects: Resting potential depolarization & membrane stabilization. * Hypokalemia=Increased risk of afterdepolarization

Answer 32

-Central acting sympathomimetic -↑medullary α2 stim -> ↓peripheral sympathetic -Presynaptic ↓ transmitter release -Postsynaptic ↓ inhibit neurons -Lowers BP by ↓ vasoconst & ↓ renal renin -Higher effect on HR & C. Outp > Methyldopa Adverse -CNS effects, Xerostomia, -fast withdrawal = Hypertensive crisis Drug Inter: TCA’s and Yohimbine

Answer 33

- Central acting sympathomimetic - Selective α2 - Sedative and analgesic - ADMIN: IV - Anesthesiology and Post-op

Answer 34

-Central acting sympathomimetic -Pro-drug -↑medullary α2 stim -> ↓peripheral sympathetic -Presynaptic ↓ transmitter release -Postsynaptic ↓ inhibit neurons -Lowers BP by ↓ vconst & ↓ renal renin -can be used during pregnancy Adverse: -CNS effects (sedation, dizziness), Xerostomia -**Hemolytic Anemia w/ + coombs test -↑ prolactin: gynecomastia Drug Interaction w/ TCA’s & Yohimbine

Answer 35

- Ganglionic Blocker - Tertiary amine: Goes to CNS - Promising in Tourettes syndrome NOT typically used TONS side effects

Answer 36

-Adrenergic Nerve Blocker -Binds to vesicles: inhibits NE into vesicle (VMAT) -Released NE metab by MAO enzyme Adverse -Sedation -Psychic depression -Stuffy nose -GI

Answer 37

-Adrenergic Nerve Blocker -Replaces NE in vesicles -Inhibits exocytosis Adverse -Interaction w/ TCAs cocaine, indirect sympath

Answer 38

``` α1 selective BLOCKER -↓ NE vasoconstriction in arteries & veins (equally) -Less tachycardia no block of alpha 2 Adverse effects -Postural Hypotension/ 1st dose effect -↑ renin= sodium water retention -Does not affect plasma lipids ``` *veins have denser alpha 1 concentrations*

Answer 39

Hydralazine Isoniazid Procainamide

Answer 40

-Reduce CO, ↓ Renin, ↓ SNS vasomotor tone -Preferred: angina, migraines, after M.I. -Least preferred: high physical activity, black, DM, ↑ cholesterol, peripheral vascular disease -Most effective in Young, and Caucasians (thiazide: elderly and blacks) -**Combine w/ other Rx to prevent tachycardia and ↑ renin from other drugs **Nebivolol ↑ endogenous NO production= ↑vasodilation ADVERSE: Heart, Lung, GI, CNS -↑ exercise tolerance, -predispose atherogenesis ↑ VLDL ↓ HDL -Mask symptoms of hypoglycemia ****C/I: Diabetes, sever CHF, heart block, asthma

Answer 41

-Alpha1 and beta blocker - ↓ BP w/o causing tachy -Lower BP in hypertensive emergency Adverse: -Orthostatic hypertension -Bronchospasm -HEPATOTOXIC Lipid Neutral

Answer 42

-IV for HTN emergencies -Specific D1 receptors agonist (no tachy from B1) -Postsynaptic relax arteriolar smooth muscle Toxicity -Reflex tachycardia -Headache -Flushing

Answer 43

-IV for HTN emergencies -Vasodilator and hyperglycemic (ARTERIES only) -Is a thiazide but not diuretic effect -Activates ATP/K+ channels (inhibit insulin release) -Used with INSULINOMA patients Adverse -Hyperglycemia -Sodium retention -Hyperuricemia (b/c its a Thiazide) -Excessive Hair growth

Answer 44

- ORAL for chronic HTN tx - dilates ARTERIES (via open K+ channel) - given in combo w/ diuretics and BB * *May induce ANGINA and MI in pts w/ CAD - inhibit insulin release

Answer 45

- Diazoxide (K channel → hyper polarize) - Minoxidil (K channel → hyper polarize) - CCB (Ca channel → no Ca induced exocytosis)

Answer 46

1) centrally acting alpha2 agonist (clonidine, methyldopa) 2) BB 3) ACEI, ARB 4) Hydralazine, Minoxidil 5) BB 6) Propanolol can mask symptoms of hypoglycemia, inhibit insulin release, and increase blood lipids

Answer 47

1) ANGINA OF EFFORT - Beta Blockers - CCB - Ranolazine (partial Beta-ox inhib) - do NOT use Hydrazine or Minoxidil w/ CAD 2) VARIANT ANGINA - DOC: Nifedipine - nitrates relieve spasm - CCB (Diltiazam) - do NOT use BB → ↓ HR → ↑ ejection time → ↑ LVEDV → ↑ o2 req.

Answer 48

Class: Hyperlipidemia MoA: Inhibits VLDL secretion, hepatic chol-genesis - ↓ VLDL & LDL - ↑ HDL USE: heterozygous familial hypercholesterolemia, combined hyperlipopreteinemia, when STATINS INEFFECTIVE ``` ADV/EFF: Vasodilation (from PG → aspirin prevents it) Nausea Elevate aminotransferases Impairs glucose tolerance Hepatotoxicity ```

Answer 49

Class: Hyperlipidemia: Fibric Acid Derivative MoA: Ligand TF for ppar-α ↑LPL activity - ↓ VLDL → ↓ TAG (may ↑ LDL) - ↓Cholesterol USE: Fam Dysbetalipoproteinemia & Hypertriglycemia Do NOT USE prim chylomicronemia & Fam Hypercholesterolemia ``` ADV/EFF Skin Rashes, Gi, Hypokalemia ↑ aminotransferases & ALP ↑ cholelithiasis/gallstones **Inhibits metabolism of statins, ↑LDL Potentiate anticoagulay ```

Answer 50

Class: Hyperlipidemia: Fibric Acid Derivative MoA: Ligand TF for ppar-α ↑LPL activity - ↓ VLDL → ↓ TAG (may ↑ LDL) - ↓Cholesterol USE: Fam Dysbetalipoproteinemia & Hypertriglycemia Do NOT USE prim chylomicronemia & Fam Hypercholesterolemia ``` ADV/EFF Skin Rashes, Gi, Hypokalemia ↑ aminotransferases & ALP ↑ cholelithiasis/gallstones **Inhibits metabolism of statins, ↑LDL Potentiate anticoagulay ```

Answer 51

Class: Hyperlipidemia: Bile Acid Resin MoA: Diver Chol from VLDL to synth of Bile Aci ↑ expression of LDL receptor, ↑ LDL uptake ↓ LDL *Take with Meals* USE: LDL elevated HETEROzygous hyperlipidemia DO NOT USE: homozygous hyperlipidemia (no LDL receptors) & hypertriglyceridemia ADV/EFF: Constipation & gallstone (less than fibric acid) Hypoprthrombinemia poor vit K absorption Impair absorption: Digitalis, thiazides, tetracycline, thyroxine, aspirin

Answer 52

Class: Hyperlipidemia: Bile Acid Resin MoA: Diver Chol from VLDL to synth of Bile Aci ↑ expression of LDL receptor, ↑ LDL uptake ↓ LDL *Take with Meals* USE: LDL elevated HETEROzygous hyperlipidemia DO NOT USE: homozygous hyperlipidemia (no LDL receptors) & hypertriglyceridemia ADV/EFF: Constipation & gallstone (less than fibric acid) Hypoprthrombinemia poor vit K absorption Impair absorption: Digitalis, thiazides, tetracycline, thyroxine, aspirin

Answer 53

Class: Hyperlipidemia: Bile Acid Resin MoA: Diver Chol from VLDL to synth of Bile Aci ↑ expression of LDL receptor, ↑ LDL uptake ↓ LDL *Take with Meals* USE: LDL elevated HETEROzygous hyperlipidemia DO NOT USE: homozygous hyperlipidemia (no LDL receptors) & hypertriglyceridemia ADV/EFF: Constipation & gallstone (less than fibric acid) Hypoprthrombinemia poor vit K absorption Impair absorption: Digitalis, thiazides, tetracycline, thyroxine, aspirin

Answer 54

Class: Hyperlipidemia, Comp inhibitor HMG CoA reduc MoA: Analogs metabolites inhibit HMG CoA, ↓ LDL, ↑ LDL receptors, ↓TAGs ↑ HDL USE: When LDL is elevated *GIVE IN EVENING* BENEFITS: ↓CRP, ↑NO, ↑plaque stability, ↓ LDL oxid ↓ platelet aggregation ``` ADV/EFF: Liver damage &↑ aminotransferase ↑ creatine kinase activity Rhabdomyolysis Myoglobinuria plugs kidney C/I in PREGNANCY Grapefut juice ↑ bioavailability, ```

Answer 55

Inhibits pancreatic lipase → ↓ TAG breakdown | used for weight loss

Answer 56

Cholesytamine, colestipol, ezetimibe Gemfibrozil Statins and niacin, ezetimibe Niacin

Answer 57

- Anticoagulant, prophylaxis against thrombosis - Binds ATIII → mainly inactivates Xa & thrombin (XII, XI, IX ) - IV ONLY (onset immediate) - can cause HIT - CI: renal or hypatic dysfunction - inactivated by protamine sulfate - monitored by PTT

Answer 58

Class: Hyperlipidemia: Inhibits cholesterol absorption MoA: Blocks absorption of cholesterol & phytosterols USE: to lower LDL & Cholesterol Synergistic with STATIN to lower Cholesterol Enterohepatic circulated Metabolized by glucoronidation No significant adverse effects

Answer 59

- Anticoagulant (LMW heparin) - Binds ATIII → mainly inactivates X - Sub-Q injection - ↓ chance of HIT - not completely reversed by protamine sulfate - monitored by PTT - used during PREGNANCY instead of warfarin

Answer 60

- Synthetic pentasaccharie - Anticoagulant (LMW heparin) - Binds ATIII → mainly inactivates X - Sub-Q injection - ↓ chance of HIT - not effected by protamine sulfate - monitored by PTT

Answer 61

DIRECT THROMBIN INHIBITOR - doenst require ATIII - given as alternative in HIT - IV ONLY - Lepirudin → kidney - Bivalrudin → liver - monitored by PTT - -Argatroban → liver

Answer 62

ORAL direct inhibitor of Thrombin

Answer 63

ORAL inhibitor of Xa | Tx: DVT, PE, and FUTURE CLOTS

Answer 64

- ORALLY, chronically - ↓ reduction of vit K → - → ↓ synthesis of VII, IX, X, II, protein C** - rapid ↓ protein C → transient hypercoag - -give w/ heparin @ initiation - delayed onset - delayed disappearance of effect - PREVENT emboli - reverse w/ - -VIT. K → slow - -FROZEN PLASMA → immediate - cant use during pregnancy (use Enoxaprin)

Answer 65

Drugs that affect: - vitamin K - clotting factors (estrogen pregnancy) - platelet aggregation/function - Inhibit microsomal liver enzymes - Induce microsomal liver enzymes

Answer 66

ANTIFIBRINOLYTIC - Inhibits plasminogen activation - Treatment of bleeding disorder - reversal of fibrinolytic therapy - oral or IV - ADVERSE: can cause intravascular thrombosis

Answer 67

FIBRINOLYTIC - IV or intra-arterially - convert plasminogen → plasmin - lysis of already formed clots → re-establish perfusion - -Higher affinity for FIBRIN-BOUND plasminogen → clot selective -Tenecteplase more fibrin specific and resistant to PAI-1

Answer 68

ANTIPLATELET Inhibitor of thrombogenesis -irreversible inhibition of COX → ↓ TXA2 -USED secondary prevention of cardiovascular events in patients with ESTABLISHED CV disease

Answer 69

Inhibitor of ADP-induced platelet aggregation -Irreversibly block ADP receptor on platelets -Given ORALLY DOC: prevent thrombosis in pt getting CORONARY STENT

Answer 70

Inhibitor of GPIIb/IIIa receptor - ↓ platelet aggregation by inhibiting GPIIb/IIIa receptor from binding FIBRINOGEN - given IV** →↑↓