Pharm Cardio List Flashcards

1
Q

Atropine

Mechanism

A

Non-selective muscarinic blocker. Decrease HR, Contraction, and AV Node

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2
Q

Atropine Contraindicated

A

With use of Viagra (NO produces GMP and Viagra blocks its breakdown

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3
Q

Epinephrine
On Target Effects
Selectivity

A

Vasoconstrictor locally, increases HR, CO through B

ALL

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4
Q

Norepinephrine
On Target Effects
Selectivity

A

Increase BP through A

a1, a2, b1

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5
Q

Dobutamine
On Target Effects
Selectivity

A

Increase HR and CO

B1

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6
Q

Phenylephrine
On Target Effects
Selectivity

A

Increase BP through A

a1

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7
Q

Ephedrine

A

Mainly increase BP through A, but HR/ CO thorugh B

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8
Q

Centrally-acting alpha-2a agonists

A
Clonidine
Methyldopa (pro)
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9
Q

Centrally-acting alpha-2a agonists

Mechanism

A

Agonist of postsynaptic A2a in Rostral Ventrolateral Medulla

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10
Q

Centrally-acting alpha-2a agonists

On Target Effects

A

Decreases sympathetic outflow of CO and/or Vascular Resistance by stimulating CNS receptors Major Compensatory responses is Na Retention Decrease Insulin Secretion

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11
Q

Methyldopa (pro)

Unusual Facts

A

Use in pregnancy
Positive Coombe’s Test
Treat HTN in preclampsia
Sedation

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12
Q

Reserpine

Mechanism

A

Prevents Dopamine Transfer to Vesicle through VMAT by destroying adrenergic synaptic receptor

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13
Q

Reserpine

On Target Effects

A

Depletes NE; reduces TPR, CO, and BP. Major Compensatory response is Na Retention

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14
Q

Reserpine

Side Effects

A

Depression, sedation, dry mouth,

night terrors

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15
Q

Alpha-Blockers

Mechanism

A

Reduce Vascular Resistance and Venous Return. Block Glucose Production. Not as good for essesntial HTN

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16
Q

Phenoxybenzamine

Mechanism

A

Binds to A receptor covalently; irreversible and non-competitive

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17
Q

Phenoxybenzamine
Indication
Selectivity
Side Effect

A

Pheocromocytoma
A1, A2
Raynaud’s phenomenon

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18
Q

Prazosin
Selectivity
Side Effect

A
A1
Orthostatic HTN (Prazosin), Syncope
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19
Q

Alpha-Blockers

Name

A

Phenoxybenzamine
Phentolamine
Prazosin

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20
Q

Phentolamine
Prazosin
Mechanism

A

Block receptors on arterioles and venules. Competitive antagonists.
(Decrease Phase 4)

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21
Q

Beta-Blockers

Mechanism

A

Block Beta Receptor, decreases sympathetic outflow,

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22
Q

Beta-Blockers

On Target Effects

A

Reduce CO, then start to reduce Vascular Resistance as well. Reduce Renin release from the kidney. Block Glucose production. Decrease Insulin secretion. Activate HSL; lowers HDL and increases TG’s Angina

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23
Q

Propanolol (MS)

Also blocks?

A

Bind and block fast Na channels responsible for rapid depolarzation of fast response cardiac AP’s

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24
Q

Labetalol

Also blocks?

A

Also blocks A1

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25
Nebivolol Special Indication
Antioxidant; NO production | Metabolic Syndrome HTN
26
Betaxolol Special Selectivity
Ca entry blockade | B1
27
Beta-Blockers | Contraindicated
Asthmatics, COPDl, and HF patients and Diabetics (NS ones)
28
Direct Vasodilators (Selective arteriolar smooth muscle relaxer)
Nitroprusside (prodrug) | Minoxidil (Rogaine)
29
Nitroprusside (prodrug) | Mechanism
Release of NO from drug or endothelium
30
Nitroprusside (prodrug) On Target Effects Indication Side Effect
Forms NO; Causes relaxation. Dilates both arteries and veins Drug of choice for malignant HTN & HTN emergency Hypotension, palpitations, tachycardia, cyanide
31
Minoxidil (Rogaine) | Mechanism
Open K channels, causing hyperpolarization of vascular smooth muscle
32
Minoxidil (Rogaine) On Target Effects Side Effect
Relaxes arterial smooth muscles. Hirsutism Powerful activatator of Renin (compensatory)
33
L-Type Calcium Channel Blockers | Name
Phenylalkylamine (Verapamil) | Benzothiazepine (Diltiazem)
34
L-Type Calcium Channel Blockers | Mechanism
Block L-type Calcium channels in Cardiac and Smooth Muscle
35
Phenylalkylamine (Verapamil) On Target Effects Selectivity
Rapid cycle; Require open channel; Decrease HR | Myocardium
36
Benzothiazepine (Diltiazem) | On Target Effects
Slow cycle; Require certain Voltage; Decrease HR
37
L-Type Calcium Channel Blockers Contraindicated Side Effect
Beta Blockers: Synergistic with SA Node Digoxin | Constipation, edema, headache, bradycardia, GI problems, dizziness, AV block, tachycardia
38
Dihydropyridines | Name
Amlodipine Nifedipine Nicardipine Nimodipine
39
Amlodipine Mechanism On Target Effects
Block L-type Calcium channels in Cardiac and Smooth Muscle. Decreases BP by relaxing arteriolar smooth muscle. Very mild changes Angina
40
Dihydropyridines | Side Effects
Edema, Reflex sympathetic response, Hypotension, Constipation Gingival Hyperplasia
41
ACE Inhibitors | Name
Captopril Lisinopril Enalapril (prodrug) Ramipril
42
ACE Inhibitors Mechanism On Target Effects
Blocks formation of Angiotensin II, decreasing Aldosterone | Lower TPR and BP, dilates vessels
43
ACE Inhibitors Indication Contraindicated Side Effects
Diabetes, Heart Failure, CKD, Stroke Renal Disease Pregnancy Cough, hyperkalemia, Hypotension,
44
AR Blockers
Losartan (prodrug) | Candesartan
45
AR Blockers Mechanism On Target Effects
Block Angiotensin II at AT receptor, decreasing aldosterone. | Vasodilation, high Na secretion, low TPR, CO, and BP.
46
AR Blockers | Contraindicated
Renal Disease Pregnancy
47
Renin Inhibitors
Aliskerin
48
Aliskerin Mechanism On Target Effects Side Effects
Inhibits Renin Decrease Ang I and therefore Ang II and Aldosterone Hyperkalemia
49
Nitrates | Name
Nitroglycerin
50
``` Nitroglycerin Mechanism On Target Effects Indication Contraindicated Side Effects ```
``` NO activates cGMP Venodilates (lowers Preload and afterload), coronary vasodilation Angina Give with Beta Blockers Sildenafil (Viagra) (type V PDE) Hypotension, Headache, Racs ```
51
ANTIARRHYTHMIC DRUGS | Classes
``` Class I (Na Blockers) Class II (Beta Adrenoceptor Blockers) Class III (K Blockers) Class IV (Ca Blockers) Digitalis Glycosides (Vagotonic) Adenosine Receptor Agonist ```
52
``` Class I (Na Blockers) Drugs ```
Procaineamide Lidocaine Flecanide
53
``` Procaineamide Mechanism On Target Effects Notes Indication Side Effects ```
Suppresses ectopic pacemaker activity in partially depolarized cells slows conduction even at slow rates. Prolongs AP (block K as well); slows conduction even at slow rates. > 1 Class I don't effect SA Node A or V Fib Torsades (3) Drug induced LUPUS Torsades de Pointes
54
``` Lidocaine On Target Effects Indication Contraindicated Side Effects ```
``` Rapid dissociation; will fall off by normal HR. Slows conduction of fast HR Least likely to have negative effects Ventricular Tachycardia Torsades (2) NOT atrial or prophylactic ```
55
Flecanide Mechanism On Target Effects Contraindicated
Suppress automaticity, increases RefractoryDissociation is very slow Organic or structural heart disease
56
``` Class II (Beta Adrenoceptor Blockers) MP ```
Propranolol | Metoprolol
57
Propranolol | Selectivity
B1, B2
58
Metoprolol | Selectivity
B1
59
Metoprolol | On Target Effects
Slow SA Node (agent of choice)
60
Class III (K Blockers)
Class III (K Blockers) Amiodarone Sotolol Ibutilide
61
``` Class III (K Blockers) Mechanism On Target Effects ```
Increase refractory period by prolonging repolarization | Prolongs phase 3, prolonging the ERP. Shows prolongation of QT Interval
62
Amiodarone Indication Side Effects
A/V arrhythmias Torsades (1) | Pulmonary Fibrosis, Hyperthyroidism, Hepatitis
63
Sotolol Notes Contraindicated Side Effects
Beta blocking effect Prolong QT Interval Torsades
64
Ibutilide Indication Side Effects
Rapid V Fib | IV only. Torsades
65
Digitalis Glycosides (Vagotonic)
Digoxin
66
Digoxin Mechanism On Target Effects
Increase vagal nerve acivity, inhibit Na/K pump (Ca overload) Slows SA Node; Antiarrythmic and arrhthmogenic
67
Digoxin Notes Contraindicated Side Effects
Causes Ventricular Bigeminy. Low Therapeutic Window Wolff Parkinson White Halo Lights
68
Adenosine Receptor Agonist
Adenosine
69
Adenosine Mechanism On Target Effects Notes
Used to terminate acute PSVT by blocking AV node Rapid half life; given IV Fixes this or allows attrial flutter diagnosis
70
HMG-CoA Reductase Inhibitors (Statins)
Lovastatin Simvastatin Pravastatin Atorvastatin
71
HMG-CoA Reductase Inhibitors (Statins) | Mechanism
Analogs of HMB-CoA that competitively inhibit the enzyme. Liver compensates by increasing number of LDL receptors.
72
HMG-CoA Reductase Inhibitors (Statins) | On Target Effects
Direct anti-atherosclerotic effects.
73
HMG-CoA Reductase Inhibitors (Statins) Notes Indication
Lowers TG's | FHCH
74
HMG-CoA Reductase Inhibitors (Statins) Contraindicated Selectivity Side Effects
Gemfibrozil CYP3A4; Cleared by liver on 1st pass CNS, Teratogenic Potential, Rhabdomyolysis , GI
75
Bile Acid Sequestrants (Resins) | Drugs
Colestipol Cholestyramine Colesevelam
76
``` Bile Acid Sequestrants (Resins) Mechanism On Target Effects Contraindicated Side Effects ```
Bind bile acids in intestine and prevent reabsorption Effects LDL only; Not TG or HDL Elderly patients and hypertriglyceridema Prevent absorption of other drugs
77
Nicotinic Acid- Vitamin B3 | Drug
Niacine
78
Niacine Mechanism On Target Effects Notes
Inhibits mobilization of FFA from adipocytes Increases HDL by 35% and ApoA1 TG. Effects all Flushing (aspirin helps) Myocitis
79
Fibric Acid Derivatives | Drugs
Fenofibrate | Gemifribozil
80
Fibric Acid Derivatives Mechanism On Target Effects
Ligand for the ligand-activated PPAR receptor | Results in increased synthesis by adipose tissue of lipoprotein lipase
81
Fenofibrate Indication Contraindicated Side Effects
Metabolized by Liver Gall stones RF Increased creatinin, pregnancy
82
Gemifribozil Notes Contraindicated
Reduce TG | Gall stones Statins
83
N-3 Fatty Acids (Fish Oil) Mechanism On Target Effects
Reducing SREBP | Reduce TG up to 35%
84
Penbutolol acts on?
The β1 adrenergic receptors in both the heart and the kidney.
85
Penbutolol to act as a partial?
Partial agonist proves useful in the prevention of bradycardia.
86
Penbutolol has also been found to be one of very few compounds that?
Are 5-HT1A antagonists. (Serotonin)
87
Bisoprolol Selectivity Side Effects
B1 Bisoprolol has both lipid and water soluble properties making it a prime candidate over other β-blockers and even over other β1-blockers, being water soluble it will have decreased incidence of CNS side effects
88
``` Ezetimibe (prodrug) Mechanism Indication Contraindicated Selectivity ```
Inhibits transporter mediates GI uptake cholesterol itself (50%) Lowers plasma cholesterol Hepatic toxicity if given with a Statin Bile sequestrants, Biliary excretion;
89
``` Ephedrine On Target Effects Notes Selectivity Side Effects ```
Mainly increase BP through Alpha, but HR/ CO through Beta Sustaining BP Mixed acting (D+ID) Baseball Player; fatal arrhythmias
90
Milrinone On Target Effects Mechanism
Milrinone is a phosphodiesterase 3 inhibitor that works to increase the heart's contractility. Phosphodiesterases are enzymes responsible for the breakdown of cAMP
91
Nesiritide Mechanism On Target Effects
The recombinant form of the 32 amino acid human B-type natriuretic peptide. Counterregulation RAAS
92
Pindolol Mechanism Selectivity Contraindicated
It possesses ISA (Intrinsic Sympathomimetic Activity). This means that pindolol, particularly in high doses, exerts effects like epinephrine or isoprenaline (increased pulse rate, increased blood pressure, bronchodilation). Nonselective beta blocker with partial beta-adrenergic receptor agonist activity. Contraindication for hyperthyroidism
93
Propafenone Mechanism Contraindicated
Slows the influx of sodium ions into the cardiac muscle cells, causing a decrease in excitability of the cells. Hepatic dysfunction, asthma, CHF, or bradycardia.
94
Ranolazine Mechanism Selectivity Contraindicated
Believed to have its effects via altering the transcellular late sodium current. Inhibits CYP2D6. Causes toxicity with drugs metabolized by CYP2D6 Contraindicated other medications that increase the QT interval
95
``` Furosemide Mechanism On Target Effects Side Effects Contraindicated ```
Inhibit Na-K-2Cl symporter in TALOH Copious diuresis with NaCl loss, loss of K+, H+, Ca2+, Mg2+, increase PG's, venous capacitance; Very protein bound. Ototoxicity Interactions with Li+, indomethacin, probenecid, warfarin
96
Spironolactone Mechanism Side Effects
Binds to aldosterone receptor in cytoplasm and prevent its translocation to the nucleus; Reduce Enac channels involved in Na reabsorption. Hyperkalemia (combine with thiazide); Gynecomastia, hirsutism, uterine bleeding.
97
Hydrochlorothiazide
Inhibit NaCl reabsorption in the Na+, K+ aldosterone independent segment of D.T. Low Na, K, Cl, Mg; Hyperuricemia, high Ca, Hyper secretion of renin and aldosterone.