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Block 3 - Cardio > Pharm Cardio Review > Flashcards

Pharm Cardio Review Flashcards

1
Q

How do Antihypertensive Agents work?

A

lower BP
–> reduce CO [BB]
–> reduce systemic vascular resistance [Alpha Blockers]
–> reduce blood volume [diuretics]

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2
Q

Carbonic Anhydrase Inhibitor Med & its MOA

A

Acetazolamide

  • Reduce reabsorption of HCO3- in PCT. (a weak diuretics)
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3
Q

Thiazide Med & its MOA

A

Hydrochlorothiazide

  • Works in kidneys – mildly blocks reabsorption of Na+ & Cl- in DCT
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4
Q

Loop Med & its MOA

A

Furosemide

  • Works in kidneys – significantly blocks reabsorption of Na+ in LOH (PCT & DCT)
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5
Q

ACEI Meds & their MOA

A

Lisinopril & Captopril

  • Blocks conversion of Angiotensin I to Angiotensin II
  • Elevate Bradykinin
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6
Q

K+ sparing Meds & their MOA

A

Triamterene
Spironolactone

  • Works in kidneys – by manipulating & Na+/K+ exchange in DCT or by blocking aldosterone
    Usually used in combination w/ Loop & Thiazide diuretics
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7
Q

Selective BB1 meds & their MOA

A

Atenolol & Metoprolol

  • Decr CO
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8
Q

Osmotic diuretic Med & its MOA

A

Mannitol

Works in kidneys – decr H20 reabsorp

Used mostly for:
- Reduction of intracranial pressure
- Incr urinary production for ingestion of toxins
- Promotion in urine production in acute kidney damage

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9
Q

Which Renin Inhibitor med did we not cover?

A

Aliskiren

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10
Q

Dihydropyridines (CCB) meds & their MOA

A

Amlodipine & Nicardipine

  • Inhibit Ca++ influx into vascular SM & myocardium
  • Mainly affect arterial vascular SM & lower BP by causing vasodilation.
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11
Q

Angiotensin receptor blocker (ARB) Med & its MOA

A

Losartan

  • Blocks binding of Angiotensin II to Vascular (AT1) Receptors
  • Reduce renal blood flow & reduce risk of renal injury
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12
Q

Alpha block meds & their MOA

A

Prazosin, Terazosin, Doxazosin, Tamsulosin

  • decr in systemic vascular resistance
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13
Q

Non-selective BBs & their MOA

A

Carvedilol, Labetalol, Propranolol

  • Decr CO, systemic vascular resistance, renin, angiotensin II, aldosterone
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14
Q

Centrally acting adrenergic agents & their MOA

A

Clonidine & Methyldopa

  • Block sympathetic activity in the brain
  • Decr systematic vascular resistance & cardiac input
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15
Q

Non-Dihydropyridines (CCB) meds & their MOA

A

Diltiazem & Verapamil

  • Inhibit Ca++ influx into vascular SM & myocardium
  • Mainly affect arterial vascular SM & lower BP by causing vasodilation.
  • Decr L-type Ca++ channels in heart muscle leading to:
  • Decr Heart contractility, HR, & conduction
  • Significant antiarrhythmic properties
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16
Q

Chronotropic agent affects…

A

HR

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17
Q

Inotropic agent affects…

A

Contractility

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18
Q

Dromotropic agent affects…

A

speed of conduction (mainly in the AV node)

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19
Q

Which diuretics are the most potent?

A

Loop

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20
Q

Loop diuretics act on the…

A

ascending loop of Henle, PCT & DCT

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21
Q

Loop diuretics can cause…

A
  • hypokalemia, hypochloridemia & metabolic alkalosis.
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22
Q

What are the oral times for loop diuretics?

A

torsemide (1hr) to 2 hrs (furosemide)

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23
Q

Loop diuretics IV timing?

A

5-20 minutes

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24
Q

Name a weak diuretic that works in DVT and antagonizes aldosterone receptor

A

K+ sparing Diuretics

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25
Q

Furosemide [Lasix]

A
  • USES: Edema (Primarily); HTN; Pulm Edema, acute
    *hypercalcemia
  • MOA: inhibits LOH, PCT & DCT Na+ & Cl- resorption
  • RXNS: hypokalemia
  • CAUTIONS: renal impairment; severe renal dz
  • BBW: fluid & electrolyte depletion
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26
Q

Spironolactone [Aldactone]

A
  • USES: CHF
    Cirrhosis + edema
    Nephrotic syndrome
    Essential HTN
    Severe HF
  • RXNS: gynecomastia; hyperkalemia
  • CAUTIONS: Avoid in pregnancy
  • Contraindicated w/ Addison’s dz
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27
Q

Hydrochlorothiazide [HCTZ]

A
  • USES: HTN & peripheral edema

** 1st line for HTN in AA pts then CCB

MOA: inhibits DCT Na+ & Cl- resorption

  • retains calcium: can be useful for pts w/ osteoporosis & HTN
  • CAUTION: avoid use if dose >50 mg/day
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28
Q

Triamterene (Dyrenium)

A

USES: peripheral edema & HTN

MOA: inhibits Na reabsorp at the DCT, decr H20 reabsorp & incr K+ retention

RXNS: anaphylaxis, ventricular arrhythmias, hyperkalemia

CAUTIONS: NO pregnancy
BBW: hyperkalemia; monitor BUN/Cr, electrolytes (K)

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29
Q

ACE inhibitors affect the ___ and block the conversion of ___.

A
  • renin-angiotensin-aldosterone system
  • angiotensin I to angiotensin II
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30
Q

Common symptoms of those who take ACEI?

A

dry, persistent cough

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31
Q

Why are ACEI the first line tx for pts Type 1 DM pts w/ HTN?

A

nephroprotective

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32
Q

ACEI activate what & inactivate what?

A

activate angiotensin I
inactivate bradykinin

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33
Q

What is the 1st choice med for HTN in those w/ kidney dz?

A

ACE or ARB

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34
Q

What causes the dry cough and angioedema of ACE inhibitors?

A

bradykinin

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35
Q

Lisinopril (Prinivil)

A

USES: HTN; CHF; MI

Generally 1st line tx for nonblack patients <60yo or w/ chronic kidney dz

MOA: Inhibits angiotensin converting enzyme, interfering w/ conversion of angiotensin I to angiotensin II

RXNS: hypoTN; dizziness; dry cough; angioedema

BBW: NO pregnancy; fetal toxicity

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36
Q

Captopril (Capoten)

A

USES: HTN; CHF; MI

MOA: Inhibits angiotensin converting enzyme, interfering w/ conversion of angiotensin I to angiotensin II

RXNS: hypoTN; dizziness; dry cough; angioedema

BBW: NO pregnancy; fetal toxicity

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37
Q

Losartan (Cozaar)

A
  • USES: HTN
    nephropathy, DM
    stroke prevention
  • MOA: selectively antagonizes angiotensin II AT1 receptors

RXNS: less cough than ACEI; angioedema; anaphylaxis; hypotension

BBW: NO pregnancy; fetal toxicity

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38
Q

MOA for Prazosin & Terazosin

A

antagonizes peripheral alpha-1 adrenergic receptors (vasodilation –> lowering BP)

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39
Q

Cautions for Alpha blockers

A
  • NO PREGNANCY
  • profound HypoTN if used w/ Sildenafil (Viagra)
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40
Q

Prazosin (Minipress)

A
  • USES: HTN; *BHP
    *Nightmares, PTSD
  • RXNS: hypotension, 1st dose;
    dizziness
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41
Q

Terazosin (Hytrin)

A

USES: HTN; BHP

RXNS: hypotension, orthostatic; syncope

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42
Q

Tamsulosin (Flomax)

A

USES: BHP; *nephrolithiasis

DOES NOT TX HTN

RXNS: abnormal ejaculation; dizziness; hypoTN, orthostatic

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43
Q

BB affects…

A
  • increase CO
  • decrease HR
  • reduce contractility
44
Q

BB: Relative contraindications

A
  • Asthma & COPD
  • Cocaine Uses
  • DM
  • Hyperthyroidism
45
Q

BB: Absolute contraindications

A

Bradycardia or Heart block

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78
Q

Amiodarone Toxicities

A
  • Bradycardia/Blue man syndrome
  • Interstitial lung disease
  • Thyroid (hyperthyroid OR hypothyroid)
  • Corneal/Cutaneous
  • Hepatic/Hypotension
79
Q

Epinephrine [adrenaline]

A
  • USES: asystole/ PEA; VF/pulseless VT; bradycardia; anaphylaxis;
    asthma exacerbation; severe
    septic shock
  • MOA: stimulates alpha & beta adrenergic receptors (sympathomimetic)

RXNS: resp difficulty; pulm edema; arrhythmia; HTN

80
Q

Digoxin [Lanoxin]

A
  • USES: CHF; AFib
    *PSVT Conversion
  • MOA: inhibits Na+/K+ ATPase

RXNS: AV block, bradycardia, ventricular arrhythmias

81
Q

Digoxin Toxicity

A
  • N/V/abdom pain
  • weakness/dizziness
  • arrhythmia symptoms
  • AMS
  • Vision changes (yellow vision)
  • the pathognomonic rhythms (atrial tach w/ 2:1 block & bidirectional ventricular tachycardia)
82
Q

Vasopressin [Pitressin]

A

USES:
MOA:
RXNS:
CAUTIONS:

83
Q

Vasopressin (Pitressin)

A

USES:
MOA:
RXNS:
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84
Q

Dobutamine

A

USES:
MOA:
RXNS:
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85
Q

Norepinephrine (Levophed)

A

USES:
MOA:
RXNS:
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86
Q

Sodium Bicarbonate

A

USES: metabolic acidosis, acute & chronic
urinary alkalization; dyspepsia;
salicylate OD
*tricyclic antidepressant OD

  • MOA: incr serum bicarb; incr pH; neutralize stomach acid
  • RXNS: - RXNS: seizures; metabolic alk; CHF exacerbation, tetany
87
Q

Cilostazol [Pletal]

A
  • USES: intermittent claudication
  • MOA: inhibits phosphodiesterase type 3, reducing platelet aggregation; suppresses cAMP degradation, producing vasodilation
  • RXNS: MI, angina, tachys, abnormal labs
  • BBW: don’t use in CHF pts
88
Q

Nitroglycerin [Nitro-Bid] (Topical)

A
  • USES: angina prophy
  • MOA: stimulates cGMP production, resulting in vascular SM relaxation
  • RXNS: HA, hypoTN, severe, syncope
  • CAUTIONS: DON’T take erectile dysfunction meds (sudden decr in BP)
89
Q

Nitroglycerin [Nitrostat] (sublingual)

A
  • USES: angina, acute; angina prophy
    **Sublingual is drug of choice for stable angina
  • MOA: stimulates cGMP production, resulting in vascular smooth muscle relaxation
  • RXNS: orthostatic hypoTN; severe hypoTN; syncope
90
Q

Key Facts about Nitrates

A
  • take 1 dose
  • if symp don’t improve repeat every 5 mins up to 3 doses
  • If they don’t improve call 911
  • stable angina–> sublingual
  • Prinzmetal angina–> nitroglycerin for acute pain, but CCB is added for long-term tx
91
Q

DHA EPA acid [Lovaza]

A
  • USES: hypertriglyceridemia, severe
  • MOA: reduces liver triglyceride synthesis
  • RXNS: GI symptoms; anaphylaxis
92
Q

Triglyceride-lowering therapies include:

A
  • fibrates
  • niacin

mipo— or lomoit—

93
Q

Cholesterol-lowering therapies include:

A
  • statins
  • bile acid resins
94
Q

Initial Hyperlipidemia Tx

A

adults 40-75 yo who have 1 or more CV RFs & an estimated 10-yr CVD risk of 10% or greater

prescribe statin

95
Q

Atorvastatin [Lipitor]

A

USES: hypercholesterolemia;
CV event prevention; atherosclerotic CV dz
*Note: Can be a good 1st line agent

  • MOA: inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, inhibiting cholesterol synthesis
  • RXNS: arthralgia; MSK pain; myalgia; Rhabdo

CAUTIONS: NO PREGNANCY; can breakdown muscle tissue

96
Q

Pravastatin [Pravachol]

A
  • USES: hypercholesterolemia
    CV prevention; atherosclerotic CV dz
  • MOA: inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, inhibiting cholesterol synthesis
  • RXNS: Fewest SEs & safest in liver dz

CAUTIONS: NO PREGNANCY; can breakdown muscle tissue

97
Q

Rosuvastatin [Crestor]

A
  • USES: hypercholesterolemia;
    CV event prevention;
    atherosclerotic CV dz

** Lowers LDL the MOST***

  • MOA: inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, inhibiting cholesterol synthesis
  • RXNS: Rhabdo; tendon rupture
  • CAUTIONS: NO PREGNANCY; can breakdown muscle tissue
98
Q

Fenofibrate [Tricor]

A
  • USES: hypercholesterolemia; mixed dyslipidemia
  • MOA: inhibits triglyceride synthesis & stimulates breakdown of triglyceride-rich lipoPROs
  • RXNS: muscle pains; rhabdomyolysis; hepatitis, cirrhosis, cholelithiasis, pancreatitis
  • CAUTIONS: can breakdown muscle tissue
99
Q

Gemfibrozil [Lopid]

A
  • USES: hypercholesterolemia; mixed dyslipidemia
  • MOA: inhibits peripheral lipolysis; decr liver FFA extraction; incr VLDL clearance (carrier apolipoPRO B)
  • RXNS: cholestatic jaundice
  • CAUTIONS: breakdown muscle tissue
100
Q

Ezetimibe [Zetia]

A
  • USES: hypercholesterolemia; mixed dyslipidemia; homozygous familial hypercholesterolemia
  • MOA: inhibits cholesterol absorp at small intestine brush border, decr liver cholesterol stores & incr blood cholesterol clearance
  • RXNS: Myalgia; Rhabdomyolysis; pancreatitis
  • CAUTIONS: can break down muscle tissue
101
Q

Key Facts about Bile Acid Sequestrants

A
  • triglycerides tend to incr
  • can be used w/ statin
102
Q

Cholestyramine [Questran]

A
  • USES: Hypercholesterolemia
  • MOA: binds to bile acids; incr bile acid fecal elimination & prevent reabsorp
  • RXNS: constipation; fat-soluble vitamin deficiency; metabolic acidosis; osteoporosis (long-term)

a powder mixed in H20
used for IBS symp in elderly (solidifies stool)

103
Q

Colesevelam [Welchol]

A
  • USES: hypercholesterolemia; Type II DM
  • MOA: binds to bile acids; incr fecal elimination & prevent reabsorp
  • RXNS: constipation

RXNS: constipation; obstructions, fecal impaction

104
Q

Key Facts about Nicotinic Acid

A
  • 1st lipid lowering agent w/ reduction in total mortality
  • ~50% of pts can’t tolerate max dose (flushing)
  • can cause gout flair
105
Q

Niacin [Niaspan]

A
  • USES: hypocholesteremia/ hypertriglyceridemia; CV event prevention; CAD
  • MOA: decr hepatic LDL & VLDL production; decr hepatic triglyceride production, incr lipoPRO lipase activity
  • RXNS: flushing; hepatotoxicity
  • CAUTION: don’t take if severe liver dz; stomach ulcer, active bleeding
  • Can give 325 mg aspirin 30 mins prior to reduce flushing

Block 3 - Cardio (13 decks)

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