Pharm-CV Flashcards
What should be used to treat primary hypertension?
Thiazide diuretics, ACE inhibitors, ARBs, dihydropyridine Ca channel blockers
What should be used to treat hypertension with HF? Which should be used cautiously and why? When should it not be used?
Diuretics, ACEIs/ARBs, Beta blockers, aldosterone antagonists
Beta blockers must be used cautiously in decompensated HF and are contraindicated in cardiogenic shock
What should be used to treat hypertnesion with DM? Which is particularly useful?
ACEIs/ARBs (protective against diabetic nephropathy), Ca channel blockers, thiazide diuretics, beta blockers
What should be used to treat hypertension in pregnancy?
Hydralazine, labetalol, methyldopa, and nifedipine
What is the mechanism of amlodipine, clevidipine, nicardipine, nifedipine? Class of drug? Where do they act? What are they used to treat? Toxicity?
Dihydropridine Calcium channel blocker
Block voltage gated L type calcium channels of smooth muscle (decr. muscle contractility)
On vascular smooth muscle
Hypertension, angina (including prinzmetal), raynaud phenomenon
cardiac depression, peripheral edema, flushing, dizziness, constipation, gingival hyperplasia
-pine=piping (vessels)
hydro=fluid=vessels
What class of drug is nimodipine? How does it differ from the others in its class?
Dihydropridine Calcium channel blocker
Not used to treat what the others are used to treat
Treats subarachnoid hemorrhage (prevents cerebral vasospasm)
What is the mechanism of diltiazem, verapamil? Class of drug? Where do they act? What are they used to treat? Toxicity?
Non Dihydropridine Calcium channel blocker
Blocks voltage gated l type calcium channels of cardiac muscle leading to decr. muscle contractility
Hypertension, angina, A-fib/flutter
AV block, hyperprolactinemia (verapamil), cardiac depression, peripheral edema, flushing, dizziness, constipation, gingival hyperplasia
What class of drug is clevidipine? How does it differ from the others in its class?
Dihydropridine Calcium channel blocker
Treats hypertensive urgency or emergency in addition to its other functions
What is the mechanism of hydralazine? Clinical applications? What is it often administered with? Why? Toxicity? contraindications?
Incr. cGMP leads to incr. smooth muscle relaxation
Vasodilates arterioles > veins
Afterload reduction
Severe hypertension
HF (with organic nitrate)
Safe to use during pregnancy
Administered with beta blocker to reduce reflex tachy
Compensatory tachy (contraindicated in angina/CAD), fluid retention, headache, angina, lupus like syndrome
What drugs should be used in a hypertensive emergency?
Clevidipine, fenoldopam, labetalol, nicardipine, nitroprusside
What is the mechanism of nitroprusside? Clinical applications? Duration of action? Toxicity?
Incr. cGMP via NO release
Short acting
Hypertensive emergency
Cyanide toxicity
What class of drug is fenoldopam? Mechanism of action? Results? Clinical applications?
Dopamine D1 receptor agonist
Coronary, periph, renal, and splanchnic vasodilation
Decr. BP and Incr. natriuresis
Hypertensive emergency
What class of drug are nitroglycerin, isosorbide dinitrate, isosorbide mononitrate? What is their mechanism? Location? Clinical application? Toxicity? Explain monday disease.
Nitrates
Vasodilate by incr. NO in vasc. smooth muscle leading to an incr. in cGMP and SM relaxation.
Veins > arteries
Decr preload
Angina, acute coronary syndrome, pulm. edema
Reflex tachy, hypotension, flushing, headache Monday disease (industrial exposure): tolerance throughout the week, lose it over the weekend, symptoms back on monday.
What is the goal of antianginal therapy? Mechanism?
Reduction of myocardial O2 consumption by decreasing EDV, BP, HR, or Contractililty
Compare and contrast nitrates and beta blockers and a combo of them bohth in their effect on EDV, BP, Contr., HR, ejection time, and MVO2? How does verapamil fit into this? Which beta blockers should not be used in angina? Why ?
NITRATES
EDV: Decr. BP: Decr. CONTR: No effect HR: Incr. (reflex) EJECTION TIME: Decr. MVO2: Decr.
BETA BLOCKERS
EDV: No effect or decr. BP: decr. CONTR: decr. HR: decr. EJECTION TIME: incr. MVO2: decr.
COMBO
EDV: no effect or decr. BP: decr. CONTR: little/no effect HR: no effect or decr. EJECTION TIME: little to no effect MVO2: decr. a lot
Verapamil has similar effects to beta blockers
pindolol and acebutolol-partial beta agonists
What class of drugs are lovastatin, pravastatin, simvastatin, atorvastatin, rosuvastatin? What is their effect on LDL, HDL, and TGs? Mechanism of action? Results? Side effects? In what conditions?
HMG-CoA reductase inhibitors (5 or suffix)
LDL: 3x decr.
HDL: 1x incr.
TGs: 1x decr.
Inhibit conversion of HMG-CoA to mevalonate, a cholesterol precursor
decr. mortality in CAD patients
Hepatotoxicity (incr. LFTs)
Myopathy (w/ fibrates or niacin)
What class of drugs are cholestyramine, colestipol, and colesevelam? What is their effect on LDL, HDL, and TGs? Mechanism of action? Side effects?
Bile acid resins (3 or prefix)
LDL: 2x decr.
HDL: slight incr.
TGs: slight incr.
Prevent intestinal absorp f bile acids; liver must use cholesterol to make more
GI upset
DEcr. absorption of other drugs and fat soluble vitamins
What class of drugs are gemfibrozil, clofibrate bezafibrate, fenofibrate? What is their effect on LDL, HDL, and TGs? Mechanism of action? Side effects?
Fibrates (4 or suffix)
LDL: 1x decr.
HDL: 1x incr.
TGs: 3x decr.
upregulate LPL which leads to incr. TG clearance
Activates PPAR-alpha t induce HDL synth
Myopathy (incr. risk with statins)
cholesterol gallstones
What the mechanism of ezetimibe? What is their effect on LDL, HDL, and TGs? Side effects?
LDL: 2x decr.
HDL: none
TGs: none
Prevent cholesterol absorption at small intestine brush border
Rare incr. LFTs
Diarrhea
What is the mechanism of Niacin? What is their effect on LDL, HDL, and TGs? Side effects?
LDL: 2x decr.
HDL: 2x incr.
TGs: 1x decr.
Inhibits lipolysis (hormone sensitive lipase) in adipose tissue Reduces hepatic VLDL synth
Red, flushed face which is decr. by NSAID use
Hyperglycemia
Hyperuricemia
What is the mechanism of digoxin? Class of drug? Clinical applications/mechanism of accomplishing it? Toxicity? What are some factors predisposing to toxicity? Antidote for toxicity?
Cardiac glycoside
Direct inhib. of Na/K ATPase leading to inhib. of Na/Ca exchanger leading to incr. intracellular calcium leading to positive inotropy.
Stimulates the vagus nerve leading to decr. HR
HF (incr. contractility) A fib (Decr. conduction at AV node and depression of AV node=vagal nerve stim.)
TOXICITIES
Cholinergic: nausea, vomiting, diarrhea, blurry yellow vision (van gogh), arrhythmias, AV block
Hyperkalemia (poor prognosis)
PREDISP TO TOXIC.
Renal failure, hypokalemia (allows digoxin to bind), verapamil, amiodarone, quinidine
ANTIDOTE
slowly normalize K+, cardiac pacer, anti-digoxin Fab fragments, Mg2+
What is the function of class 1 antiarrythmics? Which cells are they selective for? Mechanism?
Sodium channel blockers
Decr. slope of phase 0 depol.
State dependent: depress tissue that is frequently depolarized (tachy)
Slow or block conduction
Which class of drug are amiodarone, ibutilide, dofetilide, and sotalol? What is their mechanism? Clinical applications? Clinical applications of just 1 and 3? Toxicity of sotalol (1)? Ibutilide (2)? Amiodarone (3)? What should be checked when taking amiodarone? How does it differ?
Antiarr=potassium channel blockers (class III)
Incr. AP duration, incr. ERP, incr. QT interval
Afib
A flutter
ventricular tachy (1,3)
1=torsades de pointes, excessive beta blockade
2=torsades de pointes
3=pulmonary fibrosis, hepatotoxicity, hypo/hyperthyroid, acts as hapten (corneal deposits, blue/grey skin deposits), neuro effects, constipation, CV effects (bradycardia, heart block, HF)
3=check PFTs, LFTs, TFTs
3=lipophillic, all class effects.
AIDS=amiodarone, ibutilide, dofetilide, sotalol
What class of drug are lidocaine, mexiletine? Mechanism? Clinical applications? Toxicity?
Class IB (sodium channel) (2)
Decr. AP duration
Ischemic or depol. purkinje and ventricular tissue
Acute ventricular arrhythmias (especially post MI)
Digitalis induced arrhythmias
CNS stim/depressin, CV depression
1B is Best post mI
I’d Buy LIDdy’s MEXIcan Tacos (IB=LIDocaine/MEXiliTine)
