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Cardiology > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What is the mechanism of action of beta blockers?

A
  • decrease cardiac output
  • decrease PVR by decreasing renin release to lower angiotensin II LEVLES and blocking norepinephrine in CNS
  • block RAAS- decrease caridac output and PVR
  • some block alpah 1 receptors in vasculature to decrease PVR
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2
Q

Which medications are cardioselective beta blockers? which receptors do they block?

A
  • atenolol
  • metoprolol
    These medications block B1 receptors
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3
Q

which beta blockers are vasodilating nonselective beta blockers? which receptors do they block?

A
  • cavedilol
  • Labetalol
    These medications block A1, B1, B2
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4
Q

when should you use BP medications for secondary prevention?

A

recurrent CVD events in patients with clincial CVD and average BP >130/80mmHg

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5
Q

when should you use BP medications for primary prevention?

A
  1. patients with an estimated 10 year risk ASCVD > 10% and average BP > 130/80mmHg
  2. stage II hypertension
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6
Q

what are first line agents for hypertension?

A

thiazide diuretics, calcium channel blockers (dihydropyridine) and ace inhibitors or ARBs

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7
Q

Which medications are RAAS inhibitors?

A

ACEi, ARBs, DRI

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8
Q

In black adults with HTN but without HF or CKD, including those with DM, initial treatment should include?

A

Thiazide-type diuretic or CCB

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9
Q

Women with hypertension who become pregnant should avoid?

A

ACEi, ARBS, ARNI or direct renin inhibitors

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10
Q

What is the mechanism of action of ACE inhibitors?

A

Decrease production of angiotensin II and decrease the release of aldosterone

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11
Q

what is the mechanism of action of ARBs?

A

Competitive antagonism of angiotensin II receptors

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12
Q

what is the mechanism of action of direct renin inhibitors?

A

block release of renin form juxtoglomerular cells

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13
Q

which medication are Ace inhibitors

A
  • captopril
  • enalapril
  • lisinopril
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14
Q

which medications are ARBs?

A

Losartan
valsartan
candesartan

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15
Q

in which patients are ACEi beneficial? what are there contraindications?

A
  • beneficial in patients with MI, HF, CKD, DM, proteinuria
  • contraindications: bilateral renal stenosis, pregnancy, history of angioedema (ARBs have same contraindication)

avoid combining with other RAAS inhibitors, potassium sparing diuretics

avoid using with potassium supplements or salt substitutes

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16
Q

what are some side effects of ACEi

A
  • hypotension
  • renal dysfunction
  • hyperkalemia
  • cough
  • angioedema
  • taste changes

avoid in pts with symptomatic hypotension, or salt-depletion

17
Q
  • effective as monotherapy, most commonly used as second agent in combo wiht thiazide
  • do not use with other RAAS inhibitors or with drugs that increase risk for hyperkalemia
  • same contraindications (pregnancy, BRS) and drug interactions as ACE, ARBs
  • side effects: hypotension, hyperkalemia, diarrhea, abdominal pain, low risk of angioedema and cough
A

DRI (aliskerin)

18
Q

which medications are thiazides? thiazide like? potassium sparing?

A
  • thiazides: hydrochlorothiazide, chlorothiazide
  • thiazide like: chlorthalidone, indapamide
  • potassium sparing: amiloride, triamterene
19
Q

mechanism of action of diuretics?

A
  1. initally decrease preload and cardiac output
  2. decrease PVR (MOA is unknown)
20
Q
  • increasing dose does not increase BP lowering effect
  • Avoid in renal dysfunction
  • contraindication: anuric patients, sulfa allergy, gout
  • side effects: hypotension, mild metabolic acidosis, hyperlipidemia, hyperuricemia, impotence
  • use cautiously with NSAIDS, digoxin, lithium, antidiabetic meds
  • monitor BUN/Scr and potassium levels after initiation
  • prevent hypokalemia
A

thiazide

21
Q
  • least potent diuretic
  • slight (amiloride) to no (triamterene) antihypertensive effecs
  • avoid in severe renal dysfuntion
  • contraindications: anuric, hyperkalemia
A

Potassium sparing diuretics

22
Q

What is the mechanism of action of calcium channel blockers?

A
  1. decrease PVR
  2. decrease cardiac output by decreasing heart rate and contractility

Can cause reflex tacchycardia and peripheral edema

23
Q

which medications are dihydropyridine calcium channel blockers?

A
  • Nifedipine
  • amlodipine
24
Q

which medications are non-dihydropyridine calcium channel blockers

A

Verapamil
diltiazem

decrease PVR, decrease HR

have negative inotropic and chronotropic effects

25
Q

What are some side effects of calcium channel blockers?

A
  • hypotension, HA, flushing, constipation, peripheral edema, angina, worsening HF sysmptoms (non-DHP), gingival hyperplasion (DHP)
26
Q
  • Vasodilating lower BP more than other in this class
  • add to first line therapy for these indications
  • selection shoud be based on liver and/or renal function, co-morbid conditions, and need for cardioselectivity
  • side effects: hypotension, bradycardia, AV block fatigue, masks signs of hypoglycemia, hyperlipidemia, impotence, SOB, feeling cold
  • must taper over 1-2 weeks rather than D/C abruptly
A

Beta blocker

contraindication: Asthma/COPD, high degree AV block, sick sinus syndrome

27
Q
  • receptors located in vascular smooth muscle, urethra, prostate, and bladder sphincter
  • MOA: selectively block post-synaptic receptors to cause peripheral vasodilation of ateries and veins
  • potent vasodilators so can cause tacchycardia and RAAS
  • side effects: first dose phenomenon, orthostatic hypotension, syncope, peripheral edema, nasal congestion
  • start low, taper slowing, administer 1st dose at bedtime
A

alpha blockers

28
Q

which medications are alpha blockers?

A
  • doxazosin
  • prazosin
  • terazosin
29
Q
  • mixed group of drugs that work in the CNS to inhibit SNS (norepinephrine activity)
A

Central acting agents

Methyldopa, clonidine

30
Q

MOA: converted to alpha-methyl norepinephrine, a false neurotransmitter that stimulates central alpha-2 receptors to reduce sympathetic outflow from CNS (little effect on CO)

A

methyldopa

31
Q

MOA: reduce sympathetic tone within brainstem by stimulating alpha-2 receptors to inhibit outflow of impulses (slight effect on CO)

A

Clonidine

32
Q
  • use as third-fourth line agents due to side effects- combine with a diuretic to minimize edema
  • most useful in patients with hard to control BP and during hypertensive urgencies
  • side effects- bradycardia, hypotension, dizziness, orthostatic hypotension, edema, sedation, dry mouth, constipation, impotence
  • one med has withdrawal or rebound hypertension due to short half life (taper)
A

central agents
(clonidine, methyldopa)

taper clonidine. methyldopa can cause drug induce hepatitis

33
Q

Group of drugs that directly vasodilate arteries, rather than inhibiting a vasoconstricting mediator or blocking a receptor channel
hydrazaline: relaxes vascular smooth muscle possibly by increasing the concentration of nitric oxide
minoxidil: opens potassium channels in vascular smooth muscle

A

direct vasodilator

use in combo with BB to minimize reflex tach. and loop to minimize edema

34
Q
  • indication: resistant HTN due to primary aldosteronism
  • bp lowering benefit also seen in patients with normal aldosterone
  • other indications: obesity related HTN, high sodium diet
  • Spironolactone (nonselective) and eplernone (selective)
  • MOA: decrease cardiac output and decrease preload
  • contraindications: CKD
  • side effects: hyperkalemia, dizziness, hypotension, (spirogynecomastia, breast tenderness, hisutism, mestrual changes)
A

Aldosterone antogonist

35
Q

which medications are aldosterone antagonists?

A

spironolactone, epelernone

36
Q

which medications are direct vasodilators?

A

hydralazine
minoxidil

Cardiology (8 decks)

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