1
Q
What are the antihypertensives that can be given in pregnancy
A
He Likes My Neonate
- Hydralazine
- Labetalol
- Meythldopa
- Nifedipine
2
Q
What are the 2 types of CCB?
A
- Dihydropyridines (Dipine), act on vascular SM
- Non-Dihydropyridines (Verapamil, Diltiazim), act on heart
3
Q
MOA for CCB
A
- Blocks voltage dependent L-type Ca channels > Decreasing the contractility
- Verapamil stronger than diltiazim
4
Q
Use of Dihydropyridines except Nimodipine
A
HTN , Angina , Raynaud phenomenon
5
Q
Use of Nimodipine
A
SAH (prevent cerebral vasospams)
6
Q
Use of Non-dihydropyridines
A
HTN, Angina, Afib/ flutter
7
Q
What is the side effect for All CCB
A
Gingival Hyperplasia
8
Q
Side effect of Dihydropyridines
A
Peripheral edema, Flushing, Dizziness
9
Q
Side effect of non dihydropyridines
A
Cardiac depression, AV block, constipation
10
Q
Specific side effect for Verapamil
A
Hyperprolactinemia
11
Q
MOA of Hydralazine
A
increases cGMP > relaxes SMC
Works on arterioles and decreases Afterload
12
Q
Uses of Hydralazine
A
- In acute severe hypertension
- In HF (with organic nitrate)
13
Q
Side effect of Hydralazine
A
- Compensatory Tachy
- Fluid retention
- Headache
- Angina
- Drug induced lupus
14
Q
Drugs used in emergency HTN
A
Labetalol, Clevidipine, Nicardipine, Fenoldopam, Nitroprusside
15
Q
MOA of Nitroprusside
A
Releases NO > Increases cGMP > Vasodilator (arteries = veins)
16
Q
Side effect of Nitroprusside
A
Cyanide toxicity
17
Q
MOA of Fenoldopam
A
- Dopamine D1 receptor agonist
- Decreases BP and Increases Natriuresis
18
Q
Where does Fenoldopam works on
A
coronary, peripheral, Renal, Splanchnic
19
Q
Which drug is used for post operation HTN
A
Fenoldopam
20
Q
What are the nitrates
A
Nitroglycerin
Isosorbid mono/di Nitrate
21
Q
MOA of Nitrates
A
Increases NO > Inc cGMP > relaxes SMC
Works on Veins! little bit on arteries
Dec preload
22
Q
Uses of Nitrates
A
Acute coronary syndromes
Angina
Pulmonary edema
23
Q
Adverse effects of Nitrate
A
- Reflex Tachy, Hypotension, Flushing, Headache
- Monday disease (loss of tolerance in the weekend for the drug)
24
Q
Contraindicates of Nitrates
A
- Right ventricular Infarction
- Hypertrophic Cardiomyopathy
- use of PDE-5 inhibitor
25
MOA of Ranolazine
- Inhibits the late phase of inward Na current > reducing diastolic wall tension and O2 consumption
- Does not affect HR or Bp
26
Use of Ranolazine
Angina refractory to other therapies
27
Adverse effects of Ranolazine
Constipation, Headache, Dizziness, Nausea
28
MOA of Sacubitril
Neprilysin inhibitor > Prevents degradation of Natiuritic peptides, Angiotensin2 and substance P > vasodilation and dec in ECF volume
29
Uses of Sacubitril
Combined with Valsartan to treat HF with reduced EF (HFrEF)
30
Adverse effects of Sacubitril
- Hypotension
- Hyperkalemia
- Cough
- Dizziness
31
Which drug is contraindicated with Sacubitril
ACE inhibitors due to angioedema
32
How does statins affect LDL
they Increases the recycling of it by making less cholesterol
33
Lipid lowering drugs that cause Myopathy
Statins especially when used with Fibrates or Niacin
34
Side effects of Bile acid resins
GI upset
dec absorption of drugs and vitamins
35
Side effect of Ezetimibe
Inc LFT, Diarrhea
36
Which anti lipid agent increases TAG
Bile acid resins
37
Side Effect of Fibrates
Myopathy
Cholesterol gallstones (inhibits 7alpha hydroxylase)
38
Side effects of Niacin
- Flushed face (dec by NSAIDs)
- Hyperglycemia
- Hyperuricemia
39
How PCSK9 inhibitors work
inactivate the degradation of LDL receptors
40
Side effects of PCSK9 inhibitors
Myalgias, Delirium, Dementia and other neuro effects
41
how Fish oil and omega3 work
Decrease FFA delivery to liver and dec activity of TG synthesizing enzymes
42
MOA of bile acid resins (Cholestyramine, Colestipol, Colesevelam)
Prevents intestinal absorption of bile acids > liver uses cholesterol to make if
43
MOA of Ezetimibe
Prevents cholesterol absorption at small intestine brush border
44
MOA of Fibrates
- Upregulates (LPL) > Inc TAG clearance
- Activates PPAR-alpha > Makes HDL
- Decreases VLDL
45
MOA of Niacin
- Inhibits lipolysis in adipose tissue
- Decreases VLDL synthesis (from cholesterol in liver)
46
MOA of Digoxin
- Increases contractility (Na, K pump inhibition)
- Stimulates Vagus > decreases HR
47
Uses of Digoxin
- Hf
- A fib
48
Adverse effects of Digoxin
- Cholinergic (N+V+Diarrhea)
- Blurry yellow vision
- Arrhythmias
- AV block
- Hyperkalemia
49
What increases the toxicity of digoxin
- RF (digoxin excreted renaly)
- Hypokalemia
- Drugs (verapamil, Amiodarone, Quinidine) displace digoxin from binding sites and decrease clearance
50
Antidote of digoxin
Normalize K+ slowly
Cardiac pacer
Anti digoxin fab fragments
Mg
51
Classes and names of Na Channel blockers and their MOA on Na channels
- IA > Quinidine + Procainamide
> Moderate Na blockade , Some K+
- IB > Lidocaine + Mexiletine
> Weak Na blockade
- IC > Flecainide + Propafenone
> Strong Na blockade
52
All Na channel blocking agents effect on AP and ERP
- IA > Increases both + Inc QT
- IB > Decreases AP
- IC > Increases ERP in AV node and bypass tracts Only! .. minimal effect on AP
53
Uses of Class IA
- Atrial+Ventricular Arrhythmia
(re-enterant + ectopic SVT and VT specially)
54
uses for Class IB
- Acute Ventricular Arrhythmias (Post MI) > Affect ischemic tissue
- Digitals induced arrhythmias
55
uses of Class IC
- SVT
- A Fib
- Last resort in refractory VT
56
Adverse effect of Quinidine
Cinchonism (headache + Tinnitus)
57
Adverse effect of Procainamide
Reversible SLE syndrome
58
Adverse effect of Disopyramide
HF
59
common Adverse effect for All class IA
- Thrombocytopenia
- Torsade de pointes
60
Side effect of Class IB
- CNS stimulation\ depression
- Cardiovascular depression
61
Side effect of Class IC
- Proarrhythmic especially post MI
(not used for ischemic heart)
62
MOA of ClassII (Beta blockers)
- Dec cAMP and Ca current > Dec SA+AV nodes activities (Dec slope of phase4)
- Dec contractility and HR
- Dec release of renin (renin released when beta1 is stimulated)
63
Use of ClassII
- SVT
- Ventricular rate control for AFib, flutter
64
Which drug in classII leads to Dyslipedemia
Metoprolol
65
Which drug in classII leads to exacerbation of vasospasm in vasospastic angina
Propranolol
66
Side effects of ClassII
- Impotence
- Exacerbation of COPD + Asthma
- CVS effect (bradycardia, HF, AV block)
- CNS effect (sedation, sleep alterations)
- Mask signs of hypoglycemia
- unoppose alpha1 agonism if given alone for pheochromocytoma or cocaine toxicity (except carvidolol and Labetalol; non selectives)
67
Tx of beta blockers overdose
- Saline
- Atropine
- Glucagon (in cAMP)
68
What are ClassIII drugs
AIDS
Amiodarone, Ibutilide, Dofetilide, Sotalol
69
MOA of ClassIII
blocks K
Inc AP, ERP and QT
70
Use of classIII
- Afib/ Flutter
- V tach
71
Adverse effect of sotalol
- Torsades de pointes
- Excessive Beta blockade
72
Adverse effect of Ibutilide
Torsades de pointes
73
Adverse effect of Amiodarone
- P. fibrosis
- Hypo/hyperthyrodism (Amio is 40% iodine)
- Heptotoxicity
- Corneal/gray skin deposit (photodermatitis) bcz it act as hapten
- neuro, GI, heart
74
Which tests to do before starting Amiodarone
- PFT
- LFT
- TFT
75
What are classIV drugs and their MOA
- Diltiazim, Verapamil
- Dec conduction VELOCITY (slow rise of phase 0, AP)
- Inc ERP and PR
76
Uses of classIV
- Prevention of nodal Arrhythmias (SVT)
- Rate control in A fib
77
Side effects of ClassIV
constipation, flushing, edema, CVS effect
78
MOA for Adenosine
Inc K+ outside the cells > hyperpolarize cells and Dec calcium current > Dec AV node conduction
79
What increases the effect of Adenosine
Theophylline
Caffeine
80
Adverse effect of Adenosine
Flushing, Hypotension
bronchospasm
sense of impending doom
chest pain
81
MOA of Ivabradine
- Selectively inhibits funny sodium
- Prolongs slow depolarization (phase IV)
82
Use of Ivabradine
- Chronic stable angina (in people who cant take beta blockers)
- Chronic HFrEF
83
Adverse effect of Ivabradine
- Luminous phenomena (visual brightness)
- HTN
- Bradycardia
84
which drugs is used to treat wolf parkinson white syndrome?
Procainamide
Cardiovascular
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