Pharmacology: Cardiovascular Flashcards
Hydralazine
Incr cGMP
Nifedipine
Dihydropyridine
Blocks v-gated L type calcium channels, decr muscle contractility
More selective in heart muscle
Amlodipine
Dihydropyridine
Blocks v-gated L type calcium channels, decr muscle contractility
More selective in heart muscle
Verapamil
Non-dihydropyridine, Class IV anti-arrhythmic
Blocks v-gated L type calcium channels, decr muscle contractility
More selective in vascular smooth muscle
Diltiazem
Non-dihydropyridine, Class IV anti-arrhythmic
Blocks v-gated L type calcium channels, decr muscle contractility
More selective in vascular smooth muscle
Which CCB affects vascular smooth muscles more? Heart?
Vascular: dHPs
Nifedipine > diltiazem > verapamil
Heart: non-dHPs
Verapamil > diltiazem > nifedipine
Nitroprusside
What toxicity to worry about?
Direct release of NO –> incr cGMP
Short acting
Cyanide toxicity! (Tx: Amyl nitrite, B12, thiosulfate)
Fenoldapam
Dopamine D1 receptor agonist
Relaxes renal vascular smooth muscle
Diazoxide
K+ channel opener - hyperpolarizes and relaxes vascular smooth muscle
Nitroglycerin (PO)
Releases NO --> incr cGMP --> smooth muscle relaxation and vasodilation Veins >> arterioles Decrease preload (venous pooling) SE: Reflex tachy, flushing "Monday disease"
Isosorbide dinitrate (PO)
Metabolized to isosorbide mononitrate Releases NO --> incr cGMP --> smooth muscle relaxation and vasodilation Veins >> arterioles Decrease preload (venous pooling) SE: Reflex tachy, flushing "Monday disease"
Which beta-blockers are contraindicated in treating angina?
Pindolol and acebutolol: are partial beta-agonists
Digoxin
Cardiac glycoside
- Direct inhibition of Na/K ATPase increases intracellular Ca and inotropy
- Increases PSNS activity by incr vagal tone –> decr HR
What can increase Dig toxicity?
- Renal failure (decr excretion)
- Hypokalemia (more binding to Na/K channel)
- Quinidine (decr dig clearance)
Treating Dig toxicity
Slowly normalize K, lidocaine, cardiac pacer, anti-dig Fab fragments, Mg2+
Pt with CHF and blurry yellow vision. What does his EKG look like?
Dig toxicity.
Incr PR interval, decr QT, scooping, T inversions, possible arrhythmias
Nesiritide
Recombinant B-type natriuretic peptide –> incr cGMP –> vasodilation
Quinidine
Class IA antiarrhythmic
Procainamide
Class IA antiarrhythmic
Disopyramide
Class IA antiarrhythmic
Lidocaine
Class IB antiarrhythmic
Mexiletine
Class IB antiarrhythmic
Tocainide
Class IB antiarrhythmic
Moricizine
Class IC antiarrhythmic
Flecainide
Class IC antiarrhythmic
Propafenone
Class IC antiarrhythmic
Propranolol
Class II antiarrhythmic
Esmolol
Class II antiarrhythmic
Metoprolol
Class II antiarrhythmic
Atenolol
Class II antiarrhythmic
Timolol
Class II antiarrhythmic
Ibutilide
Class III antiarrhythmic
K+ channel blocker
Sotalol
Class III antiarrhythmic
K+ channel blocker
Bretylium
Class III antiarrhythmic
K+ channel blocker
Amiodarone
Class III antiarrhythmic
K+ channel blocker
Check LFTs, PFTs, TFTs
Has class I, II, III, and IV effects because it alters the lipid membrane
Dofetilide
K+ channel blocker
Adenosine
Incr K+ efflux (out of cells) –> hyperpolarizing cell, decr Ca conductance (Na/K ATPase works harder, drives Ca out more via Na/Ca exchange?)
What drug blocks the effects of adenosine? How? What is is used for?
Theophylline, a methylxanthine. Used for asthma, COPD. A non-selective adenosine R antagonist, in addition to being a competitive nonselective PDE-inhibitor that increases cAMP –>–> decreasing inflammation
Statins
HMG-CoA reductase inhibitors
Decrease LDL cholesterol!
Niacin
Inhibit lypolysis, reduces VLDL secretion
- Main effect: increases HDL!
- SEs: Flushing, hyperglycemia, hyperuricemia
Cholestyramine
Bile acid resin
- Prevent intestinal reabs of bile so liver must use up CH to make more
- Main effect: decr LDL
- SE: bad taste! cholesterol gallstones
Colestipol
Bile acid resin
- Prevent intestinal reabs of bile so liver must use up CH to make more
- Main effect: decr LDL
- SE: bad taste! cholesterol gallstones
Colesevelam
Bile acid resin
- Prevent intestinal reabs of bile so liver must use up CH to make more
- Main effect: decr LDL
- SE: bad taste! cholesterol gallstones
Ezetimibe
Cholesterol absorption blocker
- Prevent CH reabs at small intestine brush border
- Main effect: decr LDL
Gemfibrozil
Fibrate
- Upregulates LPL and increases TG clearance
- Main effect: decrease TG!
- SE: Cholesterol gallstones (from increased cholesterol in bile
Clofibrate
Fibrate
- Upregulates LPL and increases TG clearance
- Main effect: decrease TG!
- SE: Cholesterol gallstones
Benzafibrate
Fibrate
- Upregulates LPL and increases TG clearance
- Main effect: decrease TG!
- SE: Cholesterol gallstones
Fenofibrate
Fibrate
- Upregulates LPL and increases TG clearance
- Main effect: decrease TG!
- SE: Cholesterol gallstones
Ciprofibrate
Fibrate
- Upregulates LPL and increases TG clearance
- Main effect: decrease TG!
- SE: Cholesterol gallstones
The lipid-lowering agents that:
- Decrease LDL cholesterol
- Increase HDL cholesterol
- Decrease TG
- Statins, bile acid resins, cholesterol absorption blocker (exetimibe)
- Niacin
- Fibrates
The lipid-lowering agents that:
- Cause heptatoxicity
- Cause myopathy/myositis
- Cuase hyperglycemia
- Cause cholesterol stones
- Cause flushing
- Cause hyperuricemia
- Taste bad!
- Statins, fibrates
- Statins, fibrates
- Niacin
- BAS, fibrates
- Niacin
- Niacin
- BAS