Section 3: Cardiac and Renal Flashcards
Quinidine
Class: Class IA antiarrhythmic (Na channel blocker)
Use: Many arrhythmias; need initial digitalization for afib
S/E: Cinchonism (GI, tinnitus, ocular dysfxn, CNS excitation), hypotension, prolongation of QRS & ↑ QT interval associated w/ syncope (torsades)
Procainamide
Class: Class IA antiarrhythmic (Na channel blocker)
Use:
S/E: SLE-like syndrome, hematotoxicitity (thrombocytopenia, agranulocytosis); CV effects (torsades)
Lidocaine
Class: Class IB antiarrhythmic (Na channel blocker)
Use: Post-MI, open-heart surgery, digoxin toxicity
S/E:
Mexiletine
Class: Class IB antiarrhythmic (Na channel blocker)
Use: Post-MI, open-heart surgery, digoxin toxicity
S/E:
Fecainide
Class: Class IC antiarrhythmic (Na channel blocker)
Use: Limited
S/E:
Propranolol, Acebutolol, Esmolol
Class: Class II antiarrhythmics (β blocker)
Use: Prophylaxis post-MI and in SVTs (esmolol in acute SVTs)
S/E:
Amiodarone
Class: Class III antiarrhythmic (K channel blocker)
Use: Any arrhythmia
S/E: Pulmonary fibrosis, blue skin pigmentation, phototoxicity, corneal deposits, hepatic necrosis, thyroid dysfxn
Sotalol
Class: Class III antiarrhythmic (K channel blocker)
Use: Life-threatening ventricular arrhythmia
S/E: Torsades
Verapamil
Class: Class IV antiarrhythmic (CCBs)
Use: SVT
S/E: Constipation (verapamil), dizziness, flushing, hypotension, AV block
Deltiazem
Class: Class IV antiarrhythmic (CCBs)
Use: SVT
S/E: Constipation (verapamil), dizziness, flushing, hypotension, AV block
Adenosine
Class: Unclassified antiarrhythmic
Use: DOC for paroxysmal SVT & AV nodal arrhythmias
S/E: Flushing, sedation, dyspnea
Magnesium
Class: Unclassified antiarrhythmic
Use: Torsades
S/E:
Clonidine
Class: α2 agonist
Use: Mild-to-moderate HTN, opiate withdrawal
S/E: CNS depression, edema
Methyldopa
Class: α2 agonist
Use: Mild-to-moderate HTN, HTN mgmt. in pregnancy
S/E: Positive Coombs test, CNS depression, edema
Reserpine
Class: NT vesicle disruptor
Use: HTN
S/E: Depression (often severe), edema, ↑ GI secretions
Note: Destroys vesicles (NE in periphery; NE, D, 5-HT in CNS)
Guanethidine
Class: NT vesicle disruptor
Note: Accumulated into nerve endings by reuptake; binds vesicles; inhibits NE release; not used clinically
-zosins
Class: α1 blockers
Use: HTN, BPH
S/E: “first-dose” syncope, orthostatic hypotension, urinary incontinence
Note: Good effect on lipid profile (↑ HDL, ↓ LDL)
Examples: Prazosin, Doxazosin, Terazosin
β blockers
Class: β blockers
Use: HTN
S/E: CV depression, fatigue, sexual dysfunction, ↑ LDLs & TGs
Note: Caution in use w/ asthma, vasospastic disorders, DM
Hydralazine
Class: NO regulator
Use: Moderate-to-severe HTN
S/E: SLE-like syndrome, edema, reflex tachycardia
Note: ↓ TPR by arteriolar dilation
Nitroprosside
Class: NO regulator
Use: HTN emergencies (used IV, DOC)
S/E: Cyanide toxicity (co-admin w/ nitrites & thiosulfate)
Note: ↓ TPR by arterioles & venular dilation
Minoxidil
Class: K+ channel openers
Use: Severe HTN, baldness (topical)
S/E: Hyperglycemia, edema, reflex tachycardia
Note: Open K+ channel hyperpolarization of smooth muscle
Diazoxide
Class: K+ channel openers
Use: HTN emergencies
S/E: Hyperglycemia, edema, reflex tachycardia
Note: Same mech as minoxidil
Verapamil
Class: CCB
Use: HTN, angina, antiarrhythmics
S/E: Constipation
Note: Block L-type Ca2+ channels mainly in heart, also in vessels
Deltiazem
Class: CCB
Use: HTN, angina, antiarrhythmics
Note: Block L-type Ca2+ channels in both heart & vessels
Nifedipine
Class: CCB (dihydropyridine)
Use: HTN, angina
S/E: Reflex tachycardia, gingival hyperplasia
Note: Block L-type Ca2+ channels mainly in vessels, also in heart
-pril
Class: ACEI
Use: Mild-to-moderate HTN, prevention of diabetic nephropathy, CHF
S/E: Dry cough, hyperkalemia, acute renal failure in renal artery stenosis, angioedema
Note: Contraindicated in pregnancy; blocks formation of angiotensin II
Examples: Captopril, Lisinopril
-sartan
Class: ARB
Use: Mild-to-moderate HTN, prevention of diabetic nephropathy, CHF
S/E: Hyperkalemia, acute renal failure in renal artery stenosis, angioedema
Note: Contraindicated in pregnancy; blocks AT1 receptor
Examples: Losartan
Aliskiren
Class: Renin inhibitor
Use: Mild-to-moderate HTN
S/E: Hyperkalemia, acute renal failure in renal artery stenosis, angioedema
Note: Contraindicated in pregnancy; blocks formation of angiotensin I
Bosentan
Class: Endothelin-A receptor antagonist
Use: Pulmonary HTN
S/E: HA, flushing, hypotension
Note: CI in pregnancy
Epoprostenol
Class: PGI2
Use: Pulmonary HTN
S/E:
Note: Administered by infusion pumps
-fil
Class: PDE5 inhibitor Use: Pulmonary HTN S/E: Note: ↑ cGMP Example: Sildenafil
Digoxin
Class: Glycoside (inotrope)
Use: HF
S/E: Early: nausea, anorexia, ECG changes. Late: disorientation, visual effects (halos). Toxic: arrhythmias
Note: Inhibits cardiac Na/K ATPase (and neuronal Na/K ATPase); causes ↑ intracellular Ca2+; treat toxicity w/ Fab antibody fragments to digoxin
-rinone
Class: PDE inhibitors (inotrope) Use: HF S/E: Note: Examples: Milrinone, Inamrinone
Dobutamine
Dopaimine
Class: Sympathomimetics (inotrope) Use: HF S/E: Note:
Loop diuretics
Class: Loop diuretics
Use: HF (backward failure)
S/E:
Note:
Spironolactone
Class: Aldosterone inhibitor (K-sparing diuretic)
Use: HF
S/E:
Note: Used w/ ACEIs to ↓ remodeling
Metoprolol, carvedilol
Class: β blocker (metoprolol); α1 & β blocker (carvedilol)
Use: HF
S/E: See ANS section
Note:
Nesiritide
Class: Recombinant BNP
Use: Acutely decompensated CHF
S/E:
Note: Recombinant human BNP; binds natriuretic peptide receptors, ↑ cGMP vasodilation
Nitroglycerin
Class: Nitrate
Use: Angina
S/E: Flushing, HA, orthostatic hypotension, reflex tachycardia, fluid retention
Note: Prodrugs of NO; cause venodilation ↓ preload ↓ cardiac work ↓ O2 requirement. Decrease infarct size & post-MI mortality
Isosorbide
Class: Nitrate
Use: Angina
S/E: Flushing, HA, orthostatic hypotension, reflex tachycardia, fluid retention
Note: Prodrugs of NO; cause venodilation ↓ preload ↓ cardiac work ↓ O2 requirement. Decrease infarct size & post-MI mortality
CCBs
Class: CCBs
Use: Angina (nifedipine important for vasospastic angina)
S/E:
Note:
BBs, carvedilol
Class: BBs; α1 & β blocker (carvedilol)
Use: Angina (BB contraindicated in vasospastic angina)
S/E:
Note: Carvedilol is clinically equivalent to isosorbide in angina of effort
Ranolazine
Class: Late inward Na+ current blocker
Use: Angina
S/E: Constipation, nausea, QT prolongation
Note: Ischemia increased Na, which prevents Ca exit through Na/Ca exchanger; blocking Na influx decreased Ca accumulation decreased EDP & improved diastolic coronary blood flow. Contraindicated in pts w/ long QT syndrome or taking drugs that prolong QT
Mannitol
Class: Osmotic diuretic
Use: Glaucoma (↓ IOP), ↓ ICP, oliguric states (e.g. rhabdomyolysis)
S/E: Acute hypovolemia
Note: IV; inhibits H2O reabsorption throughout tubule
-zolamide
Class: Carbonic anhydrase inhibitors
Use: Glaucoma, acute mountain sickness, metabolic alkalosis
S/E: Bicarbonaturia, acidosis, hypokalemia, hyperchloremia, paresthesias, renal stones, sulfonamide HSR
Note: Blocks CA, causing ↓ H+ formation in proximal tubule cell, causing ↓ Na/H exchange ↑ Na, HCO3- in lumen diuresis
Examples: Acetazolamide, Dorzolamide
Furosemide
Class: Loop diuretics
Use: Acute pulmonary edema, HF, HTN, refractory edema, acute renal failure, anion OD, hypercalcemic states
S/E: Sulfonamide HSR (furosemide), hypokalemia, alkalosis, hypocalcemia, hypomagnesemia, hyperuricemia, ototoxicity (ethacrynic acid > furosemide)
Note: Blocks Na/K/2Cl transporter, causing –↓ intracellular K in thick ascending loop, -> back diffusion of K+, ↓ positive potential -> reabsorption of Ca & Mg -> diuresis
Ethacrinic Acid
Same as Furosemide:
Class: Loop diuretics
Use: Acute pulmonary edema, HF, HTN, refractory edema, acute renal failure, anion OD, hypercalcemic states
S/E: Sulfonamide HSR (furosemide), hypokalemia, alkalosis, hypocalcemia, hypomagnesemia, hyperuricemia, ototoxicity (ethacrynic acid > furosemide)
Note: Blocks Na/K/2Cl transporter, causing –↓ intracellular K in thick ascending loop, -> back diffusion of K+, ↓ positive potential -> reabsorption of Ca & Mg -> diuresis
HCTZ
Class: Thiazides
Use:HTN, CHF, nephrolithiasis (Ca stones), nephrogenic diabetes insipidus
S/E: Sulfonamide HSR, hypokalemia, alkalosis, hypercalcemia, hyperuricemia, hyperglycemia, HLD (except indapamide).
Note:Interacts w/ digoxin; avoid in pts w/ DM. Inhibits Na/Cl transporter -> ↑ Na & Cl in distal tubule -> diuresis
Indapamide
Same as HCTZ
Class: Thiazides
Use:HTN, CHF, nephrolithiasis (Ca stones), nephrogenic diabetes insipidus
S/E: Sulfonamide HSR, hypokalemia, alkalosis, hypercalcemia, hyperuricemia, hyperglycemia, HLD (except indapamide).
Note:Interacts w/ digoxin; avoid in pts w/ DM. Inhibits Na/Cl transporter -> ↑ Na & Cl in distal tubule -> diuresis
Spironolactone
Class: Aldosterone-receptor antagonist (K+-sparing diuretic)
Use: Hyperaldosteronic state, adjunct to K+-wasting diuretics, anti-androgenic uses (e.g. female hirsutism), CHF
S/E: Hyperkalemia, acidosis, anti-androgenic effects
Note:
Epleronone
Class: Aldosterone-receptor antagonist (K+-sparing diuretic)
Use: Hyperaldosteronic state, adjunct to K+-wasting diuretics, CHF
S/E: Hyperkalemia, acidosis
Note:
Amiloride
Class: Na-channel blockers (K+-sparing diuretic)
Use: Adjunct to K+-wasting diuretics, lithium-induced nephrogenic diabetes insipidus (amiloride)
S/E: Hyperkalemia, acidosis
Note:
Triamtrene
Same as Amiloride
Class: Na-channel blockers (K+-sparing diuretic)
Use: Adjunct to K+-wasting diuretics, lithium-induced nephrogenic diabetes insipidus (amiloride)
S/E: Hyperkalemia, acidosis
Note:
-statins
Class: HMG-CoA Reductase Inhibitors
Use: HLD (↓ LDL, VLDL, TG)
S/E: Myalgia, myopathy, rhabdomyolysis, hepatotoxicity
Note: CYP450 inhibitors enhance statin toxicity; gemfibrozil -> ↑ rhabdomyolysis
Examples: Lovastatin, Simvastatin
Cholestyramine
Class: Bile acid sequestrants
Use: HLD (↓ LDL)
S/E: ↑ VLDL & TGs, GI disturbance, malabsorption of lipid-soluble vitamins
Note: Contraindicated w/ hypertriglyceridemia; interacts w/ PO drugs inc warfarin, thiazides, digoxin
Cholestipol
Class: Bile acid sequestrants
Use: HLD (↓ LDL)
S/E: ↑ VLDL & TGs, GI disturbance, malabsorption of lipid-soluble vitamins
Note: Contraindicated w/ hypertriglyceridemia; interacts w/ PO drugs inc warfarin, thiazides, digoxin
Nicain
Vitamin B3 Class: Nicotinic acid-related Use: HLD (↓ LDL, VLDL; ↑ HDL) S/E: Flushing, pruritus, burning pain, hepatotoxicity Note:
-fibrates
Class: Fibrates Use: HLD (↓ LDL, VLDL; ↑ HDL) S/E: Gallstones, mastitis Note:Binds PPARα to increase expression of LPL. LDL reduction modest (may increase in pts w/ combined HLDs), HDL ↑ in most patients. Used in hypertriglyceridemia Examples: Gemfibrozil Fenofibrate
Ezetimibe
Class: Cholesterol absorption inhibitor
Use: HLD (↓ LDL)
S/E: GI distress
Note:Prevents intestinal absorption of cholesterol
Orlistat
Class: Pancreatic lipase inhibitor
Use: Weight loss
S/E: Steatorrhea, diarrhea, malabsorption of lipid-soluble vitamins
Note:
