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Kaplan Pharm > Section 3: Cardiac and Renal > Flashcards

Section 3: Cardiac and Renal Flashcards

1
Q

Quinidine

A

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)

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2
Q

Procainamide

A

Class: Class IA antiarrhythmic (Na channel blocker)
Use:
S/E: SLE-like syndrome, hematotoxicitity (thrombocytopenia, agranulocytosis); CV effects (torsades)

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3
Q

Lidocaine

A

Class: Class IB antiarrhythmic (Na channel blocker)
Use: Post-MI, open-heart surgery, digoxin toxicity
S/E:

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4
Q

Mexiletine

A

Class: Class IB antiarrhythmic (Na channel blocker)
Use: Post-MI, open-heart surgery, digoxin toxicity
S/E:

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5
Q

Fecainide

A

Class: Class IC antiarrhythmic (Na channel blocker)
Use: Limited
S/E:

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6
Q

Propranolol, Acebutolol, Esmolol

A

Class: Class II antiarrhythmics (β blocker)
Use: Prophylaxis post-MI and in SVTs (esmolol in acute SVTs)
S/E:

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7
Q

Amiodarone

A

Class: Class III antiarrhythmic (K channel blocker)
Use: Any arrhythmia
S/E: Pulmonary fibrosis, blue skin pigmentation, phototoxicity, corneal deposits, hepatic necrosis, thyroid dysfxn

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8
Q

Sotalol

A

Class: Class III antiarrhythmic (K channel blocker)
Use: Life-threatening ventricular arrhythmia
S/E: Torsades

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9
Q

Verapamil

A

Class: Class IV antiarrhythmic (CCBs)
Use: SVT
S/E: Constipation (verapamil), dizziness, flushing, hypotension, AV block

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10
Q

Deltiazem

A

Class: Class IV antiarrhythmic (CCBs)
Use: SVT
S/E: Constipation (verapamil), dizziness, flushing, hypotension, AV block

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11
Q

Adenosine

A

Class: Unclassified antiarrhythmic
Use: DOC for paroxysmal SVT & AV nodal arrhythmias
S/E: Flushing, sedation, dyspnea

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12
Q

Magnesium

A

Class: Unclassified antiarrhythmic
Use: Torsades
S/E:

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13
Q

Clonidine

A

Class: α2 agonist
Use: Mild-to-moderate HTN, opiate withdrawal
S/E: CNS depression, edema

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14
Q

Methyldopa

A

Class: α2 agonist
Use: Mild-to-moderate HTN, HTN mgmt. in pregnancy
S/E: Positive Coombs test, CNS depression, edema

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15
Q

Reserpine

A

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)

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16
Q

Guanethidine

A

Class: NT vesicle disruptor
Note: Accumulated into nerve endings by reuptake; binds vesicles; inhibits NE release; not used clinically

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17
Q

-zosins

A

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

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18
Q

β blockers

A

Class: β blockers
Use: HTN
S/E: CV depression, fatigue, sexual dysfunction, ↑ LDLs & TGs
Note: Caution in use w/ asthma, vasospastic disorders, DM

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19
Q

Hydralazine

A

Class: NO regulator
Use: Moderate-to-severe HTN
S/E: SLE-like syndrome, edema, reflex tachycardia
Note: ↓ TPR by arteriolar dilation

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20
Q

Nitroprosside

A

Class: NO regulator
Use: HTN emergencies (used IV, DOC)
S/E: Cyanide toxicity (co-admin w/ nitrites & thiosulfate)
Note: ↓ TPR by arterioles & venular dilation

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21
Q

Minoxidil

A

Class: K+ channel openers
Use: Severe HTN, baldness (topical)
S/E: Hyperglycemia, edema, reflex tachycardia
Note: Open K+ channel  hyperpolarization of smooth muscle

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22
Q

Diazoxide

A

Class: K+ channel openers
Use: HTN emergencies
S/E: Hyperglycemia, edema, reflex tachycardia
Note: Same mech as minoxidil

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23
Q

Verapamil

A

Class: CCB
Use: HTN, angina, antiarrhythmics
S/E: Constipation
Note: Block L-type Ca2+ channels mainly in heart, also in vessels

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24
Q

Deltiazem

A

Class: CCB
Use: HTN, angina, antiarrhythmics
Note: Block L-type Ca2+ channels in both heart & vessels

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25
Q

Nifedipine

A

Class: CCB (dihydropyridine)
Use: HTN, angina
S/E: Reflex tachycardia, gingival hyperplasia
Note: Block L-type Ca2+ channels mainly in vessels, also in heart

26
Q

-pril

A

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

27
Q

-sartan

A

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

28
Q

Aliskiren

A

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

29
Q

Bosentan

A

Class: Endothelin-A receptor antagonist
Use: Pulmonary HTN
S/E: HA, flushing, hypotension
Note: CI in pregnancy

30
Q

Epoprostenol

A

Class: PGI2
Use: Pulmonary HTN
S/E:
Note: Administered by infusion pumps

31
Q

-fil

A 
Class: PDE5 inhibitor
Use: Pulmonary HTN
S/E: 
Note: ↑ cGMP 
Example: Sildenafil
32
Q

Digoxin

A

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

33
Q

-rinone

A 
Class: PDE inhibitors (inotrope)
Use: HF
S/E: 
Note: 
Examples: Milrinone, Inamrinone
34
Q

Dobutamine

Dopaimine

A 
Class: Sympathomimetics
(inotrope)
Use: HF
S/E: 
Note:
35
Q

Loop diuretics

A

Class: Loop diuretics
Use: HF (backward failure)
S/E:
Note:

36
Q

Spironolactone

A

Class: Aldosterone inhibitor (K-sparing diuretic)
Use: HF
S/E:
Note: Used w/ ACEIs to ↓ remodeling

37
Q

Metoprolol, carvedilol

A

Class: β blocker (metoprolol); α1 & β blocker (carvedilol)
Use: HF
S/E: See ANS section
Note:

38
Q

Nesiritide

A

Class: Recombinant BNP
Use: Acutely decompensated CHF
S/E:
Note: Recombinant human BNP; binds natriuretic peptide receptors, ↑ cGMP  vasodilation

39
Q

Nitroglycerin

A

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

40
Q

Isosorbide

A

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

41
Q

CCBs

A

Class: CCBs
Use: Angina (nifedipine important for vasospastic angina)
S/E:
Note:

42
Q

BBs, carvedilol

A

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

43
Q

Ranolazine

A

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

44
Q

Mannitol

A

Class: Osmotic diuretic
Use: Glaucoma (↓ IOP), ↓ ICP, oliguric states (e.g. rhabdomyolysis)
S/E: Acute hypovolemia
Note: IV; inhibits H2O reabsorption throughout tubule

45
Q

-zolamide

A

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

46
Q

Furosemide

A

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

47
Q

Ethacrinic Acid

A

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

48
Q

HCTZ

A

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

49
Q

Indapamide

A

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

50
Q

Spironolactone

A

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:

51
Q

Epleronone

A

Class: Aldosterone-receptor antagonist (K+-sparing diuretic)
Use: Hyperaldosteronic state, adjunct to K+-wasting diuretics, CHF
S/E: Hyperkalemia, acidosis
Note:

52
Q

Amiloride

A

Class: Na-channel blockers (K+-sparing diuretic)
Use: Adjunct to K+-wasting diuretics, lithium-induced nephrogenic diabetes insipidus (amiloride)
S/E: Hyperkalemia, acidosis
Note:

53
Q

Triamtrene

A

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:

54
Q

-statins

A

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

55
Q

Cholestyramine

A

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

56
Q

Cholestipol

A

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

57
Q

Nicain

A 
Vitamin B3
Class: Nicotinic acid-related
Use: HLD (↓ LDL, VLDL; ↑ HDL)
S/E: Flushing, pruritus, burning pain, hepatotoxicity
Note:
58
Q

-fibrates

A 
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
59
Q

Ezetimibe

A

Class: Cholesterol absorption inhibitor
Use: HLD (↓ LDL)
S/E: GI distress
Note:Prevents intestinal absorption of cholesterol

60
Q

Orlistat

A

Class: Pancreatic lipase inhibitor
Use: Weight loss
S/E: Steatorrhea, diarrhea, malabsorption of lipid-soluble vitamins
Note:

Kaplan Pharm (10 decks)

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