Week 5 Flashcards
1
Q
what drugs are alpha 2 agonist- central acting
A
Clondine and Methyldopa
2
Q
What class is clondine
A
Alpha 2 Agonist- Central Acting
3
Q
What class is methyldopa
A
Alpha 2 Agonist- Central Acting
4
Q
Route of Clonidine
A
Po/ transdermal patch
5
Q
route of methyldopa
A
PO
6
Q
mechanism of action of alpha 2 agonist (clonidine and methyldopa)
A
Activates Alpha2 receptors in medulla of the brain → decreases sympathetic tone (HR / BP)
decreases sympathetic outflow to heart, kidneys and blood vessels
7
Q
uses for clondine
A
HTN (2nd or 3rd line), ADHD, opioid withdrawal and tourettes
8
Q
uses of methyldopa
A
FIRST LINE for pregnant moms
9
Q
contraindication to clonidine
A
MI, renal function impairment, bradycardia, sinus node dysfunction
10
Q
contraindication to methyldopa
A
MI, hepatic disease, MAOI use
11
Q
side effects of clonidine
A
cognitive impairment, depression
12
Q
is clonidine and methyldopa monotherapy
A
NO
13
Q
labs to check for clonidine and methyldopa
A
liver and kidney function, can cause rebound HTN if stopped abruptly
14
Q
DDI of methyldopa and clonidine
A
NO BETA BLOCKERs, MAOIs and TCAs
15
Q
which drugs are selective alpha 1 adrenergic antagonists
A
doxazosin, prazosin, terazosin
16
Q
what class is doxazosin
A
selective alpha 1 adrenergic antagonists (original sin)
17
Q
what class is prazosin
A
- BOLDED* selective alpha 1 adrenergic antagonists
18
Q
what class is terazosin
A
selective alpha 1 adrenergic antagonists
19
Q
how do selective alpha 1 adrenergic antagonists work? (prazosin)
A
block postsynaptic alpha1 receptors in vascular smooth muscle and smooth muscle in bladder, neck, and prostate.
Decrease in arterial and venous vasoconstriction
20
Q
what are Selective Alpha 1 Adrenergic Antagonists used for?
A
HTN and BPH
21
Q
what is prazosin used for?
A
HTN but NOT BPH, also PTSD
22
Q
side effects of Selective Alpha 1 Adrenergic Antagonists (prazosin)
A
Syncope
Reflective tachycardia
Orthostatic hypotension
Intraoperative floppy iris syndrome (during cataract surgery)
Parasympathetic symptoms
23
Q
how is prazosin metabolized?
A
in the liver, but does not cause reflex tachycardia
24
Q
how to stop taking Selective Alpha 1 Adrenergic Antagonists like prazosin?
A
DO NOT STOP ABRUPTLY
25
what drugs are nonselective beta blockers
PROPANOLOL and nadolol
26
what does it mean to be a nonselective beta blocker?
blocks both beta 1 and 2
27
what class is propanolol?
nonselective beta blocker
28
what drugs are selective beta blockers?
metoprolol and atenolol
29
how do beta blockers work?
B1 blocks receptors at SA node decrease HR & contractility—
slows conduction at AV junction.
B1 blocker: reduces renin release in RAS, lowers BP: Less angiotensin II.
B2 Blocker: inhibits bronchodilation receptors in lungs— causes bronchoconstriction.
Angina: Decrease myocardial o2 demand
30
what is propanolol used for
Angina
HTN: Not first line
Post MI prophy for arrhythmia
Migraine (not acute- needs wean on & Off)
(+Angina w. Hypertrophic subaortic stenosis)
Acts on thyroid prevents conversion of t4-t3
31
contraindications of propanool
AV BLOCK
Peripheral vascular disease
1st gen Caution CHF
Asthma or other resp conditions
32
difference between metoprolol and propanolol
propanolol is nonselective (blocks B1 and B2), metoprolol works more on B1
33
uses for metoprolol
Angina
HTN: Not first line
Post MI prophy for arrhythmia
34
contraindications of metoprolol
AV BLOCK
Asthma: can be considered
35
side effects of beta blockers
Most common:
CV: Brady & Hypotension (Watch for fatigue, drowsiness, weakness), orthostatic.
Caution: DM, Masks symptoms of hypoglycemia & hyperthyroidism
-Abrupt w/d can cause:
thyroid storm, Severe angina, MI, Ventricular arrhythmia,
-CNS: anx, dep, drowsy, nightmare, AMS
-GI: motility ( Anorexia, N/V/D, Constipation,
-Decreased libido= nonadherence to med.
ALL BB WEAN ON & OFF
36
lab considerations with all betablockers
watch all renal and liver labs
37
what is considered a 3rd generation beta blocker?
CARVEDILOL, labetalol
38
how do 3rd generation betablockers differ from other generations?
Selective alpha1 and nonselective beta blockers. Decrease BP and PVR by increasing vasodilation, decreasing myocardial oxygen demand, and CO.
Alpha 1 blockage is predominant (less likely to cause brady or decrease CO and decrease the reflex vasoconstriction).
39
common uses of carvedilol
HTN
Reduce progression of heart failure
Ventricular dysfunction s/p MI
Off-label: cirrhosis, gastroesophageal varices, a-fib, and Nstemi
40
side effects of 3rd generation betablockers
Hypotension, bradycardia, bronchospasm & hypoglycemia (In DM due to masking sx)
It pt has peripheral vascular disease → may cause aggravation of arterial insufficiency.
41
contraindication of labetalol?
bronchospastic disease
42
considerations of 3rd gen beta blockers (cardivilol and labetalol)
Do not stop abruptly in CAD pts → angina exacerbation, MI, v-fib / v-tach.
Caution with bronchospastic disease (but can give)
Less likely for orthostatic hypotension and exercise-induced reflex tachycardia
43
when is 3rd gen beta blockers preferred?
preferred for HTN in pts with severely damaged hearts d/t sympathetic drive
44
what drugs are ACEIs
end in PRIL
45
what class is lisinopril?
ACEI
46
how do ACEIs work?
Angiotensin-converting enzyme (ACE) inhibitors prevent the enzyme ACE from converting angiotensin I into angiotensin II. Angiotensin II is a vasoconstrictor that can cause high blood pressure by narrowing blood vessels and releasing hormones that raise blood pressure. Captopril has the shortest half-life.
47
common use for lisinopril?
HTN, post MI, heart failure
48
contraindications of ACEIs
Bilateral renal artery stenosis, angioedema, pregnancy, hyperkalemia
49
common side effects of ACEIs
Hypotension, dizziness, fatigue, DRY HACKING COUGH, HYPERkalemia
some may cause photosensitivity, rash and neutropenia in high doses
50
who are ACEIs drug of choice for?
younger, white, diabetes, HF and MF
51
cautions and CIs for ACEIs
ANGIOEDEMA**** no ACEs to be used again (higher risk in Asian and black populations), prevents remodeling post MI,
adverse reaction usually w/i first few doses
caution with hypovolemia, hyponatremic and hepatic impairment
52
drug interactions of ACEIs
NSAIDs, OTC drugs (cold remedies), lithium , antihypertensives, nitrates, alcohol, phenothiazines
53
what drugs are ARBs (angiotensin receptor blockers?
end in SARTAN (losartan), candesartin, olmesartan, telmisaratan, valsartan
54
how do ARBS work?
Angiotensin II receptor blockers (ARBs) work by binding to and inhibiting the angiotensin II type 1 receptor (AT1). This inhibits the renin-angiotensin system, which can cause arteriolar contraction and sodium retention
55
what is lorsartan used for?
HTN, stroke reduction, diabetic nephropathy
56
caution and contraindications of losartan?
Bilateral renal artery stenosis, angioedema, pregnancy, hyperkalemia
57
side effects of losartan
Hypotension, dizziness, fatigue, photosensitivity, HYPERkalemia
58
DDI of losartan and ARBs
LOWERS INHIBITORS OF CYP450, Antacids, allopurinol, capsaicin, probenecid, rifampin, fluconazole, indomethacin, digoxin, cimetidine, phenobarbital, diuretics
59
why do people switch from ACEI to ARB
less likely to be coughing
60
what drug class is digoxin?
cardiac glycoside
61
how does digoxin work
Inhibit sodium pump
Na and Ca build up in cell
Positive inotropy
High VD in skeletal muscle
62
how is digoxin used?
Rate control AFTER BB is ineffective afib/svt
HFrEF < 40% (not first line)
63
contraindications of digoxin
Contraindicated in AV block & ventricular arrhythmias (uncontrolled)
64
side effects of digoxin
Low therapeutic index
Toxicity, low GFR
Lab levels and patient presentation
“Green halo and yellow vision”
65
how is digoxin metabolized?
kidney
66
drug interactions of digoxin
MANY- food slows absorption, (amiodarone, dilt, quindine), electrolyte abn, albumin bound
67
What drug is a class 1A anti-arrhythmic
dispyramide
68
what is disopyramide used for
VT, reduced LVEF
69
what drug is a class 1 B anti-arrhythmic
mexilente
70
what is mexilente used for
exercise induced VT
71
what drugs are class 1C anti-arrhythmic
flecainide and propafenone
72
what are flecainide and propafenone used for?
anti-arrhythmic for ppl who dont respond to less toxic drugs, AF/VT and VF
73
what drug is a class 2 anti-arrhythmic
propanolol (also beta blocker)
74
what is propanolol used for in the sense of anti-arrhythmic
SVT
75
what drugs are class 3 anti-arrhythmic
amiodarone, dronedarone and sotalol
76
what is amiodarone used for
SVT and VT
77
what is dronedarone used for
AF (not long term)
78
what's sotalol used for
beta blocker also used for VT
79
what drugs are class 4 anti-arrhythmic
diltiazem and verapamil (also CCB)
80
what are dilt and verapamil used for in sense of anti-arrhythmic
rate control, reentry SVT and AF
81
what class is hydralazine
acts on NO2
82
what drug acts on NO2
hydralazine
83
what drug is a K channel stimulator
minoxidil
84
what class is minoxidil
K channel stimulator
85
how does hydralazine and minoxidil work?
Peripheral vasodilator: direct dilation of arteriolar smooth muscle decreased PVR
Do not dilate Coronaries
Do not relax venous smooth muscle
86
used for hydralazine and minoxidil
HTN (not first line) and PVD
87
contraindications of hydralazine and minoxidil
caution of CVD, PAH, does not dilate coronary arteries
88
side effects of minoxidil and hydralazine
Decreased peripheral and pulmonary vascular resistance
Tachycardia + increased contractility
Water retention
HA
tachyphylaxis
Does not cause orthostatics and ED like most other antihypertensives.
89
which drugs are dihydropyridine CCBs?
nifedipine, amlodipine, felodipine
90
how do CCBs work?
binding to and blocking the L-type calcium channels in the heart, vascular smooth muscle, and pancreas, preventing calcium from entering the cells.
Calcium is necessary for the muscular linings of blood vessels to contract, and for the heart's muscle to contract
91
what drugs are non-dihydropyridine CCBs?
verapamil and diltiazem
92
what is nifedipine used for
Angina, HTN, Raynaud’s
93
what is verapamil used for?
HTN, angina and a. Fib rate control, SVT, migraine prophy, antiarrhythmic!
93
what is amlodipine used for
HTN, angina
94
what is diltiazem used for?
Angina, HTN, esophageal spasm, Antiarrhythmic!
95
what are contraindications of dihyrdopyridine CCBs?
(nifidepine, amlodipine)- cause peripheral edema, reflex tachycardia
96
what are contraindications of non-dihydropyridine CCBs?
(verapamil and diltiazem)- Avoided in HF, can worsen bradycardia, no WPW syndrome patients
97
side effects of dihydropyridine CCBs
Reduction in BP causes dizziness, headache, hypotension, syncope, GI symptoms, hyperglycemia, photosensitivity
98
side effects of non-dihydropyridine (Verapamil)
Constipation, Bradycardia, Heart Block
99
side effects of non-dihydropyridine
Photosensitivity, Bradycardia, Heart Block
100
what drugs are thiazide diuretics?
hydrocholorthiazide, chlorothalidone and metolazone
101
drug interactions of most CCBs
CYP3A4 involved in metabolism: GRAPEFRUIT JUICE, additive effect with other hypertensives, watch NSAIDs
102
what class is hydrochlorothiazide?
thiazide diuretics
103
what is the mechanism of action of thiazide?
Distal renal tubule to inhibit sodium reabsorption (longer lasting and cause less brisk diuresis)
Decreases plasma volume, and CO. (though effects return to baseline, Peripheral vascular resistance remains ([mechanism unknown]).
104
What is hydrochlorothiazide used for?
HF, HTN (first line)
105
contraindications of hydrocholorthiazide?
hypokalemia, gout/renal calculi and hyperuricemia
106
side effects of hydrochlorothiazide?
Electrolyte imbalance, photosensitivity, hypotension, severe hyponatremia, hyperglycemia, GI upset, tinnitus/hearing loss
107
DDI with hydrochlorothiazide
drugs that decrease BP, avoid using with ACEi and ARB
108
what drugs are loop diuretics?
furosemide and bumetanide
109
how do loop diuretics work?
Inhibit Na reabsorption in ascending loop of henle
(short acting and cause large natriuresis)
Decreases plasma volume, and CO. (though effects return to baseline, Peripheral vascular resistance remains ([mechanism unknown]).
110
what is lasix and bumex used for
HF and HTN
111
side effects of lasix/bumex
Electrolyte imbalance, photosensitivity, hypotension, severe hyponatremia, hyperglycemia, GI upset, tinnitus/hearing loss
112
what drugs are potassium sparing diuretics?
spironolactone and amiloride
113
how does spironolactone work?
Inhibit excretion of potassium distally
Decreases plasma volume, and CO. (though effects return to baseline, Peripheral vascular resistance remains ([mechanism unknown]).
114
what are all diuretics used for (context of this week)
HF, HTN
115
c/i of spironolactone
hyperkalemia
116
side effects of spironolactone
Gynecomastia (50%)
Electrolyte imbalance (HYPERk)
In pts with gout → hyperuricemia
Hypotension
Occasional GI upset (take meal)
Tinnitus/ hearing loss
117
which drugs cause hyperkalemia
ACEi, ARB, renin inhibitors
118
what drug may cause lower extremity edema and constipation
amlodipine
119
which beta blocker is known to reduce mortality and HF
carvedilol
120
what is most accurate about the mechanism of furosemide when being used to induced diuresis in a patient with edema or fluid overload
Antagonizes Na+/K+/2Cl- transporter, which then blocks about 20 to 30% of sodium reabsorption by the nephron
121
what MOA applies to digoxin
Inhibits the sodium potassium ATP pump in the cardiac myocyte leading to an increase in the force of contraction
122
Which anti-rhythmic agents should generally be avoided in heart failure because of their inability to prevent cardiac remodeling
diltiazem
123
Which ECG abnormalities is most likely to occur in with the use of amiodarone or sotalol, especially in patients with hypokalemia
QT prolongation
124
which diuretic agents typically do not need potassium supplementation
aldosterone inhibitors
125
when should diuretics be taken?
upon awakening
126
how does chronic use of BB treat HTN
Reducing peripheral vascular resistance
127
What dermatological issue is linked to amiodarone?
Progressive change of skin tone toward a blue spectrum wtf
128
consequences of rapid BB withdrawal
angina and coronary artery disease
