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Details

Med Pharm Fall Final
CHF etc.
188
Pharmacology
Professional
10/25/2013

Additional Pharmacology Flashcards

 


 

Cards

Term
Acetazolamide (Diamox)
Definition

PROTOTYPE

Diuretic

Carbonic Anhydrase Inhibitor

Uses: Glaucoma (systemic), Urinary Alkalization, Metabolic Alkalosis, acute mountain sickness, seizure disorder (adjuvant)

Mechanism: Block CA in lumenal membrane in proximal tubule blockin bicarb reabsorption -> reduced H+ availability for Na/H exchange (NHE3) -> Increase Na "loss" to lumen -> Na/K exchanged in Distal Tubule -> K loss

Effects: Bicarb loss , urine alkalization, hyperchloremic metabolic acidosis, decreased CSF and aqueous humor, effectiveness decreases within days

Pharmacokinetics: oral admin., 30 min for effect, renal excretion so decrease dose if renal insufficient

Toxicity: hyperchloremic metabolic acidosis, renal stones, K wasting

Contraindication: cirrhosis, sulfa allergies


Term
Dichlorphenamide (Daranide)
Definition

Diuretic (not bolded)

Carbonic Anhydrase Inhibitor

Uses: Urinary Alkalization, Metabolic Alkalosis, acute mountain sickness, seizure disorder (adjuvant)

Mechanism: Block CA in lumenal membrane in proximal tubule blockin bicarb reabsorption -> reduced H+ availability for Na/H exchange (NHE3) -> Increase Na "loss" to lumen -> Na/K exchanged in Distal Tubule -> K loss

Effects: Bicarb loss , urine alkalization, hyperchloremic metabolic acidosis, decreased CSF and aqueous humor, effectiveness decreases within days

Pharmacokinetics: oral admin., 30 min for effect, renal excretion so decrease dose if renal insufficient

Toxicity: hyperchloremic metabolic acidosis, renal stones, K wasting

Contraindication: cirrhosis, sulfa allergies

 
Term
Methazolamide (Neptazane)
Definition

Diuretic (not bolded)

Carbonic Anhydrase Inhibitor

Uses: Urinary Alkalization, Metabolic Alkalosis, acute mountain sickness, seizure disorder (adjuvant)

Mechanism: Block CA in lumenal membrane in proximal tubule blockin bicarb reabsorption -> reduced H+ availability for Na/H exchange (NHE3) -> Increase Na "loss" to lumen -> Na/K exchanged in Distal Tubule -> K loss

Effects: Bicarb loss , urine alkalization, hyperchloremic metabolic acidosis, decreased CSF and aqueous humor, effectiveness decreases within days

Pharmacokinetics: oral admin., 30 min for effect, renal excretion so decrease dose if renal insufficient

Toxicity: hyperchloremic metabolic acidosis, renal stones, K wasting

Contraindication: cirrhosis, sulfa allergies

 
Term
Brinzolamide (Azopt) topical
Definition

Diuretic (not bolded)

Carbonic Anhydrase Inhibior

Uses: Glaucoma (topical), Urinary Alkalization, Metabolic Alkalosis, acute mountain sickness, seizure disorder (adjuvant)

Mechanism: Block CA in lumenal membrane in proximal tubule blockin bicarb reabsorption -> reduced H+ availability for Na/H exchange (NHE3) -> Increase Na "loss" to lumen -> Na/K exchanged in Distal Tubule -> K loss

Effects: Bicarb loss , urine alkalization, hyperchloremic metabolic acidosis, decreased CSF and aqueous humor, effectiveness decreases within days

Pharmacokinetics: oral admin., 30 min for effect, renal excretion so decrease dose if renal insufficient

Toxicity: hyperchloremic metabolic acidosis, renal stones, K wasting

Contraindication: cirrhosis, sulfa allergies

 
Term
Dorzolamide (Trusopt) topical
Definition

Diuretic (not bolded)

Carbonic Anhydrase Inhibitor

Uses: Glaucoma (topical), Urinary Alkalization, Metabolic Alkalosis, acute mountain sickness, seizure disorder (adjuvant)

Mechanism: Block CA in lumenal membrane in proximal tubule blockin bicarb reabsorption -> reduced H+ availability for Na/H exchange (NHE3) -> Increase Na "loss" to lumen -> Na/K exchanged in Distal Tubule -> K loss

Effects: Bicarb loss , urine alkalization, hyperchloremic metabolic acidosis, decreased CSF and aqueous humor, effectiveness decreases within days

Pharmacokinetics: oral admin., 30 min for effect, renal excretion so decrease dose if renal insufficient

Toxicity: hyperchloremic metabolic acidosis, renal stones, K wasting

Contraindication: cirrhosis, sulfa allergies

 
Term
Furosamide (lasix)
Definition

PROTOTYPE

Loop Diuretic (sulfonamide)

Uses: CHF, Pulmonary Edema, impaired renal function; 

Mechanism: Block NKCC2 in thick ascending limb (medullary) -> decreased Na and Cl reabsorption -> loss of K (Na exchanged), Cl and H20

Effects: Mg and Ca excretion,  hypochloremic hypokalemic alkalosis (K loss, no Na for H+ exchange), diminished lumen positive potential (less H+), induce PG synthesis, relieve pulmonary congestion by increasing systemic venous compliance

Pharmacokinetics: Oral, 30-60 min till onset, renal excretion

Toxicities: hypokalemic metabolic alkalosis, hypocalcemia and hypomagnesemia, hyperuricemia, ototoxicity

Drug interactions: aminoglycosides (enhanced ototoxicity), lithium (loss of Na+ increases Li+ retention, ↑ toxicity), digoxin (loss of potassium ↑ toxicity) 

 

Term
Bumetanide (Bumex)
Definition

Loop Diuretic (sulfonamide)(not bolded)

Loop Diuretic (sulfonamide)

Uses: CHF, Pulmonary Edema, impaired renal function; 

Mechanism: Block NKCC2 in thick ascending limb (medullary) -> decreased Na and Cl reabsorption -> loss of K (Na exchanged), Cl and H20

Effects: Mg and Ca excretion,  hypochloremic hypokalemic alkalosis (K loss, no Na for H+ exchange), diminished lumen positive potential (less H+), induce PG synthesis, relieve pulmonary congestion by increasing systemic venous compliance

Pharmacokinetics: Oral, 30-60 min till onset, renal excretion

Toxicities: hypokalemic metabolic alkalosis, hypocalcemia and hypomagnesemia, hyperuricemia, ototoxicity

Drug interactions: aminoglycosides (enhanced ototoxicity), lithium (loss of Naincreases Liretention, ↑ toxicity), digoxin (loss of potassium ↑ toxicity) 

 

Term
Torsemide (Demadex)
Definition

Loop Diuretic (sulfonamide)(not bolded)

Loop Diuretic (sulfonamide)

Uses: CHF, Pulmonary Edema, impaired renal function; 

Mechanism: Block NKCC2 in thick ascending limb (medullary) -> decreased Na and Cl reabsorption -> loss of K (Na exchanged), Cl and H20

Effects: Mg and Ca excretion,  hypochloremic hypokalemic alkalosis (K loss, no Na for H+ exchange), diminished lumen positive potential (less H+), induce PG synthesis, relieve pulmonary congestion by increasing systemic venous compliance

Pharmacokinetics: Oral, 30-60 min till onset, renal excretion

Toxicities: hypokalemic metabolic alkalosis, hypocalcemia and hypomagnesemia, hyperuricemia, ototoxicity

Drug interactions: aminoglycosides (enhanced ototoxicity), lithium (loss of Naincreases Liretention, ↑ toxicity), digoxin (loss of potassium ↑ toxicity) 

 

Term
Ethacrynic Acid (Edecrin)
Definition

Loop diuretic (aryloxyacetic acid derivative)(not bolded)

Loop Diuretic (sulfonamide)

Uses: CHF, Pulmonary Edema, impaired renal function, pts allergic to sulfonamide diuretics

Mechanism: Block NKCC2 in thick ascending limb (medullary) -> decreased Na and Cl reabsorption -> loss of K (Na exchanged), Cl and H20

Effects: Mg and Ca excretion,  hypochloremic hypokalemic alkalosis (K loss, no Na for H+ exchange), diminished lumen positive potential (less H+), induce PG synthesis, relieve pulmonary congestion by increasing systemic venous compliance

Pharmacokinetics: Oral, 30-60 min till onset, renal excretion

Toxicities: hypokalemic metabolic alkalosis, hypocalcemia and hypomagnesemia, hyperuricemia, ototoxicity (HIGHER RISK)

Drug interactions: aminoglycosides (enhanced ototoxicity), lithium (loss of Naincreases Liretention, ↑ toxicity), digoxin (loss of potassium ↑ toxicity) 

 

Term
Hydrochlorothiazide (Esidrix)
Definition

Prototype

Thiazide diuretic

Uses: HTN, CHF, Nephrolithiasis, nephrogenic diabetes insipidus

Mechanism: Distal convoluted tubule, blocks NCC (Na/Cl cotransporter), inhibits Na and Cl reabsoprtion; effect depends on PG synthesis and can be inhibited by NSAIDS

Effects: Increased ATP dependent K channel opening, hypokalemia, hyperuricemia (decreased uric acid excretion), decreased Ca excretion, Mg loss, iodide and bromide loss, hyperglycemia

Pharmacokinetics: oral, excreted by organic acid secreting system (uric acid competition)

Toxicities/Adverse effects: hypokalemia, hyperglycemia and carb intolerance, hyperuricemia, increased lipid levels, hypercalcemia, allergic rxn, photosensitivity, increased lithium tox, aggravated jaundice in adults 

Term
Chlorthalidone (Hygroton)
Definition

Thiazide-related diuretic

Uses: HTN, CHF, Nephrolithiasis, nephrogenic diabetes insipidus

Pharmacokinetics: slowly absorbed so longer duration, oral, excreted by organic acid secreting system (uric acid competition)

Mechanism: Distal convoluted tubule, blocks NCC (Na/Cl cotransporter), inhibits Na and Cl reabsoprtion; effect depends on PG synthesis and can be inhibited by NSAIDS

Effects: Increased ATP dependent K channel opening, hypokalemia, hyperuricemia (decreased uric acid excretion), decreased Ca excretion, Mg loss, iodide and bromide loss, hyperglycemia

Pharmacokinetics: oral, excreted by organic acid secreting system (uric acid competition)

Toxicities/Adverse effects: hypokalemia, hyperglycemia and carb intolerance, hyperuricemia, increased lipid levels, hypercalcemia, allergic rxn, photosensitivity, increased lithium tox, aggravated jaundice in adults 

Term
Indapamide (Lozol)
Definition

Thiazide-related diuretic

Uses: HTN, CHF, Nephrolithiasis, nephrogenic diabetes insipidus

Pharmacokinetics: oral, excreted by biliary system so good for pts with renal insufficiency, extensive hepatic metabolism

Effects: Does not increase lipid levels, pronounced vasodilation, Increased ATP dependent K channel opening, hypokalemia, hyperuricemia (decreased uric acid excretion), decreased Ca excretion, Mg loss, iodide and bromide loss, hyperglycemia

Mechanism: Distal convoluted tubule, blocks NCC (Na/Cl cotransporter), inhibits Na and Cl reabsoprtion; effect depends on PG synthesis and can be inhibited by NSAIDS

Effects: Increased ATP dependent K channel opening, hypokalemia, hyperuricemia (decreased uric acid excretion), decreased Ca excretion, Mg loss, iodide and bromide loss, hyperglycemia

Pharmacokinetics: oral, excreted by organic acid secreting system (uric acid competition)

Toxicities/Adverse effects: hypokalemia, hyperglycemia and carb intolerance, hyperuricemia, hypercalcemia, allergic rxn, photosensitivity, increased lithium tox, aggravated jaundice in adults 

Term
Chlorothiazide (Diuril)
Definition

Thiazide diuretic (not bolded)

Uses: HTN, CHF, Nephrolithiasis, nephrogenic diabetes insipidus

Mechanism: Distal convoluted tubule, blocks NCC (Na/Cl cotransporter), inhibits Na and Cl reabsoprtion; effect depends on PG synthesis and can be inhibited by NSAIDS

Effects: Increased ATP dependent K channel opening, hypokalemia, hyperuricemia (decreased uric acid excretion), decreased Ca excretion, Mg loss, iodide and bromide loss, hyperglycemia

Pharmacokinetics: oral, excreted by organic acid secreting system (uric acid competition)

Toxicities/Adverse effects: hypokalemia, hyperglycemia and carb intolerance, hyperuricemia, increased lipid levels, hypercalcemia, allergic rxn, photosensitivity, increased lithium tox, aggravated jaundice in adults 

Term
Bendroflumethiazide (Naturetin)
Definition

Thiazide diuretic (not bolded)

Uses: HTN, CHF, Nephrolithiasis, nephrogenic diabetes insipidus

Mechanism: Distal convoluted tubule, blocks NCC (Na/Cl cotransporter), inhibits Na and Cl reabsoprtion; effect depends on PG synthesis and can be inhibited by NSAIDS

Effects: Increased ATP dependent K channel opening, hypokalemia, hyperuricemia (decreased uric acid excretion), decreased Ca excretion, Mg loss, iodide and bromide loss, hyperglycemia

Pharmacokinetics: oral, excreted by organic acid secreting system (uric acid competition)

Toxicities/Adverse effects: hypokalemia, hyperglycemia and carb intolerance, hyperuricemia, increased lipid levels, hypercalcemia, allergic rxn, photosensitivity, increased lithium tox, aggravated jaundice in adults 

Term
Metolazone (Mykrox)
Definition

Thiazide-related diuretic (not bolded)

Uses: HTN, CHF, Nephrolithiasis, nephrogenic diabetes insipidus

Effects: Increases diuresis in pts with decreased GFR Increased ATP dependent K channel opening, hypokalemia, hyperuricemia (decreased uric acid excretion), decreased Ca excretion, Mg loss, iodide and bromide loss, hyperglycemia

Mechanism: Distal convoluted tubule, blocks NCC (Na/Cl cotransporter), inhibits Na and Cl reabsoprtion; effect depends on PG synthesis and can be inhibited by NSAIDS

Effects: Increased ATP dependent K channel opening, hypokalemia, hyperuricemia (decreased uric acid excretion), decreased Ca excretion, Mg loss, iodide and bromide loss, hyperglycemia

Pharmacokinetics: oral, excreted by organic acid secreting system (uric acid competition)

Toxicities/Adverse effects: hypokalemia, hyperglycemia and carb intolerance, hyperuricemia, increased lipid levels, hypercalcemia, allergic rxn, photosensitivity, increased lithium tox, aggravated jaundice in adults 

Term
Hydroflumethiazide (Saluron)
Definition

Thiazide diuretic (not bolded)

Uses: HTN, CHF, Nephrolithiasis, nephrogenic diabetes insipidus

Mechanism: Distal convoluted tubule, blocks NCC (Na/Cl cotransporter), inhibits Na and Cl reabsoprtion; effect depends on PG synthesis and can be inhibited by NSAIDS

Effects: Increased ATP dependent K channel opening, hypokalemia, hyperuricemia (decreased uric acid excretion), decreased Ca excretion, Mg loss, iodide and bromide loss, hyperglycemia

Pharmacokinetics: oral, excreted by organic acid secreting system (uric acid competition)

Toxicities/Adverse effects: hypokalemia, hyperglycemia and carb intolerance, hyperuricemia, increased lipid levels, hypercalcemia, allergic rxn, photosensitivity, increased lithium tox, aggravated jaundice in adults 

Term
Methyclothiazide (Enduron)
Definition

Thiazide diuretic (not bolded)

Uses: HTN, CHF, Nephrolithiasis, nephrogenic diabetes insipidus

Mechanism: Distal convoluted tubule, blocks NCC (Na/Cl cotransporter), inhibits Na and Cl reabsoprtion; effect depends on PG synthesis and can be inhibited by NSAIDS

Effects: Increased ATP dependent K channel opening, hypokalemia, hyperuricemia (decreased uric acid excretion), decreased Ca excretion, Mg loss, iodide and bromide loss, hyperglycemia

Pharmacokinetics: oral, excreted by organic acid secreting system (uric acid competition)

Toxicities/Adverse effects: hypokalemia, hyperglycemia and carb intolerance, hyperuricemia, increased lipid levels, hypercalcemia, allergic rxn, photosensitivity, increased lithium tox, aggravated jaundice in adults 

Term
Polythiazide (Renese)
Definition

Thiazide diuretic (not bolded)

Uses: HTN, CHF, Nephrolithiasis, nephrogenic diabetes insipidus

Mechanism: Distal convoluted tubule, blocks NCC (Na/Cl cotransporter), inhibits Na and Cl reabsoprtion; effect depends on PG synthesis and can be inhibited by NSAIDS

Effects: Increased ATP dependent K channel opening, hypokalemia, hyperuricemia (decreased uric acid excretion), decreased Ca excretion, Mg loss, iodide and bromide loss, hyperglycemia

Pharmacokinetics: oral, excreted by organic acid secreting system (uric acid competition)

Toxicities/Adverse effects: hypokalemia, hyperglycemia and carb intolerance, hyperuricemia, increased lipid levels, hypercalcemia, allergic rxn, photosensitivity, increased lithium tox, aggravated jaundice in adults 

Term
Quinethazone (Hydromox)
Definition

Thiazide-related diuretic (not bolded)

Uses: HTN, CHF, Nephrolithiasis, nephrogenic diabetes insipidus

Mechanism: Distal convoluted tubule, blocks NCC (Na/Cl cotransporter), inhibits Na and Cl reabsoprtion; effect depends on PG synthesis and can be inhibited by NSAIDS

Effects: Increased ATP dependent K channel opening, hypokalemia, hyperuricemia (decreased uric acid excretion), decreased Ca excretion, Mg loss, iodide and bromide loss, hyperglycemia

Pharmacokinetics: oral, excreted by organic acid secreting system (uric acid competition)

Toxicities/Adverse effects: hypokalemia, hyperglycemia and carb intolerance, hyperuricemia, increased lipid levels, hypercalcemia, allergic rxn, photosensitivity, increased lithium tox, aggravated jaundice in adults 

Term
Spironolactone (Aldactone)
Definition

Prototype

K-sparing diuretic

Uses: Edema from CHF cirrhosis or nephrotic syndrome, hyperaldosteronism, 

Mechanism: @Collecting tubule, aldosterone inhibitor decreases Na reabsorption, increases Na excretion, promotes K reabsorption; binds glucocorticoid and sex hormone receptors at high doses

Toxicities: gynecomastia, occasional hyperkalemia

Term
Eplerenone (Inspra)
Definition

K-sparing diuretic

Uses: Edema from CHF cirrhosis or nephrotic syndrome, hyperaldosteronism, 

Mechanism:@collecting tubule, selective aldosterone receptor antagonist (SARA) decreases Na reabsorption, increases Na excretion, promotes K reabsorption; LESS ENDOCRINE RELATED SIDE EFFECTS

Toxicity: increased hyperkalemia risk

NOTE: reduced all-cause mortality in for patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure 

Term
Triamterene (Dyrenium)
Definition

K-sparing diuretic

Uses: main use is in combination with potassium losing diuretics, Edema from CHF cirrhosis or nephrotic syndrome,

Mechanism: @collecting tubule, Direct Na influx inhibitor

Toxicities: Hyperkalemia, inhibits dihydrofolate reductase

Should not be given with spironolactone

Term
Amiloride (Midamor)
Definition

K-sparing diuretic

Uses: DOC for lithium induce diabetes insipidus, main use is in combination with potassium losing diuretics, Edema from CHF cirrhosis or nephrotic syndrome,

Mechanism: @collecting tubule, Direct Na influx inhibitor

Pharmacokinetics: weak diuretic effect, oral administration, absorption from G.I. tract is rapid, excreted in the urine, action is not significantly affected by either acidosis or alkalosis 

Toxicities: Hyperkalemia,

Term
Mannitol
Definition

PROTOTYPE
Osmotic Diuretic
Mechanism: filtered but not absorbed in kidney, keeps water in tubule causing diuresis

 

Pharmacokinetics: only given IV, if given orally causes diarrhea
Uses: ARF prophylaxis, decrease IO pressure (eye surgery), decrease IC pressure (brain hemorrhage), decrease CSF, protect kidney from nephrotoxic substances 
Term
Isosorbide (Ismotic)
Definition

Osmotic Diuretic (not bolded)
Mechanism: filtered but not absorbed in kidney, keeps water in tubule causing diuresis

 

Pharmacokinetics: only given IV, if given orally causes diarrhea
Uses: ARF prophylaxis, decrease IO pressure (eye surgery), decrease IC pressure (brain hemorrhage), decrease CSF, protect kidney from nephrotoxic substances 
Term
Glycerin (Osmoglyn)
Definition

Osmotic Diuretic (not bolded)
Mechanism: filtered but not absorbed in kidney, keeps water in tubule causing diuresis

 

Pharmacokinetics: only given IV, if given orally causes diarrhea
Uses: ARF prophylaxis, decrease IO pressure (eye surgery), decrease IC pressure (brain hemorrhage), decrease CSF, protect kidney from nephrotoxic substances 
Term
Urea (Ureaphil)
Definition

Osmotic Diuretic (not bolded)
Mechanism: filtered but not absorbed in kidney, keeps water in tubule causing diuresis

 

Pharmacokinetics: only given IV, if given orally causes diarrhea
Uses: ARF prophylaxis, decrease IO pressure (eye surgery), decrease IC pressure (brain hemorrhage), decrease CSF, protect kidney from nephrotoxic substances 
Term
Max. Diuretic Effect in order
Diuretic Combos
Definition

 

loop >> thiazides >> CA inhibitors > K+ sparing 

 loop agents & thiazides may produce diuresis when none of them is effective alone

potassium sparing diuretics & loop agents or thiazides may balance out potassium losses 

Term
Vasopressin
Definition

ADH agonist (anti-diuretic)

Uses:  to prevent or control polyuria, polydipsia, and dehydration in patients with central diabetes insipidus 

intravenous vasopressin is included in the Advanced Cardiac Life Support (ACLS)

algorithm as an alternative to epinephrine for the treatment of cardiac arrest associated with asystole or pulseless electrical activity 

Term
Desmopressin
Definition

ADH agonist (anti-diuretic)

Uses: Hemophilia A and von Willebrand disease and used in the treatment of bleeding esophagus varices 

Pharmacokinetics: more potent and longer lasting than vasopressin; works on V2 and has hemostatic properties

 

Term
Conivaptan (Vaprisol)
Definition

Diuretic, ADH antagonist

Uses: CHF, SIADH

Pharmacokinetics: V1, V2 action (vasopressin receptors)

Effects: Increases urine output, decreases H2O reabsorption

 

Term
Tolvaptan (Samsca)
Definition

Diuretic, ADH antagonist

Uses: CHF, SIADH

Pharmacokinetics: V1, V2 action (vasopressin receptors)

Effects: Increases urine output, decreases H2O reabsorption

Term
Demeclocycline (Declomycin)
Definition

Diuretic, ADH antagonist

tetracyclic abx

produces a nephrogenic diabetes insipidus by uncoupling the V2 receptor from adenylyl cyclase enzyme

Less toxic than lithium 

Term
Lithium
Definition

 Diuretic, ADH antagonist

produces a nephrogenic diabetes insipidus by uncoupling the

V2 receptor from adenylyl cyclase enzyme 

More toxic than demeclocycline

Term
What are the 4 effects desired for CHF treatment?
What drugs facilitate these?
Definition
  1. Reduce Preload - diuretic and venodilator
  2. Reduce Afterload - Arteriodilator
  3. Increase Contractility - inotropic drug
  4. Decrease HR (energy expenditure) - B-blockers
Term
Digoxin (Lanoxin)
Definition

CHF drug

Cardiac Glycoside

Use: CHF

Mechanism: inhibits Na/K ATPase -> increases free Ca concetration; Increases intracellular Na concenctration whil decreasing Ca expulsion

Effects: Increases contractilty by increasing interaction of actin and myosin

Given oral or IV; narrow margin of safety

Calsium enhances digitals toxicity; Potassium (competititive) and Magnesium decrease toxicity

Toxicities: earliest seen in GI i.e. anorexia, nausea, diarrhea etc;  most dangerous are cardiac toxicities = arrhythmias including sinus brady, ectopic v-beats, AV block, bigeminy, v-fib

Tx for toxicity: discontinue, K (oral or IV), lidocaine, phenytoin, propranolol, digitalis immune Fab

Term
Inamrinone (Inocor)
Definition

Prototype

CHF drug

Phosphodiesterase Inhibitor (bipyridine); inodilator

Uses: CHF when digitalis, vasodilators and diuretic are ineffective (must monitor closely in hosptial)

Mechanism: inhibit phosphodiesterase, increasing cAMP -> increased Ca influx -> vasodilation + increased contractility

Effect: increases CO, decreases survival

Route: IV

Term
Milrinone (Primacor)
Definition

CHF drug (not bolded)

Phosphodiesterase Inhibitor (bipyridine); inodilator

Uses: CHF when digitalis, vasodilators and diuretic are ineffective (must monitor closely in hosptial)

Mechanism: inhibit phosphodiesterase, increasing cAMP -> increased Ca influx -> vasodilation + increased contractility

Effect: increases CO, decreases survival

Route: IV

Term
Dobutamine (Dobutrex)
Definition
  • Sympathomimetic (not bolded)
  • Uses: Acute Heart Failure
  • selective beta-1 agonist
  • positive inotropic effect, somewhat less tachycardia
  • increased oxygen consumption
  • IV administration 
Term
Dopamine (Intropin)
Definition

Sympathomimetic (Not bolded)

Use: Acute Heart failure

Mechanism: Direct inotropic effect; increases CO and renal bf

Given IV

Effects: lowers peripheral resistance, increases Na excretion

Term
Nesiritide (Natrecor)
Definition

CHF Drug

B type natriuretic peptide (hBNP)

 Use: acute tx of decompensated CHF

No tolerance like w/ nitorglycerin

given IV

Monitor closesly for hypotension

Term
Captopril (Capoten)
Definition

Prototype

ACE inhibitor

Uses: CHF

 decreasing afterload (decreased peripheral resistance) from decreasing angiotensin-vasoconstriction

decreasing preload - decreases aldosterone release 

Term
Enalapril (Vasotec)
Definition

ACE inhibitor

Uses: CHF

 decreasing afterload (decreased peripheral resistance) from decreasing angiotensin-vasoconstriction

decreasing preload - decreases aldosterone release 

Term
Fosinopril (Monopril)
Definition

ACE inhibitor (not bolded)

Uses: CHF

 decreasing afterload (decreased peripheral resistance) from decreasing angiotensin-vasoconstriction

decreasing preload - decreases aldosterone release 

Term
Lisinopril (Zestril)
Definition

ACE inhibitor (not bolded)

Uses: CHF

 decreasing afterload (decreased peripheral resistance) from decreasing angiotensin-vasoconstriction

decreasing preload - decreases aldosterone release 

Term
Quinapril (Accupril)
Definition

ACE inhibitor (not bolded)

Uses: CHF

 decreasing afterload (decreased peripheral resistance) from decreasing angiotensin-vasoconstriction

decreasing preload - decreases aldosterone release 

Term
Ramipril (Altace)
Definition

ACE inhibitor (not bolded)

Uses: CHF

 decreasing afterload (decreased peripheral resistance) from decreasing angiotensin-vasoconstriction

decreasing preload - decreases aldosterone release 

Term
Metoprolol (Lopressor)
Definition

Prototype

Beta-blocker

Use: CHF, angina

Effects: reduce renin, decreases catecholamine effect, decrease HR, 

Dangerous due to decrease inotropic effect but decreases mortality

Antiarrhythmic effect; no coronary vasodilatory effect

Term
Bisoprolol (Zebeta)
Definition

Beta blocker (not bolded)

Use: CHF, angina

Effects: reduce renin, decreases catecholamine effect, decrease HR, 

Dangerous due to decrease inotropic effect but decreases mortality

Antiarrhythmic effect; no coronary vasodilatory effect

Term
Carvedilol (Coreg)
Definition

Beta-blocker (not bolded)

Use: CHF, angina

Effects: reduce renin, decreases catecholamine effect, decrease HR, 

Dangerous due to decrease inotropic effect but decreases mortality

Antiarrhythmic effect; no coronary vasodilatory effect

Term
Sodium nitroprusside (Nitropress)
Definition

Vasodilator

Uses: CHF

Given IV, dilates veins and arteries, decreases preload and afterload

Term
Hydralazine (Apresoline)
Definition

Vasodilator

Uses: CHF

Effect: arterial vasodilator, decreases peripheral resistance

Term
Isosorbide dinitrate (Isordil)
Definition

Vasodilator

Uses: CHF

Given orally

Lowers preload more than afterload; tolerance occurs

Term
Quinidine (Quinora)
Definition

Prototype

Class IA Antiarrhythmic

Uses: every arrhythmia, a-fib/flutter, V-tach

Mechanism: binds open and activated Na channels; decreased automaticity, increased diastolic threshold, slows rate of rise of AP, prolonged AP duration prolonging Effective Refractory Period (ERP) -> preventing re-entry circuit; blocking K channels (prolongs depolarization)

Other Effects: muscarinic receptor blockade (increases HR and AV conduction), wide QRS and QT interval, SA and AV block; blocks alpha receptors (hypotension) -> reflex tachy (maybe); cinchonism (tinnitus, headache, vertigo, allergy)

Pharmacokinetics: oral, first pass effect, T1/2 = 6 hr

Toxicity: low therapeutic index, cardiac toxicity, severe hypotension (alpha block); diarrhea

Term
Procainamide (Pronestyl)
Definition

Class IA Antiarrhythmic

Uses: every arrhythmia, a-fib/flutter, V-tach

Mechanism: binds open and activated Na channels; decreased automaticity, increased diastolic threshold, slows rate of rise of AP, prolonged AP duration prolonging Effective Refractory Period (ERP) -> preventing re-entry circuit; blocking K channels (prolongs depolarization)

Other Effects: muscarinic receptor blockade (less than quinidine, increases HR and AV conduction), wide QRS and QT interval, SA and AV block; blocks alpha receptors (hypotension) -> reflex tachy (maybe); cinchonism (tinnitus, headache, vertigo, allergy)

Pharmacokinetics: oral, first pass effect, metabolite has class III effect (K channel block), T1/2 = 3-4 hr

Toxicity: lupus erythematosus, low therapeutic index, cardiac toxicity, severe hypotension (alpha block); diarrhea

Term
Disopyramide (Norpace)
Definition

Prototype

Class IA Antiarrhythmic

Uses: ONLY V-ARRHYTHMIAS

Mechanism: binds open and activated Na channels; decreased automaticity, increased diastolic threshold, slows rate of rise of AP, prolonged AP duration prolonging Effective Refractory Period (ERP) -> preventing re-entry circuit; blocking K channels (prolongs depolarization)

Other Effects: negative inotropic effect, anticholinergic effect (dry mouth etc.); muscarinic receptor blockade (increases HR and AV conduction), wide QRS and QT interval, SA and AV block; blocks alpha receptors (hypotension) -> reflex tachy (maybe); cinchonism (tinnitus, headache, vertigo, allergy)

Pharmacokinetics: oral, first pass effect, T1/2 = 6 hr

Toxicity: low therapeutic index, cardiac toxicity, severe hypotension (alpha block); diarrhea

Term
Lidocaine (Xylocaine)
Definition

Prototype

Class IB Antiarrhythmic

Use: V-arrhythmias

Mechanism: Binds inactivated sodium channels, decreases AP duration, shorten ERP due to block of slow Na "window" currents

Effects: not for supraventricular arrhytmias, no depressant action on contractility, no vagal blocking

Pharmacokinetics: IV (NOT oral)

Toxicity: convulsion, negative inotropic effect (least of all the antiarrhythmics) aka brady

Term
Phenytoin (Dilantin)
Definition

Not bolded

Class IB Antiarrhythmic

Use: V-arrhythmias

Mechanism: Binds inactivated sodium channels, decreases AP duration, shorten ERP due to block of slow Na "window" currents

Effects: not for supraventricular arrhytmias, no depressant action on contractility, no vagal blocking

Pharmacokinetics: IV (NOT oral)

Toxicity: convulsion, negative inotropic effect (least of all the antiarrhythmics) aka brady

Term
Tocainide (Tonocard)
Definition

Not bolded

Class IB Antiarrhythmic

Use: V-arrhythmias

Mechanism: Binds inactivated sodium channels, decreases AP duration, shorten ERP due to block of slow Na "window" currents

Effects: not for supraventricular arrhytmias, no depressant action on contractility, no vagal blocking

Pharmacokinetics: IV (NOT oral)

Toxicity: convulsion, negative inotropic effect (least of all the antiarrhythmics) aka brady

Term
Mexiletine (Mexitil)
Definition

Not bolded

Class IB Antiarrhythmic

Use: V-arrhythmias

Mechanism: Binds inactivated sodium channels, decreases AP duration, shorten ERP due to block of slow Na "window" currents

Effects: not for supraventricular arrhytmias, no depressant action on contractility, no vagal blocking

Pharmacokinetics: IV (NOT oral)

Toxicity: convulsion, negative inotropic effect (least of all the antiarrhythmics) aka brady

Term
Flecainide (Tambocor)
Definition

Prototype

Class IC Antiarrhythmic

Mechanism: binds all Na channels

Uses: Supraventricular arrhythmias, life threatening V-arrhythmias

Effect: no ANS effect, STRON PRO-ARRHYTHMIC EFFECT (CHF clinical study)

Pharmacokinetics: oral

Term
Propafenone (Rythmol)
Definition

Not bolded

Class IC Antiarrhytmic

Mechanism: binds all Na channels

Uses: Supraventricular arrhythmias, life threatening V-arrhythmias; should be reserved for refractory pts with severe, life threatening arrhythmias from the strong pro-arryhtmic effects

Pharmacokinetics: Oral

Term
Moricizine (Ethmozine)
Definition

Not Bolded

Class IC

Use: life threatening V-arrhythmias

Mechanism: blocks all Na channels

Term
Propranolol (Inderal)
Definition

Bolded

Beta blocker

Mechanism: blocks all B rececptors -> decreased HR and contraction force

Term
Metoprolol (Lopressor)
Definition

Not bolded

Beta blocker

Mechanism: B1 blocker -> decreased HR and contraction force

Term
Nadolol (Corgard)
Definition

Not bolded

Beta blocker

 Mechanism: blocks all Beta receptors -> decreased HR and contraction

Term
Timolol (Blocadren)
Definition

Not bolded

Beta blocker

Mechanism: blocks all beta receptors -> decreased HR and contraction

Term
Acebutolol (Sectral)
Definition

Not bolded

Beta blocker

Term
Atenolol (Tenormin)
Definition

Not bolded

Beta blocker

Mechanism: blocks beta receptors -> decreased HR and contractility

Term
Esmolol (Brevibloc)
Definition

Not bolded

Beta blocker

Mechanism: blocks beta receptors -> decreased HR and contraction

Term
Amiodarone (Cordarone)
Definition

Prototype

Class III antiarrhytmic

Uses: supraventricular and ventricular arrhytmias

Mechanism: blocks K channels prolonging repolarizaion (class III), block inactive Na channels (Class I), Ca block (Class IV)

Pharmacokinetics: oral, T1/2 13-103 days

Toxicity: No torsades; brandy heart block, HF; deposits in tissues i.e. cornea (yellow-brown), skin (grayis-blue), photodermatitis

Term
Sotalol (Betapace)
Definition

Bolded

Class IC antiarrhytmic

Uses: V and supraV arrhytmias

Mechanism: blocks K channel, prolonging repolarization; also nonselective Beta blocker

Pharmacokinetics: oral, excreted by kidney

Term
Bretylium (Bretylol)
Definition

Not bolded

Class III antiarrhythmic

Uses: V-fib and unstable V-tachy

Mechanism: K channel blocker, prolongs repolarization

Effects: initial increase in BP and HR, followed by a rapid adrenergic blockade

Pharmacokinetics: IV or IM, duration of action 6-12 hrs, cleared by kidney and kidney disease decreases clearance

Term
Ibutilide (Corvert)
Definition

Not bolded

Class III antiarrhythmic

Uses: rapid conversion of A-fib/flutter, no effect on BP, HR, and EKG is normal

Mechanism: promotes Na influx in slow Na channel, prolongs AP duration

Pharmacokinetics: IV

Term
Dofetilide (Tikosyn)
Definition

Not bolded

Class III antiarrhythmic

Uses: A-fib/flutter conversion to and maintenance of normal sinus rythm

Mechanism: POTENT K channel block, prolonging repolarization and ventricular refratoriness

Pharmacokinetics: oral

Term
Verapamil (Calan, Isoptin)
Definition

Prototype

Class IV antiarrhythmic

Uses: Angina, Re-entrant supraventricular tachycardia, reduces Ventricular rate in A-fib/flutter

Mechanism: blocks slow Ca channels, slows AV nodal conduction, decreases HR

Pharmacokinetics: IV

Beneficial effects: decreases cardiac workload and contractilty, bradycardia by SA and AV effect (decrease); less likely to cause reflex tachy

Toxicities: GI intolerance, brady, AV block; contraindicated in presence of CHF, avoid w/ beta blockers; inhibition of insulin and platelet aggregation

Term
Diltiazem (Cardizem)
Definition

Not Bolded

Class IV antiarrhythmic

Uses: paroxysmal supraventricular tachy, ventricular rate, a-fib/flutter, (prinzmetal and stable) angina, HTN, prevention of injury following angioplasty

Mechanism: Ca channel blocker, inhibits Ca movement from ECM to ICM in myocardial and vascular smooth muscle

Effects: reduces HR -> increases excercise capacity, myocardial perfusion

Harmful effect = serious cardia depression, inhibition on insulin and platelet aggregation

Pharmacokinetics: Oral, IV available

Term
Bepridil (Vascor)
Definition

Not Bolded

Class IV antiarrhythmic

Uses: Angina

Mechanism: Ca block

Prolongs AP

Rarely used

Term
Adenosine (Adenocard)
Definition

Antiarrhythmic, Naturally occuring

Uses: Paroxysmal supraventricula tachycardia, wolff-parkinson-white syndrom

Mechanism: slows AV conduction, involves enhanced K+ conductance and inhibition of cAMP-induced Ca++ influx. 

 

 

Term
Magnesium
Definition

Antiarrhythmic

Uses: digitalis induced arrhytmias, torsades, seizures

IV admin

Term
Potassium
Definition

Bolded

Antiarrhythmic

Effects: resting potential depolarization, membrane stamilization (increased K permeability)

Hypokalemia increaes risk of afterdepolarization

hypo and hyperkalemia ar arrhythmogenic

Term
Magnesium
Definition

Antiarrhythmic

Uses: prevent and control seizures in preeclampsia and eclampsia, digitalis induced arrhythmias, polymorphic ventricualr tachyt (torsades)

Term
clonidine (Catapres)
Definition

Bolded

Centrally acting sympatholytic

Uses: HTN

Mechanism: stimulate medullary A2 adrenergic receptors to reduce peripheral sympathetic nerve activity; reduces NT release (presynaptic) and inhibits postsynaptic neurons

Effects: lowers BP, decreases renal renin secretion

Pharmacokinetics: oral, also transdermal patch

Common adverse effects: sedation, sudden withdrawal = hypertensive crisis

Effect inhibited by tricyclic antidepressants and yohimbine (A2 inhibitor)

Term
methyldopa (Aldomet)
Definition

Bolded

Centrally acting sympatholytic (prodrug)

Uses: HTN

Mechanism: stimulate medullary A2 adrenergic receptors to reduce peripheral sympathetic nerve activity; reduces NT release (presynaptic) and inhibits postsynaptic neurons

Effects: lowers BP, decreases renal renin secretion

Pharmacokinetics: oral

Common adverse effects: sedation, sudden withdrawal = hypertensive crisis, hemolytic anemia with positive coombs test

Term
Dexmedetomidine (Precedex)
Definition

Not bolded
Centrally acting sympatholytic

Uses: HTN
relatively selective alpha2-adrenoceptor agonist with centrally mediated sympatholytic, sedative, and analgesic effects
administered I.V.
used in anesthesiology and postoperative care 

 

 
Term
mecamylamine (Inversine)
Definition

Ganglion blocker

Uses: HTN

capable of entering the CNS shows promise in treating Tourette’s syndrome 

Term
trimethaphan (Arfonad)
Definition

 

  • withdrawn in 1996; it was used for inducing controlled hypotension during neurosurgery 

Term
guanethidine (Ismelin)
Definition

Not bolded (don't spend time on this)
Adrenergic neuron blocker
Uses: HTN
taken up by the nerve ending
replaces NE in the vesicles
inhibits exocytosis

 interaction with TCAs, cocaine, indirect sympathomimetics 

 

 
Term
reserpine (Serpasil)
Definition

Bolded
Adrenergic Neuron Blocker
Uses: HTN
o inhibits the active transport of NE into the vesicle
o released NE is metabolized by MAO enzyme
o serious interaction with MAOIs
adverse effects: sedation, psychic depression, stuffy nose, dry mouth, and
gastrointestinal disturbances 

 

Term
prazosin (Minipress)
Definition

Bolded

A1-antagonist

Uses: HTN

Mechanism: A1-adrenergic block reduces norepinephrine vasoconstriction to dilate both arteries and veins 

BP falls from decreases peripheral resistance

First dose postural hypotension

Term
terazosin (Hytrin)
Definition

Bolded

A1-antagonist

Uses: HTN

Mechanism: A1-adrenergic block reduces norepinephrine vasoconstriction to dilate both arteries and veins 

BP falls from decreases peripheral resistance

First dose postural hypotension

Term
doxazosin (Cardura)
Definition

Bolded

A1-antagonist

Uses: HTN

Mechanism: A1-adrenergic block reduces norepinephrine vasoconstriction to dilate both arteries and veins 

BP falls from decreases peripheral resistance

First dose postural hypotension

Term
Nebivolol (Bystolic)
Definition

Beta blocker

Uses: HTN

Mechanism: modulates NO release causing vasodilation

Term
Beta blockers are most preferred for what pts?
Least preferred for what pts?
Definition

Most preferred: angina, post MI, migraine

Least preferred: high physical activity, african heritage, asthma, DM, hypercholesterolemia, PVD

Term
labetalol (Normodyne)
Definition

Not bolded

lowers BP in HTN crisis, by blocking a and b receptors

Adverse effects: orthostatic, bronchospasm, hepatotoxicity

lipid neutral

 
Term
carvedilol (Coreg)
Definition

Bolded

lowers BP in HTN crisis, by blocking a and b receptors

Adverse effects: orthostatic, bronchospasm, hepatotoxicity

lipid neutral

Term
hydralazine (Apresoline)
Definition

Not bolded

Vasodilator

Uses: Severe HTN

Mechanism: Increase NO like nitrites; dilates arteries but not veins

Pharmacokinetics: Oral

Toxicity: headache, nausea, anorexia, palpitations, sweating, flushing ; angina, ischemic arrhythmias; SLE in slow acetylators 

Term
minoxidil (Loniten)
Definition

Not Bolded

Vasodilator

Uses: Baldness, HTN

Mechanism: opens K channel, stabilizing membrane; dilates arteries but not veins

Toxicity: hypertrichosis

Given orally

Term
sodium nitroprusside (Nipride)
Definition

Not bolded

Vasodilator

Uses: HTN

Mechanism: dilates both arteries and pain rapidly lowers blood pressure (in minutes), and effect disappears in minutes after discontinuation 

IV

Term
diazoxide (Hyperstat IV)
Definition

Not Bolded

Vasodilator

Uses: HTN, pts with insulinoma

Mechanism: activates  ATP-sensitive potassium channels, 

Oral

Adversce effects: hyperglycemis, Na and H2O retention, hyperuricemia, excessive hair growth (children)

Term
fenoldopam (Corlopam)
Definition

Not bolded

D1 receptor agonist

Mechanism: relaxes arterial smooth muscle

IV

Term
amlodipine (Norvasc)
Definition

Not bolded

Calcium channel blocker

Uses: HTN, angina

Mechanism: Blocks slow Ca channels, decreasing intracellular Ca, relaxing arteriole smooth muscle, causing vasodilation and decreased BP

 

Term
felodipine (Plendil)
Definition

Not bolded

Calcium channel blocker

Uses: HTN, angina

Mechanism: Blocks slow Ca channels, decreasing intracellular Ca, relaxing arteriole smooth muscle, causing vasodilation and decreased BP

Term
isradipine (DynaCirc)
Definition

Not bolded

Calcium channel blocker

Uses: HTN, angina

Mechanism: Blocks slow Ca channels, decreasing intracellular Ca, relaxing arteriole smooth muscle, causing vasodilation and decreased BP

Term
nicardipine (Cardene)
Definition

Not bolded

Calcium channel blocker

Uses: HTN, angina

Mechanism: Blocks slow Ca channels, decreasing intracellular Ca, relaxing arteriole smooth muscle, causing vasodilation and decreased BP

Term
nifedipine (Adalat, Procardia)
Definition

Bolded

Calcium channel blocker (strongest vasodilator of CCBs)

Uses: HTN, angina

Mechanism: Blocks slow Ca channels, decreasing intracellular Ca, relaxing arteriole smooth muscle, causing vasodilation and decreased BP

Beneficial effects: coronary vasodilation increases O2 supply and decreases afterload

Adverse effects: most likely to cause reflex tachy, enhances MI development

Term
nimodipine (Nimotop)
Definition

Not bolded

Calcium channel blocker

Uses: HTN, angina

Mechanism: Blocks slow Ca channels, decreasing intracellular Ca, relaxing arteriole smooth muscle, causing vasodilation and decreased BP; cerebral vasodilator

Term
nisoldipine (Sular)
Definition

Not bolded

Calcium channel blocker

Uses: HTN, angina

Mechanism: Blocks slow Ca channels, decreasing intracellular Ca, relaxing arteriole smooth muscle, causing vasodilation and decreased BP

Term
verapamil (Calan, Isoptin, Verelan)
Definition

Bolded

Calcium channel blocker (vasodilator); papaverine related

Uses: HTN, angina

Mechanism: Blocks slow Ca channels, decreasing intracellular Ca, relaxing cardiac smooth muscle

Effects: relaxes all smooth muscle especially cardiac sm, arterioles are more sensitive than veins; negative inotropic, slowed AV conduction, reduced impulse generation (SA node)

Term
diltiazem (Cardizem, Dilacor)
Definition

Not bolded

Benzodiazepine

Uses: HTN, angina

Mechanism: Blocks slow Ca channels, decreasing intracellular Ca, relaxing smooth muscle

Term
bepridil (Vascor)
Definition

Not bolded

Ca channel blocker

Uses: HTN, angina

Mechanism: Blocks slow Ca channels, decreasing intracellular Ca, relaxing smooth muscle

 

Term
captopril (Capoten)
Definition

Bolded

ACE inhibitor

Uses: HTN

Mechanism: Decreases angiotensin II decreasing vasoconstriction, lowering BP

Enhanced with diuretics

Oral

Term
Enalapril (Vasotec)
Definition

Not bolded

ACE inhibitor (prodrug)

Uses: HTN

Mechanism: Decreases angiotensin II decreasing vasoconstriction, lowering BP

Enhanced with diuretics

Oral

Term
Benazepril (Lotensin)
Definition

Not bolded

ACE inhibitor (prodrug)

Uses: HTN

Mechanism: Decreases angiotensin II decreasing vasoconstriction, lowering BP

Enhanced with diuretics

Oral

Term
Fosinopril (Monopril)
Definition

Not bolded

ACE inhibitor (prodrug)

Uses: HTN

Mechanism: Decreases angiotensin II decreasing vasoconstriction, lowering BP

Enhanced with diuretics

Oral

Term
Lisinopril (Privinil, Zestril)
Definition

Not bolded

ACE inhibitor (prodrug)

Uses: HTN

Mechanism: Decreases angiotensin II decreasing vasoconstriction, lowering BP

Enhanced with diuretics

Oral

Term
Moexipril (Univasc)
Definition

Not bolded

ACE inhibitor (prodrug)

Uses: HTN

Mechanism: Decreases angiotensin II decreasing vasoconstriction, lowering BP

Enhanced with diuretics

Oral

Term
Perindopril (Aceon)
Definition

Not bolded

ACE inhibitor (prodrug)

Uses: HTN

Mechanism: Decreases angiotensin II decreasing vasoconstriction, lowering BP

Enhanced with diuretics

Oral

Term
Quinapril (Accupril)
Definition

Not bolded

ACE inhibitor (prodrug)

Uses: HTN

Mechanism: Decreases angiotensin II decreasing vasoconstriction, lowering BP

Enhanced with diuretics

Oral

Term
Ramipril (Altace)
Definition

Not bolded

ACE inhibitor (prodrug)

Uses: HTN

Mechanism: Decreases angiotensin II decreasing vasoconstriction, lowering BP

Enhanced with diuretics

Oral

Term
Trandolapril (Mavik)
Definition

Not bolded

ACE inhibitor (prodrug)

Uses: HTN

Mechanism: Decreases angiotensin II decreasing vasoconstriction, lowering BP

Enhanced with diuretics

Oral

Term
candesartan (Atacand)
Definition

Not bolded

Angiotensin receptor blocker

Uses: HTN

More specific than ACE inhibitors

Oral

Term
eprosartan (Teveten)
Definition

Not bolded

Angiotensin receptor blocker

Uses: HTN

More specific than ACE inhibitors

Oral

Term
irbesartan (Avapro)
Definition

Not bolded

Angiotensin receptor blocker

Uses: HTN

More specific than ACE inhibitors

Oral

Term
losartan (Cozaar)
Definition

Not bolded

Angiotensin receptor blocker

Uses: HTN

More specific than ACE inhibitors

Oral

Term
telmisartan (Micardis)
Definition

Not bolded

Angiotensin receptor blocker

Uses: HTN

More specific than ACE inhibitors

Oral

Term
valsartan (Diovan)
Definition

Not bolded

Angiotensin receptor blocker

Uses: HTN

More specific than ACE inhibitors

Oral

Term
Aliskerin
Definition

Not bolded

Angiotensin inhibitor

Uses: HTN

blocks formation of angiotensin I in the kidney

Term
Nitroglycerin
Definition

Bolded

Nitrate/Nitrite; short acting (10-30 min)

Uses: Angina

Mechanism: nitrates cause vasodilation by releasing nitrite ion -> metabolized to nitric oxide -> activates guanylyl cyclase -> increases cGMP -> relaxes vascular smooth muscles 

Relief by 2 factors: decreases myocardial O2 requirement and redistribution of blood to ischemic areas

Effects primarily large veins, both preload and afterload are decreased

Sublingual

Adverse Effects: reflex tachy -> increased cardiac workload; acute toxicity leading to orthostatic hypotension, tachy and headaches

Term
Isosorbide dinitrate (Isordil)
Definition

Not bolded

Nitrate/Nitrite (short acting, 10-60 min)

Uses: Angina

Mechanism: nitrates cause vasodilation by releasing nitrite ion -> metabolized to nitric oxide -> activates guanylyl cyclase -> increases cGMP -> relaxes vascular smooth muscles 

Relief by 2 factors: decreases myocardial O2 requirement and redistribution of blood to ischemic areas

Effects primarily large veins, both preload and afterload are decreased

Sublingual

Adverse Effects: reflex tachy -> increased cardiac workload acute toxicity leading to orthostatic hypotension, tachy and headaches

Term
Isosorbide mononitrate (Ismo)
Definition

Not bolded

Nitrate/Nitrite (long acting (6-10 hrs)

Uses: Angina

Mechanism: nitrates cause vasodilation by releasing nitrite ion -> metabolized to nitric oxide -> activates guanylyl cyclase -> increases cGMP -> relaxes vascular smooth muscles 

Relief by 2 factors: decreases myocardial O2 requirement and redistribution of blood to ischemic areas

Effects primarily large veins, both preload and afterload are decreased

Sublingual

Adverse Effects:reflex tachy -> increased cardiac workload  acute toxicity leading to orthostatic hypotension, tachy and headaches

Term
Amyl nitrite (Aspirols)
Definition

Not bolded

Nitrate/Nitrite (very short acting, 3-5 min)

Uses: Angina

Mechanism: nitrates cause vasodilation by releasing nitrite ion -> metabolized to nitric oxide -> activates guanylyl cyclase -> increases cGMP -> relaxes vascular smooth muscles 

Relief by 2 factors: decreases myocardial O2 requirement and redistribution of blood to ischemic areas

Effects primarily large veins, both preload and afterload are decreased

Sublingual

Adverse Effects: reflex tachy -> increased cardiac workload acute toxicity leading to orthostatic hypotension, tachy and headaches

Term
Ranolazine (Ranexa)
Definition

Bolded

Partial fatty acid oxidase inhibitor (PFox)

Uses: Angina

Mechanism: PFox, inhibits late sodium current, decreases LV wall stiffness

Oral

Metabolized by liver

 

Term
Propranolol (Inderal)
Definition

Bolded

Beta blocker

Use: Angina

Actions and effects: decrease CO, decrease renin secrtion, CNS reduction of sympathetic vasomotor tone

No cardiac vasodialtion

Term
Nadolol (Corgard)
Definition

Bolded

Beta blocker

Use: Angina

Actions and effects: decrease CO, decrease renin secrtion, CNS reduction of sympathetic vasomotor tone

No cardiac vasodialtion

Term
Atenolol (Tenormin)
Definition

Bolded

Beta blocker

Use: Angina

Actions and effects: decrease CO, decrease renin secrtion, CNS reduction of sympathetic vasomotor tone

No cardiac vasodialtion

Term
Nebivolol (Bystolic)
Definition

Bolded

Beta blocker

Use: Angina

Actions and effects: decrease CO, decrease renin secrtion, CNS reduction of sympathetic vasomotor tone

No cardiac vasodialtion

Term
Sildenafil (Viagra)
Definition

Bolded

Phosphodiesterase type 5 (PDE5) inhibitor

Uses: ED, pulmonary HTN

Mechanism: selective cGMP inhibitor

Oral

Adverse effects: nasal congestion, visual impairment, headache, flushing, dyspepsia, UTI

Contraindications: pt on nitrate/nitrite, a-blockers

Term
Inhibitors of CYP 450 enzymes (3A4 and 2C9)
Definition

 

cimetidine
ritonavir, saquinavir
ketoconazole, itraconazole
erythromycin, clarithromycin
quinidine, quinine
zafirlukast, zileuton
Term
Vardenafil (Levitra)
Definition

Not bolded

Phosphodiesterase type 5 (PDE5) inhibitor

Uses: ED, pulmonary HTN

Mechanism: selective cGMP inhibitor

Oral

Adverse effects: nasal congestion, visual impairment, headache, flushing, dyspepsia, UTI

Contraindications: pt on nitrate/nitrite, a-blockers

Term
Tadalafil (Cialis)
Definition

Not bolded

Phosphodiesterase type 5 (PDE5) inhibitor

Uses: ED, pulmonary HTN

Mechanism: selective cGMP inhibitor

Oral

Adverse effects: nasal congestion, visual impairment, headache, flushing, dyspepsia, UTI

Contraindications: pt on nitrate/nitrite, a-blockers

Term
Cilostazol (Pletal)
Definition

 Bolded

Phosphodiesterase  type 3 (PDE3) inhibitor

Uses: Angina, intermittent claudication

Mechanism: PDE3 inhibiton -> antiplatelet and vasodilation


Term
Bosentan (Tracleer)
Definition

Endothelin receptor antagonist

Uses: Severe pulmonary HTN

Mechanism: endothelin receptor antagonist of both type A and B endothelin-1 receptors; cause contraction of vascular smooth muscle

Adverse effects: elevated hepatic enzymes, potential teratogenic effects, and multiple drug interactions 

Term
Niacin (Nicotinic Acid, vitamin B)
Definition

Bolded

Anti-hyperlipidemia Dx

Dx that impairs lipoprotein synthesis

Uses: Heterozygous familial hypercholesterol-emia; combined hyperlipoproteinemia, Hyperlipidemia

Effect: Lowers VLDL and LDL by inhibiting VLDL secretion; inhibits liver cholesterolgenesis, increased LPL pathway clearance, increased HDL

Oral, kidney excretion

Adverse effects: cutaneous vasodilation, nausea, abd discomfort, elevate aminotransferases or alkaline phosphatase, impairs glucose tolerance, may cause severe hepatotoxicity

 

Term
Gemfibrozil (Lopid)
Definition

Bolded

Anti-hyperlipidemia Dx

Fibric acid derivative

Uses: familia dybetalipoproteinemia, hypertriglyceridemia (NOT effective in primary chylomicronemia or familial hypercholesterolemia) 

Mechanism: ligand for peroxisom proliferator-activated receptor-alpha (PPAR-a) which causes effects

Effects: increase LPL activity (VLDL catabolism), decrease TAG (via lower VLDL concentration), decrease cholesterol (inhibit liver cholesterolgenesis)

Oral

Adverse effects: increased incidenc of cholelithiasis or gallstones, may increase LDL

Term
Clofibrate (Atromid-SR)
Definition

Not bolded

Anti-hyperlipidemia Dx

Fibric acid derivative

Uses: familia dybetalipoproteinemia, hypertriglyceridemia (NOT effective in primary chylomicronemia or familial hypercholesterolemia) 

Mechanism: ligand for peroxisom proliferator-activated receptor-alpha (PPAR-a) which causes effects

Effects: increase LPL activity (VLDL catabolism), decrease TAG (via lower VLDL concentration), decrease cholesterol (inhibit liver cholesterolgenesis)

Oral

Adverse effects: increased incidenc of cholelithiasis or gallstones, may increase LDL

Term
Fenofibrate (TriCor)
Definition

Not bolded

Anti-hyperlipidemia Dx

Fibric acid derivative

Uses: familia dybetalipoproteinemia, hypertriglyceridemia (NOT effective in primary chylomicronemia or familial hypercholesterolemia) 

Mechanism: ligand for peroxisom proliferator-activated receptor-alpha (PPAR-a) which causes effects

Effects: increase LPL activity (VLDL catabolism), decrease TAG (via lower VLDL concentration), decrease cholesterol (inhibit liver cholesterolgenesis)

Oral

Adverse effects: increased incidenc of cholelithiasis or gallstones, may increase LDL

Term
Cholestyramine (Questran)
Definition

Bolded

Anti-hyperlipidemia Dx

Bile acid binding resin

Uses: Elevated LDL as in hyterozygous familial hypercholesterolemia and combined hyperlipoproteinemia (no effect in homozygous familial hypercholesterolemia)

Mechanism: prevents intestinal reabsorption of bile acids, increases expression of liver LDL receptors, increasing LDL uptake -> lowers plasma cholesterol

Adverse effects: constipation and bloating, gallstone formation, steatorrhea, vitamin K malabsorption; may impair absorption of digitalis, thiazides, tetracycline, thyroxine or aspirin

Term
Colestipol (Colestid)
Definition

Not bolded

Anti-hyperlipidemia Dx

Bile acid binding resin

Uses: Elevated LDL as in hyterozygous familial hypercholesterolemia and combined hyperlipoproteinemia (no effect in homozygous familial hypercholesterolemia)

Mechanism: prevents intestinal reabsorption of bile acids, increases expression of liver LDL receptors, increasing LDL uptake -> lowers plasma cholesterol

Adverse effects: constipation and bloating, gallstone formation, steatorrhea, vitamin K malabsorption; may impair absorption of digitalis, thiazides, tetracycline, thyroxine or aspirin

Term
Colesevelam (WelChol)
Definition

Not bolded

Anti-hyperlipidemia Dx

Bile acid binding resin

Uses: Elevated LDL as in hyterozygous familial hypercholesterolemia and combined hyperlipoproteinemia (no effect in homozygous familial hypercholesterolemia)

Mechanism: prevents intestinal reabsorption of bile acids, increases expression of liver LDL receptors, increasing LDL uptake -> lowers plasma cholesterol

Adverse effects: constipation and bloating, gallstone formation, steatorrhea, vitamin K malabsorption; may impair absorption of digitalis, thiazides, tetracycline, thyroxine or aspirin

Term
Lovastatin (Mevacor)
Definition

Bolded

Anti-hyperlipidemia Dx

Competitive HMG-CoA reductase inhibitor

Uses: Elevated LDL as in heterozygous familial hypercholesterolemia and combined hyperlipoproteinemia

Mechanism: inactive, must be hydrolyzed; reduce plasma LDL by inhibiting HMG-CoA which increased high affinity LDL receptors
Effects: Lowers LDL, decrease TAG, increased HDL; decrease C-reactive protein, increase NO, increase plaque stability, reduce lipoprotein oxidation, decrease platelet aggregation.

Pharmacokinetics: high first pass, given in evening (highest cholesterol synth time)

Adverse effects: liver damage (alcoholics), increase creatine kinase activity, rhabdomyolysis (mannitol to counter)

Drug interactions: grapefruit juice (enhances bioavailability), gemfibrozil (inhibits metabolism)

ALL STATINS ARE CONTRAINDICATED FOR PREGNANCY (CATEGORY X) FOR MEMBRANE DEVELOPMENT

Term
Pravastatin (Pravachol)
Definition

Not Bolded

Anti-hyperlipidemia Dx

Competitive HMG-CoA reductase inhibitor

Uses: Elevated LDL as in heterozygous familial hypercholesterolemia and combined hyperlipoproteinemia

Mechanism: inactive, must be hydrolyzed; reduce plasma LDL by inhibiting HMG-CoA which increased high affinity LDL receptors
Effects: Lowers LDL, decrease TAG, increased HDL; decrease C-reactive protein, increase NO, increase plaque stability, reduce lipoprotein oxidation, decrease platelet aggregation.

Pharmacokinetics: high first pass, given in evening (highest cholesterol synth time)

Adverse effects: liver damage (alcoholics), increase creatine kinase activity, rhabdomyolysis (mannitol to counter)

Drug interactions: grapefruit juice (enhances bioavailability), gemfibrozil (inhibits metabolism)

ALL STATINS ARE CONTRAINDICATED FOR PREGNANCY (CATEGORY X) FOR MEMBRANE DEVELOPMENT

Term
Simvastatin (Zocor)
Definition

Not Bolded

Anti-hyperlipidemia Dx

Competitive HMG-CoA reductase inhibitor

Uses: Elevated LDL as in heterozygous familial hypercholesterolemia and combined hyperlipoproteinemia

Mechanism: inactive, must be hydrolyzed; reduce plasma LDL by inhibiting HMG-CoA which increased high affinity LDL receptors
Effects: Lowers LDL, decrease TAG, increased HDL; decrease C-reactive protein, increase NO, increase plaque stability, reduce lipoprotein oxidation, decrease platelet aggregation.

Pharmacokinetics: high first pass, given in evening (highest cholesterol synth time)

Adverse effects: liver damage (alcoholics), increase creatine kinase activity, rhabdomyolysis (mannitol to counter)

Drug interactions: grapefruit juice (enhances bioavailability), gemfibrozil (inhibits metabolism)

ALL STATINS ARE CONTRAINDICATED FOR PREGNANCY (CATEGORY X) FOR MEMBRANE DEVELOPMENT

Term
Fluvastatin (Lescol)
Definition

Not Bolded

Anti-hyperlipidemia Dx

Competitive HMG-CoA reductase inhibitor

Uses: Elevated LDL as in heterozygous familial hypercholesterolemia and combined hyperlipoproteinemia

Mechanism: inactive, must be hydrolyzed; reduce plasma LDL by inhibiting HMG-CoA which increased high affinity LDL receptors
Effects: Lowers LDL, decrease TAG, increased HDL; decrease C-reactive protein, increase NO, increase plaque stability, reduce lipoprotein oxidation, decrease platelet aggregation.

Pharmacokinetics: high first pass, given in evening (highest cholesterol synth time)

Adverse effects: liver damage (alcoholics), increase creatine kinase activity, rhabdomyolysis (mannitol to counter)

Drug interactions: grapefruit juice (enhances bioavailability), gemfibrozil (inhibits metabolism)

ALL STATINS ARE CONTRAINDICATED FOR PREGNANCY (CATEGORY X) FOR MEMBRANE DEVELOPMENT

Term
Atorvastatin (Lipitor)
Definition

Not Bolded

Anti-hyperlipidemia Dx

Competitive HMG-CoA reductase inhibitor

Uses: Elevated LDL as in heterozygous familial hypercholesterolemia and combined hyperlipoproteinemia

Mechanism: inactive, must be hydrolyzed; reduce plasma LDL by inhibiting HMG-CoA which increased high affinity LDL receptors
Effects: Lowers LDL, decrease TAG, increased HDL; decrease C-reactive protein, increase NO, increase plaque stability, reduce lipoprotein oxidation, decrease platelet aggregation.

Pharmacokinetics: high first pass, given in evening (highest cholesterol synth time)

Adverse effects: liver damage (alcoholics), increase creatine kinase activity, rhabdomyolysis (mannitol to counter)

Drug interactions: grapefruit juice (enhances bioavailability), gemfibrozil (inhibits metabolism)

ALL STATINS ARE CONTRAINDICATED FOR PREGNANCY (CATEGORY X) FOR MEMBRANE DEVELOPMENT

Term
Rosuvastatin (Crestor)
Definition

Not Bolded

Anti-hyperlipidemia Dx

Competitive HMG-CoA reductase inhibitor

Uses: Elevated LDL as in heterozygous familial hypercholesterolemia and combined hyperlipoproteinemia

Mechanism: inactive, must be hydrolyzed; reduce plasma LDL by inhibiting HMG-CoA which increased high affinity LDL receptors
Effects: Lowers LDL, decrease TAG, increased HDL; decrease C-reactive protein, increase NO, increase plaque stability, reduce lipoprotein oxidation, decrease platelet aggregation.

Pharmacokinetics: high first pass, given in evening (highest cholesterol synth time)

Adverse effects: liver damage (alcoholics), increase creatine kinase activity, rhabdomyolysis (mannitol to counter)

Drug interactions: grapefruit juice (enhances bioavailability), gemfibrozil (inhibits metabolism)

ALL STATINS ARE CONTRAINDICATED FOR PREGNANCY (CATEGORY X) FOR MEMBRANE DEVELOPMENT

Term
Ezetimibe (Zetia)
Definition

Bolded

Anti-hyperlipidemia Dx

Inhibitor of cholesterol absorption

Mechanism: blocks intestinal absorption; best if combined with a statin

Effects: reduces LDL cholesterol

Discontinued

Term
Orlistat (Xenical)
Definition

Bolded

Anti-hyperlipidemia Dx

Inhibits pancreatic lipase

Uses: weight loss

Mechanism: decreases TAG breakdown in intestine

Adverse effects: steatorrhea

Term
Heparin sodium (Liquaemin®)
Definition

Bolded

HMW heparin; anticoagulant

Uses: anticoagulant for operations, IV catheters, prophylaxis against thrombosis (DVT and PE)

Mechanism: contain a unique pentasaccharide that binds to and acts as a catalyst for antithrombin III (AT III); mainly affects Xa and thrombin (inhibits them)

INJECTED IV EXCLUSIVELY; onset is immediate

Adverse effects: hemorrhage, heparin-induced thrombocytopenia (HIT) due to immune response to heparin

Contraindications: Renal/hepatic dysfunction, if pt is actively bleeding, hypersensitive, hemophiliac or for brain, spinal cord or eye Sx

Term
Heparin calcium (Calciparine®)
Definition

Not Bolded

HMW heparin; anticoagulant

Uses: anticoagulant for operations, IV catheters, prophylaxis against thrombosis (DVT and PE)

Mechanism: contain a unique pentasaccharide that binds to and acts as a catalyst for antithrombin III (AT III); mainly affects Xa and thrombin (inhibits them)

INJECTED IV EXCLUSIVELY; onset is immediate

Adverse effects: hemorrhage, heparin-induced thrombocytopenia (HIT) due to immune response to heparin

Contraindications: Renal/hepatic dysfunction, if pt is actively bleeding, hypersensitive, hemophiliac or for brain, spinal cord or eye Sx

Term
Enoxaparin (Lovenox®)
Definition

Bolded

LMW heparin; anticoagulant

Mechanism: inhibits factor Xa (inhibiting prothrombin conversion to thrombin)

Can be injected subcutaneously/used in pregnancy, lower incidence of HIT (heparin induced thrombocytopenia)

Adverse effects: hemorrhage, heparin-induced thrombocytopenia (HIT) due to immune response to heparin

Contraindications: Renal/hepatic dysfunction, if pt is actively bleeding, hypersensitive, hemophiliac or for brain, spinal cord or eye Sx

Term
Dalteparin (Fragmin®)
Definition

Not Bolded

LMW heparin; anticoagulant

Mechanism: inhibits factor Xa (inhibiting prothrombin conversion to thrombin)

Can be injected subcutaneously/used in pregnancy, lower incidence of HIT (heparin induced thrombocytopenia)

Adverse effects: hemorrhage, heparin-induced thrombocytopenia (HIT) due to immune response to heparin

Contraindications: Renal/hepatic dysfunction, if pt is actively bleeding, hypersensitive, hemophiliac or for brain, spinal cord or eye Sx

Term
Danaparoid (Orgaran®)
Definition

Not Bolded

LMW heparin; anticoagulant

Mechanism: inhibits factor Xa (inhibiting prothrombin conversion to thrombin)

Can be injected subcutaneously/used in pregnancy, lower incidence of HIT (heparin induced thrombocytopenia)

Adverse effects: hemorrhage, heparin-induced thrombocytopenia (HIT) due to immune response to heparin

Contraindications: Renal/hepatic dysfunction, if pt is actively bleeding, hypersensitive, hemophiliac or for brain, spinal cord or eye Sx

Term
Fondaparinux (Arixtra®)
Definition

Not Bolded

LMW heparin; anticoagulant

Mechanism: inhibits factor Xa (inhibiting prothrombin conversion to thrombin)

Can be injected subcutaneously/used in pregnancy, lower incidence of HIT (heparin induced thrombocytopenia)

Adverse effects: hemorrhage, heparin-induced thrombocytopenia (HIT) due to immune response to heparin

Contraindications: Renal/hepatic dysfunction, if pt is actively bleeding, hypersensitive, hemophiliac or for brain, spinal cord or eye Sx

Term
Lepirudin (Refludan )
Definition

Anticoagulant

natural from leeches

Uses: alternative for HIT (heparin induced thrombocytopenia) pts

Mechanism: direct inhibitor of thrombin

IV only, cleared by kidney

Adverse effects: hypersensitivity, NO ANTIDOTE

Term
Bivalirudin (Angiomax®)
Definition

Not bolded

Anticoagulant

natural from leeches

Uses: alternative for HIT (heparin induced thrombocytopenia) pts

Mechanism: direct inhibitor of thrombin

IV only, cleared by liver

Adverse effects: hypersensitivity, NO ANTIDOTE

Term
Argatroban (Novastan®)
Definition

Bolded

SMW heparin: anticoagulant

Uses: alternative in HIT (heparin induce thrombocytopenia)

Mechanism: small molecule

Cleared by liver

continuous IV infusion

Use great caution in pts with poor liver function

Term
Dabigatran (Pradaxa®)
Definition

bolded

SMW heparin: anticoagulant

Uses: prevent stroke in pts with non-valvular a-fib

Mechanism: ORAL direct inhibitor of thrombin

Cleared by kidney

DO NOT use it pts with mechanical heart valve

AVOID ABRUPT DISONTINUATION, increased risk of thrombotic events

Term
Rivaroxaban (Xarelto®)
Definition

Bolded

Anticoagulant

Direct factor Xa inhibitor

Uses: treat DVT, PE and future clots

Mechanism: ORAL inhibitor of factor Xa

Black box: discontinue 24 hrs prior to lumbar puncture or epidural = increased risk for hematomas (epidural/spinal)

Huge deal, will take over warfarin as DOC!

Term
Apixaban (Equilis®)
Definition

Not bolded

Anticoagulant

ORAL Direct Factor Xa inhibitor

Uses: stroke and embolisms with non-valvular a-fib

Avoid abrubt discontinuation

Term
Warfarin (Coumadin®)
Definition

PROTOTYPE

Anticoagulant

Uses: prevent embolid -> DVT, thromboembolism (no effect on already formed thrombi)

Mechanism: inhibits reduction of vitamin K -> interferes with synthesis of II, VII, IX and X, protein C and S

Effects: take time to happen, lasts 4-5 days

Oral

Complicated: many conditions affect it, many drug interactions, monitored by INR (2-3)

Adverse effects: hemorrhage, reversed w/ vitamin K (takes time) and FFP (immediate), quickly reduces levels of protein C increasing chance of cutaneous necrosis and infarction

Contraindicated in pregnancy

Drug interactions: Abx, hormones, NSAIDS, albumin displacing Dx, inhibit or induce liver enzymes

Term
Protamine Sulfate
Definition

Bolded

Heparin antagonist

Uses: reverse anticoagulant effects of heparin

Mechanism: highly +, binds heparin which is highly -

Adverse effects: hypotension, pulmonary HTN, allergies

Contraindications: In the abscence of heparin has anticoagulant effect

 

Term
Vitamin K
Definition

Bolded

Uses: Reverse anticoagulant effect of warfarin

Mechanism: Reverses anticoagulant effect; Confers biologic activity on prothrombin and factors VII, IX and X by post-ribosomal modification

IV

Infusion must be slow to avoid chest pain, back pain, dyspnea or death

 

Term
Tissue plasminogen activator or t-PA (Alteplase®, Activase®)
Definition

Bolded

Fibrinolytic agent

Uses: stroke, lyse clots, severe PE, DVT, arterial thrombosis

Endogenously made by endothelial cells

IV

Side effects: serious bleeding

Term
Streptokinase (Streptase®)
Definition

Bolded

Fibrinolytic agent

Uses: not clot-fibrin specific so causes generalised fibrinolytic activity; combined with aspirin it's as good as other fibrinolytics

Mechanism: forms a complex with plasminogen, enhancing fibrinolytic activity

Can cause allergies, pyrexia, and anaphylaxis

Term
Urokinase (Abbokinase®)
Definition

Not bolded

Fibrinolytic agent

 

 Enzyme made by the kidney

Mechanism of Action:Acts directly as a plasminogen activator Indications/Therapeutic Effects: Not fibrin specific 

Term
Anistreplase (Eminase®)
Definition

Not bolded

Fibrinolytic

 

Mechanism of Action: Mixture of plasminogen and streptokinase that has been protected and rendered inert by acylation: The acyl group hydrolyzes in the blood, and the compound then becomes fibrinolytic Indications/Therapeutic Effects: More clot selective than streptokinase and can be administered more rapidly: Causes considerable fibrinogenolysis and is antigenic 

Long duration of action

Term
Aminocaproic acid (Amicar®)
Definition

Bolded

Antifibrinolytic

Uses: bleeding disorders, hemophilia, reversal of fibrinolytic therapy, prophylaxis against re-bleeding in intracranial aneurysms

Mechanism: completely inhibits plasminogen activation, prevents formation of plasmin; inhibits streptokinase/urokinase activity

Oral or IV

cleared by kidney

Adverse effects: can cause IV thrombosis, don't use in pts with DIC or GI bleeding

Term
Tranexamic acid (Cyklokapron®)
Definition

Not bolded

Antifibrinolytic

Uses: bleeding disorders, hemophilia, reversal of fibrinolytic therapy, prophylaxis against re-bleeding in intracranial aneurysms

Mechanism: completely inhibits plasminogen activation, prevents formation of plasmin; inhibits streptokinase/urokinase activity

Oral or IV

cleared by kidney

Adverse effects: can cause IV thrombosis, don't use in pts with DIC or GI bleeding

Term
Aspirin
Definition

Bolded

Antiplatelet drug

Uses: pts at risk of remoblism, primary intervention for MI

Mechanism: irreversible COX inhibiter -> decreases TXA2, lasts the life of the platelet

Don't take before dental procedures or Sx

Term
Clopidogrel (Plavix®)
Definition

Bolded

Antiplatelet drug

Uses: DOC prevent thrombosis in coronary stent placement sx; inhibit platelet aggregation in pts who are allergic to aspirin

Mechanism: Irreversibly blocks ADP receptor on platelets

Oral

Adverse effects: bleeding, nausea, diarrhea

Term
Ticlopidine (Ticlid®)
Definition

Not Bolded

Antiplatelet drug

Uses: DOC prevent thrombosis in coronary stent placement sx; inhibit platelet aggregation in pts who are allergic to aspirin

Mechanism: Irreversibly blocks ADP receptor on platelets

Oral

Adverse effects: bleeding, nausea, diarrhea

Term
Prasugrel (Effient®)
Definition

Not Bolded

Antiplatelet drug

Uses: DOC prevent thrombosis in coronary stent placement sx; inhibit platelet aggregation in pts who are allergic to aspirin

Mechanism: Irreversibly blocks ADP receptor on platelets

Oral

Adverse effects: bleeding, nausea, diarrhea

Term
Ticagrelor (Brilinta®)
Definition

Not Bolded

Antiplatelet drug

Uses: DOC prevent thrombosis in coronary stent placement sx; inhibit platelet aggregation in pts who are allergic to aspirin

Mechanism: Irreversibly blocks ADP receptor on platelets

Oral

Adverse effects: bleeding, nausea, diarrhea

Term
Abciximab (ReoPro®)
Definition

Bolded

Antiplatelet drug; monoclonal Ab

Indications: combine with heparin, angioplasty, atherectomy, stent

Mechanism: Inhibits platelet aggregation by inhibiting GPIIb/IIIa receptor from binding fibrinogen

IV

Adverse effects: bleeing, thrombocytopenia

 

Term
Eptifibatide (Integrilin®)
Definition

Not bolded

Antiplatelet drug; monoclonal Ab

Indications: combine with heparin, angioplasty, atherectomy, stent

Mechanism: Inhibits platelet aggregation by inhibiting GPIIb/IIIa receptor from binding fibrinogen

IV

Adverse effects: bleeing, thrombocytopenia

 
Term
Tirofiban (Aggrastat®)
Definition

Not bolded

Antiplatelet drug; monoclonal Ab

Indications: combine with heparin, angioplasty, atherectomy, stent

Mechanism: Inhibits platelet aggregation by inhibiting GPIIb/IIIa receptor from binding fibrinogen

IV

Adverse effects: bleeing, thrombocytopenia

 
Term
Cilostazol (Pletal®)
Definition

Bolded

Antiplatelet drug

Indication: promotes vasodilation and inhibits platelet aggregation, intermittent claudication

Mechanism: Phosphodiesterase 3 inhibitor -> increases cAMP level

Oral

Contraindicated with CHF

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