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Cardio
Pharmacology
204
Medical
Professional
09/24/2011

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Term
___________ Indications
Acute myocardial infarction
Pulmonary embolism
Deep venous thrombosis
Ischemic stroke (special circumstances only) - CAT scan, MRI first
Definition
Thrombolytic agents
Term
________: a nonenzymatic activator of plasminogen extracted from hemolytic streptococci
Definition
streptokinase
Term
serious side effect of thrombolytic agents?
Definition
hemorrhage
Term
ASA – ________ block of cycloxygenase
- will inactivate platelets for __ days
Definition
irreversible
7
Term
Aspirin
Definition
Anti-platelet Drug
Term
Clopidogrel
Definition
Anti-platelet Drug
Term
Ticlopidine
Definition
Anti-platelet Drug
Term
Dipyridamole
Definition
Anti-platelet Drug
Term
Cilostazol
Definition
Anti-Platelet Drug
Term
Pentoxifylline
Definition
Anti-Platelet Drug
Term
Abciximab
Definition
Anti-Platelet drug
Term
eptifibatide
Definition
anti-platelet drug
Term
tirofiban
Definition
anti-platelet drug
Term
ASA Should be administered routinely to virtually all patients with _______
Definition
myocardial infarction
Term
Abciximab MOA?
Definition
Prevents fibrinogen binding to glycoprotein GP IIb-IIIa, thus inhibiting platelet aggregation
Term
Clopidogrel used for? (3)
Definition
Stents
Acute coronary syndrome
prevention of ischemic events in atherosclerosis
Term
Abciximab used for?
Definition
Approved as antithrombotic during angioplasty
Term
Cilostazol MOA?
Definition
Inhibits PDE III (increases cyclic AMP)
Inhibits platelet aggregation
Stimulates vasodilation
Term
Cilostazol Indicated for?
Definition
reduction of symptoms of intermittent claudication
Term
Cilostazol contraindicated in?
Definition
patients with CHF
Term
Pentoxifylline MOA?
Definition
Hemorrheologic Agent = improves blood flow
Mechanism enhances RBC flexibility, decreases blood viscosity
may decrease TXA 2 levels and increase PGI2 levels
Term
Pentoxifylline indications? (2)
Definition
intermittent claudication
chronic occlusive arterial disease of the limbs
Term
heparin route?
warfarin route?
Definition
heparin iv - in hospital - fast onset
warfarin po - outpatient - slow onset
Term
Warfarin
Definition
anticoagulant
Term
Heparin
Definition
anticoagulant
Term
what lab used to monitor heparin?
Definition
aPTT
Term
aPTT of __-__ times control is the typical therapeutic goal when using Heparin
Definition
1.5 -2.0
Term
Tx of heparin overdose?
Definition
Stop Heparin

Protamine sulfate
binds to and inactivates heparin
must be given slowly IV

FFP
Term
Enoxaparin
Definition
LMWH
Term
Dalteparin
Definition
LMWH
Term
Ardeparin
Definition
LMWH
Term
Danaparoid
Definition
LMWH
Term
LMWH route?
Definition
SC
Term
LMWH indications? (3)
Definition
prophylaxis of DVT associated with hip, knee, and abdominal surgery
Term
Warfarin (coumadin) MOA?
Definition
inhibits vitamin K epoxide reductase
inhibits vitamin K-dependent post-translation modification of clotting factors: thrombin, VII, IX, X, Protein C and S
without addition of the  carboxyglutamic acid residue the clotting factors cannot bind Ca++ and are inactive
Term
Contraindications to Warfarin Therapy
Definition
Absolute
Pregnancy
teratogenicity
fetal hemorrhage
Term
indirect thrombin inhibitors
Definition
Heparin
LMWH
Term
direct thrombin inhibitors
Definition
Parenteral Oral
Hirudin Ximelagatran
Argatroban **Dabigatran**
Bivalirudin etexilate
Term
Dabigatran MOA?
Definition
Anticoagulant
Direct thrombin inhibitor
Term
Dabigatran indications?
Definition
Prevention of stroke and systemic embolism in non-valvular atrial fibriliation
Term
therapeutic INR?
Definition
2-3
Term
prazosin
Definition
α-adrenoceptor antagonists
Term
tamsulosin
Definition
α-adrenoceptor antagonists
Term
terazosin
Definition
α-adrenoceptor antagonists
Term
carvedilol
Definition
nonspecific β-adrenoceptor antagonists:
Term
propranolol
Definition
nonspecific β-adrenoceptor antagonists:
Term
atenolol,
Definition
β1-adrenoceptor antagonists:
Term
metoprolol succinate and metoprolol tartrate
Definition
β1-adrenoceptor antagonists:
Term
amlodipine,
Definition
Calcium channel blockers:
Term
felodipine,
Definition
Calcium channel blockers:
Term
nifedipine
Definition
Calcium channel blockers:
Term
lisinopril,
Definition
ACE-Is:
Term
ramipril
Definition
ACE-Is
Term
candesartan,
Definition
ARBs:
Term
valsartan,
Definition
ARBs:
Term
losartan,
Definition
arbs
Term
olmesartan
Definition
arbs
Term
clonidine,
Definition
Centrally acting antihypertensives:
Term
methyldopa
Definition
Centrally acting antihypertensives:
Term
ARBs – two that are FDA approved in HF in place of ACE-Is –
Definition
candesartan and valsartan
Term
furosemide,
Definition
Loop Diuretics
Term
bumetanide,
Definition
loop
Term
torsemide
Definition
loop
Term
spironolactone,
Definition
Potassium Sparing Agents
Term
triamterene,
Definition
K+ sparing diuretic
Term
amiloride
Definition
K+ sparing diuretic
Term
Diuretics
Adverse Effects and Side Effects
Definition
Electrolyte Imbalance (most common hypokalemia, then hyperkalemia but can include calcium imbalance, hypomagnesemia, hyponatremia)
Biggest concern here is dysrhythmias
Hyperlipidemia
Glucose Intolerance and Insulin Resistance
Hyperuricemia
Rare  Nephritis, blood dyscrasias, cholecystitis, pancreatitis, necrotizing vasculitis
Term
Central Acting Adrenergic Blockers MOA?
Definition
Action – Lower sympathetic activity, modest decrease in PVR/CO and Renin Level
Term
Clonidine,
Definition
Central Acting Adrenergic Blockers
Term
Methyldopa,
Definition
Central Acting Adrenergic Blockers
Term
Guanabenz,
Definition
Central Acting Adrenergic Blockers
Term
Guanfacine
Definition
Central Acting Adrenergic Blockers
Term
Peripheral Acting Adrenergic Blocker MOA?
Definition
(blocks norepinephrine uptake)
Action - Decreases PVR
Term
Central Acting Adrenergic Blockers Side Effects?
Definition
sedation, dry mouth, rebound HTN, fluid retention
Term
Reserpine,
Definition
Peripheral Acting Adrenergic Blocker
Term
Guanethidine
Definition
Peripheral Acting Adrenergic Blocker
Term
Alpha 1 Adrenergic Blockers MOA?
Definition
(Selective Post Synaptic Catecholamine Blocker)
Action – Decreases PVR and Pre Load
Term
Doxazosin,
Definition
Alpha 1 Adrenergic Blockers
Term
Prazosin,
Definition
Alpha 1 Adrenergic Blockers
Term
Terazosin
Definition
Alpha 1 Adrenergic Blockers
Term
Peripheral Acting Adrenergic Blockers Side Effects?
Definition
CNS depression (sedation and depression), nasal stuffiness
Term
Alpha 1 Adrenergic Blockers
Side Effects?
Definition
– headache, drowsiness, fatigue, dizziness, asthma type response, first dose hypotensive response
Term
Beta Adrenergic Blockers (Beta 1 and 2) MOA?
Definition
Action – Reduces CO and HR, diminishes renin release, decrease PVR (usually with time), inhibit catecholamine release
Term
Beta Adrenergic Blockers (Beta 1 and 2) Side Effects?
Definition
CNS side effects (insomnia, depressed mood, nightmares, sexual dysfunction), hypoglycemia, hypotension, bradycardia dyslipidemia (HDL,TGY), bronchospasm
Term
what are the two combined alpha and beta blockers?
Definition
Carvedilol
Labetalol - impt in heart failure – not as effective for just HTN
Term
Beta blocker will decrease contractility – will decrease stroke volume on the wiggers diagram
Definition
Term
Hydralazine,
Definition
Direct vasodilator
Term
Minoxidil,
Definition
direct vasodilator
Term
Nitroglycerin,
Definition
direct vasodilator
Term
Nitroprusside
Definition
direct vasodilator
Term
Direct vasodilators side effects?
Definition
Tachycardia, Lupus like symptoms, headaches, hirsutism (primarily Minoxidil)
Term
verapamil
Definition
Non-Dihydrapyridines CCB
Term
diltiazem;
Definition
Non-Dihydrapyridines CCB
Term
nifedipine,
Definition
Dihydropyridine CCB
Term
amlodipine,
Definition
Dihydropyridine CCB
Term
felodipine
Definition
Dihydropyridine CCB
Term
CCB Side Effects?
Definition
Ankle edema, headaches, flushing, gingival hyperplasia (primarily dihydropyridine)
Term
The only CCB you can use in HF patient is ____– doesn’t hurt or help HF = neutral
Definition
amlodipine
Term
Angiotensin Converting Enzyme Inhibitors MOA?
Definition
Inhibits Angiotensin II (direct vasoconstrictor) and increased kinin levels
Term
ACEIs Side Effects?
Definition
Dry hacking cough, angioedema, rash, first dose hypotension, hyperkalemia, caution with increasing renal insufficiency
Term
____ Contraindicated in 2nd & 3rd trimester pregnancy
Definition
Ace-Is
Term
Angiotensin Release Blocking MOA?
Definition
Action – Directly displaces Angiotensin II (direct vasoconstrictor)
Term
ARBs Side Effects?
Definition
Side Effects – hyperkalemia, angioedema, first dose hypotension, caution with increasing renal insufficiency
Term
aliskiren
Definition
direct renin inhibitor
Term
In contrast to ACE-I, no ___ with ARBs
Less chance of ___
Definition
cough
angioedema
Term
A patient is started on a drug for treatment of hypertension. On a return visit to your office, he states that shortly after he started taking the drug, he experienced a persistent cough that has not improved even though he has taken the medication as prescribed. What is the most likely drug that he was taking, and what drug could you substitute that would have similar beneficial pharmacodynamic effects while likely producing less cough?

Initial Drug Substituted Drug
moexipril telmisartan
chlorothiazide torsemide
diltiazem nifedipine
hydralazine alpha-methyldopa
Definition
moexipril telmisartan
Term
A patient is found to have new onset hypertension 145/95 mmHg. The patient is African American. Which of the following antihypertensive agents would be used initially because it is typically more effective in African Americans?

HCTZ
Lisinopril
Captopril
Valsartan
Atenolol
Prazosin
Definition
HCTZ
Term
General approach to HTN
Definition
Thiazides
ACE-I - ATII blockers (ARBS)
Beta blockers
Calcium channel blockers
Alpha blockers
Vasodilators
Term
FOR HTN in Coronary heart disease, Tx w/?
Definition
beta blockers, ACE inhibitors
Term
For HTN in CHF, tx w/?
Definition
ACE inhibitors, beta blockers, ARBs, spiranolactone
Term
For HTN in Diabetics, Tx w/?
Definition
ACE-I’s, ARBs
Term
For HTN in Renal insufficiency, Tx w/?
Definition
ACE-I’s, ARBs
Term
For HTN post MI, tx w/?
Definition
BB & ACEs
Term
What are the 3 classes of antianginals?
Definition
nitrites, BBs, and CCBs
Term
ranolazine
Definition
Late Sodium Blocker

decreased myocardial stress, increased coronary perfusion
Term
what antianginal drug can you use as an adjunct when you don't think any other drug is working?
Definition
ranolazine
Term
HMG-CoA Reductase Inhibitors are for _____
Definition
dyslipidemia
Term
HMG-CoA Reductase Inhibitors MOA?
Definition
Action – Primarily works in enhancing hepatocyte LDL receptors and increases LDL clearing from plasma
Term
HMG-CoA Reductase Inhibitors Indications?
Definition
Use – Increased LDL, TC, Apo B, Non-HDL primarily; modest effect on increased TGY; much less effect on low HDL
Term
HMG-CoA Reductase Inhibitors Side Effects?
Definition
Myopathy/Rhabdomyolysis
Increased Liver Enzymes
Term
Atorvastatin
Definition
HMG-CoA Reductase Inhibitors
Term
Lovastatin
Definition
HMG-CoA Reductase Inhibitors
Term
Bile Acid Sequestrants MOA?
Definition
Action – Primarily works in the liver by increasing LDL clearance and increased cholesterol losses in the bile
Term
Bile Acid Sequestrants Indications?
Definition
Increased LDL, TC, Non-HDL primarily; no effect or may increase TGY
Term
Cholestyramine,
Definition
Bile Acid Sequestrants
Term
Colestipol,
Definition
Bile Acid Sequestrants
Term
Colesevelam
Definition
Bile Acid Sequestrants
Term
Bile Acid Sequestrants SE?
Definition
GI distress, constipation, decreased absorption other drugs,
Term
Fibric Acids are used to treat?
Definition
dyslipidemia
Term
Fibric Acids MOA?
Definition
Action – Enhances lipoprotein lipase in the peripheral tissues and improved removal of triglycerides
Term
Fibric Acids indications?
Definition
Use - Increased TGY primarily with good effect on LDL, TC, Non-HDL; modest effect on low HDL
Term
Gemfibrozil,
Definition
fibric acid
Term
Fenofibrate,
Definition
fibric acid
Term
Clofibrate
Definition
fibric acid
Term
Fibric Acids SE?
Definition
Side Effects - Dyspepsia, Gallstones, Myopathy, Rhabdomyolysis (Myoglobinuria)
Term
Nicotinic Acids are used to treat?
Definition
dyslipidemia
Term
Nicotinic Acids MOA?
Definition
Action – Limits FFA from adipose tissue which decreases hepatic release of VLDL
Term
Nicotinic acids indications?
Definition
Use – Primarily elevates HDL, high modest lowering of LDL and Apo B, low modest effect on increased TGY
Term
Niacin,
Definition
nicotinic acid
Term
Niaspan
Definition
nicotinic acid
Term
Nicotinic Acid SE?
Definition
Flushing, hyperglycemia, hyperuricemia, UGI distress, hepatotoxicity
Term
Cholesterol Absorption Inhibitors MOA?
Definition
Action – Decreases cholesterol absorption in the gut
Term
Cholesterol Absorption Inhibitors Indications?
Definition
Use - Increased LDL and TC, Apo B; no substantial effect on HDL or TGY
Term
Ezetimibe
Definition
Cholesterol absorption inhibitor
Term
Cholesterol absorption ihibitor Side Effects?
Definition
Arthralgias, Back Pain, Abdominal Pain, Diarrhea, Cough
Term
Omega 3 Fatty Acids MOA?
Definition
Action – Reduced production of VLDL and remnants
Term
Omega 3 Fatty Acids Indications?
Definition
Use – Primarily for elevated TGY but with mild modest effects on LDL and HDL.
Term
Omega 3 Fatty Acids SE?
Definition
Side Effects - Eructation, infection, flu like syndrome, dyspepsia, taste changes, back pain
Term
statin toxicity can cause?
Definition
hepatic damage & rhabdomyolysis
Term
What lab Indicates muscle breakdown = rhabdomyolysis and need to monitor on statins?
Definition
Monitor creatine phosphokinase (CPK; CK)
Term
DOC for ↓ levels of TG (VLDL) in pts at risk for pancreatitis?
Definition
niacin
Term
How to increase HDLs?
Definition
Exercise and niacin
Term
How to treat niacin toxicity flushing?
Definition
Give aspirin (blunts, but does not remove, this effect).
Term
_________ is used for Reduction of triglycerides when VLDL is very high, or when IDL is elevated. Follow VLDL. If it is elevated, this is a candidate drug. If LDL is elevated but VLDL is not elevated, do not use this drug.
Definition
gemfibrozil
Term
What class of drug has this MOA?

Enhanced excretion of bile acids, leading to conversion of cholesterol to bile acids in the liver.

Loss of cholesterol triggers up regulation of LDL receptors in the liver: therefore,  LDL
Definition
bile acid sequestrants
Term
What drug Inhibits absorption of phytosterols and cholesterol
Definition
Ezetimibe
Term
Ezetimibe Primarily useful for reducing ____ cholesterol
Does not modify ____ absorption
Often used in combination with a ___
Definition
LDL
triglyceride
statin
Term
A 52 y/o African-American male presents for routine follow-up. He has a history of aortic valve replacement, hyperlipidemia, and hypertension. He also has a history of benign prostatic hypertrophy. He states for the past two months he has noticed progressive generalized soreness and discomfort in the muscles of his extremities especially the upper extremities. His medications include amlodipine 10 mg daily, warfarin 2.5 mg daily, doxazosin 2 mg daily, lovastatin 40 mg daily, and Centrum-multivitamin/mineral supplement.

What labs to order?
Definition
Would order a CPK – based on muscle problems
Would get a liver panel
Term
What medication is at most concern for causing
peripheral edema?
Amlodipine
Warfarin
Lovastatin
Doxazosin
Definition
Amlodipine
Term
Which drug is most likely to cause sedation & dryness of mouth?

Telmisartan
HCTz
asa
Clonidine
Definition
Clonidine
Term
Which drug most likely to cause rebound HTN?
Telmisartan
HCTz
Clonidine
asa
Definition
Clonidine
Term
What agen should not be stopped abruptly?
Ramipril
Metoprolol
Definition
Metoprolol
Term
What causes respiratory depression?
Definition
Morphine
Term
What causes progressive hypotension
Definition
Nitrate
Term
With Mobitz type II – what med should not be used?
Definition
B-blocker
Term
Pt. w/ pulmonary edema & ankle edema, what tx will help with both?
Definition
Furosemide will help with both
Term
High trigs are treated w/?
Definition
Fenofibrate
Term
Which masks hypoglycemia?
Definition
Beta blocker
Term
____ is probalby best HTN drug for someone w/ DM
Definition
ACE
Term
BP is reduced by:
Reduced CO
Increased vagus nerve activity
Decreased central sympathetic outflow
Reduced angiotensin II levels
What drug to do this?
Definition
ACEs
Term
What inhibits peptidyl dipeptidase?
Definition
ACE-Is
Term
Cutting spinal cord below T8 would _____ afterload
Definition
decrease
Term
If stellate gangion (sympathetic outflow to heart) was cut?
Definition
Decreases contractility
Term
Class I Anti-arrhythmics?
Definition
Na+ Channel Blocker; Blocks Conduction
Common Uses – AFib, Flutter; V-Tach, WPW
Medications – Quinidine, Lidocaine, Flecainide
Side Effects – Dysrhythmias, GI symptoms, Toxic, blood dyscrasias
Term
Class II Anti-arrhythmics?
Definition
Beta Adrenergic Blockers; decreases SA node automaticity; sympatholytic activity
Common Uses – Primarily AFib, Flutter; PVC's
Medications – Propranolol, Metoprolol, Atenolol, Sotalol
Side Effects – Bradycardia, bronchospasm, fatigue
Term
Class III Anti-arrhythmics?
Definition
Prolongs the action potential
Common Uses – Atrial Dysrhythmias such as AFib, Flutter, PVST; Ventricular Dysrhythmias, WPW
Medications – Amiodarone, Sotalol, Bretylium
Side Effects – Thyroid function, pulmonary function, dysrhythmias
Term
Class IV Anti-arrhythmics?
Definition
Calcium Channel Blockers; decreases SA nodal rate and AV conduction
Common Uses – Atrial Dysrhythmias
Medications – Verapamil, Diltiazem
Side Effects – Bradycardia, nausea and vomiting, hypotension
Term
Adenosine
Definition
anti-arrhythmic
Term
Digitalis
Definition
anti-arrhythmic
Term
Quinidine,
Definition
Anti-Arrhythmic
Na+ channel blocker
Term
Lidocaine,
Definition
Anti-Arrhythmic
Na+ channel blocker
Term
Flecainide
Definition
Anti-Arrhythmic
Na+ channel blocker
Term
Amiodarone,
Definition
Anti-Arrhythmic
K+ channel blocker
Term
Sotalol,
Definition
Anti-Arrhythmic
K+ channel blocker
Term
Bretylium
Definition
Anti-Arrhythmic
K+ channel blocker
Term
First Line Agents for HF? (3)
Definition
Diuretics
Typically Loop Diuretics
If wet -> Diurese

Beta Blockers (Don’t start or increase if wet)
Carvidelol
Metoprolol XL

ACEI/ARB
Term
_____ is the only oral inotrope and is a weak inotrope at best. Use is primarily useful in heart failure but is controversial.
Definition
Digoxin
Term
IV Inotropes -> Used primarily in left ventricular dysfunction such as in acute and chronic heart failure.
Medications? (2)
Definition
Dobutamine, Dopamine
Term
Drug used in severe cases of shock for vasoconstriction?
Definition
levophed
Term
Thiazides function at what part of the renal tubule?
Definition
distal convoluted tubule
Term
Carbonic anhydrase inhibitors MOA?
Definition
prevent formation of H+ and HCO3-.
Less H+ to exchange for Na+
Less Na+ reabsorbed
Water follows Na+ so less water reabsorbed.
Term
Mannitol
Definition
osmotic diuretic
Term
Urea,
Definition
osmotic diuretic
Term
glycerin
Definition
osmotic diuretic
Term
isosorbide
Definition
osmotic diuretic
Term
osmotic diuretic DOC?
Definition
Mannitol
Term
Osmotic Diuretics: Uses (3)
Definition
Acute renal failure (i.e., maintain urine flow)

Reduce cerebrospinal fluid volume and pressure Often used after head injury to reduce CSF pressure

Hemodialysis Facilitate urinary excretion of toxic substances
Term
What is a good tx for Acute pulmonary edema?
Definition
furosemide
Term
Loop diuretics indications?
Definition
1. Edema

2. Acute pulmonary edema

3. HTN that can not be controlled with other diuretics

4. Acute renal failure

5. Hypercalcemia
Term
good drug to use in hyperparthyroidism where there is hypercalcemia?
Definition
Loop diuretic
Term
indapamide,
Definition
“thiazide-like” drug
These agents work at the same site as thiazides but have different structures. When loop diuretics fail, these agent may serve as a adjunct with the loop diuretic to produce diuresis.
Term
metolazone
Definition
“thiazide-like” drug
These agents work at the same site as thiazides but have different structures. When loop diuretics fail, these agent may serve as a adjunct with the loop diuretic to produce diuresis.
Term
Spiranolactone Site of Action in renal tubule?
Definition
collecting duct
Term
Spironolactone MOA?
Definition
competes for the aldosterone receptor
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