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Pharm Cardio
Pharm Board Prep
90
Pharmacology
Graduate
03/10/2012

Additional Pharmacology Flashcards

 


 

Cards

Term
What type of drugs can be used to treat Essential hypertension?
Definition

Diuretics

ACE inhibitors

Angiotensin II receptor blockers (ARBs)

Calcium Channel blockers

Term
What type of drugs can be used to treat CHF?
Definition

Diuretics

ACE inhibitors/ARBs

β-Blockers

(compenstated CHF)

K+-sparing diuretics

Term
What drugs are contraindicated in cardiogenic shock?
Definition

β-Blockers


can be used in compensated CHF, and used cautiously in decompensated CHF

Term
What type of drugs can be used to treat hypertension in Diabetic patients?
Definition

ACE inhibitors/ARBs

Calcium channel Blockers

Diuretics

β-blockers

α-blockers

Term
What type of drugs are protective against diabetic nephropathy?
Definition
ACE inhibitors
Term
Mechanism of Hydralazine
Definition

↑ cGMP → smooth muscle relaxation

 

Vasodilates arterioles > veins

 

afterload reduction

Term
Clinical Uses of Hydralazine
Definition

Severe Hypertension, CHF

 

First-line therapy for hypertension in Pregnancy, with methyldopa





Term
What is frequently administered with Hydralazine to prevent reflex tachycardia?
Definition
β-Blockers
Term
What drug is contraindicated in angina and coronary artery disease? Why?
Definition

Hydralazine

 

Toxicity:

Compensatory tachycardia

fluid retention

nausea

headache

angina

Lupus-like syndrome

Term
What are the Calcium Channel Blockers?
Definition

Nifedipine

Verapamil

Diltiazem

Amlodipine

Term

Mechanism of Calcium Channels Blockers

(Nifedipine, Verpamil, Diltiazem, Amlodipine)

Definition

Block voltage-dependent L-type calcium channels of cardiac and smooth muscle → ↓ muscle contractility

 

Vascular smooth muscle →

nifedipine>diltiazem>verapamil

 

Heart →

verapamil>diltiazem>nifedipine

 

Term
What CCBs work best in the vascular smooth muscle?
Definition
Nifedipine > Diltiazem > Verapamil
Term
What CCBs work best in the Heart?
Definition

Verapamil > Diltiazem > Nifedipine

 

(Verapamil = Ventricle)

Term

Clinical Uses of Calcium Channel Blockers

 

(Nifedipine, Verapamil, Diltiazem, Amlodipine)

Definition

Hypertension

Angina

Arrhythmias (not nifedipine)

Prinzmetal's angina

Raynaud's

Term
What CCB should not be used in the treatment of Arrhythmias?
Definition
Nifedipine
Term

Toxicity of Calcium Channel Blockers

 

(Nifedipine, Verapamil, Diltiazem, Amlodipine)

Definition

Cardiac Depression

AV Block

Peripheral Edema

Flushing 

Dizziness

Constipation

Term
What 3 drugs are used for the treatment Malignant Hypertension?
Definition

Nitroprusside

(↑cGMP)

 

Fenoldopam

(Dopamine D1 receptor agonist)

 

Diazoxide

(K+ channel opener)

Term

Mechanism of Nitroprusside

 

(Malignant hypertension treatment)

Definition

Short Acting

 

↑cGMP via direct release of NO

 

(can cause cyanide toxicity, releases CN)

Term

Mechanism of Fenoldopam

 

(Malignant Hypertension Treatment)

Definition

Dopamine D1 receptor agonist

 

Relaxes renal vascular smooth muscle

Term

Mechanism of Diazoxide

 

(Malignant Hypertension Treatment)

Definition

K+ channel opener

 

Hyperpolarizes and relaxes vascular smooth muscle

 

Can cause hyperglycemia

(reduces insulin release)

Term
How can Diazoxide cause Hyperglycemia?
Definition

Reduces insulin release

 

 

Term

Mechanism of Nitroglycerin

(isosorbide dinitrate)

Definition

Vasodilate by releasing nitric oxide in smooth muscle → 

↑ cGMP and smooth muscle relaxation

 

Dilate veins >> arteries

 

↓ preload

Term
Clinical use of Nitroglycerin, isosorbide dinitrate
Definition

Angina

Pulmonary Edema

 

(aphrodisiac and erection enhancer)

Term
Toxicity of Nitroglycerin, isosorbide dinitrate
Definition

Reflex tachycardia

Hypotension

Flushing

Headache

"Monday Disease" in industrial exposure

 

Term

What is "Monday disease"?

What causes this?

Definition

Development of tolerance for vasodilating action during the work week and loss of tolerance over the weekend

Resulting in →

Tachycardia, Dizziness, and headache on reexposure

 

Caused by Nitroglycerin, isosorbide dinitrate

Term

What is the Goal of Antianginal Therapy?

How is this accomplished?

Definition

Goal:  Reduction of myocardial O2 consumption (MVO2)

 

Decreasing 1 or More of MVO2 Determinants:

End-diastolic volume

Blood Pressure

Heart Rate

Contractility

Ejection Time

Term
How do Nitrates affect preload?
Definition

↓ End-Diastolic Volume

↓ Blood Pressure

↑ Contractility (reflex response)

↑ Heart Rate (reflex response)

↓ Ejection Time

↓ MVO2

Term
How Do β-Blockers affect afterload?
Definition

↑ End-diastolic volume

↓ Blood Pressure

↓ Contractility

↓ Heart Rate

↑ Ejection Time

↓ MVO2

 

Term
How do Nitrates and β-Blockers work together in the treatment of angina?
Definition

No Effect or ↓ End-diastolic volume

↓ Blood Pressure

Little/No effect Contractility

↓ Heart Rate

Little/No effect Ejection Time

↓↓ MVO2

Term

What CCB have a similar effect to Nitrates in antianginal thearpy?

 

What CCB has a similar effect to β-blockers in antianginal therapy?

Definition

Nifedipine ~ Nitrates

 

Verapamil ~ β-Blockers

Term
What β-blockers are contraindicated in angina?
Definition

Pindolol and Acebutolol


Partial β-agonists

Term
What are the HMG-CoA reductase inhibitors?
Definition

Lovastatin

Pravastatin

Simvastatin

Atorvastatin

Rosuvastatin

Term

Mechanism of Action


HMG-CoA reductase Inhibitors

Lovastatin

Pravastatin

Simvastatin

Atorvastatin

Rosuvastatin

Definition
Inhibit Cholesterol Precursor, Mevalonate
Term

Side Effects/Problems


 

HMG-CoA reductase inhibitors 

Lovastatin

Pravastatin

Simvastatin

Atorvastatin

Rosuvastatin

Definition

Hepatotoxicity

(↑ LFTs)

Rhabdomyolysis

Term

Effects on Cholesterol


HMG-CoA reductase inhibitors 

 

Lovastatin

Pravastatin

Simvastatin

Atorvastatin

Rosuvastatin

Definition

LDL - ↓↓↓

HDL - ↑

Triglycerides - ↓

Term

Mechanism of Action


Niacin

Definition

Inhibits lipolysis in adipose tissue

Reduces Hepatic VLDL secretion into circulation

Term

Side Effects/Problems


Niacin

Definition

Red, Flushed Face

(↓ by aspirin or long-term use)

 

Hyperglycemia

(acanthosis nigricans)

 

Hyperuricemia

(exacerbates gout)

Term

Effects on Cholesterol


Niacin

Definition

LDL - ↓↓

HDL - ↑↑

Triglycerides - ↓

Term
What are the Bile Acid Sequestrant Drugs?
Definition

Cholestyramine

Colestipol

Colesevelam

Term

Mechanism of Action


 

Bile Acid Sequestrants

Cholestyramine

Colestipol

Colesevelam

Definition

Prevent intestinal reabsorption of bile acids → 

Liver must use cholesterol to make more

Term

Side Effects/Problems


 

Bile Acid Sequestrants

Cholestyramine

Coletipol

Colesevelam

Definition

Patients hate it → Tastes bad and causes GI discomfort

↓ absorption of fat-soluble vitamins

Cholesterol Gallstones

Term

Effects on Cholesterol


 

Bile Acid Sequestrants

Cholestyramine

Colestipol

Colesevelam

Definition

LDL - ↓↓

HDL - slight ↑

Triglicerides- slight ↑

Term
What is the cholesterol absorption blocking drug?
Definition
Ezetimibe
Term

Mechanism of Action


 

Cholesterol Absorption Blocker

Ezetimibe

Definition

Prevent cholesterol reabsorption at small intestine brush border

 

(Binds NPC1L1 protein on GI epithelial cells and hypatocytes)

Term

Effects on Cholesterol


 

Cholesterol absorption Blockers

Ezetimibe

Definition
LDL - ↓↓
Term
What are the Fibrates?
Definition

Gemfibrozil

Clofibrate

Bezafibrate

Fenofibrate

Term

Mechanism of Action


 

Fibrates

Gemifibrozil

Clofibrate

Bezafibrate

Fenofibrate

Definition
Upregulate LPL → ↑ TG clearance
Term

Side Effects/Problems


 

Fibrates

Gemifibrozil

Clofibrate

Bezafibrate

Fenofibrate

Definition

Myositis

Hepatotoxicity

↑ LFTs

Cholesterol Gallstones

Term

Effect on Cholesterol



Fibrates

Gemfibrozil

Clofibrate

Bezafibrate

Fenofibrate

Definition

LDL - ↓

HDL - ↑

Triglycerides - ↓↓↓

Term
What are the Lipid-Lowering Agents?
Definition

HMG-CoA Reductase Inhibitors 

Lovastatin

Pravastatin

Simvastatin

Atorvastatin

Rosuvastatin

 

Niacin

 

Bile Acid Resins

Cholestyramine

Colestipol

Colesevelam

 

Cholesterol Absorption Blockers

Ezetimibe

 

Fibrates

Gemfibrozil

Clofibrate

Bezafibrate

Fenofibrate

 

 

 

 

 

 

 

 

 

 

 

Term

Mechanism of Action


Cardiac Glycosides

Digoxin

Definition

Direct inhibition of Na/K ATPase → indirect inhibition of Na/Ca exchanger/antiport

 

↑ [Ca] → positive inotropy

 

Stimulates Vagus Nerve

Term

Clinical Use


Cardiac Glycosides

Digoxin

Definition

CHF - ↑ contractility

Atrial Fibrillation - ↓ conduction at AV node and depression of SA node

Term

Toxicity


Cardiac Glycosides

Digoxin

Definition

Cholinergic - nausea, vomiting, diarrhea, blurry yellow vision

 

ECG - ↑PR, ↓QT, scooping, T-wave inversion, arrhythmia, hyperkalemia

 

Worsened by →

renal failure

(↓ excretion)

hypokalemia

(allows digoxin binding at K-binding site on Na/K ATPase)

quinidine

(↓ digoxin clearance, displases digoxin from tissue binding sites)

Term
How is Digoxin Toxicity treated?
Definition

Slowly normalize K+

Lidocaine

Cardiac pacer

anti-dig Fab Fragments

Mg2+

Term

Mechanism of Action


Nesiritide

Definition

Recombinant B-type natriuretic peptide

Causes ↑ in cGMP and vasodilation

Term

Clinical Use


Nesiritide

Definition

Acute Decompensated Heart Failure


(jugular venous distension - most sensitive clinical sign)

Term

Toxicity


Nesiritide

Definition
Hypotension
Term

Class I Antiarrhythmics


Na+ channel Blockers

Definition

Class IA

Quinidine

Procainamide

Disopyramide

 

Class IB

Lidocaine

Mexiletine

Tocainide

 

Class IC

Flecainide

Propafenone

 

Term

Antiarrhythmics


Mechanism of Action

 

All Class I

Na+ Channel Blockers

 

 

Definition

Local Anesthetics

Slow or Block Conduction

(Especially in depolarized cells)

↓ slope of phase 0 depolarization

↑ threshold for firing in abnormal pacemaker cells

State Dependent

(selectively depress tissue that is frequently depolarized)

 Hyperkalemia →↑ toxicity for all class I drugs


[image]

Term

Antiarrhythmics


Mechanism of Action

 

Class IA

Na Channel Blockers

 

Quinidine

Procainamide

Disopyramide

Definition

↑ AP duration

↑ effective refractory period

↑ QT interval

 

Atrial and Ventricular Arrhythmias

(especially reentrant and ectopic supraventricular and ventricular tachycardia)

 

[image]

Term

Antiarrhythmics


Toxicity


Class IA


Quinidine

Procainamide

Disopyramide

Definition

Thrombocytopenia

Torsades de Pointes

 

Quinidine:

Cinchonism - headache, tinnitus

 

Procainamide:

reversible SLE-like syndrome

 

Term

Antiarrhythmics


Mechanism of Action

 

Class IB


Lidocaine

Mexiletine

Tocainide

Definition

↓ AP duration

Preferentially affect ischemic or depolarized Purkinje and ventricular tissue

 Useful in:

Acute Ventricular Arrhythmias

(especially post-MI)

Digitalis-induced arrythmias

 

IB is Best post-MI

[image]

Term

Antiarrhythmics


Toxicity

 

Class IB

 

Lidocaine

Mexiletine

Tocainide

Definition

Local anesthetic

CNS stimulation/Depression

Cardiovascular depression

Term

Antiarrhythmics


Mechanism of Action

 

Class IC

 

Flecainide

Propafenone

Definition

No Effect on AP duration

 

Useful in:

V-Tachs that progress to V-Fib

Intractable SVT

 

Last resort in refractory tachyarrhythmias

 

For Patients WITHOUT structural abnormalities

[image]

Term

Antiarrhythmics


Class II

β-Blockers

Definition

Propranolol

Esmolol

Metoprolol

Atenolol

Timolol

Term

Antiarrhythmics


Mechanism of Action

 

Class II

 

Propranolol

Esmolol

Metoprolol

Atenolol

Timolol

Definition

↓ cAMP, ↓ Ca2+ Currents

Suppress abnormal pacemakers by ↓ slope of phase 4

AV node particularly sensitive → ↑ PR interval


Esmolol - short acting

 

 

 

 

 

[image]

[image]

Term

Antiarrhythmics


Clinical Uses

 

Class II

 

Proranolol

Esmolol

Metoprolol

Atenolol

Timolol

Definition

V-Tach

SVT

Slowing ventricular rate during atrial fibrillation and atrial flutter

Term

Antiarrhythmics


Toxicity


Class II


Propranolol

Esmolol

Metoprolol

Atenolol

Timolol


Definition

Impotence

Exacerbation of Asthma

Cardiovascular effects

(Bradycardia, AV block, CHF)

CNS effects

(sedation, sleep alterations)

May mask hypoglycemia signs

 

Metoprolol:

Dyslipidemia

Term

Antiarrhythmics


 

Treatment of β-Blocker overdose

 

Propranolol

Esmolol

Metoprolol

Atenolol

Timolol

Definition
Glucagon
Term

Antiarrhythmics


Class III

 

K+ Channel Blockers

Definition

Ibutilide

Sotalol

Bretylium

Amiodarone

Dofetilide

 

(K IS BAD)

Term

Antiarrhythmics


Mechanism of Action


Class III


Ibutilide

Sotalol

Bretylium

Amiodarone

Dofetilide

Definition

↑ AP duration

↑ Effective Refractory Period

↑ QT interval

 

Used when other antiarrhythmics fail

 

[image]

Term

Antiarrhythmics


Toxicity


Class III


Ibutilide

Sotalol

Bretylium

Amiodarone

Dofetilide

Definition

Ibutilide:

Torsades de Pointes

 

Sotalol:

Torsades de Pointes

Excessive β-Block

 

Bretylium:

New arrhythmias

Hypotension

 

Amiodarone:

Pulmonary fibrosis

Hepatotoxicity

Hypothyroidism/Hyperthyroidism

Corneal Deposits

Skin Deposits → photodermatitis

neurologic effects

constipation

cardiovascular effects

(bradycardia, heart block, CHF)

 

 

Term

Antiarrhythmics


What drug has class I, II, II and IV effects?

Definition

Amiodarone

 

Remember to check PFTs, LFTs, and TFTs when using Amiodarone

Term

Antiarrhythnimics


Class IV

 

Ca2+ blockers

Definition

Verapamil

Diltiazem

Term

Antiarrhythmics


Mechanism of Action


Class IV


Verapamil

Diltiazem

Definition

↓ conduction velocity

↑ Effective Refractory Period

↑ PR interval

 

Used in prevention of nodal arrhythmias

 

[image]

Term

Antiarrhythmics


Toxicity

 

Class IV

 

Verapamil

Diltiazem

Definition

Constipation

Flushing

Edema

CV effects

(CHF, AV Block, Sinus Node Depression)

Term

Antiarrhythmics


Mechanism of Action

 

Adenosine

Definition

↑ K+ out of cells → hyperpolarizing the cell + ↓ ICa

 

Drug of Choice for:

Diagnosing/Abolishing Supraventricular Tachycardia

 

Very Short Acting

Term

Antiarrhythmics


Toxicity


Adenosine

Definition

Flushing

Hypotension

Chest Pain


Blocked by:

Theophylline

Term

 

Antihypertensive Therapy


 

Hypertension plus...

 

CHF

Definition

Initial Therapy


Diuretics

ACE inhibitor/ARB

β-Blocker

Aldoseterone antagonist


Avoid


β-Blockers → acute decompensated CHF or cardiogenic shock

Calcium Channel Blockers

Term

Antihypertensive


 

Hypertension plus....

 

DM

Definition

Initial Therapy


ACE inhibitor/ARB

Thiazide


Avoid


β-Blockers

Term

Antihypertensives


 

Hypertension plus...

 

Post-MI/CAD

Definition

Initial Therapy


Thiazide

β-Blocker

ACE inhibitor/ARB

CCB (for angina)

Nitrates (for angina)

Term

Antihypertensives


 

Hypertension plus...

 

Atrial Fibrillation

 

Definition

Initial Therapy


Diltiazem/Verapamil

(for rate control)

Term

Antihypertensives


 

Hypertension plus...

 

Bradycardia

 

(what to avoid only)

Definition

Avoid


 

Diltiazem/Verapamil

β-Blockers

Term

Antihypertensives


 

HTN plus...

 

Renal insufficiency

 

Definition

Initial Therapy


ACE inhibitor/ARB

(for proteinuria)


Avoid


ACE/ARB → may increase creatinine

K+ sparing diuretics

Term

Antihypertensives


 

HTN plus...

 

BPH

Definition

Initial Therapy


α-blocker

Term

Antihypertensives


 

HTN plus...

 

Hyperthyroidism

Definition

Initial Therapy


 

Propranolol

Term

Antihypertensives


 

HTN plus...

 

Hyperparathyroidism

Definition

Initial Treatment


Loop Diuretic


Avoid


Thiazide

Term

Antihypertensives


 

HTN plus...

 

Osteoporosis

Definition

Initial Therapy


 

Thiazide

Term

Antihypertensives


 

HTN plus...

 

Pregnancy

 

Definition

Initial Therapy


Hydralazine

Methyldopa

Labetalol

Dihydropyridine CCB


Avoid


ACE inhibitors/ARBs

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