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
|
|
Term
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
|
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
|
Definition
Acute Decompensated Heart Failure
(jugular venous distension - most sensitive clinical sign) |
|
|
Term
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
Antihypertensives
HTN plus...
Pregnancy
|
|
Definition
Initial Therapy
Hydralazine
Methyldopa
Labetalol
Dihydropyridine CCB
Avoid
ACE inhibitors/ARBs |
|
|
