Cardiac

Front 1

heparin

Back 1

binds to ANTIII and inactivates 10a, 9a 8a and thrombin
used post MI unstable angina, during pregnancy, thromboembolism

reversal using protamine sulfate which preferentially binds with ant 3

Front 2

LMWH

Back 2

works primarily by directly inavtivating 10a
fewer bleeing SA's than heparin

Front 3

enoxaparin

Back 3

LMWH

Front 4

Dalteparin

Back 4

LMWH

Front 5

warfarin

Back 5

vit k analog
prevents carboxylation of factors 2,7,9,10.
used in a fib presthetic heart valves
teratogenic

reversal using vit k and factor 9

Front 6

coumedin

Back 6

vit k analog
prevents carboxylation of factors 2,7,9,10.
used in a fib presthetic heart valves
teratogenic

reversal using vit k and factor 9

Front 7

lepirudin

Back 7

inhibits thrombin directly
used for unstable angina

Front 8

bivalirudin

Back 8

inhibits thrombin directly
used for unstable angina

Front 9

streptokinase

Back 9

protein from strep. that binds plasminogen

used for PE, DVT acute MI

Front 10

anistreplase

Back 10

complex of plasminogen and streptokinase with protected active site.
used for PE, DVT acute MI

Front 11

tpa

Back 11

protease
activates plasminogen bound to fibrin
used for PE, DVT acute MI

Front 12

aspirin

Back 12

irrevirsible inhibitor of COX 1 inhibits TXA2 sunth.
decreased platelet aggregation.

Front 13

ticlopidine
clopidogrel

Back 13

inhibit platelet mediated aggregation
for patients who cannot tolerate aspirin, for unstable angina

Front 14

abciximab

Back 14

prevent platelet/fibrin aggregation.
for patients who cannot tolerate aspirin

Front 15

integrelin

Back 15

taget platelet receptors to prevent platelet/fibrin aggregation.
for patients who cannot tolerate aspirin

Front 16

digoxin/digitoxin

Back 16

renal/hepatic clearance inhibits na/k atp pump. therefore increases intracellular Ca. Increased inotropy.
low dose: also vagomimetic
high dose sympathomimetic
low theraputic index
oral
reverse with K+ and digibind if necessary.
SA Av junctional rhythm, AV block, diarrhear color vision abnormal disorientation

Front 17

Dobutamine

Back 17

b1 agonist high inotropy low chronotropy.
IV for acute HF
SA: tachycardia

Front 18

Dopamine

Back 18

@heart causes NE release
@ periphery decreases NE release, (vasoldilation)
for acute HF esp w/renal failure

Front 19

amrinone

Back 19

PDE inhibitor: increased levels of cAMP, muscle relaxation/vasodilation
cardiac selective
hepatotoxicity... short term only

Front 20

Milrinone

Back 20

PDE inhibitor: increased levels of cAMP, muscle relaxation/vasodilation
cardiac selective
no better than digoxin... short term only

Front 21

Hydrochlorothiazide HCTZ

Back 21

thiazide diuretic. low ceiling
decreases NA/h2o retention

mild CHF
SA hypokalemia use supp. K+

Front 22

Furosemide

Back 22

thiazide diuretic. high ceiling
decreases NA/h2o retention

severe CHF
SA hypokalemia use supp. K+

Front 23

spirolactone

Back 23

k sparing diuretic. aldosterone antagonist

Front 24

hydralazine

Back 24

opens k channels, Ca influx for vasodilation
CHF with low ventricular output

Front 25

nitrates

Back 25

venodilator for CHF with high filling pressures and pulmonary congestion.
SA relex tachy

Front 26

Captopril

Back 26

ACE inhibitor: class 1
decrease angII, increase Bradykinin
for HTN DoC for diabtese
CHF
post MI
diabetic neuropathy
no reflex tachy
SA cough, rash, hyperK+ acute renal failure, teratogen neutropenia

Front 27

enalapril

Back 27

hepatic metabolism
ACE inhibitor: class 2
decrease angII, increase Bradykinin
for HTN DoC for diabtese
CHF
post MI
diabetic neuropathy
no reflex tachy
SA cough, rash, hyperK+ acute renal failure, teratogen neutropenia

Front 28

lisinopril

Back 28

renal excretion
ACE inhibitor: class 3
decrease angII, increase Bradykinin
for HTN DoC for diabtese
CHF
post MI
diabetic neuropathy
no reflex tachy
SA cough, rash, hyperK+ acute renal failure, teratogen neutropenia

Front 29

Losartan/Valsartan

Back 29

Angiotensin Receptor Antagonist:
no effect on bradykinin levels
similar to ACE inhibitors but no cough, rash.

Front 30

inhibition of renin release

Back 30

inhibition of sympathetics
clonidine
methydopa
propranolol etc.

Front 31

Nitrates

Back 31

activated guanylyl cyclase in peripheral tissues in order to relax smooth muscle. vasodilate
not coronary dilator
inhale, sublingual or IV
for stable angina
SA hypotTN reflex tachy
tolerance and cross tolerance

Front 32

dihydropyridines

Back 32

venodilation
arterial dilation
for stable/variant angina and HTN
SA hypoTN reflex tachy
used in subarachnoid hemmorrhage

Front 33

verapamil

Back 33

venodilation
arterial dilation
decrease HR and inotropy
for stable/variant angina HTN and antiarrhythmic
SA hypoTN NO REFLEX TACHY
brady cardia
contra: sick sinus av nodal D.
HF

Front 34

diltiazem

Back 34

venodilation
arterial dilation
decrease HR and inotropy
for stable/variant angina HTN and antiarrhythmic
SA hypoTN NO REFLEX TACHY
brady cardia
contra: sick sinus av nodal D.
HF

Front 35

B blockers for Angina

Back 35

metoprolol
atenolol
propranolol
decrease HR and inotropy (o2 demand) selective are better
contra: asthma

Front 36

HMG co A reductase

Back 36

decreases cholesterol synth.
increases production of LDL receptors in the liver
increased clearance of LDL from plasma
decreased VLDL secretion

SA: increased transaminases
acute renal failure rare but increased risk with p450 inhibitors such as cyclosporin erythromyacin
GI effects headaches, cataracts

LDL 20-65 D
HDL 5-15 I
TG 10-35 D

Front 37

fluvastatin

Back 37

weakest HMG co A reductase

Front 38

pravastatin

Back 38

safest HMG co A reductase
no liver metabolism

Front 39

lovastatin

Back 39

HMG co A reductase

Front 40

simvastatin

Back 40

HMG co A reductase

Front 41

atorvastatin

Back 41

HMG co A reductase

Front 42

Rosuvastatin

Back 42

most potent HMG co A reductase

Front 43

Bile acid sequestrants

Back 43

bind bile acids in the intestine, causes increased bile acid production in the liver using cholesterol.
Increase in LDL receptors, clear from plasma.
SA: not well tolerated: bloating abdominal pain interference with intestinal absorption pancreatitis if TG's initially high

LDL 10-30 d
HDL 3-5 I
TG 5-30 I

Front 44

cholestyramine

Back 44

Bile acid sequestrant

Front 45

cholestipol

Back 45

Bile acid sequestrant

Front 46

Colesevelam

Back 46

Bile acid sequestrant

Front 47

Ezetimibe

Back 47

Cholesterol transport inhibitor
decreased absorption of cholesterol by the small intestine. no increase in TG
combo with statins
LDL 20 D
HDL 30-40 I
TG 10 D

Front 48

Niacin (and extended release)

Back 48

Nicotinic Acid
increases HDL by decreased removal. decrease TG/VLDL production decrease LDL and LPa
LDL 10-15 D (may increase!)
HDL 10 -15 I
TG 50 D

Front 49

Gemfibrozil

Back 49

Fibric acid derivative
LDL 10-15 (poss. increase)
HDL 0-40 I
TG 40-60 D
cleared by kidneys
sig. protein binding
increase effects of statins
affects coumadin and dilantin
SA gallstones myositis renal problems arrhythmia Gi distress alopecia weight gain
gallbladder toxicity appendectomy

Front 50

fenofibrate

Back 50

Fibric acid derivative
LDL 15-30 D (may increase)
HDL 0-40 I
LDL 40-60 D
liver metab.
ok with statins
affects coumedin
SA gallstones myositis renal problems arrhythmia Gi distress alopecia weight gain

Front 51

fibric acid derivatives

Back 51

increase LP lipase activity
increase VLDL catabolism, decreased production
increase apoprotein A1 (HDL)
decreased platelet aggr.
may increase LDL
alt. omaega 3 fatty acids