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51 Cards in this Set

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heparin
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
LMWH
works primarily by directly inavtivating 10a
fewer bleeing SA's than heparin
enoxaparin
LMWH
Dalteparin
LMWH
warfarin
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
coumedin
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
lepirudin
inhibits thrombin directly
used for unstable angina
bivalirudin
inhibits thrombin directly
used for unstable angina
streptokinase
protein from strep. that binds plasminogen

used for PE, DVT acute MI
anistreplase
complex of plasminogen and streptokinase with protected active site.
used for PE, DVT acute MI
tpa
protease
activates plasminogen bound to fibrin
used for PE, DVT acute MI
aspirin
irrevirsible inhibitor of COX 1 inhibits TXA2 sunth.
decreased platelet aggregation.
ticlopidine
clopidogrel
inhibit platelet mediated aggregation
for patients who cannot tolerate aspirin, for unstable angina
abciximab
prevent platelet/fibrin aggregation.
for patients who cannot tolerate aspirin
integrelin
taget platelet receptors to prevent platelet/fibrin aggregation.
for patients who cannot tolerate aspirin
digoxin/digitoxin
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
Dobutamine
b1 agonist high inotropy low chronotropy.
IV for acute HF
SA: tachycardia
Dopamine
@heart causes NE release
@ periphery decreases NE release, (vasoldilation)
for acute HF esp w/renal failure
amrinone
PDE inhibitor: increased levels of cAMP, muscle relaxation/vasodilation
cardiac selective
hepatotoxicity... short term only
Milrinone
PDE inhibitor: increased levels of cAMP, muscle relaxation/vasodilation
cardiac selective
no better than digoxin... short term only
Hydrochlorothiazide HCTZ
thiazide diuretic. low ceiling
decreases NA/h2o retention

mild CHF
SA hypokalemia use supp. K+
Furosemide
thiazide diuretic. high ceiling
decreases NA/h2o retention

severe CHF
SA hypokalemia use supp. K+
spirolactone
k sparing diuretic. aldosterone antagonist
hydralazine
opens k channels, Ca influx for vasodilation
CHF with low ventricular output
nitrates
venodilator for CHF with high filling pressures and pulmonary congestion.
SA relex tachy
Captopril
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
enalapril
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
lisinopril
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
Losartan/Valsartan
Angiotensin Receptor Antagonist:
no effect on bradykinin levels
similar to ACE inhibitors but no cough, rash.
inhibition of renin release
inhibition of sympathetics
clonidine
methydopa
propranolol etc.
Nitrates
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
dihydropyridines
venodilation
arterial dilation
for stable/variant angina and HTN
SA hypoTN reflex tachy
used in subarachnoid hemmorrhage
verapamil
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
diltiazem
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
B blockers for Angina
metoprolol
atenolol
propranolol
decrease HR and inotropy (o2 demand) selective are better
contra: asthma
HMG co A reductase
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
fluvastatin
weakest HMG co A reductase
pravastatin
safest HMG co A reductase
no liver metabolism
lovastatin
HMG co A reductase
simvastatin
HMG co A reductase
atorvastatin
HMG co A reductase
Rosuvastatin
most potent HMG co A reductase
Bile acid sequestrants
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
cholestyramine
Bile acid sequestrant
cholestipol
Bile acid sequestrant
Colesevelam
Bile acid sequestrant
Ezetimibe
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
Niacin (and extended release)
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
Gemfibrozil
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
fenofibrate
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
fibric acid derivatives
increase LP lipase activity
increase VLDL catabolism, decreased production
increase apoprotein A1 (HDL)
decreased platelet aggr.
may increase LDL
alt. omaega 3 fatty acids