Cardiac Drugs

Front 1

loop diuretics

Back 1

inhibit Na+,K+,2Cl- cotransporter in Loop of Henle

used for rapid relief of dyspnea and fluid retention

Front 2

furosemide

Back 2

loop diuretic

SE: hypoTN, ototoxicity

hypoK, hypoMg, hyperuricemia, hyperglycemia, metabolic alkalosis

effective even w/ renal dysfcn

Front 3

thiazides

Back 3

block Na+,Cl- cotransporter on distal tubule

long duration so used for mild CHF and HTN!

Front 4

hydrochlorothiazide

Back 4

hypercholesterolemia, hypertriglyceridemia, hypoK, hypoMg, hypoNa, hyperCa, metabolic alkalosis

Front 5

K+ sparing diuretics

Back 5

inhibit Na+ reabsorption in distal tubule by competing at aldosterone R

weak Rx used with other diuretics to prevent hypoK in HF pt

Front 6

spironolactone

eplerenone

Back 6

SE: hyperK, gynecomastia (male breasts), irreg menstruation

competes w/ aldosterone R to block Na+ reabsorption (Na+ in urine so no gradient for K+ entry)

Front 7

inotropes

Back 7

improve contractility by increasing intracellular calcium

Front 8

digoxin

(cardiac glycoside)

Back 8

inhibits sarcolemmal Na+,K+ ATPase pump; slows conduction, increases refractoriness at AVnode, enhances vagal tone

used in HF w reduced contractility and atrial fib

SE: arrhythmia exacerbated by low K, Mg, high Ca or poor renal clearance, blurred vision, color disperception, n/v, anorexia

Front 9

sympathomimetic amines

Back 9

bind to cardiac B1 receptor > increase adenylate cyclase > increase cAMP > increase calcium in myocyte

Front 10

dopamine

Back 10

used for HF and shock

low dose: acts on renal B1 and mesenteric vessels > vasodilatation, increase renal blood flow

Front 11

dobutamine

Back 11

dopamine analog for B1, B2, A

no peripheral R change (B2=a)

used for HF w/o hypoTN, short term Tx

SE: tachyarrhythmia

Front 12

isoproterenol

Back 12

synthetic epi analog, B-agonist

used in EF for bradycardia or heart block, but not in myocardial ischemic pt

Front 13

milrinone

(phosphodiesterase inhibitor)

Back 13

inhibits phosphodiesterase > increased cAMP use > more Ca in cell > increased contractility

used only when standard treatment fails

SE: serious ventricular arrhythmias, systemic dilation

Front 14

beta blockers

Back 14

1gen: non selective
2gen: higher affinity for B2
3gen: selective/non + a1 block (causing vasodilation)

used for ischemic hd, CHF, HTN, tachyarrhythmias

SE: bronchospasm, vasospasm, conduction block, high triglyceride, low HDL, fatigue, insomnia, depression

not for decompensated pt, but do not stop if already on it

Front 15

metoprolol

Back 15

2gen beta blocker

Front 16

carvedilol

Back 16

3gen beta blocker

Front 17

labetolol

Back 17

3gen beta blocker

Front 18

emolol

Back 18

2gen beta blocker

Front 19

ACE Inhibitors

Back 19

used for HF, HTN, postMI, slow progression of renal disease in diabetics

SE: hypoTN, hyperK, renal insuff, cough, angioedema

renal excretion (lower dose w/ dysfcn)

not for pregnant

Front 20

captopril, enalapril, lisinopril, ramipril, trandolapril

Back 20

ACE inhibitors

do not allow ACE to convert Angiotension I > no aldosterone released; inhibits breakdown of bradykinin (a vasodilator)

all pt w/ LV dysfunction

Front 21

Angiotension Receptor Blockers (ARBS)

Back 21

used like ACEI when ACEI cannot be used (w/ cough), used for pt w/ refractory symptoms on Bblocker/ACEI

compete w/ Angiotension II for AT1 and 2 > less SNS, aldosterone, Na reabsorption

Front 22

candesartan, valsartan, losartan

Back 22

ARBS

HF, HTN, slow progression of kidney disease in diabetics

Front 23

nitrates

Back 23

used for HF w/ severe renal dysfunction and risk of hyperK

causes vasodilation by conversion to NO near sm muscle membrane
*low dose: vdilation > pooling > less return > less filling
*high dose: a+vdilation

SE: hypoTN, reflex tachycardia, flushing, headache

rapid development of tolerance

Front 24

hydrazaline

Back 24

used for HF w/ renal dysfcn and hyperK

potent and direct arteriole vasodilator

SE: headaches, flushing, palpitations, nausea, anorexia, myocardial ischemia, lupus-like syndrome

Front 25

do not use in HF pt

Back 25

NSAID - Na retention and peri vasoconstriction

most antiarrhythmic - neg inotropic and proarrhythmic

non-dihydropyridine Ca-channel blockers: neg inotropic