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49 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Hydralazine
Mechanism, Uses, Toxicities |
Mech - inc. cGMP to relax smooth muscle. Works more in arterioles than veins --> reduces afterload.
Uses: Severe HTN, CHF. Use with methyldopa for HTN in pregnancy Give with beta-blocker to prevent reflex tachycardia |
Tox: Compensatory tachycardia (bad idea in angina or coronary artery dz)
Lupus-like syndrome (one of the SHIPP drugs) Less important: fluid retention, nausea, headache, angina |
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Nifedipine
Hint: -dipine |
Class - Dihydropyridine Ca-channel blocker
Mech: block voltage-gated L-type Ca channels of vessels, dec. smooth muscle contraction Use: HTN, angina, Prinzmetal's angina, Raynaud's, Esophageal spasm |
Tox: peripheral edema
constipation (dec. sm muscle contraction -> dec. peristalsis) flushing, dizziness |
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Amlodipine
Hint: -dipine |
Class - Dihydropyridine Ca-channel blocker
Mech: block voltage-gated L-type Ca channels of vessels, dec. smooth muscle contraction Use: HTN, angina, Prinzmetal's angina, Raynaud's, Esophageal spasm |
Tox: peripheral edema
constipation (dec. sm muscle contraction -> dec. peristalsis) flushing, dizziness |
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Felodipine
Hint: -dipine |
Class - Dihydropyridine Ca-channel blocker
Mech: block voltage-gated L-type Ca channels of vessels, dec. smooth muscle contraction Use: HTN, angina, Prinzmetal's angina, Raynaud's, Esophageal spasm |
Tox: peripheral edema
constipation (dec. sm muscle contraction -> dec. peristalsis) flushing, dizziness |
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Nicardipine
Hint: -dipine |
Class - Dihydropyridine Ca-channel blocker
Mech: block voltage-gated L-type Ca channels of vessels, dec. smooth muscle contraction Use: HTN, angina, Prinzmetal's angina, Raynaud's, Esophageal spasm |
Tox: peripheral edema
constipation (dec. sm muscle contraction -> dec. peristalsis) flushing, dizziness |
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Nisoldipine
Hint: -dipine |
Class - Dihydropyridine Ca-channel blocker
Mech: block voltage-gated L-type Ca channels of vessels, dec. smooth muscle contraction Use: HTN, angina, Prinzmetal's angina, Raynaud's, Esophageal spasm |
Tox: peripheral edema
constipation (dec. sm muscle contraction -> dec. peristalsis) flushing, dizziness |
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Verapamil
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Class - non-dihydropyridine Ca-channel blocker (Class IV antiarrhythmic)
Mech: blocks voltage-gated L-type Ca channels of CARDIAC muscle (no action on vessels). Dec. conduction velocity -> inc. ERP, inc. PR interval Use: HTN, angina, arrhythmias (treatment or prevention) |
Tox: CV toxicity!!
cardiac depression, CHF, AV block, sinus node depression *caution when combining with other cardiac drugs! |
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Diltiazem
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Class - non-dihydropyridine Ca-channel blocker (Class IV antiarrhythmic)
Mech: blocks voltage-gated L-type Ca channels of CARDIAC muscle (no action on vessels). Dec. conduction velocity -> inc. ERP, inc. PR interval Use: HTN, angina, arrhythmias (treatment or prevention) |
Tox: CV toxicity!!
cardiac depression, CHF, AV block, sinus node depression *caution when combining with other cardiac drugs! |
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Nitroglycerin
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Mech: releasing NO -> inc. cGMP -> sm muscle relaxation, vasodilation.
Works more on veins than arteries - dec. preload & cardiac O2 demand. Use: Angina - redirects blood peripherally Pulmonary edema Nitrite + hydralazine -> same effects as ARBs Also: aphrodisiac, erection enhancer |
Tox: Reflex tachycardia
Hypotension Flushing, headache "Monday disease" in industrial exposure (tachycardia, dizziness, headache on reexposure) |
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Isosorbide dinitrate
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Mech: releasing NO -> inc. cGMP -> sm muscle relaxation, vasodilation.
Works more on veins than arteries - dec. preload & cardiac O2 demand. Use: Angina - redirects blood peripherally Pulmonary edema Nitrite + hydralazine -> same effects as ARBs Also: aphrodisiac, erection enhancer |
Tox: Reflex tachycardia
Hypotension Flushing, headache "Monday disease" in industrial exposure (tachycardia, dizziness, headache on reexposure) |
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Nitroprusside
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Mech: direct release of NO -> inc. cGMP -> sm muscle relaxation -> vasodilation
Use: short-acting, good for malignant HTN |
Tox: Cyanide toxicity
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Lovastatin
Hint: -statin |
Class - HMG-CoA reductase inhibitors
Mech: Inhibit cholesterol precursor (rate-limiting stem in cholesterol synthesis) Use: best effect for lowering LDL Only mild effects on HDL & TGs |
Tox: Hepatotoxic (check LFTs - if >3x normal, stop)
Rhabdomyolysis - pain or inflm |
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Pravastatin
Hint: -statin |
Class - HMG-CoA reductase inhibitors
Mech: Inhibit cholesterol precursor (rate-limiting stem in cholesterol synthesis) Use: best effect for lowering LDL Only mild effects on HDL & TGs |
Tox: Hepatotoxic (check LFTs - if >3x normal, stop)
Rhabdomyolysis - pain or inflm |
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Simvastatin
Hint: -statin |
Class - HMG-CoA reductase inhibitors
Mech: Inhibit cholesterol precursor (rate-limiting stem in cholesterol synthesis) Use: best effect for lowering LDL Only mild effects on HDL & TGs |
Tox: Hepatotoxic (check LFTs - if >3x normal, stop)
Rhabdomyolysis - pain or inflm |
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Atorvastatin
Hint: -statin |
Class - HMG-CoA reductase inhibitors
Mech: Inhibit cholesterol precursor (rate-limiting stem in cholesterol synthesis) Use: best effect for lowering LDL Only mild effects on HDL & TGs |
Tox: Hepatotoxic (check LFTs - if >3x normal, stop)
Rhabdomyolysis - pain or inflm |
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Rosuvastatin
Hint: -statin |
Class - HMG-CoA reductase inhibitors
Mech: Inhibit cholesterol precursor (rate-limiting stem in cholesterol synthesis) Use: best effect for lowering LDL Only mild effects on HDL & TGs |
Tox: Hepatotoxic (check LFTs - if >3x normal, stop)
Rhabdomyolysis - pain or inflm |
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Niacin
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Mech: Inhibits lipolysis in adipose tissue; prevent VLDL secretion by liver
Use: best effect for raising HDL Pretty good at lowering LDL Mild effect at lowering TGs |
Tox: red, flushed face - very common, poss cause of non-compliance. Dec. with aspirin or long-term use
Hyperglycemia, hyperuricemia (can exacerbate gout) |
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Cholestyramine
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Class - bile acid resins.
Less commonly used than statins. Mech: block intestinal reabsorption of bile acids, forcing liver to use cholesterol Use: pretty good at lowering LDL (not nearly as good as statins) Very slight effects on HDL & TGs |
Tox: bad taste, GI discomfort - patient non-compliance
Dec. absorption of fat-soluble vitamins (A, D, E, K) Cholesterol gallstones |
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Colestipol
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Class - bile acid resins.
Less commonly used than statins. Mech: block intestinal reabsorption of bile acids, forcing liver to use cholesterol Use: pretty good at lowering LDL (not nearly as good as statins) Very slight effects on HDL & TGs |
Tox: bad taste, GI discomfort - patient non-compliance
Dec. absorption of fat-soluble vitamins (A, D, E, K) Cholesterol gallstones |
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Colesevelam
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Class - bile acid resins.
Less commonly used than statins. Mech: block intestinal reabsorption of bile acids, forcing liver to use cholesterol Use: pretty good at lowering LDL (not nearly as good as statins) Very slight effects on HDL & TGs |
Tox: bad taste, GI discomfort - patient non-compliance
Dec. absorption of fat-soluble vitamins (A, D, E, K) Cholesterol gallstones |
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Ezetimibe
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Class - cholesterol absorption blockers
Mech: block cholesterol reabsorption at sm intestine brush border Use: pretty good dec. in LDL Use with statins - HUGELY dec. LDL |
Tox: rarely, inc. LFTs
Can thicken atherosclerotic plaque |
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Gemfibrozil
Hint: -fib |
Class - fibrates
Mech: promote LPL (lipoprotein lipase), encourage TG clearance Use: fantastic at dec. TGs (this may be more important in an acute scenerio) Mild effects on LDL & HDL |
Tox: myositis
hepatotox cholesterol gallstones Toxicities are similar to those of statins - DON'T use both! |
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Clofibrate
Hint: -fib |
Class - fibrates
Mech: promote LPL (lipoprotein lipase), encourage TG clearance Use: fantastic at dec. TGs (this may be more important in an acute scenerio) Mild effects on LDL & HDL |
Tox: myositis
hepatotox cholesterol gallstones Toxicities are similar to those of statins - DON'T use both! |
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Benzafibrate
Hint: -fib |
Class - fibrates
Mech: promote LPL (lipoprotein lipase), encourage TG clearance Use: fantastic at dec. TGs (this may be more important in an acute scenerio) Mild effects on LDL & HDL |
Tox: myositis
hepatotox cholesterol gallstones Toxicities are similar to those of statins - DON'T use both! |
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Fenofibrate
Hint: -fib |
Class - fibrates
Mech: promote LPL (lipoprotein lipase), encourage TG clearance Use: fantastic at dec. TGs (this may be more important in an acute scenerio) Mild effects on LDL & HDL |
Tox: myositis
hepatotox cholesterol gallstones Toxicities are similar to those of statins - DON'T use both! |
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Omega-3 fatty acids
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Mech: who cares?
Use: good at lowering TGs (not as good as fibrates though) Can reduce arrhythmias Can reduce effects of Rheumatoid Factor |
Downside: requires a LOT to get the benefit
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Digoxin
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Class - cardiac glycosides
Mech: inhibit Na/K/ATPase, indirectly inhibiting Na/Ca antiport on cardiac myocyte. Inc. Ca inside the cell -> inc. contractility. Stimulates vagus nerve (parasympathetic) Use: CHF - inc. contractility Atrial fibrillation - dec. AV node conduction, depresses SA node -> dec. heart rate |
Tox: Blurry yellow vision (this one's special)
Cholinergic fx - nausea, vomiting, diarrhea Arrhythmia, bradycardia, hyperkalemia Toxicities are worse with: renal failure (less clearance), hypokalemia, & quinidine To treat an OD: atropine 2nd try: cardiac pacer Anti-dig Fab fragments to prevent cardiotoxicity Magnesium for arrhythmias |
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Quinidine
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Class IA antiarrhythmic
Mech: block Na channels -> slows conduction, dec. slope of phase 0 (delays depolarization), inc. threshold for firing |
Tox: cinchonism - headache, tinnitus
Thrombocytopenia Torsades de pointes (from inc. QT interval) |
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Procainamide
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Class IA antiarrhythmic
Mech: block Na channels -> slows conduction, dec. slope of phase 0 (delays depolarization), inc. threshold for firing |
Tox: thrombocytopenia
Torsades de pointes (from inc. QT interval) Wolf-Parkinson-White syndrome Drug-induced lupus (one of the Ps in SHIPP) |
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Disopyramide
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Class IA antiarrhythmic
Mech: block Na channels -> slows conduction, dec. slope of phase 0 (delays depolarization), inc. threshold for firing |
Tox: thrombocytopenia
Torsades de pointes (from inc. QT interval) |
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Lidocaine
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Class IB Antiarrhythmics
Mech: slows conduction, dec. AP duration. Dec. slope of phase 0 -> delayed depolarization. Inc. threshold for firing in pacemaker cells Use: Acute ventricular tachyarrhythmias, esp. post MI Digitalis-induced arrhythmias |
Tox: local anesthetic
CNS stimulation/depression CV depression |
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Mexiletine
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Class IB Antiarrhythmics
Mech: slows conduction, dec. AP duration. Dec. slope of phase 0 -> delayed depolarization. Inc. threshold for firing in pacemaker cells Use: Acute ventricular tachyarrhythmias, esp. post MI |
Tox: local anesthetic
CNS stimulation/depression CV depression |
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Tocainide
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Class IB Antiarrhythmics
Mech: slows conduction, dec. AP duration. Dec. slope of phase 0 -> delayed depolarization. Inc. threshold for firing in pacemaker cells Use: Acute ventricular tachyarrhythmias, esp. post MI |
Tox: local anesthetic
CNS stimulation/depression CV depression |
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Flecainide
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Class IC Antiarrhythmic
Mech: slows conduction. Dec. slope of phase 0 -> delayed depolarization. Inc. threshold for firing in pacemaker cells Use: V-tach that progresses to V-fib Intractable SVT |
Tox: C/I post-MI!! Likely to cause arrhythmia
Prolongs refractory period in AV node |
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Encainide
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Class IC Antiarrhythmic
Mech: slows conduction. Dec. slope of phase 0 -> delayed depolarization. Inc. threshold for firing in pacemaker cells Use: V-tach that progresses to V-fib Intractable SVT |
Tox: C/I post-MI!! Likely to cause arrhythmia
Prolongs refractory period in AV node |
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Propafenone
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Class IC Antiarrhythmic
Mech: slows conduction. Dec. slope of phase 0 -> delayed depolarization. Inc. threshold for firing in pacemaker cells Use: V-tach that progresses to V-fib Intractable SVT |
Tox: C/I post-MI!! Likely to cause arrhythmia
Prolongs refractory period in AV node |
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Propanolol
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Class II Antiarrhythmics (Beta blockers)
(non-selective) Mech: dec. cAMP, dec. Ca currents. Dec. slope of phase 4 -> suppress abnormal pacemakers Inc. PR interval Use: V-tach, SVT, slowing ventricular rate during A-fib or atrial flutter |
Tox: impotence, asthma exacerbation
Bradycardia, AV block, CHF Sedation, sleep alterations Can mask signs of hypoglycemia in diabetics |
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Timolol
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Class II Antiarrhythmics (Beta blockers)
(non-selective) Mech: dec. cAMP, dec. Ca currents. Dec. slope of phase 4 -> suppress abnormal pacemakers Inc. PR interval Use: V-tach, SVT, slowing ventricular rate during A-fib or atrial flutter |
Tox: impotence, asthma exacerbation
Bradycardia, AV block, CHF Sedation, sleep alterations Can mask signs of hypoglycemia in diabetics |
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Esmolol
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Class II Antiarrhythmics (Beta blockers)
(beta1 selective) Mech: dec. cAMP, dec. Ca currents. Dec. slope of phase 4 -> suppress abnormal pacemakers Inc. PR interval Very short-acting! Use: V-tach, SVT, slowing ventricular rate during A-fib or atrial flutter |
Tox: impotence, bradycardia, AV block, CHF
Sedation, sleep alterations Can mask signs of hypoglycemia in diabetics |
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Metoprolol
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Class II Antiarrhythmics (Beta blockers)
(beta1 selective) Mech: dec. cAMP, dec. Ca currents. Dec. slope of phase 4 -> suppress abnormal pacemakers Inc. PR interval Use: V-tach, SVT, slowing ventricular rate during A-fib or atrial flutter |
Tox: impotence, bradycardia, AV block, CHF
Sedation, sleep alterations Dyslipidemia Can mask signs of hypoglycemia in diabetics |
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Atenolol
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Class II Antiarrhythmics (Beta blockers)
(beta1 selective) Mech: dec. cAMP, dec. Ca currents. Dec. slope of phase 4 -> suppress abnormal pacemakers Inc. PR interval Use: V-tach, SVT, slowing ventricular rate during A-fib or atrial flutter |
Tox: impotence, bradycardia, AV block, CHF
Sedation, sleep alterations Can mask signs of hypoglycemia in diabetics |
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Sotalol
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Class III Antiarrhythmic (K channel blockers)
NOT a beta blocker even tho it ends in -lol!! Mech: inc. AP duration, inc. ERP Use: after other antiarrhythmics fail |
Tox: torsades de pointes, excessive beta block
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Amiodarone
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Class III Antiarrhythmic (K channel blockers)
Mech: inc. AP duration, inc. ERP Use: after other antiarrhythmics fail Has effects of classes I, II, III, & IV because it alters the lipid membrane. |
Tox: lots. Three biggies:
Pulmonary fibrosis. Hepatotoxicity. Hypo/hyperthyroidism. Check PFTs, LFTs, & TFTs! Also: bradycardia, heart block, CHF Corneal deposits, skin deposits, photodermatitis, constipation, neurologic effects |
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Ibutilide
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Class III Antiarrhythmic (K channel blockers)
Mech: inc. AP duration, inc. ERP Use: after other antiarrhythmics fail |
Tox: torsades
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Bretylium
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Class III Antiarrhythmic (K channel blockers)
Mech: inc. AP duration, inc. ERP Use: after other antiarrhythmics fail |
Tox: new arrhythmias, hypotension
Torsades |
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Dofetilide
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Class III Antiarrhythmic (K channel blockers)
Mech: inc. AP duration, inc. ERP Use: after other antiarrhythmics fail |
Tox: torsades
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Adenosine
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Mech: inc. K efflux, hyperpolarizes myocytes and dec. intracellular Ca.
Use: to diagnose/stop SVT Short-acting (about 15 s) |
Tox: hypotension, chest pain, flushing.
Can be blocked by theophylline |
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Potassium
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Mech: depresses ectopic pacemakers
Use: in hypokalemia (like dig toxicity) |
If K is sub-normal, inc. risk of MI and arrhythmias
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Magnesium
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Mech: not sure.
Use: in torsades de pointes and digoxin toxicity |
If Mg is sub-normal, inc. risk of MI and arrhythmias
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