Cardiac Pharm

Front 1

Non-dihydropyridines

Back 1

Verapamil>diltiazem;

Block MYOCYTE voltage-dependent L-type calcium channels causing decreased contractility.

Used for HTN, angina, Aflutter/fib.

SE: cardiac depression, AV block, prolactinemia, constipation

Front 2

Dihydropyridines

Back 2

Amlodipine, nifedipine, clevidipine (HTN urgency), nimodipine (prevents cerebral vasospasm);

Block SMOOTH MUSCLE voltage-dependent L-type calcium channels, causing vasodilation.

Uses: HTN, angina, raynauds.

SE: peripheral edema, flushing, dizziness, gingival hyperplasia

Front 3

Hydralazine

Back 3

Increase cGMP causing vasodilation (arterioles>veins), reduces afterload.

Use: severe HTN, HF. Not for CAD or angina.

Taken with b-blocker to prevent reflex tachycardia.

SE: tachycadia, fluid retention, HA, angina, lupus-like syndrome.

Front 4

Nitroprusside

Back 4

Short acting direct NO release (increased cGMP);

for HTN emergencies.

SE: cyanide toxicity

Front 5

Fenolodopam

Back 5

D1 receptor agonist; causes vasodilation and natriuresis.

Used for HTN emergency and pstop antihypertensive.

SE: hypotension and tachy

Front 6

Nitrates

Back 6

Increase NO in vascular smooth muscle (increase cGMP) and vasodilate VEINS (decreased preload).

Used for angina, ACS, pulmonary edema.

SE: reflex tachy (tx with b-blockers), hypotension, flushing, headache. "Monday disease" - tolerance build up over the week and tachy, dizziness, HA on reexposure.

Front 7

Ranolazine

Back 7

Inhibits late Na current, reducing diastolic wall tension and O2 consumption. No change in HR or contractility.

Used for angina refractory to other tx.

SE: constipation, dizziness, nausea, HA, long QT

Front 8

Lovastatin, pravastatin

Back 8

HMG-CoA reductase inhibitors (inhibit mevalonate -> cholesterol);

Major decrease in LDL, also TG decrease and HDL increase.

SE: hepatotoxic, myopathy with fibrates or niacin

Front 9

Cholestyramine, colestipol, colsevelam

Back 9

Prevent bile acid reabsorption;

Decrease LDL, slight increase in TG and HDL.

SE: GI upset, decreased absorption of fat soluble vitamins and other drugs

Front 10

Ezetimibe

Back 10

Prevent cholesterol absorption at small intestine brush border;

decrease LDL.

SE: Rare, hepatotoxic and diarrhea

Front 11

Fibrates (gemfibrozil, bezafibrate, fenofibrate)

Back 11

Upregulate LPL causing TG clearance; activates PPAR-alpha to induce HDL synthesis.

Major decrease in TG, some increase in HDL and LDL decrease.

SE: myopathy (esp with statins), cholesterol gall stones

Front 12

Niacin

Back 12

Inhibits lipase in adipose tissue, reducing VLDL synthesis;

Decrease in LDL, increase in HDL, some decrease in TG.

SE: red flushed face (disappears with NSAIDs or long term use), hyperglycemia, hyperuricemia.

Front 13

Digoxin

Back 13

Inhibits Na/K/ATPase leading to increased intracellular Ca and increased contractility.

Also stimulates vagus nerve -> decreased HR.

Used in HF and afib.

SE: cholinergic (N/V, diarrhea, blurry yellow vission, AV block), hyperkalemia, arrhythmias, confusion, fatigue, weakness

Clearance inhibited by verapamil, amiodarone, quinidine (decrease renal clearance).

Front 14

Sodium channel blockers (Class 1)

Back 14

slow conduction by decreasing slope of phase 0 depolarization. Selectively depress tissue that is frequently depolarized.

Front 15

Class 1A sodium channel blockers

Back 15

Quinidine, procainamide, disopyramide.

Increase AP duration, effective refractory period and QT interval.

Used in re-entrant and ectopic SVT, VT.

SE: cinchonism (quinidine), reversible SLE-like syndrome (procainamide), heart failure (disopyramde), thrombocytopenia, torsades.

Front 16

Class 1B sodium channel blockers

Back 16

Lidocaine, mexileitine.

Decreased AP duration, preferentially affect ischemic or depolarized tissue.

Used for post-MI arrhythmias.

SE: CNS stimulation/depression, cardiac depression.

Front 17

Class 1C sodium channel blockers

Back 17

Flecainide, propafenone.

Prolong effective refractory period in AV node. No effect on Purkinje or ventricular tissue. Don't affect AP duration.

Uses: SVT (A-fib).

SE: proarrhythmic, don't use post-MI.

Front 18

Beta blockers (Class 2 antiarrhythmics)

Back 18

-olol, carvedilol and labetalol

Decrease SA and AV activity (decrease cAMP, decreasing Ca currents). Suppress phase 4 slope. Increase PR interval.

Used for SVT, ventricular control for afib/aflutter.

Front 19

Beta-blocker side effects

Back 19

Impotence,

Exacerbation of COPD and asthma,

Bradycardia, AV block, HF,

Sedation, sleep alterations,Masks hypoglycemia symptoms.

Selective beta blockers - vasoconstriction with pheochromocytoma or cocaine.

Metoprolol - dyslipedemia.

Propanolol- vasospasm.

Front 20

Beta blocker overdose

Back 20

Treat with saline, atropine, glucagon.

Front 21

Potassium channel blockers (Class III)

Back 21

Amiodarone, ibutilide, dofetilide, sotalol.

Increase AP duration, refractory period, QT interval.

Uses: Afib/flutter. Amiodarone and sotalol for V tach.

SE: torsades.

Front 22

Amiodarone

Back 22

Lipophilic. Class 1, 2, 3, and 4 antiarrhythmic effects.

Extensive SE: always check PFTs, LFTs, and TFTs.

Pulm fibrosis, hepatotoxic, hypo and hyperthyroidism, can act as a hapten (corneal deposits, blue/gray skin deposits, photodermatitis), neuro effects, constipation, bradycardia, heart block, HF.

Front 23

Calcium channel blocks (Class IV)

Back 23

Verapamil, diltiazem.

Decrease conduction velocity, increase refractory period, increase PR interval.

Uses: rate control in Afib, prevents nodal arrhythmias.

SE: flushing, edema, sinus node depression, AV block, HF.

Front 24

Adenosine

Back 24

Increases K efflux, hyperpolarizing the cell and decreasing intracellular Ca.

Used for diagnosing and terminating certain types of SVT.

Extremely short acting. Effects blunted by theophylline and caffeine (adenosine receptor antagonists).

SE: flushing, hypotension, chest pain, sense of doom, bronchospasm.

Front 25

Magnesium

Back 25

Used for torsades and digoxin toxicity.

Front 26

Treatment for HTN in pregnancy.

Back 26

Hydralazine,

Labetalol,

Methyldopa,

Nifedipine

Front 27

Medications causing dilated cardiomyopathy

Back 27

Anthracyclines (doxorubicin, daunorubicin).

Prevent with dexrazoxane.

Front 28

Medications causing torsades de pointes

Back 28

Antiarrhythmics (Class 1A and 3),

Antibiotics (macrolides),

Antipsychotics (haloperidol),

Antidepressants (TCAs),

Antiemetics (ondansetron).

Front 29

Medications causing coronary vasospasm

Back 29

Cocaine,

Sumatriptan,

ergot alkaloids (migraine rx, LSD)

Front 30

Dobutamine

Back 30

B1 receptor agonist (some b2 and a).

Inotrope.

For HF, cardiac stress testing.

Front 31

Dopamine

Back 31

beta>alpha agonist

Inotrope and chronotrope at low doses.

Front 32

Midodrine

Back 32

alpha 1 agonist.

For autonomic insufficiency and postural hypotension.

SE: hypertension.

Front 33

Norepinephrine

Back 33

a1>a2>b1 agonist.

For hypotension and shock.

Front 34

Phenylephrine

Back 34

a1>a2 agonist.

For hypotension, ocular procedures (mydriatic), rhinitis (decongestant).

Front 35

alpha-methyldopa

Back 35

alpha2 agonist

For HTN in pregnancy.

SE: direct Coombs hemolysis, SLE-like syndrome.

Front 36

beta1 selective antagonists

Back 36

acebutolol (partial agonist),

atenolol,

betaxolol,

esmolol (short acting),

metoprolol

Front 37

nonselective a- and b-antagonists

Back 37

Carvedilol,

labetalol

Front 38

Nonselective beta antagonists

Back 38

nadolol,

pindolol (partial agonist),

propanolol,

timolol

Front 39

Survival Benefit in Heart Failure

Back 39

Beta blockers (carvedilol, metoprolol, bisoprolol),

ACEI/ARBs,

Aldosterone antagonists

Front 40

Cilostazol, dipyridamole

Back 40

phosphodiesterase III inhibitor (breaks down cAMP), causing increased cAMP - vasodilation and inhibiting platelet aggregation.

Uses: intermittent claudication, coronary vasodilation, angina and stroke prophylaxis.

SE: nausea, HA, flushing, hypotension, abdominal pain