Cardio Drugs

Front 1

statins

Back 1

cornerstone of atheroprotective therapy
proven to decrease mortality

Front 2

statin moa

Back 2

competitive inhibition of hmg-coa reductase --> decreased cholesterol synthesis

Front 3

statin actions

Back 3

stimulate no production, inhibit smc proliferation, decrease pro-inflammatory mediators (crp)

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vytorin

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simvastatin and ezetimibe (2 drugs for 1 disease)

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caduet

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atorvastatin and amlodipine (2 drugs for 2 diseases)

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statin adverse effects

Back 6

headaches, increase liver transaminases, myopathy (dose-dependent; increased incidence with cyp 450 inhibitors)

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fluvastatin

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CYP 2c9

Front 8

pravastatin

Back 8

only statin not metabolized by cyp 450's

Front 9

ACE inhbitors moa for atheroprotection

Back 9

inhibition of tissue angiotensis 2

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atheroprotective ACE inhibitors

Back 10

enalopril, ramipril

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atheroprotective CCB's

Back 11

3rd generation DHP's (amlodipine)

Front 12

Aspirin MOA

Back 12

irriversible COX inhibitor; decreases TXA2 synthesis. 10% platelet inhibition

Front 13

management for acute MI

Back 13

aspirin (325 mg, chewable), nitroglycerine (i.v.), morphine sulfate, b-blocker, Ace-inhibitor (decreases mortality if begun asap after mi)

Front 14

thrombolytics

Back 14

tPA, streptokinase

Front 15

tPA moa

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activates tissue plasminogen

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alteplase

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human recombinant tPA

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reteplase

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genetically engineered tPA

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Streptokinase

Back 18

streptococcal protein complexed with proactivator plasminogen

Front 19

sirolimus/rapamycin

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macrolide antibiotic immunosuppressant (drug-eluting stents)

Front 20

paclitaxel

Back 20

newly approved for drug-eluting stents

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ami discgarge meds

Back 21

aspirin, b-blockers, statin (usu ace-i/arb)

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ADP inhibitors

Back 22

irreversibly inhibit binding of ADP to platelet receptors--> decreased platelet aggregation (no action on prostaglandin metabolism); 30% platelet inhibition

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Clopidogrel

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ADP inhibitor; good for pts about to undergo stent placement

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Ticlopidine

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ADP inhibitor

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GP IIB/IIIA inhibitors

Back 25

block activation of glycoprotein 2b/3a complex (final common pathway for platelet activation); 90% platelet inhibition

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abciximab

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i.v. monoclonal antibody against 2b/3a complex; long acting; preferred for cath lab intervention

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Eptifibatide

Back 27

short acting 2b/3a inhibitor; decreases cardia ischemic events assoc. with angioplasty/angina

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gp2a/3b side effects

Back 28

can cause severe thrombocytopenia

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class I antiarrhythmics

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na channel blockers

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class II antiarrhythmics

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beta blockers

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class III antiarrhythmics

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k channel blockers

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clas IV antiarrhythmics

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calcium channel blockers

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class I A

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(intermediate) Quinidine, Procainimide, Disopyramide

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Class I B

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(fast on-off) Lidocaine, mexilitine, phenytoin

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Class I C

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(slow on-off) flecainide, propafenone

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class III drugs

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amiodarone, dofetilide, ibutilide, sotalol

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class IV drugs

Back 37

diltiazem, verapamil

Front 38

Quinidine moa

Back 38

(na channel blocker)blocks ach release from vagus; increases conduction velocity through av node

Front 39

quinidine adverse effects

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cinchonism (tinnitus, blurred vision, headache, psychosis); cardiotoxic effects exacerbated by hyperkalemia [monitoring for tocixity only]

Front 40

quinidine interactions

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many-cyp metabolism; increases digoxin levels; is eliminated by phenytoin

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procainimide

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na channel blocker

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procainamide dosing

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i.v. only--must be given over 45 ins (therefore not good for emergency v. fib)

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procainamide adverse effects

Back 43

hyptension-infusion reaction; reversible lupus-like syndrome

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procainamide interactions

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qt-prolinging drugs

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procainamide monitoring

Back 45

must monitor both procainamide (metabolism) and napa(renal clearance) levels

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disopyramide contraindications

Back 46

greater (-) intropic effect than quinidine (therefore cannot use in HF); causes peripheral vasodilation (not good for reynaud's hypotension)

Front 47

disopyramide pks

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hepatic metabolism; renal clearance (dose adjust for crcl <40)

Front 48

disopyramide monitoring

Back 48

cns anticholinergic toxicity (confusion, agitation)

Front 49

class 1 A uses

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tx atrial, av, and ventricular tachyarrhythimias

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class 1 B uses

Back 50

only for ventricular arrhythmias (shorten action potential, shorten qrs)

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lidocaine pk

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extensive 1st pass metabolism in liver --> therefore only give iv; dosage adjust for liver failure pts

Front 52

lidocaine monitoring

Back 52

>6 micrograms/ml assoc. with toxicity (sezures)

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mexitiline pk

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similar to lidocaine but po;

Front 54

mexilitine interactions

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significant-cyp metabolite; urinary alkalinizers decrease elim, urinary acidifiers increase elim

Front 55

mexilitine monitoring

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toxic >2 micrograms/ml

Front 56

class I C uses

Back 56

PVC's, PSVT, Afib (most potent na channel blockers---significant depression in myocardial function-> should not be given to pts with structural heart defects); proarrhythmic effects shown to cause increased mortality

Front 57

flecainide

Back 57

for reractory arrhythmias in pts without heart damage; negative inotrope

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flecainide adverse effects

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photopsia

Front 59

propafenone

Back 59

broad spectrum; possesses some beta-blocking activity

Front 60

beta-blocker (antiarrhythmic) moa

Back 60

negative chronotropes, dromotropes, inotropes, lusitropes

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beta blocker, 1st generation

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propanalol, nadolol, timolol; non-selective--adverse effects from non-cardiac beta receptors (fatigue, impotence)

Front 62

b-blocker, 1st gen uses

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treat tachyarrhythmias from catecholamine stimulation

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b-blockers, 2nd generation

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esmolol only one indicated for arrhythmias; selective at low doses

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b-bloskers, 3rd gen

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labetolol, carvedilol; also antagonize alpha receptors--> vasodilation

Front 65

class III moa

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cause longer plateau, longer repolarization; exhibit reverse-use dependency (prolongation more pronounced at slow rates)

Front 66

amiodarone

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most frequently used antiarrhythmic (can be used for both atrial and ventricular arrhythmias)---exhibits activities of all classes; least likely to cause torsades

Front 67

amiodarone pk

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unstable iv sol'n--must be filtered at admin; distributes EVERYWHERE, long t1/2)

Front 68

amiodarone adverse effects

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hypotension (infusion syndrome), smurf syndrome, hypo/hyperthyroidism, reversible corneal deposits, hypersensitivity pneumonitis (early)/pulmonary fibrosis (late

Front 69

amiodarone monitoring

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lft's, tft's, annual pft's/cxr, eye exam, ekg

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dofetilide

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only affects k channels; only avialable to special club memebers; used in afib/flutter

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dofetilide initiation

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corrected electrolytes(k>4, mg>2); wash out interacting meds; initial dose based solely on crcl;pts must be monitored 1st 72 hours of tx

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dofetilide adverse effects

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torsades

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dofetilide interactions

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many--tricyclics, quinolones

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ibutilide

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for afib/flutter; available only as injection--admin over 10 mins (must stop infusion as soon as rhythm converts)

Front 75

sotalol

Back 75

class III agent with non-selective beta-blocking activity

Front 76

sotalol uses

Back 76

life-threatening v-tach/symptomatic afib/flutter

Front 77

class IV moa

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(ndhps)decreases rate of phase 4 spontaneous depolarization; use-dependent; atrial arrhythmias only

Front 78

diltiazem

Back 78

rapid absorption with extensive 1st pass effects

Front 79

verapimil

Back 79

long t1/2 with bad adverse effects (gingival hyperplasia, constipation)

Front 80

adenosine

Back 80

first line for cardioversion from supraventricular tachycardia; must be given rapidly; transient adverse effects

Front 81

digoxin

Back 81

controls ventricular response in afib/flutter (poisons av node)

Front 82

digoxin adverse effects

Back 82

ataxia, 2nd/3rd degree heart block

Front 83

atropine

Back 83

anti ach agent; used to treat symptomatic sinus bradycardia

Front 84

nicotinic acid (niacin/niaspan)moa

Back 84

decrease production of vldvl --> decreased tg's; decreases ld particle number and increases circulation hdl

Front 85

niacin adverse effects

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cutaneous flushing (blocked by aspirin); asthma aggravation

Front 86

fibric acid derivatives

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clofibrate, fenofibrate, gemfibrozil

Front 87

fibrate moa

Back 87

(unkown) decrease vldl production and increase production of ApoA1(major protein of HDL)

Front 88

fibrate adverse effects

Back 88

myositis; clofibrate--ventricular arrhythmias

Front 89

fibrate long-term risks

Back 89

gallbladder toxicities, cancinogenesis, hepatotoxicity (fenofibrate)

Front 90

bile acid sequestrants

Back 90

chloestyramine, cholestipol, colesevelam

Front 91

bile acid sequestrants moa

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anion exchange resins-- bind bile acids in intestine and prevent their reabsorption--> increased bile acid production in liver--> increased need for cholesterol and subsequent upregulation of ldl-r's-->faster ldl clearance from circulation

Front 92

bile acid sequestrant adverse effects

Back 92

constipation, malabsorption(e.g. fat soluble vitamins), pancreatitis secondary to high triglycerides (contraindicated in hypertriglyceridemia)

Front 93

bile acid sequestrant interactions

Back 93

statins- bind to hmg coa reductase

Front 94

ezetimibe

Back 94

cholesterol transport inhibitor; no adverse effects

Front 95

cholesterol transport inhibitor moa

Back 95

inhibit absorption of cholesterol by small intestine

Front 96

fish oil (omega-3 fatty acids) moa

Back 96

inhibit tg synthesis in liver (must take 4gm/day); decreases ldl particle number; anti-inflammatory

Front 97

fish oil adverse effects

Back 97

safe--but must monitor pts on anticoags (but safe with low-dose aspirin); no known drug interactions

Front 98

propanolol

Back 98

non-selective b1/b2 antagonist (blocks renin release); useful in mild-moderate htn

Front 99

propanolol side effects

Back 99

crosses bbb; may mask hypoglycemia

Front 100

atenolol

Back 100

selective b1-antagonist; useful for mild-moderate htn

Front 101

carvedilol

Back 101

best! selective b1 antagonist with a1 antagonist action; used in mild-moderate htn (esp post mi, chf)

Front 102

prazosin

Back 102

selective a1 antagonist; mild-moderate htn add-on; also used for bph

Front 103

a-blockers

Back 103

act on peripheral vasculature(derease svr); side effects--orthostatic/first dose hypotension

Front 104

centrally acting adrenergic blockers

Back 104

clonidine, methyldopa

Front 105

reserpine

Back 105

ne depleting agent

Front 106

ace inhibitors moa

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"ils"; competitive antagonists of ace; prevent cleavage of terminal aa's from ang1 preventing transformation to ang 2

Front 107

ace-i actions

Back 107

inhibit degradation of bradykinin-->no productoin and vasodilation (atheroprotection!); inhibit tissue ace; inhibit activation of nadphoxidase--> regulates cell growth in vascular smooth muscle

Front 108

ace-i side effects

Back 108

cough, angioedema, hyperkalemia; 1st dose hypotension, renal failure in pts with renal artery stenosis; contraindicated in pregnancy

Front 109

captopril

Back 109

mild-severe htn; side effects: loss of taste

Front 110

enalopril

Back 110

lipophilic-> acts on tissue ace

Front 111

lisinopril

Back 111

prodrug

Front 112

quinopril

Back 112

long actin

Front 113

ramipril

Back 113

long acting, lipophilic (tissue ace)

Front 114

angiotensin receptor blockers moa

Back 114

competitive antagonists of At1 receptor class; contraindicated in pragnancy

Front 115

arbs

Back 115

losartan, candesartan, valsartan

Front 116

diuretics moa

Back 116

increase urinary output and decrease total body water

Front 117

thiazide diurects moa

Back 117

inhibit na/cl co-transporter on luminal membrane of dct

Front 118

thiazide diuretics side effects

Back 118

hypokalemia, hyperuricemia, gout, dyslipidemia; sudden cardiac death (high doses only)

Front 119

thiazide diuretics contraindications

Back 119

severe renal failure, gout, pregnancy

Front 120

thiazide diuretics interactions

Back 120

digitalis

Front 121

thiazide diuretics

Back 121

hydrochlorothiazide, chlorathiazide

Front 122

loop diuretics moa

Back 122

inhibit na/cl cotransporter in luminal membrane of thick ascending loop of henle; not widely used--STRONG diureses (primarily used to relieve edema)

Front 123

furosemide

Back 123

loop diuretic; assoc. with dose-related reversible hearing impairment, hypokalemia

Front 124

spironolactone

Back 124

aldosterone antagonist (potassium sparing diuretic)

Front 125

spironolactone moa

Back 125

prevents binding of aldosterone receptor complex to promotor for na/k atp-ase gene in collecting duct epithelium; decreased aldosterone levels causes down-reg of pumps on luminal membrane-> decreased na reabsorption/k secretion-> increased urinary output

Front 126

amiloride

Back 126

na channel blocker (potassium sparing diuretic); blocks na channel of luminal membrane of collecting duct coupled to potassium efflux (not recommended for nonotherapy)

Front 127

triamterene

Back 127

(same as amiloride---na channel blocking potassium sparing diuretic)

Front 128

amlodipine

Back 128

long acting dhp ccb with good vascular selectivity (only ccm shown to decrease atherogenic activity in humans)

Front 129

nifedipine

Back 129

short-acting dhp ccb

Front 130

diltiazem

Back 130

short-acting ndhp ccb

Front 131

verapamil

Back 131

short acting ndhp ccb

Front 132

ccb side effects

Back 132

short-acting linked to increased mortality; serious hypotension

Front 133

dhp ccb side effects and contraindi

Back 133

ischmic cardiac pain, tachycardia, palpitations, perpheral edema

Front 134

ndhp ccb side effects and contraindications

Back 134

hedaches, flushing, conduction disturbances; bradycardia, sss, av block, as

Front 135

hydralazine

Back 135

direct vasodilator (relaxes arteriolar smooth muscle; use in combo (rapid tachyphylaxis if used alone)

Front 136

digoxin

Back 136

cardiac glycoside--inhibits na/k atp-ase -->increased intracellular calcium levels--> increased contractility (adverse effects due to increased automaticity due to high calcium levels); narrow therapeutic window--tocixity amplified by low serum k/mg (digibind)

Front 137

pde-inhibitors

Back 137

myocytes-increse contractility; vascular smooth muscle-vasodilate (both via increased camp)

Front 138

amnirone

Back 138

pde-inhibitor; adverse effects: thrombocytopenia

Front 139

milnarone

Back 139

pde-inhibitor; precipitates when mixed with furosemide; assoc with ventricular arrhythmias, hypotension, and angina