Cardiovascular Drugs

Front 1

Three drug families that treat angina:

Back 1

Organic nitrates
Ca channel blockers
Beta blockers

Front 2

Organic nitrate that promotes vasodilation
Decreases preload
Treats both classic and variant angina
Rapidly metabolized and should be taken sublingually
Produces NO in the body (vasodilator)

Back 2

Nitroglycerin

Front 3

Nitroglycerin patch

Back 3

Nitro-Dur

Front 4

Adverse effects of nitroglycerin:

Back 4

Headache, dizziness
Orthostatic hypotension
Reflex tachycardia

Front 5

Similar to nitroglycerin but can be taken orally or sublingually
Taken prophylactically

Back 5

Isosorbide Mononitrate
Isosorbide Dinitrate

Front 6

Originally for angina but also metabolized into NO and causes intense vasodilation
Now a common drug of abuse

Back 6

Amyl Nitrite

Front 7

Three drugs used for ED that are metabolized into NO for vasodilation
Off-label for pulmonary hypertension in peds

Back 7

Viagra
Cialis
Levitra

Front 8

Calcium channel blockers treat angina by:

Back 8

causing relaxation of VSM of mainly arteries, reducing afterload
Treats both kinds of angina

Front 9

Beta blockers treat angina by:

Back 9

decreasing the rate and contractility of the heart
Treats only classic angina

Front 10

Congestive Heart Failure results in:

Back 10

Lowered arterial BP which causes tachycardia
Decrease in blood through kidneys
Smaller urine amount, higher blood amount
Renin release, causing vasoconstriction
Increased venous pressure
Peripheral and pulmonary edema
Enlarged heart

Front 11

Diuretics used for CHF:

Back 11

Hydrochlorothiazide (HCTZ)
Furosemide (more commonly prescribed)

Front 12

Increases contractility of the heart (positive inotropic)
Slows down the SA node and AV conduction, allowing for the ventricles to fill
Harvested from foxglove
Very small TI (dysrhythmias, heart block)
Does not increase life expectancy

Back 12

Digoxin (Digitalis)

Front 13

Adverse effects of Digoxin:

Back 13

Nausea
AV heart block
Ectopic foci (atrial fib.)
Hypokalemia increases likelihood of effects
Male impotence (45%)

Front 14

ACE inhibitors for CHF:
Arteriodilation (actually decrease mortality)

Back 14

Lisinopril
Quinapril
Enalapril

Front 15

Beta Blockers for CHF:
(Decrease mortality)

Back 15

Metoprolol
Cervedilol

Front 16

Lowers mortality rate of CHF patients by 30%

Back 16

Spironolactone

Front 17

A platelet plug is formed by:

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Thromboxane A2

Front 18

Hemostasis is restrained by:

Back 18

Antithrombin III (inhibits clotting factors and thrombin)

Front 19

Clots are hydrolyzed by:

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Plasmin (used to be plasminogen)

Front 20

Enzymes that catalyze the activation of plasminogen to plasmin:

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Streptokinase
Alteplase (tPA)
Urokinase

Front 21

Anticoagulant that augments the effect of antithrombin III, which inhibits thrombin, which converts fibrinogen into fibrin.
Polysaccharide (large molecule), cannot be broken down in GI tract and is inactivated by HCl (IV only)
Low TI (hemorrhage) Need to test PTT
Harvested from cow lungs and pig intestines
Most of this drug comes from China

Back 21

Heparin

Front 22

PTT
and what a normal PTT would be:

Back 22

Partial Thromboplastin Time
25-35 seconds is normal; on Heparin, it should be 2-2.5 times that.

Front 23

Anticoagulant with a lower molecular weight than heparin
Better for prophylactic use
Longer half life than Heparin, with less blood tests
Bid subcutaneous injections
Best for outpatients, as less dangerous

Back 23

Enoxaparin

Front 24

Anticoagulant that is a vitamin K antagonist (required for synthesis of factors VII, IX, X and prothrombin)
Very non-polar and taken orally
Takes several days for max. efficacy, same for quitting
Vitamin K in diets can affect the amount of drug
Low TI; need to calculate PT
Teratogenic

Back 24

Warfarin

Front 25

INR

Back 25

International Normalized Ratio
(ratio of anticoagulated PT and normal PT)
Should be 2-3.5
Higher means less clotting, more hemorrhage

Front 26

Anticoagulant that reduces blood viscosity
Mechanism unknown
Used for intermittent claudication
Taken PO tid

Back 26

Pentoxifylline

Front 27

Anticoagulant that inhibits the synthesis of thromboxane A2 (involved in platelet aggregation)
Inhibits mucus lining in stomach (ulcers)

Back 27

Baby Aspirin

Front 28

Irreversibly inhibits platelet aggregation for MI, stroke, arterial disease patients
Increases risk of bleeding
Much more expensive than aspirin
Commonly prescribed, especially with aspirin for 12 months after a stent is put into place

Back 28

Clopidogrel

Front 29

Decreases platelet aggregation
Used after angioplasty to prevent clot formation
Combined with heparin

Back 29

Abciximab

Front 30

Modeled after anticoagulant in snake venom
Can reduce MI 30-40% in unstable angina patients
Not yet FDA approved

Back 30

Tirofiban

Front 31

Thrombolytic made by genetic engineering
Used to treat MIs and strokes
$4000 for this drug

Back 31

tPA (tissue plasminogen activator)

Front 32

Cholesterol levels that are considered a significant health risk:

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Total cholesterol over 200 mg/dL
LDL levels over 135 mg/dL

Front 33

Good/Bad cholesterol/HDL ratio:

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Under 5 is good, above 5 is bad
The lower the number, the better
(Total cholesterol/HDL)

Front 34

The statin drug family inhibits this enzyme in the liver that catalyzes cholesterol synthesis:
This lowers the serum cholesterol by inhibiting the body's capability of making it

Back 34

HMG CoA reductase

Front 35

Adverse effects of statins:

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Liver abnomalities (liver function monitored) (2%)
Myopathy
GI Problems
Headaches
Rash
Teratogenic

Front 36

Two most common statin drugs:

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Atorvastatin
Simvastatin

Front 37

Other statin drugs:

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Lovastatin
Pravastatin
Rosuvastatin

Front 38

Statin claiming to reduce HDL more than others
Mainly prescribed for diabetics

Back 38

Pitavastatin

Front 39

Statin that is a dietary supplement, derived from red yeast
Makes a naturally occurring HMG CoA reductase inhibitor

Back 39

Cholestin

Front 40

New drug that inhibits cholesterol absorption through the intestine
Often combined with statins

Back 40

Ezetemibe

Front 41

Ezetemibe and Simvastatin combo

Back 41

Vytorin

Front 42

Lowers triglycerides, raises HDL, lowers LDL
Cutaneous flushing, GI upset
Megadoses can cause liver problems

Back 42

Niacin

Front 43

Activates lipoprotein lipase
Lowers triglycerides and LDL, raises HDL
Is not shown to decrease MI, but decreases nephropathy, retinopathy, and peripheral vas disease

Back 43

Fenofibrate

Front 44

Was a drug that raised HDL levels, but was later proven to increase mortality (positive surrogate outcome, negative clinical outcome)

Back 44

Torcetrapib

Front 45

Naturally occurring glycoprotein in the adrenal cortex for stimulating red blood cell production
Used in anemics or in chemotherapy
IV only

Back 45

Erythropoietin

Front 46

Synthetic form of hormone in the thyroid gland
Taken orally to treat fatigue, depression, menstrual cramps, bradycardia
Taken orally before food
Soy products are to be avoided
A rating on teratogenicity scale

Back 46

Levothyroxine