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49 Cards in this Set

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What are 6 side effects of thiazide diuretics?
1) hypokalemia
2) hypercalcemia
3) hyperglycemia
4) hyperuricemia
5) hyperlipidemia
6) lassitude
What are 4 adverse effects of loop diuretics?
1) ototoxicity (with aminoglycosides)
2) K+ wasting
3) metabolic alkalosis
4) hypotension
What are 3 side effects of clonidine?
1) severe rebound HTN
2) dry mouth
3) sedation
What are 2 side effects of methyldopa?
1) + Coombs test
2) sedation
What are 4 side effects of hexamethonium?
1) severe orthostatic hypotension
2) blurry vision
3) constipation
4) sexual dysfunction
What are 4 side effects of reserpine?
1) sedation
2) DEPRESSION!
3) nasal stuffiness
4) diarrhea
What are 3 side effects of guanethidine?
1) orthostatic and exercise hypotension
2) sexual dysfunction
3) diarrhea
What are 3 side effects of prazosin?
1) 1st dose hypotension
2) dizzy
3) HA
What are 4 side effects of beta blockers?
1) asthma (B2 block)
2) impotence
3) bradycardia/CHF/AV block
4) sedation/sleep alterations
Which vasodilator causes lupus-like syndrome, reflex tachycardia, and salt retention?
hydralazine - give with beta blocker and diuretic!
Which vasodilator causes hypertrichosis, pericardial effusion, reflex tachycardia, and salt retention?
minoxidil - use with beta blocker and diuretic!
What are side effects of calcium channel blockers?
dizziness, flushing, nausea, constipation (verapamil)
What is a side effect of nitroprusside?
cyanide release
What are side effects of ACE inhibitors? (CAPTOPRIL + 1 more)
Cough, Angioedema, Proteinuria, Taste change, hypOtension, Pregancy problem, Rash, Increased renin, Lower AII, hyperkalemia
What is Losartan? Side effects?
AII receptor blocker - fetal renal toxicity, hyperkalemia
How does hydralazine work?
increases cGMP --> smooth muscle relaxation (arterioles)
How do calcium channel blockers work?
block L-type Ca channels of cardiac and SM --> reduce muscle contractility
Which calcium channel blocker has greatest effects on vascular smooth muscle?
nifedipine
Which calcium channel blocker has greatest effects on heart muscle?
verapamil
What are Ca channel blockers used for?
HTN, angina, arrhythmia (except nifedipine)
How do nitroglycerin and isosorbide dinitrite work?
release NO in smooth muscle, causing inc. cGMP, relaxation, venous dilation
How could you reduce myocardial O2 consumption?
1) lower EDV
2) lower BP
3) lower contractility
4) lower HR
5) lower ejection time
Nifedipine : ?
Verapamil : ?
nitrates
beta blockers
What cardiac drug can cause the following changes on EKG: inc. PR, dec. QT, scooped ST segment, T wave inversion
digoxin
A patient you know to be taking medications for his CHF comes in complaining of nausea and diarrhea as well as "everything looks yellow." What is he on?
digoxin (also worry about arrhythmia when on Dig)
What can make toxicities of digoxin worse? (3)
- hypokalemia
- renal insufficiency
- quinidine
What are antidotes for digoxin toxicity?
- lidocaine
- slowly normalize K+
- cardiac pacer
- anti-dig Fab fragments
In general, how to the Class 1 antiarrhythmics work?
They bind specifically to depolarized cells and block Na channels, decreasing slope of Phase 4 depolarization and increasing the threshold for firing.
What are the 4 Class 1a antiarrhythmics?
quinidine, procainamide, amiodarone, disopyramide
The Class 1a drugs INCREASE 3 things that affect atrial and ventricular arrhythmias:
- axn potential duration
- QT interval
- refractory period
What are toxicities of quinidine?
- cinchonism (HA, tinnitus)
- thrombocytopenia
- torsades de pointes (due to prolonged QT)
What are toxicities of procainamide?
reversible lupus-like syndrome (part of "HIPP")
What are 3 Class 1b antiarrhythmics?
lidocaine, tocainide, mexiletine
How do the Class 1b drugs work?
decrease axn potential duration - affect ischemic or depolarized Purkinje & ventricular tissue only (so is good for dig-induced ventricular arrhythmia)
What are toxicities of Class 1b drugs?
local anesthetic, CNS stimulation/depression, cardiovascular depression
What are the 3 Class 1c drugs?
flecainide, encainide, propafenone
When would you use a Class 1c drug? When are they contraindicated?
Useful in v-tachs that progress to v-fib, and in intractable SVT (last resort). Contraindicated in post-MI because can induce arrhythmia.
What are the Class 2 antiarrhythmics? ("PEMAT")
beta-blockers! propranolol, esmolol, metoprolol, atenolol, timolol
How do beta blockers work as antiarrhythmics?
decrease cAMP, decrease Ca currents, suppress abnormal pacemakers (like AV node) by decreasing slope of Phase 4 depolarization
If you decrease the slope of Phase 4 depolarization, how is that shown on EKG?
lengthen PR interval (slowed atrial depolarization)
What are toxicities of beta-blockers? (laundry list...I think I have another card asking the same thing, but oh well, answer me again!)
- impotence
- worsen asthma
- bradycardia, AV block, CHF
- sedation, sleep alterations
- MASK signs of HYPOGLYCEMIA
What are the Class 3 antiarrhythmics? (4)
K+ channel blockers: sotalol, ibutilide, bretylium, amiodarone
How do K+ channel blockers help in arrhythmia?
increase axn potential duration (repolarization phase) and refractory period (used when other drugs fail)
What are the main toxicities of amiodarone?
- pulmonary fibrosis
- hepatotoxicity
- hypo-/hyperthyroidism
(other tox: neurologic, bradycardia, heart block, CHF, constipation, corneal deposits, photodermatitis)
What are the Class 4 antiarrhythmics? (2)
Ca channel blockers: verapamil, diltiazem
What type of cells do verapamil and diltiazem affect?
AV nodal cells - good for nodal arrhythmias like SVT
What are toxicities of Ca channel blockers?
constipation, flushing, edema, AV block, torsades de pointes
What is adenosine good for?
drug of choice in Dx and abolishing AV node arrhythmia
How is K+ an antiarrhythmic?
depresses ectopic pacemakers, esp. in Dig-toxicity