Cardiovascular, Pulmonary And Renal Drugs

Front 1

Captopril, enalapril, lisinopril, fosinopril

Back 1

ACE inhibitors
MECH: Short peptide analogs reversibly bind to zinc (catalytic site of metalloenzyme ACE) → inhibit ATI/ATII conversion: ↓ATII → ↓vasoconstriction (afterload); ↓cardiac remodeling; ↓aldosterone → ↓Na retention (preload); ↑bradykinin → vasodilation
USE: CHF, HTN, slow progression of renal dz (esp. in diabetics)
TOX: hypotension, hyperkalemia, renal impairment, cough and angioedema (bradykinin), fetal renal damage, taste changes, rash

Hint 1

ACEi

Front 2

Losartan, valsartan

Back 2

Angiotensin II receptor blockers
MECH: competitively antagonize AT1 (responsible for pressor actions), AT2, AT4 receptors; since AT is made in non-ACE pathways, these drugs may be more effective
USE: CHF, HTN
TOX: hyperkalemia, dizziness, fetal renal damage

Hint 2

ARBs

Front 3

Digoxin

Back 3

Cardiac glycoside
MECH: inhibits cardiac Na/K ATPase → ↑Na inside → ↑Ca inside → ↑ inotropy; ↑vagal tone → delayed AV node conduction
USE: CHF, atrial fibrillation
TOX: arrhythmia, ↑parasympathetic (N/V, diarrhea, blurry yellow vision); Tox is increased by: hypokalemia, hypercalcemia & Ca channel blockers, quinidine

Hint 3

Cardiac glycoside

Front 4

Quinidine

Back 4

Class 1a Antiarrhythmic
MECH: Blocks fast Na channels: ↓ phase 0 depolarization, ↑ AP duration, ↑ effective refractory period, ↑ QT interval
USE: supraventricular and ventricular tachycardias (esp. reentrant and ectopic)
TOX: cinchonism (HA, tinnitus), thrombocytopenia, torsade de pointes

Hint 4

antiarrhythmic

Front 5

Procainamide

Back 5

Class 1a Antiarrhythmic
MECH: Blocks fast Na channels: ↓ phase 0 depolarization, ↑ AP duration, ↑ effective refractory period, ↑ QT interval
USE: supraventricular and ventricular tachycardias (esp. reentrant and ectopic)
TOX: reversible SLE-like syndrome

Hint 5

antiarrhythmic

Front 6

Amiodarone

Back 6

Class 1a Antiarrhythmic
MECH: Blocks fast Na channels: ↓ phase 0 depolarization, ↑ AP duration, ↑ effective refractory period, ↑ QT interval

Class III Antiarrhythmic
MECH: K channel blocker → ↑AP duration, ↑ERP, ↑QT interval

USE: supraventricular and ventricular tachycardias (esp. reentrant and ectopic); Wolff-Parkinson-White syndrome
TOX: pulmonary fibrosis, corneal deposits, hepatotox, skin deposits resulting in photodermatitis, neurologic effects, constipation, hypo/hyperthyroidism. *check PFTs, LFTs, and TFTs

Hint 6

antiarrhythmic

Front 7

Disopyramide

Back 7

Class 1a Antiarrhythmic
MECH: Blocks fast Na channels: ↓ phase 0 depolarization, ↑ AP duration, ↑ effective refractory period, ↑ QT interval
USE: supraventricular and ventricular tachycardias (esp. reentrant and ectopic)
TOX: anticholinergic fx

Hint 7

antiarrhythmic

Front 8

Lidocaine

Back 8

Class 1b Antiarrhythmic
MECH: Blocks fast Na channels: ↓ phase 0 depolarization, ↓ AP duration
USE: acute ventricular arrhythmias, dig-induced arrhythmias
TOX: local anesthetic, CNS stim/depression, CV depression

Hint 8

Antiarrhythmic

Front 9

Mexiletine

Back 9

Class 1b Antiarrhythmic
MECH: Blocks fast Na channels: ↓ phase 0 depolarization, ↓ AP duration
USE: acute ventricular arrhythmias, dig-induced arrhythmias
TOX: local anesthetic, CNS stim/depression, CV depression

Hint 9

Antiarrhythmic

Front 10

Tocainide

Back 10

Class 1b Antiarrhythmic
MECH: Blocks fast Na channels: ↓ phase 0 depolarization, ↓ AP duration
USE: acute ventricular arrhythmias, dig-induced arrhythmias
TOX: local anesthetic, CNS stim/depression, CV depression

Hint 10

Antiarrhythmic

Front 11

Flecainide

Back 11

Class 1c Antiarrhythmic
MECH: Blocks fast Na channels: ↓ phase 0 depolarization, no effect on AP duration
USE: last resort in refractory tachy-arrhythmias
TOX: proarrhythmic (post-MI)

Hint 11

Antiarrhythmic

Front 12

Encainide

Back 12

Class 1c Antiarrhythmic
MECH: Blocks fast Na channels: ↓ phase 0 depolarization, no effect on AP duration
USE: last resort in refractory tachy-arrhythmias
TOX: proarrhythmic (post-MI)

Hint 12

Antiarrhythmic

Front 13

Propafenone

Back 13

Class 1c Antiarrhythmic
MECH: Blocks fast Na channels: ↓ phase 0 depolarization, no effect on AP duration
USE: last resort in refractory tachy-arrhythmias
TOX: proarrhythmic (post-MI)

Hint 13

Antiarrhythmic

Front 14

Propranolol, esmolol, metoprolol, atenonol, timolol

Back 14

Class II Antiarrhythmics - Beta Blockers
MECH: ↓cAMP → ↓Ca currents → inhibit phase 4 depol, depress automaticity, prolong AV conduction, ↓HR
USE: tachyarrhythmias caused by symp activity, AFib, prevent reflex tachycardia produced by vasodilating agents
TOX: impotence, asthma exacerbation, CV fx, CNS fx

Hint 14

Antiarrhythmics

Front 15

Sotalol

Back 15

Class III Antiarrhythmic
MECH: K channel blocker → ↑AP duration, ↑ERP, ↑QT interval
USE: when other antiarrhythmics fail
TOX: torsades de pointes, excessive Beta block

Hint 15

Antiarrhythmic

Front 16

Ibutilide

Back 16

Class III Antiarrhythmic
MECH: K channel blocker → ↑AP duration, ↑ERP, ↑QT interval
USE: when other antiarrhythmics fail
TOX: torsades de pointes

Hint 16

Antiarrhythmic

Front 17

Bretylium

Back 17

Class III Antiarrhythmic
MECH: K channel blocker → ↑AP duration, ↑ERP, ↑QT interval
USE: when other antiarrhythmics fail
TOX: new arrhythmias, hypotension

Hint 17

Antiarrhythmic

Front 18

Diltiazem

Back 18

Blocks L-type Ca channels
MECH:
-Class IV Antiarrythmic: ↓ conduction velocity, ↑ERP, ↑PR interval
-Vasodilation: ↓smooth muscle contracility
-Heart: ↓cardiac muscle contractility
USE: nodal arrhythmias, HTN, angina, Prinzemetal's, Raynaud's
TOX; constipation, flushing, edema, dizziness, AV block, sinus node depression

Hint 18

Ca channel blocker

Front 19

Verapamil

Back 19

Blocks L-type Ca channels
MECH:
-Class IV Antiarrythmic: ↓ conduction velocity, ↑ERP, ↑PR interval
-Vasodilation: ↓smooth muscle contracility
-Heart: ↓cardiac muscle contractility
USE: nodal arrhythmias, HTN, angina, Prinzemetal's, Raynaud's
TOX; constipation, flushing, edema, dizziness, AV block, sinus node depression

Hint 19

Ca channel blocker

Front 20

Nifedipine

Back 20

Blocks L-type Ca channels
MECH:
-Vasodilation: ↓smooth muscle contracility
-Heart: ↓cardiac muscle contractility
USE: HTN, angina, Prinzemetal's, Raynaud's
TOX; constipation, flushing, edema, dizziness, AV block, sinus node depression

Hint 20

Ca channel blocker

Front 21

Adenosine

Back 21

MECH: ↑K efflux, ↓Ca influx → hyperpolarized myocytes
USE: AV nodal arrhythmias

Front 22

Potassium

Back 22

MECH: depresses ectopic pacemakers
USE: digoxin toxicity

Front 23

Magnesium

Back 23

USE: digoxin toxicity and torsades de pointes

Front 24

Nitroglycerin

Back 24

MECH: ↑cGMP → smooth muscle relaxation
USE: angina, pulmonary edema
TOX: tachycardia, hypotension, flushing, HA

Front 25

Isosorbide dinitrate

Back 25

MECH: ↑cGMP → smooth muscle relaxation
USE: angina, pulmonary edema
TOX: tachycardia, hypotension, flushing, HA

Front 26

Lovastatin, pravastatin, simvastatin, atorvastatin

Back 26

HMG-CoA reductase inhibitors
MECH: competitively bind the rate-limiting enzyme in cholesterol biosynthesis → ↑hepatic uptake of LDL cholesterol; ↓↓LDL; ↑HDL; ↓TG
USE: hyperlipidemia
TOX: myositis, rhabodomyolysis, hepatotox (↑LFTs)

Hint 26

lipid-lowering agent

Front 27

Niacin/Nicotinic Acid

Back 27

MECH: inhibits syn & esterification of FAs in liver and lipolysis in adipose tissue → ↓VLDL → ↓LDL; ↑HDL; ↓TG
USE: hyperlipidema
TOX: red, flushed face, itching & burning sensation

Hint 27

lipid-lowering agent

Front 28

Fibrates (gemfibrozil, clofibrate, bezefibrate, fenofibrate)

Back 28

MECH: Stimulate PPARα receptors → ↑lipoprotin lipase and apolipoprotein III → ↑catabolism of VLDL; reduce hepatic synthesis of cholesterol. ↓LDL; ↑HDL; ↓↓TG
USE: hyperlipidemia, chylomicronemia
TOX: myositis, ↑LFTs

Hint 28

lipid-lowering agent

Front 29

Ezetimibe

Back 29

MECH; block cholesterol absorption in the intestine. ↓LDL
USE: hyperlipidemia
TOX: fatigue, abd pain, diarrhea

Hint 29

lipid-lowering agent

Front 30

Cholestyramine & colestipol

Back 30

Bile acid resins
MECH: bind bile salts in the intestine and prevent enterohepatic reutlilization. ↓LDL; ↑TG*slightly
USE: hyperlipidemia
TOX: taste bad and cause discomfort

Hint 30

lipid-lowering agent

Front 31

Albuterol

Back 31

MECH: β2 → relaxation of bronchial smooth muscle
USE: acute asthma attack/exacerbation
TOX: long-term used associated with diminished control

Hint 31

asthma

Front 32

Salmeterol, formoterol

Back 32

MECH: β2 → relaxation of bronchial smooth muscle
USE: asthma prophylaxis (long-acting)
TOX: skeletal muscle tremor, arrhythmia

Hint 32

asthma

Front 33

Theophylline

Back 33

Methylxanthine
MECH: possibly phosphodiesterase inhibition → cAMP → bronchodilation
USE: acute or chronic asthma, COPD
TOX: narrow therapeutic index, cardiotox, neurotox

Hint 33

asthma

Front 34

Ipratropium

Back 34

Muscarinic antagonist
MECH: prevents bronchoconstriction (aerosol)
USE: asthma prophylaxis
TOX: low systemic absorption limits side fx

Hint 34

asthma

Front 35

Cromolyn

Back 35

MECH: prevents mast cell release of mediators
USE: asthma prophylaxis
TOX: localized, sore throat, cough, dry mouth

Hint 35

asthma

Front 36

Beclomethasone

Back 36

Glucocorticoid
MECH: inhibits cytokine synthesis, inhibit phospholipase A → less inflammatory agest
USE: first line for chronic asthma
TOX: infections

Hint 36

asthma

Front 37

Prednisone

Back 37

Glucocorticoid
MECH: inhibits cytokine synthesis, inhibit phospholipase A → less inflammatory agest
USE: first line for chronic asthma
TOX: infections

Hint 37

asthma

Front 38

Zileuton

Back 38

Antileukotriene
MECH: 5-lipoxyoxygenase pathway inhibitor → blocks leukotriene synthesis → less bronchoconstriction and inflam cell infiltrate
USE: chronic asthma
TOX: HA, hepatotox

Hint 38

asthma

Front 39

Zafirlukast, montelukast

Back 39

Antileukotrienes
MECH: block leukotriene receptor → less bronchoconstriction and inflam cell infiltrate
USE: chronic asthma
TOX: HA, LFTs

Hint 39

asthma

Front 40

Diphenhydramine

Back 40

MECH: reversibly inhibit H1 histamine receptors
USE: Allergy, motion sickness, sleep aid
TOX: sedation, anti-muscarinic, anti-alpha-adrenergic

Hint 40

allergy

Front 41

Dimenhydrinate

Back 41

MECH: reversibly inhibit H1 histamine receptors
USE: Allergy, motion sickness, sleep aid
TOX: sedation, anti-muscarinic, anti-alpha-adrenergic

Hint 41

allergy

Front 42

Chlorpheniramine

Back 42

MECH: reversibly inhibit H1 histamine receptors
USE: Allergy, motion sickness, sleep aid
TOX: sedation, anti-muscarinic, anti-alpha-adrenergic

Hint 42

allergy

Front 43

Loratidine, desloratidine

Back 43

MECH: reversibly inhibit H1 histamine receptors
USE: Allergy
TOX: less sedation than generation 1

Hint 43

allergy

Front 44

Fexofenidine

Back 44

MECH: reversibly inhibit H1 histamine receptors
USE: Allergy
TOX: less sedation than generation 1

Hint 44

allergy

Front 45

Guanifenesin

Back 45

Expectorant
MECH: stimulates less-viscous mucus
TOX: near-emetic doses required for fx, does not suppress cough

Front 46

N-acetylcystine

Back 46

Mucolytic
MECH: cleaves disulfide bonds in mucous to reduce viscosity
USE: CF

Front 47

Acetazolamide

Back 47

MECH: carbonic anhydrase inhibitor → NaHCO3 diuresis →↓total-body HCO3- stores
UES: glaucoma, urinary alkalinization, metabolic alkalosis, altitude sickness
TOX: hyperchloremic metabolic acidosis, neuropathy, NH3 toxicity, sulfa allergy

Hint 47

Diuretic
"ACIDazolamide causes ACIDosis"

Front 48

Mannitol

Back 48

Osmotic agent
MECH: ↑tubular fluid osmolarity →↑urine flow
USE: shock, drug overdose, to ↓intracranial/intraocular pressure
TOX: pulmonary edema, dehydration; contraindicated with anuria and CHF

Hint 48

Diuretic

Front 49

Furosamide

Back 49

Loop diuretic (sulfonamide)
MECH: inhibits cotransport system (Na,K,2Cl) → abolishes hypertonicity of the medulla preventing urine concentration; ↑Ca excretion
USE: edematous states (CHF, cirrhosis, nephrotic syndrome, pulmonary edema), HTN, hypercalcemia
TOX: Ototox, hypokalemia, dehydration, allergy (sulfa), nephritis (interstitial), gout

Hint 49

Diuretic

Front 50

Ethacrynic acid

Back 50

Loop diuretic (non-sulfa)
MECH: inhibits cotransport system (Na,K,2Cl) → abolishes hypertonicity of the medulla preventing urine concentration; ↑Ca excretion
USE: edematous states (CHF, cirrhosis, nephrotic syndrome, pulmonary edema), HTN, hypercalcemia
TOX: Ototox, hypokalemia, dehydration, nephritis (interstitial)

Hint 50

Diuretic

Front 51

Hydrochlorathiazide

Back 51

Thiazide diuretic
MECH: inhibits NaCl reabsorption in the early distal tubule →↓diluting capacity of the nephron; ↓Ca excretion
USE: HTN, CHF, idiopathic hypercalciuria, nephrogenic diabetes insipidus
TOX: hypokalemia met alkalosis, hyponatremia, hyperglycemia, hyperlipidemia, hyperuricema, hypercalcemia; sulfa allergy

Hint 51

Diuretic

Front 52

Spironolactone

Back 52

K-sparing diuretic
MECH: competitive aldosterone receptor antagonist in the cortical collecting tubule
USE: hyperaldosteronism, K+ depletion, CHF
TOX: hyperkalemia, endocrine effects (gynocomastia, antiandrogen effects)

Hint 52

Diuretic

Front 53

Triamterene

Back 53

K-sparing diuretic
MECH: block Na channels in the cortical collecting tubule
USE: hyperaldosteronism, K+ depletion, CHF
TOX: hyperkalemia

Hint 53

Diuretic

Front 54

Amiloride

Back 54

K-sparing diuretic
MECH: block Na channels in the cortical collecting tubule
USE: hyperaldosteronism, K+ depletion, CHF
TOX: hyperkalemia