Cardiovascular System Agents

Front 1

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Beta Receptor Antagonists (Beta Blockers)
Mech of action:

Back 1

These drugs are targeted to block the B1 receptor, which functions to increase heart rate and force contraction of the heart muscle. By blocking this receptor, the following occur
-heart rate and cardiac output are decreased. This results in decreased blood pressure and increased tissue perfusion.
-Cardiac conduction rate is slowed, decreasing the possibility of arrhythmias
-The production of renin is decreased, resulting in reduced production of the vasoconstrictor angiotensin II

Front 2

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Beta Receptor Antagonists (Beta Blockers)
Adverse effects:

Back 2

The blockade of B1 and/or B2 receptors may interfere with the regulation of blood sugar (this is a diabetic contraindication).
The blockade of B2 receptors may cause bronchoconstriction (asthmatic contraindication)

Front 3

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
List All Drug Sub Classes:

Back 3

Beta Receptor Antagonists (Beta Blockers)
Beta Receptor Agonists
Isoproternol (Isuprel)
Alpha Receptor Antagonists
Alpha2 Receptor Agonists
Muscarinic Antagonists

Front 4

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Beta Receptor Antagonists (Beta Blockers)
List all drugs:

Back 4

1. Propranolol (Inderal, Inderal SA (sustained release formulation)
2.Atenolol (Tenormin)
3. Metoprolol succinate (Toprol-XL)
4. Metoprolol tartrate ( Lopressor)

Front 5

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Beta Receptor Antagonists (Beta Blockers)
Propranolol (Inderal, Inderal SA (sustained release formulation)
Contraindicated:

Back 5

in patients with dieabetes or asthmatics, due to effects on blood-sugar regulation and possible bronchiolar constriction, respectively

Front 6

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Beta Receptor Antagonists (Beta Blockers)
Propranolol (Inderal, Inderal SA (sustained release formulation)
Mechanism of action:

Back 6

“pan beta”… blocks both b1 and b2 receptors equally

Front 7

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Beta Receptor Agonists
Mech of action:

Back 7

These drugs are useful in increasing the force of contraction of the heart, which raises blood pressure and cardiac output. These may be useful in cases of hypovolemia, severe hypotension, etc. These agents can also increase blood sugar. Selective B2 receptor agonists are useful in the therapy of asthma.

Front 8

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Beta Receptor Agonists
List all drugs:

Back 8

Isoproternol (Isuprel)

Front 9

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Beta Receptor Agonists
Isoproternol (Isuprel)
Mech of action:

Back 9

stimulates both b1 and b2 receptors, Increases blood pressure, cardiac output, heart rate, blood sugar, renin, and angiotensin production

Front 10

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Alpha Receptor Antagonists
Mech of action:

Back 10

Blockade of <><1 receptor results in a decrease in peripheral vasoconstriction, and a lowering of blood pressure and cardiac afterload.

Front 11

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Alpha Receptor Antagonists
Uses:

Back 11

The major therapeutic use of these drugs is in the therapy of hypertension
Adverse effects: The major adverse effect is postural hypotension

Front 12

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Alpha Receptor Antagonists
List all drugs:

Back 12

1. Doxazosin mesylate (Cardura)
2. Prazosin hydrochloride (minipress)
3. Terazosin ( Hytrin)

Front 13

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Alpha Receptor Antagonists
Doxazosin mesylate (Cardura)
Uses

Back 13

in therapy of benign prostatic hypertrophy

Front 14

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Alpha Receptor Antagonists
Doxazosin mesylate (Cardura)
Adverse effects:

Back 14

postural hypotension

Front 15

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Alpha Receptor Antagonists
Prazosin hydrochloride (minipress)
Contraindicated:

Back 15

Diuretic

Front 16

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Alpha Receptor Antagonists
Prazosin hydrochloride (minipress)
Adverse :

Back 16

hypertension; postural hypertension

Front 17

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Alpha Receptor Agonists
Mech of action:

Back 17

In emergency situations, these drugs are used IV in the therapy of shock. They are also used intranasally as decongestants. Adverse effects of these are related to increases in blood pressure

Front 18

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Alpha Receptor Agonists
List all drugs:

Back 18

1. Norepinephrine (levophed)
2. Epinephrine (adrenalin)
3. Phenylephrine (Neo Synephrine)
4. Tetrahyrozyline (various)
5. Oxymetazoline ( various)

Front 19

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Alpha Receptor Agonists
Norepinephrine (levophed)
Mech of action:

Back 19

Stimulate alpha1 receptors, so blood pressure is increased, (also stimulates b1 receptors, so heart rate, renin, and blood sugar are affected).

Front 20

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Alpha Receptor Agonists
Norepinephrine (levophed)
Form:

Back 20

always given IV

Front 21

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Alpha Receptor Agonists
Epinephrine (adrenalin)
Mech of action:

Back 21

stimulates all four adrenergic receptors. A variety of effects may be seen (most are similar to those of nerepinephrine), depending on how the drug is administered

Front 22

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Alpha Receptor Agonists
Epinephrine (adrenalin)
Uses:

Back 22

stimulates the B2 receptor, so it dilates bronchioles. It may be used in the therapy of asthma.

Front 23

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Alpha Receptor Agonists
Phenylephrine (Neo Synephrine)
Uses:

Back 23

useful in suppository preps; intranasal preps as a nasal decongestant

Front 24

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Alpha Receptor Agonists
Tetrahyrozyline (various) (visine)
Uses:

Back 24

opthalmic; constricts blood vesses in the conjunctiva, resulting in less redness of the eye
Decongestant-constricts blood vessels in nasal passages, resulting in increased sinus drainage

Front 25

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Alpha Receptor Agonists
Tetrahyrozyline (various) (visine)
Adverse:

Back 25

may aggravate hypertension or benign prostatic hypertrophy (BPH) if absorbed systemically (through nasal mucosa)

Front 26

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Alpha Receptor Agonists
Oxymetazoline (various)
Mech:

Back 26

stimualtes both a 1 and a 2 receptors, decreasing the possibility that the drug will aggravate hypertension or BPH.

Front 27

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
ALPHA2 RECEPTOR AGONIST
Mech of action:

Back 27

These agents decrease the release of norepinephrine by binding to the regulatory alpha 2 receptor on the sympathetic neuronal ending and nucleus tractus solitarius (NTS)

Front 28

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
ALPHA2 RECEPTOR AGONIST
Uses:

Back 28

Therapy of Hypertension; therapy of opiate addiction as the A2 receptor seems to be involved in the manifestation of oppiate cravings

Front 29

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
ALPHA2 RECEPTOR AGONIST
List all drugs:

Back 29

1. Clonidine hydrochloride (Catapres)
2. Alpha methyldopa ( <>< -methyl dopa)

Front 30

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
ALPHA2 RECEPTOR AGONIST
Clonidine hydrochloride (Catapres)
Mech of action:

Back 30

-Clonidine acts directly on alpha2 receptors and stimulates them, causing an inhibition of norepinephrine release, has a central action-it affects the nucleus tractus sloitarius (NTS) of the hypothalamus, which regulates the activity of the ANS

Front 31

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
ALPHA2 RECEPTOR AGONIST
Clonidine hydrochloride (Catapres)
form:

Back 31

IV (100 mcg) for epidual infusion

Front 32

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
ALPHA2 RECEPTOR AGONIST
Clonidine hydrochloride (Catapres)
Withdrawl

Back 32

abrupt withdrawal may lead to dramatically increased blood pressure levels and hypertensive crisis. This effect is decreased by the administion of an A1 antagonist and increased by concurrent therapy with a B1 antagonist (B1 blockers must be withdrawn before discontiuing clonidine therapy if used concurrently.

Front 33

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
ALPHA2 RECEPTOR AGONIST
Alpha methyldopa ( <>< -methyl dopa)
Mech of action:

Back 33

has no activity on its own-it must be taken up into the neuronal ending to work. Thus, if the reuptake pump is blocked (with tricyclic antidepressants), the drug will not work.

Front 34

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
ALPHA2 RECEPTOR AGONIST
Alpha methyldopa ( <>< -methyl dopa)
Adverse Effects:

Back 34

May cause rash, liver damage, GI upset, breast enlargement, joint pain, bone marrow depression. May also aggravate angina and congestive heart failure (CHF). May cause hypotension, if the patient is put under anesthesia. May interfere with standard laboratory blood analyses (STOT creatinine clearance)

Crosses the blood-brain barrier and thus can cause atropine intoxication (confusion, incoordination). It decreases secretions, causing dry mouth and lack of stomach acid

Front 35

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
ALPHA2 RECEPTOR AGONIST
Alpha methyldopa ( <>< -methyl dopa)
Contraindications:

Back 35

: has no activity on its own- it must be taken up into the neuronal ending to work. Thus, If the reuptake pump is blocked (eg. With tricyclic antidepressants) the drug will not work.

Front 36

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
ALPHA2 RECEPTOR AGONIST
Alpha methyldopa ( <>< -methyl dopa)
Uses:

Back 36

Pre-aneshetic medication to reduce bronchial secretions and normalize cardiac function; therapy of heart block, hyperactive sinus reflex; antidote for cholinesterase inhibitor overdose (e.g. insecticideds such as Malathion); antidote for muscarine poisoning (wild mushroom poisoning); topical ophthalmic solution for the therapy of glaucoma

Front 37

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Muscarinic Antagonists
Mech of action:

Back 37

These drugs act at the level of the muscarinic receptor to block parasympathetic effects. Since the effects of the parasympathetic system are dominant over those of the sympathetic system, by blocking the parasympathetic system, sypathetic effects are seen

Front 38

CARDIOVASCULAR SYSTEM AGENTS
Drugs that affect the ANS
Muscarinic Antagonists
List all drug(s)

Back 38

Atopine ( Sal-Tropine, Artpisol (opthalmic)

Front 39

CARDIOVASCULAR SYSTEM AGENTS
CALCIUM CHANNEL BLOCKERS
List all drugs:

Back 39

1. Dihyropyridenes
A. Nifedipine (Adalat, Procardia, Procardia XL)
B. Nicardipine (Cardene)
C.Nimodipine (Nimotop)
D.Amlodipine (Norvasc, amlopine-1, Lotrel ( amlodipine and Benazepril)

2.Verapamil (Calan, Isoptin, Verelan, Verelan SR, Verelan PM (chronotherapeutic), CoVera HS.
3.Diltiazem ( Cardizem, Dilacor, Tiazac, Tiamate, Cartia XT, Taztia XT, Diltiazem HCI, Cardizem SR, Cardizem CD, Dilacor XR, Cardizem Monovial for continuous infusion (75 mg of diltiazem plus 100 mg of mannitol)

Front 40

CARDIOVASCULAR SYSTEM AGENTS
CALCIUM CHANNEL BLOCKERS
mech of action:

Back 40

block the “L” membrane channels for calcium, resulting in decreased calcium entry into the cells, in a dose-dependent manner. There are three basic areas that are affected. Clinically, the most important of these are:
-Vascular smooth muscle-calcium channel blockers can relax the smooth muscle of arteries and cause vasodilation. They are therefore useful as antihypertensive and antianginal drugs.
-Cardiac muscle-certain calcium channel blockers decrease conduction rate in cardiac tissue, resulting in a decrease in heart rate and cardiac excitability. These drugs are thus useful as antiarrhythmics and antihypertensives, as well as in the therapy of angina.
-Calcium channel blockers can also affect neuronal tissue in high therapeutic doses. Calcium is required for the release of neurotransmitter, and calcium channel blockers can actuallly have a cympatholytic effect.

Front 41

CARDIOVASCULAR SYSTEM AGENTS
CALCIUM CHANNEL BLOCKERS
Adverse effects:

Back 41

flushing, dizziness, constipation, and nausea.

Front 42

CARDIOVASCULAR SYSTEM AGENTS
CALCIUM CHANNEL BLOCKERS
Dihyropyridenes
Nifedipine (Adalat, Procardia, Procardia XL)
Uses:

Back 42

antianginal and antihypertensive therapy

Front 43

CARDIOVASCULAR SYSTEM AGENTS
CALCIUM CHANNEL BLOCKERS
Dihyropyridenes
Nifedipine (Adalat, Procardia, Procardia XL)
Half life:

Back 43

2-5 hours

Front 44

CARDIOVASCULAR SYSTEM AGENTS
CALCIUM CHANNEL BLOCKERS
Dihyropyridenes
Nifedipine (Adalat, Procardia, Procardia XL)
Metabolized:

Back 44

liver

Front 45

CARDIOVASCULAR SYSTEM AGENTS
CALCIUM CHANNEL BLOCKERS
Dihyropyridenes
Nifedipine (Adalat, Procardia, Procardia XL)
CARDIOVASCULAR SYSTEM AGENTS
CALCIUM CHANNEL BLOCKERS
Dihyropyridenes
Nifedipine (Adalat, Procardia, Procardia XL)
overdose:

Back 45

not removed by hemodialysis

Front 46

CARDIOVASCULAR SYSTEM AGENTS
CALCIUM CHANNEL BLOCKERS
Dihyropyridenes
Nimodipine (Nimotop)
Contraindications:

Back 46

food or administered IV

Front 47

CARDIOVASCULAR SYSTEM AGENTS
CALCIUM CHANNEL BLOCKERS
Dihyropyridenes
Amlodipine (Norvasc, amlopine-1, Lotrel ( amlodipine and Benazepril)
Uses:

Back 47

therapy of chronic stable angina, vasospactic angina, and hypertension

Front 48

CARDIOVASCULAR SYSTEM AGENTS
CALCIUM CHANNEL BLOCKERS Diltiazem ( Cardizem, Dilacor, Tiazac, Tiamate, Cartia XT, Taztia XT, Diltiazem HCI, Cardizem SR, Cardizem CD, Dilacor XR, Cardizem Monovial for continuous infusion (75 mg of diltiazem plus 100 mg of mannitol)
Mechanism of Action:

Back 48

decreases excitability and the rate of cardiac conduction, making it useful as an atrial antiarrhythmic, relaxes vascular smooth muscle, making it useful in the therapy of hypertension and patients with low cardiac ejection fratction.

Front 49

CARDIOVASCULAR SYSTEM AGENTS
Inhibitors of Angiotensin-Converting Enzyme ( ACE Inhibitors)
Mech of action:

Back 49

competitive antagonists of ACE-they bind to angiotensin I and compete with ACE for binding sites. The effects of the drugs are thus dose-dependant

Front 50

CARDIOVASCULAR SYSTEM AGENTS
Inhibitors of Angiotensin-Converting Enzyme ( ACE Inhibitors)
Adverse effects:

Back 50

hypotension, possible rash, altered sense of taste, and dry cough. Serious adverse effects insclude bone marrow suppression and renal damage

Front 51

CARDIOVASCULAR SYSTEM AGENTS
Inhibitors of Angiotensin-Converting Enzyme ( ACE Inhibitors)
Contraindicated:

Back 51

pregnancy (all ACE inhibitors)

Front 52

CARDIOVASCULAR SYSTEM AGENTS
Inhibitors of Angiotensin-Converting Enzyme ( ACE Inhibitors)
Benazepril ( Lotensin)
Mechanism of action

Back 52

Pro drug… metabolized to the active form benzepril

Front 53

CARDIOVASCULAR SYSTEM AGENTS
Inhibitors of Angiotensin-Converting Enzyme ( ACE Inhibitors)
Captopril (Capoten)
Half life:

Back 53

short (3-4) hours

Front 54

CARDIOVASCULAR SYSTEM AGENTS
Inhibitors of Angiotensin-Converting Enzyme ( ACE Inhibitors)
Captopril (Capoten)
Contraindicated:

Back 54

sulfer allergic patients-hypotensive effects are additive with diuretics. Racial differences.

Front 55

CARDIOVASCULAR SYSTEM AGENTS
Inhibitors of Angiotensin-Converting Enzyme ( ACE Inhibitors)
Enalapril (Vasotec)
Contraindicated

Back 55

with potassium supplements (including salt substitues) as hyperkalemia may result

Front 56

CARDIOVASCULAR SYSTEM AGENTS
Inhibitors of Angiotensin-Converting Enzyme ( ACE Inhibitors)
Enalapril (Vasotec)
Mech

Back 56

pro-drug. It is enzymatically converted into its active form, enalaprilat

Front 57

CARDIOVASCULAR SYSTEM AGENTS
Inhibitors of Angiotensin-Converting Enzyme ( ACE Inhibitors)
Enalapril (Vasotec)
Half life:

Back 57

14 hours

Front 58

CARDIOVASCULAR SYSTEM AGENTS
Inhibitors of Angiotensin-Converting Enzyme ( ACE Inhibitors)
list all drugs:

Back 58

A. Benazepril ( Lotensin)
B. Captopril (Capoten)
C. Enalapril (Vasotec)
D. Fosinopril Sodium (Monopril)
E. Lisinopril (Prinivil, Zestril)
F. Combination Drugs (Prinzide, Zestoretic (lisinopril with hydrochlorothiazide)

Front 59

CARDIOVASCULAR SYSTEM AGENTS
Inhibitors of Angiotensin-Converting Enzyme ( ACE Inhibitors)
Fosinopril Sodium (Monopril)
Mech:

Back 59

Pro-drug… metabolized to fosinoprilat

Front 60

CARDIOVASCULAR SYSTEM AGENTS
Inhibitors of Angiotensin-Converting Enzyme ( ACE Inhibitors)
Lisinopril (Prinivil, Zestril)
Mech:

Back 60

active metabolite of enalaprat

Front 61

CARDIOVASCULAR SYSTEM AGENTS
Angiotensin II Receptor Blockers
Mech of action:

Back 61

These agents are simply competitive antagonists of angiotensin II at its receptor. Effects are dose-dependant. Less adverse effects are seen with these drugs than with the ACE inhibitors, due to less bradykinin available, but the total blood pressure-lowering effect is also less. Angiotensin II receptor blockers reduce the effects (not Levels) of angiotensinII (e.g. vasoconstriction and increased secretion of aldosterone, a hormone that retains sodium and water from the renal tubules). Unlike the ACE inhibitors, angiotensin II receptor blockers do not have an effect on the levels of bradykinin (a blood factor that promotes vasodilation), so the effects may be more predictable

Front 62

CARDIOVASCULAR SYSTEM AGENTS
Angiotensin II Receptor Blockers
List all drugs:

Back 62

A. Candesartan cilexetil (Atacand)
B. Irbesartan (Avapro)
C. Telmisartan ( Micardis)
D. Valsartan (Diovan)
E. Losartan Potassium ( Cozaar, Hyzaar (with HCTZ)

Front 63

CARDIOVASCULAR SYSTEM AGENTS
Angiotensin II Receptor Blockers
Candesartan cilexetil (Atacand)
Combination drug:

Back 63

Atacnad HCT ( Candesartan with hydrocholorthiazide)

Front 64

CARDIOVASCULAR SYSTEM AGENTS
Angiotensin II Receptor Blockers
Candesartan cilexetil (Atacand)
Adverse effects:

Back 64

headache and dizziness

Front 65

CARDIOVASCULAR SYSTEM AGENTS
Angiotensin II Receptor Blockers
Telmisartan ( Micardis)
Adverse effects:

Back 65

May cause severe hypotension in volume-depleted patients.

Front 66

CARDIOVASCULAR SYSTEM AGENTS
Angiotensin II Receptor Blockers
Losartan Potassium ( Cozaar, Hyzaar (with HCTZ)
Metabolized:

Back 66

extensively metabolized and has a high first-pass effect (T½= 2 hours); the metabolizem of losartan produces and active metabolite (T½=6 to 9 hours); extensively bound to plasma albumin, so it may have drug binding interactions. Dosage should be reduced in patients with reduced renal or hepatic funciton.

Front 67

CARDIOVASCULAR SYSTEM AGENTS
Direct Vasodialators
Mech of action:

Back 67

Direct vasodilators act at the level of arteriolar smooth muscle to relax it, resulting in dilation of the arteriole.

Front 68

CARDIOVASCULAR SYSTEM AGENTS
Direct Vasodialators
list all drugs:

Back 68

A.Hydralazine (Apresazide = hydralazine and HCTZ)
B. Diazoxide (Hyperstat IV)

Front 69

CARDIOVASCULAR SYSTEM AGENTS
Direct Vasodialators
Diaz oxide (Hyperstat IV)
Used:

Back 69

in the therapy of hypoglycemia (by oral administration) and hypertension (intravenous administration)

Front 70

CARDIOVASCULAR SYSTEM AGENTS
Direct Vasodialators
Diaz oxide (Hyperstat IV)
Adverse effects:

Back 70

increased retention of fluid and sodium, decreased renal filtration; enhances loss of uric acid and retention of potassium; increases blood glucos through inhibition of insulin relase.

Front 71

CARDIOVASCULAR SYSTEM AGENTS
Direct Vasodialators
Diaz oxide (Hyperstat IV)
Half life=

Back 71

21 to 36 hours, increased to 53 hours in renally compromised patients.

Front 72

CARDIOVASCULAR SYSTEM AGENTS
Venodiators (Nitrates)
Mech of action:

Back 72

act at the level of the vein to relax venous smooth muscle and increase capacitance. They work through increasing levels of nitric oxide, which in turn increases cellular levels of cyclic GMP, a smooth-muscle relaxant. The effects of these drugs are dose dependant- the more nitric oxide that is produced, the more dilation is seen. These drugs primarily cause dilation of veins, and so have the following effects
-decrease in the filling of the heart(preload), leading to increased cardiac efficiency
-an increase in tissue perfusion, leading to increased oxygen delivery to the tissues
-pooling of blood in the lower extemities

Front 73

CARDIOVASCULAR SYSTEM AGENTS
Venodiators (Nitrates)
caution:

Back 73

venodilators are not useful in the therapy of hypertension, as they do not sig: nificantly affect arteriolar smooth muscle.

Front 74

CARDIOVASCULAR SYSTEM AGENTS
Venodiators (Nitrates)
Adverse effects:

Back 74

nausea and vomiting;fainting; postural hypotension, leading to dizziness; palpitations, increased heart rate; headache, due to arteriolar dilation; occasionally methemoglobinemia, due to oxidation of hemoglobin

Front 75

CARDIOVASCULAR SYSTEM AGENTS
Venodiators (Nitrates)
List all drugs:

Back 75

A. Nitroglycerin (Nitrol, nitro-BID, Nitrostat, Nitrostat Sub (sublingual preparations), Nitro-Dur, Nitro Trans, Deponit, Nitro Disc, Minitran TDS (patch formulations)
B. Isosorbide Mononitrate (Ismo, Monoket, Imdur)
C. Isosorbide dinitrate (Isordil)
D. Sodium nitroprusside ( Nitropress, Nitroprussin)

Front 76

CARDIOVASCULAR SYSTEM AGENTS
Venodiators (Nitrates)
Nitroglycerin (Nitrol, nitro-BID, Nitrostat, Nitrostat Sub (sublingual preparations), Nitro-Dur, Nitro Trans, Deponit, Nitro Disc, Minitran TDS (patch formulations)
Half life:

Back 76

short minutes

Front 77

CARDIOVASCULAR SYSTEM AGENTS
Venodiators (Nitrates)
Nitroglycerin (Nitrol, nitro-BID, Nitrostat, Nitrostat Sub (sublingual preparations), Nitro-Dur, Nitro Trans, Deponit, Nitro Disc, Minitran TDS (patch formulations)
Packaging:

Back 77

glass

Front 78

CARDIOVASCULAR SYSTEM AGENTS
Venodiators (Nitrates)
Nitroglycerin (Nitrol, nitro-BID, Nitrostat, Nitrostat Sub (sublingual preparations), Nitro-Dur, Nitro Trans, Deponit, Nitro Disc, Minitran TDS (patch formulations)
Uses:

Back 78

for acute attacks

Front 79

CARDIOVASCULAR SYSTEM AGENTS
Venodiators (Nitrates)
Isosorbide dinitrate (Isordil)
Metabolism:

Back 79

: Isosorbide dinitrate is converted to isosorbide mononitrate, releasing a nitrate group. This nitrate group is converted to nitric oxide in the lining of the blood vessel (vascular endothelium) and causes dilation of the vessel.
Uses: malignant hypertension

Front 80

CARDIOVASCULAR SYSTEM AGENTS
Venodiators (Nitrates)
Isosorbide dinitrate (Isordil)
Uses:

Back 80

malignant hypertension

Front 81

CARDIOVASCULAR SYSTEM AGENTS
Venodiators (Nitrates)
Sodium nitroprusside ( Nitropress, Nitroprussin)
Adverse effects:

Back 81

: can cause a preciptious drop in blood pressure, resulting in decreased perfusion and oxygen deprivation in tissues (ischemia).

Front 82

CARDIOVASCULAR SYSTEM AGENTS
Venodiators (Nitrates)
Sodium nitroprusside ( Nitropress, Nitroprussin)
Uses:

Back 82

malignant hypertension

Front 83

CARDIOVASCULAR SYSTEM AGENTS
Venodiators (Nitrates)
Sodium nitroprusside ( Nitropress, Nitroprussin)
Effects

Back 83

Dialates both arterioles and veins.

Front 84

CARDIOVASCULAR SYSTEM AGENTS
Cardiac Glycosides
Mech of action-

Back 84

inhibit the actions of the cellular pump that pumps sodium out of the cell and potassium back in, aafter the action potential has ocurred. The result is a buildup of sodium in the cell that can then exchange for calcium. As heart cells depend on calcium from the outside, the trapping of calcium in the cell and the additional pumping of calcium in from ousde causes a large amount of calcium to be available for contraction and increases the number of contracting muscle fibers.

Front 85

CARDIOVASCULAR SYSTEM AGENTS
Cardiac Glycosides
Adverse effects:

Back 85

Include CNS effects such as fatigue, drowsiness, mental confusion, and yellow/blurring vision, and gastrointestinal effects such as gastrointestinal irritation, resulting in nausea and vomiting. Toxicity is manifested in two stages:

1. Early effects are seen as a slowing of heart rate (bradycaria). Patients should be advised to moniter their heart rate at regular intervals, particularly after a dose. If the heart rate falls below 60 beats per minute, this may signify the beginning of toxicxity.

Front 86

CARDIOVASCULAR SYSTEM AGENTS
Cardiac Glycosides
List all drugs:

Back 86

A. Digoxin ( Lanoxicaps, Lanoxin)
B. Digitoxin ( Crystodigin)
C. Dopamine ( N/A)
D. Dobutamine (Dobutrex)

Front 87

CARDIOVASCULAR SYSTEM AGENTS
Cardiac Glycosides
Digoxin ( Lanoxicaps, Lanoxin)
Metabolized:

Back 87

kidney

Front 88

CARDIOVASCULAR SYSTEM AGENTS
Cardiac Glycosides
Digitoxin ( Crystodigin)
Contraindication:

Back 88

food that contains fiber, should not be taken within 6 hours of antacids or binding polymers (e.g. sucralfate, sholestyramine, kaopectate) synergistic effects with other antiarrhythmic agents (e.g. quindine, which also has potassium interactions).

Front 89

CARDIOVASCULAR SYSTEM AGENTS
Cardiac Glycosides
Digitoxin ( Crystodigin)
Caution:

Back 89

Serum potassium levels are critical with this drug-diuretics (e.g. thiazides) or potassium supplementation may have detrimental effects.

Front 90

CARDIOVASCULAR SYSTEM AGENTS
Cardiac Glycosides
Digitoxin ( Crystodigin)
Metabolized:

Back 90

the metabolites are active. They are dumped into the bile, secreted into the intestine, and reabsorbed (enterohpatic recycling).

Front 91

CARDIOVASCULAR SYSTEM AGENTS
Cardiac Glycosides
Digitoxin ( Crystodigin)
Half life:

Back 91

very long

Front 92

CARDIOVASCULAR SYSTEM AGENTS
Cardiac Glycosides
Digitoxin ( Crystodigin)
Uses:

Back 92

therapy of atrail and supraventricular arrhythmias

Front 93

CARDIOVASCULAR SYSTEM AGENTS
Cardiac Glycosides
Dobutamine (Dobutrex)
Half life

Back 93

Short:

Front 94

CARDIOVASCULAR SYSTEM AGENTS
Phosphodiesterase Inhibitors (all IV)
Mech of action:

Back 94

increase levels of cAMP, resulting in longer and stronger contraction of cardiac muscle.

Front 95

CARDIOVASCULAR SYSTEM AGENTS
Phosphodiesterase Inhibitors (all IV)
List all drugs:

Back 95

A. Amrinone (Inocor IV)
B Milrinone ( Primacor)

Front 96

CARDIOVASCULAR SYSTEM AGENTS
Sodium Channel Blockers
Mech of action:

Back 96

used as local anesthetics. They decrease excitation of conductive tissue. As agents used to block pain, they decrease the firing of pain neurons. These drugs also decrease conduction in nodal tissue and are useful as antiarrhythmics

Front 97

CARDIOVASCULAR SYSTEM AGENTS
Sodium Channel Blockers
List all drugs:

Back 97

A. Lidocaine ( Xylocaine)
B.Quinidine ( Cardioquin, Quinaglute Dura)
C. Disopyramide (Norpace)

Front 98

CARDIOVASCULAR SYSTEM AGENTS
Sodium Channel Blockers
Quinidine ( Cardioquin, Quinaglute Dura)
Adverse effects:

Back 98

Because of the changes in cadiac conduction, this drug may cause a potentially fatal arrhythmia called torsades des points, which can lead into ventricular fibrillation.
The hallmark of quinidine toxicity is cinchosnism, which is characterized by headache, dizziness, and ringing in the ears.

Front 99

CARDIOVASCULAR CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Decrease Fluid Volume ( Diuretics)
Mech of action:

Back 99

act on the nephron to increase retention of sodium in the urine, decrease the concentrating ability of the renal medulla, or increase the excretion of water and salts.

Front 100

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Decrease Fluid Volume ( Diuretics)
List all subclasses:

Back 100

Loop Diuretics
Thiazide Diuretics
Carbonic Anhydrase Inhibitors
Potassium-Sparing Diuretics
Osmotic Diruetics

Front 101

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Decrease Fluid Volume ( Diuretics)
Loop Diuretics
Mech of action:

Back 101

These drugs act by disrupting the concentration mechanism in the kidney. As a result, the urine is very dilute, which means that more water is eliminated. As water is eliminated, the plasma becomes more concentrated, drawing water out of tissues and decreasing edema.

Front 102

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Decrease Fluid Volume ( Diuretics)
Loop Diuretics
Adverse effects:

Back 102

toxcity to the ear (ototoxicity); Potassium loss-loop diuretics should be supplemented with potassium tabs

Front 103

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Decrease Fluid Volume ( Diuretics)
Loop Diuretics
List all drugs:

Back 103

1.Bumetanide ( Bumex)
2. Furosemide (lasix, Myrodemide)
3. Tosemide (Demedex)

Front 104

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Decrease Fluid Volume ( Diuretics)
Thiazide Diuretics
Mech of action:

Back 104

Act at the distal end of the nephron and impair the ability of the kidney to reabsorb chloride (and thus sodium) into the body. As sodium attracts water(ie., has a “layer of hydation”), this means that water is also retained in the urine, along with the sodium. These drugs also inhibit carbonic anhydrase.

Front 105

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Decrease Fluid Volume ( Diuretics)
Thiazide Diuretics
Adverse effects:

Back 105

Potassium loss; alterations in glomerular filtration rate (GFR)

Front 106

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Decrease Fluid Volume ( Diuretics)
Thiazide Diuretics
List all drugs:

Back 106

1.Chlorothiazide ( Diuril)
2. Hydrochlorothiazide ( Esiderex, Ezide, Oretic)

Front 107

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Decrease Fluid Volume ( Diuretics)
Carbonic Anhydrase Inhibitors
Mech of action-

Back 107

These drugs inhibit the conversion of carbon dioxide to carbonic acid, a process that utilizes water and brings it back into the body. The result is a slight loss of water and a large loss of bicarbonate, producing alkaline urine.

Front 108

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Decrease Fluid Volume ( Diuretics)
Carbonic Anhydrase Inhibitors
Adverse effects:

Back 108

Carbonic anhydrase inhibitors cause exretion of bicarbonate. Thus, they produce alkaline urine and may cause systemic acidosis. They may, however, be useful in correcting systemic alkalosis.

Front 109

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Decrease Fluid Volume ( Diuretics)
Carbonic Anhydrase Inhibitors
Uses:

Back 109

Lowering of intraoclar pressure- the inhibiton of the conversion of carbonic acid to carbon dioxide and water results in decreased formation of aqueous humor and decreased intraocular pressure. These drugs are thus useful as opthalmic preparations in the therapy of glaucoma.

Front 110

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Decrease Fluid Volume ( Diuretics)
Carbonic Anhydrase Inhibitors
List drugs:

Back 110

Acetazolamide ( Diamox)

Front 111

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Decrease Fluid Volume ( Diuretics)
Potassium-Sparing Diuretics
Mech of action

Back 111

used in combo with a potassium -wasting diuretic (eg thiazides), or they may be used as monotherapy if fluid retention is not severe.

Front 112

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Decrease Fluid Volume ( Diuretics)
Potassium-Sparing Diuretics
List all drugs:

Back 112

1. Amiloride hydrochloride (midamor)
2. Spironolactone ( Aldactone)
3. Triamterene and hydrochlorothiazide (Dyazide, maxzide) (potassium sparing diuretics with HCTZ)

Front 113

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Decrease Fluid Volume ( Diuretics)
Potassium-Sparing Diuretics
Triamterene and hydrochlorothiazide (Dyazide, maxzide) (potassium sparing diuretics with HCTZ)
Uses:

Back 113

this drug is a membrane sparing agent, which decrease the excitability of renal tubular cells and prevent sodium and potassium transport.

Front 114

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Decrease Fluid Volume ( Diuretics)
Potassium-Sparing Diuretics
Spironolactone ( Aldactone)
Uses:

Back 114

this drug is an aldosterone antagonist, which compete with aldosterone for binding sites on its receptor. These drugs are only effective in patients with evlevated levels of aldosterone.

Front 115

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Decrease Fluid Volume ( Diuretics)
Osmotic Diruetics (IV)
Mech of action:

Back 115

sugar polymers that bind to water and are filtered into the urine. As a result, they prevent the reabsorbtion of water and cause diuresis. There is no selective loss of one ion with these drugs-salt loss is more uniform

Front 116

CARDIOVASCULAR SYSTEM AGENTS
Drugs used in the therapy of Inappropriate ADH secretion (SIADH) Syndrome
List all drugs:

Back 116

Demeclocyline ( Declomycin)

Front 117

CARDIOVASCULAR SYSTEM AGENTS
Drugs used in the therapy of Inappropriate ADH secretion (SIADH) Syndrome
Demeclocyline ( Declomycin)
Mech of action:

Back 117

low potency tetracycline antibiotic but is not used as an antibiotic.

Front 118

CARDIOVASCULAR SYSTEM AGENTS
Drugs used in the therapy of Inappropriate ADH secretion (SIADH) Syndrome
Demeclocyline ( Declomycin)
Adverse effects:

Back 118

ability to suppress ADH. It is this effect that makes it a useful drug in the therapy of SIADH. The drug exhibit’s the characteristic effects of the tetracyclines such as promoting photosensitvity, and binding divalent ions such as calcium and magnesium.

Front 119

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Reduce Blood Cholesterol
Bile Binding Resins
Mech of action-

Back 119

bind salts in the intestine

Front 120

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Reduce Blood Cholesterol
Bile Binding Resins
Caution:

Back 120

these drugs are not useful for lowering triglyceride levels, only cholesterol (specifically the LDL form.)

Front 121

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Reduce Blood Cholesterol
Bile Binding Resins
Adverse effects:

Back 121

These drugs are not palatable and therefore have low patient compliance. They can cause constipation and may cause liver toxicity.

Front 122

CARDIOVASCULAR SYSTEM AGENTS
Drugs used to Reduce Blood Cholesterol
Bile Binding Resins
List all drugs:

Back 122

Cholestyramine( prevalite, Questran)

Front 123

CARDIOVASCULAR SYSTEM AGENTS
Drugs that Interfere with Triglyceride synthesis (Firates)
Mech of action

Back 123

decrease blood levels of triglycerides.

Front 124

CARDIOVASCULAR SYSTEM AGENTS
Drugs that Interfere with Triglyceride synthesis (Firates)
Uses:

Back 124

the enzyme lipoprotein lipase breaks down VLDL. Fibrates increase the synthesis of this enzyme, resulting in decreased levels of VLDL. These drugs are useful in hypertriglyceridemia, as they decrease blood levels of triglycerides.

Front 125

CARDIOVASCULAR SYSTEM AGENTS
Drugs that Interfere with Triglyceride synthesis (Firates)
Adverse effects:

Back 125

anemia, myositis (inflammation of muscle)

Front 126

CARDIOVASCULAR SYSTEM AGENTS
Drugs that Interfere with Triglyceride synthesis (Firates)
Interactions:

Back 126

Anticoagulants. These drugs will increase anticoagulant effects.2. Fibrates and statins synergize and will produce significantly more myositis if used together. Use with caution.

Front 127

CARDIOVASCULAR SYSTEM AGENTS
Drugs that Interfere with Triglyceride synthesis (Firates)
Contraindications:

Back 127

may potentiate the effects of anticoagulants such as warfarin. Grapefruit juice decreases the rate of breakdown of the drug and may lead to toxic levels, and/ or increase in adverse effects.

Front 128

CARDIOVASCULAR SYSTEM AGENTS
Drugs that Interfere with Triglyceride synthesis (Firates)
List all drugs:

Back 128

1. Gemfibozil ( lopid)
2. Clofibrate ( Atromid-s)

Front 129

CARDIOVASCULAR SYSTEM AGENTS
Inhibitors of HMG CoA reductase
Mech of action:

Back 129

inhibit the first step in cholesterol biosythesis, Thus, cholesterol synthesis is inhibited in a dose dependant manner.

Front 130

CARDIOVASCULAR SYSTEM AGENTS
Inhibitors of HMG CoA reductase
List all drugs:

Back 130

A. Fluvastin ( lescol)
B. Lovastatin ( mevinolin)
C. Simvastatin ( Zocor)

Front 131

CARDIOVASCULAR SYSTEM AGENTS
DRUGS THAT AFFECT THE BLOOD AND BLOOD CLOTTING
List all subclasses:

Back 131

Anticoagulants
Antithrombotic Agents
Thrombolytic Drugs

Front 132

CARDIOVASCULAR SYSTEM AGENTS
DRUGS THAT AFFECT THE BLOOD AND BLOOD CLOTTING
Anticoagulants
Mech of action:

Back 132

interfere with various stages of the clotting cascade in blood plasma. They do not have a major effect on platelets

Front 133

CARDIOVASCULAR SYSTEM AGENTS
DRUGS THAT AFFECT THE BLOOD AND BLOOD CLOTTING
Anticoagulants
List all drugs:

Back 133

1. Heparin aka heparin sulfate proteoglycan
2.Warfin sodium (coumadin)

Front 134

CARDIOVASCULAR SYSTEM AGENTS
DRUGS THAT AFFECT THE BLOOD AND BLOOD CLOTTING
Anticoagulants
Heparin aka heparin sulfate proteoglycan (iv)
Mech of action:

Back 134

carbohydrate polymere that potentiates a natural anticoagulant called antithrombin III. This substance interfers with the formation of thrombin, which is required for clot formation.

Front 135

CARDIOVASCULAR SYSTEM AGENTS
DRUGS THAT AFFECT THE BLOOD AND BLOOD CLOTTING
Anticoagulants
Heparin aka heparin sulfate proteoglycan (iv)
Warfin sodium (coumadin)
Metabolism:

Back 135

because liver stores of vitamin K must be used up before the clotting factors become inactive, this drug has a delayed clinical onset

Front 136

CARDIOVASCULAR SYSTEM AGENTS
DRUGS THAT AFFECT THE BLOOD AND BLOOD CLOTTING
Anticoagulants
Heparin aka heparin sulfate proteoglycan (iv)
Warfin sodium (coumadin)
Recovery:

Back 136

recovery from the drug is also delayed, as vitamin K, must be replenished before clotting can resume.

Front 137

CARDIOVASCULAR SYSTEM AGENTS
DRUGS THAT AFFECT THE BLOOD AND BLOOD CLOTTING
Anticoagulants
Warfin sodium (coumadin)
Contraindications:

Back 137

include vitamin K, antibiotics decrease the number of vitamin K producing bacteria in the intestine and can ampify the effects of warfin

Front 138

CARDIOVASCULAR SYSTEM AGENTS
DRUGS THAT AFFECT THE BLOOD AND BLOOD CLOTTING
Antithrombotic Agents
Mech of action:

Back 138

interfere with the actions of the platelet plug and decrease platelet aggregation. This may result in a decrease in the number of small clots (thrombi) that routinely form in the course fo normal blood flow, due to random platelet activation

Front 139

CARDIOVASCULAR SYSTEM AGENTS
DRUGS THAT AFFECT THE BLOOD AND BLOOD CLOTTING
Antithrombotic Agents
List all drugs:

Back 139

1. Aspirin (low dose-80mg)
2. Ticlopidine (ticlid)

Front 140

CARDIOVASCULAR SYSTEM AGENTS
DRUGS THAT AFFECT THE BLOOD AND BLOOD CLOTTING
Antithrombotic Agents
Aspirin (low dose-80mg)
Mech:

Back 140

inhibit’s the formation of platelet thromboxanes, resulting in decreased platelet aggregation.

Front 141

CARDIOVASCULAR SYSTEM AGENTS
DRUGS THAT AFFECT THE BLOOD AND BLOOD CLOTTING
Antithrombotic Agents
Aspirin (low dose-80mg)
Caution:

Back 141

taken at doses therapeutic for pain will not have the beneficial effedts of the lower dose, as vascular prostacyclin synthesis is also inhibited.

Front 142

CARDIOVASCULAR SYSTEM AGENTS
DRUGS THAT AFFECT THE BLOOD AND BLOOD CLOTTING
Thrombolytic Drugs (IV)
Mech of action

Back 142

break up formed clots. They act from within the clot to lyse (break up) the clot.

Front 143

CARDIOVASCULAR SYSTEM AGENTS
DRUGS THAT AFFECT THE BLOOD AND BLOOD CLOTTING
Thrombolytic Drugs (IV)
List all drugs:

Back 143

1. Streptokinase ( kabikinase, streptase)
2. Urokinase (abbokinase)
3. Tissue plasminogen activator aka TPA (N/a)