Fa: Cardiac Pharm

Front 1

class I antiarrhythmics

Back 1

- cardiac anesthetic, blocking phase 0 of AP
- class Ia: quinidine, procainamide (prolong repolarization)
- class Ib: lidocaine, tocainide (shorten repolarization)
- class Ic: propafenone (no effect on repolarization)

Front 2

class II antiarrhythmics

Back 2

- beta-blockers

Front 3

class III antiarrhythmics

Back 3

- phase 3 prolonger
- bretylium, amiodarone

Front 4

class IV antiarrhythmics

Back 4

- Ca++ channel blocker
- phase 2 blocker
- Ca++ is coagulant factor IV
- verapamil, diltiazem, nifedipine ("Very Different Names")

Front 5

what are 4 drugs notable for causing heart block?

Back 5

ABCD: adenosine, beta-blocker, Ca++ channel blocker, digoxin

don't give 2 from this list at the same time

Front 6

what are 4 drugs that poison cAMP phosphodiesterase?

Back 6

4 A's: amrinone, aminophylline, anti-inflammatories, aspirin

[leads to higher cAMP levels -> higher Ca++ levels -> contractility]

Front 7

what are the ABC's & D of cardiac drugs?

Back 7

ACE inhibitor
Anesthetics
Anticoagulant

Beta blocker

Ca++ Channel blocker
Cholesterol/triglyceride lowering
Clot busters

Delayed repolarization
Digoxin, other inotropes, Diuretics
Direct vasodilator

Front 8

what are the ABC's & D of hypertensive drugs?

Back 8

ACE inhibitor (esp when SCRAP beta blockers)

Beta blockers

Ca++ channel blockers

Direct vasodilators
Diuretics

Front 9

what cardiac drugs cause a lupus-like syndrome?

Back 9

procainamide, hydralazine, minoxidil

Front 10

what 2 cardiac drugs have reciprocal effects?

Back 10

digoxin and quinidine

Front 11

mannitol

Back 11

osmotic diuretic; increases urine osmolarity

C: shock, drug O/D, decrease intracranial & intraocular pressure

X: pulmonary edema (drug moves right to the extracellular compartment and pulls out water)

Front 12

acetazolamide

Back 12

carbonic anhydrase inhibitor; leads to self limited NaHCO3 diuresis and lower bicarb stores

C: glaucoma, metabolic alkalosis and altitude sickness

X: hyperchloremic metabolic acidosis, neuropathy, NH3 toxicity, sulfa allergy

Front 13

furosemide

Back 13

sulfonamide loop diuretic; blocks cotransport system Na+/K+/Cl- in thick ascending loop; abolish hypertonicity of medulla to prevent concentration of urine; increase Ca++ excretion

C: treat edema (CHF, cirrhosis, nephrotic syndrome, pulmonary edema), HTN, hypercalcemia

X: OH DANG! Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa), Nephritis, Gout

Front 14

ethacrynic acid

Back 14

phenoxyacetic acid derivative (NOT a sulfonamide); same action as furosemide (ie. blocks Na/K/2Cl cotransport system of thick ascending limb

C: diuresis for pts allergic to sulfa drugs

X: similar to furosemide EXCEPT the sulfa allergy

Front 15

hydrochlorothiazide

Back 15

thiazide diuretic; block NaCl absorption in early distal tubule ; reduces diluting capacity of nephron and decreases Ca++ excretion

C: HTN, CHF, idiopathic hypercalciuria, nephrogenic diabetes insipidus

X: sulfa allergy, hypo K+, hypo Na+ and hyperGLUC (hyper -Glycemia, -Lipidemia, -Uricemia, -Calcemia)

Front 16

spironolactone

Back 16

K+ sparing diuretic; competitive aldosterone receptor inhibitor antagonist in cortical collecting tubule

C: hyperaldosteronism, K+ depletion, CHF

X: hyperkalemia, gynecomastia, antiandrogen effects

Front 17

triamterene

Back 17

K+ sparing diuretic; block Na+ channels in the collecting tubule

C: hyperaldosteronism, K+ depletion, CHF

X: hyperkalemia

Front 18

amiloride

Back 18

K+ sparing diuretic; block Na+ channels in the collecting tubule

C: hyperaldosteronism, K+ depletion, CHF

X: hyperkalemia

Front 19

hydralazine

Back 19

+ cGMP -> smooth muscle relaxation vasodilates arterioles > veins to reduce afterload

C: severe HTN, CHF

X: SLE-like syndrome, compensatory tachycardia, fluid retention

Front 20

nifedipine

Back 20

calcium channel blocker; block L-type channels of cardiac and smooth muscle to reduce contractility

C: hypertension, angina [vascular smooth muscle: nifedipine > diltiazem > verapamil]

Front 21

verapamil

Back 21

class IV antiarrhythmic act on AV nodal cells, - conduction velocity, + ERP, + PR interval; prevent nodal arrhythmias calcium channel blocker; block L-type channels of cardiac and smooth muscle to reduce contractility [heart: verapamil > diltiazem > nifedipine]

C: supraventricular arrhythmias

X: hypotension, constipation

Front 22

diltiazem

Back 22

class IV antiarrhythmic act on AV nodal cells, - conduction velocity, + ERP, + PR interval; prevent nodal arrhythmias calcium channel blocker; block L-type channels of cardiac and smooth muscle to reduce contractility [heart: verapamil > diltiazem > nifedipine]

Front 23

captopril

Back 23

ACE-inhibitor; lowers angiotensin II levels and prevents inactivation of bradykinin renin release is increased due to loss of feedback inhibition

C: HTN, CHF, diabetic renal disease

X: "CAPTOPRIL"

Front 24

enalapril

Back 24

ACE-inhibitor; lowers angiotensin II levels and prevents inactivation of bradykinin renin release is increased due to loss of feedback inhibition

C: HTN, CHF, diabetic renal disease

X: "CAPTOPRIL"

Front 25

lisinopril

Back 25

ACE-inhibitor; lowers angiotensin II levels and prevents inactivation of bradykinin renin release is increased due to loss of feedback inhibition

C: HTN, CHF, diabetic renal disease

X: "CAPTOPRIL"

Front 26

losartan

Back 26

angiotensin II receptor antagonist; NOT an ACE inhibitor and does NOT cause cough

C: HTN, CHF, diabetic renal disease

X: hyperkalemia, DON'T give in pregnancy

Front 27

nitroglycerin

Back 27

vasodilate by releasing NO in smooth muscle, causing + in cGMP and smooth muscle relaxation dilate veins >> arteries

C: angina, pulmonary edema; aphrodisiac and erection enhancer

X: tachycardia, hypotension, "Monday disease"

Front 28

isosorbide dinitrate

mxn? X?

Back 28

vasodilate by releasing NO in smooth muscle, causing + in cGMP and smooth muscle relaxation dilate veins >> arteries

C: angina, pulmonary edema; aphrodisiac and erection enhancer

X: tachycardia, hypotension, headache; "Monday disease" in industrial exposure (tolerance during work week and tachycardia on weekends)

Front 29

digoxin

Back 29

block Na+/K+ ATPase of cell membrane, causing + Na+ in cell and + Ca++ in cell (antiport no longer working well) -> + inotropy ; 75% bioavailability, 20-40% protein bound, t(1/2) 40 hrs, urinary excretion

C: CHF (+ contractility); atrial fibrillation (- conduction of AV node) [Youel: digoxin and quinidine are opposites]

X: nausea, vomiting, diarrhea, blurry yellow vision, arrhythmia; made worse by renal failure, hypokalemia, quinidine (displace from tissue binding sites)

Front 30

quinidine

Back 30

antiarrhythmic class IA; blocks Na+ channel blocks conduction (esp. depolarized cells), decrease slope of phase 4 depolarization and + threshold for firing in abnormal pacemaker cells; state-dependent (selectively depress tissue that is frequently depolarized)

C: atrial and ventricular arrhythmia [Youel: digoxin and quinidine are opposites]

X: cinchonism (headache, tinnitus); thrombocytopenia, torsade de pointes

Front 31

amiodarone

Back 31

[considered class IA and class III antiarrhythmic...more class III]

class IA antiarrhythmic; Na+ channel blocker; lengthens AP blocks conduction (esp. depolarized cells), decrease slop of phase 4 depolarization and + threshold for firing in abnormal pacemaker cells; state-dependent (selectively depress tissue that is frequently depolarized)

C: atrial and ventricular arrhythmia

Front 32

procainamide

Back 32

class IA antiarrhythmic; Na+ channel blocker; lengthens AP blocks conduction (esp. depolarized cells), decrease slope of phase 4 depolarization and + threshold for firing in abnormal pacemaker cells; state-dependent (selectively depress tissue that is frequently depolarized)

C: atrial and ventricular arrhythmia; premature ventricular contractions

X: torsade de pointes, drug-induced SLE, pleuritis and pericarditis

Front 33

disopyramide

Back 33

class IA antiarrhythmic; Na+ channel blocker; lengthens AP blocks conduction (esp. depolarized cells), decrease slope of phase 4 depolarization and + threshold for firing in abnormal pacemaker cells; state-dependent (selectively depress tissue that is frequently depolarized)

C: atrial and ventricular arrhythmia

X: anticholinergic effects (dry mouth, urinary retention); torsade de pointes

Front 34

lidocaine

Back 34

class IB antiarrhythmic; Na+ channel blocker lowers AP duration

DOC for acute ventricular arrhythmias (post MI!) and digitalis-induced arrhthmias

X: CNS effects - drowsiness, numbness, slurred speech

Front 35

mexiletine

Back 35

class IB antiarrhythmic; Na+ channel blocker lowers AP duration

DOC for acute ventricular arrhythmias (post MI!) and digitalis-induced arrhythmias

X: blood dyscrasias, nystagmus, thrombocytopenia, leukopenia

Front 36

tocainide

Back 36

class IB antiarrhythmic; Na+ channel blocker lowers AP duration

DOC for acute ventricular arrhythmias (post MI!) and digitalis-induced arrhythmias

X: AV block, hypotension

Front 37

flecainide

Back 37

class IC antiarrhthmic; Na+ channel blocker no effect on AP

C: good for V-tachs that progress to VF and intractable SVT; last resort in refractory tachyarrhythmias (Pharm Recall: treat life-threatening supraventricular and ventricular arrhythmias)

X: pro-arrhythmogenic, so last-line agent

Front 38

encainide

Back 38

class IC antiarrhythmic; Na+ channel blocker no effect on AP

C: good for V-tachs that progress to VF and intractable SVT; last resort in refractory tachyarrhythmias

X: pro-arrhythmic, especially post-MI

Front 39

propafenone

Back 39

class IC antiarrhythmic; Na+ channel blocker no effect on AP

C: good for V-tachs that progress to VF and intractable SVT; last resort in refractory tachyarrhythmias

X: proarrhythmic effects

Front 40

propranolol

Back 40

class II antiarrhythmics; beta blocker - cAMP, - Ca++ currents; suppress abnormal pacemakers by decreasing slope of phase 4; AV node especially sensitive

X: impotence, worsen asthma, CV effects, CNS effects, mask hypoglycemia

Front 41

esmolol

Back 41

class II antiarrhythmics; beta blocker; short acting - cAMP, - Ca++ currents; suppress abnormal pacemakers by decreasing slope of phase 4; AV node especially sensitive

X: impotence, worsen asthma, CV effects, CNS effects, mask hypoglycemia

Front 42

metoprolol

Back 42

class II antiarrhythmics; beta blocker - cAMP, - Ca++ currents; suppress abnormal pacemakers by decreasing slope of phase 4; AV node especially sensitive


X: impotence, worsen asthma, CV effects, CNS effects, mask hypoglycemia

Front 43

atenolol

Back 43

class II antiarrhythmics; beta blocker - cAMP, - Ca++ currents; suppress abnormal pacemakers by decreasing slope of phase 4; AV node especially sensitive; decreased automaticity


X: impotence, worsen asthma, CV effects, CNS effects, mask hypoglycemia

Front 44

timolol

Back 44

class II antiarrhythmics; beta blocker - cAMP, - Ca++ currents; suppress abnormal pacemakers by decreasing slope of phase 4; AV node especially sensitive

X: impotence, exacerbate asthma, CV effects, CNS effects (sedation, nightmares), mask hypoglycemia

Front 45

sotalol

Back 45

class III antiarrhythmic; K+ channel blocker

C: Vtach; used when other antiarrhythmics fail; + AP duration, + ERP, + QT interval

X: torsade de pointes; excessive beta block

Front 46

ibutilide

Back 46

class III antiarrhythmic; K+ channel blocker

C: Vtach; used when other antiarrhythmics fail; + AP duration, + ERP, + QT interval

X: torsade de pointes

Front 47

bretylium

Back 47

class III antiarrhythmic; K+ channel blocker; blocks NE release

C: used for refractory v-fib and v-tach during times of cardiac arrest; + AP duration, + ERP, + QT interval

Front 48

amiodarone

Back 48

class III antiarrhythmic; K+ channel blocker (drug structure is related to thyroid hormone)

C: treat refractory atrial flutter/fibrillation and v-tach; + AP duration, + ERP, + QT interval

X: thyroid dysfunction, hepatocellular necrosis, interstitial pulmonary fibrosis

Front 49

dofetilide

Back 49

class III antiarrhythmic; K+ channel blocker

C: Vtach; used when other antiarrhythmics fail; + AP duration, + ERP, + QT interval

Front 50

adenosine

Back 50

other anti arrhythmic

DOC to diagnose/abolish AV nodal arrhythmias

Front 51

K+

Back 51

other anti-arrhythmic depress ectopic pacemaker, esp in digoxin toxicity

Front 52

Mg+

Back 52

effective in torsades de pointes and digitoxin toxicity

Front 53

lovastatin

Back 53

HMG-CoA reductase inhibitor; lowers LDL a lot and raises HDL a little;

X: expensive, reversible + LFTs and myositis

Front 54

pravastatin

Back 54

HMG-CoA reductase inhibitor; lowers LDL a lot and raises HDL a little; X: expensive, reversible + LFTs and myositis

Front 55

simvastatin

Back 55

HMG-CoA reductase inhibitor; lowers LDL a lot and raises HDL a little;

X: expensive, reversible + LFTs and myositis

Front 56

atorvastatin

Back 56

HMG-CoA reductase inhibitor; lowers LDL a lot and raises HDL a little;

X: expensive, reversible + LFTs and myositis

Front 57

niacin

Back 57

moderate decrease in LDL and moderate increase in HDL;

X: red, flushed face which goes down with aspirin and long term use

Front 58

cholestyramine

Back 58

bile acid resin; moderate decrease in LDL; X: pts hate it, tastes bad, GI discomfort

Front 59

colestipol

Back 59

bile acid resin; moderate decrease in LDL; X: pts hate it, tastes bad, GI discomfort

Front 60

ezetimibe

Back 60

cholesterol absorption blocker; moderate decrease in LDL;

X: rare + LFTs

Front 61

gemfibrozil

Back 61

fibrate; big drop in triglycerides; X: myositis, + LFTs

Front 62

clofibrate

Back 62

fibrate; big drop in triglycerides;

X: myositis, + LFTs

Front 63

bezafibrate

Back 63

fibrate; big drop in triglycerides; X: myositis, + LFTs

Front 64

fenofibrate

Back 64

fibrate; big drop in triglycerides; X: myositis, + LFTs

Front 65

streptokinase

Back 65

thrombolytic; aid in conversion of plasminogen to plasmin, which cleaves thrombin and fibrin clots;

C: early MI, early ischemic stroke

X: bleeding

Front 66

urokinase

Back 66

thrombolytic; aid in conversion of plasminogen to plasmin, which cleaves thrombin and fibrin clots;

C: early MI, early ischemic stroke

X: bleeding

Front 67

tPA (alteplase)

Back 67

thrombolytic; aid in conversion of plasminogen to plasmin, which cleaves thrombin and fibrin clots;

C: early MI, early ischemic stroke

X: bleeding

Front 68

APSAC (anistreplase)

Back 68

thrombolytic; aid in conversion of plasminogen to plasmin, which cleaves thrombin and fibrin clots;

C: early MI, early ischemic stroke

X: bleeding

Front 69

heparin

Back 69

anti coagulant; catalyzes the activation of antithrombin III, decreases thrombin and Xa, short half life

C: immediate anticoagulant for PE, stroke, angina, MI, DVT; used in pregancy since it doesn't cross placenta; follow PTT

X: bleeding, thrombocytopenia, drug-drug interactions

Front 70

warfarin/coumadin

Back 70

anti coagulant; interferes with normal synthesis and gamma-carboxylation of vitamin K dependent clotting factors II, VII, IX, X, protein C & S; WEPT (Warfarin Extrinsic +PT); long half-life

C: chronic anticoagulation; contraindicated in pregnancy

X: bleeding, teratogenic, drug-drug interactions

Front 71

aspirin

Back 71

NSAID; acetylates and irreversibly inhibits both COX1 and COX2 to prevent conversion of arachidonic acid to prostaglandins; NO effect on PT or PTT

C: antipyretic, analgesic, anti-inflammatory, anti-platelet

X: gastric ulceration, bleeding, hyperventilation, Reye's syndrome, tinnitus

Front 72

clopidogrel

Back 72

anti platelet; irreversibly block ADP receptor and inhibit fibrinogen binding by preventing glycoprotein IIb/IIIa expression

C: acute coronary syndrome; coronary stenting; reduce incidence or recurrence of thrombotic stroke

Front 73

ticlopidine

Back 73

anti platelet; irreversibly block ADP receptor and inhibit fibrinogen binding by preventing glycoprotein IIb/IIIa expression

C: acute coronary syndrome; coronary stenting; reduce incidence or recurrence of thrombotic stroke

X: neutropenia

Front 74

abciximab

Back 74

anti platelet; bind to the glycoprotein receptor IIb/IIIa on activated platelets

C: acute coronary syndromes, percutaneous transluminal coronary angioplasty

X: bleeding, thrombocytopenia

Front 75

X: hydrochlorothiazide

Back 75

hypokalemia, hyponatremia

hyperGLUC: hyper-
Glycemia
Lipidemia
Uricemia
Calcemia

Front 76

X: loop diuretics

Back 76

potassium wasting, metabolic alkalosis, hypotension, ototoxicity

Front 77

X: clonidine

Back 77

dry mouth, sedation, severe rebound hypertension

[stimulates presynaptic alpha2 adrenergic receptor; leads to decreased NE release]

Front 78

X: methyldopa

Back 78

sedation, positive Coombs' test

Front 79

X: hexamethonium

Back 79

sever orthostatic hypotension, blurred vision, constipation and sexual dysfunction

Front 80

X: reserpine

Back 80

sedation, depression, nasal stuffiness, diarrhea

(blocks NE release)

Front 81

X: guanethidine

Back 81

orthostatic and exercise hypotension, sexual dysfunction, diarrhea

[blocks NE release]

Front 82

X: beta blockers

Back 82

impotence, asthma, CV effects (bradycardia, CHF, AV block), CNS effects (sedation, sleep alterations)

Front 83

X: hydralazine*

Back 83

nausea, headache, lupus-like syndrome, reflex tachycardia, angina, salt retention

*take with beta blockers to avoid reflex tachycardia, diuretic to block salt retention

Front 84

X: minoxidil

Back 84

hypertrichosis, pericardial effusion, reflex tachycardia, angina, salt retention

*take with beta blockers to avoid reflex tachycardia, diuretic to block salt retention

Front 85

X: nifedipine, verapamil

Back 85

dizziness, flushing, constipation (verapamil), nausea

Front 86

X: nitroprusside

Back 86

cyanide toxicity (releases CN)

Front 87

X: captopril and other ACE inhibitors

Back 87

Cough
Angioedema
Proteinuria
Taste changes
hypOtension
Pregnancy problems (fetal renal damage)
Rash
Increased renin
Lower angiotensin II
(hyperkalemia)

Front 88

X: losartan

Back 88

fetal renal toxicity, hyperkalemia

Front 89

what cardiac drugs are particularly contraindicated in pregnancy?

Back 89

ACE inhibitors and losartan (ARB)