First Aid - Cardiovascular - Pharmacology

Front 1

What are diuretics first line therapy for?

Back 1

Essential HTN
CHF

also use ACEi's / ARBs

Front 2

What is first line therapy for cardiac management of diabetics?

Back 2

ACEi's/ARBs --> prevent remodeling
CCB
diuretics (not first line as thought)

Front 3

Hydralazine MOA?

Back 3

vasodilates arteries > veins
smooth mm relaxation by increase cGMP

used for: severe HTN, 1st line for HTN in preg (w/methyldopa)
administer w/beta-blocker to prevent reflex tachycardia

Front 4

Which Ca channel blockers act on smooth mm & which on heart?

Back 4

vascular smooth mm: nifedipine > diltiazem > verapamil

heart: verapamil > diltiazem > nifedipine

Verapamil = Ventricle

Front 5

How do you tx malignant HTN?

Back 5

Nitroprusside - direct release of NO increases cGMP; can cause CN toxicity

Fenoldopam - dopamine D1 agonist; relaxes renal vascular mm

Diazoxide - opens K+ channels, hyperpolarize & relax smooth mm

Front 6

Isosorbide Dinitrate

MOA?
Other drug sharing MOA?

Back 6

vasodilates by releasing NO in smooth mm
veins >> arteries in vasodilating, decrease preload

use for angina, pulmonary edema

Front 7

What can you use to tx pulmonary edema?

Back 7

isosorbide dinitrate, nitroglycerin

Front 8

Liken nifedipine & verapamil to other ant-anginal meds

Back 8

Nifedipine is like Nitrates
verapamil is like beta-blockers

Front 9

what lipid lower agent is contraindicated in hyperuricemia?

Back 9

niacin

Front 10

what lipid lower agent is contraindicated in hyperglycemia?

Back 10

niacin

Front 11

What drug best lowers LDL?

Back 11

statins (HMG-CoA reductase)

hepatotoxicity
rhabdomyolysis

Front 12

What drug best raises HDL?

Back 12

Niacin

contraindicated in hyperglycemia & hyperuricemia

Front 13

What drug best lowers TGs?

Back 13

Fibrates (gemfibrozil, clofibrate, bezafibrate, fenofibrate)

upregulates LPL --> increased TG clearance

Front 14

What is digoxin used for?

Back 14

CHF (increase contractility)
A.fib (decrease AV node & SA node)

inhibits Na/K pump, binds at K spot (effects potentiated by hypokalemia)

Front 15

What does digitoxin OD look like?

Back 15

Cholinergic - nausea, vomiting, diarreha, blurry yellow vision
ECG - increased PR, decreased QT, T-wave inversion, hyperkalemia

Front 16

What exacerbates digitoxin toxicity?

Back 16

renal failure (excretion decreased)
hypokalemia
quinidine (decreases digoxin clearance, displaces from tissue binding sites)

Front 17

What is nesiritide?

Back 17

recombinant BNP
increases cGMP --> vasodilation

use for acute decompensated heart failure

Front 18

Antiarrhythmics - which class is which?!?

Back 18

Now Beating Cardiac Killing
I - Na channel blocker
II - beta blockers
III - K channel blockers
IV - Ca channel blockers

Front 19

what anti arrhythmic is contraindicated post MI?

why would you use it?

Back 19

Class IC's
-flecainide, propafenone
-not good if pt has structural abnormalities

Used for:
-V-tachs that progress to VF
-intractable SVT
-last resort in tachyarrhythmias

Front 20

Which phase of cardiac AP do class I antiarrhytmics work on?

Back 20

Phase 0 - the myocyte depolarizes less steeply

Front 21

Which class I antiarrhythmic prolongs ERP (phase 3)?

What does this put pt at risk for?

Back 21

Class IA

increased QT --> torsades de pointes

Front 22

Class IA --> ?
Class IB --> ?
Class IC --> ?

Back 22

A - primary que defender
B - let me through (next)
C - finally, props (for waiting)

Class IA --> Quinidine, Procainamide, Disopyramide
Class IB --> Lidocaine, Mexiletine, Tocainide
Class IC --> Flecainide, propafenone

Front 23

What antiarrhythmic is useful post MI?

Back 23

Class IB (lidocaine, mexiletine, tocainide)

preferentially affect ischemic or depolarized purkinje & ventricular tissue;

also helpful in digitalis induced arrhythmias

Front 24

What antiarrhytmic is useful for both atrial & ventricular arrhythmia?

Back 24

Class IA

especially good for reentrant & ectopic SVT & VT

Front 25

What works on phase 4 of the AV node?

Back 25

Class II - beta blockers (propranolol, esmolol, metoprolol, atenolol, timolol)

decrease cAMP & Ca2+ current
increase PR interval

Front 26

What works for slowing ventricular rate during a-fib & a-flutter?

Back 26

Class II - beta blockers

also good for SVT & V-tach

Front 27

Names of the class III antiarrhythmics?

Back 27

Ibutilide
Sotalol
Bretylium
Amiodarone
Dofetilide

"K IS BAD"

Front 28

What do you watch out for w/amiodarone use?

Back 28

check PFTs, LFTs, TFTs

pulmonary fibrosis
hepatotoxicity
hypo/hyper-thyroidism

Front 29

What do you use when other antiarrhthmics fail?

Back 29

Class III

increase AP duration
increase ERP
increase QT interval

Amiodarone has class I, II, III, and IV effects - alters lipid membrane

Front 30

What antiarrhytmic is used for prevention of nodal arrhythmias (eg SVT)?

Back 30

Class IV - Ca channel blockers

Verapamil
Diltiazem
(remember, Verapmil for Ventricle; nifedipine works on smooth mm not so much on heart)

Front 31

What effects do Class IV antiarrhythmics have physiologically?

Back 31

Calcium channel blockers

decreased conduction velocity
increased ERP
increased PR

Front 32

What is useful for torsades de pointes and digitoxin toxicity?

Back 32

Mg

Front 33

What is drug of choice for diagnosing / abolishing supraventricular tachycardia?

What is the MOA?

Back 33

Adenosine

increases K efflux, hyperpolarizing & decreasing Ca current

Effects are blocked by theophylline