Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/233

Click to flip

233 Cards in this Set

  • Front
  • Back
Secondary medication causes of hypertension
midodrine
sirolimus
cyclosporine/tacrolimus
sibutramine
hydrochlorothiazide brand
hydroDIURIL
Esidrix
chlorothiazide sodium brand
Diuril
indapamide brand
Lozol (thiazide diuretic)
metolazone brand
Zaroxolyn (thiazide related)
torsemide brand
Demedex (loop diuretic)
triamterene brand
Dyrenium
eplerenone brand
Inspra
methyldopa brand
Aldomet
terazosin brand
Hytrin
prazosin brand
Minipress
doxazosin brand
Cardura
hydralazine brand
Apresoline
propanolol brand
Inderal
labetalol brand
Normodyne
carvedilol brand
Coreg
amlodipine brand
Norvasc
felodipine brand
Plendil
nisoldipine brand
Sular
nicardipine brand
Cardene
nifedipine brand
Procardia
Adalat
verapamil brand
Calan
Isoptin
verapamil SR
Calan SR
Isoptin SR
Verelan
verapamil ER
Verelen PM
Covera HS
diltiazem CD
Cardizem CD
Dilacor XR
Tiazac
Cartia XT
losartan brand
Cozaar
valsartan brand
Diovan
irbesartin brand
Avapro
candesartan brand
Atacand
telmisartan brand
Micardis
eprosartan brand
Teveten
olmesartan brand
Benicar
benazepril brand
Lotensin
captopril brand
Capoten
enalapril brand
Vasotec
fosinopril brand
Monopril
lisinopril brand
Zestril
Prinivil
ramipril brand
Altace
quinapril brand
Accupril
trandolapril brand
Mavik
perindopril brand
Aceon
amiloride/HCTZ combination brand
Moduretic
triamterne/HCTZ combination brand
dyazide (capsules)
maxzide (tablets)
benazepril/amlodipine combination brand
Lotrel
enalapril/feldopine combination brand
Lexxel
enalapril/diltiazem combination brand
Teczem
trandolapril/verapamil combination brand
Tarka
pulmonary hypertension medication cause
fenfluramine
pulmonary hypertension treatment
CCB
epoprostenol/trepostinil/iloprost
bosentin (endothelial blocker)
sildenafil
ambrisentin (endothelial blocker?)
Shown reduced mortality in hypertensive patients
thiazide diuretics
Thiazide location
cortical diluting segment
Thiazide effect on electrolytes
dec:
K, Mg
Inc:
Ca, GLC, Lipid, Uric acid
Thiazide effect on lithium concentrations
increases
thiazide or thiazide like that has vasodilation properties
indapamide
Loop diuretics location
thick ascending loop of Henle
Loop diuretics effects on electrolytes
dec:
K, Mg, Ca
Short-acting, very ototoxic loop diuretic with no sulfonamide moeity
ethacrynic acid
longest acting loop diuretic
torsemide
IV use of loop diuretics induces _
venous vasodilation
beta-blockers with ISA
pindolol
acebutolol
penbutolol
beta blockers with alpha blocking properties
labetalol
carvedilol
IV beta blocker with short half life
esmolol
renally eliminated beta blockers
atenolol
bisoprolol
nadolol
sotalol
ACE inhibitors adverse effects
dysgeusia
first-dose hypotension
renal failure
hyperkalemia
nonproductive cough
angioedema
ACE inhibitors and ARBs effects on lithium
increase lithium conc
ACE inhibitor that may be consideration in pts w/ renal disease
fosinopril
Food effects absoprtion of what beta blockers
captopril
moexipril
Central alpha2 agonists adverse effects
dry mouth
bradycardia
CNS
Rebound hypertension
Sometimes causes positive Coomb's test
methyldopa
Drug-induced SLE
hydralazine
hirsutism and pericarditis
minoxidil
depression
reserpine
Elderly population choice
diuretic
African-americans
CCB
diuretic
CAD
beta-blocker
HF
ACE (ARB)
Diabetes
ACE(ARB)
pregnancy
central alpha2 agonists
Avoid ACE and ARB
Definition of hypertensive emergency
severe HTN (diastolic >120) w/ concurrent end-organ damage:
AMS
papilledema
proteinuria
chest pain
DOC for hypertensive emergencies
nitroprusside
drawbacks of nitroprusside
coronary steal (dilate healthy vessels as opposed to ischemic ones)
increase ICP
cyanide toxiicty
liver dz (need rhodanase enzyme to convert cyanide to thiocyanate)
DOC if patient has HTN and chest pain
nitroglycerin
labetalol
how is thiocyanate eliminated
renally
risk factors for NTP to cause cyanide toxicity
>10mcg/kg/min
liver dz
rhodanase deficiency
thiazide and loop diuretic patient information
upset GI system (may take c food)
may cause photosensitiviy
elevate GLC in DM patients
precipitate gout attack
central alpha agonist patient information
patches may take 2-3 d for onset of effect
drowsiness
don't abruptly d/c
beta blockers patient information
drowsiness, fatigue, nightmares
alter GLC conc
mask hypoglycemia
take sotalol on empty stomach
hydralazine pt information
notify of pericardial, pleural, or joint pain
CCB pt information
may cause constipation, swelling of hands or feet, slow heart rate
ACE inhibitor pt information
seek emergent attention if lips, throat, or tongue swell
may cause extreme orthostasis after initial dose
may alter taste perception
avoid high intake of foods rich in K
bosentan pt info
notify of darkened urine, light-colored stools, or abdominal discomfort
do not use if pregnant
Calculating LDL
LDL= TC - (HDL + TG/5)
TG<400
secondary medication causes of hyperlipidemia
ticlopidine
cyclosporin
atypical antipsychotics (pines)
propofol
progesterone
beta blockers
thiazide diuretics
NCEP ATP III guidelines
LDL cholesterol
a)pts w/o CAD and minimal risk
b)pts w/ CAD and modest risk
patients w/ CAD,DM, or at high risk
a)<160
b)<130
c)<100

TG<150
HDL>40
Elevated triglycerides treatment
fibrate
niacin
omega esters

primary target if TG>500
reduced HDL treatment
fibrate
niacin
bile acid sequestrants dosage administration
before meals
take w/ 120mL chiiled noncarbonated beverages
allow mixture to stand for 1-2 mins before stirring
bile acid sequestrants adverse effects
GI-diarrhea, constipation, belching, bloating
raised TG and VLDL
nicotinic acid dosage administration
75-325mg aspirin 30 min prior to niacin dose
take w/meals or after eating
avoid taking with warm beverages
nicotinic acid adverse effects
facial flushing
inrease uric acid, glucose
gastric irritation
hepatitis (SR dosage forms)
pruritis
gemfibrozil dosage administration
take 30 min prior to meals
fibric acid adverse effects
gallstones
GI
may elevate LDL
less risk for rhabdo when this is used with statins
fenofibrate
statin that should be taken with meals
lovastatin
don't have to take these statins in evening
atorvastatin
rosuvastatin

due to long half life
statin adverse effects
myalgias
GI
hepatitis
sleep disturbances
increased risk of rhabdomyolysis when used with statins
nicontini acid
fibrates
erythromycin
cyclosporin
Statins that are metabolized by CYP3A4
lovastatin
simvastatin
atorvastatin
statins that are metabolized by CYP2C9
fluvastatin
ezetimibe adverse effects
arthalgia
headache
diarrhea
infection
ezetimibe should not be used concurrently with
bile acid sequestrant
omega-3-acid esters indication
TGS>500
reduce hepatic synthesis of triglycerides
omega-3-acid esters adverse effects
GI
enhanced bleeding?
niacin/lovastatin combination brand
Advicor
cholestyramine brand
Questran
colesevelam
Welchol
colestipol
Colestid
fenofibrate
Tricor
fluvastatin
Lescol
gemfibrozil
Lopid
omega-3-acid
Omacor
0= rapid sodium influx
1= slow potassium efflux
2= slow calcium influx w/ potassium efflux
3= potassium efflux
4= sodium efflux and potassium influx
Identify phases of action potential
Class 1A
slows phase 0
prolongs APD
Class IB
slows phase 0
shortens APD
Class 1C
markedly prolongs phase 0
no effect on APD
Class II
slows phase 4 rise
Class III
prolongs APD
Class IV
slows phase 4 rise
PHenothiazines
"quinidine" like effects
TCAs
"quinidine-like effects"
phenytoin
"lidocaine-like effects)
Classes that prolong QT interval
Class 1A
Class III
Class 1A agents
quinidine
procainamide
disopyramide
Class 1B agents
lidocaine
mexiletine
Class 1C agents
flecainide
propafenone
Class II agents
beta-blockers
Class III agents
amiodarone
sotalol
dofetilide
ibutilide
Class IV agents
CCBs
quinidine adverse effects
GI (NVD)
cinchonism (tinnitus, headache, dizziness, blurred vision)
thrombocytopenia
hepatitis
quinidine sulfate and quinidine gluconate percent of base
quinidine sulfate = 83%
quinidine gluconate = 62%
quinidine drug interactions
elevates digoxin conc
enhance warfarin effect
conc elevated by amiodarone
quinidine elimination
liver
procainamidE adverse effects
drug induced SLE
neutropenia
GI
procainamide metabolite
50% metabolized to NAPA in liver (rapid production= fast acetylators) then NAPA is renally excreted
test that is commonly positive with use of procainamide
ANA
Classification of antiarrhythmic agents based on roman numerals 1-4
I. Sodium channel blockers
II. Beta blockers
III. Potassium blockers
IV. Calcium channel blockers
Can be used to reverse digitalis-induced arrhythmias
Phenytoin (1B activity)
Commonly used in arrhythmias during the acute phase of myocardial infarction
Procainamide
Quinidine and digoxin interaction
quinidine reduces clearance of digoxin and may increase the serum concentration markedly
Exacerbates cardiac toxicity of class 1 drugs
hyperkalemia
Treatment of overdose with class I agents
sodium lactate (reverse drug-induced arrhtyhmias)

pressor sympathomimetics (reverse drug-induced hypotension)
Disopyramide notes
antimuscarinic effects and may precipitate heart failure

negative inotrope
Why is lidocaine never given orally?
very high first past effect and its metabolites are potentially cardiotoxic
Useful in acute ventricular arrhtyhmias especially those involving ischemia (following MI)
lidocaine
lidocaine adverse effects
CNS stimulation (convulsions)
allergy (rash to anaphylaxis)
Approved only for refractory ventricular tachycardias that tend to progress to VF at unpredictable times, resulting in "sudden death" and for certain intractable supraventricular arrhyhtmias
flecainide
Flecainide notes
Very proarrhythmic
Negative inotrope
CNS and GI toxicity
Class II drugs (beta-blockers) mechanism of action
cardiac beta blockade and reduction in cAMP, which results in reduction of both sodium and calcium currents and suppression of abnormal pacemakers
Class III agents sotalol, ibutilide, dofetilide toxicities
proarrhthymic (sotalol, ibutilide)
torsades de pointes
antiarrhythmic agents that are renally eliminated
sotalol, dofetilide, digoxin, NAPA

flecainide, disopyramide (partially)
predominately used to convert atrial fibrillation/flutter to normal sinus rhythm
ibutilide, dofetilide
Considered the most effective antiarrhythmic for ventricular arrhythmias
amiodarone
Amiodarone half life
35-110days
Amiodarone adverse effects
pulmonary fibrosis
thyroid dysfunction
corneal deposits
optic neuritis
hepatotoxicity
blue-gray skin
photosensitivity
CNS
GI
Amiodarone drug interactions
elevates concentrations of:
warfarin
digoxin
phenytoin
quinidine
Advantage of amiodarone against other antiarrhythmics
minimal proarrhythmic effects
Amiodarone is metabolized by the
liver
Amiodarone and Warfarin interaction
empiric dosage reduction in warfarin of 30-50% when amiodarone is added
Cause state or use-dependent actions
class I and class IV
Type IV antiarrhythmic prototype
verapamil (can be given parentally)
Drug of choice for abolishing AV nodal arrhythmias
adenosine
adenosine MOA
blocks conduction in AV node by hyperpolarizing this tissue (through increased Ik) and by reducing calcium current
adenosine adverse effects
facial flushing
dyspnea
chest pressure
hypotension
short term asystole (<1min)
Potentiates adenosines effects
dipyridamole
carbamazepine
Antagonizes adenosine's effects
methylxanthines (theophylline, caffeine)
adenosine should not be used in patients with...
heart transplants
digoxin notes
renally eliminated
36h t1/2 and long distribution phase (wait 6-12 hours after administration before measuring conc)
factors enhancing digoxin tocicity
hypokalemia
hypomagnesemia
hypercalcemia
hypothyroidism
Elevated digoxin concentrations can cause...
hyperkalemia
concurrent use of these may enhance digoxin absorption
macrolide antibiotics
tetracyclines
PPIs
rapid injection of digoxin may cause...
peripheral vasoconstriction
Effect of sodium lactage in Class I overdose
increase sodium current by increasing the ionic gradient

reduce drug-receptor binding by alkalinizing the tissue
Propofenone notes
combined type 1C and b-blocker antiarrhythmic
non-linear first pass effect and non-linear elimination
metabolized to active cmpds
GI and CNS toxicity
Adenosine brand
Adenocard
amiodarone brand
Cordarone
Pacerone
disopyramide brand
Norpace
dofetilide brand
Tikosyn
esmolol brand
Brevibloc
flecainide brand
Tambocor
ibutilide brand
Corvert
lidocaine brand
Xylocaine
procainamide brand
Procanbid
sotalol brand
Betapace
Medications which may cause heart failure
-negative inotropes
CCBs
BBs
disopyramide
flecainide
propafenone
sotalol
medications which may cause heart failure
-exogenous sodium administration
sodium polystyrene sulfonate
antibiotics (PCNS, CEPH)
antacids
cough syrups
medications which may caused heart faiilure
-sodium retaining products
NSAIDs
glucocorticoids
androgens/estrogens
medications which may cause heart failure
-cardiotoxins
doxorubicin
ethanol
medications which may cause heart failure
-other
glitazones
infliximab
trastuzamab
digoxin MOA
inhibition of Na/K ATPase
reduction of calcium expulsion from cell by Na/Ca exchanger caused by increase in intracellular sodium
Oral bioavailability of furosemide
50%
demonstrated to improve survival in CHF patients
ACE-I, ARB, hydralazine/ISDN
This benefited african american patients with heart failure
Hydralazine/ISDN 75/40 TID added to ACE-I or ARB
beta blockers approved for heart failure
bisoprolol
metoprolol
carvedilol
considered for patients with decompensated CHF and in acute heart failure
dobutamine
milrinone
can help prevent dysrhythmias in patients w/ CHF w/o worsening surival
amiodarone
dofetilide
digoxin bioavailability
-IV
-Caps
-Soln
-Tabs
IV=100%
Caps=90-100%
Soln=75-85%
Tabs=70-80%
predisposing factors to digoxin toxicity
hypokalemia
hypomagnesemia
hypercalcemia
hypothyroidimsm
alkalosis
digoxin therapeutic range
1-2ng/mL
digoxin distributive phase
6-12h
renal failure and effect on digoxin
require smaller doses due to decreased Vd
drugs enhancing digoxin absorption
macrolides
PPIs
"conazoles"
ranolazine
one vial of digibind binds how much digoxin
0.5mg of digoxin
digoxin elimination
predominately renal
loading dose of digoxin in pts wihth renal insufficiency
reduced due to alterations in tissue protein binding
avoid obtaining blood to measure digoxins concentrations during this period
6-12h
half life of digoxin in patients with normal renal function
1.5days
Use IBW in obese patients when calculating loading dose
True; since digoxin distributes mostly into muscle tissue
therapeutic range considered optimal in treating CHF
0.6-1ng/mL
Administer potassium in a chronic digoxin patient or in acute overdose
chronic
digoxin toxicity
arrhtyhmias
GI/anorexia
visual disturbances
mental confusion
More predictable absorption with digoxin caps or tabs
caps
nesiritide
human brain natriuretic hormone
reduces preload and afterload
stimulates diuresis
half-life 20min
dopamine doses that exhibit renal perfusion
<5mcg/kg/min
dopamine doses that exhibit mostly vasoconstrictive activity
>15mcg/kg/min
digoxin immune Fab brand
Digibind
hydralazine/ISDN brand
BiDil
infliximab brand
Remicade
inamrinone brand
Inocor
milrinone brand
Primacor
nesiritide brand
Natrecor
dobutamine effect on CO and preload and afterload
increases CO
decreases preload and afterload
dopamine effect on CO and preload and afterload
increases CO
increases preload and afterload
hormones released by the posterior pituitary
vasopressin
oxytocin (uterine contractions, lactation)