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233 Cards in this Set
- Front
- Back
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Secondary medication causes of hypertension
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midodrine
sirolimus cyclosporine/tacrolimus sibutramine |
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hydrochlorothiazide brand
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hydroDIURIL
Esidrix |
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chlorothiazide sodium brand
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Diuril
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indapamide brand
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Lozol (thiazide diuretic)
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metolazone brand
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Zaroxolyn (thiazide related)
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torsemide brand
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Demedex (loop diuretic)
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triamterene brand
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Dyrenium
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eplerenone brand
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Inspra
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methyldopa brand
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Aldomet
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terazosin brand
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Hytrin
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prazosin brand
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Minipress
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doxazosin brand
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Cardura
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hydralazine brand
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Apresoline
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propanolol brand
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Inderal
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labetalol brand
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Normodyne
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carvedilol brand
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Coreg
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amlodipine brand
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Norvasc
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felodipine brand
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Plendil
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nisoldipine brand
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Sular
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nicardipine brand
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Cardene
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nifedipine brand
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Procardia
Adalat |
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verapamil brand
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Calan
Isoptin |
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verapamil SR
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Calan SR
Isoptin SR Verelan |
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verapamil ER
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Verelen PM
Covera HS |
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diltiazem CD
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Cardizem CD
Dilacor XR Tiazac Cartia XT |
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losartan brand
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Cozaar
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valsartan brand
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Diovan
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irbesartin brand
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Avapro
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candesartan brand
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Atacand
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telmisartan brand
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Micardis
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eprosartan brand
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Teveten
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olmesartan brand
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Benicar
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benazepril brand
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Lotensin
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captopril brand
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Capoten
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enalapril brand
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Vasotec
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fosinopril brand
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Monopril
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lisinopril brand
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Zestril
Prinivil |
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ramipril brand
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Altace
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quinapril brand
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Accupril
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trandolapril brand
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Mavik
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perindopril brand
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Aceon
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amiloride/HCTZ combination brand
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Moduretic
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triamterne/HCTZ combination brand
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dyazide (capsules)
maxzide (tablets) |
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benazepril/amlodipine combination brand
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Lotrel
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enalapril/feldopine combination brand
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Lexxel
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enalapril/diltiazem combination brand
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Teczem
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trandolapril/verapamil combination brand
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Tarka
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pulmonary hypertension medication cause
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fenfluramine
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pulmonary hypertension treatment
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CCB
epoprostenol/trepostinil/iloprost bosentin (endothelial blocker) sildenafil ambrisentin (endothelial blocker?) |
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Shown reduced mortality in hypertensive patients
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thiazide diuretics
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Thiazide location
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cortical diluting segment
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Thiazide effect on electrolytes
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dec:
K, Mg Inc: Ca, GLC, Lipid, Uric acid |
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Thiazide effect on lithium concentrations
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increases
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thiazide or thiazide like that has vasodilation properties
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indapamide
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Loop diuretics location
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thick ascending loop of Henle
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Loop diuretics effects on electrolytes
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dec:
K, Mg, Ca |
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Short-acting, very ototoxic loop diuretic with no sulfonamide moeity
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ethacrynic acid
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longest acting loop diuretic
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torsemide
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IV use of loop diuretics induces _
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venous vasodilation
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beta-blockers with ISA
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pindolol
acebutolol penbutolol |
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beta blockers with alpha blocking properties
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labetalol
carvedilol |
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IV beta blocker with short half life
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esmolol
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renally eliminated beta blockers
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atenolol
bisoprolol nadolol sotalol |
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ACE inhibitors adverse effects
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dysgeusia
first-dose hypotension renal failure hyperkalemia nonproductive cough angioedema |
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ACE inhibitors and ARBs effects on lithium
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increase lithium conc
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ACE inhibitor that may be consideration in pts w/ renal disease
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fosinopril
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Food effects absoprtion of what beta blockers
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captopril
moexipril |
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Central alpha2 agonists adverse effects
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dry mouth
bradycardia CNS Rebound hypertension |
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Sometimes causes positive Coomb's test
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methyldopa
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Drug-induced SLE
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hydralazine
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hirsutism and pericarditis
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minoxidil
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depression
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reserpine
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Elderly population choice
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diuretic
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African-americans
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CCB
diuretic |
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CAD
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beta-blocker
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HF
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ACE (ARB)
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Diabetes
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ACE(ARB)
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pregnancy
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central alpha2 agonists
Avoid ACE and ARB |
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Definition of hypertensive emergency
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severe HTN (diastolic >120) w/ concurrent end-organ damage:
AMS papilledema proteinuria chest pain |
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DOC for hypertensive emergencies
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nitroprusside
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drawbacks of nitroprusside
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coronary steal (dilate healthy vessels as opposed to ischemic ones)
increase ICP cyanide toxiicty liver dz (need rhodanase enzyme to convert cyanide to thiocyanate) |
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DOC if patient has HTN and chest pain
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nitroglycerin
labetalol |
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how is thiocyanate eliminated
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renally
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risk factors for NTP to cause cyanide toxicity
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>10mcg/kg/min
liver dz rhodanase deficiency |
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thiazide and loop diuretic patient information
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upset GI system (may take c food)
may cause photosensitiviy elevate GLC in DM patients precipitate gout attack |
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central alpha agonist patient information
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patches may take 2-3 d for onset of effect
drowsiness don't abruptly d/c |
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beta blockers patient information
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drowsiness, fatigue, nightmares
alter GLC conc mask hypoglycemia take sotalol on empty stomach |
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hydralazine pt information
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notify of pericardial, pleural, or joint pain
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CCB pt information
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may cause constipation, swelling of hands or feet, slow heart rate
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ACE inhibitor pt information
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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 |
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bosentan pt info
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notify of darkened urine, light-colored stools, or abdominal discomfort
do not use if pregnant |
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Calculating LDL
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LDL= TC - (HDL + TG/5)
TG<400 |
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secondary medication causes of hyperlipidemia
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ticlopidine
cyclosporin atypical antipsychotics (pines) propofol progesterone beta blockers thiazide diuretics |
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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 |
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Elevated triglycerides treatment
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fibrate
niacin omega esters primary target if TG>500 |
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reduced HDL treatment
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fibrate
niacin |
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bile acid sequestrants dosage administration
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before meals
take w/ 120mL chiiled noncarbonated beverages allow mixture to stand for 1-2 mins before stirring |
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bile acid sequestrants adverse effects
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GI-diarrhea, constipation, belching, bloating
raised TG and VLDL |
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nicotinic acid dosage administration
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75-325mg aspirin 30 min prior to niacin dose
take w/meals or after eating avoid taking with warm beverages |
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nicotinic acid adverse effects
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facial flushing
inrease uric acid, glucose gastric irritation hepatitis (SR dosage forms) pruritis |
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gemfibrozil dosage administration
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take 30 min prior to meals
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fibric acid adverse effects
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gallstones
GI may elevate LDL |
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less risk for rhabdo when this is used with statins
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fenofibrate
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statin that should be taken with meals
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lovastatin
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don't have to take these statins in evening
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atorvastatin
rosuvastatin due to long half life |
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statin adverse effects
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myalgias
GI hepatitis sleep disturbances |
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increased risk of rhabdomyolysis when used with statins
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nicontini acid
fibrates erythromycin cyclosporin |
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Statins that are metabolized by CYP3A4
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lovastatin
simvastatin atorvastatin |
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statins that are metabolized by CYP2C9
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fluvastatin
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ezetimibe adverse effects
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arthalgia
headache diarrhea infection |
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ezetimibe should not be used concurrently with
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bile acid sequestrant
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omega-3-acid esters indication
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TGS>500
reduce hepatic synthesis of triglycerides |
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omega-3-acid esters adverse effects
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GI
enhanced bleeding? |
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niacin/lovastatin combination brand
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Advicor
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cholestyramine brand
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Questran
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colesevelam
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Welchol
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colestipol
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Colestid
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fenofibrate
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Tricor
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fluvastatin
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Lescol
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gemfibrozil
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Lopid
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omega-3-acid
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Omacor
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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
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Class 1A
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slows phase 0
prolongs APD |
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Class IB
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slows phase 0
shortens APD |
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Class 1C
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markedly prolongs phase 0
no effect on APD |
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Class II
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slows phase 4 rise
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Class III
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prolongs APD
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Class IV
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slows phase 4 rise
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PHenothiazines
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"quinidine" like effects
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TCAs
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"quinidine-like effects"
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phenytoin
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"lidocaine-like effects)
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Classes that prolong QT interval
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Class 1A
Class III |
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Class 1A agents
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quinidine
procainamide disopyramide |
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Class 1B agents
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lidocaine
mexiletine |
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Class 1C agents
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flecainide
propafenone |
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Class II agents
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beta-blockers
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Class III agents
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amiodarone
sotalol dofetilide ibutilide |
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Class IV agents
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CCBs
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quinidine adverse effects
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GI (NVD)
cinchonism (tinnitus, headache, dizziness, blurred vision) thrombocytopenia hepatitis |
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quinidine sulfate and quinidine gluconate percent of base
|
quinidine sulfate = 83%
quinidine gluconate = 62% |
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quinidine drug interactions
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elevates digoxin conc
enhance warfarin effect conc elevated by amiodarone |
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quinidine elimination
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liver
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procainamidE adverse effects
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drug induced SLE
neutropenia GI |
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procainamide metabolite
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50% metabolized to NAPA in liver (rapid production= fast acetylators) then NAPA is renally excreted
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test that is commonly positive with use of procainamide
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ANA
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Classification of antiarrhythmic agents based on roman numerals 1-4
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I. Sodium channel blockers
II. Beta blockers III. Potassium blockers IV. Calcium channel blockers |
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Can be used to reverse digitalis-induced arrhythmias
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Phenytoin (1B activity)
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Commonly used in arrhythmias during the acute phase of myocardial infarction
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Procainamide
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Quinidine and digoxin interaction
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quinidine reduces clearance of digoxin and may increase the serum concentration markedly
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Exacerbates cardiac toxicity of class 1 drugs
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hyperkalemia
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Treatment of overdose with class I agents
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sodium lactate (reverse drug-induced arrhtyhmias)
pressor sympathomimetics (reverse drug-induced hypotension) |
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Disopyramide notes
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antimuscarinic effects and may precipitate heart failure
negative inotrope |
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Why is lidocaine never given orally?
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very high first past effect and its metabolites are potentially cardiotoxic
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Useful in acute ventricular arrhtyhmias especially those involving ischemia (following MI)
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lidocaine
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lidocaine adverse effects
|
CNS stimulation (convulsions)
allergy (rash to anaphylaxis) |
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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
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flecainide
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Flecainide notes
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Very proarrhythmic
Negative inotrope CNS and GI toxicity |
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Class II drugs (beta-blockers) mechanism of action
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cardiac beta blockade and reduction in cAMP, which results in reduction of both sodium and calcium currents and suppression of abnormal pacemakers
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Class III agents sotalol, ibutilide, dofetilide toxicities
|
proarrhthymic (sotalol, ibutilide)
torsades de pointes |
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antiarrhythmic agents that are renally eliminated
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sotalol, dofetilide, digoxin, NAPA
flecainide, disopyramide (partially) |
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predominately used to convert atrial fibrillation/flutter to normal sinus rhythm
|
ibutilide, dofetilide
|
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Considered the most effective antiarrhythmic for ventricular arrhythmias
|
amiodarone
|
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Amiodarone half life
|
35-110days
|
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Amiodarone adverse effects
|
pulmonary fibrosis
thyroid dysfunction corneal deposits optic neuritis hepatotoxicity blue-gray skin photosensitivity CNS GI |
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Amiodarone drug interactions
|
elevates concentrations of:
warfarin digoxin phenytoin quinidine |
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Advantage of amiodarone against other antiarrhythmics
|
minimal proarrhythmic effects
|
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Amiodarone is metabolized by the
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liver
|
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Amiodarone and Warfarin interaction
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empiric dosage reduction in warfarin of 30-50% when amiodarone is added
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Cause state or use-dependent actions
|
class I and class IV
|
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Type IV antiarrhythmic prototype
|
verapamil (can be given parentally)
|
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Drug of choice for abolishing AV nodal arrhythmias
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adenosine
|
|
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adenosine MOA
|
blocks conduction in AV node by hyperpolarizing this tissue (through increased Ik) and by reducing calcium current
|
|
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adenosine adverse effects
|
facial flushing
dyspnea chest pressure hypotension short term asystole (<1min) |
|
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Potentiates adenosines effects
|
dipyridamole
carbamazepine |
|
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Antagonizes adenosine's effects
|
methylxanthines (theophylline, caffeine)
|
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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) |
|
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factors enhancing digoxin tocicity
|
hypokalemia
hypomagnesemia hypercalcemia hypothyroidism |
|
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Elevated digoxin concentrations can cause...
|
hyperkalemia
|
|
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concurrent use of these may enhance digoxin absorption
|
macrolide antibiotics
tetracyclines PPIs |
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rapid injection of digoxin may cause...
|
peripheral vasoconstriction
|
|
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Effect of sodium lactage in Class I overdose
|
increase sodium current by increasing the ionic gradient
reduce drug-receptor binding by alkalinizing the tissue |
|
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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 |
|
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Adenosine brand
|
Adenocard
|
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amiodarone brand
|
Cordarone
Pacerone |
|
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disopyramide brand
|
Norpace
|
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dofetilide brand
|
Tikosyn
|
|
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esmolol brand
|
Brevibloc
|
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flecainide brand
|
Tambocor
|
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ibutilide brand
|
Corvert
|
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lidocaine brand
|
Xylocaine
|
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procainamide brand
|
Procanbid
|
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sotalol brand
|
Betapace
|
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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) |
