One Liners Pharm Cardiovascular

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Inhibit angiotensin-converting enzyme (ACE)

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Ace inhibitors

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MOA of class I A (eg. Procainamide), class IB (eg. Lidocaine), and class IC (eg. Flecainide) antiarrhythmics

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Sodium channel blockers

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Captopril and enalapril (-OPRIL ending) are

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Ace inhibitors

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MOA of sildenafil (Viagra)

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Inhibits phosphodiesterase-5, enhancing effects of nitric oxide-activated increases in cGMP

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Side effect of ACE inhibitors

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Dry cough, hyperkalemia.

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SE of procainamide

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Lupus-like syndrome

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Ace inhibitors are contraindicated in

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pregnancy and with K+

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MOA of Cardiac glycosides (eg. digoxin)

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Indirectly increase intracellular calcium and cardiac contractility by inhibiting Na+/K+ ATPase

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Losartan and valsartan block

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Angiotensin receptor

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Limiting side effect of Quinidine

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Prolongs QT interval

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Angiotensin receptor blockers do NOT cause

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Dry cough

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Drugs used in the management of angina

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Aspirin, Nitrates, CCB, and Beta blockers

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Block L-type calcium channel

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Calcium channel blockers

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Other side effects of Quinidine

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Thrombocytopenic purpura, and CINCHONISM

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CCB contraindicated in CHF

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Verapamil

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Digoxin is used in

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Atrial fibrillation and CHF

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CCB with predominate effect on arteriole dilation

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Nifedipine

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Major drug interaction with Quinidine

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Increases concentration of Digoxin

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SE of CCB

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Constipation, edema, and headache

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Aspirin reduces mortality in unstable angina by

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Platelet aggregation inhibition

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Reduce heart rate, contractility, and O2 demand

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Beta-blockers

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DOC for management of acute Ventricular arrhythmias

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Amiodarone

Note: lidocaine,use to be the DOC, but lidocaine is esp used in post MI and digitalis-induced arrhythmias.

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B-blockers that are more cardioselective

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Beta-1 selective blockers

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Drugs decrease intestinal absorption of cholesterol

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Bile acid-binding resins

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Cardioselective Beta 1-blockers

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Atenolol, acebutolol, and metoprolol

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DOC for digoxin induced arrhythmias

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Phenytoin

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Beta-blockers should be used cautiously in

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Asthma (bronchospastic effects), diabetes (block signs of hypoglycemia) and peripheral vascular disease

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MOA of nitrates

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Relax vascular smooth muscle, at low doses dilate veins and at high doses dilate arterioles

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Non-selective Beta-blocker also used for migraine prophylaxis

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Propranolol

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SE of phenytoin

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Gingival hyperplasia

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SE of beta blockers

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Bradycardia, SEXUAL DYSFUNCTION, decrease in HDL, and increase in Triglycerols (TG)

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Digoxin toxicity can be precipitated by

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Hypokalemia

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Alpha 1selective blockers

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Prazosin, terazosin and doxazosin (-AZOSIN ending)

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Class of anti-arrhythmics that has a pro-arrhythmic effect (CAST trial), therefore are used as last line agents

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Class IC (flecainide, propafenone, moricizine)

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Non-selective Alpha1blockers use to treat pheochromocytoma

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Phenoxybenzamine

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Nitrate used for acute anginal attacks

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Nitroglycerin sublingual tablets

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For rebound HTN from rapid clonidine withdrawal

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Phentolamine

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Class II antiarrhythmics are

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B-blockers

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A1a-selective blocker with no effects on HTN used for BPH

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Tamsulosin (Flomax)

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Antidote for digoxin toxicity

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Digibind

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SE of alpha blockers

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Orthostatic hypotension (especially with first dose) and reflex tachycardia

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Antiarrhythmic that exhibits Class II and III properties

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Sotalol

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Presynaptic Alpha 2 agonist used in HTN, and acts centrally

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Clonidine, and methyldopa

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Nitrate used to prevent further attacks

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Oral and transdermal forms of nitroglycerin

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SE of methyldopa

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Positive Comb's test, depression

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Side effect of sotalol

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prolongs QT and PR interval

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Methyldopa is contraindicated in

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Geriatrics due to its CNS (depression) effects

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SelectiveB1 Receptor blockers that may be useful in treating patients even though they have asthma

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Acebutolol, atenolol, esmolol, metoprolol

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SE of clonidine

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Rebound HTN, sedation, dry mouth

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Used intravenously for acute arrhythmias during surgery

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Esmolol

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Direct vasodilator of arteriolar smooth muscle

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Hydralazine

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Nitrate free intervals are needed due to

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Tolerance

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SE of hydralazine

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Lupus-like syndrome

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Anti-arrhythmics that decrease mortality

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B-blockers

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Arterial vasodilator that works by opening K+ channels

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Minoxidil

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Phosphodiesterase inhibitors that increase mortality and have been found to have NO beneficial effects

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Amrinone and milrinone

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SE of minoxidil

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Hypertrichosis and hirsuitism

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MOA of class III antiarrhythmics

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Potassium channel blockers

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IV Drug used Hypertensive Crisis

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Nitroprusside

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SE of nitrates

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Postural hypotension, reflex tachycardia, hot flashes, and throbbing headache due to meningeal artery dilation

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Nitroprusside vasodilates

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Arteries and veins

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Class III antiarrhythmic that exhibits properties of all 4 classes

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Amiodarone

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Toxicity caused by nitroprusside and treatment

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Cyanide toxicity treated with sodium thiosulfate

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SE of amrinone

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Thrombocytopenia

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Specific pharmacokinetic characteristic of amiodarone

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Prolonged half-life, up to six weeks

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CCB are DOC for

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Prinzmetal's angina

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Antiarrhythmic effective in most types of arrhythmia

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Amiodarone

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Cholestyramine and colestipol are

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Bile acid-binding resins

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SE of Amiodarone

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Cardiac dysfunction, photosensitivity, skin (blue smurf syndrome), Pulmonary fibrosis, thyroid and corneal deposits

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Beta blockers are used for which type of anginal attack

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Classic

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MOA of class IV antiarrhythmics

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Calcium channel blockers

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Beta 1 agonists used in acute CHF

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Dobutamine and dopamine

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Life threatening cardiac event that prolong QT leads to

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Torsades de pointes

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Diuretics work in CHF by

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Reducing preload

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Agent to treat torsades de pointes

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Magnesium sulfate

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Combined alpha and beta blocking agents that may have application in treatment of CHF

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Labetalol and carvedilol

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Drug used supraventricular arrhythmias

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Digoxin

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Beta blockers work in CHF by

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Reducing progression of heart failure (never use in acute heart failure)

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DOC for paroxysmal supraventricular tachycardia; has high efficacy and short duration of action

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Adenosine

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Peptide drug used to treat CHF

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Nesiritide (BNP)

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Adenosine's MOA

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Activates acetylcholine sensitive K+ channels in SA and AV node

And inhibition of Ca++ current resulting in marked hyperpolarization

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Major nutritional side effect of bile acid-binding resins

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Impair absorption of fat soluble vitamin absorption (A,D,E,K)

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Anti-arrhythmic with 15 second duration of action

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Adenosine

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MOA of nesiritide

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Increasing sodium excretion and decreases arterial and venous tone

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Anti-arrhythmic with 15 second duration of action

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Adenosine

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SE of nesiritide

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Excessive hypotension and kidney failure

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Beta blockers partial agonist activity (intrinsic sympathomimetic activity) cause some bronchodilation and may have an advantage in treating patients with asthma

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Pindolol and acebutolol

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Agent used in CHF that is a selective alpha and nonselective beta blocker

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Carvedilol

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Agent used in acutely decompensated CHF resembling natriuretic peptide

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Nesiritide (Natrecor)

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MOA of lovastatin (STATIN)

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inhibits HMG COA reductase

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This beta blocker lacks local anesthetic activity (a property which decreases protective reflexes and increases the risk of corneal ulceration) and used in treating glaucoma

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Timolol

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HMG CoA reductase inhibitors are contraindicated in

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Pregnancy

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This parenteral beta blocker is a short acting (minutes)

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Esmolol

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MOA of drug or foods (grapefruit juice) that increase statin effect

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Inhibit Cytochrome P450 3A4

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This beta blocker is the longest acting

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Nadolol

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SE of HMG COA reductase inhibitors

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Rhabdomyolysis and Hepatotoxicity

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These beta blockers are less lipid soluble

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Acebutolol and atenolol

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Monitoring parameter to obtain before initiation of STATINS

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LFT's

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This beta blocker is highly lipid soluble and may account for side effects such as nightmares

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Propranolol

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Decreases liver triglycerol synthesis

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Niacin

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Clinical uses of these agents include treatment of HTN, angina, arrhythmias, chronic CHF, and selected post MI patients

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Beta blockers

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SE of niacin

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Cutaneous flush

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Toxicity of these agents include bradycardia, AV blockade, exacerbation of acute CHF; signs of hypoglycemia may be masked (tachycardia, tremor, and anxiety)

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Beta blockers

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Cutaneous flush and be reduced by pretreatment with

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Aspirin

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Fibrates (gemfibrozil) increase activity of

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Lipoprotein lipase

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Most common SE of fibrates

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Nausea

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Fibrates are contraindicated in

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Pregnancy

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Concurrent use of fibrates and statins increases risk of

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Rhabdomyolysis

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New class of drugs that works by inhibiting absorption of intestinal cholesterol and can be given concurrently with the Statins

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Ezetimibe (Zetia)