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89 Cards in this Set
- Front
- Back
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lovostatin and atorvastatin
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HMG-CoA reductase inhibitors causing upreg of hepatic LDL receptors. Decreases: LDL (20-55), Tri (10-35)
used for high chol or LDL, atherosclerosis, prevent coronary HD AE: FDA-X, renal damage from myopathy after inhibition of p450 or use with fibric acid or niacin |
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cholestyramine
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bile acid resin binding that prevents re-uptake of bile acids, so chol excret is up 10 fold, forcing upreg of hepatic LDL receptors. Decreases LDL (10-35), but can INCREASE TRIs!! Has F=zero
give with ezetimibe and/or statin used for high LDL AE constipation, decreased absorb of fat sol vit, hypertrigly, increase coag from decreased Vit K absorb. Also messes with absorb of warfarin, statins, thiazides, aspirin, thyroxine |
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niacin
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inhibits lipolysis in adipose tissue. Decreases LDL (15-25), VLDL (15-40), Tris (30-50) and increases HDL (15-30). Only drug with large increase in HDL.
used for high VLDL/LDL, low HDL AE: stim of histamine, flushing, decreased glu tolerance, rhabdomyolysis when with statin. Contra in peptic ulcer, DM, gout, liver disease, bleeding disorder. DO NOT give with statin |
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gemfibrozil
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fibric acid that activates transcription leading to increase in lipoprotein lipase synth, so VLDL is removed. Decreases Tri (30-60), VLDL (20-30), increases HDL (5-10).
used for type 3 hyperlipoproteinemia and high Tris AE: cholelithiasis, DO NOT give with statin (chance of rhabdomyolysis) |
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ezetimibe
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localizes at small intestine brush border inhibiting chol and sterol absorp. Decrease in LDL (15-20) and Apo-B (16). Give with ezetimibe for statin
used for hyperlipid AE: diarrhea, hypersens rxn. Contra in hepatic disease |
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Amy nitrite
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decrease O2 demand by reducing preload (main action) and increase O2 delivery my relieving coronary spasm. Duration is 3-5min. Converted to NO, increasing cGMP, increases dephos MLC via activation of kinase G. Thereby stim guanylyl cyclase in platelets and decreasing availability of tissue -SH groups. Marked relaxation of large veins. Rapid appearance and disappearance of tolerance.
used for cyanide poisoning AE: throbbing headache, profound hypotension contra in hypertrophic cardiomy, constrictive pericarditis, hypotension, hyperthyroid, heptic disease |
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nitroglycerin
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decrease O2 demand by reducing preload (main action) and increase O2 delivery my relieving coronary spasm. Duration is 3-5min. Converted to NO, increasing cGMP, increases dephos MLC via activation of kinase G. Thereby stim guanylyl cyclase in platelets and decreasing availability of tissue -SH groups. Marked relaxation of large veins. Rapid appearance and disappearance of tolerance.
used for angina, exertional, variant, and unstable, heart failure, MI, and cyanide poisoning AE: throbbing headache, profound hypotension contra in hypertrophic cardiomy, constrictive pericarditis, hypotension, hyperthyroid, heptic disease |
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isosorbide mononitrate
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decrease O2 demand by reducing preload (main action) and increase O2 delivery my relieving coronary spasm. Duration is 3-5min. Converted to NO, increasing cGMP, increases dephos MLC via activation of kinase G. Thereby stim guanylyl cyclase in platelets and decreasing availability of tissue -SH groups. Marked relaxation of large veins. Rapid appearance and disappearance of tolerance.
used for angina, exertional, variant, and unstable, heart failure, MI, and cyanide poisoning AE: throbbing headache, profound hypotension contra in hypertrophic cardiomy, constrictive pericarditis, hypotension, hyperthyroid, heptic disease |
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propranolol
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decrease O2 demand by reducing contract and rate, increase myocardial perfusion due to increased dyastole
used for MI and exertional angina. NOT for variant angina AE: increased EDV, increased ejection time, withdrawl effect, bad for asthmatics and DM |
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metoprolol
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decrease O2 demand by reducing contract and rate, increase myocardial perfusion due to increased dyastole
used for MI and exertional angina. NOT for variant angina AE: increased EDV, increased ejection time, withdrawl effect, bad for asthmatics and DM |
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nifedipine and nimodipine
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blocks Ca channels in vasculature. Decreases O2 demand by decreasing afterload through decreased TPR through vasodilation.
used for extertiona and variant angina, HTN, and Raynaud's phenom AE hypotension, tachy, aggravation of myocardial ischemia via coronary steal, contra in AV block, WPW, vent tachy, systolic failure |
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verapamil and diltiazem
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blocks Ca channels in vasculature and heart. Decreases O2 demand by decreasing afterload through decreased TPR through vasodilation and increases O2 supply by relieving coronary spasms.
used for extertiona and variant angina, HTN, and Raynaud's phenom AE hypotension, tachy, aggravation of myocardial ischemia via coronary steal, contra in AV block, WPW, vent tachy, systolic failure |
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digoxin (MOA and use)
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steriod glycoside, inhibits Na/K pump, so intracellualar Na in increased, so Ca in increased as well. More Ca leads to increased contract
used for acute or chronic systolic heart failure, atrial flutter, atrial fibrilation, atrial/nodal tachy AE-many, see other card |
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digoxin (AE)
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very narrow theraputic index!! toxicity is dose dep and cumulative due to long half life (40hrs). Can lead to arrhytmias (vent tachy is lethal), N/V, CNS disturbances (digitalis delirium), green-yellow halos, hyperkalemia. Tx with Digibind, and/or lidocaine/phenytoin (for vent tachy). Contra in hyperCa, hypoK, hyperK, hypoMg.
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digoxin (contras)
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digoxin contra in hypertrophic cardiomy, diastolic dysfunction, cor pulmonale, WPW syndrome, vent arrhythmias, AV blocks, MI, myocarditis, amyloid cardiomy
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digoxin drug interactions
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amiodarone/verapamil (increase serum lvl of digoxin)
macrolides, tetracyclines, aminoglycosides (decrease bact that biotransform digoxin) spironolactone (increases serum lvl of digoxin up to 30%) |
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dopamine
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low dose is D1 receptor agonist, mid-dose is B1 agonist, high dose is a1 and d2 agonist. Therefore low dose has vasodilation in renal, middose has pos inotropic effect, high dose can cause HTN
tx of cardiac failure when poor renal perfusion contributes AE tolerance, arrhythmias, anginal pain, vasospasm |
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dobutamine
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b1-agonst. (no change in TPR/BP)
tx for acute cardiac failure with depressed left vent function |
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milrinone
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phosphodiesterase inhibitor of isozyme 3, leading to increase in cAMP. In cardiac there is increased Ca, in smooth muscle MLCK is inactivated, therefore in heart there is positive inotropic effect, peripheral effect is vasodilation
used fro acute decompensated heart failure or cardiogenic shock in pts where other therapy is not working, they are on beta blockers AE hypotension, vent arrythmias, thrombocytopenia!!! |
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diuretics for HTN name
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HCTZ, indapamide, furosemide, spironolactone
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central sypathetics for HTN name
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clonidine, methydopa
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a1 blockers for HTN name
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Prazosin
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b-blockers for HTN name
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Propranolol, Labetalol, Esmolol
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ACE inhibitors for HTN name
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Captopril, Enalapril
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AT2R blockers for HTN name
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Losartan
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Ca Channel blocker (name
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nifedipine and Nicardipine (only vascular).
verapamil and dilitazem (caridac and vascular) |
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Vasodilators for HTN (name)
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nitroprusside, hydralazine, minoxidil, diazoxide, fendolapam
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diuretics for HTN function
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initial effects are volume reduction, but longterm effects are arterolar vasodilation
in HTN, thiazides are most effective with intact renal function, often given with K sparring, and note that spirololactone is used for hyperaldosteroniam |
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central sypathetics for HTN function (Clonidine)
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a2-antagonist, reducing symp output
2nd choice for HTN due to toxicity AE drowsiness, sudden withdrawl leads to hypertensive crisis, xerostomia, postural hypotension |
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central sypathetics for HTN function (methydopa)
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converted to methylNE that acts on a2
used to treat HTN in PREG AE postural hypotension, drowsiness, sudden withdrawl leads to hypertensive crisis, xerostomia can cause hemolytic anemia |
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a1 blockers for HTN function (prazosin)
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blocks a1 leading to vasodilation in periphery
used as 2nd choice for HTN AE postural hypotension, nasal stuffiness, sexual dysfun, peripheral edema after chronic tx |
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b-blockers for HTN function (propranolol, labetalol, esmolol)
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reduces HR, contract, and renin release
used for HTN in young, supravent arryth, hypertrophic cardiac, angina, post MI, hypertensive emerg (labetalol) AE DM, asthmaics, can give postural hypotension, cardiogenic shock in pheochromocytoma |
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ACE inhibitors for HTN function (captopril, enalapril)
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block ACE, also leads to decrease in bradykinin breakdown
decrease in venous tone, slight postural hypotension 1st choice in HTN, good for MI for HF pts, CHF AE dry cough, postural hypotension, hypokalemia Conta in PREG, renal/aortic stenosis, |
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AT2R blockers for HTN function (lorsartan, valsartan)
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blocks AT1 recceptor, more complete inhibition that ACE-Is, no effect on bradykinin
used for HTN, no cough or angioedema AE contra in PREG and renal/aortic stenosis |
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nifedipine and nicardipine
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vascualar selective Ca channel blocker, limits contration by blocking L-type Ca channel, decreases TPR, slight increase in HR
used for mild/moderate HTN when angina, tachy, or broncospastic disease present AE hypotension. Contra in cardiac failure pts |
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verapamil
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vascualar and cardiac Ca channel blocker, limits contration by blocking L-type Ca channel, decreases TPR
used for mild/moderate HTN when angina, tachy, or broncospastic disease present AE hypotension. Contra in cardiac failure pts |
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diltiazem
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vascualar and cardiac Ca channel blocker, limits contration by blocking L-type Ca channel, decreases TPR
used for mild/moderate HTN when angina, tachy, or broncospastic disease present AE hypotension. Contra in cardiac failure pts |
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nitroprusside
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metabolized into NO in smooth muscle cells, strong decrease in TPR, reflex increase in HR. When RBCs metabolize, cyanide is produced
used for hypertensive emergy, NOT for chronic use AE strong postural hypotension, accumulation of cyanide (tx with amyl nitrite), thiocyanate has CNS toxicity. Contra in intracranial pressure |
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hydralazine
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unk, but thought to limit Ca release from SR, leads to arteriolar vasodilation, decrease in TPR, increase in HR, can undergo tolerance
used to HTN AE nausea, dizziness, palpitations, sweating, flushing. Can create lupoid syndrome |
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minoxidil
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opens K channels in smooth muscle, vasodilation is mostly arteriolar vasodilation, prodrug transformed by liver
rarely used for HTN due to toxicity, but is used for hair growth AE na/water retention, pericardial effusion, cardiac failure w/ LVH, hypertrichosis (hair growth), adn allergic rxns |
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diazoxide
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opens K channels in smooth muscle, vasodilation is mostly arteriolar vasodilation,
used in HTN crisis and hypoglycemia secondary to insulinoma AE na/water retention, hyperglycemia (50% of pts), hypertrichosis, sulf rxns, contra in angina |
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fenoldpoam
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D1 agonist, vasodilates the kidney
used for HTN crisis AE reflex tachy, flushing, increased intraocular pressure, so CONTRA in glaucoma |
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Acetazolamide
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carbonic anhydrase inhibit
up excreation of Na, K, HCO3 down excretion of NH4, H used for open angle glaucoma, altitude sickness, made urine alkaline AE: sulf sens, nephrolithiasis, hyperuricemia, hypokalemia contra in COPD |
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Dorzolamide
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a topical carbonic anhydrase inhibit
up excreation of Na, K, HCO3 down excretion of NH4, H used for open angle glaucoma, contra in COPD |
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hydrochlorothiazide
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blocks Na/Cl symport, decreasing diluting capacity, long term arteriolar vasodilation, is a sulfa
up excret of Na, K, H, Cl, HCO3, acidifies urine down excret of Ca (unique) and NH4 used to HTN, edema, nephrolithiasis, nephrogenic diabetes AE hpercalcemia (unique), hypokalcemia, metabolic alkalosis , impaired glu toler, postural hypotension contra in PREG, DM |
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Indapamide
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blocks Na/Cl symport, decreasing diluting capacity, long term arteriolar vasodilation, is a sulfa
up excret of Na, K, H, Cl, HCO3, acidifies urine down excret of Ca (unique) and NH4 used to HTN, edema, nephrolithiasis, nephrogenic diabetes AE hpercalcemia (unique), hypokalcemia, metabolic alkalosis , impaired glu toler, postural hypotension contra in PREG, DM |
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Furosemide
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blocks Na/K/Cl triport decreasing lumen potential, conc ability, and inhibition of macula densa, works with low GFR, urine Osm=blood Osm
up excret of Na, K, H, Ca, Cl down excret of urates, acidifies pH of blood used for pul edema, heart failure, renal failure edema, HTN with renal insufficiency AE hypocalcemia, hypokalemia, hypochloremia, post hypotension, tinnitus contra in DM pts, is a sulfa drug |
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Ethacrynic acid
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NOT a sulfa. blocks Na/K/Cl triport decreasing lumen potential, conc ability, and inhibition of macula densa, works with low GFR, urine Osm=blood Osm
up excret of Na, K, H, Ca, Cl down excret of urates, acidifies pH of blood used for pul edema, heart failure, renal failure edema, HTN with renal insufficiency AE hypocalcemia, hypokalemia, hypochloremia, post hypotension, tinnitus contra in DM pts |
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Triamterene
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Blocks Na channels directly in DCT, sparring K
up excret of Na, Cl down excret of K, H used to counteract K loss of other diuretics AE hyperkalemia |
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Amiloride
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Blocks Na channels directly in DCT, sparring K
up excret of Na, Cl down excret of K, H used to counteract Li-induced nephrogenic DI AE hyperkalemia |
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Spironolactone
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Blocks aldosterone receptors in DCT, sparring K
up excret of Na, Cl down excret of K, H used to counteract Li-induced nephrogenic DI AE hyperkalemia, sexual dysfunct, and steriod side effects (gynocomastia, menses irregularites) |
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Mannitol
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increases Osm of tubular fluid
increases excretion of everything, urine is acidic but blood is normal, can cause extracellular volume expansion, then extracellular volume reduction used for cerebral edema and reduce intraocular pressure in closed angle glaucoma AE if renal failure, excess fluid can not be removed so leads to pulm edema |
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Class 1a
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Quinidine, Procainamide
blocks activated Na and K channels |
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Class 1b
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Lidocaine, Mexiletine, Pheytoin
blocks inactivated Na channels |
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Class 1c
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Flecainide
blocks activated Na and K channels |
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Class 2
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Metoprolol, Propranolol, Esmolol
b-blocker |
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Class 3
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Amiodarone (K channel blockade and inactivated Na channels)
Ibutilde (blocks K and activates inward Na) Sotalol (blocks K and B activity) |
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Class 4
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Verapamil and Diltiazem (Ca channel blocker: activated and inactivated)
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quiidine
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Class 1a, blocks act Na and K. increase in phase 0 and prolonged repol
seldomly used for a-fib, recurrent supravent tachy AE: Torsade de pointes, cinchonism, thrombocytopenia, digitalis tox, increases QT interval!! note: some anti-muscarinic activity |
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procainamide
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Class 1a, blocks act Na and K. decrease in phase 0 and prolonged repol
used for WPW (Wolff-Parkinson-White syndrome AE: Torsade de pointes, cinchonism, digitalis tox, increases QT interval!! Lupoid syndrome in 30% |
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lidocaine
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Class 1b, blocks inact Na and a little act Na. Little change in phase 0, increased refractoriness in depolarized damaged cells
used for vent arrhythmias only!!! Can be used in digitalis induced issues Contra in A-fib, heart blocks |
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mexiletine
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Class 1b, blocks inact Na and a little act Na. Little change in phase 0, increased refractoriness in depolarized damaged cells
used for vent arrhythmias only!!! Can be used in digitalis induced issues Contra in A-fib, heart blocks |
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pheytoin
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Class 1b, blocks inact Na and a little act Na. Little change in phase 0, increased refractoriness in depolarized damaged cells
used for vent arrhythmias only!!! Can be used in digitalis induced issues Contra in A-fib, heart blocks |
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flecainide
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class 1c, blocks activated Na and K. decrease in phase 0, increase in refractoriness and repol
used for supravent arryth AE: worsens CHF, visual disturbances, dizziness, tremor |
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metoprolol
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class 2, b-blocker, decreases conduction, increased refractoriness
used for a-fib/flutter and supravent reentry arryth, hypertrophic cardiomy, prophylaxis of v-fib post MI AE |
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propranolol
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class 2, b-blocker, decreases conduction, increased refractoriness
used for a-fib/flutter and supravent reentry arryth, hypertrophic cardiomy, prophylaxis of v-fib post MI AE |
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esmolol
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class 2, b-blocker, decreases conduction, increased refractoriness
used for a-fib/flutter and supravent reentry arryth, hypertrophic cardiomy, prophylaxis of v-fib post MI AE |
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amiodarone
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class 3, K and inact (only) Na channel block,
used for most arrythmias, though has toxicity. AE: increased QT, decreased conduction, inhibits p450, 25 day half life, 70% of pts have AE: hypotension, torsade de pointes, constipation, CNS issues, pulmonary fibrosis (can be fatal), hypothyroidism, corneal microdeposits contra in Preg (FDA-D), heart blocks, long QT |
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ibutilide
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class 3, blocks K and ACTIVATES inward Na channels. Leads to prolonged AP duration.
used for a-fib and flutter AE: can lead to torsade de pointes |
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sotalol
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class 3, blocks K and b-blocking activity.
used for supra and vent arryth AE: can lead to torsade de pointes |
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verapamil
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Class 4, Ca channel blocker (both inact and act). Decrease in phase 0 slope, decrease in conduction, increase in PR int
used for supravent tachy, A-fib, flutter contra: WPW, and not effective on vent arrhythmias |
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diltiazem
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Class 4, Ca channel blocker (both inact and act). Decrease in phase 0 slope, decrease in conduction, increase in PR int
used for supravent tachy, A-fib, flutter contra: WPW, and not effective on vent arrhythmias |
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adenosine
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activates K channels, leading to hyperpol. Decreased automaticity, decreased conduction.
used for paroxysmal supravent tachy AE flushing, chest pain, hypotension |
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magnesium sulfate
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unkn MOA
used to prevent recurring torsade de pointes and treatment of digitalis-induced arrhythmias |
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absolute contra for Heart failure or Hx of MI
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Flecainide
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absolute contra for SA, AV, nodal block ; sic sinus syndrome
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Digoxin, Ca++ blockers, beta-blockers, amiodarone
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absolute contra for Wolff-Parkinson-White synd
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Digoxin, Ca++ blockers
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absolute contra for Diarrhea
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Quinidine
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absolute contra for Constipation
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Verapamil, diltiazem
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absolute contra for Arthritis
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Chronic procainamide
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absolute contra for Lung disease, thyroid disorders
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Amiodarone
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absolute contra for Asthma,peripheral vascular disease, diabetes
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beta-blockers
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absolute contra for Long QT interval
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Quinidine, procainamide, sotalol, amiodarone
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therapy for ectopic beats
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if symptomatic use beta blockers
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therapy for atrial fib/flutter/tachy
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to stop cardioversion: ibutilide
for rate control: b-blocker, Ca blocker, digoxin |
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therapy for AV nodal re-entry tachy
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acute tx: vagal maneuver, adenosine, amiodarone, procainamide
chronic tx: amiodarone, procainamide, sotalol, abaltion |
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therapy for ventricular tachy
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acute tx: amiodarone, lidocaine, procainamide
chronic : mexiletine |
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therapy for torsade de pointes
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acute tx: cardioversion, Mg sulphate, isoproterenol
chronic: Mg sulphate |
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therapy for V-fib
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acute tx: cardioversion then amiodarone, lidocaine
chronic: ICD, amiodarone, b-blocker |
