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67 Cards in this Set
- Front
- Back
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Digoxin
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Indications: cardiac glycoside; antiarrythmic
MOA: Na-ATPase inhibitor; (+) inotrope Toxicity: EKG disturbances; caution with diuretics can cause hypokalemia; SI; anorexia, N/V, blurred vision, chromatopsia, sz, gynecomastia |
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Dobutamine
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Indications: cardiogenic shock, failure, stress test
MOA: B1 agonist, selective; (+) inotrope Toxicity: not shown to improve survival |
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Inamirone
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Indications: CHF
MOA: phosphodiesterase inhibitor; (+) inotrope Toxicity: ↑[cAMP], ↑Ca2+ influx, significant vasodilating effect, acute: ↑CO; long term: ↓survival |
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Milrinone
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Indications: CHF
MOA: phosphodiesterase inhibitor Toxicity: ↑[cAMP], ↑Ca2+ influx, significant vasodilating effect, acute: ↑CO; long term: ↓survival |
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Enalapril
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Indications: HTN, CHF
MOA: ACE inhibitor Toxicity: hyperkalemia, RF, cough, teratogenic, angioedema, loss of taste,rash, neutropenia |
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Valsartan
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Indications: HTN, CHF
MOA: angiotensin inhibitor Toxicity: cough, RF, hypotension, hyperkalemia, rash, teratogenic |
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Losartan
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Indications: HTN, CHF
MOA: angiotensin inhibitor Toxicity: cough, RF, hypotension, hyperkalemia, rash, teratogenic |
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Hydralazine
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Indications: HTN
MOA: nitrate Toxicity: HA, tachycardia, angina, palpitations, NVD, rash, lupus erythematosus, dizziness, fluid retention, hypertrichosis (minoxidil); inhibited by NSAIDs |
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Isosorbide dinitrate
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Indications: HTN
MOA: nitrate, stim cGMP Toxicity: HA, dizziness, hypotension-orthostatic; mononitrate metabolite is very active |
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Amlodipine
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Indications: HTN, CAD
MOA: CA2+ blocker Toxicity: peripheral edema, HA, fatigue, dizziness, fatigue; caution w/black pts, asthamtics; gingival hyperplasia; inhibited by cimetidine |
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Minoxidil
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Indications: HTN-severe
MOA: nitrate-directly dilates peripheral vessels Toxicity: tolerance req a nitrate free period daily |
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NTG
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Indications: HTN, CHF, angina (acute), prophylaxis
MOA: nitrate, stim cGMP, b-type Toxicity: HA; nitrate tolerance |
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Nesiritide
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Indications: acute failure
MOA: natriuretic peptide Toxicity: very short T1/2, hypotension; made w/ recombinant e. coli |
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Spironolactone
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Indications: edema, HTN (hyperaldosteronism), diuretic induced hypokalemia, CHF
MOA: aldosterone antagonist; K-sparing diuretic; inhibits distal convoluted tubule aldosterone mediated Na+ reabsorption Toxicity: hyperkalemia, hypercholoremic metabolic acidosis, gynecomastia, impotence |
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Amiloride
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Indications: HTN, CHF, Li-induced polyuria
MOA: K-sparing diuretic; inhibits distal convoluted tubule aldosterone mediated Na+ reabsorption Toxicity: hyperkalemia, hyperchloremic metabolic acidosis |
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Triamterene
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Indications: peripheral edema
MOA: K-sparing; inhibit distal convoluting tubule aldosterone-induced Na+ reabsorption Toxicity: hyperkalemia, hyperchloremic metabolic acidosis, nephrolithiasis w/ indo→ARF |
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Lasix
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Indications: edema, acute plum edema, HTN, hypercalcemia, hyperkalemia, ARF, anion OD
MOA: inhibits LoH & PCT/DCT Na/Cl reabsorption; inhibit Na/K/Cl cotransport in ascend LoH Toxicity: hypokalemic metabolic alkalosis, ototoxicity, hyperuricemia, hypomagnesemia, allregic sulfonamide rxn, rash, eosinophilia, interstitial nephritis; with oat-cell carcinoma: severe dehydration, hyponatremia, hypercalcemia |
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Indapamide
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Indications: HTN, CHF-edema, diabetes insipidus, kidney stones
MOA: thiazide; inhibits distal convoluted tubule Na/Cl reabsorption; enhances Ca2+ reabsorption; inhibited by NSAIDs Toxicity: hypokalemia, hyponatremia, hyperuricemia, rash, N/V, abd px |
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HCTZ
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Indications: HTN, CHF-edema, diabetes insipidus, kidney stones
MOA: thiazide (II); inhibits distal convoluted tubule Na/Cl reabsorption; enhances Ca2+ reabsorption; inhibited by NSAIDs Toxicity: photosensitivity, hypokalemia, hypocholremia, hyponatremia, hypomagnesemia, hypercalcemia, hyperuricemia, hyperglycemia, hyperlipidemia |
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Mannitol
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Indications: Htn, edema, CHI
MOA: osmotic diuretic; elevates glomerular filtrate osmolarity Toxicity: HA, N/V, polyuria, rash |
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Acetazolamide
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Indications: glaucoma, altitude sickness, CHF, edema, epilepsy urinary alkanization
MOA: blocks bicarb reabsorption resulting in bicarb diuresis Toxicity: kidney stones, renal K+ wasting, hyperchloremic metabolic acidosis |
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Fenoldopam
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Indications: HTN
MOA: D1, a2 agonist Toxicity: HA, flushing, hypotension N/V/D, tachycardia, anxiety |
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Atenolol
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Indications: HTN, angina, post-MI
MOA: selective beta1 blocker Toxicity: CI in asthma; bradycardia, lethargy, N/D |
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Carvedilol
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Indications: CHF, HTN, post-MI
MOA: a1/2, B1/2 blocker; has antioxidant effects Toxicity: CI in asthma |
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Esmolol
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Indications:HTN, tachycardia, a-fib
MOA: B1 antagonist, class II Toxicity: CI in asthma; hypotension, N/D, somnolence; prolongs phase 4, may aggravate CHF |
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Metoprolol
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Indications: post-MI, HTN, migraine
MOA: B1 blocker, selective Toxicity: CI w/ asthma |
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Propanolol
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Indications: post-MI, HTN, migraine prophylaxis, angina, arrhythmias, hyperthyroidism, stage fright, CHF
MOA: non-selective B1 antagonist Toxicity: CI w/ asthma/COPD |
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Sotalol
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Indications: ventricular arrhythmias
MOA: prolongs 3rd phase of action potential; B1 B2 blockade Toxicity: dry mouth, sedation, sexual dysfunction |
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Clonidine
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Indications: HTN, CA px adjunct, hot flashes pre-anesthetic
MOA: a2 agonist Toxicity: dry mouth, dizziness, N/V |
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Prazosin
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Indications: HTN, BPH
MOA: a1 blocker Toxicity: dizziness, decrease ejaculation |
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Captopril
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Indications: HTN, CHF, MI
MOA: ACE inhibitors Toxicity: black box-pregnancy |
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Lovastatin
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Indications: hyperlipidemia, mixed dyslipidemia, ↑ triglycerides, CAD, cardiac event prevention
MOA: HMG-CoA Reductase Toxicity: hepatotoxicity, caution with grapefruit, teratogenic, nursing |
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Simvastatin
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Indications: hyperlipidemia, mixed dyslipidemia, ↑ triglycerides, CAD, cardiac event prevention
MOA: HMG-CoA Reductase Toxicity: hepatotoxicity, caution with grapefruit, teratogenic, nursing |
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Ezetimibe
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Indications: hyperlipidemia, mixed dyslipidemia
MOA: inibits the absorption of cholesterol across the brush border Toxicity: URI, diarrhea, myalgia |
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Gemfibrozil
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Indications: ↑triglycerides, mixed dyslipidemia, increased LPL activity
MOA: inhibits peripheral lipolysis; dec free fatty acid extraction; useful in type III hyperlipidemia Toxicity: |
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Cholestyramine
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Indications: hyperlipidemia
MOA: bile acid resin; useful in type IIA and type IIB hyperlipidemia Toxicity: GI upset/black, tarry stools |
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Niacin
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Indications: hyperlipidemia, mixed dyslipidemia, ↑triglycerides, CAD, cardiac event prevention, blocks lipolysis, reduces LDL/vLDL synthesis
MOA: vitamin; useful in type IIB and IV hyperlipidemia Toxicity: flushing, pruritus, hypotension, N/V/D |
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Quinidine
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Indications: A-fib SVT/VT
MOA: class IA; stabilizes membranes, depression action potential phase 0; non-life threatening arrhythmias prototype, slows phase 0 and phase 3 -> lengthen AP, state dependent Toxicity: SA or AV block, arrhythmogenic |
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Procainamide
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Indications: ventricular/supra arrhythmias
MOA: stabilizes membranes, depression action potential phase 0 Toxicity: proarrhythmia |
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Lidocaine
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Indications: ventricular arrhythmias, status, local anesthesia
MOA: Class IB; depresses AP phase 0; shortens phase 3 Toxicity: arrhythmogenic, some CNS |
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Flecanide
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Indications: ventricular arrhythmia prevention; refractory a-fib
MOA: Class IC-depresses action potential phase 0 Toxicity: major phase 0 slowing, arrthymogenic, may aggravate CHF |
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Amiodarone
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Indications: A-fib, hypertrophic cardiomyopathy, supraventricular arrhythmias
MOA: Class III; prolongs phase 3 action potential Toxicity: thyroid dysfxn, pulmonary fibrosis, tissue discoloration, constipation, liver toxicity toxicity: bradycardia, heart block, HF |
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Diltiazem
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Indications: A-fib, angina
MOA: Class IV; Ca2+ channel blocker Toxicity: negative inotrope- may aggrevate CHF, hypotension, constipation |
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Verapamil
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Indications: Angina, HTN, a-fib, migraine prophylaxis
MOA: Class IV; Ca2+ channel blocker Toxicity: negative inotropic- may aggravate CHF, hypotension, constipation |
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Adenosine
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Indications: PSVT, narrow complex tachycardia, wide complex tachycardia
MOA: Class V; slows AV node conduction; ↑K+ conductance and inhib cAMP-induced Ca2+ influx, directly inhib AV conduction Toxicity: flushing, SOB, chest burning, hypotension, HA, N |
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Mag Sulfate
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Indications: SZ-preeclampsia, TdP, tocolysis, ventricular arrhythmias
MOA: mech unk Toxicity: depressed reflexes, hypotension, flushing |
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B-Blockers Toxicity
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-Bronchoconstriction
-Impaired glycogenolysis -bradycardia -Depression -Fatigue -Nightmares -inhibited by NSAIDs |
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a2-Agonist Toxicity
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-Rebound HTN
-Dry mouth -Fatigue/sedation -Inhibited by TCAs -Sedation exacerbated by CNS depressants |
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Methyldopa
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Centrally acting a2-agonist
Toxicity: Anemia, hep, lupus Notes: safe in pregnancy |
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ACE Inhibitor Toxicity
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-RF
-Cough -Hyperkalemia -Angioedema -Loss of taste -Neutropenia -Rash -Teratogenic -Can elevate [lithium]; use with caution -Inhbited by NSAIDs |
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ARB Toxicity
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-Hyperkalemia
-RF -Teratogenic -p450 effects: metabolism inhibited by cimetidine (tagamet), augumented by barbs |
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Consequences of damaged endothelium
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-Loss of NO production results in decreased dilatory response
-Proliferation/migration of SMCs -Production of matrix by SMCs |
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Final stage of lesion formation...
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-Necrosis
-Calcification |
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Final event of lesion
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-Rupture
-Thrombosis |
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VariantAngina
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-aka Pinzmetal's angina
-Due to coronary vasospasm -Atherosclerosis usually present -Associated with MI/sudden death |
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Angina Pectoris TX
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-NTG/nitrates
-Ca2+ channel blockers -Beta blockers |
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Beta-Blockers
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-Decrease O2 demand
-Negative inotrope -Negative chronotrope -Increases coronary perfusion time -Reduced BP -Not for use in variant angina |
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Ca2+ Channel Blockers
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-Class 4 antiarrhythmics
-Block L-type channels and slow phase 4 depolarization -Binds to open, depolarized channels -Toxicity: negative inotropic, hypotension, arrhythmias, constipation, edema |
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CHF
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-Reduced CO
-Often due to: ischemic heart dz, HTN, valvular dysfxn, arrhythmia, viral/congenital cardiomyopathy |
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Left heart failure
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-Increased pulmonary pressure
-Pulmonary edema -Pulmonary congestion -Hypoxemia -Dyspnea (exertional, orthopnea, paroxysmal nocturnal) |
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Right Heart failure
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-Ankle edema
-dependent edema -Can precipitate left heart failure |
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Compensation vs decompensation
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-Reduction in perfusion increases sympathetic tone
-Eventually this fails and decompensation occurs |
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Reduction of Preload via...
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Diuretic
Venodilator |
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Reduction of afterload via...
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Arteriodilator
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Increase in contractility via...
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Inotropics
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Reduce energy expenditures (dec HR) via...
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B-blockers
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Conditions promoting the development of edema...
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-Increased arterial or venous pressure
-Decreased osmotic gradient, Na/H2O retention -Inadequate lymphatic drainage |
