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43 Cards in this Set
- Front
- Back
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Drugs for Essential hypertension |
1- ACEi 2- ARB 3- Ca channel blocker 4- Thiazide |
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Drugs used for hypertension with heart failure |
1- ACEi 2- ARB 3- Beta blocker (except in cardiogenic shock and decompensated heart failure) 4- Diuretics |
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Drugs for hypertension and diabetes Mellitus |
1- ACEi - protect against diabetic nephropathy 2- ARB - protect against diabetic nephropathy 3- Beta blocker (can mask hypoglycemic symptoms) 4- Thiazide diuretics |
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Drugs for Hypertension and asthma |
1- Avoid non selective beta blocker to prevent exacerbation 2- Avoid ACEi to prevent confusion of dry cough or asthma induced cough |
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Hypertensive medication in pregnancy |
Hydralazine Labatalol Methyldopa Nifedipine |
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Dihydropyridine Ca Chanel blocker amlodipine, nifedipine , nicardipine, nimodipine, clevidipine |
1- Act in vascular smooth muscle 2- Block voltage dependent L type calcium channel of cardiac and smooth muscle -decrease muscle contraction 3- Use 1- Hypertension 2- Angina 3- Raymond phenomenon Nimodipine- Subarachnoid hemorrhage (preven cerebral vasospasm) Nicardipin, Clevidipine- Hypertensive urgency and emergency 4- Side effects 1- Gingival hyperplasia 2- Peripheral edema 3- Flushing 4- Edema |
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Non dihydropyridine Ca channel blocker verapamil diltiazem |
1- Act on heart 2- Blocks voltage dependent L type Ca channel of cardiac and smooth muscle- decrease muscle contraction 3- Use 1- Hypertension 2- Angina 3- Atrial fibrillation/flutter 4- Side effects 1- Gingival hyperplasia 2- Cardiac depression 3- Constipation 4- AV block 5- Hyperprolactinemia (verapamil) |
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Hydralazine |
1- Increase cGMP- smooth muscle relaxation. Vasodilator arterioles > veins. Decrease afterload 2- Use 1- Sever hypertension (in acute state) 2- HF (with organic nitrates) 3- Safe in pregnancy (administered with beta blocker to prevent reflex tachycardia 3- Side effect- 1- Compensatory tachycardia 2- Peripheral edema 3- Angina 4- Headache 5- Drug induced lupus 4- Contraindication- CAD/angina |
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Why is Hydralazine contraindicated in coronary heart disease |
Causes reflex tachycardia, which can increase oxygen demand and precipitate/worsen acute coronary syndrome |
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Nitroprusside |
1- Short acting vasodilator 2- Increase cGMP via direct release of NO 3- Side effect- cyanide toxicity |
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Fenoldopam |
1- Dopamine D1 receptor agonist of coronary, peripheral, renal and splanchnic vasodilation 2- Decrease BP, Increase Natriuresis 3- Use postoperatively as an anti hypertensive 4- Side effect- hypotension and tachycardia |
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Nitrates nitroglycerin, isorbide dinitrate, isoebide mononitrate |
1- Vasodilation by increase NO in vascular smooth muscle- increase cGMP and smooth muscle relaxation vein>artery decrease preload 2- Use 1- Angina 2- Acute coronary syndrome 3- Pulmonary edema 3- Side effect (Monday disease )(people who work with NO have a tolerance during the week but on weekends decrease tolerance when return to work Monday have side effects) 1- Reflex tachycardia 2- Flushing 3- Headache 4- Hypotension 4- Contraindication 1- Right ventricular failure 2- Hypertrophic cardiomyopathy 3- Concurrent with PDE- 5 inhibitor
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Why might sublingual nitroglycerin cause palpitation |
Decrease preload with leads to reflex tachycardia |
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What effect do beta blockers have on ejection time, blood pressure, contractility heart rate and myocardial oxygen use |
Ejection time- increase Blood pressure - decrease Contractility- decrease Herat rate - decrease Myocardial oxygen use - decrease |
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What is the effect of nitrates in ejection time, blood pressure, contractility, heart rate and myocardial oxygen use |
Ejection time- Decrease Blood pressure- decrease Contractile- increase Heart rate- increase Myocardial oxygen use- decrease |
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What calcium channel blocker has an similar effect to beta blocker |
Verapamil |
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Which beta blocker should be used with caution in patients with angina |
Pindolol and acebutolol (partial beta agonist) due to increase intrinsic sympathomimetics activity |
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Ranolazine |
1- Inhibit the late phase of inward sodium current therapy reducing diastolic wall tension and myocardial oxygen consumption. No effect of heart rate or blood pressure 2- Use- Angina refractory to other medication 3- Side effect- 1- Constipation 2- Dizziness 3- Headache 4- Nausea |
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Sacubitril |
1- Neprilysin inhibitor - prevent degradation of natriuretic peptide, angiotensin II and substance P- increase vasodilation decrease extracellular fluid 2- Use- combine with valsartan to treat HF 3- Side effect- 1- Hypotension 2- Hypokalemia 3- Cough 4- Dizziness 5- Angioedema 4- Contraindicated ACEi due to angioedema |
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Adenosine |
1- Increase K out of cell- hyperpolarization of cell Decrease Ca channel decrease AV nodal conduction 2- Use 1- Diagnosis/ termination of certain SVT 2- Very short acting (15s) 3- Effects blunted with theophylline and caffeine 3- Side effects 1- Hypotension 2- Flushing 3- Bronchospasm 4- Chest pain 5- Sense of impeding doom
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Magnesium |
Treat torsades de pointes and digoxin toxicity |
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Ivabradine |
1- Prolong slow depolarization by selectively inhibiting funny sodium channels (phase 4 SAN) 2- Use 1- stable angina in patients who cannot take beta blockers 2- Chronic heart failure with reduced ejection fraction 3- Side effect 1- Hypertension 2- Bradycardia 3- Vision disturbance/luminous phenomena |
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HMCG CoA reductase inhibitor (statins) |
1- Inhibit the conversion of HMG-CoA to Mevalonate, cholesterol precursor Increase LDL recycling. Decrease Morbidity in CAD 2- Side effect 1- Hepatotoxicity 2- Myopathy (esp when used with fibrates and niacin) |
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Bile acid resins (cholestyramine, colestipol, colesevelance) |
1- Prevent intestinal reabsorption of bile acid. Liver uses cholesterol to make more 2- Side effect 1- GI upset 2- Decrease absorption of some drugs and fat soluble vitamin |
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Ezerimibe |
1- Prevent cholesterol reabsorption in brush border of intestine 2- Side effect 1- Diarrhea |
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Fibrate |
1- Upregulation of LDL- increase TGR clearance Activate PPAR-alpha and induce HDL synthesis 2- Side effect 1- Myopathy 2- Chloesterol gallstones (via inhibition of cholesterol 7 alpha hydroxylase) |
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Niacin |
1- Inhibit lipolysis in adipose tissue and reduce hepatic VLDL synthesis 2- Side effect 1- Flushed face (decrease NSAIDs on long term use) 2- Hyperglycemia 3- Hyperurecemia |
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PCSK9 inhibitor (Alirocumab, evolocumab) |
1- Inactivate LDL receptor degradation- increase removal of LDL form blood stream 2- Side effect. 1- Myalgia 2- Delirium 3- Dementia 4- Other neurocognitive effects |
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PCSK9 inhibitor (Alirocumab, evolocumab) |
1- Inactivate LDL receptor degradation- increase removal of LDL form blood stream 2- Side effect. 1- Myalgia 2- Delirium 3- Dementia 4- Other neurocognitive effects |
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Fish oil and marine omega 3 fatty acid |
1- Decrease FFA delivery to liver and decrease activity of TG- synthesis enzyme 2- Side effect 1- Nausea 2- Fish oil taste |
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Which lipid lowering agents should be avoided in patients with osteopenia and osteoporosis why |
Bile acid resins (eg cholestyramine, colestipol, colesevelam) because they interfere with absorption of fat vitamin |
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Which 2 classes of lipid lowering agents are most effective at lowering LDL levels and decrease morbidity in CAD |
HMG CoA reductase inhibitor PCSK9 inhibitor |
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Digoxin |
1- Inhibit Na/ K ATPase pump- indirectly inhibiting Na/Ca exchanger- Increase Intracellular Ca- positive ionotrope Stimulate vagus nerve - decrease HR 2- Use- 1- HF 2- Atrial fibrillation (decrease conduction at AV node and depression of SAN) 3- Side effects 1- Cholinergic effects (nausea, vomiting diarrhea) 2- Blurred yellow vision 3- Arrhythmia 4- AV block 5- Hyperkalemia 4- Antidotes 1- Slow normalization of k 2- Cardiac pacing 3- Anti- digoxin fab fragments 4- Mg |
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Digoxin |
1- Inhibit Na/ K ATPase pump- indirectly inhibiting Na/Ca exchanger- Increase Intracellular Ca- positive ionotrope Stimulate vagus nerve - decrease HR 2- Use- 1- HF 2- Atrial fibrillation (decrease conduction at AV node and depression of SAN) 3- Side effects 1- Cholinergic effects (nausea, vomiting diarrhea) 2- Blurred yellow vision 3- Arrhythmia 4- AV block 5- Hyperkalemia 4- Antidotes 1- Slow normalization of k 2- Cardiac pacing 3- Anti- digoxin fab fragments 4- Mg |
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Factors predisposing to digoxin toxicity |
1- Renal failure (decrease excretion) 2- Hypokalemia (K compete for Na/K ATPase pump) 3- Drugs that displace digoxin from its binding site and decrease clearance ( verapamil, Amiodarone and Quinidine) |
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What is the main reason digoxin is used to treat HF |
It increase contractility |
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Digoxin toxicity on ECG |
1- Inverted T waves 2- Increase PR interval 3- Decrease QT interval |
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Class 4 anti arrhythmiasc non dihydropridine |
Verapamil diltiazam |
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Sodium channel blocker class 1A Quinidine, Procainamide, Disopyramide |
1- Moderate Na channel blockade increase AP duration, increase effective refractory periods (ERP) in ventricular action potential increase QT interval some potassium channel blocking effects 2- Use 1- Both atrial and ventricular arrhythmia 2- Re-entry and ectopic SVT 3- Side effects 1- Cinchonism (headache, tinnitus with Quinidine) 2- Drug induced lupus - Procainamide 3- HF- disopyramide 4- Thrombocytopenia 5- Torsades de pointes |
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Sodium channel blocker class 1B lidocaine, Mexiletine |
1- Weak Na channel blockade, decrease AP duration. Preferentially affect ischemic depolarized purkinje and ventricular tissue phenytoin fall in this category 2- Use 1- Ventricular arrhythmia 2- Digitalis induced arrhythmia 3- Side effect 1- CNS stimulation/depression 2- Cardiovascular depression |
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Sodium channel blocker class 1C Flecainide, Prolafenone |
1- Strong Na channel blockade, Significantly prolongs ERP in AV mode and accessory bypass tracts No effect on ERP in purkinje and ventricular tissue 2- Use 1- SVT including atrial fibrillation 2- Last resort for refractory SVT 3- Adverse effects 1- Structural and ischemic heart disease |
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Beta blocker class 2 anti arrhythmic metaoprolol, Proponolol esmolol atenolol Timolol carvedilol |
1- 1- Decrease SAN and AVN activity by decrease cAMP and Decreasing Ca current 2- Suppress abnormal pacemaker by decreasing the slop of phase 4 3- AV node particularly sensitive - Prolonged PR interval 4- Esmolol short acting 2- Use 1- SVT 2- Atrial fibrillation/flutter 3- Side effects 1- Cardiovascular depression 2- CNS effects (Sedation and sleep alteration) 3- Exacerbation of COPD 4- Impotence 5- May mask hypoglycemia 6- Metaprolol cause Dyslipidemia 7- Proponolol cause vasospasm 4- Beta blocker (except non selective beta and alpha antagonist carvedilol and La beta lol) cause unopposed alpha agonism if given for pheochromocytoma or cocaine toxicity 5- Antidote 1- Atropine 2- Saline 3- Glucagon |
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Class 3 anti arrhythmics potassium channel blockers Amiodarone, Ibutitide, Profetilide, Sotolol |
1- Increase AP, ERP and QT 2- Use 1- Atrial fibrillation/flutter 2- Ventricular tachycardia 3- Side effects 1- Torsades de pointes Amiodarone 1- Neurolgical effects 2- Hypo/Hyperthyroidism 3- Cardiovascular effects (bradycardia, HF and heart block) 4- Pulmonary fibrosis 5- Hepatotoxicity 6- Constipation 7- Photodermatitis (corneal deposit and blue grey skin deposits) 4- Check PFT, LFT and TFT before starting Amiodarone 5- Amiodarone is lipophilic and has class 1,2,3 and 4 effects |
