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110 Cards in this Set
- Front
- Back
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Abciximab
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Mech: Platelet glycoprotein (GPIIb/IIIa) receptor antagonist. Prevents platelet aggregation by preventing crosslinking via fibrinogen; prevents thrombus formation.
Tx: Unstable angina, prevent cardiovascular events in high-risk pts, support after coronary intervention. IV. S/E: Thrombocytopenia, bleeding, antigenicity, expensive. |
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Acetazolamide
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Mech: CA inhibitor, reduces reabsorption of HCO₃⁻ → urine ↑[HCO₃⁻], [K⁺], H₂O.
Tx: Metabolic alkalosis, glaucoma, mountain sickness (not HTN/CHF). S/E: Metabolic acidosis |
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Albuterol
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x
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Aldosterone
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x
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Alendronate
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Need to tx hypocalcemia first (thiazides!).
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Allopurinol
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Eliminated in kidneys, accumulate in renal impairment.
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Alpha methyldopa
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Mech: Central α₂-agonist; ↓sympathetic outflow→↓TPR→↓BP.
Tx: HTN S/E: Sedation, dry mouth, bradycardia (↓sympathetic to heart) Caution: Bradycardia+depression in elderly. |
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Alteplase
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Mech: Recombinant tPA, activates plasminogen→plasmin→↑fibrinolysis.
Tx: Multiple pulmonary emboli, acute MI, acute stroke (IV). S/E: None too specific, hypocoag state (bleeding), re-occulsion, lysis of old, needed clots. |
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Amiloride
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Mech: DCT+CD Na⁺-channel inhibitor, K⁺-sparing diuretic. Slight ↑urine [Na⁺], [Cl⁻], H₂O. ↓Urine [K⁺], [H⁺].
Tx: HTN w/thiazide/loop (for K⁺ loss), CHF. S/E: Hyperkalemia. C/I: Hyperkalemic drugs (ACEIs, ARBs, etc). |
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Aminocaproic acid
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Mech: Antithrombolytic, inhibits plasminogen activation→inhibits fibrinolysis, prevents clot dissociation.
Tx: Stop bleeding from heart surgery, trauma, placenta abruption. |
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Amiodarone
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Probably wrong answer. Class III anti-arrhythmic, but really "other". Inhibits CYP, increases [warfarin].
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Amlodipine
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Difference from Nifedipine: slow absorption, long effect (35-50 hr half-life, once-a-day dosing), less reflex tachy. Hepatic, dose less in elderly.
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Angiotensin
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x
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Antithrombin III
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Native serine protease inhibitor, anti-clotting effect (IXa/Xa) w/heparin - endothelial cells. Deficiency→venous thromboembolism, oral contraceptives+estrogen decrease levels.
ATIII+Heparin+SP→ATIII-SP + Heparin |
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Aspirin
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Mech: Antiplatelet. Irriversible COX1 inhibition, prevents thrombin/adp-activated TxA₂ synthesis. Endothelial cells can synthesize new COX1, platelets cannot. ~7d for new platelet synthesis.
Tx: Prevent re-infarction, re-stroke, MI in unstable angina, reocclusion following coronary surgery. S/E: GI ulceration/bleeding/heartburn→use omeprazole to counter, may impair surgical hemostasis, prolongs gestation (↓uterine motility). Caution: 3rd trimester, risk of bleeding in mother+fetus. |
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Atenolol
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Mech: β-blocker; ↓BP; ↓ino, ↓chrono, ↓CO (1); ↓cardiac O₂ (2); initial ↑TPR, then normalization; ↓sympathetic response (3), ↓dromo (4); ↓[renin].
Tx: (1) HTN, (2) angina, (3) CHF, (4) arrhythmia S/E: AV impairment C/I: COPD, AV impairment - verapamil, diltiazem (heart block!). |
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Bisacodyl
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Stimulant laxative.
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Black Cohosh
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Use: Menopause symptoms
Origin: NA Part: Root Active: Pill (standardized) Mech: May be "estrogenic" w/o tumor effects, anti-inflammatory. |
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Bradykinin
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x
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Captopril
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Mech: Competitive reversible inhibitor of ACE. ↓BP, ↓TPR, ↑[bradykinin], ↑[renin] (blocked by propranalol), ↓[aldosterone].
Tx: HTN, CHF (↑Na⁺/H₂O excretion, ↓preload, ↓afterload, ↓NE release, ↓hypertrophy). S/E: Dry cough, hyperkalemia, hypotension, angioneurotic edema. C/I: Pregnancy, K⁺-sparing diuretics Caution: NSAIDs attenuate effects. |
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Carvedilol
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Mech: β-blocker; ↓BP; ↓ino, ↓chrono, ↓CO (1); ↓cardiac O₂ (2); initial ↑TPR, then normalization; ↓sympathetic response (3), ↓dromo (4); ↓[renin], ↑airway resistance.
Tx: (1) HTN, (2) angina, (3) CHF, (4) arrhythmia S/E: AV impairment C/I: COPD, AV impairment - verapamil, diltiazem (heart block!). |
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Chlorthalidone
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Mech: Early DCT, inhibit NaCl c/t. ↑Urine [Na⁺], [K⁺], [Cl⁻], [H⁺], [HCO₃⁻] (metabolic alkalosis), [Mg²⁺], H₂O. ↓Urine [UA], [Ca²⁺]. Less potent than loops.
Tx: HTN, edema (CHF, etc), kidney stones, osteoporosis. S/E: Hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypotension, hypercalcemia, hyperuricemia, hyperglycemia, ECF volume depletion, metabolic alkalosis. |
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Clonidine
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Mech: Central α₂-agonist; ↓sympathetic outflow→↓TPR→↓BP.
Tx: HTN S/E: Sedation, dry mouth, bradycardia (↓sympathetic to heart) |
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Clopidogrel
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Like ticlopidine, used with aspirin or alone for similar things (MI, stroke, etc) PO. Less toxic than ticlopidine (less thrombocytopenia, neutropenia), PREFERRED. PRODRUG.
CAUTION: OMEPRAZOLE INHIBITS P450 AND REDUCES EFFECT! |
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Coumarin
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Like warfarin.
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Daunorubicin
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x
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Diazepam
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Plasma-protein bound. Can you get rid of it if you see it? Can cause falls.
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Diazoxide
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Mech: Direct vasodilator (arteries only). Opens ATP-sensitive K⁺ channels, hyperpolarizing arterial smooth muscle. ↓TPR→↓BP.
Tx: Acute HTN. S/E: Excessive vasodilation. |
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Digitalis
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Mech: Na⁺/K⁺-ATPase inhibitor, ↑Ca²⁺, ↑ino, ↓automaticity in atrial/AV (↑vagal, ↓sympathetic), ↓dromo.
Tx: CHF, atrial arrhythmias. S/E: High concentrations: sinus bradycardia (arrest), prolonged AV conduction (heart block). Ventricular arrhythmias. Vision disturbance, nausea, vomiting, diarrhea. C/I: Verapamil/diltiazem (↑[digoxin], AV block), quinidine (↑[digoxin], AV block; not for CHF together). Antitox: Discontinue digitalis, ↑[K⁺], antiarrythmics (lidocaine, phenytoin - NOT quinidine or β-blockers). Anti-digitalis Ab. Caution: Thiazides/loops (↓[K⁺] - low [K⁺] potentiates digitalis), ACEi (↑[digoxin]), β-blocker (↓dromo). Lower doses in elderly (hepatic, renal). |
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Digitoxin
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Mech: Na⁺/K⁺-ATPase inhibitor, ↑Ca²⁺, ↑ino, ↓automaticity in atrial/AV (↑vagal, ↓sympathetic), ↓dromo.
Tx: CHF, atrial arrhythmias. S/E: High concentrations: sinus bradycardia (arrest), prolonged AV conduction (heart block). Ventricular arrhythmias. Vision disturbance, nausea, vomiting, diarrhea. C/I: Verapamil/diltiazem (↑[digoxin], AV block), quinidine (↑[digoxin], AV block; not for CHF together). Antitox: Discontinue digitalis, ↑[K⁺], antiarrythmics (lidocaine, phenytoin - NOT quinidine or β-blockers). Anti-digitalis Ab. Caution: Thiazides/loops (↓[K⁺] - low [K⁺] potentiates digitalis), ACEi (↑[digoxin]), β-blocker (↓dromo). Lower doses in elderly (hepatic, renal). |
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Digoxin
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Mech: Na⁺/K⁺-ATPase inhibitor, ↑Ca²⁺, ↑ino, ↓automaticity in atrial/AV (↑vagal, ↓sympathetic), ↓dromo.
Tx: CHF, atrial arrhythmias. S/E: High concentrations: sinus bradycardia (arrest), prolonged AV conduction (heart block). Ventricular arrhythmias. Vision disturbance, nausea, vomiting, diarrhea. C/I: Verapamil/diltiazem (↑[digoxin], AV block), quinidine (↑[digoxin], AV block; not for CHF together). Antitox: Discontinue digitalis, ↑[K⁺], antiarrythmics (lidocaine, phenytoin - NOT quinidine or β-blockers). Anti-digitalis Ab. Caution: Thiazides/loops (↓[K⁺] - low [K⁺] potentiates digitalis), ACEi (↑[digoxin]), β-blocker (↓dromo). Lower doses in elderly (hepatic, renal). |
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Diltiazem
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Mech: phenylalkylamine, L-type Ca²⁺ blocker, vasodilator (arteries only)→↓Peripheral vascular resistance (less than nifedipine); ↑coronary blood flow; ↓BP; strong direct ↓inotrope (overcome sympathetic reflex), ↓chronotrope, ↓dromotrope (verapamil > diltiazem). Well absorbed, but extensive FPE. 1-2 hrs PO, minutes IV.
Tx: Angina, HTN, arrhythmia Side-Fx: CHF! (esp. IV, SA/AV problems, or beta-blockers - which can cause bradycardia or AV block). Less likely to aggravate ischemia like nifedipine. Caution: Hepatic, dose less in elderly. |
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Disopyramide
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Mech: Quinidine-like Ia, no anti-adrenergic, strong anti-muscarinic effect.
Tx: S.v./v. arrhythmias (v.tach). |
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Dobutamine
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Mech: β₁-agonist, ↑CO.
Tx: Acute CHF. S/E: Headache, nausea, angina, a.tach, v.arrythmia. |
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Docusate
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Stool softener.
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Enalapril
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Mech: Competitive reversible inhibitor of ACE. ↓BP, ↓TPR, ↑[bradykinin], ↑[renin] (blocked by propranalol), ↓[aldosterone].
Tx: HTN, CHF (↑Na⁺/H₂O excretion, ↓preload, ↓afterload, ↓NE release, ↓hypertrophy). S/E: Dry cough, hyperkalemia, hypotension, angioneurotic edema. C/I: Pregnancy, K⁺-sparing diuretics Caution: NSAIDs attenuate effects. |
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Ethacrynic acid
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Like furosemide, but no sulfa allergy and stronger ototoxicity.
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Furosemide
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Mech: Loop diuretic. ↑Urine [Na⁺], [K⁺], [Cl⁻], [H⁺], [Ca²⁺], [Mg²⁺], H₂O. ↓HCO₃⁻ reabsorption (weak CA inhibitor). Urine ↓[UA]. Given PO, IV, short half-life. Secreted into urine by organic acid transporters in PCT. Must be secreted to inhibit transporter.
Tx: Acute pulmonary edema, HTN, CHF, hypercalcemia. Edema in general. S/E: Ototoxicity (ethacrynic acid > furosemide) in age extremes, electrolyte imbalance (hypokalemia, hypocalcemia, hyponatremia, hypomagnesemia, hyperuricemia (gout!), metabolic alkalosis), volume contraction, hyperglycemia, c/i sulfa allergy, hypokalemia (digoxin), volume contraction (elderly w/o edema), aminoglycosides (ototoxicity synergism). |
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GABA
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Neurotransmitter, receptor (Cl-channel) Interacts with Kava, sedative effect
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Ginkgo biloba
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Use: Cognitive esp in elderly, tinnitus
Origin: Modern Part: Leaves Active: Pill (standardized) Mech: Cognitive, vasoprotective (vasodilator, pro-elasticity, anti-platelet, anti-edema), antioxidant |
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Ginseng
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Use: Well-being
Origin: TCM/NA Part: Root Active: Tea, pill (standardized) Mech: May involve cortisol/ACTH axis. |
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Glycerin
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Stool softener.
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Guanethidine
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NE release inhibitor, HTN use. Can cause orthostatic hypotension in elderly.
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Heparin
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Mech: ATIII cofractor to inactivate thrombin (IIa) and others like Xa. Reused, but ATIII depleted. Inhibits platelet aggregation somewhat.
Tx: Venous thrombosis, pulmonary embolism, unstable angina + acute MI, angioplasty/stent placement/cardiopulmonary bypass surgery, DIC Caution: SAFE in pregnancy (watch for low ATIII), IV or SC, use ~5d prior to oral anticoags. S/E: Thrombocytopenia (HIT) due to IgG response against platelet-heparin complexes (discontinue all heparins), bleeding (Tx IV protamine), nausea/lacrimation/headache/fever/anaphylaxis/myalgia/osteopenia/↓aldosterone. |
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Hydralazine
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Mech: Relaxes arterial smooth muscle only→↓TPR→↓BP.
Tx: HTN, CHF. S/E: Excessive vasodilation (baroreflex), tachycardia, angina, ↑[renin], edema, headache, nausea, dizziness. Adj: β₁-blockers attenuate baroreflex on heart (↓tachycardia) and kidneys (↓[renin]). |
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Hydrochlorothiazide
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Mech: Early DCT, inhibit NaCl c/t. ↑Urine [Na⁺], [K⁺], [Cl⁻], [H⁺], [HCO₃⁻] (metabolic alkalosis), [Mg²⁺], H₂O. ↓Urine [UA], [Ca²⁺]. Less potent than loops.
Tx: HTN, edema (CHF, etc), kidney stones, osteoporosis. S/E: Hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypotension, hypercalcemia, hyperuricemia, hyperglycemia, ECF volume depletion, metabolic alkalosis. |
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Ibuprofen
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NSAID.
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Ibutilide
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Mech: Class III, K⁺-blocker. ↑AP length, ↑PR interval, ↓dromo.
Tx: A.fib/a.flut, severe sustained ventricular tach. S/E: Long QT, torsades de pointes. |
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Isosorbide dinitrate
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Like nitroglycerin, but can be used for CHF.
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Israpidine
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Difference from Nifedipine: Does not increase HR (slows SA), does not inhibit AV, half-life 9 hrs (b.i.d.).
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Kava
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Use: Antianxiety, relaxation, hypnotic, intoxicant
Origin: Pacific Part: Root Active: Pill (standardized), beverage Mech: Upregulates GABA-receptors (Cl-channel) |
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Kavapyrones
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Active ingredient in Kava
6 major, 18 total oxididized/reduced forms Sedative role |
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Lepirudin
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Mech: Direct thrombin inhibitor (DTI), independent of ATIII. Recombinant leech hirudin. Binds active+substrate site of thrombin.
Tx: IV to heparin-sensitive pts (e.g., HIT or HIT-risk on cardiopulmonary bypass) Caution: Renal, may accumulate to toxic levels, too much bleeding. |
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Levalbuterol
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Elderly have stereospecific metabolism?
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Lidocaine
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Mech: Blocks active/inactive Na⁺-channels, more depolarized than not. Little effect on atria. Reduces Purkinje automaticity.
Tx: V. arrhythmias! Digitalis tox! |
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Lisinopril
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Mech: Competitive reversible inhibitor of ACE. ↓BP, ↓TPR, ↑[bradykinin], ↑[renin] (blocked by propranalol), ↓[aldosterone].
Tx: HTN, CHF (↑Na⁺/H₂O excretion, ↓preload, ↓afterload, ↓NE release, ↓hypertrophy). S/E: Dry cough, hyperkalemia, hypotension, angioneurotic edema. C/I: Pregnancy, K⁺-sparing diuretics Caution: NSAIDs attenuate effects. |
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Losartan
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Mech: Competitive AT1 receptor antagonist. ↓BP, ↓TPR, ↓[aldosterone], increased salt and water excretion, decreased plasma volume.
Tx: HTN, CHF (↑Na⁺/H₂O excretion, ↓preload, ↓afterload, ↓NE release, ↓hypertrophy). S/E: Modest hyperkalemia. C/I: Pregnancy. |
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Magnesium citrate
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Tx: Torsades de pointes (IV).
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Magnesium sulfate
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Tx: Torsades de pointes (IV).
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Mannitol
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Mech: Osmotic diuretic, in PCT+Loop. ↑Urine H₂O, some [Na⁺]. Expands ECF volume (increased plasma osmolality). Avoid in pts w/CHF, CRF.
Tx: IV only; acute-only; preop for cerebral edema, acute intraocular pressure, prophylaxis against renal dysfunction. C/I: CHF (→worsen HF), pulmonary congestion (→pulmonary edema). Tox mech: ↑ECF volume. |
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Methyldopa
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Mech: Central α₂-agonist; ↓sympathetic outflow→↓TPR→↓BP.
Tx: HTN S/E: Sedation, dry mouth, bradycardia (↓sympathetic to heart) |
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Metoprolol
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Mech: β-blocker; ↓BP; ↓ino, ↓chrono, ↓CO (1); ↓cardiac O₂ (2); initial ↑TPR, then normalization; ↓sympathetic response (3), ↓dromo (4); ↓[renin].
Tx: (1) HTN, (2) angina, (3) CHF, (4) arrhythmia S/E: AV impairment C/I: COPD, AV impairment - verapamil, diltiazem (heart block!). |
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Mexiletine
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Mech: Blocks active/inactive Na⁺-channels, more depolarized than not. Little effect on atria. Reduces Purkinje automaticity.
Tx: V. arrhythmias! Digitalis tox! |
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Milrinone
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Mech: Phosphodiesterase inhibitor→↑[cAMP]→↑[Ca²⁺], ↑ino, ↑CO, arterial+venous dilation.
Tx: Acute CHF. |
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Minoxidil
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Mech: Direct vasodilator (arteries only). Opens ATP-sensitive K⁺ channels, hyperpolarizing arterial smooth muscle. ↓TPR→↓BP.
Tx: Acute HTN. S/E: Excessive vasodilation, hypertrichosis. |
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Nadolol
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Mech: β-blocker; ↓BP; ↓ino, ↓chrono, ↓CO (1); ↓cardiac O₂ (2); initial ↑TPR, then normalization; ↓sympathetic response, ↓dromo (4); ↓[renin], ↑airway resistance.
Tx: (1) HTN, (2) angina, (4) arrhythmia S/E: AV impairment C/I: COPD, AV impairment - verapamil, diltiazem (heart block!), CHF (↓ino). |
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Nicardipine
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Difference from Nifedipine: More selective for coronary than peripheral vessels, ONLY dihydropyridine used IV for HTN emergencies, short half-life (8 hr, t.i.d.).
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Nifedipine
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Mech: dihydropyridine, L-type Ca²⁺ blocker, vasodilator (arteries only)→↓Peripheral vascular resistance; ↑coronary blood flow; ↓BP; weak direct ↓inotrope masked by strong ↑sympathetic baroreflex (↑HR, tachycardia), ↑inotrope (overall); ↑CO. Little SA/AV effect.
50% absorbed PO, 100% absorbed SL, high plasma protein binding, high FPE, inactive liver metabolites, cimetidine inhibits P450 (↑drug concentration). Tx: HTN, angina (not arrhythmia). Side-Fx: Excessive vasodilation, tachycardia, aggravate coronary ischemia (due to tachy), peripheral edema (↑[renin]), constipation (smooth muscle relax in GI). Hepatic, dose less in elderly. |
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Nitric oxide
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x
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Nitroglycerin
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Mech: NO release, like direct vasodilators (dephosphorylate myosin LC). Venodilation (↓preload), arteriodilation at high doses (↓afterload). High FPE, high dose - s/e.
Tx: Angina (stable alone) S/E: Tolerance (1 x 8 hrs max), excessive vasodilation: orthostatic hypotension, headache, dizziness, tachycardia. Adj: w/β-blocker for unstable angina. |
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Nitroprusside
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Mech: Nonselective vasodilator; metabolized to NO→↑cGMP→vasodilation (arteries+veins).
Tx: IV-only; Acute HTN, Acute CHF. S/E: Excessive vasodilation→hypotension, edema, palpitations, headache, nausea, vomiting, sweating. |
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Norepinephrine
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x
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Omeprazole
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Proton pump inhibitor. NOTE: Can be used for aspirin GI symptoms, BUT if used with ADP receptor antagonists will inhibit P450, REDUCING PRODRUG CONVERSION, decreases absorption of other drugs (less acid).
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Plasmin
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x
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Plasminogen
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x
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Prazosin
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Mech: α₁-blocker→vasodilation(arteries+veins)→↓TPR→↓BP
Tx: acute HTN, acute CHF S/E: Orthostatic hypotension, reflex tachycardia, nasal congestion, Na⁺ retention, ejaculation inhibition. C/I: Old age |
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Prednisone
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x
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Procainamide
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Like quinidine, no cinchoism.
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Propranolol
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Mech: β-blocker; ↓BP; ↓ino, ↓chrono, ↓CO (1); ↓cardiac O₂ (2); initial ↑TPR, then normalization; ↓sympathetic response, ↓dromo (4); ↓[renin], ↑airway resistance.
Tx: (1) HTN, (2) angina, (4) arrhythmia S/E: AV impairment C/I: COPD, AV impairment - verapamil, diltiazem (heart block!), CHF (↓ino). Caution: Hepatic, dose less in elderly. |
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Protamine
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Mech: Basic substance
Tx: Neutralizes acidic heparin |
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Prothrombin
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x
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Quinidine
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Mech: Open-Na⁺-channel blocker (I), K⁺-channel blocker (III), blocks Ca²⁺ at high dose (IV), inhibits β/α-adrenergics (II), inhibits mACh. In a./v.-muscle+Purkinje, ↓rise phase0, ↓AP repolarization, ↑AP length, ↓ino, ↓chrono, ↓dromo.
Tx: S.v. arrhythmias, a.flut/a.fib, v. arrhythmias. Can use with digitalis for atrial arrhythmias. C/I: DIGITALIS intoxication! CHF (↓ino) Caution: Long-QT/Torsades-de-pointes. S/E: Cinchoism (headache+dizziness+tinnitus+hearing loss+blurring vision), GI disturbance. Increases [digitalis]. |
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Renin
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x
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Saw Palmetto
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Use: BPH
Origin: NA Part: Fleshy fruit Active: Pill (standardized) Mech: Inhibits 5a-reductase (ala finasteride) and aromatase, DHT binding inhibition, anti-inflammatory in prostate. |
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Serotonin
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Released from platelets on thrombin/TxA₂ stimulus, promotes platelet aggregation.
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Sotalol
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Mech: Class III, K⁺-blocker. ↑AP length, ↑PR interval, ↓dromo.
Tx: A.fib/a.flut, severe sustained ventricular tach. S/E: Long QT, torsades de pointes. |
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Spironolactone
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Mech: Aldosterone antagonist, K⁺-sparing diuretic, DCT+CD. Slight ↑urine [Na⁺], [Cl⁻], H₂O. ↓Urine [K⁺], [H⁺].
Tx: HTN w/thiazide/loop (for K⁺ loss), CHF. S/E: Hyperkalemia. C/I: Hyperkalemic drugs (ACEIs, ARBs, etc). |
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Terazosin
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Mech: α₁-blocker→vasodilation(arteries+veins)→↓TPR→↓BP
Tx: acute HTN, acute CHF S/E: Orthostatic hypotension, reflex tachycardia, nasal congestion, Na⁺ retention, ejaculation inhibition. C/I: Old age |
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Thiazide
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Mech: Early DCT, inhibit NaCl c/t. ↑Urine [Na⁺], [K⁺], [Cl⁻], [H⁺], [HCO₃⁻] (metabolic alkalosis), [Mg²⁺], H₂O. ↓Urine [UA], [Ca²⁺]. Less potent than loops.
Tx: HTN, edema (CHF, etc), kidney stones, osteoporosis. S/E: Hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypotension, hypercalcemia, hyperuricemia, hyperglycemia, ECF volume depletion, metabolic alkalosis. |
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Thrombin
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x
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Ticlopidine
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Mech: ADP receptor antagonist, irreversibly blocks P2Y₁₂ on platelets, enhances cAMP-induced inhibition of platelet activation; prevents activation of GPIIA/IIIA complex by ADP, preventing activation+aggregation. PRODRUG, requires P450 conversion.
Tx: Reduced risk of repeated MI, stroke, other vascular problems; prevent MI in unstable angina and coronary artery occlusion following vascular surgery. S/E: Thrombocytopenia, aplastic anemia; neutropenia (rare, life-threatening), GI disturbance, liver dysfunction. |
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Timolol
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Mech: β-blocker; ↓BP; ↓ino, ↓chrono, ↓CO (1); ↓cardiac O₂ (2); initial ↑TPR, then normalization; ↓sympathetic response, ↓dromo (4); ↓[renin], ↑airway resistance.
Tx: (1) HTN, (2) angina, (4) arrhythmia S/E: AV impairment C/I: COPD, AV impairment - verapamil, diltiazem (heart block!), CHF (↓ino). |
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Tirofiban
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Mech: Platelet glycoprotein (GPIIb/IIIa) receptor antagonist. Prevents platelet aggregation by preventing crosslinking via fibrinogen; prevents thrombus formation.
Tx: Unstable angina, prevent cardiovascular events in high-risk pts, support after coronary intervention. IV. S/E: Thrombocytopenia (less than abciximab), bleeding, less effective than abciximab (more specific). |
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Triamterene
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Mech: DCT+CD Na⁺-channel inhibitor, K⁺-sparing diuretic. Slight ↑urine [Na⁺], [Cl⁻], H₂O. ↓Urine [K⁺], [H⁺].
Tx: HTN w/thiazide/loop (for K⁺ loss), CHF. S/E: Hyperkalemia. C/I: Hyperkalemic drugs (ACEIs, ARBs, etc). |
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Valsartan
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Mech: Competitive AT1 receptor antagonist. ↓BP, ↓TPR, ↓[aldosterone], increased salt and water excretion, decreased plasma volume.
Tx: HTN, CHF (↑Na⁺/H₂O excretion, ↓preload, ↓afterload, ↓NE release, ↓hypertrophy). S/E: Modest hyperkalemia. C/I: Pregnancy. |
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Verapamil
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Mech: phenylalkylamine, L-type Ca²⁺ blocker, vasodilator (arteries only)→↓Peripheral vascular resistance (less than nifedipine); ↑coronary blood flow; ↓BP; strong direct ↓inotrope (overcome sympathetic reflex), ↓chronotrope, ↓dromotrope (verapamil > diltiazem). Well absorbed, but extensive FPE. 1-2 hrs PO, minutes IV.
Tx: Angina, HTN, arrhythmia Side-Fx: CHF! (esp. IV, SA/AV problems, or beta-blockers - which can cause bradycardia or AV block). Less likely to aggravate ischemia like nifedipine. ↑[digoxin]. |
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Vincristine
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x
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Vitamin D
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Critical in pediatric and geriatric populations.
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Warfarin
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Mech: Inhibits Vit K epoxide reductase (cannot reduce Vit K from KO to KH₂). Independent of II, VII, X, C/S. HIGHLY plasma protein bound.
Tx: Oral anticoag; start w/heparin, maintain w/warfarin. Elderly sensitive, start slow. S/E: Bleeding. Necrotic lesions in days3-10 (hypercoag state) tx w/lepirudin. Dependent on CYP2C9. Reverse: d/c, give vit K, fresh-frozen plasma/IX concentrates. C/I: PREGNANCY! Teratogenic. Do not use after any cerebral or cranial hemorrhage, open wounds, liver/kidney problem. ↑Anticoag: CYP2C9 inhibition (amiodarone), liver disease or hyperthyroidism, antiplat agents (e.g., aspirin), gut-derived vit.K reduction (antibiotics!). ↓Anticoag: CYP2C9 induction (barb, pheny), cholestyramine resins, ↑vitK, diuretics (HTCZ, K-spar), genetics, hypothyroidism. |
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Treatment of Edema
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Thiazide/Loop diuretics, no other diuretics.
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Angiotensin II Effects
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↑BP (↑TPR): contract arteriolar smooth muscle (AT-1R).
Stimulate aldosterone (↓urine Na⁺/H₂O, ↑urine K⁺). ↑NE release. ↓Renin release. Mitogenic for cardiac myocytes (cardiac hypertrophy - HF!). |
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Direct vasodilator effects
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Relax smooth muscle→↓TPR→↓BP.
S/E: Baroreflex ↑sympathetic activity→↑chronotrope,↑inotrope, ↑venous tone, ↑TPR. ↑NE→↑[renin]→↑[ATII]→↑[aldosterone]→↑[Na⁺],H₂O. Cardiac/Renal: β₁ mediated Dihydropyridines+α₁ blockers have similar effects at high dose. |
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HTN Drug Combo Rules
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ACEi + Thiazide/Furosemide (different sites, good)
ACEi/ARB + K⁺-sparing diuretic (same side-effects, bad) β-blocker+verapamil/diltiazem (same side-effects, bad) |
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Digitalis combinations
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Good: Digoxin + HCTZ/Furosemide/ACEi
Bad: Digoxin + Verapamil/Propranalol Bad: Digoxin + ACEi + K⁺-sparing diuretic |
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CHF treatment
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1st: ACEi unless C/I. If C/I try ARBs or hydralazine (↓afterload)+isosorbide dinitrate (↓preload)
Unless C/I, β-blocker for mild-moderate (selective like meta or carve, not prop) Fluid retention: diuretic (loop/HCTZ). Careful with K-sparing, do not give pure combo w/ACEi/ARBs, can in larger (e.g., ACEi+HCTZ+spiro). Digoxin: if needed symptomatically. |
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Drugs that decrease intracellular [Ca²⁺]
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Class II + Class IV + Adenosine, use for atrial arrhythmias (decrease AV conduction).
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Arrhythmia tx strategy
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A.fib/a.flutter, anything s.v. - class II, IV, digoxin. Slow AV conduction, reduce v. response.
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Types of thrombus
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Arterial: Platelet-initiated (white then red), tx anti-platelet.
Venous: Fibrin-initiated from hemostasis, traps RBCs (red thrombus), causes pain, swelling, p. embolus, tx anticoag. |
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LMW Heparin
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Low molecular weight heparin. Only inhibits Xa, not IIa.
Tx: DVT (SC), abdominal/lower limb surgery. Caution: Can use weight-adjusted, less risk of HIT but NOT used if HIT seen; ~60% reversible w/protamine. |
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Falls causing agents
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Benzos, weak assoc. between IA antiarrhythmics+digoxin+diuretics.
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