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USMLE - CVD Drugs, Kaplan Pharmacology

Orthostatic hypotension a1 block or decrease in SANS tone --> venular dilation
what drugs cause SLE-like syndromes? In what type of people do they occur? Hydralazine > Procainamide > INH. In slow acetylators (can't break down/conjugate the drug).
Drugs that relax uterine smooth muscle Diazoxide (vasodilator) and Ritodrine (B2 agonist)
-olol B blockers
-prils ACEi
-sartans AT1 receptor antagonists (adrenal gland and vessels)
-dipines vascular selective Ca channel blockers
if angina and HTN, what drug should be used? B blockers and CCBs
if diabetes and HTN, what drug should be used? ACEi and AT-1 antag
if CHF and HTN, what drug should be used? ACEi and AT-1 antag
if post-MI and HTN, what drug should be used? B blockers
if BPH and HTN, what drug should be used? a blockers
if dyslipidemias and HTN, what drug should be used? a blockers, CCBs
what breaks down bradykinin? ACE
what does bradykinin do? vasodilator and increases vascular permeability
What is a common side effect of pts on ACEi's? cough caused by bradykinin because it is no longer metabolized by ACE since ACE is being inhibited
what do cardiac glycosides do for the heart? increase contractility and vagal tone (slows the reflex tachy in CHF), stimulates B1 receptors (increases HR and conduction velocity)
what is the mechanism of cardiac glycosides? binds to and inhibits Na/K ATPase --> decreases 3Na/Ca exchange --> more Ca stays in the sarcoplasmic reticulum and is available for use by actin and myosin in contraction --> increased contractility
digoxin is what type of drug? cardiac glycoside from digitalis plant
If pt has Wolff-Parkinson-White arrhythmias, what drug should you avoid if they have CHF? digitalis (wolves can't eat digitalis)
-rinone bipyridines
what is the mechanism of bipyridines? inhibit PDE --> increase cAMP --> increase contractility and vasodilation
milrinone and CHF decreases survival!
for CHF, what drugs would you use to decrease preload? DAAV: Diuretics, ACEi, AT-1 antag, Vasodilators
for CHF, what drugs would you use to decrease afterload? AAV: ACEi, AT-1 antag, Vasodilators
for CHF, what drugs would you use to increase contractility? DuBBi: Diuretics, B agnoists, bipyridines
what is DOC for treating CHF? ACEi
what does Nesiritide do? used in CHF, is recombinant ANF, relaxes veins and arteries by increasing cGMP
what is angina? sx of ischemic heart dz (not enough O2 to the heart)
name the three types of angina classic, vasospastic/Prinzmetal, unstable/crescendo
What is classic angina? angina of effort/exercise due to atherosclerosis of the coronary vessels
what is Prinzmetal/vasospastic angina? decrease in coronary blood flow that is reversible
what is unstable angina? not enough O2 due to platelet aggregation
what are the three things you want to do to treat CHF? decrease preload, decrease afterload, increase contractility
what are the two things you want to do for classic/vasospastic angina? increase O2 delivery or decrease O2 requirement
What drugs would you use to increase O2 delivery to anginal heart? decrease vasospasm with CaCB and nitrates
What drugs would you use to decrease O2 requirement in anginal heart? decrease TPR and/or decrease CO with CaCB, nitrates, and B blockers
what is contraindicated for the administration of nitrates? sildenafil (viagra)
what is methemoglobin? a form of Hb (Fe3+ instead of Fe2+) that doesn't bind O2 --> anemia and tissue hypoxia
what is the mechanism of sildenafil? inhibits PDE5 --> increases cGMP --> vasodilation --> increase blood flow to corpora cavernosa --> strengthen eretile response
Why shouldn't sildenafil be used with nitrates both are vasodilators --> excessive decrease in BP --> sudden death
what causes torsades? anything that prolongs phase III of the action potential (repolarization, K+ channels)
acetazolamide carbonic anhydrase inhibitor --> diuretic
what does acetazolamide do in terms of electrolytes? CAi's inhibit HCO3- absorption in the proximal convoluted tubule (PCT) --> decreases Na absorption in PCT --> increases the load of Na to be reabsorbed later in the tube --> hyperCl-, hyperCa+, hypoK+, acidosis (because you lose a lot of HCO3-)
furosemide loop diuretic (thick ascending limb), inhibits Na/Cl/K cotransporter
what does furosemide do in terms of electrolytes? hypoCa2+, hypoMg2+, hypoK+, alkalosis (lose H+)
hydroclorothiazide thiazide diuretic, inhibits Na/Cl cotransporter in distal convoluted tubule
what does hydrochlorothiazide do in terms of electrolytes? hypoK+, alkalosis, hypo Cl-; possible hyperCa2+ due to increased PTH levels trying to maintain blood Ca2+ levels
spironolactone K-sparing, aldosterone receptor antagonist
amiloride K-sparing, Na channel blocker in CT
triamterene K-sparing, Na channel blocker in CT
K sparing diuretics cause what? retention of K+ and H+ ions, loss of Na+
mannitol osmotic diuretic - inhibits the reabsorption of H2O in the PCT
what is cinchonism? tinnitus, hallucinations, dizzy, nausea, bothered by bright lights, diplopia
what is cinchonism caused by? quinidine (class IA antiarrhythmic) or quinine (anti malarial)
quinidine class 1A anti arrhythmic, causes cinchonism
procainamide class 1A anti arrhythmic
lidocaine class 1B anti arrhythmic
phenytoin class 1B anti arrhythmic
flecainide class 1C anti arrhythmic
propranolol B blocker, Class II anti-arrhythmic
acebutolol B blocker, Class II anti-arrhythmic
esmolol B blocker, Class II anti-arrhythmic
bretylium Class III anti-arrhythmic
amiodarone Class III anti-arrhythmic
verapamil CaCB, Class IV anti-arrhythmic
diltiazem CaCB, Class IV anti-arrhythmic
adenosine anti arrhythmic, DOC for AV node arrhythmias and PSVT's (causes membrane hyperpolarization -- K+ flows out of cell)
Created by: christinapham



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