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Diuretics and CV
HTN, Diuretics and other cardiac drugs
| Question | Answer |
|---|---|
| Inhibit angiotensin-converting enzyme (ACE) | ACE inhibitors |
| SE of ACE inhibitors | Dry cough, hyperkalemia |
| ACE inhibitors are contraindicated in | pregnancy and with K+ |
| Losartan and valsartan block | Angiotensin receptor |
| Angiotensin receptor blockers do NOT cause | Dry cough |
| Agents that block L-type calcium channel | Calcium channel blockers |
| CCB contraindicated in CHF | Verapamil |
| CCB with predominate effect on arteriole dilation | Nifedipine |
| SE of CCB | Constipation, edema, and headache |
| Agents that reduce heart rate, contractility, and O2 demand | Beta-blockers |
| B-blockers that are more cardioselective | Beta-1 selective blockers |
| Cardioselective Beta 1-blockers | Atenolol, acebutolol, and metoprolol |
| Beta-blockers should be used cautiously in | Asthma (bronchospastic effects), diabetes (block signs of hypoglycemia) and peripheral vascular disease |
| Non-selective Beta-blocker also used for migraine prophylaxis | Propranolol |
| SE of beta blockers | Bradycardia, SEXUAL DYSFUNCTION, * decrease in HDL, and increase in Triglycerols (TG) |
| Alpha 1selective blockers | Prazosin, terazosin and doxazosin (- AZOSIN ending) |
| Non-selective Alpha1blockers use to treat pheochromocytoma | Phenoxybenzamine |
| For rebound HTN from rapid clonidine withdrawal | Phentolamine |
| A1a-selective blocker with no effects on HTN used for BPH | Tamsulosin (Flomax) |
| SE of alpha blockers | Orthostatic hypotension (especially with first dose) and reflex tachycardia |
| Presynaptic Alpha 2 agonist used in HTN, and acts centrally | Clonidine, and methyldopa |
| SE of methyldopa | Positive Comb's test, depression |
| Methyldopa is contraindicated in | Geriatrics due to its CNS (depression) effects |
| SE of clonidine | Rebound HTN, sedation, dry mouth |
| Direct vasodilator of arteriolar smooth muscle | Hydralazine |
| SE of hydralazine | Lupus-like syndrome |
| Arterial vasodilator that works by opening K+ channels | Minoxidil |
| SE of minoxidil | Hypertrichosis |
| IV Drug used Hypertensive Crisis | Nitroprusside |
| Nitroprusside vasodilates | Arteries and veins |
| Toxicity caused by nitroprusside and treatment | Cyanide toxicity treated with sodium thiosulfate |
| Carbonic anhydrase inhibitor | Acetazolamide |
| Diuretic used for mountain sickness and glaucoma | Acetazolamide |
| SE of acetazolamide | Paresthesias, alkalization of the urine (which may ppt. Ca salts), hypokalemia, acidosis, and encephalopathy in patients with hepatic impairment |
| MOA of loop diuretics | inhibits Na+/K+/2Cl- cotransport |
| Site of action of loop diuretics | Thick ascending limb |
| SE of loop (furosemide) diuretics | Hyperuricemia, hypokalemia and ototoxicity |
| Aminoglycosides used with loop diuretics potentiate adverse effect | Ototoxicity |
| Loops lose and thiazide diuretics retain | Calcium |
| MOA of thiazide diuretics | Inhibit Na+/Cl- cotransport |
| Site of action of thiazide diuretics | Work at early distal convoluted tubule |
| Class of drugs that may cause cross-sensitivity with thiazide diuretics | Sulfonamides |
| SE of thiazide (HCTZ) diuretics | Hyperuricemia, hypokalemia and hyperglycemia |
| Potassium sparing diuretics inhibit | Na+/K+ exchange |
| Diuretic used to treat primary aldosteronism | Spironolactone |
| SE of spironolactone | Gynecomastia hyperkalemia, and impotence |
| Osmotic diuretic used to treat increased intracranial pressure | Mannitol |
| ADH agonist used for pituitary diabetes insipidus | Desmopressin (DDAVP) |
| Used for SIADH | Demeclocycline |
| SE of demeclocycline | Bone marrow and teeth discoloration for children under 8 years of age |
| MOA of class I A (eg. Procainamide), class IB (eg. Lidocaine), and class IC (eg. Flecainide) antiarrhythmics | Sodium channel blockers |
| SE of procainamide | Lupus-like syndrome |
| Limiting side effect of Quinidine | Prolongs QT interval |
| Other side effects of Quinidine | Thrombocytopenic purpura, and CINCHONISM |
| Major drug interaction with Quinidine | Increases concentration of Digoxin |
| DOC for management of acute ventricular arrhythmias | Amiodarone |
| DOC for digoxin induced arrhythmias | Phenytoin |
| SE of phenytoin | Gingival hyperplasia |
| Class of anti-arrhythmics that has a pro-arrhythmic effect (CAST trial), therefore are used as last line agents | Class IC (flecainide, propafenone, moricizine |
| Class II antiarrhythmics are | B-blockers |
| Antiarrhythmic that exhibits Class II and III propertie | Sotalol |
| Side effect of sotalol | prolongs QT and PR interval |
| Used intravenously for acute arrhythmias during surgery | Esmolol |
| Anti-arrhythmics that decrease mortality | B-blockers |
| MOA of class III antiarrhythmics | Potassium channel blockers |
| Class III antiarrhythmic that exhibits properties of all 4 classes | Amiodarone |
| Specific pharmacokinetic characteristic of amiodarone | Prolonged half-life, up to six weeks |
| Antiarrhythmic effective in most types of arrhythmia | Amiodarone |
| SE of Amiodarone | Cardiac dysfunction, photosensitivity, skin (blue smurf syndrome), Pulmonary fibrosis, thyroid and corneal deposits |
| MOA of class IV antiarrhythmics | Calcium channel blockers |
| Life threatening cardiac event that prolong QT leads to | Torsades de pointes |
| Agent to treat torsades de pointes | Magnesium sulfate |
| Drug used supraventricular arrhythmias | Digoxin |
| DOC for paroxysmal supraventricular tachycardia (PSVT) | Adenosine |
| Adenosine's MOA | Activattion on an inward K+ current and inhibition of Ca++ current resulting in marked hyperpolarization |
| Anti-arrhythmic with 15 second duration of action | Adenosine |
| MOA of sildenafil (Viagra) | Inhibits phosphodiesterase-5, enhancing effects of nitric oxide-activated increases in cGMP |
| Drugs used in the management of angina | Aspirin, Nitrates, CCB, and Beta blockers |
| Aspirin reduces mortality in unstable angina by | Platelet aggregation inhibition |
| MOA of nitrates | Relax vascular smooth muscle, at low * doses dilate veins and at high doses dilate arterioles |
| Nitrate used for acute anginal attacks | Nitroglycerin sublingual tablets |
| Nitrate used to prevent further attacks | Oral and transdermal forms of nitroglycerin |
| Nitrate free intervals are needed due to | Tolerance |
| SE of nitrates | Postural hypotension, reflex tachycardia, hot flashes, and throbbing headache due to meningeal artery dilation |
| CCB are DOC for | Prinzmetal's angina |
| Beta blockers are used for which type of anginal attack | Classic |
| MOA of Cardiac glycosides (eg. digoxin) | Indirectly increase intracellular calcium and cardiac contractility by inhibiting Na+/K+ ATPase |
| Digoxin is used in | Atrial fibrillation and CHF |
| Digoxin toxicity can be precipitated by | Hypokalemia |
| Antidote for digoxin toxicity | Digibind |
| Phosphodiesterase inhibitors that increase mortality and have been found to have NO beneficial effects | Amrinone and milrinone |
| SE of amrinone | Thrombocytopenia |
| Beta 1 agonists used in acute CHF | Dobutamine and dopamine |
| Diuretics work in CHF by | Reducing preload |
| Beta blockers work in CHF by | Reducing progression of heart failure (never use in acute heart failure) |
| Peptide drug used to treat CHF | Nesiritide (BNP) |
| MOA of nesiritide | Increasing sodium excretion and decreases arterial and venous tone |
| SE of nesiritide | Excessive hypotension and kidney failure |
| Agent used in CHF that is a selective alpha and nonselective beta blocker | Carvedilol |
| Agent used in acutely decompensated CHF resembling natriuretic peptide | Nesiritide (Natrecor) |
| Vitamin K dependent anticoagulant | Warfarin (PT) |
| Warfarin is contraindicated in | Pregnancy |
| Anticoagulant of choice in pregnancy | Heparin |
| Heparin (PTT) increases activity of | Antithrombin 3 |
| Route of administration of warfarin | Oral |
| Routes of administration of heparin | IV and IM (only LMW) |
| SE of both warfarin and heparin | Bleeding |
| Alternative anticoagulant used if HIT develops | Lepirudin |
| Antidote to reverse actions of warfarin | Vitamin K or fresh frozen plasma |
| Antidote to reverse actions of heparin | Protamine sulfate |
| MOA of aspirin | Irreversibly blocking cyclooxygenase |
| Agent used to treat MI and to reduce incidence of subsequent MI | Aspirin, metoprolol |
| SE of Aspirin | GI bleeding |
| Antiplatelet drug reserved for patients allergic to aspirin | Ticlopidine |
| SE for ticlopidine | Neutropenia and agranulocytosis |
| Effective in preventing TIA's | Clopidogrel and ticlopidine |
| Prevents thrombosis in patients with artificial heart valve | Dipyridamole |
| Block glycoprotein IIb/IIIa involved in platelet cross- linking | Abciximab, tirofiban and eptifibatid |
| MOA of thrombolytics | Degradation of fibrin clots and are administered IV |
| Thrombolytics are used for | Pulmonary embolism and DVT |
| Thrombolytic that can cause allergic reaction | Streptokinase |
| Thrombolytic used for acute MI and ischemic (non hemorrhagic) CVA | Tissue plasmin activator |
| SE of tPA | Cerebral hemorrhage |
| Antidote for thrombolytics | Aminocaproic acid |
| Drugs decrease intestinal absorption of cholesterol | Bile acid-binding resins |
| Cholestyramine and colestipol are | Bile acid-binding resins |
| Major nutritional side effect of bile acid-binding resins | Impair absorption of fat soluble vitamin absorption (A,D,E,K) |
| MOA of lovastatin (STATIN) | inhibits HMG COA reductase |
| HMG CoA reductase inhibitors are contraindicated in | Pregnancy |
| MOA of drug or foods (grapefruit juice) that increase statin effect | Inhibit Cytochrome P450 3A4 |
| SE of HMG COA reductase inhibitors | Rhabdomyolysis and Hepatotoxicity |
| Monitoring parameter to obtain before initiation of STATINS | LFT's |
| Decreases liver triglycerol synthesis | Niacin |
| SE of niacin | Cutaneous flush |
| Cutaneous flush and be reduced by pretreatment with | Aspirin |
| Fibrates (gemfibrozil) increase activity of | Lipoprotein lipase |
| Most common SE of fibrates | Nausea |
| Fibrates are contraindicated in | Pregnancy |
| Concurrent use of fibrates and statins increases risk of | Rhabdomyolysis |
| New class of drugs that works by inhibiting absorption of intestinal cholesterol and can be given concurrently with the Statins | Ezetimibe (Zetia) |
Created by:
tessah10
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