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Diuretics and CV

HTN, Diuretics and other cardiac drugs

QuestionAnswer
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