Cardio Pharmacology

Question 1

Selective a1-antagonists

Answer 1

Prazosin and other “osins”

MOA: Block a1 vasoconstriction = decrease SVR = decrease BP

USE: HTN (not 1st), BPH

AE: Orthostatic hypotension, Reflex tachycardia

Question 2

a2-agonists

Answer 2

Clonidine, methyldopa

MOA: stimulates selectively a2 receptors

USE: HTN (not 1st), methyldopa = pregnancy related HTN

AE: Sedation, Dry mouth

Question 3

B-antagonists

Answer 3

“lols”

MOA: competitive antagonists at b-receptors

USE: HTN (not 1st), angina, HF, MI, arr

AE: Brady, broncho-constriction, AVB, HF
-Caution in diabetics, can decrease peripheral circulation

Question 4

Do not stop b-antagonists _____ = may result in sudden ____

Answer 4

abruptly, cardiac death

Question 5

Selection of a b-antagonist:

Answer 5

In heart failure, only metoprolol, carvedilol, and bisoprolol have efficacy that has been established in RCTs

Question 6

Inhibitors of the RAS

Answer 6

Question 7

Direct renin inhibitors: DRIs

Answer 7

Aliskiren

MOA: comp. inhibitor of renin, decreases ang I, ang II, aldosterone

USE: HTN

AE: well tolerated, DONT use in pregnancy

Question 8

ACE inhibitors: ACEI

Answer 8

Enalapril [VASOTEC] and other “prils”

MOA: inhibit Ang I to Ang II, increase bradykinin levels

USE: HTN, HF, MI, diabetic nephropathy

AE: cough, angioedema, hyperkalemia, DONT use in pregnancy

Question 9

ARBs:

Answer 9

Losartan [COZAAR] and other “sartans”

MOA: antagonist at AT1 receptor

USE: HTN, HF, MI, diabetic nephropathy

AE: well tolerated, hyperkalemia, DONT use in pregnancy

Question 10

Ca2+ Channel Blockers

Answer 10

Amlodipine [NORVASC] and other “dipines”, Verapamil [CALAN]

MOA: blocks LTCC
-DHP: Dipines block it on VSM
-Non-DHP: Verapamil/Diltiazem block it on heart and VSM

USE: HTN (1st line), angina, some arr

AE:
-Dipines: hypotension, headache, peri edema
-Verapamil: Brady, AVB, HF, constipation

Question 11

NO Donors (PO)

Answer 11

Nitroglycerin

MOA: release NO, increase cGMP = vasodilation

USE: angina

AE: vasodilation (hypotension, headache, flushing, reflex tachycardia)
– Tolerance: regimen must include 12-14 hr nitrate-free interval daily

Question 12

NO Donors (IV)

Answer 12

Nitroprusside

USE: Hypertensive emergencies, acute HF, controlled hypotension during surgery

AE: hypotension, cyanide toxicity

Question 13

PDE5 inhibitors

Answer 13

Sildenafil [VIAGRA] and other
“afils”

MOA: inhibit PDE5, decrease cGMP, increase effects of NO

USE: ED, pulmonary HTN

AE: headache, flushing, back pain, vision loss (color), hearing loss, decrease BP if taking antihypertensive drugs
-CI if taking organic nitrates

Question 14

Cardiac glycosides

Answer 14

Digoxin

MOA: inhibit Na/K/ATPase = increase IS, also decrease AVC

USE: HF, HFrEF, arr

AE: GI (N/V/D/Anorexia), arr, low therapeutic index

Question 15

Sympathomimetic amines

Answer 15

Dobutamine

MOA: B1 agonist = increase IS

USE: acute HF (short term)

AE: tachycardia

Question 16

Aspirin

Answer 16

For prevention of MI

MOA: NSAID, inhibit COX-1 (cause inhibition of platelet aggregation)

AE:
-GI (ulcers, abd. pain, nausea, bleeding, resp. disease)

Question 17

ARNIs

Answer 17

Valsartan, Sacubitril (combo drug)

MOA: Increase BK

USE: HF

AE: hypotension, cough, kidney impairment

Question 18

Aldosterone-receptor antagonist

Answer 18

Spironolactone, Eplerenone

MOA: block MR, decrease fluid/Na retention

USE: HF, HTN, edema

AE: hyperkalemia, gynecomastia