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Cardiac Flashcards

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1
Q

What is a strong contraindication for Ca channel blockers?

A

Heart failure

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2
Q

MOA metoprolol

A

Cardio selective beta blocker (b1)

Decreases HR, contractility, and conduction

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3
Q

MOA propanolol

A

Non cardio selective beta blocker

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4
Q

MOA sotalol

A

Non cardio selective beta blocker

Also inhibits potassium channels, working as anti-arrythmic

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5
Q

MOA carvedilol and labetalol

A

Alpha and beta blocker —> potent vasodilation

Decrease resistance, preload and afterload

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6
Q

Which beta blocker can be used for arrythmias?

A

Sotalol

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7
Q

Which beta blockers are used for cardiac ischemia or heart failure?

A

Cardio selective —> metoprolol

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8
Q

Which beta blocker can be used for migraine, tremors, tirotoxicosis, and portal hypertension?

A

Propanolol

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9
Q

Which beta blocker can be used in pregnancy?

A

Labetalol
Carvedilol

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10
Q

When are partial symphathomimetic agonists recommended?

A

Metabolic syndrome (alprenolol)

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11
Q

What are 3 strong contraindications of beta blockers?

A
  • Bradicardia
  • AV block
  • ASTHMA, COPD, COVID, etc.
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12
Q

Which beta blocker can be used in hypertensive emergencies?

A

IV labetalol

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13
Q

Main side effects of cardio selective beta blockers? (3)

A
  • Bradycardia
  • Bradyarrythmia
  • Torsades de pointes (vent. Taquiarrythmia)
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14
Q

Main side effects of NON cardio selective beta blockers?

A
  • Bronchoconstriction
  • Vasoconstriction
  • Hyper or hypo glycemia
  • Bradycardia
  • Higher triglycerides
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15
Q

MOA calcium channel blockers

A

Block type L channels in myocardium and smooth muscle

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16
Q

Types of Ca channel blockers and the difference

A

Dyhydropyridines —> nefidipine, amlodipine
*Act on all smooth muscle = vasodilation

Non-dyhydropyridines —> verapamil, diltiazem
*Act on cardiac muscle = crono, ino, and dromo negative

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17
Q

If a person has a fall risk, which is the antihypertensive category that is most important to AVOID?

A

Ca channel blockers

Risk of orthostatic hypotension

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18
Q

Ca channel blockers (Dihydropyridine) main indications

A
  • Hypertension, including emergency
  • Angina (long acting)
  • Raynaud phenomenon
  • Subarachnoid hemorrhage
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19
Q

Ca channel blockers (non-dihydropyridine) main indications(5)

A
  • Hypertension
  • Supraventricular tachyarrythmia
  • Angina
  • Hypertrophic cardiomyopathy
  • Migraine (verapamil)
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20
Q

What is the strongest contraindication for Ca channel blockers?

A

Acute coronary syndrome

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21
Q

If a patient has acute coronary syndrome, which antihypertensive CAN’T you give?

A

Ca channel blockers

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22
Q

Why can’t more than 1 RAAS system inhibitor be given at a time?

A

High risk of hyperpotassemia

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23
Q

Which medication for hypertension would you give post myocardial infarction?

A

Cardio selective beta blocker

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24
Q

Effects of ACE inhibitors

A

Less vasoconstriction, GFR, aldosterone, reabsorption

More bradykinin = more vasodilation

Less proteinuria and cardiac remodeling

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25
Which hypertensive medication is preferred in diabetics and why?
ACE inhibitors (captopril, enalapril) Nephroprotective
26
Which antihypertensive class causes a dry cough?
ACE inhibitors
27
CAPTOPRIL mnemonic for side effects
Cough Angioedema Pemphigus vulgaris Teratogenic O hypOtension Potassium elevation Renal failure Increase creatinine Low GFR
28
ACE inhibitor main indications
- Hypertension *diabetes - Heart failure with reduced ejection fraction - MI history - CKD with proteinuria
29
When are ARB inhibitors used?
If ACE inhibitors were not tolerated (valsartan, losartan)
30
Which is the prototipic renin inhibitor?
Aliskiren aLISkiREN (LIS RENin)
31
Which antihypertensives can be used in pregnancy and what is their classification? (4)
New Moms Love Hugs: - Labetalol (alpha and beta blocker) - Hydralazine (vasodilator) - Nifedipine (dihydropyridine) - Methyldopa (alpha agonist) - Aliskiren (renin inhibitor)
32
What can you combine ACE inhibitors with to stabilize K?
Thiazide diuretics
33
Which medication class has rebound hypertension as a clearly described effect?
ACE inhibitors Therefore, start at very small dosis
34
MOA nitrates
NO —> increase cGMP —> less intracellular Ca = smooth muscle relaxation —> vasodilation **VEINS = less preload
35
Nitrates main indications (5 )
- Acute angina - Emergency hypertension - Acute coronary syndrome - Pulmonary hypertension with edema - Chronic heart failure
36
What are important side effects of hydralazine? (2)
Reflex tachycardia Drug-induced lupus
37
Which direct vasodilator is not selective between veins and arteries?
Nitroprusside
38
Which beta blocker can be used for glaucoma?
Timolol
39
Categories of PDE inhibitors
- Nonspecific: theophylline, dipyridamole - PDE-5: sildenaFIL, vardenaFIL - PDE-4: roflumilast - PDE-3: milrinone, cilostazole
40
Which PDE inhibitors are “platelet inhibitors”?
Cilostazol Dipyridamole
41
MOA nonspecific PDE inhibitors
—> increased cAMP = bronchial smooth muscle relaxation
42
MOA PDE-5 inhibitors
Less cGMP hydrolysis —> more cAMP = vasodilation Important increased flow in corpus cavernosum, FILls the penis
43
MOA PDE-4 inhibitors
Increase cAMP in neutrophils, granulocytes, and bronchi
44
MOA PDE-3 inhibitors
Increase cAMP in: Cardiomyocytes —> + ino and chronotropy Vascular muscle —> vasodilation
45
How do PDE inhibitors affect platelets?
Inhibit their aggregation
46
Which PDE inhibitors are used for erectile dysfunction, prostatic hyperplasia, and pulmonary hypertension?
PDE-5 inhibitors ProsTAtic = TAdalafil
47
Which PDE inhibitors are used for airway? Ex. COPD, asthma
Nonspecific (theophylline) PDE-4 inhibitor (roflumilast)
48
Which PDE inhibitors are used for acute decompensated HF?
PDE-3 inhibitors
49
Sildenafil category and main side effects (4H’s)
PDE-5 inhibitors - Hot and sweaty - Headache - Heartburn - Hypotension Cyanopia
50
First-line treatment for hypertension options (3)
- Thiazide diuretics - ACE inhibitors or ARBs - Dihydropyridine Ca block
51
First-line treatment for hypertension WITH HF options (3)
- Diuretics - ACE inhibitors/ARBs - Beta blockers ONLY if compensated
52
First-line treatment for hypertension WITH ASTHMA options (4)
- ARBs - Ca channel blockers - Thiazide diuretics - Cardioselective beta blockers
53
How do you prevent reflex tachycardia in a patient taking hydralazine?
Add beta blcoker
54
Hypertensive emergency options (5)
- Labetalol - Clevidipine - Fenoldopam - Nicardipine - Nitroprusside
55
Angina main medication categories used (2)
Nitrates Beta blockers
56
MOA statins
Inhibit HMG-CoA reductase = no conversion to mevalonate —> less cholesterol Atorvastatin Simvastatin
57
Main side effects of statins (2)
Hepatotoxicity Myopathy when used with fibrates or niacin
58
Which 2 categories of lipid-lowering agents lower LDL the most?
HMG-CoA reductase inhibitors (statins) PCSK9 inhibitors
59
Which category of lipid-lowering agents lowers TRIGLYCERIDES the most?
Fibrates
60
MOA resins
Prevent reabsorption of bile acids in the intestines —> liver uses cholesterol to make more Cholestyramine Colestipol Colesevelam
61
Which lipid-lowering agents can slightly increase triglycerides?
Bile acid resins
62
MOA ezetimibe
Prevents cholesterol absorption in small intestine
63
Most lipid-lowering agents (increase/decrease) LDL, (increase/decrease) HDL, and (increase/decrease) TG
Decrease LDL Increase HDL Decrease TG (except bile acid resins)
64
MOA fibrates
Activate PPAR-a: —> upregulate lipoproteic lipase —> TG clearance *MOST EFFECT OF ALL LIPID LOWERING AGENTS —> induce HDL synthesis Benzafibrate, fenofibrate, gemfibrozil
65
Statins main side effects (2 )
- MYOPATHY - Cholelithiasis
66
MOA niacin
Inhibit lipolysis Reduce hepatic VLDL synthesis Increases HDL more than others
67
Niacin main side effects (3)
- Flushed face —> give aspirin - Hyperglycemia - Hyperuricemia
68
MOA PCSK9 inhibitors
Inactivate LDL-receptor degradation = more LDL removal Alirocumab Evolocumab
69
PCSK9 inhibitors main side effects (2)
- Myalgias - Neurocognitive: dementia, delirium
70
MOA cardiac glycosides
Inhibit Na/K ATPase —> inhibition of Na/Ca exchange = increased Ca intracellular = + inotropic effect and vagus nerve stimulation = lower HR DIGOXIN
71
What is digoxin used for? (2)
- HF - afib
72
Important digoxin side effects (5)
- Cholinergic: nausea, vomit, diarrhea - YELLOW blurry vision - Arrhythmias - AV block - HyperK
73
Antiarrhythmics classes and targets
Ia: moderate Na Ib: weak Na Ic: strong Na II: beta blockers III: K block IV: Ca block
74
Class I antiarrhythmic medications
Ia: Quinidine, PROCainamide, DISOpyramide “The Queen Proclaims Diso’s pyramid” Ib: LIDocaine, PHenytoin, MEXIletine “I’d Buy Liddy’s Phine Mexican tacos” Ic: Flecainide, Propafenenone “Can I have Fries, Please?”
75
Class III antiarrhythmic medications
AIDS: Amiodarone Ibutilide Dofetilide Sotalol
76
Class IV antiarrhythmic medications
- Diltiazem - Verapamil
77
Which is the best antiarrhythmic post-MI?
Class IB - ex. Lidocaine
78
Which antiarrhythmics are contraindicated in structural and ischemic heart disease?
IC
79
Safest and most used antiarrhythmic?
Amiodarone, has effects of all classes
80
Important side effect of class III antiarrhythmics?
Torsades de pointes (sotalol and ibutilide)
81
With which antiarrhythmic must PFTs, LFTs, and TFTs be checked?
Amiodarone Risk of pulmonary fibrosis, hepatotoxicity, and hypo or hyperthyroidism (has iodine)

Pharmacology (13 decks)

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