cardiac Flashcards
(14 cards)
Mechanism of Action of ACE Inhibitors
ACE inhibitors block the angiotensin-converting enzyme (ACE), preventing the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This leads to vasodilation, reduced aldosterone secretion, and decreased sodium and water retention. Additionally, ACE inhibitors inhibit the breakdown of bradykinin, a vasodilator, further enhancing their antihypertensive effect.
Patients with Comorbid Hypertension and BPH, Already on Losartan, Which Additional Antihypertensive Would Be Best?
An alpha-blocker (e.g., doxazosin, prazosin, or terazosin) would be a good choice. Alpha-blockers help lower blood pressure and also improve symptoms of benign prostatic hyperplasia (BPH) by relaxing the smooth muscle in the prostate and bladder neck.
MOA statins
Prevent production of mevalonate> building block of cholesterol
Decrease hepatic cholesterol synthesis
Decrease LDL & triglycerides, increase hdl
MOA thiazide diuretics
Thiazide Diuretics: Act on the distal convoluted tubule of the kidney, decrease blood volume, decrease CO, decrease peripheral resistance, decrease BP
Which Cardiac Medication Has a Common Side Effect of Gout?
thiazide diuretics
Diuretic Used for Management of Ascites
Spironolactone, a potassium-sparing diuretic, is commonly used for ascites in conditions like cirrhosis.
Patient with Diagnosis of AFib, Tachycardia, Which Medication Would You Use to Lower Heart Rate?
Non-dihydropyridine calcium channel blockers (CCBs) like Verapamil or Diltiazem are used to control heart rate in atrial fibrillation by slowing AV nodal conduction.
Beta-blockers (e.g., metoprolol, atenolol) can also be used for rate control.
Mechanism of Action of Sublingual Nitroglycerin
Nitroglycerin is a vasodilator that releases nitric oxide (NO), leading to smooth muscle relaxation in the vascular system. It reduces preload and myocardial oxygen demand, helping relieve angina.
Which Cardiac Medications When Used Together Increase the Likelihood of Hyperkalemia?
ACE inhibitors + ARBs + Potassium-sparing diuretics (e.g., spironolactone)
ACE inhibitors or ARBs + Potassium supplements
These combinations increase potassium retention, raising the risk of hyperkalemia.
Mechanism of Action of PCSK9 Inhibitors
PCSK9 inhibitors prevent the degradation of LDL receptors in the liver, leading to more LDL receptors, which results in increased clearance of LDL from circulation and lower cholesterol levels.
Which Drugs Are Contraindicated in Patients on a Statin Due to Increased Risk of Rhabdo?
Fibrates (e.g., Gemfibrozil) should be avoided as they increase statin levels, raising the risk of rhabdomyolysis.
Which Cardiac Medications Are Indicated for Use in Patients with Heart Failure with Reduced Ejection Fraction (HFrEF)?
ACE inhibitors (e.g., lisinopril, enalapril)
ARBs (e.g., losartan, valsartan)
Beta-blockers (e.g., metoprolol, carvedilol)
Aldosterone antagonists (e.g., spironolactone)
Loop diuretics (e.g., furosemide) for volume overload
Hydralazine + nitrates (for patients who cannot tolerate ACE inhibitors/ARBs)
SGLT2 inhibitors (e.g., dapagliflozin) (not in your slides but recommended in guidelines)
These medicationsreduce afterload, preload, and improve cardiac outputin patients withHFrEF
Compelling Indications for an ACE Inhibitor as a Treatment for Hypertension
Diabetes with proteinuria
Chronic kidney disease (CKD)
Heart failure with reduced ejection fraction (HFrEF)
Post-myocardial infarction (MI)
Left ventricular hypertrophy (LVH)
High cardiovascular risk
These medicationsreduce afterload, preload, and improve cardiac outputin patients withHFrEF.
Why Choose an ACE Inhibitor for Hypertension?
Lowers blood pressure effectively
Reduces cardiovascular events (MI, stroke, HF)
Protects the kidneys (especially in diabetes & CKD)
Prevents heart failure progression (HFrEF, LVH, post-MI patients)
Good monotherapy or combination therapy option
