Cardiac Drugs Part 2 Flashcards
(125 cards)
1
Q
Ideal starting agent for HTN
A
Hydrochlorothiazide
2
Q
MOA: Distal Tubule Diuretics (Thiazides)
A
Inhibits sodium and chloride reabsorption in the distal tubule - increase sodium and water excretion
3
Q
Avoid Hydrochlorothiazide if they have a past history or at risk for
A
Gout
4
Q
Thiazide and Loop diuretics increase potassium and sodium loss - what can you do in a hypokalemic state
A
add a K+ sparing diuretic to fix the electrolyte imbalance
5
Q
Chlorthalidone is
A
a distal tubule diuretic (thiazide)
lower bioavailability than thiazides
HTN
6
Q
Metolazone is
A
often used together with loop diuretics for the treatment of excess fluid in HF (once every four days - not everyday)
safe to use in states of renal insufficiency
7
Q
Metolazone is __________ more potent than ________
A
10 times
hydrochlorothiazide
8
Q
Indapamide is used for
A
HTN and decompensated HF but is uncommonly used
9
Q
MOA: Loop diuretics
A
Inhibits chloride reabsorption at the Loop of Henle
10
Q
When using loop diuretics you need to take caution with any _______ loss
A
hearing (ototoxic)
11
Q
Furosemide is preferred in pts with low _____ and in _______ emergencies.
A
GFR
Hypertensive
12
Q
MOA furosemide
A
inhibits chloride reabsorption which leads to high potassium loss in urine (need baseline K+ and check every so often)
13
Q
SE furosemide
A
increases toxicity of ototoxic and nephrotoxic drugs and lithium
14
Q
Loop diuretics - caution using in pts with _______ allergy
A
sulfa drug
15
Q
Bumetanide is the _______ potent loop diuretic
A
most potent
16
Q
Bumetanide had not been reported to have
A
ototoxicity
17
Q
Large doses of Bumetanide have show to cause
A
severe myalgias (cramps)
18
Q
MOA torsemide
A
blocks sodium, potassium and chloride carrier in thick ascending loop
19
Q
SE of torsemide
A
HA and dizziness
20
Q
MOA K+ sparing diuretics
A
Inhibit potassium secretion and influence sodium excretion in the distal tubule (reduces potassium loss in the urine)
21
Q
SE of K+ sparing diuretics
A
hyperkalemia
22
Q
Amiloride
Spironolactone
Triamterene
Eplerenone
Are all example of what class of drugs
A
K+ sparing diuretics
23
Q
Spironolactone is used for
A
Daily management of edema, prevent acute pulmonary edema
Can be co-prescribed with thiazides
24
Q
MOA spironolactone
A
aldosterone receptor antagonist –> competes with aldosterone to bind to mineralocorticoid receptor –> preventing sodium reabsorption and potassium excretion
25
SE of spironolactone
gynecomastia
increased risk for digitalis toxicity when co-administered
26
Spironolactone is contraindicated in
pregnancy
27
Eplerenone is used in
edema in HF, resistant HTN, hyperaldosteronism (adrenal gland releasing too much aldosterone)
28
Eplerenone is considered to have ________ risk of ___________ than spironolactone
lower
gynecomastia
29
Eplerenone is metabolized by
CYP
30
Triamterene is used in
HTN and is typically paired with thiazide diuretic
31
SE of triamterene
may turn urine blue
cause crystalluria and cast formation
decrease renal blood flow - caution in pts with renal disease
32
Acetazolamide is in what class of drugs
Carbonic anhydrase inhibitor
33
MOA of acetazolamide
inhibits the enzyme carbonic anhydrase in proximal renal tubule --> promoting renal excretion of sodium, potassium, bicarbonate and water
34
SE of acetazolamide
metabolic acidosis
renal stones
hyperammonemia - causing impairment in cognition
35
Acetazolamide is contraindicated in
pts with sulfa allergy
36
Acetazolamide is used in
prophylaxis of altitude sickness and chronic open-angle glaucome
37
Drugs that fall in the Osmotic diuretic category
mannitol
38
MOA mannitol
Blocking the reabsorption of water by kidney tubules at the glomerulus/ proximal convoluted tubule
39
Mannitol is used
to decreased pressure in the eyes (glaucoma), to lower increased ICP (intracranial pressure) and lithium toxicity
40
Do not use thiazides in the treatment of
hypercalcemia - can exacerbate hypercalcemia by increasing tubular calcium resorption
41
Enalapril
Captopril
Lisinopril
Are all drugs that fall into what category
ACE inhibitors
42
MOA ACE inhibitors
suppress synthesis of angiotensin 2 - suppress aldosterone resulting in natriuresis (more sodium/ more volume voided)
43
ACE inhibitors are used for treatment of
first line HTN in pts with high coronary disease risk, diabetes, stroke, HF, myocardial infarction or chronic kidney disease
44
_______ levels are not affected when taking ACE inhibitors
glucose levels, this is why it is preferred in pts with diabetic nephropathy (renoprotective)
45
ACE inhibitors decrease
peripheral vascular resistance
46
SE ACE inhibitors
first dose Hypotension (body will acclimate)
cough
47
The IV form of Enalapril is
Enalaprilat (which is the prodrug of the oral preperation)
48
Captopril infrequently causes
agranulocytosis or neutropenia (increased risk of infection)
49
Lisinopril is used to treat
HTN and HF
50
Lisinopril helps slow down ______ and lowers some ______.
diabetic kidney disease
lowering of blood sugars
51
Losartan
Valsartan
Candesartan
Olmesartan
Are all drugs that fall under what category
ARBs (angiotensin receptor blocker)
52
SE ARBs
dry cough (less common than ACEi)
altered taste
additive effect with antihypertensive drugs
53
MOA of ARBs
produce arteriolar and venous dilation and block aldosterone secretion
54
ARBs have shown to help slow effects of
diabetic neuropathy
55
Losartan is used
for HTN, diabetic neuropathy
good to give in pts who have gout
56
Valsartan is used
for treatment of HF and HTN management
57
Olmesartan is used for
HTN
significant mean blood pressure reduction
58
What drug is the direct renin inhibitor?
Aliskiren
59
MOA Aliskiren
Binds tightly with renin and thereby inhibits the cleavage of angiotensinogen into angiotensin 1
metabolized by CYP
60
Aliskiren is used for
HTN
61
SE Aliskiren
diarrhea at high doses
62
Ambrisentan treats
Pulmonary HTN
improves exercise ability
63
MOA Bosentan
Non Selectively blocks endothelin receptors
64
MOA Ambrisentan
Selectively blocks type A endothelin receptors
65
Bosentan treats
Pulmonary HTN
66
Do not use __________ in HF
calcium channel blockers
67
MOA calcium channel blockers
selectively blocks Ca2+ channels in the myocardium
decreases arterial pressure
decreased heart rate
decreased AV nodal conduction
decreased force of contraction
increased coronary perfusion
68
In calcium channel blockers you need to dose adjust in
renal pts
69
Verapamil
Diltiazem
are apart of what drug category
non-dihydropyridines (calcium channel blockers)
70
Verapamil is used for
stable and vasospastic angina, essential HTN, dysrhythmias
stops the heart from beating too fast - monitor for bradyarrhythmias and heart block
71
Diltiazem is used for
stable and vasospastic angina, essential HTN, dysrhythmias
immediate in its actions
monitor for bradyarrhythmias and heart block
72
Nifedipine
Amlodipine
Felodipine
Are drugs that fall into what category
Dihydropyridines (calcium channel blockers)
73
Dihydropyridines MOA
potent vasodilators
do not alter conduction through AV node
74
Non Dihydropyridines MOA
decrease HR, slow AV nodal conduction
antihypertensives
75
Nifedipine is used for
HTN, stable and vasospastic angina, migraine, raynaud's disease
prevents vascular contraction
76
Amlodipine is used for
HTN, stable, vasospastic angina
77
Felodipine is used for
HTN, stable and vasospastic angina
78
Amlodipine doesn't need to be
monitored because it does not have the potential to cause electrolyte imbalances
79
Isosorbide dinitrate
nitroglycerin
are drugs that fall into what category of drugs
Venous Vasodilators
80
Nitroglycerin indications
treats chronic angina
severe hypertension
81
Isosorbide dinitrate or monotrate indications
HF treatment in black pts incombo with hydralazine
prophylaxis of angina, esophageal spasm
82
MOA of venous dilators
converted to nitric oxide in the body --> vasodilation --> decreased cardiac O2 demand
83
Hydralazine
Minoxidil
Diazoxide
Are all drugs that fall under what category
Arterial vasodilators
84
Hydralazine is used for
essential HTN
used to decrease afterload in HF pts
85
SE of hydralazine
SLE syndrome
flushing
86
Minoxidil (rogaine) is used for
reserved for pts with severe HTN
stimulant for hair growth
87
Diazoxide is used for
acute or malignant HTN
hypoglycemia (inhibits insulin release from the pancreas)
88
MOA minoxidil
opens K+ channels in vascular smooth muscle --> K+ flows out --> decreasing cells ability to contract --> arteriolar dilation
89
MOA diazoxide
long-acting K+ channel opener --> salt and water retention
90
SE diazoxide
excessive hypotension
91
Sodium nitroprusside is a
venous and arteriolar vasodilator
92
MOA of sodium nitroprusside
breaks down and releases nitric oxide --> activates guanylate cyclase --> catalyzes the production of cyclic GMP --> relaxes smooth muscle of veins and arterioles --> decreasing BP
93
Sodium nitroprusside indications
HTN emergencies
94
MOA Digoxin
inhibits Na+/K+ ATPase --> promotes calcium influx in myocytes --> increasing contractility increase in vagal tone --> slows SA node firing and AV node conduction
95
Digoxin indications
acute decompensated HF, dysrhythmias
96
Digoxin is second line is HF and does not ______ life
prolong
97
MOA Milrinone
PDE inhibitor --> decreased breakdown of cAMP --> increased cAMP levels --> increased Ca2+ influx in myocytes and vasodilation in vasc sm muscle
98
Milrinone indications
short term support for acute hemodynamic and sx relief in pts with HFrEF
99
MOA Dobutamine
agonizes B1 receptors - increases HR1
100
Dobutamine is a pressor in states of
acute heart failure
101
MOA Ranolazine
inhibits late stage of Na+ current --> improvement O2 supply and demand
102
Ranolazine indications
stable angina, arrhythmias
103
Phenoxybenzamine MOA
irreversible non selective a1 and a2 receptors -- decrease vasoconstriction
104
Phenoxybenzamine indications
excessive sweating and HTN associated with pheochromocytoma
105
Phentolamine MOA
reversible nonselective blockade of peripheral a1 and a2 receptors -- decreased vasoconstriction
106
Phentolamine indications
Dx and tx of pheo
HTN emergencies
107
Prazosin and Doxasosin are (MOA)
selective a1 inhibitors -- decreased vasoconstriction
108
Propanolol
timolol
nadolol
are (MOA)
Nonselective B1 and B2 inhibition
109
Prazosin and Doxazosin indications
HTN
PTSD nightmares
110
Propanolol indications
performance anxiety, migraine prophylaxis, postural tremor
111
Nadolol indications
HTN and management of chronic angina
112
Pindolol indications
HTN
113
Timolol indications
chronic glaucoma management
114
Pindolol should be avoided in pts with prior
MI/ angina
115
Metoprolol indications
HTN, stable and unstable angina, acute MI, supraventricular tachycardia, ventricular tachycardia, chronic stable HF, migraine prophylaxis
116
Atenolol indications
HTN, stable and unstable angina, acute MI, supraventricular tachycardia, ventricular tachycardia, chronic stable HF, migraine prophylaxis
117
Nebivolol indications
HTN and HF
118
Carvedilol indications
chronic stable HF
decreases mortality in pts with prior MI
119
Labetalol indications
HTN d/t pheo
HTN emergencies
Preeclampsia
120
Labetalol and Carvedilol (MOA)
Non selectively blocks a1 b1 and b2 -- peripheral vasodilation
121
SE Carvedilol and Labetalol
orthostatic hypertension and dizziness
hypoglycemia
122
Metoprolol
Atenolol
Nebivolol
Are (MOA)
selectively inhibits b1 receptors
123
Nebivolol is the most ______ selective of all beta blockers
cardio
124
Pindolol MOA
partial b1 and b2 agonist
125
Organic nitrates contraindications
Coadministration of PDE-5 inhibitors
severe anemia
