Cardiac Meds Flashcards
(29 cards)
Furosemide
MOA: Action in the Loop of Henle to induce diuresis
Use: HF, edema, HTN, other conditions with edema
Complications: hypotension, ototoxicity, hypokalemia, electrolyte imbalances
-interacts with a lot of drugs
Hydrochlorothiazide
thiazide diuretic
MOA: Work in the early distal convoluted tubule
Use: 1st choice for essential HTN, HF, liver and kidney disease, promote absorption of Ca
Complications: dehydration and electrolyte imbalances (hypokalemia and hyperglycemia)
Spironolactone
MOA: Potassium-sparing diuretics block aldosterone
Uses: HTN, edema, HF
Complications: hyperkalemia (monitor ECG)= switch diuretic or admin insulin
-ACEs, ARBs, or Direct renin inhibitors + spironolactone = hyperkalemia
-Endocrine effects: good for PCOS to counteract hyperandrogenism
Mannitol
osmotic diuretic
MOA: Reduce Intracranial pressure (ICP) and intraocular pressure (By drawing fluid back into the vascular and extravascular spaces)
Use: prevents kidney failure, cerebral edema, high eye pressure, oliguria phase of AKI
Complications: HF, pulmonary edema, rebound increased ICP, Fluid and electrolyte imbalances (metabolic acidosis)
Captopril
ACEs
MOA: Reduce production of Angiotensin II by blocking conversion from A I to A II and increasing levels of bradykinin, which leads to: vasodilation, excrete Na, water, and retain K
Uses: HTN, HF, MI (decreases risks/mortality), Nephropathy
Complications: 1st dose orthostatic hypotension, cough, hyperkalemia, rash, altered taste, angioedema, neutropenia
Eplerenone
Aldosterone Antagonists
MOA: Reduces blood volume by blocking aldosterone receptors in the kidney, thus promoting excretion of Na and H20, retain K
Uses: HTN, HF, PMS, PCOS, Acne in young females, Primary hyperaldosteronism
Complications: Hyperkalemia, hyponatremia, flu-like symptoms, endocrine changes, dizziness/fatigue
Losartan
ARBs
MOA: Block A II in the body causing vasodilation and excretion of Na and water
Uses: HTN, Stroke, delay progression of diabetic nephropathy, slow development of diabetic retinopathy
Complications: Angioedema, fetal injury, hypotension, dizziness, lightheadedness
Aliskiren
Direct Renin Inhibitors
MOA: Binds w/ renin to inhibit production of A I thus decreasing production of A II and aldosterone
Uses: HTN (often combined with other anti-hypertensives)
Complications: Angioedema, rash, cough, hyperkalemia, diarrhea, hypotension
-Don’t give with high fat foods (reduces absorption)
Nifedipine, Verapamil, Diltiazem
Calcium Channel Blockers (CCBs)
MOA Nifedipine: Block CCBs leading to vasodilation of smooth muscle in the heart (arterioles mainly affected)
MOA Verapamil & Diltiazem: Same as above BUT also in the myocardium, SA and AV node leading to lesser contraction force and slowing conduction/rate
Uses: Angina and HTN for all 3
-+ dysrhythmias (afib/flutter/SVT) for Verapamil and diltiazem only
Complications Nifedipine: Reflex tachycardia (give a beta blocker to help), acute toxicity, orthostatic hypotension and peripheral edema
Complications V and D: Orthostatic hypotension and peripheral edema, constipation (V), suppression of cardiac function, Dysrhythmias (cause a wide QRS or QT interval), acute toxicity
Prazosin
Alpha adrenergic blockers/sympatholytic
MOA: alpha 1 blockade results in venous and arterial dilation, smooth muscle relaxation on the prostatic capsule and bladder neck
Use: HTN (other meds in this category help more with BPH)
Complications: 1st dose orthostatic hypotension
Clonidine
Centrally acting alpha2 agonists
MOA: Act within the CNS to decrease sympathetic outflow thus decreasing stimulation of alpha and beta receptors of the heart and peripheral vasculature
Uses: HTN, severe cancer pain, ADHD management
-Investigational uses: Migraine, flushing w/ menopause, Tourette syndrome management, alcohol/tobacco/opioid withdrawal
Complications: Drowsiness, sedation, dry mouth, rebound HTN if stopped abruptly
Metoprolol
-Cardioselective (B1 only affects heart)
-Nonselective (B1 and B2 only affects heart and lungs)
-Alpha and Beta blockers (Hearts/lungs and more!)
-Beta adrenergic blockers (Beta Blockers; -lols)
MOA: Blockade in the myocardium and conduction system
-Decreased: HR, contractility, CO, renin release (increase Na/H20 excretion)
-Carvedilol and labetalol also add vasodilation
Uses: HTN, Angina, tachydysrhythmias, HF, MI, suppresses reflex tachycardia due to vasodilators
-others like glaucoma, hyperthyroidism, migraines
Complications:
-B1 Blockade Metoprolol and Propranolol: Bradycardia, decreased CO, AV block, orthostatic hypotension, rebound myocardium excitation
-B2 blockade- Propranolol: Glycogenolysis (converting glycogen into glucose impaired= hypoglycemia)
-Nonselective (Propranolol/Nadolol): Don’t give in asthmatics, HF, bronchospasm because it also affects the lungs
Nitroprusside
med for hypertensive crisis
MOA: Direct vasodilation of arteries and veins resulting in rapid reduction of BP
Used for hypertensive crisis only
Complications: Excessive hypotension, cyanide poisoning/thiocyanate poisoning, Brady, Tachy, or EKG changes
Digoxin
cardiac glycoside
MOA: Positive inotropic effect: Good strong pumping! Negative chronotropic effect: decreased HR and conductivity (decreased workload)
Use: 2nd line for HF, dysrhythmias (afib), helps with symptoms, does not prolong life
Complications: Dysrhythmias, cardiotoxicity, GI effects, CNS effects
-lots of interactions
Catecholamines
Adrenergic agonist
MOA:
-Alpha receptors: Activates receptors in arterioles of skin, viscera and mucous membranes, and veins leads to vasocontraction (but dilates pupil)
-B1 receptors: Heart stimulation leads to increased HR, contractility, increased rate of conduction thus improved HF (also releases renin)
-B2 receptors: Arterioles of heart, lungs, skeletal muscles = vasodilation and raises blood sugar
Dopamine Receptors: Renal blood vessels dilate, increase renal perfusion, reduce risk of renal failure
Use and complications:
-Epi: Anaphylaxis, slows local anesthetics, superficial bleeding, nasal congestion, bronchodilation, AV block, HF, cardiac arrest, Hypertensive crisis, angina, necrosis
-Dopamine: HF, shock, AKI, angina, necrosis
-Dobutamine: HF, increase HR
Sacubitril/Valsartan
Angiotensin receptor neprilysin inhibitor (ARNI)
MOA: Inhibits RAAS
Use: Class II-IV HF and reduced EF to replace an ACE or ARB
Complications: Angioedema, hyperkalemia, hypotension, cough, dizziness, renal failure
Nitroglycerine
organic nitrates
MOA: In chronic stable angina it dilates veins and decreased preload thus decreasing cardiac oxygen demand
-In Prinzmetal/vasospastic it reduces spasms thus increasing oxygen supply
Uses: Acute angina, prophylaxis of chronic or variant angina
Complications: HA, orthostatic hypotension, reflex tachy, tolerance
-DON’T give if patient takes erectile dysfunction meds = life threatening hypotension
Ranolazine
antianginal agent
MOA: Lowers cardiac O2 demand, more efficient energy in the myocardium so it can decrease accumulation of Na and Ca in the cells
Uses: Chronic stable angina in combo with amlodipine (CCB) or a beta blocker or organic nitrate
Complications: QT prolongation, elevated BP
Atorvastatin
Antilipemic Agents: HMG-CoA reductase inhibitors
-statins
MOA: Decrease production of LDL and VLDL, lower triglycerides in some, increase HDL, promotes vasodilation, decrease in plaque site inflammation, thromboembolism, and risk of afib
Uses: Primary hypercholesterolemia, prevention of coronary events/strokes in DM patient
Complications: Hepatotoxicity, myopathy
-don’t take with grapefruit juice
Ezetimibe
Cholesterol absorption inhibitor
MOA: inhibits reabsorption of cholesterol secreted in bile and absorption of cholesterol with food
Uses: Use with a modified diet to lower cholesterol, can combine with stain
Complications: Hepatitis, myopathy
Colesevelam
Bile-acid sequestrant
MOA: Decrease LDL only
Use: Alone or with a statin + lifestyle changes
Complications: constipation
-Interferes with absorption of many meds and vitamins so space it out
Gemfibrozil
fibrates
MOA: Decrease triglyceride levels, increase HDL
Uses: Reduce VLDL and HDL
Complications: GI distress, gallstones, myopathy, hepatotoxicity
-Don’t take with a statin (increase in myopathy)
Alirocumab
Monoclonal Antibodies
MOA: Decreased LDL by binding to LDL receptors
Use: Lower LDL in addition to dietary changes
Complications: Hypersensitivity reaction, local injection site reaction
-give subQ
-rarely used
IA: Quinidine
MOA: Slows impulse conduction in the atria ventricles, and Purkinje fibers, delay repolarization
Uses: SVT, Vtach, Afib/flutter suppression long term
Complications: diarrhea, cinchonism (tinnitus, HA, nausea, vertigo, vision issues), Cardiotoxicity, hypotension
