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424 Pharmacology > Cardio > Flashcards

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1
Q

ACE inhibitors

-prils

Indications & Pharmacodynamics

A

Indications: hypertension, hypertensive proteinuric diabetes, angina, ischemic heart disease, post-MI, heart failure

Pharmacodynamics: lower BP by inhibiting conversion of angiotensin I to angiotensin II (potent vasoconstrictor); inhibit degradation of bradykinin and increase the synthesis of vasodilating prostaglandins

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2
Q

ACE inhibitors

-prils

Caution/contraindications: avoid, caution, pregnancy, interaction, peds

A
  • Avoid: renal artery stenosis; idiopathic or hereditary angioedema
  • Caution: renal and hepatic impairment
  • Pregnancy/lactation: avoid
  • Drug interaction: ARB, aliskiren
  • Peds: Limited data for less than 6 years old; 6+ approved
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3
Q

ACE inhibitors

-prils

Adverse fx (8)

Which populations are at higher risk for a certain adverse effect?

A
  1. dry cough
  2. hyperkalemia
  3. skin rash
  4. hypertension
  5. dizziness
  6. headache
  7. fatigue
  8. angioedema

Higher risk of angioedema in african american and asian populations

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4
Q

Angiotensin II Receptor Blockers

-sartans

Indications & Pharmacodynamics

A

Indications: hypertension, hypertensive proteinuric diabetes, angina and ischemic heart disease, post-MI, heart failure

Pharmacodynamics: block angiotensin II receptors, thus reducing aldosterone secretion, and reducing retention of sodium and water

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5
Q

Angiotensin II Receptor Blockers

-sartans

Caution/contraindications: avoid, caution, pregnancy, interaction, peds

A
  • Avoid in bilateral renal artery stenosis
  • Caution: renal and hepatic impairment
  • Pregnancy/lactation: avoid
  • Drug interactions: ACE inhibitors, caution with other meds that can cause hyperkalemia
  • Peds: Approved 6+
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6
Q

Angiotensin II Receptor Blockers

-sartans

Adverse fx (5)

A
  1. dizziness
  2. hypotension
  3. hyperkalemia
  4. fatigue
  5. URI
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7
Q

Calcium Channel Blockers

Dihydropyridines: -pines

Indications & Pharmacodynamics

A

Indications: hypertension and angina

Pharmacodynamics: inhibits calcium ions from crossing the cell membrane, resulting in marked decrease in transmembrane calcium content and prolonged vascular smooth muscle relaxation

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8
Q

Calcium Channel Blockers

Dihydropyridines: -pines

Caution/contraindications: avoid, caution, pregnancy, peds

A
  • Avoid: significant peripheral edema, unstable angina
  • Caution: hepatic impairment
  • Pregnancy/lactation: Nifedipine OK, avoid amlodipine
  • Peds: 6+
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9
Q

Calcium Channel Blockers

Dihydropyridines: -pines

Adverse fx (8)

A
  1. flushing
  2. dizziness
  3. HA
  4. hypotension
  5. peripheral edema
  6. gingival hyperplasia
  7. reflux tachycardia
  8. nausea
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10
Q

Calcium Channel Blockers

Non-dihydropyridines: veramapil, diltiazem

Indications & Pharmacodynamics

A

Indications: angina, hypertension, atrial fibrillation, SVT

Pharmacodynamics: inhibit calcium ions from crossing the cell membrane, resulting in a decrease of calcium content, leading to vascular smooth muscle relaxation and coronary vasodilation

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11
Q

Calcium Channel Blockers

Non-dihydropyridines: veramapil, diltiazem

Caution/contraindications: avoid, pregnancy

A
  • Avoid in heart failure with EF less than 40, ventricular dysfunction, SA or AV nodal conduction disturbances, SBP is below 90
  • Pregnancy/lactation: Avoid
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12
Q

Calcium Channel Blockers

Non-dihydropyridines: verapamil, diltiazem

Adverse fx (4)

A
  1. edema
  2. HA
  3. gingival hyperplasia
  4. constipation
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13
Q

Diuretics

Thiazide diuretics: chlorthalidone, HCTZ, metolazone

Indications & Pharmacodynamics

A

Indications: hypertension, mild fluid retention

Pharmacodynamics: act on distal renal tubule to inhibit sodium reabsorption

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14
Q

Diuretics

Thiazide diuretics: chlorthalidone, HCTZ, metolazone

Caution/contraindications: caution, avoid, pregnancy, peds

A
  • Caution: gout hx, electrolyte disturbances, hyperlipidemia, diabetes, elderly
  • Avoid: renal impairment
  • Pregnancy: OK
  • Peds: OK
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15
Q

Diuretics

Thiazide diuretics: chlorthalidone, HCTZ, metolazone

Adverse fx (8)

A
  1. hypokalemia
  2. hyperuricemia
  3. hypotension
  4. hyponatremia
  5. hypocalcemia
  6. hyperglycemia
  7. dizziness
  8. increase in cholesterol, LDL and triglycerides
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16
Q

Diuretics

Loop diuretics: furosemide (lasix), bumetainde, torsemide

Indications & Pharmacodynamics

A

Indications: edema associated with CHF, hepatic cirrhosis, renal disease

Pharmacodynamics: inhibits sodium reabsorption in the ascending loop of Henle

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17
Q

Diuretics

Loop diuretics: furosemide (lasix), bumetainde, torsemide

Caution/contraindications: avoid, caution, pregnancy, peds, interaction

A
  • Avoid in patients who are anuric
  • Caution: gout hx, electrolyte disturbances, prior allergic rxn to sulfonamides, elderly
  • Pregnancy/lactation: caution
  • Peds: OK
  • Drug interaction: Sulfa
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18
Q

Diuretics

Loop diuretics: Furosemide (Lasix), bumetanide, torsemide

Adverse fx (5)

A
  1. hypokalemia
  2. hypouricemia
  3. hypotension
  4. hyponatremia
  5. hypercalcemia
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19
Q

Diuretics

Potassium-sparing diuretics: spironolactone, triamterene, eplerenone

Indications & Pharmacodynamics

A

Indications: edema related to CHF (used in combo with thiazide)

Pharmacodynamics: competes with aldosterone for receptor sites in the distal renal tubules, increasing sodium and water excretion and maintaining potassium

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20
Q

Diuretics

Potassium-sparing diuretics: spironolactone, triamterene, eplerenone

Caution/contraindications: contraindication, caution, pregnancy, peds

A
  • Contraindication: anuria
  • Caution: renal and hepatic impairment, electrolyte disturbances, allergy to sulfonylureas
  • Pregnancy: caution; lactation: avoid
  • Peds: OK if used by specialists
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21
Q

Diuretics

Potassium-sparing diuretics: spironolactone, triamterene, eplerenone

Adverse fx (5)

A
  1. hyperkalemia
  2. gynecomastia
  3. rash
  4. hyperuricemia
  5. hyponatremia
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22
Q

Direct renin inhibitors

Aliskiren

Indications, Pharmacodynamics, pregnancy consideration

A
  • Indications: hypertension
  • Pharmacodynamics: Works on the RAAS
  • Pregnancy/lactation: caution
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23
Q

Neprilysin inhibitors: Sacubitril valsartan

Indication

A
  • Indications: EF <40%
  • Taken in place of ACE or ARB, not given with beta-blockers
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24
Q

Cardiac Glycosides and antiarrhythmics

Amiodarone

Indications & Pharmacodynamics

A

Indications: atrial fibrillation, atrial flutter

Pharmacodynamics: class III antiarrhythmic agent that inhibits adrenergic stimulation, affects sodium, potassium and calcium channels; prolongs the action potential and refractory period in the myocardium

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25
Cardiac Glycosides and antiarrhythmics Amiodarone **Caution/contraindications: avoid, pregnancy, peds, monitoring**
* Avoid: iodine hypersensitivity, sick sinus syndrome, 2nd to 3rd degree AV block * Pregnancy/lactation: Cardiology would prescribe * Peds: approved * Monitoring: chest x-ray, PFT, TSH, free T4, ophthalmic exam, liver function tests
26
Cardiac glycosides & antiarrythmics: Amiodarone What is there an increased risk for developing and why?
Increased risk of development of pulmonary fibrosis & hypo/hyperthyroidism due to action at T3 and T4
27
Cardiac Glycosides and antiarrhythmics Amiodarone **Adverse fx (5)**
1. extrapyramidal syndrome 2. hepatic dysfunction 3. corneal deposits 4. peripheral neuropathy 5. extreme burning photosensitivity - can result in blue-gray skin tone
28
Cardiac Glycosides and antiarrhythmics Digoxin **Indications & Pharmacodynamics**
Indications: a.fib, SVT, heart failure Pharmacodynamics: selectively inhibits the Na/K pump in myocardial cells, resulting in transient increase in intracellular sodium, promoting calcium influx, which leads to increased contractility; decreases positive inotropic fx, enhances vagal tone and decreases ventricular rate
29
Cardiac Glycosides and antiarrhythmics Digoxin **Caution/contraindications: avoid, caution, pregnancy, peds, monitoring**
* Avoid: AV block, uncontrolled ventricular arrythmias * Caution: renal and hepatic impairment, elderly * Pregnancy/lactation: Consult with OB * Peds: approved * Monitoring: narrow TI (1ng/mL), monitor drug levels for toxicity, potassium levels
30
Cardiac Glycosides and antiarrhythmics Digoxin **Adverse fx (5)**
1. fatigue 2. anorexia 3. nausea 4. vomiting 5. diarrhea
31
Cardiac Glycosides and antiarrhythmics Digoxin **What are signs/symptoms of toxicity?**
* Early: visual disturbances - yellow/green halos * Late: palpitations
32
Nitrates What formulation has the quickest onset and how can it be administered?
Sublingual nitroglycerin - may repeat every 5 minutes up to 3 doses
33
Which nitrates are used for prevention of angina?
1. isosorbide dinitrate 2. isosorbide mononitrate
34
Nitrates ## Footnote **Indications & Pharmacodynamics**
Indications: sudden angina Pharmacodynamics: relaxes vascular smooth muscle, dilates coronary vessels and peripheral veins
35
Nitrates ## Footnote **Caution/contraindications: interaction, pregnancy, peds**
* Interaction: Contraindicated with PDE5 inhibitors * Pregnancy/lactation: consult cardio * Peds: consult cardio
36
Nitrates ## Footnote **Adverse fx (3)**
1. HA 2. hypotension 3. flushing tachycardia
37
Peripheral vasodilators Sodium channel inhibitor: Ranolazine **Indications & Pharmacodynamics**
Indications: refractory cases of angina Pharmacodynamics: inhibits late phase of sodium current, improving O2 supply and demand
38
Peripheral vasodilators Sodium channel inhibitor: Ranolazine **Caution/contraindications: other consideration, interactions**
* Other consideration: Anti-anginal fx considerably less in women than men * Drug interactions: CYP inducers (St Johns wort), antifungals, agents that prolong the QT interval
39
Vasodilators Hydralazine **Indications & Pharmacodynamics**
Indications: hypertension, heart failure Pharmacodynamics: acts by direct relaxation and dilation of arteriolar smooth muscle, leading to a decrease in peripheral vascular resistance
40
Vasodilators Hydralazine **Caution/contraindications: avoid, caution, pregnancy, peds**
* Avoid: CAD, hypertension and heart failure * Caution: renal impairment, mitral valvular disease * Pregnancy: caution; lactation: OK * Peds: more data needed
41
Vasodilators Hydralazine **Adverse fx (9)**
1. HA 2. tachycardia 3. palpitations 4. angina 5. nausea 6. orthostatic hypotension 7. peripheral edema 8. dizziness 9. rare lupus like syndrome
42
Antilipidemics HMG CoA reductase inhibitors -statins **Effects on triglyceride levels (LDL, HDL, trigylcerides)**
* greatest reduction on LDL * modest increase in HDL * modest decrease on triglycerides
43
Antilipidemics HMG CoA reductase inhibitors -statins **Pharmacodynamics**
Pharmacodynamics: block the conversion of HMG-CoA to mevalonate, which is the rate-limiting step in the production of cholesterol in the liver; blocking cholesterol production leads to an increase in the number of LDL receptors in the liver, allowing for a larger amount of LDL and VLDL to be taken up by the liver
44
Antilipidemics HMG CoA reductase inhibitors -statins **Caution/contraindications: avoid, interactions, other considerations, pregnancy, peds**
* Avoid: active liver disease, unexplained persistent elevations of serum transaminases * Interactions: avoid grapefruit juice * Other considerations: Should be taken in the evening * Pregnancy/lactation: avoid * Peds: limited data younger than 10
45
Antilipidemics HMG CoA reductase inhibitors -statins **Adverse fx (6)**
1. myalgia 2. arthralgia 3. diarrhea 4. nausea 5. abdominal pain 6. HA
46
Antilipidemics Niacin **Effects on triglyceride levels (3)**
* Moderate decrease in LDL * greatest increase in HDL * moderate decrease in triglycerides
47
Antilipidemics Niacin **What is important to be aware of regarding this medication as a prescriber?**
No longer approved by the US FDA for use in lipid management due to ADRs stronger than the benefit
48
Antilipidemics Niacin **Caution/contraindications: avoid, pregnancy, peds**
* Avoid: hepatic dysfunction, uncontrolled diabetes, gout, new onset a.fib, active peptic ulcers * Pregnancy/lactation: avoid * Peds: limited data
49
Antilipidemics Niacin **Adverse fx (5)**
1. flushing 2. pruritis 3. rash 4. diarrhea 5. hepatotoxicity
50
Antilipidemics Fibrates: Gemfibrozil, fenofibrate **Indications & Pharmacodynamics**
Indications: high triglyceride levels (400+), once reach 300 switch to statin Pharmacodynamics: increase lipolysis of triglycerides via lipoprotein lipase, resulting in a large decrease in triglyceride, thus increasing HDL
51
Antilipidemics Fibrates: Gemfibrozil, fenofibrate **Effects on triglyceride levels (LDL, HDL, triglycerides)**
* mild decrease in LDL * moderate increase of HDL * greatest decrease in triglycerides
52
Antilipidemics Fibrates: Gemfibrozil, fenofibrate **Caution/contraindications: avoid, pregnancy, peds, interactions**
* Avoid: severe renal impairment, active liver disease, pre-existing gallbladder disease, unexplained persistent elevations of serum transaminases * Pregnancy/lactation: avoid * Peds: avoid younger than 18 * Interactions: avoid with statins
53
Antilipidemics Fibrates: Gemfibrozil, fenofibrate **Adverse fx (4)**
1. increased serum transaminases 2. dyspepsia 3. abdominal pain 4. diarrhea
54
Antilipidemics Bile-acid sequestrants: cholestyramine **Effects on triglycerides (LDL, HDL, triglycerides)**
* Moderate decrease in LDL * mild increase in HDL * mild increase in triglycerides
55
Antilipidemics Bile-acid sequestrants: cholestyramine **Indications & Pharmacodynamics**
Indications: patients with low cardiovascular risk profile and moderately elevated LDL Pharmacodynamics: forms a nonabsorbable complex with bile acids in the intestine; inhibits enterohepatic reuptake of intestinal bile salts, resulting in increased fecal removal of LDL cholesterol
56
Antilipidemics Bile-acid sequestrants: cholestyramine **Caution/contraindications (5)**
* Avoid: complete biliary obstruction, patients with triglyceride levels of 300+ * Caution: renal impairment * Interactions: can impact absorption of other meds, separate admin * Pregnancy/lactation: recommended treatment for hyperlipidemia * Peds: limited data
57
Antilipidemics Bile-acid sequestrants: cholestyramine **Adverse fx (4)**
1. flatulence 2. bloating 3. abdominal pain 4. constipation
58
Antilipidemics Cholesterol absorption inhibitors: Ezetimibe **Effects on triglyceride levels (LDL, HDL, triglycerides)**
* mild decrease in LDL * mild increase in HDL * mild decrease in triglycerides
59
Antilipidemics Cholesterol absorption inhibitors: Ezetimibe **Indication & Pharmacodynamics**
Indication: modest LDL decrease, best in combo with statin Pharmacodynamics: blocks the absorption of cholesterol across the intestinal border; decreased delivery of cholesterol to the liver, reduction in hepatic-cholesterol stores, increased clearance of cholesterol from the bloodstream
60
Antilipidemics Cholesterol absorption inhibitors: Ezetimibe **Caution/contraindications: avoid, caution, pregnancy, peds**
* Avoid: active liver disease, unexplained persistent elevations of serum transaminases * Caution: renal and hepatic impairment * Pregnancy/lactation: avoid * Peds: limited data younger than 10
61
Antilipidemics Cholesterol absorption inhibitors: Ezetimibe **Adverse fx (4)**
1. fatigue 2. diarrhea 3. increased serum transaminases 4. arthralgia
62
Antilipidemics PCSK9 inhibitors: Evolocumab **Effects on triglyceride levels (LDL, HDL, triglycerides)**
* greatest decrease in LDL * moderate increase in HDL * mild decrease in trigylcerides
63
Antilipidemics PCSK9 inhibitors: Evolocumab **Pharmacodynamics**
Pharmacodynamics: human monoclonal antibody that binds to PCSK9 inhibitors, inhibits binding of PCKS9 to LDL receptors which allows for increased LDL receptors on the cell surface, therefore decreasing LDL in the blood stream

424 Pharmacology (12 decks)

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