Cardio: antiHTN, Ca, NO, etc. Flashcards Preview

Pharmacology > Cardio: antiHTN, Ca, NO, etc. > Flashcards

Flashcards in Cardio: antiHTN, Ca, NO, etc. Deck (27)
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1
Q

Antihypertensive therapy:
Primary (Essential) HTN

A
  • Diuretics
  • ACE inhibitors
  • Angiotensin II receptor blockers (ARBs)
  • Ca2+ channel blockers
2
Q

Antihypertensive therapy:
Hypertension with CHF

A
  • Diuretics
  • ACE inhibitors
  • ARBs
  • β-blockers (compensated CHF) (cautiously in decompensated CHF and contraindicated in Cardiogenic Shock)
  • Aldosterone antagonists
3
Q

Antihypertensive therapy:
Hypertension with Diabetes mellitus

A
  • Diuretics
  • ACE inhibitors
  • ARBs
  • Ca2+ channel blockers
  • β-blockers
  • α-blockers
  • ACE inhibitors and ARBs are protective against diabetic nephropathy
4
Q

Ca2+ channel blocker drugs

A
  • Verapamil (non-dihydropyridine)
  • Diltiazem
  • Nifedipine (dihydropyridine)
  • Amlodipine
  • Nimodipine
5
Q

Ca2+ channel blocker: Mechanism

A
  • Blocks voltage-dependent L-type Ca2+ channels of cardiac muscle and blood vessels (“-dipines”)
    → ↓ [Ca2+]
    → ↓ Contactility, CO (Verapamil and Ditiazem),
    → ↓ TPR (acll CCBs)
  • Vascular smooth muscle:
    • Amlodipine, Nifedipine > Diltiazem > Verapamil
  • Heart:
    • Verapamil > Diltiazem > Amlodipine, Nifedipine
6
Q

Ca2+ channel blocker: Clinical Use

A
  • Nifedipine (dihydropyridine) (except Nimodipine)
    • HTN, Angina (including Prinzmetal), Raynaud phenomenon,
    • Antiarrhythmics (only use Verapamil, Diltiazem)
  • Verapamil (Non-dihydropyridine)
    • HTN, Angina, Atrial fibrillation / flutter
  • Nimodipine
    • Subarachnoid hemorrhage (prevents cerebral vasospasm)
7
Q

Ca2+ channel blocker: Toxicity

A
  • Reflex tachycardia (“-dipines”)
  • ☆ Gingival hyperplasia (“-dipines”) (Gum problems)
    • ​Phenytoin (CNS acting drug)
  • Constipation (Verapamil)
  • Cardiac depression
  • AV block
  • Peripheral edema
  • Flushing
  • Dizziness
  • Hyperprolactinemia (high levels of prolactin in blood)
8
Q

Hydralazine: Mechanism

A
  • Increases cGMP –> smooth muscle relaxation
  • Vasodilates arterioles > veins
  • Afterload reduction
9
Q

Hydralazine: Clinical Use

A
  • Severe HTN
  • CHF
  • First-lne therapy for HTN in pregnancy w/ methyldopa
  • Frequently coadministered with a β-blocker to prevent reflex tacycardia
10
Q

Hydralazine: Toxicity

A
  • Compensatory tachycardia (contraindicated in Angina / CAD)
  • Fluid retention
  • Nausea
  • Headache
  • Angina
  • SLE-like syndrome
11
Q

Hypertensive Emergency Drugs

A
  • Commonly used drugs include:
    • Nitroprusside (NO)
    • Fenoldopam (D1)
    • Nicardipine (Dihydro CCB)
    • Clevidipine (Dihydro CCB)
    • Labetalol (α1, β1, β2 -blocker)
12
Q

Nitroprusside: Mechanism

A
  • Short acting
    • Increases cGMP via direct release of NO​
    • Can cause cyanide toxicity (releases cyanide)
13
Q

Fenoldopam: Mechanism

A
  • Dopamine D1 receptor agonist –> vasodilation
    • Coronary
    • Peripheral
    • Renal
    • Splanchnic
  • *Decreases *Blood Pressure
  • Increases Natriuresis (excreting Na in urine w/ Kidneys)
14
Q

Mechanism of Nitroglycerin, Isosorbide dinitrate:

A
  • Vasodilate by ↑ NO in vascular smooth muscle→ ↑ in cGMP and smooth muscle relaxation
  • Dilate veins >> arteries → ↓ Preload
15
Q

Clincal use of Nitroglycerin, Isosorbide dinitrate:

A
  • Angina
  • Acute Coronary syndrome
  • Pulmonary edema
16
Q

Toxicity of Nigroglycerin, Isosorbide dinitrate:

A
  • Reflex tachycardia (treat with β-blockers)
  • Hypotension
  • Flushing
  • Headache
  • “Monday disease” - in industrial exposure: development of tolerance for the vasodilating action during the work week and loss of tolerance over the weekend results in tachycardia, dizziness, and headache upon reexposure
17
Q

Goal of Antianginal therapy

A
  • Reduction of myocardial O2 consumption (MVO2) by ↓ in one or more of the determinants of MVO2:
    • End-diastolic volume
    • Blood pressure
    • Contractility
    • Heart rate
18
Q

Effect of Nitrates on Preload:

A
  • End-diastolic Volume: ↓
  • Blood Pressure: ↓
  • Contractility: ↑ (reflex response)
  • Heart Rate: ↑ (reflex response)
  • Ejection time: ↓
  • MVO2: ↓
  • Calcium channel blockers - Nifedipine is similar to Nitrates in effect
19
Q

Effect of β-blockers on Afterload:

A
  • End-diastolic Volume: ↑
  • Blood Pressure: ↓
  • Contractility: ↓
  • Heart Rate: ↓
  • Ejection time: ↑
  • MVO2: ↓
  • Verapamil is similar to β-blockers in effect
  • Pindolol and Acebutolol - partial β-agonists contraindicated in angina
20
Q

Effect of Nitrates + β-blockers:

A
  • End-diastolic Volume: No effect or ↓
  • Blood Pressure: ↓
  • Contractility: Little / No effect
  • Heart Rate: ↓
  • Ejection time: Little / No effect
  • MVO2: ↓↓
21
Q

Adverse effects common to all ACE inhibitors:

A
  • Dry cough
  • Angioedema (rarely)
  • Hypotension
  • Hyperkalemia
22
Q

Adverse effects common to all ARBs:

A
  • Dizziness
  • Hyperkalemia
23
Q

Diuretic agents:

A
  • Thiazide diuretics - mild to moderate HTN
  • Loop diuretics - used in combination with sympatholytic agents
  • Potassium-sparing agents - used with digoxin (cardiac glycosides)
24
Q
  • β-Adrenocepter antagonist
  • Antagonizes catecholamine action at both β1- and β2-receptors
  • Sustained reduction in peripheral Vascular Resistance
  • Blockade of β1-adrenoreceptors reduces heart rate and contractility
  • Blockage of β2-adrenoreceptors increases Airway resistance and decreases Catecholamine glycogenolysis and Peripheral vasodilation
  • β- in CNS decreases Sympathetic activity
  • Decreases Renin release
A

Propranolol (Inderal)

Used w/ mild to moderate Hypertension

25
Q

Antihypertensive therapy:
Hypertension with Angina

A
  • Diuretics
  • ACE inhibitors
  • ARBs
  • β-blockers
  • CCBs
26
Q

Antihypertensive therapy:
Hypertension with post-MI

A
  • Diuretics
  • ACE inhibitors
  • ARBs
  • β-blockers
27
Q

Antihypertensive therapy:
Hypertension with Dyslipidemias

A
  • Diuretics
  • ACE inhibitors
  • ARBs
  • α-blockers
  • β-blockers
  • CCBs