Cardiology Pharm - First Aid Flashcards
Hypertension in pregnancy
hydralazine, labetalol, methyldopa, nifedipine
Calcium channel blockers, mechanism
block voltage dependent L-type calcium channels of cardiac smooth muscle, decreasing muscle contractility.
calcium channel blockers working on vascular smooth muscle
amlodipine, nifedipine (class called dihydropyridines)
calcium channel blockers acting on heart
diltiazem, verapamil (non-dihydropyridines)
specific clinical uses nimodipine
subarachnoid hemorrhage
dihydropiridines
hypertension, angina (including prinzmetal), raynauds
Hydralazine mechanism of action
increases cGMP leading to smooth muscle relaxation. vasodilates arterioles > venules. reduces afterload.
Hydralazine clinical uses
severe hypertension, particularly acute. safe to use in pregnancy.
Hydralazine adverse effects
compensatory tachycardia (treat with beta blocker), fluid retention, headache
Treatment of hypertensive emergency
nitroprusside - increases cGMP via direct release of NO. can causes cyanide toxicity
fenoldopam - dopamine D1 receptor agonist. coronary, peripheral, renal, splanchnic vasodilation. decrease BP, increases naturiesis.
nitrates - vasodilate by increasing NO in vascular smooth muscle. increase cyclic GMP leading to smooth muscle relaxation in veins»_space; arteries. decrease in preload.
–> adverse effects, reflex tachycardia, treat with beta blocker.
HMG-CoA reductase inhibitors mechanism of action
lovastatin, pravastatin
decrease LDL, increase HDL, decrease triglycerides. They inhibit the conversion of HMG COA to mevalonate a cholesterol precursor.
HMG-CoA reductase inhibitors adverse effects
hepatotoxicity (increase LFTs), myopathy (especially when used with fibrates or niacin)
bile acid resins mechanism of action
cholestyramine, colestipol, colesevelam
decrease LDL, slightly increase HDL, slightly increase triglycerides. prevent intestinal reabsorption of bile acids. liver must use cholesterol to make more bile acids.
bile acid resins adverse effects
GI upset. decreased absorption of other drugs and fat soluble vitamins
Ezetimibe mechanism of action
decrease cholesterol reabsorption. prevent cholesterol absorption at the brush border.
Ezetimibe adverse effects
rare increas in LFTs, diarrhea
Fibrates mechanism of action
gemfibrozil, bezafibrate, fenofibrate
DECREASE triglycerides. increase HDL. slight decrease in LDL. upregulate LPL to TG clearance. activates PPAR-alpha to induce HDL synthesis.
Fibrates adverse effects
myopathy (increased risk with statin), cholesterol gall stones
Niacin (Vitamin B3) mechanism of action
decrease LDL, increase HDL, decrease triglycerides. Inhibits lipolysis (hormone sensitive lipase) in adipose tissue, reduces hepatic VLDL synthesis.
Niacin (Vitamin B3) adverse effects
red, flushed face, which can be improved with NSAIDs or long term use,
hyperglycemia
hyperuricemia
image page 300 for lipid lowering agents
first aid page 300
Digoxin mechanism of action
direct inhibition of Na/K ATPase –> indirect inhibition of Na/Ca exchanger. Increase Ca –> positive inotropy. Stimulates vagus nerve, decrease HR
Digoxin adverse effects
cholinergic - nausea, vomiting, afib, blurry yellow vision, arrhythmias, AV block,
–> can lead to hyperkalemia, poor prognosis.
factors predisposing to toxicity: renal failure leading to decreased excretion, hypokalemia
Antiarrhythmics - class I mechanism of action
sodium channel blockers. they slow or block conduction especially in depolarized cells. they decrease slope of phase 0.