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Intro To Drugs > Cardiovascular system agents > Flashcards

Cardiovascular system agents Flashcards

1
Q

Hypertension

A

Defined as persistently elevated arterial blood pressure
What do the numbers mean?
BP ≥ 140/90 mm Hg (or)
Currently on antihypertensive therapy
72 million Americans (31% of the US population) have BP ≥ 140/90 mm Hg

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2
Q

Arterial BP

A

pressure in the arterial wall

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3
Q

Hydrochlorothiazide

A

Thiazide Diuretics

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4
Q

Hydrochlorothiazide MOA

A

Inhibit reabsorption of sodium and chloride in the distal tubules 
Increased urinary excretion of sodium and chloride

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5
Q

Hydrochlorothiazide uses

A

Hypertension

Edema

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6
Q

Hydrochlorothiazide adverse effects

A

Hypokalemia, hypochloremic alkalosis, orthostatic hypotension, photosensitivity

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7
Q

Hydrochlorothiazide interactions

A

Loop Diuretics
NSAIDs
Digoxin

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8
Q

Hydrochlorothiazide counseling

A

Take in the morning to avoid increased urination at night

Antihypertensive effects may take several days

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9
Q

Hydrochlorothiazide key points

A

Along with use for the treatment of mild hypertension, thiazides can also be used for edema; however, they often only work for mild edema, and a loop diuretic is often required for more severe edema associated with heart failure.
The 50 mg dose of HCTZ has increased adverse effects without added efficacy and should generally be avoided

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10
Q

Furosemide

A

Loop Diuretics

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11
Q

Furosemide MOA

A

Inhibit reabsorption of sodium and chloride at the thick ascending limb of the loop of Henle 
Increased excretion of sodium, water, chloride, calcium, and magnesium

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12
Q

Furosemide uses

A

Edema

Hypertension

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13
Q

Furosemide adverse effects

A

Electrolyte depletion, hyperuricemia, hypochloremic alkalosis, hypotension, orthostasis, renal function impairment, ototoxicity, skin rash

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14
Q

Furosemide interactions

A

NSAIDs
Aminoglycosides
Digoxin

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15
Q

Furosemide BBwarning

A

May cause profound diuresis with water and electrolyte imbalances. Medical supervision is required

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16
Q

Furosemide counseling

A

Avoid taking before bedtime
With the possibility of hypokalemia there may be a need for additional potassium in the diet; do not change diet without first checking with your healthcare professional
Use caution when getting up suddenly from a lying or sitting position
Be cautious in using alcohol, while standing for long periods or exercising, and during hot weather because of enhanced orthostatic hypotensive effects
Regular monitoring of lab tests (potassium, serum creatinine) and blood pressure is necessary to ensure safe use of the drug and avoid adverse effects

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17
Q

Furosemide key points

A

Commonly used to treat edema

Monitor closely to make sure electrolyte disturbances and hypotension do not occur

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18
Q

Sprionolactone

A

Potassium Sparing Diuretics - Aldosterone Antagonists

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19
Q

Sprionolactone MOA

A

Inhibit aldosterone binding to aldosterone receptors of the distal tubules in the kidney 
Increase sodium chloride and water excretion
NO increase in potassium and/or hydrogen ion excretion

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20
Q

Sprionolactone uses

A 
Edema
Heart failure
HTN
Hyperaldosteronism
Hypokalemia
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21
Q

Sprionolactone adverse effects

A

Hyperkalemia, cramping, diarrhea, gynecomastia, renal dysfunction

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22
Q

Sprionolactone drug interactions

A

Potassium supplements

ACEIs, ARBs

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23
Q

Sprionolactone counseling

A

Avoid ingestion of food high in potassium or use of salt substitutes or other potassium supplements without the advice of your healthcare professional

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24
Q

Sprionolactone key points

A

The use in patients with cirrhosis requires much higher dosing (up to 200 mg daily) than what is recommended in patients with heart failure (max of 50 mg daily)
Monitor patients closely for hyperkalemia and renal dysfunction

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25
Lisinopril, Enalapril
Angiotensin-Converting Enzyme (ACE) Inhibitors
26
Lisinopril, Enalapril MOA
Suppression of RAAS Inhibition of ACE  Inhibition of the conversion of angiotensin I to angiotensin II
27
Lisinopril, Enalapril uses
HTN Diabetic nephropathy Heart failure s/p MI
28
Lisinopril, Enalapril adverse effects
Hypotension, hyperkalemia, cough, angioedema, increased Scr, renal failure
29
Lisinopril, Enalapril contraindications
pregnancy
30
Lisinopril, Enalapril interactions
Antihypertensive Agents ARBs, Potassium Sparing Diuretics, Potassium Supplements Diuretics NSAIDs
31
Lisinopril, Enalapril counseling
Some lab work will be needed periodically to monitor therapy (potassium, serum creatinine) Avoid salt substitutes containing potassium Seek help immediately if swelling in face, lips, tongue, or throat occurs Women: Notify your physician if pregnancy is suspected
32
Lisinopril, Enalapril key points
Widely used for the treatment of HTN, heart failure, and other CV diseases. There are some potentially fatal adverse effects associated with their use, so appropriate monitoring and patient counseling is necessary
33
Irbesartan, Losartan, Valsartan
Angiotensin II Receptor Blockers (ARBs)
34
Irbesartan, Losartan, Valsartan MOA
Suppression of RAAS Block the binding of angiotensin II to the AT1 receptor  Inhibition of the effects of antiotensin II
35
Irbesartan, Losartan, Valsartan uses
HTN Diabetic nephropathy Heart failure s/p MI
36
Irbesartan, Losartan, Valsartan adverse effects
Hypotension, hyperkalemia, angioedema, increased Scr, renal failure No Cough!!!
37
Irbesartan, Losartan, Valsartan contraindications
pregnancy
38
Irbesartan, Losartan, Valsartan interactions
Antihypertensive Agents ARBs, Potassium Sparing Diuretics, Potassium Supplements Diuretics NSAIDs
39
Irbesartan, Losartan, Valsartan counseling
Some lab work will be needed periodically to monitor therapy (potassium, serum creatinine) Avoid salt substitutes containing potassium Seek help immediately if swelling in face, lips, tongue, or throat occurs Women: Notify your physician if pregnancy is suspected
40
Irbesartan, Losartan, Valsartan key points
Often used in patients intolerant to ACEIs
41
Aliskiren
Direct Renin Inhibitor
42
Aliskiren MOA
Suppression of RAAS Inhibition of renin  Inhibition of the conversion of angiotensinogen to angiotensin I
43
Aliskiren uses
HTN | Diabetic nephropathy
44
Aliskiren adverse effects
Hypotension, hyperkalemia, angioedema, increased Scr, renal failure
45
Aliskiren contraindications
Pregnancy | Concomitant use with ACEI or ARB in patients with DM and/or renal impairment
46
Aliskiren interactions
Antihypertensive Agents ARBs, Potassium Sparing Diuretics, Potassium Supplements Diuretics NSAIDs
47
Aliskiren counseling
Some lab work will be needed periodically to monitor therapy (potassium, serum creatinine) Avoid salt substitutes containing potassium Seek help immediately if swelling in face, lips, tongue, or throat occurs Women: Notify your physician if pregnancy is suspected
48
selective beta blockers
Atenolol | Metoprolol
49
non-selective beta- blockers
Carvedilol Labetolol Propranolol
50
Atenolol, Metoprolol, Carvedilol, Labetolol, Propranolol MOA
Block response to β stimulation
51
Atenolol, Metoprolol, Carvedilol, Labetolol, Propranolol uses
``` HTN Heart Failure s/p MI Angina Arrhythmias Non-cardiovascular: migraine prophylaxis, anxiety, etc ```
52
Atenolol, Metoprolol, Carvedilol, Labetolol, Propranolol adverse effects
Hypotension, bradycardia Dizziness, fatigue, lethargy, depression, decreased sexual ability Bronchoconstriction (especially non-selective)
53
Atenolol, Metoprolol, Carvedilol, Labetolol, Propranolol drug interactions
Negative Chronotropes - Digoxin, diltiazem, verapamil Anti-diabetic agents NSAIDS Decongestants
54
Atenolol, Metoprolol, Carvedilol, Labetolol, Propranolol counseling
Do not abruptly stop taking medication May mask symptoms of hypoglycemia Notify your physician if you experience dizziness, lightheadedness, difficulty breathing
55
Atenolol, Metoprolol, Carvedilol, Labetolol, Propranolol key points
Very effective for the treatment of many CV diseases Also used for some off-label uses not associated directly with CV disease Caution in asthma and COPD
56
non-selective Alpha-1 blockers
Doxazosin, Terazosin
57
prostate selective Alpha-1 blockers
Tamsulosin, Alfuzosin
58
Doxazosin, Terazosin Tamsulosin, Alfuzosin MOA
Antagonists of α₁-adrenergic receptors Relaxes smooth muscle of the peripheral vasculature Vasodilation ↓ BP (also relax smooth muscle of the prostate)
59
Doxazosin, Terazosin Tamsulosin, Alfuzosin uses
HTN Second-line BPH
60
Doxazosin, Terazosin Tamsulosin, Alfuzosin adverse effects
Orthostatic hypotension, dizziness, syncope, headache
61
Doxazosin, Terazosin Tamsulosin, Alfuzosin interactions
Antihypertensive agents
62
Doxazosin, Terazosin Tamsulosin, Alfuzosin counseling
May cause dizziness and/or drowsiness | Use caution when getting up from a sitting or lying position
63
Doxazosin, Terazosin Tamsulosin, Alfuzosin key points
Indicated in HTN but not first-line
64
Clonidine,
Alpha-2 Agonists
65
Clonidine MOA
Stimulation of α-2 receptors in the brainstem
66
Clonidine uses
HTN Second-line Other - Alcohol/heroin/nicotine withdrawal, etc.
67
Clonidine adverse effects
Orthostatic hypotension, bradycardia CNS depression, dizziness, drowsiness Constipation, dry mouth, contact dermatitis Withdrawal syndrome/rebound hypertension
68
Clonidine interactions
Antihypertensive agents CNS depressants Beta-blockers
69
Clonidine counseling
Do not abruptly stop taking medication Oral therapy and transdermal therapy may overlap for 1-2 days Apply transdermal patch weekly to clean hairless area of upper outer arm or chest and rotate sites weekly Transdermal patch may contain metal – remove prior to MRI
70
Clonidine key points
Often used in resistant HTN High risk of rebound HTN if discontinued abruptly Transdermal route takes 2-3 days for full therapeutic effect
71
Hydralazine
Vasodilator
72
Hydralazine MOA
Directly relaxes vascular smooth muscle
73
Hydralazine uses
HTN Heart Failure Often used in combination
74
Hydralazine adverse effects
Tachycardia, angina, headache | Drug-induced lupus-like syndrome
75
Hydralazine counseling
Must be taken 3-4 times daily | Be aware of lupus-like symptoms
76
Hydralazine key points
Often used in resistant HTN | Patient compliance may be an issue
77
Angina
Chest pain or discomfort due to formation of atherosclerotic plaques within the coronary arteries causing decreased blood flow and lack of oxygen supply to the heart
78
Isosorbide mononitrate, Nitroglycerin
Nitrates
79
Isosorbide mononitrate, Nitroglycerin MOA
Stimulate cGMP production Vascular smooth muscle relaxation Vasodilation
80
Isosorbide mononitrate, Nitroglycerin uses
``` HTN Heart Failure Angina Pulmonary HTN Esophageal spastic disorders ```
81
Isosorbide mononitrate key points
Used for long-term treatment of chronic angina
82
Nitroglycerin key points
Used for relief of angina attacks only | Store in original container
83
Isosorbide mononitrate, Nitroglycerin adverse effects
Hypotension, headache, lightheadedness, syncope, flushing
84
Isosorbide mononitrate, Nitroglycerin interactions
Antihypertensive agents | Phosphodiesterase Inhibitors – AVOID/CI within 24 hours
85
Isosorbide mononitrate, Nitroglycerin counseling
Headaches may occur - aspirin or APAP may be used to relieve pain Extended-release tablets/capsules, sublingual tablets, transdermal patch
86
Isosorbide mononitrate, Nitroglycerin key points
Nitrate-free interval | Angina
87
Dihydropyridine MOA
Inhibit movement of calcium ions across cell membranes Relaxation of coronary vascular smooth muscle Vasodilation
88
Dihydropyridine uses
HTN Angina Pulmonary HTN
89
Dihydropyridine adverse effects
Hypotension, dizziness, lightheadedness, flushing, headache | Peripheral edema
90
Dihydropyridine drug interactions
Antihypertensive agents | CYP3A4 inhibitors/inducers
91
Dihydropyridine counseling
Notify physician if swelling of the hands and feet occur
92
Dihydropyridine key points
Used primarily for HTN | Also in angina
93
Arrhythmias
An irregular heart rhythm, or an abnormality in the timing or pattern of the heartbeat, causing the heart to beat too rapidly, too slowly, or irregularly
94
Amiodarone MOA
↓HR | blocks Na channels, K channels, Ca channels, and Beta-receptors
95
Amiodarone uses
Arrhythmias
96
Digoxin MOA
Inhibits Na/K ATPase  | ↑ intracellular Na and stimulation of Na/Ca exhange
97
Digoxin uses
Arrhythmias | Heart failure
98
Amiodarone adverse effects
Bradycardia, hypotension | Blue/grey skin discoloration, hyper/hypothyroidism, liver toxicity, pulmonary toxicity
99
Amiodarone interactions
``` Negative chronotropes (↓HR) Drugs that prolong QT interval Digoxin (reduce digoxin dose 50%) Warfarin (reduce warfarin dose 50%) ```
100
Digoxin adverse effects
GI toxicity Visual disturbances Cardiac toxicity
101
Digoxin interactions
``` Amiodarone, Dronedarone (reduce digoxin dose 50%) Diuretics Negative chronotropes (↓HR) ```
102
Amiodarone counseling
Sunscreen | Monitor PFTs, TFTs, LFTs
103
Amiodarone key points
Most commonly used anti-arrhythmic agent
104
Digoxin counseling
Notify physician if any signs of toxicity occur
105
Digoxin key points
Often used in symptomatic HF | Narrow therapeutic index

Intro To Drugs (13 decks)

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