CV

Question 1

diuretic thiazide- HCTZ, chlorthalidone

Answer 1

moa: low vol sodium depletion that leads to PVR reduction. BP= HR x SV x (v)PVR. doc when no compelling indications. Gout- absolute contraind. doesn’t work as well in renal impairment.

Question 2

beta adrenergic antagonist (BB)- (-olol)

Answer 2

moa: block adrenergic __ receptor sites, blunt catecholamine response; non-cardioselective. BP= HR(v) x SV (v) x PVR. better in young pop. contraind: heart block & poorly controlled airway dz. masks hypoglycemia sx’s. w/ dc, taper dose over 10-14 d period. only drug that affects CO and not PVR.

Question 3

alpha-beta adrenergic antagonists

Answer 3

carvedilol, labetalol. BP= HR(v) x SV(v) x PVR(v)

Question 4

ACEI= lisinopril, enalapril

Answer 4

moa: attenuate AgII (a potent vasoconstrictor that also stim adrenal catecholamine release) effect by minimizing its production (__) or blocking its action (ARB). BP= HR x SV x PVR(v). adjust dose in renal insuff. do NOT use in renal artery stenosis. mod hyperkalemia risk. most common se: cough. most dangerous se: angioedema.

Question 5

CCB= dihydropyridine: amlodipine, felodipine. nonDHP: diltiazem, verapamil.

Answer 5

moa: causes vasodilation. BP= HR x SV x PVR(v). avoid use in heart failure, renal, or hepatic impairment.

Question 6

Aldosterone antagonist= spironolactone, eplerenone

Answer 6

moa: block effects of aldosterone therefore better regulating Na+ & water homeostasis & maintenance of intravascular vol. BP= HR x SV x PVR(v). hyperkalemia risk. gynecomastia use w/ prolonged use. caution in renal impairment.

Question 7

alpha adrenergic antagonist= terazosin, doxazosin

Answer 7

moa: causes vasodilation. BP= HR x SV x PVR(v). not as solo or 1st agent- higher rate stroke, heart failure (ALLHAT). helpful in prostatism.

Question 8

centrally-acting agents= clonidine, methyldopa

Answer 8

moa: works at brain BP control center. BP= HR x SV x PVR(v). sedation risk. abrupt w/drawal of (cl) can lead to rebound htn.

Question 9

HMG CoA reductase inhibitor= statins

Answer 9

(v)LDL 18-55%. check hepatic enzymes prior to initiation to est baseline. no further routine hepatic monitoring warranted during use. t2dm risk slight inc’d. caution w/ concomitant use of grapefruit juice. check CK at initiation to est baseline. ongoing eval in absence of sx’s not warranted. AE: rhabdomyolysis & myositis.

Question 10

bile acid sequestrants= cholestyramine, colestipol, colesevelam

Answer 10

(v)LDL 15-30%. ^TG if >/=400 mg/dl. nonsystemic w/ no hepatic monitoring required. AE: GI distress.

Question 11

selective cholesterol absorption inhibitor= ezetimibe (zetia)

Answer 11

(v)LDL= 15-20%. min effect on TG. usually in combo w/ statin. few AE’s. when combined w/ simvastatin= Vytorin.

Question 12

Niacin= niapsan

Answer 12

^HDL 15-35%. (v)TG 20-50%. AE: flushing (potentially minimized by taking asa 1h prior to dose). contraind: active liver dz, severe gout, peptic ulcer.

Question 13

fibrin acid derivatives (fibrates)= gemfibrozil, fenofibrate, fenofibric acid

Answer 13

^HDL 10-20%, (v)TG 20-50%. can cause ^ in LDL-C w/ very high TG. AE: dyspepsia, gallstones, myopathy incl’ing rhabdomyolysis if taken w/ statin. v(TG) to (v) pancreatic risk not CV risk.