CV-Renal Drugs

Question 1

Doxazosin (Cardura)

Answer 1

Selective a1-blocker resulting in decreased arterial tone.
Secondarily, blood pressure would drop.

Tx:
Hypertension

Question 2

Clonidine (Catapres)

Answer 2

a2-receptor agonist which acts to reduce sympathetic tone to peripheral structures, resulting in decreased PVR & HR.
Also acts to reduce Renin activity Thereby further lowering PVR and reducing SV (and thus CO).

Tx: Hypertension

Question 3

Dobutamine

Answer 3

a-receptor agonist which increases cellular cAMP levels in the heart resulting in Positive Inotropic Effects (increased Cardiac contractility & output).

Tx: Heart Failure

Question 4

Metoprolol (Lopressor)

Answer 4

Selective B1-receptor inhibitor which reduces;
Cardiac contractility & HR-> Decreased Cardiac Output
Renin Release -> Reduced PVR & CO

Tx: Angina, Arrhythmias, & HTN

Question 5

Atenolol (Tenormin)

Answer 5

Selective B1-receptor inhibitor which reduces;
Cardiac contractility & HR-> Decreased Cardiac Output
Renin Release -> Reduced PVR & CO

Tx: Angina & HTN

Question 6

Carvedilol (Coreg)

Answer 6

Non selective B-receptor inhibitor which decreases HR & plasma renin activity

Tx: Heart failure & HTN

Question 7

Nitroglycerin

Answer 7

Vasodilator
Converted to NO Intracellularly which activates Guanylyl cyclase, causing and increase in i[cGMP] which causes depohosphorylation of MLC and promoting relaxation of vascular smooth muscle and vasodilation.

Tx: Angina, OCAD

Question 8

Amyl Nitrate

Answer 8

Vasodilator
Converted to NO Intracellularly which activates Guanylyl cyclase, causing and increase in i[cGMP] which causes depohosphorylation of MLC and promoting relaxation of vascular smooth muscle and vasodilation.
Vasodilation leads to decreased preload & increased blood flow to the myocardium

Tx: Angina

Question 9

Hydralazine

Answer 9

Vasodilator
Promotes arteriole smooth m. relaxation & Vasodilation

Tx: Hypertension

Question 10

Verapamil (Calan)

Answer 10

Vasodilator: Calcium Channel Blocker
Blocks voltage calcium channels located primarily in cardiac muscle & vascular smooth muscle, leading to decreased i[Ca2+] and promoting muscle relaxation & dilation of peripheral vasculature.
Also causes a decrease in myocardial contractile force
*Cardiac Suppression

Tx: Antiarrhythmia, HTN, Angina

Question 11

Diltiazem (Cardizem)

Answer 11

Vasodilator: Calcium Channel Blocker
Blocks voltage calcium channels located primarily in cardiac muscle & vascular smooth muscle, leading to decreased i[Ca2+] and promoting muscle relaxation & dilation of peripheral vasculature.
Also causes a decrease in myocardial contractile force
*Cardiac Suppression

Tx: Antiarrhythmia, HTN, Angina

Question 12

Amiodipine (Norvasc)

Answer 12

Vasodilator: Calcium Channel Blocker
Block voltage sensitive calcium channels located primarily in the cardiac muscle & in vascular smooth muscle, causing decreased intracellular Calcium and leading to muscle relaxation
Block Cyclic nucleotide PDE which increases cGMP & decreases Calcium influx
Results in dilation of peripheral arterioles and venules

TX: Hypertension & Angina

Question 13

Nifedipine (Procardia)

Answer 13

Vasodilator: Calcium Channel Blocker
Block voltage sensitive calcium channels located primarily in the cardiac muscle & in vascular smooth muscle, causing decreased intracellular Calcium and leading to muscle relaxation
Block Cyclic nucleotide PDE which increases cGMP & decreases Calcium influx
Results in dilation of peripheral arterioles and venules

TX: Hypertension & Angina

Question 14

Lisinopril (Prinivil)

Answer 14

Angiotensin/Renin Agents: ACE-inhibitor
Inhibit the formation of Angiotensin II from Angiotensin I via ACE
Resulting in:
• Decrease PVR & Blood volume -> CO

Tx: Hypertension & Heart Failure

Question 15

Enalapril (Vasotec)

Answer 15

Angiotensin/Renin Agents: ACE-inhibitor
Inhibit the formation of Angiotensin II from Angiotensin I via ACE
Resulting in:
• Decrease PVR & Blood volume -> CO

Tx: Heart Failure & Hypertension

Question 16

Losartan (Cozaar)

Answer 16

Angiotensin/Renin Agents: Angiotensin Receptor Blocker (ARB)
Blocks Angiotensin II receptors preventing vasoconstriction (& thus promoting vasodilation)

Tx: Hypertension

Question 17

Valsartan (Diovan)

Answer 17

Angiotensin/Renin Agents: Angiotensin Receptor Blocker (ARB)
Blocks Angiotensin II receptors preventing vasoconstriction (& thus promoting vasodilation)

Tx: Heart Failure & Hypertension

Question 18

Hydrochlorothiazide

Answer 18

Diuretics: Thiazides
Increase urinary & salt excretion by inhibiting Na+ & Cl- Reabsorption in the Distal Tubule (DCT) and causing net excretion of H2O (Diuresis)

Tx: Hypertension & Edema

Question 19

Chlorthalidone (Thalitone)

Answer 19

Diuretics: Thiazides
Increase urinary & salt excretion by inhibiting Na+ & Cl- Reabsorption in the Distal Tubule (DCT) and causing net excretion of H2O (Diuresis)

Tx: Hypertension & Edema

Question 20

Furosemide (Lasix)

Answer 20

Diuretics: Loop
Inhibition of Na+ & Cl- reabsorption in the TAL (cortical & medullary), resulting in increased NaCl excretion & Diuresis.
Also Promotes Ca2+ excretion*

Tx: Heart Failure associated Edema, HTN

Question 21

Spironolactone (Aldactone)

Answer 21

Diuretics: K+ Sparing
Inhibition of aldosterone effects in the CCT, resulting in Na+ excretion, while retaining K+.

Tx: HF, HTN, Hypokalemia, Edema

Question 22

Acetazolamide (Diamox)

Answer 22

Diuretics: Carbonic Anhydrase Inhibitior
Reversible inhibition of CA results in decreased H+ secretion at the Renal Tubule
*Also decreases Aqueous Humor Secretion

Tx: Edema, Glaucoma

Question 23

Conivaptan (Vaprisol)

Answer 23

Diuretics: Vasopressin-Receptor (ADH) Inhibitor
Inhibition of the V2 vasopressin receptor, resulting in excretion of free water

Tx: Hyponatremia

Question 24

Mannitol (Osmitrol)

Answer 24

Osmotic Diuretics
Increases osmotic pressure of glomerular filtrate, thus increasing urine output by decreasing fluid & electrolyte reabsorption

Tx: Hypernatremia* & Headache

Question 25

Lidocaine (Xylocaine)

Answer 25

Na+ Channel blocker: Class I Anti-Arr • Inhibit Both inactive & active Na+ channels • Act preferentially on depolarized arrhythmogenic tissue • Shorten AP duration Tx: Anti-Arr

Question 26

Amiodarone (Cordarone)

Answer 26

``` K+ Channel blockers: Class III Anti-Arr • Prolongs AP duration by blocking K+ channels • Does not affect conduction velocity • Blocks calcium channels • Some B-blocker activity • Coronary & peripheral vasodilator ``` Tx: Anti-Arr

Question 27

Digoxin (Lanoxin)

Answer 27

Cardiac Glycoside: • Inhibit Na/K ATPase, leading to increased i[Na+] • Increased i[Na+] leads to a decrease in activity for the Na/Ca exchanger, resulting in an increased in i[Ca2+] • Increased i[Ca2+] leads for increased contractile force • Direct electrical effects on the heart include decrease in AP duration, Ectopic beats, and arrhythmias Tx: Heart Failure & Anti-Arr

Question 28

Milrinone

Answer 28

PDE inhibitor: Vasodilator? • Inhibition of PDE leads to elevated cAMP • Selective for Cardiac isoform of PDE • Results in vasodilation and inotropic effects Tx: Acute Chronic Heart Failure