CVS Drugs

Question 1

Ciprofibrate

Answer 1

Fibrate - PPAR agonist

Notes - Reduces serum LDL & TGs & increases serum HDL. CAUTION WITH STATINS (ESP. GEMFIBROZIL)

Question 2

Femofibrate

Answer 2

Fibrate - PPAR agonist

Notes - Reduces serum LDL & TGs & increases serum HDL. CAUTION WITH STATINS (ESP. GEMFIBROZIL) Used for hypertriglyceridemia

Question 3

Gemfibrozil

Answer 3

Fibrate - PPAR agonist

Notes - Reduces serum LDL & TGs & increases serum HDL. CAUTION WITH STATINS (ESP. GEMFIBROZIL)

Question 4

Amiloride

Answer 4

K+ Sparring diuretic

Question 5

Spironolactone

Answer 5

K+ Sparring diuretic & anti-androgen

Question 6

Amiodarone

Answer 6

K+ channel blocker

Notes - Slows HR (by prolonging QT interval). Used for supraventricular & ventricular tachycardias. Has long half life in fat bc lipophilic

Question 7

Dronedarone

Answer 7

K+ channel blocker

Notes - Slows HR (by prolonging QT interval). Analogue of amiodarone that is less effective. SE - paradoxical pro-arrhythmic effects “Torsades du pontes”

Question 8

Sotalol

Answer 8

K+ channel blocker

Notes - Slows HR (by prolonging QT interval).

Question 9

Disopyramide

Answer 9

Class Ia Na+ channel blocker

Notes - Slows HR by acting on non-nodal AP. Blocks Na+ channels during phase 0 block ++, Moderate A/D. Also blocks K+ channels during phase 3 and prevents outward flow so prolongs ERP, reducing the frequency of APs. Used for ventricular arrhythmias and AFib. SE - anti-cholinergic effects & constipation

Question 10

Lidocaine

Answer 10

Na+ channel blocker

Notes - Slows HR by acting on non-nodal AP. Blocks Na+ channels during phase 0 block + (least), Fastest A/D.

Question 11

Flecainide

Answer 11

Na+ channel blocker

Notes - Slows HR by acting on non-nodal AP. Blocks Na+ channels during phase 0 block +++ (most), Slowest A/D. used for ventricular arrhythmias. C/i in patients with structural heart disease

Question 12

Statins

Answer 12

Competitive HMGCoA reductase inhibitors

Notes - reduce cholesterol synthesis, increase clearance of plasma cholesterol by increasing LDL receptors, decrease ox stress, increase stability of atherosclerotic lesions, decrease TG & increase HDL. SE - HMGCoA (hepatotoxicity/headache, myalgia/myopathy, GI effects, CPK increase, Avoid in pregnancy, liver impairment, elderly, hypothyroidism, hx of muscle disorders). CYP inhibitors. DDI with fibrates ESP gemfibrozil bc increases renal toxicity

Question 13

Alirocumab, Evolocumab

Answer 13

mAb PCKS9 inhibitor

Notes - encourage LDL internalization/recycling. Reduce LDL 50-70%. Administer s/c every 2 weeks

Question 14

Inclisiran

Answer 14

siRNA PCKS9 inhibitor

Question 15

Glycerol trinitrate

Answer 15

Nitrate (vasodilator)

Notes - Causes spontaneous NO release. used with ACEi/ARB. used for pulmonary congestion & dyspnea. Taken sublingually. Tolerance with prolonged use. SE - postural hypotension & headache

Question 16

Isosorbate mono/dinitrate

Answer 16

Nitrate (vasodilator)

Notes - Longer acting nitrate. Causes spontaneous NO release. used with ACEi/ARB. used for pulmonary congestion & dyspnea. Taken sublingually. Tolerance with prolonged use. SE - postural hypotension & headache

Question 17

Hydralazine

Answer 17

Arteriodilator

Notes - direct acting vasodilator. Used for fatigue associated with CHF, preeclampsia, HT+HF in Africans

Question 18

Nitropruside

Answer 18

Combined venodilator + arteriodilator

Notes - used for Acute HF IV only

Question 19

Minoxidil

Answer 19

Direct acting vasodilator

Question 20

Losartan, Valsartan

Answer 20

ARBs (inhibit RAAS)

Notes - SE same as ACEi but less severe. C/i in renal artery stenosis & breastfeeding. Can reduce fetal blood flow. NOT to be used with ACEi. especially effective against cerebrovascular events, TII diabetic nephropathy & bilateral renal artery stenosis (bc ACEi can’t be used).

Question 21

Enalapril, Captopril

Answer 21

ACEi (inhibit RAAS)

Notes - SE “TOPCARD” Teratogen, orthostatic hypotension, potassium increase, cough dry (bc buildup of bradykinin in lungs), angioedema, renal impairment, dizziness. C/i bilateral renal artery stenosis. Used for post MI, HT w HF, HT w LV dysfunction, secondary stroke prevention

Question 22

Bisoprolol

Answer 22

BB (b1)

Notes - cardio depressive. Slow disease progression. c/i in variant angina

Question 23

Carvedilol

Answer 23

BB (b and alpha1 blocker)

Notes - cardio depressive. Slow disease progression. Lowers TPR while preventing reflex tachycardia. Used for Asthma. c/i in variant angina

Question 24

Labetolol

Answer 24

BB

Notes - cardio depressive. Slow disease progression. Used in pregnancy & for asthma. c/i in variant angina

Question 25

Nebivolol

Answer 25

BB (b blocker and NO release from V-ECs) Notes - cardio depressive. Slow disease progression. Racemic mixture of D/L isomers. c/i in variant angina

Question 26

Metoprolol

Answer 26

BB Notes - cardio depressive. Slow disease progression. Used for arrhythmias by elevated SNS activity (ex. after MI), AV node re-entry, supraventricular tachycardia, AFib & flutter. c/i in variant angina

Question 27

Clonidine, Methyldopa

Answer 27

Centrally acting a2 agonists Notes - Decreases TPR, HR & SNS activity. hypertensive crisis if withdrawn quickly. c/i depression

Question 28

Doxazosin, Prazosin, Terazosin

Answer 28

a1 Antagonists "zosins" Notes - relax SMC. SE - 1st dose orthostatic hypotension

Question 29

Dobutamine

Answer 29

beta agonist Notes - Used in acute HF only. Increases contractility, HR & CO.

Question 30

Dopamine

Answer 30

beta agonist Notes - Used in acute HF only. Increases contractility, HR & CO. used to increase renal perfusion & excretion of sodium. High doses bind b1 receptors

Question 31

Digoxin

Answer 31

Cardiac glycoside Notes - Positive inotropy. improves symptoms but NOT mortality. Inhibits NaK ATPase pump so sodium remains in cell. Low TI. Toxicity 2 ways 1) with diuretics can cause hypokalemia 2) slowed clearance in patients with renal failure can buildup in plasma. DDI verapamil (CCB) & amiodarone (anti-arrhythmic)

Question 32

Verapamil

Answer 32

Non-DHP CCB Notes -Inhibit VGLCC. Act on cardiac muscle. SE - constipation, heart block, worse HF. NOT TO BE USED WITH BB

Question 33

Diltiazem

Answer 33

Non-DHP CCB Notes -Inhibit VGLCC. Act on cardiac muscle and SMC

Question 34

Nifedipine

Answer 34

DHP CCB Notes -Inhibit VGLCC. Act on SMC. SE - "Cow"cium channel SHRED - slower heart rate, hypotension/headache, reflex tachycardia, edema, dizziness/flushing. Used for treatment of Raynauds. Can combine with BB to limit reflex tacchy so it is more effective for HT therapy

Question 35

Nicardipine

Answer 35

DHP CCB Notes -Inhibit VGLCC. Act on SMC. SE - "Cow"cium channel SHRED - slower heart rate, hypotension/headache, reflex tachycardia, edema, dizziness/flushing

Question 36

Felodipine

Answer 36

DHP CCB Notes -Inhibit VGLCC. Act on SMC. SE - "Cow"cium channel SHRED - slower heart rate, hypotension/headache, reflex tachycardia, edema, dizziness/flushing

Question 37

Amlodipine

Answer 37

DHP CCB Notes -Inhibit VGLCC. Act on SMC. SE - "Cow"cium channel SHRED - slower heart rate, hypotension/headache, reflex tachycardia, edema, dizziness/flushing. Long-acting so good for LT HT therapy

Question 38

Colesevelam

Answer 38

Cholesterol absorption inhibitor Notes - sequester bile acids. SE - bulky, unpalatable, diarrhea/constipation. DDI - impair absorption of anionic/neutral drugs ex warfarin, digoxin, thiazides

Question 39

Colestipol

Answer 39

Cholesterol absorption inhibitor Notes - sequester bile acids. SE - bulky, unpalatable, diarrhea/constipation. DDI - impair absorption of anionic/neutral drugs ex warfarin, digoxin, thiazides

Question 40

Ezetimibe

Answer 40

Cholesterol absorption inhibitor Notes - sequester bile acids. SE - bulky, unpalatable, diarrhea/constipation.

Question 41

Nicorandil

Answer 41

K+ Channel agonist (NO donor) Noters - hyperpolarizes the cell

Question 42

Ranolazine

Answer 42

K+ Channel agonist (indirectly decreases calcium entry) Notes - relaxes SMC & decreases contractility

Question 43

Ivabradine

Answer 43

Bradycardic Notes - inhibits If current in SA node to decrease HR. Used for chronic stable angina when BB contraindicated. Pro is that it has little effect on non-vascular SMC.