Drugs for the treatment of CHF, HTN, angina and HLD Flashcards Preview

Pharmacology > Drugs for the treatment of CHF, HTN, angina and HLD > Flashcards

Flashcards in Drugs for the treatment of CHF, HTN, angina and HLD Deck (110):
1

Digoxin MOA

Inhibits the Na/K ATPase at the potassium binding site (less Na so more Ca) to increase contractility. Reduces HR (decreases SNS tone which prevails in CHF). Increases CO in the failing heart.

2

Digoxin Main Effect

Positive Inotrope for CHF.

3

Digoxin Side Effects

Narrow margin of safety. Earliest sign of toxicity is GI upset. CNS effects. Cardiac arrhythmias are the most common and most dangerous: Bigeminy.

4

Treatment of Digoxin toxicity

Discontinue or reduce amount of digoxin. Moderate toxicity: oral/IV potassium. Severe: Digitalis immune Fab with potassium.

5

increased Digoxin toxicity

Hypokalemia (loops/thiazides and diarrhea)

6

Phosphodiesterase Inhibitors MOA

Inhibit cAMP phosphodiesterase to increase cAMP leading to more calcium influx and stronger contraction with significant vasodilation.

7

Inamrinone

Phosphodiesterase Inhibitor

8

Milrinone

Phosphodiesterase Inhibitor

9

Phosphodiesterase Inhibitors Indication

Acute heart failure. Increases CO as a last ditch effeort

10

Drugs that Reduce CHF mortality

Aldosterone antagonists, beta blockers, ACE-I and ARBs

11

Dopamine Indications

Severe refractory CHF. At a moderate dose will bind beta 1 receptors in the heart. IV only.

12

Dobutamine (Dobutrex)

Beta-1 agonist that is a positive inotrope (less tachycardia). Decreases filling pressure and increases oxygen consumption. IV only.

13

Diuretics Used for CHF

Spironolactone and Eplerenone (aldosterone antagonists). Reduces mortality rate in CHF. Decreases venous pressure to decrease edema and cardiac size.

14

DOC for CHF

ACE inhibitors (-prils). Reduces mortality.

15

ACE inhibitors MOA

"-prils" Inhibits ACE to stop conversion of angiotensin I to angiotensin II. Decreases afterload (Less angio II induced vasoconstriction) and decreases preload (less aldosterone) decreases cardiac remodeling.

16

ACE inhibitor Side Effects

Dry cough and angioedema due to increases in bradykinin.

17

Angiotensin II receptor blockers (ARB) MOA

"-sartans" Block the binding of angiotensin II to the AT1 receptor.

18

Beta-Blockers and CHF

Decreases renin secretion, attenuates catecholamine effects, decreases HR, stops cardiac remodeling. Decreases mortality. Only use in the early stages due to negative inotropic effect. Carvedilol and metoprolol.

19

Vasodilators used for CHF

Sodium nitroprusside (nitropress), Isosorbide dinitrate, hydralazine (SLE causing). Decrease preload, afterload and cardiac remodeling.

20

DOC for HTN

Thiazides

21

Adverse effects of thiazides

Reduced glucose tolerance

22

Thiazide contraindication

Diabetes

23

Clonidine

Centrally acting sympatholytic.

24

Methyldopa

Centrally acting sympatholytic

25

Centrally acting sympatholytic MOA

Bind alpha 2 adrenergic receptors to decrease neurotransmitter release and decrease peripheral SNS activity.

26

Centrally acting sympatholytic Effects

Decrease SNS outflow

27

DOC for HTN in pregnancy

Methyldopa

28

Methyldopa Side effects

Hemolytic anemia

29

Prazosin

Alpha-adrenergic Antagonist

30

Terazosin

Alpha-adrenergic Antagonist

31

Doxazosin

Alpha-adrenergic Antagonist

32

Alpha-adrenergic Antagonist Indications

Useful for treating HTN in men with BPH

33

Alpha-adrenergic Antagonist Side Effects

First dose phenomenon

34

Timolol

Non-selective Beta Blocker

35

Propanolol

Non-selective Beta Blocker

36

Nadolol

Non-selective Beta Blocker

37

Metoprolol

Beta 1 blocker

38

Atenolol

Beta 1 blocker

39

Nebivolol

Beta 1 blocker

40

Acebutolol

Beta 1 blocker

41

Beta Blocker effects

Decrease CO, renin secretion and SNS tone.

42

Beta Blocker Indications

Reduces mortality in CHF. Angina, Post-MI, Migraines.

43

Beta Blocker side effects

Blocks insulin release and inhibits recovery from hypoglycemia.

44

Beta Blocker contraindications

DM, asthma, heart block and end stage CHF

45

Carvedilol

Alpha and Beta Blocker

46

Labetalol

Alpha and Beta Blocker

47

Alpha and Beta Blocker MOA

Vasodilation without the reflex tachycardia or renin release

48

Labetalol Indications

HTN emergencies. Acute and maintenance use in pregnancy.

49

Carvedilol Inditations

HTN and CHF especially post-MI

50

Alpha and Beta Blocker Side effects

Hepatotoxicity (especially labetalol)

51

Vasodilator side effects

Reflex tachycardia, HA, fluching, palpitations. Long term lead to fluid retention.

52

Hydralazine

Vasodilator that acts through NO.

53

Hydralazine side effects

Lupus is slow acetylators

54

Sodium Nitroprusside

Vasodialtor that acts through NO. Emergency HTN, IV only.

55

Sodium Nitroprusside adverse effects

Metabolized by thiocyanate and causes cyandide accumulation

56

Minoxidil MOA

Vasodilator that opens potassium channels to cause hyperpolarization and smooth muscle relaxation.

57

Fenoldopam

D1 receptor agonist. Mainly effects the renal vasculature.

58

Nifedipine

CCB dihydropine. Strongest vasodilatory effects so increases HR

59

Verapamil

CCB with the strongest cardiac effects leading to a decreased HR

60

Diltiazem

CCB with vasodilatory and cardiac effects.

61

CCB contraindications

CHF. don't use along with a nitrate.

62

DOC for HTN in DM

ACE-I

63

-prils

ACE-I

64

DOC for HTN in CKD

ACE-I

65

DOC for HTN in CHF

ACE-I

66

ACE-I adverse effects

Increased bradykinin leading to dry cough and angioedema

67

-sartans

ARBs

68

ARBs MOA

Block the effects of angiotensin II without effecting Bradykinin (no cough or angioedema). Similar to ACE-I

69

DOC For Acute Anginal Attack

Nitrates

70

Nitrate indications

Acute use in classic and vasospastic. Long term maintenance in classic angina.

71

Nitrate Side effects

Throbbing head aches

72

Nitrate contraindications

Don't use with sildenafil

73

Monday's disease

Frequent exposure to nitrates builds up tolerance. Not effective for long term treatment

74

CCB indications

Treatment of HTN and angina

75

Beta blockers and Angina

Decrease cardiac workload to decrease oxygen demand. Only useful in classic angina

76

Ranolazine Indications

Refractory angina

77

Sildenafil (viagra)

Phosphodiesterase type 5 inhibitor

78

Sildenafil (viagra) Adverse effects

Blue visual disturbances

79

Sildenafil (viagra) Contraindications

Use with an alpha blocker, nitrate or grapefruit juice

80

Vardenafil (levitra)

Phosphodiesterase type 5 inhibitor. More selective for PD5 and faster onset of action.

81

Tadalafil (cialis)

Phosphodiesterase type 5 inhibitor. More selective for PD5. Longer duration of action.

82

Statin MOA

Structural analog for HMG-CoA reductase. Blocks de novo synthesis of cholesterorl in the liver causing and increase in high affinity LDL receptors which will decrease plasma levels.

83

DOC for Decreasing LDL

Statins

84

Statin effects

Decreases LDL and triglycerides while increasing HDL. Decreases CRP, lipoprotein oxidation and platelet aggregation. Increases NO production and plaque stability.

85

Statin adverse effects

Increased LFTs (caution in patients will existing liver problems). Muscle pain that can lead to rhabdomyolysis.

86

Statin Contraindications

pregnancy, Grapefruit juice.

87

Statin drug interactions

gemfibrozil will inhibit their metabolism

88

Chlestyramine

Bile acid binding resin

89

Colestipol

Bile acid binding resin

90

Colesevelam

Bile acid binding resin

91

Bile acid binding resin MOA

inhibits bile acid reabsorption. Decrease LDL. No effect on familial hypercholesteremia

92

Bile acid binding resin Side effects

Constipation and bloating. Impairs the absorption of fat soluble vitamins and other drugs.

93

Niacin MOA

Inhibits VLDL secretion and increases HDL

94

Niacin adverse effects

Cutaneous vasodilation due to prostaglandins (aspirin first)

95

Gemfibrozil

Fibric Acid Derivative

96

Fenofibrate

Fibric Acid Derivative

97

Fenofibric acid

Fibric Acid Derivative

98

Fibric Acid Derivative MOA

PPAR-alpha ligand receptor to upregulate LPL genes. Decrases Triglycerides.

99

Fibric Acid Derivative Side effects

Gall stones

100

Ezetimibe MOA

Blocks intestinal absorption of cholesteral. Synergistic with statins.

101

Alirocumab

PCSK9

102

Evolocumab

PCSK9

103

PCSK9 MOA

Antibodies that inhibit LDL receptor breakdown. Given as a subcutaneous injection.

104

Treatment of HTN with Angina

Beta-blocker

105

Treatment of HTN post-MI

Beta blocker

106

Treatment of HTN with asthma

CCB

107

Treatment of HTN with DM

ACEI

108

Treatment of HTN with CKD

ACEI

109

Treatment of HTN with BPH

Alpha blocker

110

Treatment of HTN with migraines

Beta blocker