Lesson 2 Flashcards
1
Q
Diuretics used for hypertension
A
Hydrochlorothiazide
Chlorthalidone
Indapamide
Metolazone
Microside
2
Q
Thiazides SE
A
Hypokalemia
Hypomagnesemia
Hypercalcemia
Hyperuricemia
Hyperglycemia
Hyperlipidemia
3
Q
Beta Blockers MOA
A
negative inotropic, chronotropic action
4
Q
Beta Blocker (Cardio Selective at Low Dose) Examples
A
Atenolol
Betaxolol
Bisoprolol
Metoprolol
5
Q
Beta Blocker (Intrinsic Sympathomimetic Activity
A
Acebutolol
Carteolol
Penbutolol
Pindolol
6
Q
Beta blockers with extensive first pass metabolism
A
Propranolol
Metoprolol
7
Q
Beta Blocker with long half-life, renal excretion
A
Atenolol
Nadolol
8
Q
SE Beta Blocker
A
Hypotension
Bradycardia
Heart failure
Heart block
Bronchospasm
Peripheral vasoconstriction and Intermittent claudication
9
Q
ACE inhibitors examples
A
Captopril
Ramipril
Enalapril
Imidapril
10
Q
It blocks conversion of angiotensin I to angiotensin II
It blocks the degradation of bradykinin—angioedema
It is given once daily except captopril (2-3x a day)
A
Angiotensin Converting Enzyme (ACE) Inhibitors
11
Q
It blocks angiotensin type (AT 1) receptor.
It is contraindicated in pregnancy.
A
Angiotensin II Receptor Blockers
12
Q
Examples of Angiotensin II Receptor Blockers
A
Losartan
Valsartan
Candesartan
Irbesartan
Valsartan
13
Q
It blocks voltage sensitive calcium channels in cardiac and smooth muscles.
A
Calcium Channel Blockers
14
Q
2 Classes of Calcium Channel Blockers
A
Non dihydropyridine
Dihydropyridine
15
Q
Non dihydropyridine Examples
A
Diltiazem
Verapamil
16
Q
Dihydropyridine Examples
A
Nifedipine
Felodipine
Amlodipine
17
Q
Non dihydropyridine SE
A
Bradycardia
AV Block
Heart Failure
Constipation
18
Q
Dihydropyridine SE
A
Dizziness
Headache
19
Q
A1 Receptor Blockers
A
Prazosin
Terazosin
Doxazosin
20
Q
It is reserved for patients with BPH
A
A1 Receptor Blockers
21
Q
A1 Receptor Blockers SE
A
First-dose phenomenon - Orthostatic hypotension (dizziness, faintness,
syncope)
Sodium and water retention
22
Q
Centrally acting/A2 agonist
A
Methyldopa
Clonidine
Guanabenz
Guanfacine
23
Q
Presynaptic A2 agonist—-negative feedback—Dec. NE release
A
Centrally Acting A2 Agonist
24
Q
The activity of methyldopa is due to stimulation of central alpha adrenoreceptors by methyldopamine and methylnorephinephrine
A
25
Centrally Acting A2 Agonists SE
- Sedation, dry mouth, depression
- Sodium and water retention (esp. methyldopa)
- Rebound hypertension (esp. clonidine)
26
It depletes NE and blocks transport of NE into its storage vesicles.
Reserpine
27
Reserpine SE
Sodium and fluid retention
Parasympathetic effect (nasal congestion, diarrhea, bradycardia),
Depression
28
It increases HR and renin release ( should be given with beta blocker and a diuretic)
Vasodilators (Direct Arteriolar)
29
Examples of Vasodilators
Hydralazine - for eclampsia
Methyldopa - for chronic HTN in pregnant patients
Minoxidil
30
Side Effects of Hydralazine
Lupus-like reaction (rash, arthralgia; reversible)
31
Side effects of Minoxidil
Hypertrichosis (overgrowth of hair)
32
It depletes and inhibits the release of NE
Postganglionic Sympathetic Inhibitors
33
Postganglionic sympathetic inhibitors Examples
Guanethidine
Guanadrel
34
Postganglionic Sympathetic Inhibitors SE
Orthostatic Hypotension
35
Primary Agents:
Diuretics
Beta Blockers
ACE Inhibitors
Angiotensin II Receptor Blockers
Calcium Channel Blockers
36
Alternatives for HTN Treatment:
A-Blockers
A2 Agonists
Adrenergic Inhibitors
37
Drugs for Hypertensive Urgency
Oral: Captopril, Clonidine, Labetalol
38
Drugs for Hypertensive Emergency
IV Nitroprusside
Nitroglycerin
Nicardipine
Felodopam
Labetalol or Hydralazine
39
It is a chest pain due to decreased blood flow to the heart or due to an inadequate supply of oxygen to the heart muscle.
The pain is typically severe and crushing, and it is characterized by a feeling of pressure and suffocation just behind the breastbone.
Angina Pectoris
40
Angina can accompany or be a precursor of a:
Heart Attack
41
2 Main Types of Angina
Exertional Angina
Vasospastic Angina
42
It is caused by increased physical exertion.
- Most common type
- Due to atherosclerosis of the coronary artery
Exertional Angina
43
Exertional Angina is also called:
Chronic Stable Angina
Classic Angina
Typical Angina
Effect-induced Angina
44
It is caused by vasospasm of the coronary artery.
Vasospastic Angina
45
Vasospastic Angina is also called:
Rest Angina
Variant
Prinzmetal
46
Angina treatment to increase O2 delivery
Nitrates
Vasodilators
Ca blockers
47
Angina treatment to decrease O2 demand
B-Blockers
Ca Blockers
48
It is the most widely used drug of this class (Nitrates)
Nitroglycerin
49
Nitroglycerin routes
Sublingual
Buccal
Spray
Patch
50
Types of Nitrates
Nitroglycerin
ISDN
ISMN
51
ISDN meaning and route
Isosorbide dinitrate
Oral / Sublingual
52
ISMN meaning and route
Isosorbide Mononitrate
Oral
53
It is converted to nitric oxide (NO)---this increase cGMP-----smooth muscle relaxation----vasodilation----venodilation and arterial dilation---decrease oxygen demand---therefore dilation of coronary artery.
Nitrates
54
Drugs for Acute Attack (Angina)
Nitroglycerin - Sublingual, Buccal, Spray
ISDN - Sublingual
55
Drugs for Prophylaxis (Angina)
Nitroglycerin - patch
ISDN - oral
ISMN - oral
56
Note:
- The nitrates undergo extensive first pass metabolism
-Tolerance (have 8-12-hour nitrate free interval)
57
Nitrates SE
Postural hypotension
Reflex tachycardia
Headache
Flushing
58
- Also known as coronary artery disease (CAD)
- Lack of oxygen and decreased or no blood flow to the heart due to coronary artery narrowing or obstruction
Ischemic Heart Disease
59
Ischemic Heart Disease may present as:
Acute MI
Unstable angina
Chronic stable angina
Variant angina
60
It is the beta blocker most widely used in the treatment of angina.
Propranolol
61
Antagonize or reverse the effects of sympathetic activation caused by exercise and other physical or mental exertions thereby decreasing HR, contractility and BP which reduces myocardial oxygen demand.
Beta Blockers
62
Beta Blockers are effective as mono therapy and in combination with:
Nitrates
Calcium Channel Blockers
63
Agents of choice for variant or Prinz metal angina
Calcium Channel Blockers
64
It is a chronic progressive condition that affects the pumping power of your heart muscles.
It specifically refers to the stage in which fluid builds up around the heart and causes it to pump inefficiently.
Congestive Heart Failure
65
It is the inability of the heart to pump sufficient blood to meet the metabolic needs of the body.
Heart Failure
66
Common Causes of Heart Failure
Atherosclerosis
Arteriosclerosis
Myocardial ischemia and infarction, Hypertension
Valvular stenosis
Regurgitation
67
First Line Therapies for Heart failure
Cardiac Glycosides (Digoxin, Digitoxin, Others (Deslanoside, Ouabain)
68
The major side effect of cardiac glycosides
Hypokalemia
69
It is the method of dosage with cardiac glycosides that rapidly produces effective drug level.
Digitalization
70
Daily dosage of glycoside that maintains effective drug levels in the blood.
Maintenance
71
It is a problem with the rate or rhythm of your heartbeat. It means that your heart beats too quickly, too slowly, or with an irregular pattern.
Arrhythmia
72
Heart beats faster than normal
Tachycardia
73
Heart beats too slowly
Bradycardia
74
The most common type of arrhythmia, which causes an irregular and fast heartbeat.
Atrial fibrillation
75
Tachycardia[ atrial or ventricular] beats/min
150 - 250
76
Atrial flutter beats/min
200 - 350
77
Atrial Fibrillation beats/min
greater than 350
78
Ventricular Fibrillation characteristic rate
Uncoordinated Contraction
79
Premature contraction of aorta characteristic rate
Variable
80
Premature contractions of the ventricles characteristic rate
Variable
81
Bradycardia beat/min
Less than 50
82
It is the most serious arrythmia ; can result in cardiac arrest and death.
Ventricular fibrillation
83
Signs and Symptoms of Arrhythmia
Palpitations
Irregular pulse
Dizziness
Syncope
Heart failure
Chest pain
84
How is arrhythmia diagnosed?
Through Electrocardiogram (ECG)
85
Class I of Antiarrhythmic drugs (Sodium Channel Blockers)
Class 1A:
- Procainamide
- Quinidine
- Disopyramide
86
Class II Antiarrhythmic drugs (Beta blockers)
Propranolol
Esmolol
- for patients with AF
87
Class III Antiarrhythmic drugs (Potassium Channel Blockers)
Bretylium
Sotalol
Ibutilide and doletilide
Amiodarone
88
Class IV Antiarrhythmic drugs (Calcium Channel Blockers)
Verapamil
Diltiazem
89
Miscellaneous antiarrhythmics drugs:
Adenosine
Magnesium Sulfate
90
Non-Pharmacologic treatment for Arrhythmia
Defibrillation
Pacemaker
91
this is a specific type of abnormal heart rhythm that can lead to sudden cardiac death... a polymorphic ventricular tachycardia
torsades de pointes
92
a good enzyme in the heart
cGMP - Cyclic Guanosine Monophosphatase
93
S/Sx of Heart Failure
Dyspnea
Orthopnea
Fatigue
Cough
94
Lipid Solubility of Digoxin
Medium
95
Lipid Solubility of Digitoxin
High
96
Half-Life of of Digoxin
Short
97
Half-life of Digitoxin
Long
98
Digoxin Excretion
Renal
99
Digitoxin Excretion
Hepatic
100
Cardiac Glycosides Interactions
1. Diuretics
2. ACE Inhibitors
3. Beta Blockers
4. Diuretics
101
Types of Arrhythmia / Commonly Occurring Arrhythmia
Tachycardia
Atrial Flutter
Atrial Fibrillation
Ventricular Fibrillation
Premature Contraction of Aorta
Premature Contraction of Ventricles
Bradycardia
102
Uses and SE of Procainamide
- All types: AF, VT
- Hypotension, Lupus
103
SE of Quinidine
Cinchonism, GI Upset, Torsades de pointes
104
SE of Disopyramide
Antimuscarinic (dry mouth, blurred vision, hot and flushed skin, dry skin, inc. intraocular pressure)
105
Uses of Class II Beta Blockers (Propranolol, Esmolol)
For patients with AF
106
Uses and SE of Bretyllium
- Refractory Post-MI, VF
- Arrhythmia, Hypotension
107
Uses and SE of Sotalol
- Oral
- Torsades, Bradycardia, Asthma
108
Uses and SE of Ibutilide and Doletilide
- Atrial Fibrillation
- Torsades
109
Uses and SE of Amiodarone
Most effective
Blocks Na, Ca, K channels and B receptors
VT (1st line)
- Corneal deposits, Hypothyroidism, Pulmonary Fibrosis
110
Uses and SE of Verapamil
Atrial Fibrillation (1st line)
IV, Oral
- Hypotension
