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Block 3 - Cardio > Pharm Cardio Review > Flashcards

Pharm Cardio Review Flashcards

(105 cards)

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1
Q

How do Antihypertensive Agents work?

A

lower BP
–> reduce CO [BB]
–> reduce systemic vascular resistance [Alpha Blockers]
–> reduce blood volume [diuretics]

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2
Q

Carbonic Anhydrase Inhibitor Med & its MOA

A

Acetazolamide

  • Reduce reabsorption of HCO3- in PCT. (a weak diuretics)
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3
Q

Thiazide Med & its MOA

A

Hydrochlorothiazide

  • Works in kidneys – mildly blocks reabsorption of Na+ & Cl- in DCT
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4
Q

Loop Med & its MOA

A

Furosemide

  • Works in kidneys – significantly blocks reabsorption of Na+ in LOH (PCT & DCT)
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5
Q

ACEI Meds & their MOA

A

Lisinopril & Captopril

  • Blocks conversion of Angiotensin I to Angiotensin II
  • Elevate Bradykinin
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6
Q

K+ sparing Meds & their MOA

A

Triamterene
Spironolactone

  • Works in kidneys – by manipulating & Na+/K+ exchange in DCT or by blocking aldosterone
    Usually used in combination w/ Loop & Thiazide diuretics
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7
Q

Selective BB1 meds & their MOA

A

Atenolol & Metoprolol

  • Decr CO
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8
Q

Osmotic diuretic Med & its MOA

A

Mannitol

Works in kidneys – decr H20 reabsorp

Used mostly for:
- Reduction of intracranial pressure
- Incr urinary production for ingestion of toxins
- Promotion in urine production in acute kidney damage

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9
Q

Which Renin Inhibitor med did we not cover?

A

Aliskiren

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10
Q

Dihydropyridines (CCB) meds & their MOA

A

Amlodipine & Nicardipine

  • Inhibit Ca++ influx into vascular SM & myocardium
  • Mainly affect arterial vascular SM & lower BP by causing vasodilation.
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11
Q

Angiotensin receptor blocker (ARB) Med & its MOA

A

Losartan

  • Blocks binding of Angiotensin II to Vascular (AT1) Receptors
  • Reduce renal blood flow & reduce risk of renal injury
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12
Q

Alpha block meds & their MOA

A

Prazosin, Terazosin, Doxazosin, Tamsulosin

  • decr in systemic vascular resistance
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13
Q

Non-selective BBs & their MOA

A

Carvedilol, Labetalol, Propranolol

  • Decr CO, systemic vascular resistance, renin, angiotensin II, aldosterone
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14
Q

Centrally acting adrenergic agents & their MOA

A

Clonidine & Methyldopa

  • Block sympathetic activity in the brain
  • Decr systematic vascular resistance & cardiac input
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15
Q

Non-Dihydropyridines (CCB) meds & their MOA

A

Diltiazem & Verapamil

  • Inhibit Ca++ influx into vascular SM & myocardium
  • Mainly affect arterial vascular SM & lower BP by causing vasodilation.
  • Decr L-type Ca++ channels in heart muscle leading to:
  • Decr Heart contractility, HR, & conduction
  • Significant antiarrhythmic properties
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16
Q

Chronotropic agent affects…

A

HR

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17
Q

Inotropic agent affects…

A

Contractility

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18
Q

Dromotropic agent affects…

A

speed of conduction (mainly in the AV node)

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19
Q

Which diuretics are the most potent?

A

Loop

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20
Q

Loop diuretics act on the…

A

ascending loop of Henle, PCT & DCT

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21
Q

Loop diuretics can cause…

A
  • hypokalemia, hypochloridemia & metabolic alkalosis.
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22
Q

What are the oral times for loop diuretics?

A

torsemide (1hr) to 2 hrs (furosemide)

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23
Q

Loop diuretics IV timing?

A

5-20 minutes

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24
Q

Name a weak diuretic that works in DVT and antagonizes aldosterone receptor

A

K+ sparing Diuretics

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25
Furosemide [Lasix]
- USES: Edema (Primarily); HTN; Pulm Edema, acute *hypercalcemia - MOA: inhibits LOH, PCT & DCT Na+ & Cl- resorption - RXNS: hypokalemia - CAUTIONS: renal impairment; severe renal dz - BBW: fluid & electrolyte depletion
26
Spironolactone [Aldactone]
- USES: CHF Cirrhosis + edema Nephrotic syndrome Essential HTN Severe HF - RXNS: gynecomastia; hyperkalemia - CAUTIONS: Avoid in pregnancy - Contraindicated w/ Addison's dz
27
Hydrochlorothiazide [HCTZ]
- USES: HTN & peripheral edema ** 1st line for HTN in AA pts then CCB MOA: inhibits DCT Na+ & Cl- resorption - retains calcium: can be useful for pts w/ osteoporosis & HTN - CAUTION: avoid use if dose >50 mg/day
28
Triamterene (Dyrenium)
USES: peripheral edema & HTN MOA: inhibits Na reabsorp at the DCT, decr H20 reabsorp & incr K+ retention RXNS: anaphylaxis, ventricular arrhythmias, hyperkalemia CAUTIONS: NO pregnancy BBW: hyperkalemia; monitor BUN/Cr, electrolytes (K)
29
ACE inhibitors affect the ___ and block the conversion of ___.
- renin-angiotensin-aldosterone system - angiotensin I to angiotensin II
30
Common symptoms of those who take ACEI?
dry, persistent cough
31
Why are ACEI the first line tx for pts Type 1 DM pts w/ HTN?
nephroprotective
32
ACEI activate what & inactivate what?
activate angiotensin I inactivate bradykinin
33
What is the 1st choice med for HTN in those w/ kidney dz?
ACE or ARB
34
What causes the dry cough and angioedema of ACE inhibitors?
bradykinin
35
Lisinopril (Prinivil)
USES: HTN; CHF; MI Generally 1st line tx for nonblack patients <60yo or w/ chronic kidney dz MOA: Inhibits angiotensin converting enzyme, interfering w/ conversion of angiotensin I to angiotensin II RXNS: hypoTN; dizziness; dry cough; angioedema BBW: NO pregnancy; fetal toxicity
36
Captopril (Capoten)
USES: HTN; CHF; MI MOA: Inhibits angiotensin converting enzyme, interfering w/ conversion of angiotensin I to angiotensin II RXNS: hypoTN; dizziness; dry cough; angioedema BBW: NO pregnancy; fetal toxicity
37
Losartan (Cozaar)
- USES: HTN nephropathy, DM stroke prevention - MOA: selectively antagonizes angiotensin II AT1 receptors RXNS: less cough than ACEI; angioedema; anaphylaxis; hypotension BBW: NO pregnancy; fetal toxicity
38
MOA for Prazosin & Terazosin
antagonizes peripheral alpha-1 adrenergic receptors (vasodilation --> lowering BP)
39
Cautions for Alpha blockers
- NO PREGNANCY - profound HypoTN if used w/ Sildenafil (Viagra)
40
Prazosin (Minipress)
- USES: HTN; *BHP *Nightmares, PTSD - RXNS: hypotension, 1st dose; dizziness
41
Terazosin (Hytrin)
USES: HTN; BHP RXNS: hypotension, orthostatic; syncope
42
Tamsulosin (Flomax)
USES: BHP; *nephrolithiasis DOES NOT TX HTN RXNS: abnormal ejaculation; dizziness; hypoTN, orthostatic
43
BB affects...
- increase CO - decrease HR - reduce contractility
44
BB: Relative contraindications
- Asthma & COPD - Cocaine Uses - DM - Hyperthyroidism
45
BB: Absolute contraindications
Bradycardia or Heart block
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Amiodarone Toxicities
- Bradycardia/Blue man syndrome - Interstitial lung disease - Thyroid (hyperthyroid OR hypothyroid) - Corneal/Cutaneous - Hepatic/Hypotension
79
Epinephrine [adrenaline]
- USES: asystole/ PEA; VF/pulseless VT; bradycardia; anaphylaxis; asthma exacerbation; severe septic shock - MOA: stimulates alpha & beta adrenergic receptors (sympathomimetic) RXNS: resp difficulty; pulm edema; arrhythmia; HTN
80
Digoxin [Lanoxin]
- USES: CHF; AFib *PSVT Conversion - MOA: inhibits Na+/K+ ATPase RXNS: AV block, bradycardia, ventricular arrhythmias
81
Digoxin Toxicity
- N/V/abdom pain - weakness/dizziness - arrhythmia symptoms - AMS - Vision changes (yellow vision) - the pathognomonic rhythms (atrial tach w/ 2:1 block & bidirectional ventricular tachycardia)
82
Vasopressin [Pitressin]
USES: MOA: RXNS: CAUTIONS:
83
Vasopressin (Pitressin)
USES: MOA: RXNS: CAUTIONS:
84
Dobutamine
USES: MOA: RXNS: CAUTIONS:
85
Norepinephrine (Levophed)
USES: MOA: RXNS: CAUTIONS:
86
Sodium Bicarbonate
USES: metabolic acidosis, acute & chronic urinary alkalization; dyspepsia; salicylate OD *tricyclic antidepressant OD - MOA: incr serum bicarb; incr pH; neutralize stomach acid - RXNS: - RXNS: seizures; metabolic alk; CHF exacerbation, tetany
87
Cilostazol [Pletal]
- USES: intermittent claudication - MOA: inhibits phosphodiesterase type 3, reducing platelet aggregation; suppresses cAMP degradation, producing vasodilation - RXNS: MI, angina, tachys, abnormal labs - BBW: don't use in CHF pts
88
Nitroglycerin [Nitro-Bid] (Topical)
- USES: angina prophy - MOA: stimulates cGMP production, resulting in vascular SM relaxation - RXNS: HA, hypoTN, severe, syncope - CAUTIONS: DON'T take erectile dysfunction meds (sudden decr in BP)
89
Nitroglycerin [Nitrostat] (sublingual)
- USES: angina, acute; angina prophy **Sublingual is drug of choice for stable angina - MOA: stimulates cGMP production, resulting in vascular smooth muscle relaxation - RXNS: orthostatic hypoTN; severe hypoTN; syncope
90
Key Facts about Nitrates
- take 1 dose - if symp don't improve repeat every 5 mins up to 3 doses - If they don't improve call 911 - stable angina--> sublingual - Prinzmetal angina--> nitroglycerin for acute pain, but CCB is added for long-term tx
91
DHA EPA acid [Lovaza]
- USES: hypertriglyceridemia, severe - MOA: reduces liver triglyceride synthesis - RXNS: GI symptoms; anaphylaxis
92
Triglyceride-lowering therapies include:
- fibrates - niacin mipo--- or lomoit---
93
Cholesterol-lowering therapies include:
- statins - bile acid resins
94
Initial Hyperlipidemia Tx
adults 40-75 yo who have 1 or more CV RFs & an estimated 10-yr CVD risk of 10% or greater prescribe statin
95
Atorvastatin [Lipitor]
USES: hypercholesterolemia; CV event prevention; atherosclerotic CV dz *Note: Can be a good 1st line agent - MOA: inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, inhibiting cholesterol synthesis - RXNS: arthralgia; MSK pain; myalgia; Rhabdo CAUTIONS: NO PREGNANCY; can breakdown muscle tissue
96
Pravastatin [Pravachol]
- USES: hypercholesterolemia CV prevention; atherosclerotic CV dz - MOA: inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, inhibiting cholesterol synthesis - RXNS: Fewest SEs & safest in liver dz CAUTIONS: NO PREGNANCY; can breakdown muscle tissue
97
Rosuvastatin [Crestor]
- USES: hypercholesterolemia; CV event prevention; atherosclerotic CV dz ** Lowers LDL the MOST*** - MOA: inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, inhibiting cholesterol synthesis - RXNS: Rhabdo; tendon rupture - CAUTIONS: NO PREGNANCY; can breakdown muscle tissue
98
Fenofibrate [Tricor]
- USES: hypercholesterolemia; mixed dyslipidemia - MOA: inhibits triglyceride synthesis & stimulates breakdown of triglyceride-rich lipoPROs - RXNS: muscle pains; rhabdomyolysis; hepatitis, cirrhosis, cholelithiasis, pancreatitis - CAUTIONS: can breakdown muscle tissue
99
Gemfibrozil [Lopid]
- USES: hypercholesterolemia; mixed dyslipidemia - MOA: inhibits peripheral lipolysis; decr liver FFA extraction; incr VLDL clearance (carrier apolipoPRO B) - RXNS: cholestatic jaundice - CAUTIONS: breakdown muscle tissue
100
Ezetimibe [Zetia]
- USES: hypercholesterolemia; mixed dyslipidemia; **homozygous familial hypercholesterolemia** - MOA: inhibits cholesterol absorp at small intestine brush border, decr liver cholesterol stores & incr blood cholesterol clearance - RXNS: Myalgia; Rhabdomyolysis; pancreatitis - CAUTIONS: can break down muscle tissue
101
Key Facts about Bile Acid Sequestrants
- triglycerides tend to incr - can be used w/ statin
102
Cholestyramine [Questran]
- USES: Hypercholesterolemia - MOA: binds to bile acids; incr bile acid fecal elimination & prevent reabsorp - RXNS: constipation; fat-soluble vitamin deficiency; metabolic acidosis; osteoporosis (long-term) a powder mixed in H20 used for IBS symp in elderly (solidifies stool)
103
Colesevelam [Welchol]
- USES: hypercholesterolemia; Type II DM - MOA: binds to bile acids; incr fecal elimination & prevent reabsorp - RXNS: constipation RXNS: constipation; obstructions, fecal impaction
104
Key Facts about Nicotinic Acid
- 1st lipid lowering agent w/ reduction in total mortality - ~50% of pts can't tolerate max dose (flushing) - can cause gout flair
105
Niacin [Niaspan]
- USES: hypocholesteremia/ hypertriglyceridemia; CV event prevention; CAD - MOA: decr hepatic LDL & VLDL production; decr hepatic triglyceride production, incr lipoPRO lipase activity - RXNS: flushing; hepatotoxicity - CAUTION: don't take if severe liver dz; stomach ulcer, active bleeding - Can give 325 mg aspirin 30 mins prior to reduce flushing

Block 3 - Cardio (13 decks)

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