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Flashcards in Reverse Pharm-CV Deck (21):
1

Dihydropridine Calcium channel blocker (4)

Block voltage gated L type calcium channels of smooth muscle (decr. muscle contractility)

On vascular smooth muscle

Hypertension, angina (including prinzmetal), raynaud phenomenon

cardiac depression, peripheral edema, flushing, dizziness, constipation, gingival hyperplasia

amlodipine, clevidipine, nicardipine, nifedipine

2

Dihydropridine Calcium channel blocker

Not used to treat what the others are used to treat
Treats subarachnoid hemorrhage (prevents cerebral vasospasm)

Nimodipine

3

Non Dihydropridine Calcium channel blocker (2)

Blocks voltage gated l type calcium channels of cardiac muscle leading to decr. muscle contractility

Hypertension, angina, A-fib/flutter

AV block, hyperprolactinemia (verapamil), cardiac depression, peripheral edema, flushing, dizziness, constipation, gingival hyperplasia

diltiazem, verapamil

4

Dihydropridine Calcium channel blocker

Treats hypertensive urgency or emergency in addition to its other functions

clevidipine

5

Incr. cGMP via NO release

Short acting

Hypertensive emergency

Cyanide toxicity

nitroprusside

6

Dopamine D1 receptor agonist

Coronary, periph, renal, and splanchnic vasodilation

Decr. BP and Incr. natriuresis

Hypertensive emergency

fenoldopam

7

Nitrates

Vasodilate by incr. NO in vasc. smooth muscle leading to an incr. in cGMP and SM relaxation.

Veins > arteries
Decr preload

Angina, acute coronary syndrome, pulm. edema

Reflex tachy, hypotension, flushing, headache
Monday disease (industrial exposure): tolerance throughout the week, lose it over the weekend, symptoms back on monday.

nitroglycerin, isosorbide dinitrate, isosorbide mononitrate

8

HMG-CoA reductase inhibitors (5 or suffix)

LDL: 3x decr.
HDL: 1x incr.
TGs: 1x decr.

Inhibit conversion of HMG-CoA to mevalonate, a cholesterol precursor

decr. mortality in CAD patients

Hepatotoxicity (incr. LFTs)
Myopathy (w/ fibrates or niacin)

lovastatin, pravastatin, simvastatin, atorvastatin, rosuvastatin

9

Bile acid resins (3 or prefix)

LDL: 2x decr.
HDL: slight incr.
TGs: slight incr.

Prevent intestinal absorp f bile acids; liver must use cholesterol to make more

GI upset
DEcr. absorption of other drugs and fat soluble vitamins

cholestyramine, colestipol, and colesevelam

10

Fibrates (4 or suffix)

LDL: 1x decr.
HDL: 1x incr.
TGs: 3x decr.

upregulate LPL which leads to incr. TG clearance
Activates PPAR-alpha t induce HDL synth

Myopathy (incr. risk with statins)
cholesterol gallstones

gemfibrozil, clofibrate bezafibrate, fenofibrate

11

LDL: 2x decr.
HDL: none
TGs: none

Prevent cholesterol absorption at small intestine brush border

Rare incr. LFTs
Diarrhea

ezetimibe

12

LDL: 2x decr.
HDL: 2x incr.
TGs: 1x decr.

Inhibits lipolysis (hormone sensitive lipase) in adipose tissue
Reduces hepatic VLDL synth

Red, flushed face which is decr. by NSAID use
Hyperglycemia
Hyperuricemia

Niacin

13

Cardiac glycoside

Direct inhib. of Na/K ATPase leading to inhib. of Na/Ca exchanger leading to incr. intracellular calcium leading to positive inotropy.
Stimulates the vagus nerve leading to decr. HR

HF (incr. contractility)
A fib (Decr. conduction at AV node and depression of AV node=vagal nerve stim.)

TOXICITIES
Cholinergic: nausea, vomiting, diarrhea, blurry yellow vision (van gogh), arrhythmias, AV block
Hyperkalemia (poor prognosis)

PREDISP TO TOXIC.
Renal failure, hypokalemia (allows digoxin to bind), verapamil, amiodarone, quinidine

ANTIDOTE
slowly normalize K+, cardiac pacer, anti-digoxin Fab fragments, Mg2+

digoxin

14

Incr. K+ out of cells leads to hyperpolarizing of cell and thus decr. calcium current into cell.

Drug of choice in diagnosing/abolishing SVTs

Very short acting (15 sec)

Blunted by theophylline and caffeine

Flushing, hypotension, chest pain, sense of impending doom, bronchospasm

adenosine

15

Class IA antiarrhythmics (3)

Incr. AP duration
Incr. ERP
Incr. QT interval

Atrial and ventricular arrhythmias, especially re-entrant and ectopic SVT and VT

1=Cinchonism (headache, tinnitus)
2=reversible SLE like syndrome
3=HF

thrombocytopenia
Torsades de pointes due to incr. QT
nosine

Quinidine (1), procainamide (2), disopyramide (3)

16

Uses: Torsades de Pointes and Digoxin toxicity

Mg2+

17

Class IV antiarrythmics (2)

Decr. conduction velocity
Incr. ERP
Incr. PR interval

Prevention of nodal arrhythmias (SVT)
Rate control in a fib

Constipation flushing, edema, CV effects

Verapamil, Diltiazem

18

Class IC (2)

Prolongs ERP in AV node and accessory bypass tracts.
No effect on ERP in purkinje and ventricular tissue
Minimal effect on AP duration

SVTs, including a fib.
Last resort in refractory VT

Proarrhythmic, especially post MI (contraindicated)

flecainide, propafenone

19

Class II antiarr (beta blockers) (6)

decr. SA and AV nodal activity by decr. cAMP and Ca currents.
Suppress abnormal pacemakers by decr. slope of phase 4.
AV node sensitive=Incr. PR interval

SVT, ventricular rate control for a fib and a flutter

Toxicity: Impotence, exacerbation of asthma and COPD, CV effects, CNS effects, mask signs of hypoglycemia

1=dyslipidemia
2=exacerbate vasospasm in prinzmetal angina

Toxicity treatment: Saline, atropine, and glucagon

metoprolol (1), propranolol (2), esmolol, atenolol, timolol, and carvedilol

20

Class IB (sodium channel) (2)

Decr. AP duration
Ischemic or depol. purkinje and ventricular tissue

Acute ventricular arrhythmias (especially post MI)
Digitalis induced arrhythmias

CNS stim/depressin, CV depression

lidocaine, mexiletine

21

Antiarr=potassium channel blockers (class III) (3)

Incr. AP duration, incr. ERP, incr. QT interval

Afib
A flutter
ventricular tachy (1,3)

1=torsades de pointes, excessive beta blockade

2=torsades de pointes

3=pulmonary fibrosis, hepatotoxicity, hypo/hyperthyroid, acts as hapten (corneal deposits, blue/grey skin deposits), neuro effects, constipation, CV effects (bradycardia, heart block, HF)

3=check PFTs, LFTs, TFTs

3=lipophillic, all class effects.

sotalol (1) Ibutilide (2) Amiodarone (3)