Section 3: Cardiac and Renal

Question 1

Quinidine

Answer 1

Class: Class IA antiarrhythmic (Na channel blocker)
Use: Many arrhythmias; need initial digitalization for afib
S/E: Cinchonism (GI, tinnitus, ocular dysfxn, CNS excitation), hypotension, prolongation of QRS & ↑ QT interval associated w/ syncope (torsades)

Question 2

Procainamide

Answer 2

Class: Class IA antiarrhythmic (Na channel blocker)
Use:
S/E: SLE-like syndrome, hematotoxicitity (thrombocytopenia, agranulocytosis); CV effects (torsades)

Question 3

Lidocaine

Answer 3

Class: Class IB antiarrhythmic (Na channel blocker)
Use: Post-MI, open-heart surgery, digoxin toxicity
S/E:

Question 4

Mexiletine

Answer 4

Class: Class IB antiarrhythmic (Na channel blocker)
Use: Post-MI, open-heart surgery, digoxin toxicity
S/E:

Question 5

Fecainide

Answer 5

Class: Class IC antiarrhythmic (Na channel blocker)
Use: Limited
S/E:

Question 6

Propranolol, Acebutolol, Esmolol

Answer 6

Class: Class II antiarrhythmics (β blocker)
Use: Prophylaxis post-MI and in SVTs (esmolol in acute SVTs)
S/E:

Question 7

Amiodarone

Answer 7

Class: Class III antiarrhythmic (K channel blocker)
Use: Any arrhythmia
S/E: Pulmonary fibrosis, blue skin pigmentation, phototoxicity, corneal deposits, hepatic necrosis, thyroid dysfxn

Question 8

Sotalol

Answer 8

Class: Class III antiarrhythmic (K channel blocker)
Use: Life-threatening ventricular arrhythmia
S/E: Torsades

Question 9

Verapamil

Answer 9

Class: Class IV antiarrhythmic (CCBs)
Use: SVT
S/E: Constipation (verapamil), dizziness, flushing, hypotension, AV block

Question 10

Deltiazem

Answer 10

Class: Class IV antiarrhythmic (CCBs)
Use: SVT
S/E: Constipation (verapamil), dizziness, flushing, hypotension, AV block

Question 11

Adenosine

Answer 11

Class: Unclassified antiarrhythmic
Use: DOC for paroxysmal SVT & AV nodal arrhythmias
S/E: Flushing, sedation, dyspnea

Question 12

Magnesium

Answer 12

Class: Unclassified antiarrhythmic
Use: Torsades
S/E:

Question 13

Clonidine

Answer 13

Class: α2 agonist
Use: Mild-to-moderate HTN, opiate withdrawal
S/E: CNS depression, edema

Question 14

Methyldopa

Answer 14

Class: α2 agonist
Use: Mild-to-moderate HTN, HTN mgmt. in pregnancy
S/E: Positive Coombs test, CNS depression, edema

Question 15

Reserpine

Answer 15

Class: NT vesicle disruptor
Use: HTN
S/E: Depression (often severe), edema, ↑ GI secretions
Note: Destroys vesicles (NE in periphery; NE, D, 5-HT in CNS)

Question 16

Guanethidine

Answer 16

Class: NT vesicle disruptor
Note: Accumulated into nerve endings by reuptake; binds vesicles; inhibits NE release; not used clinically

Question 17

-zosins

Answer 17

Class: α1 blockers
Use: HTN, BPH
S/E: “first-dose” syncope, orthostatic hypotension, urinary incontinence
Note: Good effect on lipid profile (↑ HDL, ↓ LDL)
Examples: Prazosin, Doxazosin, Terazosin

Question 18

β blockers

Answer 18

Class: β blockers
Use: HTN
S/E: CV depression, fatigue, sexual dysfunction, ↑ LDLs & TGs
Note: Caution in use w/ asthma, vasospastic disorders, DM

Question 19

Hydralazine

Answer 19

Class: NO regulator
Use: Moderate-to-severe HTN
S/E: SLE-like syndrome, edema, reflex tachycardia
Note: ↓ TPR by arteriolar dilation

Question 20

Nitroprosside

Answer 20

Class: NO regulator
Use: HTN emergencies (used IV, DOC)
S/E: Cyanide toxicity (co-admin w/ nitrites & thiosulfate)
Note: ↓ TPR by arterioles & venular dilation

Question 21

Minoxidil

Answer 21

Class: K+ channel openers
Use: Severe HTN, baldness (topical)
S/E: Hyperglycemia, edema, reflex tachycardia
Note: Open K+ channel  hyperpolarization of smooth muscle

Question 22

Diazoxide

Answer 22

Class: K+ channel openers
Use: HTN emergencies
S/E: Hyperglycemia, edema, reflex tachycardia
Note: Same mech as minoxidil

Question 23

Verapamil

Answer 23

Class: CCB
Use: HTN, angina, antiarrhythmics
S/E: Constipation
Note: Block L-type Ca2+ channels mainly in heart, also in vessels

Question 24

Deltiazem

Answer 24

Class: CCB
Use: HTN, angina, antiarrhythmics
Note: Block L-type Ca2+ channels in both heart & vessels

Question 25

Nifedipine

Answer 25

Class: CCB (dihydropyridine) Use: HTN, angina S/E: Reflex tachycardia, gingival hyperplasia Note: Block L-type Ca2+ channels mainly in vessels, also in heart

Question 26

-pril

Answer 26

Class: ACEI Use: Mild-to-moderate HTN, prevention of diabetic nephropathy, CHF S/E: Dry cough, hyperkalemia, acute renal failure in renal artery stenosis, angioedema Note: Contraindicated in pregnancy; blocks formation of angiotensin II Examples: Captopril, Lisinopril

Question 27

-sartan

Answer 27

Class: ARB Use: Mild-to-moderate HTN, prevention of diabetic nephropathy, CHF S/E: Hyperkalemia, acute renal failure in renal artery stenosis, angioedema Note: Contraindicated in pregnancy; blocks AT1 receptor Examples: Losartan

Question 28

Aliskiren

Answer 28

Class: Renin inhibitor Use: Mild-to-moderate HTN S/E: Hyperkalemia, acute renal failure in renal artery stenosis, angioedema Note: Contraindicated in pregnancy; blocks formation of angiotensin I

Question 29

Bosentan

Answer 29

Class: Endothelin-A receptor antagonist Use: Pulmonary HTN S/E: HA, flushing, hypotension Note: CI in pregnancy

Question 30

Epoprostenol

Answer 30

Class: PGI2 Use: Pulmonary HTN S/E: Note: Administered by infusion pumps

Question 31

-fil

Answer 31

``` Class: PDE5 inhibitor Use: Pulmonary HTN S/E: Note: ↑ cGMP Example: Sildenafil ```

Question 32

Digoxin

Answer 32

Class: Glycoside (inotrope) Use: HF S/E: Early: nausea, anorexia, ECG changes. Late: disorientation, visual effects (halos). Toxic: arrhythmias Note: Inhibits cardiac Na/K ATPase (and neuronal Na/K ATPase); causes ↑ intracellular Ca2+; treat toxicity w/ Fab antibody fragments to digoxin

Question 33

-rinone

Answer 33

``` Class: PDE inhibitors (inotrope) Use: HF S/E: Note: Examples: Milrinone, Inamrinone ```

Question 34

Dobutamine | Dopaimine

Answer 34

``` Class: Sympathomimetics (inotrope) Use: HF S/E: Note: ```

Question 35

Loop diuretics

Answer 35

Class: Loop diuretics Use: HF (backward failure) S/E: Note:

Question 36

Spironolactone

Answer 36

Class: Aldosterone inhibitor (K-sparing diuretic) Use: HF S/E: Note: Used w/ ACEIs to ↓ remodeling

Question 37

Metoprolol, carvedilol

Answer 37

Class: β blocker (metoprolol); α1 & β blocker (carvedilol) Use: HF S/E: See ANS section Note:

Question 38

Nesiritide

Answer 38

Class: Recombinant BNP Use: Acutely decompensated CHF S/E: Note: Recombinant human BNP; binds natriuretic peptide receptors, ↑ cGMP  vasodilation

Question 39

Nitroglycerin

Answer 39

Class: Nitrate Use: Angina S/E: Flushing, HA, orthostatic hypotension, reflex tachycardia, fluid retention Note: Prodrugs of NO; cause venodilation  ↓ preload  ↓ cardiac work  ↓ O2 requirement. Decrease infarct size & post-MI mortality

Question 40

Isosorbide

Answer 40

Class: Nitrate Use: Angina S/E: Flushing, HA, orthostatic hypotension, reflex tachycardia, fluid retention Note: Prodrugs of NO; cause venodilation  ↓ preload  ↓ cardiac work  ↓ O2 requirement. Decrease infarct size & post-MI mortality

Question 41

CCBs

Answer 41

Class: CCBs Use: Angina (nifedipine important for vasospastic angina) S/E: Note:

Question 42

BBs, carvedilol

Answer 42

Class: BBs; α1 & β blocker (carvedilol) Use: Angina (BB contraindicated in vasospastic angina) S/E: Note: Carvedilol is clinically equivalent to isosorbide in angina of effort

Question 43

Ranolazine

Answer 43

Class: Late inward Na+ current blocker Use: Angina S/E: Constipation, nausea, QT prolongation Note: Ischemia  increased Na, which prevents Ca exit through Na/Ca exchanger; blocking Na influx  decreased Ca accumulation  decreased EDP & improved diastolic coronary blood flow. Contraindicated in pts w/ long QT syndrome or taking drugs that prolong QT

Question 44

Mannitol

Answer 44

Class: Osmotic diuretic Use: Glaucoma (↓ IOP), ↓ ICP, oliguric states (e.g. rhabdomyolysis) S/E: Acute hypovolemia Note: IV; inhibits H2O reabsorption throughout tubule

Question 45

-zolamide

Answer 45

Class: Carbonic anhydrase inhibitors Use: Glaucoma, acute mountain sickness, metabolic alkalosis S/E: Bicarbonaturia, acidosis, hypokalemia, hyperchloremia, paresthesias, renal stones, sulfonamide HSR Note: Blocks CA, causing ↓ H+ formation in proximal tubule cell, causing ↓ Na/H exchange  ↑ Na, HCO3- in lumen  diuresis Examples: Acetazolamide, Dorzolamide

Question 46

Furosemide

Answer 46

Class: Loop diuretics Use: Acute pulmonary edema, HF, HTN, refractory edema, acute renal failure, anion OD, hypercalcemic states S/E: Sulfonamide HSR (furosemide), hypokalemia, alkalosis, hypocalcemia, hypomagnesemia, hyperuricemia, ototoxicity (ethacrynic acid > furosemide) Note: Blocks Na/K/2Cl transporter, causing –↓ intracellular K in thick ascending loop, -> back diffusion of K+, ↓ positive potential -> reabsorption of Ca & Mg -> diuresis

Question 47

Ethacrinic Acid

Answer 47

Same as Furosemide: Class: Loop diuretics Use: Acute pulmonary edema, HF, HTN, refractory edema, acute renal failure, anion OD, hypercalcemic states S/E: Sulfonamide HSR (furosemide), hypokalemia, alkalosis, hypocalcemia, hypomagnesemia, hyperuricemia, ototoxicity (ethacrynic acid > furosemide) Note: Blocks Na/K/2Cl transporter, causing –↓ intracellular K in thick ascending loop, -> back diffusion of K+, ↓ positive potential -> reabsorption of Ca & Mg -> diuresis

Question 48

HCTZ

Answer 48

Class: Thiazides Use:HTN, CHF, nephrolithiasis (Ca stones), nephrogenic diabetes insipidus S/E: Sulfonamide HSR, hypokalemia, alkalosis, hypercalcemia, hyperuricemia, hyperglycemia, HLD (except indapamide). Note:Interacts w/ digoxin; avoid in pts w/ DM. Inhibits Na/Cl transporter -> ↑ Na & Cl in distal tubule -> diuresis

Question 49

Indapamide

Answer 49

Same as HCTZ Class: Thiazides Use:HTN, CHF, nephrolithiasis (Ca stones), nephrogenic diabetes insipidus S/E: Sulfonamide HSR, hypokalemia, alkalosis, hypercalcemia, hyperuricemia, hyperglycemia, HLD (except indapamide). Note:Interacts w/ digoxin; avoid in pts w/ DM. Inhibits Na/Cl transporter -> ↑ Na & Cl in distal tubule -> diuresis

Question 50

Spironolactone

Answer 50

Class: Aldosterone-receptor antagonist (K+-sparing diuretic) Use: Hyperaldosteronic state, adjunct to K+-wasting diuretics, anti-androgenic uses (e.g. female hirsutism), CHF S/E: Hyperkalemia, acidosis, anti-androgenic effects Note:

Question 51

Epleronone

Answer 51

Class: Aldosterone-receptor antagonist (K+-sparing diuretic) Use: Hyperaldosteronic state, adjunct to K+-wasting diuretics, CHF S/E: Hyperkalemia, acidosis Note:

Question 52

Amiloride

Answer 52

Class: Na-channel blockers (K+-sparing diuretic) Use: Adjunct to K+-wasting diuretics, lithium-induced nephrogenic diabetes insipidus (amiloride) S/E: Hyperkalemia, acidosis Note:

Question 53

Triamtrene

Answer 53

Same as Amiloride Class: Na-channel blockers (K+-sparing diuretic) Use: Adjunct to K+-wasting diuretics, lithium-induced nephrogenic diabetes insipidus (amiloride) S/E: Hyperkalemia, acidosis Note:

Question 54

-statins

Answer 54

Class: HMG-CoA Reductase Inhibitors Use: HLD (↓ LDL, VLDL, TG) S/E: Myalgia, myopathy, rhabdomyolysis, hepatotoxicity Note: CYP450 inhibitors enhance statin toxicity; gemfibrozil -> ↑ rhabdomyolysis Examples: Lovastatin, Simvastatin

Question 55

Cholestyramine

Answer 55

Class: Bile acid sequestrants Use: HLD (↓ LDL) S/E: ↑ VLDL & TGs, GI disturbance, malabsorption of lipid-soluble vitamins Note: Contraindicated w/ hypertriglyceridemia; interacts w/ PO drugs inc warfarin, thiazides, digoxin

Question 56

Cholestipol

Answer 56

Class: Bile acid sequestrants Use: HLD (↓ LDL) S/E: ↑ VLDL & TGs, GI disturbance, malabsorption of lipid-soluble vitamins Note: Contraindicated w/ hypertriglyceridemia; interacts w/ PO drugs inc warfarin, thiazides, digoxin

Question 57

Nicain

Answer 57

``` Vitamin B3 Class: Nicotinic acid-related Use: HLD (↓ LDL, VLDL; ↑ HDL) S/E: Flushing, pruritus, burning pain, hepatotoxicity Note: ```

Question 58

-fibrates

Answer 58

``` Class: Fibrates Use: HLD (↓ LDL, VLDL; ↑ HDL) S/E: Gallstones, mastitis Note:Binds PPARα to increase expression of LPL. LDL reduction modest (may increase in pts w/ combined HLDs), HDL ↑ in most patients. Used in hypertriglyceridemia Examples: Gemfibrozil Fenofibrate ```

Question 59

Ezetimibe

Answer 59

Class: Cholesterol absorption inhibitor Use: HLD (↓ LDL) S/E: GI distress Note:Prevents intestinal absorption of cholesterol

Question 60

Orlistat

Answer 60

Class: Pancreatic lipase inhibitor Use: Weight loss S/E: Steatorrhea, diarrhea, malabsorption of lipid-soluble vitamins Note: