Cardiology Meds

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arh3321
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178493
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Cardiology Meds
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2012-10-20 00:18:42
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cardiology
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Medication to treat cardiology
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  1. Antihypertensive drugs
    • Diuretics
    • Sympatholytics
    • ACE Inhibitors
    • Angiotensin
    • II Receptor Blockers (ARB)
    • Calcium Channel Blockers (CCB)
    • Additional Drugs
  2. Propranolol (what is and how it works)
    • Beta-Blocker (Non-selective)
    • blocks beta-1 receptors of heart-->decreases HR/contractility--> decreases BP.  (May also blocks beta-2 receptors of lungs)

    • Main uses:hypertension, angina, cardiac arrhythmias, post
    • myocardial infarction, hyperthyroidism
  3. Propranolol
    • ADR’s:Cardiac effects: bradycardia, heart failure, Bronchoconstriction(problem for asmatics)  CNS:depression, insomnia, nightmares Inhibit glycogenolysis of liver and muscle, hypoglycemia(tell diabetes pt to look for other signs of hypoglycemia), Tired or fatigue(transient)
    • (CNS ones and sexual dysfunction will go away w/time) 

    • Interactions with calcium channel blockers (also suppress cardiac function)
    • Precautions:Diabetes-blocks early warning signal of hypoglycemia(tachycardia) and promotes hypoglycemia, Cardiac disease, Asthma/COPD

    Monitor HR & BP
  4. Nadolol (What it is and how it works)
    Beta-Blocker (Non-selective)blocks beta-1 receptors of heart-->decreases HR/contractility--> decreases BP.  (May also blocks beta-2 receptors of lungs)

    Main uses:hypertension, angina, cardiac arrhythmias, postmyocardial infarction, hyperthyroidism
  5. Nadolol
    • ADR’s:
    • Cardiac effects: bradycardia, heart failure, Bronchoconstriction(problem for asmatics)  CNS:depression, insomnia, nightmares Inhibit glycogenolysis of liver and muscle, hypoglycemia(tell diabetes pt to look for other signs of hypoglycemia), Tired or fatigue(transient)(CNS ones and sexual dysfunction will go away w/time) 

    Interactions with calcium channel blockers (also suppress cardiac function)

    Precautions:Diabetes-blocks early warning signal of hypoglycemia(tachycardia) and promotes hypoglycemia, Cardiac disease, Asthma/COPD

    Monitor HR & BP
  6. Metoprolol (What it is and how it works)
    Beta-blockers (Selective)

    Mechanism of action: blocks only beta-1 receptors of heart --> decrease BP (decreases HR)

    No bronchoconstriction at lower doses (so okay for asthmatics to a degree; may lose selectivity at higher doses)

    Does not inhibit glycogen breakdown (so okay for diabetics)
  7. Atenolol
    • Beta-blockers (Selective)
    • Mechanism of action: blocks only beta-1 receptors of heart --> decrease BP (decreases HR)

    No bronchoconstriction at lower doses (so okay for asthmatics to a degree; may lose selectivity at higher doses)

    Does not inhibit glycogen breakdown (so okay for diabetics)
  8. Labetalol (Normodyne®, Trandate®) (how it works and uses)
    Alpha/Beta blockers

    Mechanism of action: blocks alpha-1 receptors of vessels and beta receptors (beta 1&2) of heart-->decrease BP

    Main use: hypertension
  9. Labetalol (Normodyne®, Trandate®)
    Main ADR: orthostatic hypotension(b/c alpha 1-->vasodilation); slow HR

     Do not use for asthmatics (b/c beta 2)


    First dose response- Give at bedtime
  10. Carvedilol
    (Coreg®) (how works and uses)
    Alpha/Beta blockers

    Mechanism of action: blocks alpha-1 receptors of vessels and beta receptors (beta 1&2) of heart-->decrease BP

    Main use: hypertensionMain
  11. Carvedilol(Coreg®)
    ADR: orthostatic hypotension(b/c alpha 1-->vasodilation); slow HR 

    Do not use for asthmatics (b/c beta 2)

    First dose response-Give at bedtime
  12. Terazosin (Hytrin)(how it works and uses)
    Alpha-1 Blockers

    Main use: Hypertension and BP
  13. Terazosin (Hytrin)
    ADR’s: Hypotension, Nasal congestion(use alpha agonist which is vasoconstrictor), Sexual dysfunction (retrograde ejaculation)

    First dose response-take at bedtime
  14. Doxazosin (Cardura) (how it works and uses)
    • Alpha-1 Blockers
    • Main use: Hypertension and BP
  15. Doxazosin (Cardura)
    ADR’s: Hypotension, Nasal congestion(use alpha agonist which is a vasoconstrictor), Sexual dysfunction (retrograde ejaculation)

    First dose response-take at bedtime
  16. Clonidine (Catapres®) (how it works and uses)
    Alpha-2 agonist (centrally acting)

    Mechanism of action: stimulates alpha-2 receptors in CNS-->suppress SNS-->decrease BP (b/c norepinephrine)

    Main use: hypertension
  17. Clonidine (Catapres®)
    ADR’s: Rebound hypertension (avoid by discontinuing slowly), Drowsiness, Fatigue(dont operate heavy mech), dry mouth(hard candy), constipation, impotence

    Can be very sedating (take at bedtime)

    change patch every 7 days

    HTN crisis- give orally

    0.1-0.2 mg
  18. Captopril (Capoten®)(how works and uses)
    ACE inhibitors

    Mechanism of action: block ACE -->decrease production of angiotensin II -->decrease BP

    Main uses: Hypertension, Heart failure,To decrease mortality after MI, Diabetic and non-diabetic renal disease, Prevent MI/stroke/death in those at high risk
  19. Captopril (Capoten®)
    • ADR’s:Dry hacking cough (~ 5%, most common reason to d/c and start ARBS instead), First-dose hypotension, Hyperkalemia(can cause arrhythmias), Renal failure (okay to use if one kidney), Angioedema-rare but potentially fatal
    • **swelling of tongue and face medical emergency- stop meds, give Benedryl, steroid, or epinephrine, and never give ACE inhibitor or ARBS again.

    Drug interactions: Drugs that lower BP, Drugs that increase potassium, Lithium

    Contraindications: Dont use in pregnancy 

    Monitor K

    stay hydrated- dehyrdation can cause renal failure

    dont take salt substitute b/c na=K-->hyperkalemia

    For microalbuminemia in diabetes
  20. Enalapril (Vasotec) (how works and uses)
    ACE inhibitorsMechanism of action: block ACE -->decrease production of angiotensin II -->decrease BP

    Main uses: Hypertension, Heart failure,To decrease mortality after MI, Diabetic and non-diabetic renal disease, Prevent MI/stroke/death in those at high risk
  21. Enalapril (Vasotec)
    ADR’s:Dry hacking cough (~ 5%, most common reason to d/c and start ARBS instead), First-dose hypotension, Hyperkalemia(can cause arrhythmias), Renal failure (okay to use if one kidney), Angioedema-rare but potentially fatal

    **swelling of tongue and face medical emergency- stop meds, give Benedryl, steroid, or epinephrine, and never give ACE inhibitor or ARBS again.

    Drug interactions: Drugs that lower BP, Drugs that increase potassium, Lithium

    Contraindications: Dont use in pregnancy 

    Monitor K

    stay hydrated- dehyrdation can cause renal failure

    dont take salt substitute b/c na=K-->hyperkalemia

    For microalbuminemia in diabetes
  22. Benazepril
    (Lotensin®) (how it works and uses)
    ACE inhibitors

    Mechanism of action: block ACE -->decrease production of angiotensin II -->decrease BP

    Main uses: Hypertension, Heart failure,To decrease mortality after MI, Diabetic and non-diabetic renal disease, Prevent MI/stroke/death in those at high risk
  23. Benazepril(Lotensin®)
    ADR’s:Dry hacking cough (~ 5%, most common reason to d/c and start ARBS instead), First-dose hypotension, Hyperkalemia(can cause arrhythmias), Renal failure (okay to use if one kidney), Angioedema-rare but potentially fatal

    **swelling of tongue and face medical emergency- stop meds, give Benedryl, steroid, or epinephrine, and never give ACE inhibitor or ARBS again.

    Drug interactions: Drugs that lower BP, Drugs that increase potassium, Lithium

    Contraindications: Dont use in pregnancy

     Monitor K

    stay hydrated- dehyrdation can cause renal failure

    dont take salt substitute b/c na=K-->hyperkalemia

    For microalbuminemia in diabetes
  24. Losartan (Cozaar) (uses and how works)
    Angiotensin II Receptor Blockers (ARBS)

    blocks the actions of angiotensin II 

    Main use: hypertension and heart failure
  25. Losartan (Cozaar)
    • ADR’s: Hyperkalemia (less than ACEI), Angioedema, Renal
    • failure(can give if have one kidney)

    Dont use in pregnancy

    Monitor K and SrC, urinalysis, albumin, bilirubin

    Given when cough is seen in ACE inhibitors
  26. Olmesartan (Benicar) (how works and uses)
    Angiotensin II Receptor Blockers (ARBS)

    blocks the actions of angiotensin II 

    Main use: hypertension and heart failure
  27. Olmesartan (Benicar)
    ADR’s: Hyperkalemia (less than ACEI), Angioedema, Renalfailure(can give if have one kidney)

    Dont use in pregnancy

    Monitor K and SrC, urinalysis, albumin, bilirubin

    Given when cough is seen in ACE inhibitors
  28. Verapamil (Calan®) (how works and uses)
    CCA act on peripheral vascular smooth muscle (VSM) and heart (slows HR and decreases BP) (acts like beta blockers)

    Block calcium channels of VSM --->vasodilation -->decrease in BP

    Block calcium channels of heart that regulate heart muscle, pacemaker of SA node, and conduction through AV node-->decrease in heart rate and conduction-->decrease in BP

    • Main uses: Hypertension, Angina, Cardiac
    • dysrhythmias
  29. Verapamil (Calan®)
    ADR’s: Constipation, Hypotension, Bradycardia (if HR slows too much put on another agent)

    Drug interactions: Digoxin(also has cardiac effects), Verapamil(may increase digoxin levels), Beta-blockers(also decrease HR and conduction)

    Dont give to HF pts b/c can worsen HF
  30. Diltiazem (Cardizem®) (how works and uses)
    CCA act on peripheral vascular smooth muscle (VSM) and heart (slows HR and decreases BP) (acts like beta blockers)

    Block calcium channels of VSM --->vasodilation -->decrease in BP

    Block calcium channels of heart that regulate heart muscle, pacemaker of SA node, and conduction through AV node-->decrease in heart rate and conduction-->decrease in BP

    Main uses: Hypertension, Angina, Cardiacdysrhythmias
  31. Diltiazem (Cardizem®)
    ADR’s: Hypotension, Bradycardia (if HR slows too much put on another agent)

    Drug interactions: Digoxin(also has cardiac effects), Verapamil(may increase digoxin levels), Beta-blockers(also decrease HR and conduction)

    Dont give to HF pts b/c can worsen HF
  32. Nifedipine (Procardia®) (how it works and uses)
    Mechanism of action: blocks calcium channels of VSM-->vasodilation-->decreases BP (doesn't slow HR)

    Main uses: Hypertension, Angina
  33. Nifedipine (Procardia®)
    ADR’s: Reflex tachycardia- combined with a beta- blocker to counteract (r/t barocepter), Hypotension, Edema(duiretics sometimes used), 



    Monitor weight (b/c edema)
  34. Amlodipine
    (Norvasc®) (how works and uses)
    Mechanism of action: blocks calcium channels of VSM-->vasodilation-->decreases BP (doesn't slow HR)

    Main uses: Hypertension, Angina
  35. Amlodipine(Norvasc®)
    ADR’s: Reflex tachycardia- combined with a beta- blocker to counteract (r/t barocepter), Hypotension, Edema(duiretics sometimes used),
  36. Hydralazine
    (Apresoline®)(how works and uses)
    Dilates arterioles only

    Main use: hypertensive crisis

    3rd or 4th line 
  37. Hydralazine(Apresoline®)
    ADR’s: Lupus-like syndrome(joint pain, fever, monitor CBC), Reflex tachycardia- combine with a beta-blocker

    MOnitor CBCS (infection)

    Lupus like syndrome goes away after drug is stopped
  38. Minoxidil (Loniten®) (How is works and uses)
    Dilates arterioles only

    • Use: severe hypertension refractory to safer drugs, topical
    • minoxidil (Rogaine®) is used to promote hair growth
  39. Minoxidil (Loniten®)
    ADR’s: Hypertrichosis(hair growth), Significant water/retention (combine with diuretic), Reflex tachycardia (combine with a beta-blocker)
  40. Nitroprusside (Nitropress®) (how it works and uses)
    dilates arterioles and veins 

    Main use: hypertensive crisis

    similar to nitroglycerin
  41. Nitroprusside (Nitropress®)
    • ADR’s: Rarely, cyanide poisoning can occur(usualy if used for sign. amount of time).  More common
    • in liver disease.  Infuse slowly and coadminister
    • thiosulfate.

    Fasting acting hypertensive available

    can decrease BP quickly

    Can only be on for 24 hours

    Antedote= Sodium Thiocyanate
  42. Antihypertenisves used in Diabetes
    ACEI’s, ARB’s, CCB’s, low dose diuretics
  43. Antihypertensives used in renal disease
    ACEI’s, ARB’s
  44. Antihypertensives used for MI
    beta-blockers, ACEI’s, potassium-sparing diuretic
  45. Duiretics used for AA
    thiazide diuretics

    Beta-blockers, ACE inhibitors less effective
  46. Elderly can take 
    beta-blockers or thiazide diuretics
  47. Nitroglycerin (how works)
    Treats Angina Pectoris

    Primary mech. of action: directly dilates veins--> decreases venous return to heart and ventricular filling (preload)-->decreases oxygen demand of heart (lowers BP and vasodilates) 

    Effective; fast-acting; inexpensive
  48. Nitroglycerin
    ADR’s: (all due to vasodilation) Headache(take tylenol), Orthostatic hypotension,Tachycardia

    Important drug interactions: Antihypertensives, Viagra®
  49. Long acting Nitroglycerin
    • for long-term prophylaxis:
    • Sustained-release
    • oral tablets/capsules
    • Transmucosal tablets
    • Topical ointments
    • Transdermal
    • IV administration (when nothing else works)

    Do slow to avoid vasospasm

    intermittent schedule that allows at least 8 hours of drug-free hours each day

    Should use lowest effective dose 
  50. Short term Nitroglycerin
    for acute attacks and prophylaxis prior to exertion:

    • Sublingual tablets
    • Translingual spray
    • Transmucosal tablets
  51. Heart failure Drugs
    Drugs that inhibit RAAS:ACE Inhibitors, ARBS, Aldosterone, antagonists (spironolactone)

    Beta-blockers(selective)

    Diuretics

    Inotropic agents: Digoxin
  52. Digoxin (how works and uses)
    Used for Heart Failure

    Inotropic agent

    • Mechanism of action: increases force of ventricular
    • contractions-->increases CO-->decreases signs and symptoms of CHF.

    A cardiac glycoside

    • Main uses: Second-line drug for heart failure(Used with
    • ACEI’s, beta-blockers, diuretics if inadequate response),Dysrhythmias(A-fib)
  53. Digoxin
    Most significant ADR: cardiac dysrhythmias (Most commonly due to hypokalemia from diuretic use)

    Theraputic level= <1 but up to 2 (low TI so monitor)

    mortality associated with women

    used to treat arrhythmia but can also cause

    • Non-cardiac ADR’s (which usually precede cardiac
    • dysrhythmias):
    • GI:anorexia, nausea, vomiting
    • CNS: fatigue, visual disturbances (blurred vision, yellow-tinged vision, halos around objects)

    drug interactions:Thiazide and loop diuretics (cause hypokalemia which may increase digoxin level)

    Extreme overdose: give Digibind
  54. Dopamine
    Used for HR

    Inotropic Drugs

    Mechanism: a catecholamine that activates receptors of sympathetic nervous system

    • oBeta-1 receptors in heart- increases CO
    • oDopamine receptors in kidney, 
    • oAlpha-1 of vessels at high doses

    Main use: rescue drug for severe heart failure

    Administered: only IV, constant monitoring
  55. Dobutamine
    Inotropic Drug

    Mechanism: a synthetic catecholamine that activates only beta-1 receptors

    Main use: rescue drug for severe heart failure
  56. Drugs for Hypercholesterolemia
    • oHMG-CoA Reductase Inhibitors (“Statins”)
    • oBile-Acid Sequestrants
    • oNicotinic Acid
    • oFibrates
    • oOthers: Ezetimibe (Zetia®)
  57. Atorvastatin (Lipitor) (how works and uses)
    Used for hypercholesterolemia (to reduce cholestrol)

    Mechanism of action: inhibit HMG- CoA reductase in liver to decrease cholesterol synthesis à liver cells make more enzyme and more LDL receptors -->more LDL removed from blood

    Reduces LDL, VLDV and increases HDL
  58. Atorvastatin (Lipitor)
    ADR:Hepatotoxicity, Myositis, Rhabdomyolysis

    DO NOT use in pregnancy (cat X)

    monitor LFT, AST, ALT (b/c hepatotoxicity), monitor CK or CPK(b/c rhabdomyolysis)

    Keep hydrated
  59. simvastatin (Zocor) (uses and how works)
    Used for hypercholesterolemia (to reduce cholestrol)

    Mechanism of action: inhibit HMG- CoA reductase in liver to decrease cholesterol synthesis à liver cells make more enzyme and more LDL receptors -->more LDL removed from blood

    Reduces LDL, VLDV and increases HDL
  60. simvastatin (Zocor)
    ADR:Hepatotoxicity, Myositis, Rhabdomyolysis

    DO NOT use in pregnancy (cat X)

    monitor LFT, AST, ALT (b/c hepatotoxicity), monitor CK or CPK(b/c rhabdomyolysis)

    Keep hydrated
  61. Cholestyramine (Questran®)(how works and uses)
    Bile-acid sequestrant

    • Mechanism of action: bind to bile acids in gut and prevent
    • reabsorption-->liver makes more bile acids out of LDL-->liver increases LDL receptors--> increases LDL uptake -->decreases LDL

    Main use: decrease LDL (want LDL <100)
  62. Cholestyramine (Questran®)
    • ADR’s: Limited to GI tract: constipation, gas, cramping
    • No systemic effects because not absorbed 
    • **Interfere with absorption of fat-soluble vitamins(A,E,K)

    Dont work as well as statins-use if not too high choles. or cant take statin

    *Give at separate time than other meds b/c binds to other meds
  63. Colestipol (Colestid®)(how works and uses)
    Bile-acid sequestrant

    Mechanism of action: bind to bile acids in gut and preventreabsorption-->liver makes more bile acids out of LDL-->liver increases LDL receptors--> increases LDL uptake -->decreases LDL

    Main use: decrease LDL (want LDL <100)
  64. Colestipol (Colestid®)
    • ADR’s: Limited to GI tract: constipation, gas, cramping
    • No systemic effects because not absorbed
    •  **Interfere with absorption of fat-soluble vitamins(A,E,K)

    Dont work as well as statins-use if not too high choles. or cant take statin

    *Give at separate time than other meds b/c binds to other meds
  65. Welchol® (Colesevelam)(how it works and uses)
    Bile-acid sequestrant (newer)

    Mechanism of action: bind to bile acids in gut and preventreabsorption-->liver makes more bile acids out of LDL-->liver increases LDL receptors--> increases LDL uptake -->decreases LDL

    Main use: decrease LDL (want LDL <100)
  66. Welchol® (Colesevelam)
    • ADR’s: Limited to GI tract: constipation(causes less than older BS), gas, cramping
    • No systemic effects because not absorbed

    Dont work as well as statins-use if not too high choles. or cant take statin

    *Give at separate time than other meds b/c binds to other meds

    Has fewer drug interactions than older BS
  67. Nicotinic Acid (Niacin) (how it works and uses)
    • Mechansim of action: decreases production of VLDL by
    • decreasing fat breakdown in adipose tissue-->decreases LDL

    Uses:Decreases LDL and VLDL; increases HDL
  68. Nicotinic Acid (Niacin)
    CommonADR’s: Flushing/itching of skin( pre-treat with aspirin), Nausea/vomiting,diarrhea *Hepatotoxic,*Hyperglycemia

    Monitor AST, ALT (b/c hepatatoxicity), Blood Sugar(hyperglycemia)*careful in diabetic pts

    Cheap!

    Can increase Uric acid *monitor gout pts
  69. Fenofibrate (tricor)(how works and uses)
    Fibrate

    Mechanism of action: activate PPARs of liver and adipose which leads to increased clearance of VLDLs (triglycerides) and increased formation of HDL

    Uses:Most effective drugs for lowering triglycerides (dont use to decrease LDL)
  70. Fenofibrate (tricor)
    Common ADR: rash, nausea diarrhea

    Significant but less common ADR’s: Gallstones, Myopathy--> rhabdomyolysis and hepatotoxicity

    Drug interactions: Statins (also associated with myopathy)
  71. Gemfibrozil (Lopid)(how works and uses)
    Fibrate

    Mechanism of action: activate PPARs of liver and adipose which leads to increased clearance of VLDLs (triglycerides) and increased formation of HDL

    Uses:Most effective drugs for lowering triglycerides (dont use to decrease LDL)
  72. Gemfibrozil (Lopid)
    Common ADR: rash, nausea diarrhea

    Significant but less common ADR’s: Gallstones, Myopathy--> rhabdomyolysis and hepatotoxicity

    Drug interactions: Statins (also associated with myopathy)
  73. Fenofibric acid (Trilipix)(how works and uses)
    Fibrate

    Mechanism of action: activate PPARs of liver and adipose which leads to increased clearance of VLDLs (triglycerides) and increased formation of HDL

    Uses:Most effective drugs for lowering triglycerides (dont use to decrease LDL)
  74. Fenofibric acid (Trilipix)
    Common ADR: rash, nausea diarrhea

    Significant but less common ADR’s: Gallstones, Myopathy--> rhabdomyolysis and hepatotoxicity

    Drug interactions: Statins (also associated with myopathy)
  75. Ezetimibe (Zetia®)(how it works and uses)
    New class of drug for high cholesterol

    • Mechanism of action: inhibits cholesterol absorption in small
    • intestine

    Uses:Decreases LDL, Decreases triglycerides, Increases HDL

    ADR’s: Well-tolerated
  76. Hypoglycemia
    diploplia, tachycardia, HA, hungry, sweating, tingling or numbness, weakness, trouble sleeping, aggitation

    below ~70 is considred low

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