shosh: cardio drugs

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shosh114
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95219
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shosh: cardio drugs
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2011-07-27 10:44:13
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  1. Drug of choice in a diabetic with CHF
    ACE inhibitors
  2. Problem of using beta blockers in a diabetic
    Mask symptoms of hypoglycemia
  3. Hydralazine (mechanism, indication, side effects)
    • Preferentially vasodilates arterioles with a cGMP mediated mechanism
    • Drug of choice for hypertension in pregnancy, with methyldopa
    • Can cause drug-induced SLE
    • Give with a beta blocker to prevent reflex tachycardia
  4. Mechanism of minoxidil
    • Opens ATP-dependent K channels in vasculature and pancreatic beta cells
    • Prevents insulin release
  5. Nifedipine
    Blocks DHPR Ca channels in vasculature
  6. Verapamil, diltiazem
    • Block L-type Ca channels
    • Vasodilation and reduced conduction through the AV node
    • Diltiazem works on heart, not vasculature
  7. Main venous vasodilator, and its main side effect
    • Nitroglycerin--causes reflex tachycardia
    • Decreases preload
    • Spread out doses to prevent tolerance
  8. Drug of choice in hypertensive emergency
    Nitroprusside--arteriolar and venous dilation, via cGMP
  9. Toxicity of nitroprusside
    Cyanide poisoning--treat with thiosulfates and nitrites (increase concentration of methemoglobin, which preferentially binds to CN, and keeps it away from the ETC)
  10. Fenoldopam
    Dopamine agonist, relaxes renal vasculature
  11. Diazoxide
    K channel opener--hyperpolarizes and relaxes vascular SM. Also inhibits insulin release.
  12. Pindolol, acebutolol
    Partial beta blockers, contraindicated in angina
  13. Mechanism and side effects of statins
    • Inhibit HMG CoA reductase
    • Cause hepatotoxicity and rhabdomyolysis
  14. Mechanism and side effects of niacin
    • Inhibits VLDL release from the liver, increases HDL
    • Side effects include flushing, hyperglycemia, and hyperuricemia
  15. Mechanism of ezetimibe
    • Prevents cholesterol reabsorption at intestinal brush border
    • No major side effects (!!)
  16. Mechanism and side effects of fibrates
    • Upregulate lipoprotein lipase, increase triglyceride clearance
    • Side effects include myositis, hepatotoxicity, and cholesterol stones
  17. Mechanism of B1 receptors
    Gs proteins, increase intracellular cAMP, activate PKA. PKA phosphorylates Ca channels and phospholamban, which increase Ca concentration inside the cell, thereby increasing contractility
  18. Digoxin
    • Increases Ca concentration in the cardiac cells by inhibiting the Na/K ATPase. Also directly stimulates vagus, which slows heart rate.
    • Use to treat CHF and A fib
    • Causes blurry yellow vision
    • Hypokalemia and quinidine increase toxicity
  19. Name 3 class 1A antiarrhythmics, and their mechanism of action
    • Quinidine, procainamide, disopyramide
    • Block Na channels in the open conformation, decrease slope of phase zero
  20. Toxicity of quinidine
    • Cinchonism (headache, tinnitus, thrombocytopenia) when used in combination with digoxin.
    • Torsades des pointes (quinidine is also a muscarinic antagonist, so can trigger tachycardia)
  21. Major toxicity of procainide
    SLE
  22. Name three class 1B antiarrhythmics, and their mechanism of action. When are they used
    • Lidocaine, mexiletine, tocainide
    • Block in activated Na channels, and slow Na channels during action potential plateau (shorten plateau)
    • Use for ventricular arrhythmias, post-MI
  23. What class do flecainide, encainide, and propafenone belong to?
    1C antiarrhythmics--last resort drugs, don't use post-MI
  24. Name five class II antiarrhythmics and their mechanism of action
    • Propranolol, timolol, esmolol, metoprolol, atenolol
    • Inhibit adrenergic innervation in the AV node, decrease slope of phase 4 in the action potential
  25. Uses and side effects of class II antiarrhythmics
    • Drug of choice for SVT
    • Can cause impotence, exacerbate asthma, and mask signs of hypoglycemia
  26. Short acting beta blocker
    Esmolol
  27. Sotalol
    Class III antiarrhythmic, and beta blocker
  28. Ibutilide
    Class III antiarrhythmic
  29. Bretylium
    Class III antiarrhythmic
  30. Dofetilide
    Class III antiarrhythmic
  31. Amiodarone--class and toxicities
    • Class III antiarrhythmic
    • Can cause torsades, pulmonary fibrosis, and thyroid dysfunction. Blue-grey deposits in skin
  32. Two class IV antiarrythmics
    Verapmil, diltiazem--act on AV node
  33. Why should beta blockers not be given with verapamil?
    They can cause AV block
  34. Adenosine
    • Increases K efflux, hyperpolarizing the cell
    • Drug of choice for supraventricular tachycardia
    • Very short acting, but causes bronchospasm
    • Effects blocked by theophylline
  35. Bosentan
    • Blocks endothelin receptors, thereby inhibiting vasoconstriction
    • Use to treat pulmonary hypertension
  36. Clonidine, alpha methyldopa
    • Alpha 2 agonists, centrally inhibit sympathetic innervation
    • Use methyldopa for htn during pregnancy
    • Effects are blocked by tricyclic antidepressants
  37. Selective beta 1 blockers
    • Acebutalol
    • Betaxolol
    • Esmolol
    • Atenolol
    • Metoprolol
  38. Labetolol
    • Mixed alpha and beta antagonist
    • Decreases peripheral vascular resistance without triggering reflex tachycardia
  39. Noncompetitive nonselective alpha blocker
    Phenoxybenzamine

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