-
Drug of choice in a diabetic with CHF
ACE inhibitors
-
Problem of using beta blockers in a diabetic
Mask symptoms of hypoglycemia
-
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
-
Mechanism of minoxidil
- Opens ATP-dependent K channels in vasculature and pancreatic beta cells
- Prevents insulin release
-
Nifedipine
Blocks DHPR Ca channels in vasculature
-
Verapamil, diltiazem
- Block L-type Ca channels
- Vasodilation and reduced conduction through the AV node
- Diltiazem works on heart, not vasculature
-
Main venous vasodilator, and its main side effect
- Nitroglycerin--causes reflex tachycardia
- Decreases preload
- Spread out doses to prevent tolerance
-
Drug of choice in hypertensive emergency
Nitroprusside--arteriolar and venous dilation, via cGMP
-
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)
-
Fenoldopam
Dopamine agonist, relaxes renal vasculature
-
Diazoxide
K channel opener--hyperpolarizes and relaxes vascular SM. Also inhibits insulin release.
-
Pindolol, acebutolol
Partial beta blockers, contraindicated in angina
-
Mechanism and side effects of statins
- Inhibit HMG CoA reductase
- Cause hepatotoxicity and rhabdomyolysis
-
Mechanism and side effects of niacin
- Inhibits VLDL release from the liver, increases HDL
- Side effects include flushing, hyperglycemia, and hyperuricemia
-
Mechanism of ezetimibe
- Prevents cholesterol reabsorption at intestinal brush border
- No major side effects (!!)
-
Mechanism and side effects of fibrates
- Upregulate lipoprotein lipase, increase triglyceride clearance
- Side effects include myositis, hepatotoxicity, and cholesterol stones
-
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
-
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
-
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
-
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)
-
Major toxicity of procainide
SLE
-
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
-
What class do flecainide, encainide, and propafenone belong to?
1C antiarrhythmics--last resort drugs, don't use post-MI
-
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
-
Uses and side effects of class II antiarrhythmics
- Drug of choice for SVT
- Can cause impotence, exacerbate asthma, and mask signs of hypoglycemia
-
Short acting beta blocker
Esmolol
-
Sotalol
Class III antiarrhythmic, and beta blocker
-
Ibutilide
Class III antiarrhythmic
-
Bretylium
Class III antiarrhythmic
-
Dofetilide
Class III antiarrhythmic
-
Amiodarone--class and toxicities
- Class III antiarrhythmic
- Can cause torsades, pulmonary fibrosis, and thyroid dysfunction. Blue-grey deposits in skin
-
Two class IV antiarrythmics
Verapmil, diltiazem--act on AV node
-
Why should beta blockers not be given with verapamil?
They can cause AV block
-
Adenosine
- Increases K efflux, hyperpolarizing the cell
- Drug of choice for supraventricular tachycardia
- Very short acting, but causes bronchospasm
- Effects blocked by theophylline
-
Bosentan
- Blocks endothelin receptors, thereby inhibiting vasoconstriction
- Use to treat pulmonary hypertension
-
Clonidine, alpha methyldopa
- Alpha 2 agonists, centrally inhibit sympathetic innervation
- Use methyldopa for htn during pregnancy
- Effects are blocked by tricyclic antidepressants
-
Selective beta 1 blockers
- Acebutalol
- Betaxolol
- Esmolol
- Atenolol
- Metoprolol
-
Labetolol
- Mixed alpha and beta antagonist
- Decreases peripheral vascular resistance without triggering reflex tachycardia
-
Noncompetitive nonselective alpha blocker
Phenoxybenzamine
|
|