Glossary of STEP 1: Cardiac Drugs

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Digoxin increases ___ and slows ____.
This --> ____
PARAsympathetic tone
conduction thru the AV node
Decrease in HR

Side Effects of Digoxin:

Most important:

N/V, stomach discomfort, COLOR/VISION changes, HYPERKALEMIA

Hyperkalemia is the most dangerous --> VFib

COUGH = ____
ACE inhibitors


ACE inhibitors can be replaced with ____.

Sartans = ARBS
Angiotension receptor blockers

Good for:
Renal Dx

ACE inhibitors:
Class I Antiarrythmics block _____.

Ex that does NOT prolong QT interval:

Na channels
B/C of their effect on the kidneys, ____ can lead to renal underperfusion, which presents as _____ and ____.
ACE inhibitors

Creatine incerases, myalgias may ensue

Do NOT use ACE inhibitors on pts with ______.
Renal Artery Stenosis
Warmth, Flushing + Itchiness =
______ can ______ insulin response, and _______ vasodialation.

Therefore, these adjustments should be made.

Decreases insulin response
Increases vasodialation

Diabetes meds: increase w niacin
Hypertension meds: decrease with niacin

Think __(4)____
1. Niacin
2. Pyrizinamide
3. Hydrochlorothiazide
4. Cyclosporin

"The Nice Pirate had to Hide his Cycle."

Selectively blocks active sodium channels
Prolongs cardiac Action Potential

"Disco Pyramid = LOOOONG night"

Slows conduction through the AV node AND increases intracellular Ca++ (= increased contractility)
ACE inhibitors decrease GFR by ____.
DILATING the Efferent arteriole
Should be monitored in connection with LUPUS and DEPRESSION
Treatment for claudication
Phenoxybenzamine MOA:
Antagonist if a1/2 receptors

Can decrease the vasoconstrictive action of Norepinephrine

Decreases activity of platelet phosphodiesterase (2)

Also vasodialates



____ Activates ____ receptors in renal vessels.
______ renal blood flow in ___ doses.


At moderate doses, Dopamine _____ cardiac contractility and increases _____ pressure.
increases, systolic

It has little effect on diastolic.

Therefore, at moderate doses, dopamine increases CO

At high doses, dopamine activates ___ and ____.
a1 receptors, causing vasoconstriction and increasing afterload = decrease in CO
______ inhibit CytP450 and cannot be used with ____ or ____.
Macrolides (=thromycins)
Warfarin or -statins

can cause myopathies and RHABDOMYOLYSIS (=renal issues)


Statin NOT broken down by P450 System
Macrolide that does NOT effect the P450 System
Combo that causes increased myopathy
Statins + Fibrates

Statins are known to cause elevated creatine, and fibrates exacerbate the effects of statins

Nitrate with highest ORAL bioavailability
Isosorbite MONOnitrate
Arteriolar (only) Dilators

Possible problem?

Hydralazine, Minoxidil

Edema due to salt and water retention
Reflex tachycardia

Lowered BP activates renin system and the kidneys end up retaining salt. it also stimulates an increase in HR to maintain CO

Heart Drug toxicity with color vision change, think _____ and then ____.
Digoxin --> ARRYTHMIA due to hyperkalemia
K Sparing Diuretics

Must be careful when used with _____ because of elevated K levels

Amiloride, Spironolactone, Triamterene

-ACE inhibitors

Digoxin in hibits _____ , which leads to ______.
Na/K ATPase, increased CO and decreased Rt Atrial Pressure

This causes the Na/Ca++ exchanger to shut down, and Ca++ stays INSIDE the cell increasing contractile force

Prolongs QT interval via its influence on K channels WITHOUT increasng the risk of Torsades de Pointes

"Amy likes it longer, but not backwards"

These vasoconstrictors are a-agonists that can be used for Rhinitis.

However, if overused, ____ can occur because ___ is depleted from the nerve terminals.

Phenylephrine + the "-ZOLINS"

tachyphylaxis occurs when norepinephrine is depleted

Thiazides INCREASE:
1. Cholesterol
2. Ca++
3. Uric Acid (Gout)
4. Triglycerides

Beta blockers work on these 2 cell types:

Their work in the kidneys inhibit catecholamine induced RENIN release

Treatment for aldosterone secreting tumor
(Note: BP will be very elevated with LOW RENIN levels = tumor)
Acts on Beta 1 AND 2 receptors

This means that at low doses, B2 activity leads to ________ and at higher doses, B1 activity increases _____.


Cardiac Contractility

Norepinephrine 2nd messengers:

a1: ____ --> _____
a2: ____ --> ______
b1: _____ --> _____

a1: IP3 increase -->vasoconstriction
a2: cAMP decrease--> decrease NE and insulin
b1: cAMP increase -->increased heart contractility

ONly class 3 antiarrythmic that prolongs QT AND DECREASES HR
bile acid resins (the "chol"s) tend to INCREASE serum ____ levels.

They are also known to cause ______ upset.



Vignette: A pt being treated for high cholesterol has mentioned stomach ache and labs show high triglycerides

These drugs can counter the reflex tachycardia that may occur when nitrates are administered.
B Blockers
Warfarin = ______
It blocks _____ dependent clotting factors: ______

When Warfarin is administered, the ____ must be monitored closely


Vitamin K: 10,9,7,2

PT: Prothrombin Time

Phosphodiesterase inhibitors are used in _____. They all end in ____.

Be careful when used with ____ because they can have compounding effects.

Erectile Disfunction

Nitrates increase cGMP levels and Phosphodiesterase inhibitors prevent cGMP breakdown --> too much cGMP
--> PROFOUND hypotension (60/40)

______ can cause warmth and skin flushing via activation of ______.

This reaction can be decreased if the pt takes ____ about 30min before each dose.

Niacin, prostaglandins


NO is beneficial to the heart because it decreases ____ by increasing _____.
blood storage in large VEINS
_______ causes peripheral vasodilation which can lead to reflex ____.

Techycardia: this is the drug of choice in a pt with hypertension and a LOW HR

increases in cAMP cause _____ in vasculature. This process can be implemented with _______ inhibitors.

In the heart these drugs cause ______.


Increased contractility.

Common side effects of nitrates
HEADACHES and flushing
If a pt has a history of:
1. Heart failure (lung crackles, pillows to sleep, dyspnea)
2. MI
3. HTN

Suggest _____ as FIRST line.

ACE inhibitors - they are the only drug known to decrease heart remodeling that leads to cardiac hypertrophy.

Trick: do not be fooled by diuretics in the question stem due the presence of lung crackles.

Dobutamine increases cardiac contractility, which can be useful.
What are some other effects that can be counterproductive? (2)

These effects are due to its effects on ____receptors.

1. Increases HR = increased heart O2 consumption
2. Increased conduction velocity = arrythmias

B1 receptors

drug that blocks platelet aggregation AND vasodialates
Excessive Nitroprusside can lead to _____ toxicity.

To counter this, use compunds that contain ____.



(pts will present to ER with extreme hypertension, and after the drug is administered will be confused and disoriented)

A secondary effect of ACE inhibitors can be _______.
It is thought to be caused by ____accumulation.

*Think swelling of tongue, lips, or eyelids

IV derivative of dopamine: _____

Works via _____ receptors to cause vasodilation.
Useful in _______.


D1 receptors

Hypertensive emergencies

Vignette with this phrase: "arterialization of the RT ventricle" = ______

Mother with bipolar disorder takes lithium and causes heart problems in fetus

First dose hypotension is a risk factor for _______.

_______ can exacerbate this effect making it dangerous to pair these 2 drugs types.

ACE inhibitors

Thiazide diuretics

These cause hyponatremia and hypovolemia which increase the chances of hypotension

These 2 drug types are known to slow the progression of diabetic neuropathy
ACE inhibitors ("-oprils"
ARBS ("-sartans")
Alpha 1 blockers are the -" ______"

They can be used for _____ AND ____



Man over 50 comes in with HTN and problems urinating: the answer is a zosin

These two drug classes increase the cholesterol content of bile: _______

This could lead to ______.

Fibrates and Bile resins (-chol's)


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