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Glossary of STEP 1: Cardiac Drugs

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Created by evrigsby

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

The "-OPRILS"

ACE inhibitors can be replaced with ____.
-Sartans

Sartans = ARBS
Angiotension receptor blockers


Good for:
HTN
Diabetes
Renal Dx


ACE inhibitors:
The - OPRILS
Class I Antiarrythmics block _____.

Ex that does NOT prolong QT interval:

Na channels
Propafenone
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 =
Niacin
______ can ______ insulin response, and _______ vasodialation.

Therefore, these adjustments should be made.

Niacin
Decreases insulin response
Increases vasodialation

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






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

"The Nice Pirate had to Hide his Cycle."




Selectively blocks active sodium channels
Lidocaine
Prolongs cardiac Action Potential
Disopyramide

"Disco Pyramid = LOOOONG night"

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

Can decrease the vasoconstrictive action of Norepinephrine

Decreases activity of platelet phosphodiesterase (2)

Also vasodialates

Cilostazol
Dipyridamole

Colistazol


____ Activates ____ receptors in renal vessels.
______ renal blood flow in ___ doses.
Dopamine
D1

Increases
Low



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)



-statins



Statin NOT broken down by P450 System
PARVAstatin
Macrolide that does NOT effect the P450 System
Azithromycin
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

In short, Na EFFLUX is DECREASED.
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
Amiodarone

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


Beta blockers work on these 2 cell types:
cardiac
Juxtaglomerular

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)
Eplerenone
Acts on Beta 1 AND 2 receptors

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

Isoproterenol

Vasodilation
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
Sotalol
bile acid resins (the "chol"s) tend to INCREASE serum ____ levels.

They are also known to cause ______ upset.

triglyceride

GI

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


Coumadin

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
"-AFIL"

Nitrates:
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

Aspirin

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

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 ______.

vasodilation
Phosphodiesterase

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
Cilostazol
Excessive Nitroprusside can lead to _____ toxicity.

To counter this, use compunds that contain ____.

Cyanide

Sulfur

(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.
Angioedema
Bradykinin

*Think swelling of tongue, lips, or eyelids


IV derivative of dopamine: _____

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


Fenoldopam

D1 receptors

Hypertensive emergencies



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

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 ____

-zosins

HTN and BPH

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)

Gallstones

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