Glossary of STEP 1: Cardiac Drugs
Created by evrigsby
- Digoxin increases ___ and slows ____.
This --> ____
- PARAsympathetic tone
conduction thru the AV node
Decrease in HR
- Side Effects of Digoxin:
- 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:
- ACE inhibitors:
The - OPRILS
- 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
Diabetes meds: increase w niacin
Hypertension meds: decrease with niacin
- 1. Niacin
"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)
- ____ 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
- Hydralazine, Minoxidil
Edema due to salt and water retention
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
- 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
"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
3. Uric Acid (Gout)
- 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 _____.
- 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 ______.
- Common side effects of nitrates
- HEADACHES and flushing
- If a pt has a history of:
1. Heart failure (lung crackles, pillows to sleep, dyspnea)
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
- 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 _______.
- 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
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"
- Alpha 1 blockers are the -" ______"
They can be used for _____ AND ____
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)
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