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150 Cards in this Set

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Carbonic Anhydrase Inhibitor
Diuretic Agent

Inh CA (proximal tubule) → ↓ bicarb reabsorption, ↑ Na excretion (↓H+ IC), so ↑ K exc.
Alkalinizes urine, hyper-Cl, hypo-K, metabolic acidosis, ↓ aqueous humor
Tx: met alkalosis, acute mtn sickness, glaucoma, alkalinize urine
CI: cirrhosis
Effective for only a few days
Acetazolamide
Diuretic Agent

Carbonic Anhydrase Inhibitor

Oral
Brinzolamide
Diuretic Agent

Carbonic Anhydrase Inhibitor

Topical
Dorzolamide
Diuretic Agent

Carbonic Anhydrase Inhibitor

Topical
Loop Diuretic (25% of Na)
Diuretic Agent

Block NaK2Cl cotransport (thick asc. loop) → ↑Na, K, Mg, Ca, H+ excretion
Hypo-K, hypo-Cl, metabolic alkalosis, ototoxic, heavy diuresis
Tx: CHF, pulm edema, acute renal failure, hyper-K, hyper-Ca
CI: avoid NSAIDs,

Oral
Furosemide (Lasix)
Diuretic Agent

Loop Diuretic (25% of Na)
Torsemide
Diuretic Agent

Loop Diuretic (25% of Na)

Lower dose
Bumetanide
Diuretic Agent

Loop Diuretic (25% of Na)

Lower dose
Ethacrynic Acid
Diuretic Agent

Loop Diuretic (25% of Na)

Most ototoxic, non-sulfa
Thiazide Diuretic and related (5% of Na)
Diuretic Agent

Inh Na reabsorption (distal diluting site) → ↑Na, K, Cl excretion, Ca sparing
Hypo-K, met alkalosis, Ca sparing (↓ stones), hyperglycemia, hyperlipidemia, hyperuricemia, liver metabolism
Tx: HTN, CHF, nephrogenic D. insipidus
CI: avoid NSAIDs

Oral
Hydrochlorothiazide
Diuretic Agent

Thiazide Diuretic and related (5% of Na)

DOC: HTN
Chlorthalidone
Diuretic Agent

Thiazide Diuretic and related (5% of Na)

Slower absorption, longer duration
Metolazone
Diuretic Agent

Thiazide Diuretic and related (5% of Na)

Diuresis in patients w/reduced GFR
Indapamide
Diuretic Agent

Thiazide Diuretic and related (5% of Na)

less metabolic complications, CCB like effects
Potassium Sparing Diuretic
Diuretic Agent

Inh Na/K exchange (collecting ducts) → ↑Na excretion, K sparing
Hyper-K, acute renal failure
Tx: CHF, combined with K losing drugs, cirrhosis
CI: Hyper-K

Oral
Triamterene
Diuretic Agent

Potassium Sparing Diuretic
Amiloride
Diuretic Agent

Potassium Sparing Diuretic
Aldosterone Antagonists
Diuretic Agent

Potassium Sparing Diuretic

inh. Aldosterone receptors in distal/collecting duct
Spironolactone
Diuretic Agent

Potassium Sparing Diuretic

increased survival in CHF, gynecomastia
Eplerenone
Diuretic Agent

Potassium Sparing Diuretic

Increase survival in CHF, decreased endocrine SE's, CYP3A4 met
Osmotic Diuretic - IV
Diuretic Agent

Increased osmotic activity, water retention (prox, loop, CD) (freely filterable agents)
Dehydration, hyper-Na
CI: severe CHF (early over-expansion of intravascular space)
Mannitol
Diuretic Agent

Osmotic Diuretic

↓ intracranial pressure, neuro-sx prophylaxis
Isosorbide
Diuretic Agent

Osmotic Diuretic
Glycerin
Diuretic Agent

Osmotic Diuretic
Urea
Diuretic Agent

Osmotic Diuretic
ADH Antagonist
Diuretic Agent

↑ permeability in CD
Demeclocycline
Diuretic Agent

ADH Antagonist
Lithium
Diuretic Agent

ADH Antagonist
Digitalis (foxglove, Digitalis purpurea, draft evaders, arrow poison) oral
CHF Drugs
Inotropic Agents

Inh Na/K-ATPase → ↑ IC Na (↓ IC K) → ↓ Ca expulsion so ↑ IC Ca → ↑ contractility
↑ contractility, ↓ HR, ↑ CO & vaso-D in failing hearts only, ↓ AV conduction
Tx: CHF, A-fib, A-flutter
SE: GI upset → lower dose, cardiac (brady, AV block, bigeminy) → cease therapy; CNS
Toxicity: ↑ by Ca, ↓ by K; Tx toxicity w/ K or DigiBind for OD
CI(relative): quinidine (↑ serum drug), K losing drugs, ß-blockers, cardioversion (except v-fib)
Digoxin
CHF Drugs
Inotropic Agents

Digitalis

1 week to steady state
Digitoxin
CHF Drugs
Inotropic Agents

Digitalis

not in US, unfavorable PHK
Ouabain
CHF Drugs
Inotropic Agents

Digitalis

experimental
Phosphodiesterase Inhibitor (inodilators) IV
CHF Drugs
Inotropic Agents

Inh PDE 3 → ↑cAMP → ↑contractility, vasodilation, ↑ CO
↑ Mortality
Inamrinone
CHF Drugs
Inotropic Agents

Phosphodiesterase Inhibitor (inodilators) IV
Milrinone
CHF Drugs
Inotropic Agents

Phosphodiesterase Inhibitor (inodilators) IV
Dobutamine
CHF Drugs
Inotropic Agents

Sympathomimetic

ß-1 agonist, ↑ contractility, mild ↑ HR, IV
Dopamine
CHF Drugs
Inotropic Agents

Sympathomimetic

low dose - ↑renal BF (↑ urine production), ↑CO, Tx: severe refractory CHF;
med dose – ß1 agonist, little to no change in BP; high dose – α agonist, vaso-c, ↑BP
Levosimendan, pimobendan
CHF Drugs
Inotropic Agents

Calcium Sensitizer

experimental
Loop agent
Drugs w/out Positive Inotropic Effects

Intensive diuresis
Furosemide
Drugs w/out Positive Inotropic Effects

Loop agent
torsemide
Drugs w/out Positive Inotropic Effects

Loop agent
bumetanide
Drugs w/out Positive Inotropic Effects

Loop agent
ethacrynic acid
Drugs w/out Positive Inotropic Effects

Loop agent
Thiazides and Related Compounds
Drugs w/out Positive Inotropic Effects

Maintenance therapy
Hydrochlorothiazide, etc.
Drugs w/out Positive Inotropic Effects

Thiazides and Related Compounds
Metolazone, indapamide, etc
Drugs w/out Positive Inotropic Effects

Thiazides and Related Compounds
Triamterene, amiloride
Drugs w/out Positive Inotropic Effects

K Sparing (including Aldosterone Antagonists)

↓mortality
Nesiritide (Natrecor)
Drugs w/out Positive Inotropic Effects

B Type Natriuretic Peptide

Tx: acute decompensated CHF; will ↓PCWP
ACE Inhibitors – oral or IV
Drugs w/out Positive Inotropic Effects

↓preload (↓ direct vaso-C), ↓afterload (↓ aldosterone), ↓tissue remodeling
SE: dry cough (↑bradykinin), hyper-K
CI: bilateral renal artery stenosis, pregnancy
↓mortality, no reflex tachy
Captopril, Enalapril, etc.
Drugs w/out Positive Inotropic Effects

ACE Inhibitors
Angiotensin II Receptor Blockers (ARB’s) – oral
Drugs w/out Positive Inotropic Effects

Same effects as ACE Inh. w/ out ↑bradykinin and cough
Losartan
Drugs w/out Positive Inotropic Effects

Angiotensin II Receptor Blockers (ARB’s) – oral
valsartan
Drugs w/out Positive Inotropic Effects

Angiotensin II Receptor Blockers (ARB’s) – oral
candesartan
Drugs w/out Positive Inotropic Effects

Angiotensin II Receptor Blockers (ARB’s) – oral
Beta-Blockers
Drugs w/out Positive Inotropic Effects

Carvedilol (Coreg; α-1 & ß); Bisoprolol, Metoprolol (Lopressor; ß-1), etc ; ↓mortality, ↓remodeling, ↓renin CI: severe CHF
Vasodilators
Drugs w/out Positive Inotropic Effects

SE: reflex tachycardia, fluid retention → give concomitantly w/ ß-blocker and diuretic
Sodium nitroprusside
Drugs w/out Positive Inotropic Effects

Vasodilators

IV, dilates arteries and veins, tx: acute decomp. CHF
Hydralazine
Drugs w/out Positive Inotropic Effects

Vasodilators

oral, dilates arteries, ↑CO, SE: SLE
Isosorbide dinitrate, nitroglycerin
Drugs w/out Positive Inotropic Effects

Vasodilators

sublingual (skip 1st pass), dilates veins →↓preload, develop tolerance so not for long term use
Calcium Channel Blockers
Drugs w/out Positive Inotropic Effects


Generally CI in CHF
Amlodipine
Drugs w/out Positive Inotropic Effects

Calcium Channel Blockers

slightest negative inotropic effect, being studied for use in CHF
Amiodarone
Drugs w/out Positive Inotropic Effects

class III antiarrhythmic, may ↑ ejection fraction in CHF
[I-A]
Drugs Used in Cardiac Arrhythmias

Class I (Sodium channel blockers)

bind open & inactivated Na channels →↑ERP, ↑AP duration,
↑ QRS,QT durations →torsades;
[I-B]
Drugs Used in Cardiac Arrhythmias

Class I (Sodium channel blockers)

↓ERP, no Δ QRS,QT
[I-C]
Drugs Used in Cardiac Arrhythmias

Class I (Sodium channel blockers)

potent, Tx: life threatening ventricular arrhythmias
Quinidine
Drugs Used in Cardiac Arrhythmias

Class I (Sodium channel blockers)

oral; SE: GI upset(diarrhea), paradoxical tachy-C, torsades & syncope, ↑axn of warfarin, digoxin, & NMJ blockers axn, cinchonism; Tx: broad spectrum, supravent. & vent. arrhythmias

[I-A]
Procainamide
Drugs Used in Cardiac Arrhythmias

Class I (Sodium channel blockers)

CI: AV block

[I-A]
Disopyramide
Drugs Used in Cardiac Arrhythmias

Class I (Sodium channel blockers)

oral ; Tx: ventricular tachycardia; SE: (-)inotropic

[I-A]
Lidocaine
Drugs Used in Cardiac Arrhythmias

Class I (Sodium channel blockers)

[I-B]

IV; Tx: ventricular arr; convulsion, bradycardia
Phenytoin
Drugs Used in Cardiac Arrhythmias

Class I (Sodium channel blockers)

[I-B]

oral/IV; Tx: dig. induced vent. arr; Interaxn: protein binding, P-450
Tocainide
Drugs Used in Cardiac Arrhythmias

Class I (Sodium channel blockers)

[I-B]

oral; Use: pts w/ lido allergy, vent. arr
Mexiletine
Drugs Used in Cardiac Arrhythmias

Class I (Sodium channel blockers)

[I-B]

Tx: painful diabetic neuropathy, vent. arr. in lido resistant pts
Flecainide
Drugs Used in Cardiac Arrhythmias

Class I (Sodium channel blockers)

[I-C]

oral; inh. fast Na channels; ↓AP duration, ↑QRS; Tx: PSVT, A-fib, A-flutter; CI: AV block, CHF
Propafenone
Drugs Used in Cardiac Arrhythmias

Class I (Sodium channel blockers)

[I-C]

oral
Moricizine
Drugs Used in Cardiac Arrhythmias

Class I (Sodium channel blockers)

[I-C]

oral; IA, IB, IC like effects
Propranolol
Drugs Used in Cardiac Arrhythmias

Class II (Beta-blockers)

Tx: A-fib, A-flutter, PSVT, WPW, selected vent. arr; SE: angina if w/drawn quickly; CI: Raynaud’s
Esmolol (Brevibloc)
Drugs Used in Cardiac Arrhythmias

Class II (Beta-blockers)

IV; ß-l block; rapid & short axn; Tx: acute PSVT (2nd to adenosine)
Amiodarone
Drugs Used in Cardiac Arrhythmias

Class III (prolong repolarization; K channel blockers)

oral/IV; class I-IV effects & some α, ß blocking; ↓HR, ↓conduction, ↑QRS,QT; SE: Elvira(brown eyes, gray skin), brady, pulm. fibrosis, less proarrhythmic; Tx: broad arr, ACLS v-tach, v-fib
Sotalol (Betapace)
Drugs Used in Cardiac Arrhythmias

Class III (prolong repolarization; K channel blockers)

oral; class II & III effects; Tx: vent. & supravent. arr; SE: torsades, ß-block
Bretylium
Drugs Used in Cardiac Arrhythmias

Class III (prolong repolarization; K channel blockers)

IV; Tx: v-fib, v-tach
Ibutilide, Dofetilide
Drugs Used in Cardiac Arrhythmias

Class III (prolong repolarization; K channel blockers)

Tx: convert A-fib & A-flutter to normal sinus; SE: torsades
Class IV (Calcium channel blockers)
Drugs Used in Cardiac Arrhythmias

Inh L-type Ca channels, ↑ERP, ↓HR, (-)inotrope
Verapamil
Drugs Used in Cardiac Arrhythmias

Class IV (Calcium channel blockers)

Tx: reentrant supravent. tachy-C; CI: vent. Arr, CHF, AV block, ß-blockers
Diltiazem (Cardizem)
Drugs Used in Cardiac Arrhythmias

Class IV (Calcium channel blockers)

oral/IV more peripheral effects than verapamil→ ↑CO;
Tx: Prinzmetal’s variant angina, stable angina
Bepridil
Drugs Used in Cardiac Arrhythmias

Class IV (Calcium channel blockers)
Adenosine
Drugs Used in Cardiac Arrhythmias (Misc)

IV; ↑K conductance, ↓cAMP-Ca; Tx: DOC acute PSVT, WPW, reentry
Digoxin
Drugs Used in Cardiac Arrhythmias (Misc)

Tx: pre-tx for A-fib before class IA is given
Magnesium
Drugs Used in Cardiac Arrhythmias (Misc)

Tx: torsades de pointes, eclampsia
Potassium
Drugs Used in Cardiac Arrhythmias (Misc)

tx digoxin toxicity
Hydrochlorothiazide
Antihypertensive Agents
Diuretics (Thiazides, Loops, K Sparing)

first drug; African Americans; SE: hyperuricemia, ED
Chlorthalidone, Metolazone
Antihypertensive Agents
Diuretics (Thiazides, Loops, K Sparing)
Indapamide
Antihypertensive Agents
Diuretics (Thiazides, Loops, K Sparing)

direct vasodilator
Furosemide (Loop)
Antihypertensive Agents
Diuretics (Thiazides, Loops, K Sparing)

severe cases, pts w/ renal insufficiency, CHF
Triamterene (K sparing)
Antihypertensive Agents
Diuretics (Thiazides, Loops, K Sparing)

combo w/ HCTZ and loops
Spironolactone, Eplerenone
Antihypertensive Agents
Diuretics (Thiazides, Loops, K Sparing)

aldosterone antag. & K sparing
Sympatholytic
Activate baroreflexes and retain Na → combine w/ diuretic
Centrally Acting Drugs
Sympatholytic
Centrally Acting Drugs

α-2 agonist → ↓symp. tone, ↓renin; SE: sedation; Drug Intraxn: yohimbine
Clonidine
Sympatholytic
Centrally Acting Drugs

sudden withdrawal → HTN crisis
Methyldopa
Sympatholytic
Centrally Acting Drugs

SE: hemolytic anemia w/ (+)Coombs test
Mecamylamine
Sympatholytic
Ganglion Blocking Agents

many SE’s
Adrenergic Neuron-blocking Agents
Sympatholytic

↓NE release →↓sympathetic tone
Guanethidine
Sympatholytic
Adrenergic Neuron-blocking Agents

Replaces NE in vesicles →↓NE release; vaso-D; causes hypertensive crisis in pheochromocytoma (initial large NE bolus release)
Reserpine
Sympatholytic
Adrenergic Neuron-blocking Agents

Inh NE transport into vesicles
Phenelzine
Sympatholytic
MAO Inhibitors
Alpha-1 Adrenergic Blockers
Sympatholytic

α-1 block → vaso-D, less reflex tachy; SE: 1st dose phenomenon →hypotension
Prazosin, Doxazosin, Terazosin
Sympatholytic
Alpha-1 Adrenergic Blockers
Beta-receptor Blockers
Sympatholytic
Beta-receptor Blockers

Works well for caucasians & young; Avoid in pts w/ DM, hyperlipid, severe CHF
↓CO, initial ↓renin; SE: reflex ↑renin and tachy-C, and the usual
Propranolol, Nadolol, Timolol
Sympatholytic
Beta-receptor Blockers

nonselective
Metoprolol (Lopressor), Atenolol, Bisoprolol
Sympatholytic
Beta-receptor Blockers

ß-1 block
Pindolol
Sympatholytic
Beta-receptor Blockers

ß-block w/ ISA
Acebutolol
Sympatholytic
Beta-receptor Blockers

ß-1 block w/ ISA
Labetalol, Carvedilol (Coreg)
Sympatholytic
Beta-receptor Blockers

α-1 & ß blocker
Direct Acting Vasodilators
Sympatholytic
Direct Acting Vasodilators

SE: reflex ↑renin & tachy-C, fluid retention → give w/ ß-blocker and diuretic
Sodium nitroprusside
Sympatholytic
Direct Acting Vasodilators

IV; dilates arteries & veins, Tx: severe HTN, acute decomp. CHF
Hydralazine
Sympatholytic
Direct Acting Vasodilators

oral; dilates arteries, ↑CO, SE: SLE, angina
Isosorbide dinitrate, nitroglycerin
Sympatholytic
Direct Acting Vasodilators

sublingual (skip 1st pass); dilates veins →↓preload, develop tolerance so not for long term use
Minoxidil
Sympatholytic
Direct Acting Vasodilators

oral; arteries; opens K channels; hypertrichosis (topical: Rogaine)
Diazoxide
Sympatholytic
Direct Acting Vasodilators

IV; arteries; +ATP-K channels; ↓insulin secretion (tx: insulinoma)
Fenoldopam
Sympatholytic
Direct Acting Vasodilators

IV; arteries; D1 agonist →vaso-D
Verapamil
Sympatholytic
Calcium Channel Blockers

strongest cardiac effects; ↓HR, (-)inotrope, depress SA/AV; SE:constipation
Diltiazem (Cardizem)
Sympatholytic
Calcium Channel Blockers

in-between Verapamil and Nifedipine; depress SA and AV node directly
Nifedipine (Procardia), Amlodipine (Norvasc)
Sympatholytic
Calcium Channel Blockers

strongest vasodilators; reflex tachycardia
ACE Inhibitors – oral or IV
Sympatholytic
ACE Inhibitors – oral or IV

↓preload (↓ direct vaso-C), ↓afterload (↓ aldosterone), ↓tissue remodeling
Tx: first choice for DM, chronic renal disease, LVH
SE: dry cough (↑bradykinin), hyper-K, angioedema
CI: bilateral renal artery stenosis, pregnancy
Captopril, Enalapril, etc.
Sympatholytic
ACE Inhibitors – oral or IV
Angiotensin II Receptor Blockers (ARB’s) – oral
Sympatholytic

Same effects as ACE Inh. w/ out ↑bradykinin, cough, or angio(neurotic)edema
Losartan, valsartan, candesartan
Sympatholytic
Angiotensin II Receptor Blockers (ARB’s) – oral
Aliskiren (Tekturna)
Sympatholytic
Renin Antagonist

like ARB’s
Nitrates and Nitrites – sublingual
Vasodilators and the Tx of Angina Pectoris

Most effect on veins; nitrite ion →NO →↑cGMP →vaso-D; Tx: angina, CN poisoning
Tolerance develops quickly, Monday disease in explosive manufacturers
Nitroglycerin, Isosorbide dinitrate, Amyl nitrite
Vasodilators and the Tx of Angina Pectoris

Nitrates and Nitrites – sublingual

(inhaled, euphoria)
Verapamil
Vasodilators and the Tx of Angina Pectoris

Calcium Channel Blockers - oral

strongest cardiac effects; ↓HR, (-)inotrope, depress SA/AV; SE:constipation
Diltiazem (Cardizem)
Vasodilators and the Tx of Angina Pectoris

Calcium Channel Blockers - oral

in between Verapamil and Nifedipine; depress SA/AV node directly
Dihydropyridines
Vasodilators and the Tx of Angina Pectoris

Calcium Channel Blockers - oral

Strongest vasodilators; reflex tachycardia
Nifedipine (Procardia)
Vasodilators and the Tx of Angina Pectoris

Calcium Channel Blockers - oral

oral/topical; Amlodipine (Norvasc), Isradipine
Beta Blockers
Vasodilators and the Tx of Angina Pectoris

↓cardiac workload →↓O2 demand; ↓HR →↑perfusion time; ↓vaso-C
Propranolol (ß), Metoprolol(ß-1), Atenolol(ß-1)
Vasodilators and the Tx of Angina Pectoris

Beta Blockers
Phosphodiesterase-5 Inhibitors - oral
Vasodilators and the Tx of Angina Pectoris

Phosphodiesterase-5 Inhibitors - oral

Inh PDE5(& some PDE6) →↑cGMP; Tx: erectile dysfunction; SE: headache, flushing
Sildenafil (Viagra)
Vasodilators and the Tx of Angina Pectoris

Phosphodiesterase-5 Inhibitors - oral

~60 min to axn; CYP3A4; CI: nitrates, α blockers; SE: visual
Vardenafil (Levitra)
Vasodilators and the Tx of Angina Pectoris

Phosphodiesterase-5 Inhibitors - oral

more selective for PDE5→↓visual SE; faster onset of axn
Tadalafil (Cialis)
Vasodilators and the Tx of Angina Pectoris

Phosphodiesterase-5 Inhibitors - oral

longest duration of axn; allows for crazy weekends in Vegas
Ranolazine
Vasodilators and the Tx of Angina Pectoris (others)

oral; Inh. PFox, inh. Late Na current; ↓LV wall stiffness; Tx: chronic stable angina (not 1st line); SE: CYP3A4, teratogenic
Bosentan
Vasodilators and the Tx of Angina Pectoris (others)

oral; endothelin receptor antagonist; only use in severe pulmonary HTN
Cholestyramine, colestipol, colesevelam
Agents Used in Hyperlipidemia

Bile Acid Binding Resins

binds bile acids to prevent intestinal absorption; ↑LDL receptors (liver)→ ↓serum LDL; SE: constipation, bloating, impair drug absorption; not effective in homozygous familial hyperchol. (no LDL receptors)
Nicotinic Acid
Agents Used in Hyperlipidemia

Drugs that Impair Synthesis of Lipoproteins

inh. VLDL secretion; ↑HDL; SE: skin flushes, hyperuricemia
HMG-CoA reductase inhibitors - ↓LDL synthesis, ↑LDL receptors; CI: pregnancy
Also ↓CRP, ↑NO, ↑plaque stability, ↓oxidation, ↓plt. agg; SE: liver, rhabdomyolysis
Lovastatin (Mevacor), Simvastatin (Zocor), Atorvastatin (Lipitor), Rosuvastatin (Crestor), etc
Agents Used in Hyperlipidemia

Drugs that Impair Synthesis of Lipoproteins
Fibric Acid Derivatives - oral
Agents Used in Hyperlipidemia

PPAR-α ligand →↑lipoprotein lipase activity → VLDL catabolism, ↓TG’s;
SE: liver, cholethiasis; ineffective in familial hypercholesterolemia
Gemfibrozil, Clofibrate, Fenofibrate (Tricor)
Agents Used in Hyperlipidemia

Fibric Acid Derivatives - oral
Ezetimibe (Zetia)
Agents Used in Hyperlipidemia (Others)

blocks intestinal absorption of cholesterol; combine w/ statin
Probucol
Agents Used in Hyperlipidemia (Others)

Inh. cholesterol transport from intestine & ↑chol. Excretion, ↓ plaque progression; SE: ↓HDL
d-Thyroxine
Agents Used in Hyperlipidemia (Others)

obsolete
Vytorin
Agents Used in Hyperlipidemia (Others)

Ezetimibe/Simvastatin