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Cardioselective (beta 1) blockers
Atenolol, Metoprolol, Acebutolol
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problems w/ beta 2 block
asthma, diabetes, vascular disease
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Decrease arteriolar tone (decr TPR) and incr venous compliance (decr CO—low SV)
alpha blockers
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Mixed acting alpha blocker, short acting, iv, reversible
Phentolamine
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Mixed alpha blocker, Irreversible, nonselective
Phenoxybenzamine
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“First Dose Effect” hypotension. Sympathetic and Renin-Angiotensin-Aldosterone compensations --> (Na+ and water retention, potassium loss)
problems w/ alpha blockers
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Decr CO & TPR simultaneously. Decr VMC activity
Alpha 2 agonists
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Problems w/ alpha 2 agonists
CNS depression, Rebound phenomenon, Low blood pressure. Dry mouth
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Mixed alpha & beta antagonist. Can be used in Hypertensive crisis, Pheochromocytoma, Clonidine withdrawal rebound
Labetalol
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alpha & beta mixed antagonist having special use in congestive heart failure
Carvedilol
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no crossing BBB, no CNS depression. Reversible displacement of NE from vesicles. 1st effect is positive. Hypotension, diarrhea
Guanethidine
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Proximal convoluted tubule carbonic anhydrase inhibitor
acetazolamide
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Acetazolamide side effects
Metabolic acidosis, Elevated urinary pH and renal stones
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ascending loop diuretics
Furosemide, Ethacrynic Acid, Bumetamide
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Side effects of Ethacrynic acid
Hypokalemia, Alkalosis, Hypovolemia, Ototoxicity
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Side effects for Furosemide & Bumetamide
Hyperuricemia, Hyperglycemia, Sulfa sensitivity – skin rash, nephritis
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used w/ thiazides to counteract potassium loss
amiloride and triamterene
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Potassium sparing diuretics & their side effects
Amiloride, Triamterene, spironolactone. Hyperkalemia & metabolic acidosis.
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CHF cardiac hypertrophy may benefit from which hypertensive drug?
ACE inhibitors
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act at arteriole only, block L-type calcium channels, and decrease vascular resistance.
Nifedipine and other dipines
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calcium channel blockers for arteriole and heart, therefore resist reflex tach.
and useful against arrhythmias and angina pectoris
Verapamil and Diltiazem
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side effects of Verapamil and Diltiazem
Hypotension, cardiac depression (SA & AV node), asystole
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interferes w/ action of IP3, limiting Ca release from SR of smooth muscle. never given to males over 45 --> chest pain & MI
Hydralazine vasodilator
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side effects of Hydralazine
headache, flushing, dizziness, hypotension, tachycardia, angina pectoris. Lupus syndrome
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activates K channels. Drug available orally & IV. Always used w/ beta blocker or diuretic.
Minoxidil vasodilator
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side effects of minoxidil
Hypertrichosis. Hypotension, SANS and AII compensations. Hyperglycemia
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Longer use is associated with hyperglycemia (50%) and hypertrichosis (20%). Low BP, tachycardia, angina, myocardial ischemia, hyperglycemia,
water retention
Diazoxide vasodilator
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Metoprolol often combined w/ _____ for hypertension
Hydrochlorothiazide
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Clonidine often used in combo w/ __________ for hypertension
Chlorthalidone
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Reserpine and amiloride each can be used in combo w/ __________ for hypertension
Hydrochlorothiazide
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Verapamil can be used in combo w/ _______ for hypertension
enalapril
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Prazosin can be used w/ ______ for hypertension
Polythiazide
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Cardiotonics for CHF
Digitalis (Ca++) , Dobutamine (Beta-1) , Inamrinone (c-AMP)
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As anti-arrhythmia, Ca channel blockers treat ...
- SA node - Sinus Tachycardia.
- AV node - Paroxysmal Supraventricular Tachycardia
- Protect the ventricle
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Beta blocker w/o CNS depression and non selective
Nadolol
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use in Variant angina alone; Typical angina use with a Beta blocker. Arterioles only. Can cause coronary steal
Nifedipine
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drugs that Increases slope of phase 4 depolarization --> problems w/ automaticity of impulse
NE/E, hyperthyroidism, atropine, hypokalemia, digoxin
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problems w/ automaticity of impulse: Decreased slope of phase 4 caused by
Ca channel blockers and beta blockers
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problems generating automaticity: Hyperpolarized diastolic potential caused by
vagal/PSNS activity, muscarinic agonists, anticholinesterase, digoxin
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problems generating automaticity: elevated threshold caused by
sodium channel blockers and injury
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Early after depol (EAD): during phase 3, can trigger V tach and Torsades des pointes. Can be caused by
Beta blockers, long action potential duration (long QT syndrome, class III antiarrythmias potassium channel blockers), hypokalemia (diuretics)
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Late after depol (LAD): arise from phase 4 caused by
elevated intracellular calcium (digoxin), hypokalemia (diuretics), excessive catecholamines (SANS, hyperthyroidism, drugs), or ischemia
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Blocks Na+ channel, K+ channel, Blocks M2 receptor, Alpha-1 receptors
Quinidine
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anti-arrhythmia drug that blocks Na channels and M2 receptors but doesnt block alpha 1 receptors
Disopyramide
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anti-arrhythmia drug. Na+ channel block, no M2 or Alpha-1 block Prefer iv route to avoid metabolism or slow metabolism. Can lead to lupus syndrome, long QT syndrome, and torsades des pointes
Procainamide
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anti-arrhythmia drug that can lead to lupus syndrome if not metabolized and lead to long QT syndrome and torsades des pointes if metabolized to NAPA
Procainamide
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orally available versions of lidocaine
Mexiletine, tocainide
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Class IB anti-arrhythmia drug. Given iv, short-acting and safe. Used for ventricular extrasystoles Activates AV node to increase conduct. Can suppress digoxin V. arrhythmias w/o aggravating dig.-related AV node depression
phenytoin
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Class IC anti-arrhythmias. Potent sodium channel blockers CAST trial revealed danger, therefore used only as last resort or short-term
Flecainide, Encainide, Moricizine
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Class III anti-arrhythmia drug. Long t1/2, difficult dosing. Many dangerous and unusual side effects: Cardiac depression, pulm. fibrosis, liver damage, optic nerve, cornea halos, and blue skin
Amiodarone
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Arrhythmias of sodium-conducting pathways of atria or ventricles respond to...
class I and III drugs
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Arrhythmias of calcium-conducting sites, SA node, AV node respond to...
class II and IV drugs
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Atrial flutter, a fib treatments
Digoxin- AV depression, Protect the ventricle, Also verapamil, beta blockers. Class IA to suppress the sodium driven ectopic focus or foci.
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SVT caused by Atrial, AV node reentry circuit can be treated with...
Verapamil, beta blockers, digoxin, and adenosine (all AV depressants)
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SVT caused by atrial wall re-entry can be treated with
- Inhibit initiation of action w/ Class IA - Quinidine, etc.
- Increase refractoriness w/ Class III – Amiodarone
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Treatment for Premature V contraction, extra systoles, EADs, DADs
Lidocaine, other class I drugs, and beta blocker in SNS
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Ventricular tachycardia Caused by repeated ectopic depolarizations in conducting tissue or by a conducting path reentry circuit. Sodium driven. can be treated w/
Lidocaine, class IA, or Class III drugs
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V fib can be treated w/
Class IA, IB, and class III
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treatment for Digitalis - induced arrhythmias. Extrasystoles or Vtach w/ added danger of AV nodal depression.
Class IB, phenytoin, Procainamide. All has no AV depression effect
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block ADP – prevents platelet formation
Ticlopidine, clopidogrel
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Bronchodilation, vasodilation, cardiac stimulation due to phosphodiesterase inhibition (cAMP)
Aminophylline
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treatments for pulmonary congestion due to acute heart failure
furosemide, morphine pain reliever, Aminophylline
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Block PDE, cAMP up to increase cardiac output
Inamrinone and Milrinone
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CHF drugs that decrease afterload, decrease blood volume, decrease cardiac remodeling
ACE inhibitors
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Blocks Na+, K+-ATPase. Improves calcium availability in cardiac cells in CHF. Protect ventricle. additional use in AV node depression.
digoxin (digitalis)
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side effects: Ventricular Extrasystoles leading to V tach & V fib. Can have too much AV node depression
digoxin (digitalis)
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side effects of diuretics in CHF
hypokalemia and will aggravate ventricular arrhythmias. Lack of moderating ion, high calcium
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Brain Natriuretic Peptide (BNP) increases cGMP, relaxes smooth muscle. For CHF
Nesiritide
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