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What are the six category's of cardio pharm
- Diuretics
- Angiotensin Converting Enzyme Inhibitors (ACEI)
- Angiotension receptor blockers (ARB)
- Beta Blockers (BB)
- Calcium channel blockers (CCB)
- Nitrates
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Hydrochlorothiazide mechanism of action
Inhibits sodium reabsorption in the distal tubules leading to water loss, Na+ loss, and K+ loss
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What conditions is hydrochlorothiazide used for
Moderate hypertension, in severe hypertension taken with other drugs
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Contraindications of Hydrochlorothiazide
Dangerous taken with digitalis, MI, and chronic arrhythmias
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What is the most common side effects of Hydrochlorothiazide
Potassium depletion
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Captopril has what mechanism of action
(ACE inhibitor) It inhibits formation of angiotensin II and prevents the breakdown of bradykinin (dialates vessels)
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What are the therapeutic uses of captopril
- Hypertension
- Heart failure
- MI
- LV dysfunction
- Diabetic nephropathy
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What are the adverse affects of Captopril
- Hypotension (patients with hypovolemia)
- Dry cough
- Hyperkalemia
- Angioedema (swelling of face and lips)
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Captopril should not be taken under what conditions
Pregnancy
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What can captopril react with
- Potassium supplements
- NSAID's block vasodilating effects of bradykinin
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People with African descent have what unique characteristics with BP
- They retain sodium more
- More prone to high BP
- Beta blockers don't work well with them
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What is a side effect of Captopril that isn't a side effect with Valsartan
A Dry cough, but Valsartan does present dizziness sometimes
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What is the MOA of Valsartan
- (ARB) Angiotensin II Receptor 1 Blocker
- Prevents vasoconstriction and aldosterone release
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What are the therapeutic uses of Valsartan
- Hypertension
- Heart failure
- LV dysfunction following MI
- Unstable angina
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What are the adverse affects of Valsartan
- Hyperkalemia
- Hypotension
- Renal damage
- Dizziness
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When should Valsartan not be taken
During pregnancy
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Propranolol has what MOA
Non-selective beta-adrenergic receptor blocker (AV, SA, Artria, Beta 1 and 2)
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What are the therapeutic uses of propranolol
- Hypertension
- Angina
- Prevent MI
- Anxiety
- Supra-ventricular arrhythmia
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What are the adverse affects of Propranolol
- Bradycardia
- Hypotension
- Hypoglycemia
- Hyperlipidemia
- Bronchospasm
- Sexual Dysfunction
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What are the contraindictions of Propanolol
- Don't withdraw quickly
- Asthma
- COPD
- Bradycardia
- Congestive heart failure
- > 1st degree heart block
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What is the MOA for Nifedipine
Inhibits calcium entry from L-type Ca+ channels in smooth muscle and cardiac muscle
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What are the therapeutic uses of Nifedipine
- Chronic stable angina or vasospastic agina
- Hypertension
- Premature labor
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What are the adverse side effects of Nifedipine
- Flushing
- Orthostatic hypertension
- Headache
- Nausea
- Sexual Dysfunction
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What are the contraindictions of Nifedipine
- Hypersensitivity
- Cardiogenic shock
- Unstable Angina
- Hypertensive emergencies
- Acute MI
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What is Ischemia
When the blood supply to a tissue is inadequate to meet the tissues metabolic demands
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What are the three biochemical components of Ischemia
- Hypoxia
- Insufficiency of nutrients
- Accumulation of metabolic wastes
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Which is worse, ischemia or hypoxia
Ischemia due to the increase in wastes and insufficient nutrients
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What are the three types of angina
- Chronic stable (Narrowing of coronary art.)
- Unstable (Blood clot within coronary art.)
- Vasospastic (Stress induced)
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Nitroglyceride should not be used with
Viagra
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MOA of Nitroglyceride
- Convert to NO by aldehyde dehydrogenase in mitochondria
- NO activates cGMP which in turn activates MLCK leading to smooth muscle relaxation
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What does a low dose of Nitroglycerine do
- Decreases the preload by dilating systemic and pulmonary veins
- Decrease EDP, heart size, O2 demand
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What does a high dose of nitroglycerine do
Decreases arterial blood pressure, afterload, and myocardial workload
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What is nitroglyceride used for
- Angina
- Heart failure
- MI
- Pulmonary hypertension
- Hypertension in heart surgery
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What are the adverse effects of nitroglycerine
- Hypotension
- Headache (very common)
- Tachycardia
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MOA of mucolytics
Alter the structure of mucus to decrease its viscosity as to help its removal
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What are the different types of mucolytics
- N-acetylcysteine
- Carbocysteine
- Dornase alfa
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Dornase alfa is used specifically for
Mucous secretions in cystic fibrosis by hydrolysing neutrophil DNA
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What do expectorants do
Increase the volume of secretions in the respiratory tract
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What are the expectorants that are used often
- Ipecacuanha "Ipecac"
- Ammonium salts
- Iodine compounds
- Guaifenesin (not in US)
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Iodine salts in expectorants are cautioned why
They are believed to thyroid suppression not to be used in children, pregnant women, or patients with goiter
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What are hydrating agents for, and what are some examples
- They liquefy mucus
- Menthol
- Benzoin
- Volatile oils
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What are the common used Anti-Tussive agents (cough suppressants), and how do they work
- Dextromethorphan
- Codeine (treat analgesics as well)
- Pholcodine (not is US)
- They increase the threshold of the brain for coughing stimuli
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Levodropropizine and moguisteine
Drugs used for cough suppressants acting on the periphery not available in the US
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Dimenhydrinate
Diphenhydramine
Chlorpheniramine
Antihistamines used as cough suppressants, allergies and motion sickness
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What are some bronchodilators commonly used
- Beta 2 agonists
- Albuterol (short acting)
- Salmeterol (long acting)
- M3 antagonists
- Ipratropium
- Tiotropium
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Prednisolone
- Respiratory steroid
- Decreases inflammation by inhibiting neutrophil migration, and decreases capillary permeability
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What precautions must be taken with patients taking prednisolone
- When they stop they need to withdraw slowly
- BP, Blood sugar, intraocular pressure, and bone density must be monitored
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Montelukast
- Leukotriene receptor antagonist
- Used for chronic treatment of asthma and seasonal allergies
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Methylxanthines (aminophylline, caffeine)
- Phosphodiesterase inhibitor
- Used for asthma
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Cromolyn sodium
- Mast cell stabilizer, and prevents release of histamine and leukotrienes
- Used for allergic disorders and asthma
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