Cardio+renal drugs

• Block fast Na channels (open state)
• only fast fibers!
• decrease slope of phase 0
• increase APD, ERP, QT interval
• (also block K-channels- prolong repol)

USE- atrial AND ventricular arrhythmias, esp Re-entrant and Ectopic supraventricular and ventricular tachycardia! (Wolff-Parkinson-White syndrome!)

SE- thrombocytopenia, torsades (inc QT)

DRUGS: Quinidine, Procainamide, Disopyramide

• Class 1A antiarrhythmic
• block fast Na channels (open) - only fast fibers!
• M- and Alpha blocker too!
• block K-channels (prolong repol)

• -decrease Phase 0 (CV), increase APD, ERP, QT
• -M2 block--> tachycardia!
• -Alpha2 block--> reflex tachycardia!

• USE- atrial fibrillation (give Digoxin first- slow AV) PO
• -great for Wolff-Parkinson-White syndrome (block accessory path, increase AV node)

• SE- Cinchonism (block both M and Alpha!)- GI distress, tinnitus, ocular dysfunction, CNS excitation. Hypotension, Torsades (incr QRS, QT),
• hemolytic anemia, thrombocytopenia

• NOTE- Hyperkalemia (depol cells)-->enhance chance of torsades! Quinine & Verapamil displace Digoxin--> incrs it's toxicity.
• -Quinidine a weak base, absorption incrs w/antiacids.

• Class 1A antiarrhythmic
• -block fast Na channels (open)- only fast fibers!
• -M-blocker too (incr HR), but less than Quinidine
• -block K-channel (prolong repol)
• -decrease Phase 0 (CV), increase APD, ERP, QT

• USE- atrial AND ventricular arrhythmias
• -but monitor HR b/c M-blockade-->+AV--> QT--> torsades

• UNIQE-metabolized by N-acetyltransferase (slow & fast acetylators)-->active metabolite.
• -good hapten, goes everywhere

• SE- drug induced-SLE! (anti-histone) more likely with slow acetylators. Hematotoxicity (thrombocytopenia, agranulocytosis) do reg CBC!
• Torsades, Hypotension

• Class 1A antiarrhythmic
• Block fast Na channels (open state)only fast fibers!
• -decrease slope of phase 0increase APD, ERP, QT interval
• -Block M receptor!
• -Decrease contractility!
• -(also block K-channels- prolong repol)

• -USE- atrial AND ventricular arrhythmias
• -Great for Hypertrophic Cardiomyopathy (neg inotropy)

-SE- thrombocytopenia, torsades (inc QT)

• Procainamide
• Hydralazine
• Isoniazid

+ anti- histone!!

• Block fast Na channels (inactivated!)
• -Target ischemic/depolarized perkinje or ventricular tissue
• -slow conduction in ischemic tissue, keep it refractory b/c that's where arrhythmias begin.
• -decrease APD! block slow Na (window current at plateau phase), but this increase diastole, time to recover.

• USE-acute ventricular arrhythmia (esp. post-MI)
• -Digitalis-induced arrhythmias

SE- local anesthetic, CNS stimulate/depress, CV depress

DRUGS: Lidocaine, Mexiletine, Tocainide

• Block fast Na channels (inactivated!)
• -Target ischemic/depolarized perkinje or ventricular tissue
• -slow conduction in ischemic tissue, keep it refractory b/c that's where arrhythmias begin
• -decrease APD! block slow Na (window current at plateau phase), but this increase diastole, time to recover.

• USE- post-MI
• -Open heart surgery (b/c tissue depol)
• -Digoxin toxicity (block Na/K pump-->depol cell)

SE- CNS toxicity (seizures), Least cardiotoxic of antiarrhythmics!

UNIQUE- only IV! so to take home, give Mexiletie or Tocainide.

• Block fast Na channels (inactivated!)
• -Target ischemic/depolarized perkinje or ventricular tissue -slow conduction in ischemic tissue, keep it refractory b/c that's where arrhythmias begin.
• -decrease APD! block slow Na (window current at plateau phase), but this increase diastole, time to recover.

USE-acute ventricular arrhythmia (esp. post-MI)-Digitalis-induced arrhythmias

• SE- local anesthetic, CNS stimulate/depress, CV depress
• UNIQUE- can take oral! so give to outpatients. b/c Lidocaine is IV only.

• Block fast Na channels (inactivated!)
• -Target ischemic/depolarized perkinje or ventricular tissue -slow conduction in ischemic tissue, keep it refractory b/c that's where arrhythmias begin.
• -decrease APD! block slow Na (window current at plateau phase), but this increase diastole, time to recover.

USE-acute ventricular arrhythmia (esp. post-MI)-Digitalis-induced arrhythmias

• SE- local anesthetic, CNS stimulate/depress, CV depress
• UNIQUE- can take oral! so give to outpatients. b/c Lidocaine is IV only.

• Block ANY fast Na channel
• -esp. His-Punrkinje tissue
• -No effect on APD
• -No ANS effects

• USE- V-tachs that --> V-fib and SVT.
• -LAST RESORT when nothing else works!

• SE- very proarrhythmic! esp post-MI
• significantly prolong refractory period of AV node.

do NOT use in post-MI

DRUGS: Flecainide, Encainide, Propafenone

• Block ANY fast Na channel
• -esp. His-Punrkinje tissue
• -No effect on APD
• -No ANS effects

• USE- V-tachs that --> V-fib and SVT.
• -LAST RESORT when nothing else works!

• SE- very proarrhythmic! esp post-MIsignificantly prolong refractory period of AV node.
• do NOT use in post-MI!

• Block ANY fast Na channel
• -esp. His-Punrkinje tissue
• -No effect on APD
• -No ANS effects

• USE- V-tachs that --> V-fib and SVT.
• -LAST RESORT when nothing else works!

• SE-very proarrhythmic! esp post-MIsignificantly prolong refractory period of AV node.
• do NOT use in post-MI!

• Block ANY fast Na channel
• -esp. His-Punrkinje tissue
• -No effect on APD
• -No ANS effects

• USE- V-tachs that --> V-fib and SVT.
• -LAST RESORT when nothing else works!

• SE-very proarrhythmic! esp post-MIsignificantly prolong refractory period of AV node.
• do NOT use in post-MI!

• Beta blockers!
• -work on pacemakers SA, AV!
• -AV esp sensitive
• -block B1-receptor--> decrease cAMP--> decrease Ca influx--> decrease slope Phase 4 (automaticity slope)
• - increase PR!

• USE- prophylaxis post MI (neg inotropy!)
• -SVT, slow ventricular rate during A-fib and A-flutter. (neg chronotropy)

SE- Impotence, Exacerbate asthma, COPD, bradycardia, AV block, CHF, Sedation, Hypoglycemia, Hyperlipidemia

Rx overdose with Glucagon!

• Acebutolol- no hyperlipidemia
• Atenolol- no sedation
• Pindolol- no hyperlipidemia, no asthma
• Propranolol- most sedation

• Class II antiarrhthmic
• nonselective beta blocker
• -decrease cAMP at SA, AV-->dec Ca--> dec phase 4 slope--> dec HR, increaes PR

USE- angina, MI, HTN, tachyarrhthmias (SVT),Migraine, Thyrotoxicosis, performance anxiety, essential tremor! (block deiodinase)

UNIQUE- cause severe SEDATION!

SE-hypotension, bradycardia, sedation, bronchospasm, vasospasm, hyperlipidemia, impotence

DO NOT USE IN BRADYCARDIA, HEART BLOCK, SEVERE ASHMA, COPD, PRINZMETAL, COCAINE-INDUCED ANGINA! DECOMPENSATED CHF!

• Class II antiarrhthmic
• beta-1 blocker
• -decrease cAMP at SA, AV-->dec Ca--> dec phase 4 slope--> dec HR, increaes PR

• USE-acute SVT (very short acting)
• - IV only!

SE-hypotension, bradycardia, sedation, bronchospasm, vasospasm, hyperlipidemia, impotence

• Class II antiarrhthmic
• beta-1 blocker
• -decrease cAMP at SA, AV-->dec Ca--> dec phase 4 slope--> dec HR, increaes PR

• USE- Angina, MI, CHF
• -prophylaxis post MI
• -SVT, slow ventricular rate during A-fib and A-flutter.

SE-hypotension, bradycardia, sedation, bronchospasm, vasospasm, hyperlipidemia, impotence

DO NOT USE IN BRADYCARDIA, HEART BLOCK, SEVERE ASHMA, COPD, PRINZMETAL, COCAINE-INDUCED ANGINA! DECOMPENSATED CHF!

• Class II antiarrhthmic
• beta-1 blocker (longer acting)
• -decrease cAMP at SA, AV-->dec Ca--> dec phase 4 slope--> dec HR, increaes PR

• USE- Angina, MI, HTN
• -prophylaxis post MI
• - SVT, slow ventricular rate during A-fib and A-flutter.

DOES NOT CAUSE SEDATION! (safe to use in sedated patients taking anti-depressants, BDZ, alcohol)

• SE-hypotension, bradycardia, bronchospasm, vasospasm, hyperlipidemia
• DO NOT USE IN BRADYCARDIA, HEART BLOCK, SEVERE ASHMA, COPD, PRINZMETAL, COCAINE-INDUCED ANGINA! DECOMPENSATED CHF!

• Class II antiarrhthmic
• non selective beta blocker (same as propranolol)
• -decrease cAMP at SA, AV-->dec Ca--> dec phase 4 slope--> dec HR, increaes PR

• USE- SVT
• - Open angle Glaucoma! (eye drops)
• -decrease aqeous humor formation, release intraocular pressure.
• -mostly beta-2 receptors in ciliary body epithelium.

SE-hypotension, bradycardia, sedation, bronchospasm, vasospasm, hyperlipidemia

• K-channel blockers (delayed rectifier)
• -prolong repolarization--> increase APD, ERP, QT

DRUGS: Amiodarone, Sotalol, Ibutilide, Bretylium, Dofetilide

• Class III antiarrhythmic
• K-channel blocker (delayed rectifier)
• -prolong repolarization--> increase APD, ERP, QT!
• -but NOT as much torsades despite QT!

-also block Na, Ca, Beta!! (alters lipid mem)

• USE- ANY arrhythmias!
• but, too many SE! so use when only all else fails.
• -can use for Wolff-Parkinson-White syndrome

• SE- LONG HALF LIFE! (3mo) HAPTEN, STAYS IN TISSUES FOREVER (high Vd), IODINATES! (it's an iodine)
• -pulmonary fibrosis
• -blue pigmentation of skin (smurf skin)
• -hypo/hyper thyroidism
• - phototoxicity, corneal deposits
• -hepatic necrosis
• -CV effects

Class Ia and Class III!

QT elongate--> torsades. but, NOT amiodarone!

• Amiordarone
• Bleomycin

• Class III antiarrhythmic + Beta-blocker
• -K-channel blocker (delayed rectifier)-prolong repolarization--> increase APD, ERP, QT
• -Beta1 block--> slow HR, AV conduc.

USE- only life-threathening arrhythmias

SE- Torsades (QT), exessive Beta block

• Class III antiarrhythmic
• K-channel blocker (delayed rectifier)
• -prolong repolarization--> increase APD, ERP, QT

USE- when all other antiarrhythmics fail.

SE- torsades (QT)

• Class III antiarrhythmic
• K-channel blocker (delayed rectifier)
• -prolong repolarization--> increase APD, ERP, QT

USE- when all other antiarrhythmics fail.

SE- torsades (QT), new arrhythmias, hypotension

• Class IV antiarrhythmic & antihypertensitve!
• -L-type-Ca channel blocker
• -decr. phase 0 and phase 4 in SA, AV node
• -decr. CV, incrs ERP, incrs PR-interval
• -decr. CO, decr SVR (all CCBs)
• USE- SVT, angina, prinzmetal's angina
• - HTN (but likes heart more!), Raynaud's

• SE-AV block, constipation,hypotension, flushing, dizziness, edema
• -displace Digoxin from its target (like Quinidine)
• - ADDITIVE EFFECT w/ Beta-blockers & Digoxin!!--> increase PR! monitor!

• Class IV antiarrhythmic & anti-hypertensive!
• -L-type-Ca channel blocker
• -decr. phase 0 and phase 4 in SA, AV node
• -decr. CV, incrs ERP, incrs PR-interval
• -dec CO, dec SVR (all CCBs)

• USE- SVT, angina, prinzmetal's angina
• -HTN, Raynaud's

• SE-AV block, constipation,hypotension, flushing, dizziness, edema
• - ADDITIVE EFFECT w/ Beta-blockers & Digoxin!!--> increase PR! monitor!

• Unclassified antiarrhythimic
• -Adenosine-R in heart-->Gi-->dec cAMP--> dec phase 4-->hyperpol--> dec HR at SA, AV (like M2)
• -incr PR

USE- DOC for Paroxysmal SVT!!

• very very short acting!! (15sec)
• antagonized by theophylline, coffee

• SE- dyspnea!, flushing, sedation, hypotension
• -Adenosine R-> Gq in bronchiole-->bronchoconstrict!

• Unclassified antiarrhythmic
• -acts to compete Ca--> decrease it's effects

• USE- torsades!!, digoxin toxicity (like lidocaine)
• -premature labor
• -seizure

anything that keeps cells depol longer!

• K-channel blockers (class IA, III)
• Anti-muscarinic
• Anti-psychotics
• Anti-histamines
• TCAs

torsades- QT increase->ventricular arrhythmia!

• -correct hypokalemia
• -correct hypomagnesemia
• -stop drugs that prolong QT
• -shorte APD with drugs (ex. isoproterenol) or electrical pacing

• Unclassified antiarrhythmic
• depress ectopic pacemakers in hypokalemia
• ex. digoxin toxicity

Hypekalemia--> depolarize cells!!

BOTH HYPERkalemia and HYPOkalemia are arrhythmogenic!!!

• Alpha-2 agonist (anti-hypertensive!)
• Decrease NE release (dec alpha-1, beta-1--> vasodilate, decrease HR)

• USE-mild to moderate HTN (esp w/renal disease)
• -Opioid withdrawl

• SE- CNS depression (no NE), Edema (RAA),sexual dysfunction, dry mouth
• -immediate stopping-->rebound HTN, so taper off gradually!!

• UNIQUE- opposition with TCA! (incr NE)
• do not give with TCA! cancel each other's effect!
• - b/c it's indirect, NO immediate effect! it takes time to work.
• - no need to worry about reflex tachycardia!

• Alpha-2 agonist (anti-hypertensive!)
• Decrease NE release (dec alpha-1, beta-1--> vasodilate, decrease HR)

USE- HTN in Pregnancy (safe)! also with renal disease (b/c does NOT decrease blood flow to kidney)

• SE- Hemolytic anemia (+ coombs), hepatotoxic, edema, impotence, sedation,dry mouth lactation (prolactin incr)
• -safe in pregnancy b/c high plasma protein binding (why it's a good hapten-->autoimmune hemolysis!)

- TCAs and alpha-2 agonists cancel each other's effects!!

• Indirect antiadrenergic (old~ antihypertensive)
• -Block Vesicular DA-beta hydroxylase (in NE storage vesicle, marker enzyme of NE-neurons)
• -decr release of NE, 5-HT, DA!

USE- used to be anti-hypertensive, but removed because it causes SEVERE DEPRESSION!

SE- suicidal! (b/c NE, 5-HT, DA all reduced in brain!) edema, incr GI secretion (PED pts hate it!)

• Indirect antiadrenergic (old~ antihypertensive)
• -enters thru NE-reuptake transporter--> block release of NE vesicles!
• -vasodilate, decrease HR

USE-old antihypertensive

• SE- diarrhea, edema (RAA)
• do not give with TCAs! useless!
• -TCAs block NE reuptake transporter, so Guanethidine would have no entry.

• alpha-1 blocker, antihypertensive
• (relax areterioles + venules)

• USE-HTN
• -BPH- relax sphincter so they can pee
• -Raynaud's phenomenon

• SE-orthostatic hypertension, urinary incontinence, sexual dysfunction, nightmare
• -good lipid profile unlike beta-blockers! (incr HDL, dec LDL)

alpha-1 blockers DO cause reflex tachycardia!

similar: doxazosin, terazosin, samulosin

antihypertensive, post-MI, antiarrhythmic

-block renin release! (also decr HR, CO helps too)

SE- AV block (bradycardia), CNS depression, Dec sex arousal, hyperlipidemia (dec lipolysis B2), hypoglycemia

• - no reflex tachycardia!
• -watch out in use w/ Asthma, Vaspospastic dx, Diabetes!

• antihypertensive
• direct-acting vasodilator!
• arteriole only.

-prodrug-->met in arterioles only--incr cGMP->vasodilate-->dec SVR-->decr afterload

• -USE- IV severe HTN (pregnancy safe!)
• - CHF
• -SE- SLE- in slow acetylators! edema (RAA), reflex tachycardia
• -give with diruretics or beta blocker

• antihypertensive
• direct acting vasodilator!
• prodrug-->incr cGMP-->aterioles+ veins

• USE- IV- hypertensive emergency (short term only!)
• SE- CN-poisoning (prusside-CN)
• -give with nitrite + thiosulfate!

-caused by Nitroprusside, combustion of Polyurethane (house fires!)

• -CN--> bind Fe-containing enzymes (esp Heme in Cyt oxidase)--> inhibit ETC--> hypoxia!
• -initial CNS and Cardio stimulation-->CNS depression, death.
• -rapid onset flushing, tachypnea, tachycardia, headache, nausea, vomiting, severe lactic acidosis (hypoxia), High venous PO2 (tissues cannot extract)

Amyl Nitrite--> induce methehmoglobin (Fe+3)-->Met-Hb bind CN, release more O2 to tissues-->thiosulfate--> SCN- + Met-Hb

• anti-hypertensive
• ATP-dep K-channel blocker
• (arterioles , pancreas beta cells)
• -hyperpol cells

• USE- IV- severe HTN
• -baldness (rogaine)

• SE- hypertichosis, hyperglycemia (dec Insulin release), edema, reflex tachycardia
• -use with beta blockers!

• anti-hypertensive
• ATP-dep K-channel blocker
• (arterioles , pancreas beta cells)
• -hyperpol SMC-->relax

• USE- IV- hypertensive crisis
• -insulinomas!! (b/c decr insulin release!)

• SE- hyperglycemia (decr insulin release), Edema, Reflex tachycardia
• -use with beta-blockers!

• anti-hypertensive! direct vasodilator
• L-type Ca-channel blocker
• "dipines"= dihydropyridines

• USE- HTN, Prinzmetal's angina
• (not approved for antiarrhythmic!- only Verapamil, Diltiazem).

• SE- reflex tachycardia, gyngival hyperplasia!
• AV block, edema, flushing, dizziness
• -Phenytoin also cause gyngival hyperplasia.

• ACE inhibitor
• block Ang-II form.
• -arteriole + venus dilation
• -inhibit BK breakdown!

• USE- HTN, CHF, Diabetic nephropathy!
• (dec afterload, dec heart remodeling)

• SE-hyperkalemia, dry cough (BK), hypotension (esp. Na-depleted pt) ,acute renal failure in renal artery stenosis!, angioedema!
• do NOT use in bilateral renal a. stenosis, pregnancy!!

• ARB
• -AngII-receptor blocker
• -arteriole + venus dilator
• -does NOT inhibit BK breakdown

• USE- HTN, CHF, Diabetic nephropathy
• (dec afterload, prevent heart remodeling)

• SE- hyperkalemia, hypotension, acute renal failure in renal a. stenosis
• do NOT use in bilateral renal a. stenosis, pregnancy!

Block Renin

USE- HTN

• SE-hypotension, hyperkalemia, acute renal failure in renal a stenosis.
• do NOT use in bilateral renal a. stenosis, pregnancy!

• beta blockers
• calcium channel blockers

• ACE-inhibitors
• ARB

(improve blood supply to the hyalin-sclerosing glomeruli)

• ACE-inhibitor
• ARBs
• beta blockers

Beta blockers

Alpha-1 blockers

• Alpha-1 blocker
• Calcium channel blocker
• ACEI, ARB

NOT beta-blockers! (hypoglycemia, hyperlipidemia)

• anti-hypertension for Pulmonary HTN!
• -inhibit Endothelin-receptorA

• USE- Pulm HTN
• great b/c endothelin-->vasoconstrict + endothelial hyperplasia!

• SE-hypotension, flushing, leg edma
• -hepatitis (high dose)
• -induce CYP, dec warfarin (pulm HTN patienst usu on it!)

• anti-hypertensive for Pulm HTN!
• PGI2- analog--> incr cAMP-->vasodilate

USE- Puml HTN

• SE- Jaw pain, headache, flusing
• -need to infuse slowly IV (short half life)

• vasodilator
• -inhibit PDE-V--> incr cGMP--> NO--> vasodilate

USE- erectile dysfunction, Pulm HTN!

• SE- headache, flushing, priapism (color vision change)
• - potentiate vasodilation of Nitroglycerin (inc cGMP)!--> severe hypotension!!

• + inotropic agent
• direct-block Na/K-ATPase in heart muscle (incr Na, dec gradient for Na/Ca exchanger)-->incr Ca-->incr contractility!
• indirect- depol all neurons-->incrs Vagal tone (node) AND Symp tone (muscle)--> dec HR, incr contractility!

• USE- CHF (acute+chronic)
• -A-fib (ironic, but incr vagal to AV)

• SE-cholinergic: nausea, diarrhea, blurry vision
• ECG- incr PR, dec QT, T-invert, sccoping, arrhythmia (depol), hyperkalemia

• do NOT use in Hypokalemia, AV block, Wolff-Parkinson-White syndrome!!
• -long half life-need loading dose "digitalize"
• -cleared by kidney-->bad kidney, incr toxicity!
• -high Vd (high tissue binding)-->displaced by Verapamil, Quinidine-->incr toxicity!
• -Diuretics-->hypokalemia-->incr toxicity!

• slowly normalize K+ , Mg+2
• Lidocaine (class Ib)-Rx arrythmia in digitalized (depol) area
• anti-digoxin Fab fragment

Block fast accessory pathway, increase AV node conduction

USE- Class Ia (Quinidine) or III (Amiodarone)

Don't use- AV blockers! ( Digoxin, B-blocker, Ca-channel blocker, adenosine)

• + inotropic agent
• -PDE-III inhibitor (heart, SM)
• -inhibit cAMP breakdown
• -cAMP, heart--> incrs contractiliy!
• -cAMPT, BV--> vasodilate!

• USE- decompensated Heart Failure!
• increase contractiliy + decrease afterload

SE-vent arrhythmias! hypotension, hepatotoxicity

• + inotropic agent
• -PDE-III inhibitor (heart, SM)
• -inhibit cAMP breakdown
• -cAMP, heart--> incrs contractiliy!
• -cAMPT, BV--> vasodilate!

• USE- decompensated Heart Failure!
• increase contractiliy + decrease afterload

SE-vent arrhythmias! hypotension, hepatotoxicity

• beta blocker + alpha-1 blocker!!
• Vasodilatory beta blocker!

• USE- CHF!!
• - block beta--> decrease O2 demand, decrease renin
• - block alpha--> decrease SVR, decrease afterload, preload.

• SE- Hypotension, Bradycardia, Bronchospasm.
• DO NOT USE IN DECOMPENSATED HEART FAILURE!

• beta blocker + alpha-1 blocker + partial beta2-agonist!!
• Vasodilatory beta blocker!

• USE- CHF!!
• - block beta--> decrease O2 demand, decrease renin
• - block alpha--> decrease SVR, decrease afterload, preload.

• SE- Hypotension, Bradycardia, Bronchospasm.
• DO NOT USE IN DECOMPENSATED HEART FAILURE!

• Vasodilator for CHF
• recombinant BNP
• -bind ANP, BNP receptors--> cGMP-->NO--> vasodilate, natriurisis!
• USE- acutely decompensated CHF
• -expensive!
• SE- hypotension

• Nitrates, direct vasodilator
• -dilate VEINS! --> decr preload--> decr MVO2
• -prodrug--> free nitrite (need Cystein from Glutathione)--> NO--> inc cGMP
• -decr EDV, BP,
• -incrs HR, contractility (reflex)
• -decr Ejection time

• USE- ANGINA! , pulmonary edema
• -decr infarct size, improve post-MI survival
• -Nitroglycerin- sublingual (bc 1st pass), IV, patch
• -Isosorbide- oral, extended release
• -give with beta-blocker (prevent reflex)

• SE- hypotension, reflex tachycardia (bad for MI!). flushing, headache (meningeal-a dilation), methemoglobinemia
• - Tachyphylaxis! (acute tolerance-24hr)

do NOT use with Sidenafil!!! (hypotensive crisis-->massive reflex tachycardia--> MVO2--> death in MI patients!!)

• Nitroprusside - arteriole + vein (CN-toxicity)
• Hydralazine- arteriole (SLE)
• Nitroglycerin- vein (tachyphylaxis)

• -Patients taking daily maintenance nitrates need to have nitrate-fee period every day to avoid tolerance!!
• -so skip a night time dose!!

• all CCB can be used!
• -Verapamil (heart)- constipation
• -Diltiazem
• -Nifedipine (BV-vasospastic prinzmetal)- gyngival hyperplasia

• -decr afterload!
• -decr HR, contractility, BP, MVO2
• -incr EDV

• -Great for Stable angina!
• -Shitty for Prinzmetal angina!- worsen vasospasm!
• ex. Pindolol, Acebutolol- contraindicated in angina!!-partial agonists--> may incr MVO2

ex. Carvedilol- beta+alpha-blocker- same efficacy as isosorbide in stable angina and decr. MI risk!!

• PDE inhibitor, Adenosine-R blocker
• - incr cAMP in heart--> tachycardia
• -incr cAMP in smooth muscle--> bronchodilate, vasodilate
• - inhibit Adeno- R heart (Gi)--> incr cAMP

USE- COPD, Asthma

SE- narrow TI! tremor, agitation, arrhythmia, seizures

• Osmotic diuretic -increase tubular fluid osmolarity--> trap water in tubule--> increase urine volune, water loss!!
• -think Glucose-->sorbitol--> diuresis in Diabetics!
• -site- entire tubule,but most effect at PT

• USE- acute narrow angle glaucoma attack
• -decr ICP
• -oligouria
• -clear toxins- Rhabdomyolysis (statins!)- Mb toxic to tubules.
• -shock

• SE- acute hypovolemia (may incr reflex tachy, ADH, Aldosterone), pulm edema
• - DO NOT USE IN CHF, Anuria!

• CA-inhibitor
• NaHCO3 diuresis!
• -decr H+ formation in PT cell-->decr Na/H antiport--> prevent reabsorption Na + HCO3---> diuresis!

• USE- acute mountain sickness (Rx resp alkalosis + pulm edema)!
• -metabolic alkalosis
• -rhabdomyolysis-induced renal failure
• -open angle glaucoma (block HCO3 form in eye, decr aqu humor)

• SE- Hypokalemia + Acidosis!! (unique!)
• -Hyperchloremia (b/c Na now reabsorbs with Cl-)
• -renal stones (b/c alkalize urine!)
• -sulfonamide hypersensitivity
• -neuropathy, NH3 toxicity

• 1. Block NKCC pump
• --> decr Na, Cl, K reabsoprtion!
• --> decr transport of K in tubule cell--> derc back diffusion--> decr + potential--> decr reabsorb Ca, Mg
• decrease Na, Cl, K, Ca, Mg!!!!!!!

2. Vasodilate! (incr PG!--> vasodilate afferent arteriole + others--> decr BP)

• Loop
• - block NKCC--> decrease Na, Cl, K, Ca,Mg!!!!!!!
• -eliminate + charge lumen in TAL
• -Vasodilate by incr PGs--> decr BP

• USE-Edema! (CHF, cirrhosis, nephroic syndrome, pulm edema)
• -HTN!
• -Hypercalcemia (b/c gets rid of Ca)
• - Anion overdose

• SE- sulfonamide hypersensitivity! (use Ethacrynic acid in sulfa-allergic pts!)
• -Hypokalemia + Alkalosis (classic!-bc aldosterone + incr Na deliver/reabsorb at distal tubule)
• -Hypocalcemia (opposite of TZDs)
• -Hypomagnesemia
• -Hyperuricemia! (weak acid drugs compete w/secretion pump in PT!)
• -Ototoxicity- irreversible w/ ethacrynics!!
• do NOT use with sulfa-allergic, gout patients!!

• +Aminoglycosides enhance ototoxicity!
• + Digoxin tocitiy enhances w/ hypokalemia!!
• +Lithium clearnce decrease!
• +NSAIDs cancle anti-HTN effect

• Loop
• - block NKCC--> decrease Na, Cl, K, Ca,Mg!!!!!!!
• -eliminate + charge lumen in TAL
• -Vasodilate by incr PGs--> decr BP

• USE- Sulfa-allergy patients!!!
• Edema! (CHF, cirrhosis, nephroic syndrome, pulm edema)
• -HTN!
• -Hypercalcemia (b/c gets rid of Ca)
• - Anion overdose

• SE-Hypokalemia + Alkalosis (classic!-bc aldosterone + incr Na deliver/reabsorb at distal tubule)
• -Hypocalcemia (opposite of TZDs)
• -Hypomagnesemia
• -Hyperuricemia! (weak acid drugs compete w/secretion pump in PT!)
• -Ototoxicity- irreversible w/ ethacrynics!!
• -do NOT use w/ gout patients!!

• +Aminoglycosides enhance ototoxicity!
• + Digoxin tocitiy enhances w/ hypokalemia!!
• +Lithium clearnce decrease!
• +NSAIDs cancle anti-HTN

Sulfa- lipid soluble, enhance drug absorption, but binds proteins--> hapten-->hypersensitivity potential

• cross allergy w:
• CA inhibitors (acetazolamide)
• All Loops!! except ethacrynic acid
• Thiazides
• Sulfa-antibiotics
• Celecoxib
• -anydrug with Sulfo- or Thio- in it!!!!

• Thiazide diuretic (week bc= only 10% Na)
• inhibit Na/Cl transporter in DCT--> NaCl Diuresis + increase Ca absorption
• also block ATP-dependant K-channel (like Minoxidil)

• USE- HTN, CHF
• -kidney stones (decr Ca)
• -Nephrogenic DM (combine free water loss with salt, induce Aldosterone)

• SE- Sulfonamide hypersensitivity
• Kypokalemia + alkalosis
• Hypercalcemia, Hypeuricemia
• Hyperglycemia + Hyperlipidemia (decr insulin release)

• -increase Digoxin toxicity (hypokalemia)
• -NOT good for DM!! (also b-blockers) use ACEI, ARBs!

• Thiazide diuretic (week bc= only 10% Na)
• inhibit Na/Cl transporter in DCT--> NaCl Diuresis + increase Ca absorption
• also block ATP-dependant K-channel (like Minoxidil)

• USE- HTN, CHF
• -kidney stones (decr Ca)
• -Nephrogenic DM (combine free water loss with salt, induce Aldosterone)

• SE- Sulfonamide hypersensitivity
• Kypokalemia+alkalosis
• Hypercalcemia,Hypeuricemia
• Hyperglycemia (decr insulin release)
• -increase Digoxin toxicity(hypokalemia)
• -NOT good for DM!! (also b-blockers) use ACEI, ARBs!

• K+ sparing diuretic
• -block Aldosterone receptor at CD
• -also block androgen receptor

• USE- Hyperaldosteronic state,CHF
• -Adjuct to K-wasting diuretics
• -antiandrogenic uses (female hirsutism)

• SE- Hyperkalemia, acidosis
• -antiandrogen effects! (male gynecomastia) do NOT use in RENAL FAILURE or Rhabdomyolysis!! (can cause Hyperkalemia!)

• K+ sparing diuretic
• -block Aldosterone receptor at CD
• -does NOT block androgen receptors like Spironolactone! (more selective)

• USE- Hyperaldosteronic state,CHF
• -Adjuct to K-wasting diuretics

SE- Hyperkalemia + acidosis

• K+ sparing diuretic
• -block ENAC at CD

USE- adjuct to K+ wating diuretics

SE-hyperkalemia + acidosis

• K+ sparing diuretic
• -block ENAC at CD

• USE- adjuct to K+ wating diuretics
• -lithium-induced nephrogenic diabetes insipidus

SE-hyperkalemia + acidosis

• HMG-Coa-reductase inhibitor
• (decr mevalonate->decr liver Xol, incr LDL-R, decr plasma LDL)
• Block VLDL synthesis (decr TGs!)

USE-combined hyperlipidemias!(decr Xol + TG)

• SE- Rhabdomyolysis! (release Mb-->ATN), myalgia/myopathy (check CKMM), Hepatotoxicity (check liver enzymes!)
• -DO NOT use with Genfibrozil (incr rhabdomyolysis! by decr statin clearance)
• -Cyp inhibitors incr toxicity (acute alcohol, grapefruit juice..)

• Bile acid sequestrants (resin)
• -complex w bile in gult-->decr bile salt circ-->incr syn bile, decr liver Xol-->incr LDLR-->decr blood LDL

USE-pure high XOL (NOT high TG!)

• SE- incre VLDL and TGs!!(b/c doesn't block VLDL syn like statins, incr precursors of LDL (VLDL, IDL)
• -bad taste, malabsorption (steatorrhea, diarrhea), xol gallstones, decr absorption of lipid soluble drugs!(warfarin, thiazides, digoxin)
• DO NOT use in high TG pts!!

• Bile acid sequestrants (resin)
• -complex w bile in gult-->decr bile salt circ-->incr syn bile, decr liver Xol-->incr LDLR-->decr blood LDL

USE-pure high XOL (NOT high TG!)

• SE- incre VLDL and TGs!!(b/c doesn't block VLDL syn like statins, incr precursors of LDL (VLDL, IDL)
• -bad taste, malabsorption (steatorrhea, diarrhea), Xol gallstones, decr absorption of lipid soluble drugs!(warfarin, thiazides, digoxin)
• DO NOT use in high TG pts!!

• VLDL synthesis blocker
• -block lipolysis in adipose--> decr VLDL in liver,decrs LDL, incr HDL!

USE- high XOL and high TG(?)

• SE- flushing, pruritis, rash - PG mediated! (decr with Aspirin!)
• Hyperglycemia (acanthosis nigricans), Hyperuricemia (worsens gout)hepatotoxicity
• -do NOT use in DM, Gout pts!!

• Fibrates!
• activate Lipoprotein lipase-->decr VLDL, IDL, slight decr LDL,incrs HDL--> mostly decrs TG!!

USE-hypertriglyceridemia!!!

• SE-Myositis, hepatotoxicity (incr LFTs)
• Xol gallstones

• Fibrates!
• activate Lipoprotein lipase-->decr VLDL, IDL, slight decr LDL,incrs HDL--> mostly decrs TG!!

USE-hypertriglyceridemia!!!

SE-Myositis, hepatotoxicity (incr LFTs)Xol gallstones

• Prevent GI Xol absoprtion at SI!
• --> decr LDL
• (no effect on HDL or TG)

USE- high Xol

SE- not much.. GI distress

• Weight loss agent
• -block Pancreatic lipase--> decr TG breakdown

USE- weight loss (high TG)

SE- steatorrhea, diarrhea, decr absorption of Vit ADEK!

High XOL--> Cholestyramine, Colestipol, Ezetimibe

High TG-->Gemfibrozil, Clofibrate, Bezafibrate

High XOL + TG--> Statins, Niacin, Ezetimibe

abdominal pain, vomiting, diarrhea, arrhythmias, seizures (major)

bradycardia, hypotension, cardiovascular collapse