Module 4 Cardiovascular, Renal, and Hematological Agents Flashcards

Comprehensive practice flashcards covering cardiovascular and renal pharmacology, anticoagulation, and hematopoietic agents based on the module transcript.

ACEIs Suffix

The common pharmacological suffix "prils" refers to this drug class.

ACEIs MOA (Angiotensin)

Inhibit ACE which inhibits conversion of angiotensin I to angiotensin II.

ACEIs MOA (Aldosterone)

Decreases the production of aldosterone, leading to decreased sodium and water retention.

ACEIs MOA (Bradykinin)

Prevent breakdown of bradykinin, which increases vasodilation but may cause bronchial irritation.

ARBs Suffix

The common pharmacological suffix "sartans" refers to this drug class.

ARBs MOA

Block the angiotensin II receptor, affecting vasoconstriction and aldosterone secretion without affecting bradykinin.

DRIs Example

aliskiren [Tekturna] is the prototype for this drug class.

DRIs MOA

Inhibit the conversion of angiotensinogen to angiotensin I, reducing the formation of both angiotensin I and II.

RAAS (Abbreviation)

Stands for the Renin-Angiotensin-Aldosterone System.

Renin Site of Origin

According to the RAAS diagram, the kidney is the source of this enzyme.

Angiotensin II Effects

Causes vasoconstriction and triggers aldosterone secretion from the adrenal gland.

ACEIs, ARBs, & DRIs Combination Rule

None of these drugs should be combined; use one or the other.

Bilateral renal artery stenosis

A major contraindication for ACEIs, ARBs, and DRIs.

Angioedema

A life-threatening adverse effect associated specifically with ACEIs and DRIs.

Pregnancy

A contraindication for RAAS inhibitors due to risk of fetal harm.

ACEI-induced Cough

Bronchial irritation caused by increased bradykinin levels.

Hyperkalemia

A common electrolyte adverse effect for ACEIs, ARBs, and DRIs.

Renoprotection

The clinical effect of ACEIs and ARBs for patients who have proteinuria.

First-line HTN for Diabetes Mellitus

ACEIs and ARBs are the first-line therapy for this population.

Black Patient HTN therapy

ACEIs and ARBs are characterized as not as effective in this population, with an increased risk of angioedema.

ACEI Post-MI benefit

Early initiation helps decrease mortality in patients who have suffered a myocardial infarction.

ACEI HF benefit

Decreases remodeling, hospitalization, and mortality in heart failure patients.

ACEI/ARB Monitoring (Renal)

Evaluate serum creatinine prior to prescribing and during therapy.

Calcium Channel Blockers MOA

Block the influx of calcium to inhibit cardiac and vascular smooth muscle contraction.

Dihydropyridines (Type 2) Suffix

The common pharmacological suffix "dipines" refers to this CCB sub-class.

Dihydropyridines Effect Profile

Focus on vasodilation with less cardiac effect; they do not affect conduction through the AV node.

Non-dihydropyridines (Type 1) Examples

Referred to as "mil & dil" (verapamil and diltiazem).

Non-dihydropyridines Effect Profile

Focus on cardiac effects over vasodilation; they affect conduction through the AV node to decrease heart rate.

Non-dihydropyridines Contraindication

Should be avoided in heart failure (HF) and bradycardia.

Dihydropyridines Contraindication

Should be avoided in significant peripheral edema and unstable angina.

Verapamil specific adverse effect

Constipation is a common side effect, which is noted to be worse with this specific drug.

Reflex Tachycardia

An adverse effect specifically associated with Dihydropyridine CCBs.

Peripheral Edema

A common adverse effect for Dihydropyridines.

CYP3A4

The enzyme system responsible for metabolizing CCBs; inhibitors like grapefruit juice increase drug levels.

Grapefruit Juice Interaction

Inhibits the CYP3A4 system, which can increase free drug levels of Calcium Channel Blockers.

Prinzmetal’s Angina

A clinical use for Calcium Channel Blockers.

HTN therapy for Black Patients

Calcium Channel Blockers are considered better for this population than ACEIs/ARBs.

SVT/a-fib CCB choice

Non-dihydropyridines are used for rate control in these conditions.

Raynaud’s Syndrome

A clinical use for Calcium Channel Blockers involving peripheral vasoconstriction.

CCB Monitoring

Check liver function before initiating, heart rate, and monitoring for edema or HF symptoms.

Loop Diuretics MOA

Inhibit sodium reabsorption in the ascending loop of Henle.

furosemide [Lasix]

The prototype drug for Loop Diuretics.

Thiazide-type Diuretics MOA

Inhibit sodium reabsorption in the distal renal tubule.

chlorthalidone [Thalitone]

An example of a Thiazide-type diuretic.

hydrochlorothiazide [HCTZ]

A common Thiazide-type diuretic used for HTN.

Potassium-sparing Diuretics MOA

Inhibit sodium reabsorption and potassium excretion in the distal renal tubule.

spironolactone [Aldactone]

The prototype drug for Potassium-sparing diuretics.

Diuretic Threshold for Renal Impairment

Precautions are needed if CrCl is $< 30\,mL/min$.

Hypokalemia

An adverse effect associated with loop and thiazide-type diuretics.

Hyperuricemia

An adverse effect of diuretics that can trigger gout.

Gynecomastia

A specific adverse effect associated with spironolactone.

NSAIDs and Diuretics

These drugs decrease the effectiveness of all diuretic classes.

First-line HTN Monotherapy

Thiazide-type diuretics are recommended as first-line for this purpose.

Diuretic for Low CrCl

Loop diuretics are the most effective and can be used when CrCl is $< 30\,mL/min$.

Potassium Supplementation Threshold

Required if potassium levels are $< 3.5\,mEq/L$ during diuretic therapy.

Diuretic Education (Timing)

Instruct the patient not to take the medication after $4p$ (4 PM).

HTN Lifestyle Modifications

Should be the first step for all patients diagnosed with hypertension.

Stage 1 HTN First-line Classes

ACEIs, ARBs, CCBs, and thiazide diuretics.

Alternative for ACEI Intolerance

An ARB is usually chosen if the patient is unable to take an ACEI.

Labetalol [Trandate]

Recommended for the management of HTN in pregnant patients.

Methyldopa [Aldomet]

Recommended for the management of HTN in pregnant patients.

HFrEF Compelling Indication

Requires ACEI or ARB, beta blocker, diuretic, and aldosterone antagonist.

Post-MI Compelling Indication

Requires ACEI or ARB, beta blocker, and aldosterone antagonist.

Proteinuric CKD Indication

An ACE inhibitor or ARB is the specific antihypertensive drug class indicated.

Benign Prostatic Hyperplasia Comorbidity

Alpha blockers are likely to have a favorable effect on symptoms.

Essential Tremor Comorbidity

Noncardioselective beta blockers are likely to have a favorable effect.

Osteoporosis Comorbidity

Thiazide diuretics are likely to have a favorable effect.

Bronchospastic Disease Contraindication

Do not use a non-selective beta blocker.

Gout Contraindication

Generally avoid loop or thiazide diuretics in this condition.

Hyponatremia Precaution

Generally avoid thiazide diuretics in this condition.

Cardiac Glycosides MOA

Inhibit the $Na^+/K^+\text{ ATPase}$ pump to increase intracellular sodium and calcium.

Inotropic Effect of Digoxin

It is positive, meaning it increases contractility.

Chronotropic Effect of Digoxin

It is negative, meaning it slows conduction through the AV node to decrease heart rate.

digoxin [Lanoxin]

The primary drug listed under Cardiac Glycosides.

Digoxin Toxicity Threshold

Occurs with serum drug levels $> 2\,ng/mL$.

Digoxin Visual Disturbances

Signs of toxicity include blurred vision and green/yellow halos around lights.

Digoxin Immune Fab [Digibind]

The antidote for severe or life-threatening digoxin toxicity.

Hypokalemia and Digoxin

This electrolyte abnormality increases the risk of digoxin toxicity.

Antiarrhythmics Class Ia

Sodium channel blockers that prolong the action potential; e.g., quinidine.

Antiarrhythmics Class Ib

Sodium channel blockers that shorten the action potential; e.g., lidocaine.

Antiarrhythmics Class Ic

Sodium channel blockers with no effect on the action potential; e.g., flecainide [Tambocor].

Antiarrhythmics Class II

Standard drug class consists of beta blockers.

Antiarrhythmics Class III

Potassium channel blockers; e.g., amiodarone [Cordarone] and sotalol [Betapace].

Antiarrhythmics Class IV

Calcium channel blockers, specifically "mil & dil" (verapamil and diltiazem).

Amiodarone Thyroid Effects

Can cause both thyrotoxicosis and hypothyroidism.

Amiodarone Skin Side Effect

Can cause a distinct blue-gray skin tone.

Amiodarone Organ Toxicities

Includes pulmonary fibrosis, hepatitis, and corneal deposits.

Amiodarone Monitoring

Requires CXR/PFTs, thyroid function tests, and eye exams.

Nitrates MOA

Vasodilators that relax smooth muscle to decrease afterload and preload, reducing myocardial oxygen demand.

Nitrate Examples

isosorbide mononitrate/dinitrate [Imdur/Isordil] and NTG.

PDE-5 Inhibitors Nitrate Interaction

Concurrent use of drugs like sildenafil [Viagra] is a major contraindication.

Nitrate Tolerance

To prevent this, patients need a nitrate-free period of $10-12$ hours each day.

Nitrate Headache

A common adverse effect due to vasodilation.

Exertional Angina Education

Take NTG $5-10$ minutes before activity.

Acute Angina Protocol

Take $1$ NTG every $5$ minutes up to $3$ doses; call 911 if no relief after the 2nd tablet.

Nitrate Storage

Keep in a glass bottle, protect from heat/light, and replace every $6$ months.

Peripheral Vasodilators Examples

hydralazine [Apresoline] and minoxidil [Loniten].

Peripheral Vasodilators Adverse Effect

Commonly associated with reflex tachycardia.

Peripheral Vasodilators Clinical Use

Indicated for resistant HTN, but not as first-line therapy.

Bile-acid Sequestrants Examples

colestipol [Colestid] and cholestyramine [Questran].