CARDIO 1

Thiazide diuretics: which drugs are in this class?

Hydrochlorothiazide, chlorothiazide, chlorthalidone, and metolazone.

Thiazide diuretics: mechanism of action?

Inhibit NaCl transport in the early distal convoluted tubule.

Thiazide diuretics: indications?

Hypertension and chronic edema from heart failure.

Thiazide diuretics: contraindications?

Sulfa allergy and anuria.

Thiazide diuretics: common adverse effects?

Hypotension/dizziness, skin photosensitivity, electrolyte imbalances, gout, vision changes, and acute angle-closure glaucoma.

Loop diuretics: which drugs are in this class?

Furosemide, bumetanide, torsemide, and ethacrynic acid.

Loop diuretics: mechanism of action?

Inhibit Na+/K+/Cl- cotransport.

Loop diuretics: indications?

Edema from heart failure, ascites, pulmonary edema, and hypertension when a thiazide is inadequate.

Loop diuretics: contraindications?

Sulfa allergy and altered kidney function/dialysis.

Loop diuretics: common adverse effects?

Ototoxicity, acute kidney injury, and electrolyte imbalance (potassium supplement usually given).

Potassium-sparing diuretics / aldosterone receptor antagonists: which drugs are in this class?

Eplerenone, spironolactone, amiloride, and triamterene.

Potassium-sparing diuretics / aldosterone receptor antagonists: mechanism of action?

Antagonize sodium reabsorption at the distal convoluted tubule and cortical collecting tubule.

Potassium-sparing diuretics / aldosterone receptor antagonists: indications?

Heart failure and hypertension (not initial management).

Potassium-sparing diuretics / aldosterone receptor antagonists: contraindications?

Hypokalemia (as listed on slide), Addison's disease, and altered kidney function.

Potassium-sparing diuretics / aldosterone receptor antagonists: common adverse effects?

Hyperkalemia and gynecomastia.

Potassium-sparing diuretics: which supplement must be avoided?

Potassium supplements, due to hyperkalemia risk.

Clonidine (centrally acting sympathoplegic): mechanism of action?

Reduction of cardiac output due to decreased heart rate and relaxation of capacitance vessels, as well as a reduction in peripheral vascular resistance

Clonidine (centrally acting sympathoplegic): indications?

Hypertension, plus several non-cardiac mental health uses.

Clonidine (centrally acting sympathoplegic): contraindications?

Depression and concurrent tricyclic antidepressant use (TCAs).

Clonidine (centrally acting sympathoplegic): common adverse effects?

Dry mouth, sedation, and life-threatening hypertensive crisis on abrupt withdrawal.

Methyldopa (centrally acting sympathoplegic (stimulates Alpha-2) ): mechanism of action?

Lowers peripheral vascular resistance with variable reduction in heart rate and cardiac output.

Methyldopa (centrally acting sympathoplegic): indications?

Hypertension in pregnancy.

Methyldopa (centrally acting sympathoplegic): contraindications?

Active hepatic disease and concurrent Monoamine oxidase inhibitors (MAOI) use.

Methyldopa (centrally acting sympathoplegic): common adverse effects?

Sedation, nightmares, depression, vertigo, and extrapyramidal signs- rare

Cardio-selective β-blockers (metoprolol, atenolol): which drugs are in this class?

Metoprolol (tartrate IR, succinate ER) and atenolol.

Cardio-selective β-blockers (metoprolol, atenolol): mechanism of action?

Block β receptors, slowing AV conduction.

Cardio-selective β-blockers (metoprolol, atenolol): indications?

Chronic stable angina, arrhythmias, post-MI, heart failure (metoprolol succinate), and hypertension (not initial therapy).

Cardio-selective β-blockers (metoprolol, atenolol): contraindications?

Second- or third-degree heart block.

Cardio-selective β-blockers (metoprolol, atenolol): common adverse effects?

Bradycardia, bronchospasm, fatigue, insomnia, and vivid dreams.

Metoprolol/atenolol: what happens with abrupt withdrawal?

Rebound tachycardia, hypertension, and ischemia, so taper instead.

Which metoprolol formulation is used for heart failure?

Succinate (extended-release).

β-blockers with vasodilating effects (carvedilol, labetalol, esmolol): which drugs are in this class?

Carvedilol, labetalol, and IV esmolol.

β-blockers with vasodilating effects (carvedilol, labetalol, esmolol): mechanism of action?

β-blockade combined with vasodilation.

β-blockers with vasodilating effects (carvedilol, labetalol, esmolol): indications?

Hypertension and congestive heart failure.

β-blockers with vasodilating effects (carvedilol, labetalol, esmolol): contraindications?

Bronchial asthma, second/third-degree block or sick sinus syndrome, and severe bradycardia.

β-blockers with vasodilating effects (carvedilol, labetalol, esmolol): common adverse effects?

Bradyarrhythmias, bronchospasm, fatigue/insomnia, and hypoglycemia.

Non-selective β-blockers (per lecture): which drugs are in this class?

Propranolol, nadolol, betaxolol, and bisoprolol.

Non-selective β-blockers (per lecture): mechanism of action?

Decrease cardiac output and inhibit renin release.

Non-selective β-blockers (per lecture): indications?

Mild-to-moderate hypertension, SVT, and off-label performance anxiety.

Non-selective β-blockers (per lecture): contraindications?

Heart block greater than first degree, uncompensated heart failure, and severe sinus bradycardia.

Non-selective β-blockers (per lecture): common adverse effects?

Withdrawal syndrome with tachycardia, nervousness, worsening angina, and elevated BP.

Alpha-1 blockers: which drugs are in this class?

Prazosin, terazosin, and doxazosin.

Alpha-1 blockers: mechanism of action?

Selectively block α1 receptors, dilating both arterioles and venules.

Alpha-1 blockers: indications?

Mild-to-moderate hypertension (with a β-blocker or diuretic, not alone) and BPH.

Alpha-1 blockers: contraindications?

Orthostatic hypotension.

Alpha-1 blockers: common adverse effects?

Dizziness, palpitations, headache, and fatigue.

Which alpha-1 blocker is used for PTSD nightmares?

Prazosin.

Non-selective alpha blockers: which drugs are in this class?

Phentolamine and phenoxybenzamine (rarely used).

Non-selective alpha blockers: mechanism of action?

Block α receptors on vascular smooth muscle, lowering peripheral resistance.

Non-selective alpha blockers: indications?

Pheochromocytoma and hypertensive emergencies.

Non-selective alpha blockers: contraindications?

Current or prior MI, coronary insufficiency, and angina.

Non-selective alpha blockers: common adverse effects?

Tachycardia, arrhythmias, and myocardial ischemia.

ACE inhibitors: which drugs are in this class?

Lisinopril, captopril, enalapril, benazepril, fosinopril, and ramipril.

ACE inhibitors: mechanism of action?

Block conversion of angiotensin I to angiotensin II, preventing aldosterone release.

ACE inhibitors: indications?

Hypertension, post-MI, heart failure, and kidney protection in diabetes.

ACE inhibitors: contraindications?

Pregnancy (black box) and heart failure with hypotension.

ACE inhibitors: common adverse effects?

Acute kidney injury, angioedema, cough, and hyperkalemia.

ARBs: which drugs are in this class?

Losartan, valsartan, azilsartan, candesartan, irbesartan, and olmesartan.

ARBs: mechanism of action?

Block the angiotensin II receptor (more selectively than ACE-I), preventing aldosterone release.

ARBs: indications?

Hypertension, post-MI, heart failure, and kidney protection in CKD.

ARBs: contraindications?

Pregnancy (black box) and heart failure with hypotension.

ARBs: common adverse effects?

Acute kidney injury, hyperkalemia, and angioedema/cough (less often than ACE-I).

Aliskiren (renin inhibitor): mechanism of action?

Blocks renin, halting the RAAS cascade.

Aliskiren (renin inhibitor): indications?

Hypertension.

Aliskiren (renin inhibitor): contraindications?

Pregnancy, children under 2, and combination with ACE-I/ARB in diabetics.

Aliskiren (renin inhibitor): common adverse effects?

Increased BUN and creatinine.

Oral vasodilators (hydralazine, minoxidil): mechanism of action?

Relax arteriolar (not venous) smooth muscle, lowering peripheral resistance.

Oral vasodilators (hydralazine, minoxidil): indications?

Severe hypertension and heart failure combined with nitrates, as long-term outpatient therapy.

Oral vasodilators (hydralazine, minoxidil): contraindications?

Coronary artery disease and rheumatic mitral valve disease.

Oral vasodilators (hydralazine, minoxidil): common adverse effects?

Headache, nausea, anorexia, palpitations, sweating, and flushing.

IV vasodilators (sodium nitroprusside, fenoldopam, diazoxide): mechanism of action?

Relax smooth muscle of both arterioles and veins, given parenterally inpatient.

IV vasodilators (sodium nitroprusside, fenoldopam, diazoxide): indications?

Hypertensive emergency, severe heart failure, acute aortic dissection, and acute ischemic stroke.

IV vasodilators (sodium nitroprusside, fenoldopam, diazoxide): contraindications?

Septic shock and functional hypoglycemia.

IV vasodilators (sodium nitroprusside, fenoldopam, diazoxide): common adverse effects?

Hypotension, metabolic acidosis, and arrhythmias.

Sodium nitroprusside: which toxic byproduct can accumulate and cause death?

Cyanide.

Nitrates: which drugs are in this class?

Nitroglycerin (SL) and isosorbide dinitrate.

Nitrates: mechanism of action?

Converted to nitric oxide, relaxing vascular smooth muscle and dilating vessels.

Nitrates: indications?

Angina, heart failure, and hypertensive emergency.

Nitrates: contraindications?

PDE-5 inhibitor use, shock/acute circulatory failure, increased intracranial pressure, and severe anemia.

Nitrates: common adverse effects?

Orthostatic hypotension, syncope, throbbing headache, and temporal artery pulsations.

Non-dihydropyridine CCBs (verapamil, diltiazem): mechanism of action?

Block activated and inactivated Ca2+ channels in frequently firing tissue like the SA and AV nodes.

Non-dihydropyridine CCBs (verapamil, diltiazem): indications?

Hypertension, angina (incl. Prinzmetal), atrial fibrillation, SVT, and ventricular tachycardia.

Non-dihydropyridine CCBs (verapamil, diltiazem): contraindications?

Severe LV dysfunction, WPW, second/third-degree AV block, and SBP <90 mmHg.

Non-dihydropyridine CCBs (verapamil, diltiazem): common adverse effects?

Bradyarrhythmias, heart failure, and hepatic effects.

Dihydropyridine CCBs: which drugs are in this class?

Amlodipine, felodipine, nifedipine, and nicardipine.

Dihydropyridine CCBs: mechanism of action?

Preferentially block vascular smooth muscle Ca2+ channels, causing vasodilation.

Dihydropyridine CCBs: indications?

Hypertension, angina, and Raynaud phenomenon.

Dihydropyridine CCBs: contraindications?

Breastfeeding, hypotension, and cardiogenic shock.

Dihydropyridine CCBs: common adverse effects?

Peripheral edema, flushing, and headache.

Aspirin: mechanism of action?

Irreversibly inhibits platelet COX for the platelet's lifespan (8–10 days).

Aspirin: indications?

ASCVD, pain/inflammation, and VTE prevention in valvular disease and polycythemia vera.

Aspirin: contraindications?

History of asthma/rhinitis/nasal polyps, bleeding or platelet disorders, and severe hepatic impairment.

Aspirin: common adverse effects?

GI mucosal damage ranging from dyspepsia to hemorrhage, plus angioedema/urticaria.

P2Y12 inhibitors: which drugs are in this class?

Clopidogrel, prasugrel, and ticagrelor.

P2Y12 inhibitors: mechanism of action?

Block the platelet ADP (P2Y12) receptor, preventing aggregation.

P2Y12 inhibitors: indications?

Acute coronary syndrome managed with PCI/stent.

P2Y12 inhibitors: contraindications?

Active pathological bleeding, prior TIA/stroke, and age >75 (weigh risk vs benefit).

P2Y12 inhibitors: common adverse effects?

Bleeding, bradyarrhythmias, and dyspnea/sleep apnea.

Glycoprotein IIb/IIIa inhibitors: which drugs are in this class?

Tirofiban and eptifibatide.

Glycoprotein IIb/IIIa inhibitors: mechanism of action?

Bind platelet GP IIb/IIIa receptors, preventing aggregation.