Cardiac med comparisons, review, MCs

Most common ACE inhibitor?

Lisinopril

Most common beta blocker?

Metoprolol

Most common loop diuretic?

Furosemide (Lasix)

Most common thiazide diuretic?

Hydrochlorothiazide (HCTZ)

Most common K-sparing diuretic?

Spironolactone

Most common osmotic diuretic?

Mannitol

Most common carbonic anhydrase inhibitor?

Acetazolamide

Which antihypertensive class commonly causes dry cough?

ACE inhibitors

ACE inhibitor vs ARB: major difference?

ARBs less likely to cause cough/angioedema

Which RAAS blocker class causes hyperkalemia?

ACE inhibitors, ARBs, direct renin inhibitors

Which RAAS blocker class is contraindicated in renal artery stenosis?

ACEIs and ARBs

Which fetal complication occurs with RAAS blockers?

Oligohydramnios

Which medication class commonly reduces antihypertensive efficacy?

NSAIDs

Why do NSAIDs reduce antihypertensive efficacy?

Block prostaglandins

Which antihypertensive class should not be stopped abruptly?

Beta blockers

Why should beta blockers not be stopped abruptly?

Rebound adrenergic activity → angina/MI

Beta blockers can mask what dangerous condition?

Hypoglycemia

Which beta blocker type is preferred in asthma/COPD?

Cardioselective beta blockers

Why avoid nonselective beta blockers in asthma?

Beta-2 blockade → bronchospasm

What medication causes additive bradycardia with beta blockers?

Digoxin

What antihypertensive class commonly causes bradycardia?

Beta blockers

Which antihypertensive class commonly causes bronchospasm?

Beta blockers

Which diuretic causes blue urine?

Triamterene

Which diuretic class causes ototoxicity?

Loop diuretics

Which loop diuretic is safest in sulfa allergy?

Ethacrynic acid

Which diuretic class causes hyperuricemia/gout?

Thiazides

Which diuretic class causes metabolic acidosis?

Carbonic anhydrase inhibitors

Which diuretic class is weakest overall?

Carbonic anhydrase inhibitors

Which diuretic class is IV only?

Osmotic diuretics

Which diuretic class is used for cerebral edema?

Osmotic diuretics

Which diuretic class is first-line for HTN?

Thiazides

Which diuretic class is strongest for emergent fluid reduction in CHF?

Loop diuretics

Which diuretic class is safer in diabetes?

Thiazide-like diuretics

Which diuretic class is safer with reduced creatinine clearance?

Thiazide-like diuretics

What medication toxicity increases with hypokalemia?

Digoxin toxicity

Classic signs of digoxin toxicity?

Anorexia, N/V, paresthesias, confusion

Which antihypertensives improve survival after MI?

ACE inhibitors and beta blockers

Which direct vasodilator is used for hypertensive emergency?

Nitroprusside

Which direct vasodilator is used for pre-eclampsia HTN?

Hydralazine

Which direct vasodilator is reserved for refractory severe HTN despite diuretic + 2 agents?

Minoxidil

Which direct vasodilator commonly causes reflex tachycardia?

Hydralazine

Why are beta blockers combined with hydralazine?

Reduce reflex tachycardia

Which direct vasodilator opens ATP-sensitive potassium channels?

Minoxidil

Which direct vasodilator classically causes hirsutism?

Minoxidil

Which direct vasodilator causes sodium and water retention?

Minoxidil

Which direct vasodilator can increase ICP?

Minoxidil

Which direct vasodilator dilates veins more than arteries?

Nitroprusside

Which direct vasodilator dilates arteries more than veins?

Minoxidil

Which direct vasodilator is limited to short-term use (1-3 days)?

Nitroprusside

Which direct vasodilator has cyanide toxicity risk?

Nitroprusside

Which direct vasodilator has thiocyanate toxicity risk?

Nitroprusside

Which direct vasodilator causes hydralazine-induced lupus syndrome?

Hydralazine

A patient receiving IV antihypertensive infusion develops tinnitus and hyperreflexia. Which toxicity is suspected?

Thiocyanate toxicity

Which medication/toxicity is associated with almond breath and lactic acidosis?

Nitroprusside; cyanide toxicity

Why are PDE-5 inhibitors contraindicated with nitroprusside?

Risk of profound hypotension

Which CCB is most commonly used for BP control?

Amlodipine

Which non-dihydropyridine CCB is MC used for rate control?

Diltiazem

Which CCB is used after subarachnoid hemorrhage for vasospasm?

Nimodipine

Which CCB subclass is most associated with bradycardia?

Non-dihydropyridines

Which CCB subclass is contraindicated in heart block?

Non-dihydropyridines

Which CCBs are contraindicated in wide-complex ventricular tachycardia?

Diltiazem and verapamil

A patient on a CCB develops bilateral lower-extremity edema. What drug class is responsible?

Calcium channel blockers

Gingival hyperplasia is classically associated with what medication class?

CCBs

Which CCB interaction can worsen bradycardia?

Digoxin

Vitamin D and calcium supplements reduce effectiveness of what class?

CCBs

Which centrally acting alpha-agonist is preferred in pregnancy?

Methyldopa

Which centrally acting alpha-agonist is available in patch form?

Clonidine

Which centrally acting alpha-agonist treats opioid withdrawal?

Clonidine

What major adverse effect pattern do clonidine and methyldopa share?

Increased parasympathetic effects/sedation

Which centrally acting alpha-agonist can cause hemolytic anemia?

Methyldopa

Which centrally acting alpha-agonist can cause positive Coombs test?

Methyldopa

Which centrally acting alpha-agonist commonly causes rebound HTN after abrupt discontinuation?

Clonidine

Why does clonidine withdrawal cause rebound HTN?

Norepinephrine surge from alpha-2 receptor downregulation

Which centrally acting alpha-agonist should NOT be stopped abruptly?

Clonidine

Which centrally acting alpha-agonist is contraindicated in active liver disease?

Methyldopa

A pregnant patient with HTN needs therapy. Which drug is preferred?

Methyldopa

A patient abruptly stops BP medication and develops rebound hypertension. Which drug is likely?

Clonidine OR Methyldopa

A patient develops positive Coombs test and elevated LFTs on antihypertensive therapy. Which drug is responsible?

Methyldopa

What pump does digoxin inhibit?

Na/K ATPase pump

How does digoxin increase intracellular calcium?

Na/K ATPase inhibition

What cardiac effect of digoxin increases cardiac output?

Positive inotropy

What heart-rate effect of digoxin occurs?

Negative chronotropy

What electrolyte abnormality increases digoxin toxicity risk?

Hypokalemia

What electrolyte abnormality decreases digoxin effectiveness?

Hyperkalemia

Why does hypokalemia increase digoxin toxicity?

Less potassium competition at Na/K ATPase

Which antiarrhythmic increases digoxin concentration?

Amiodarone

Which antiarrhythmic classically increases digoxin toxicity?

Quinidine

Which CCB increases digoxin concentration?

Verapamil

High-fiber meals decrease effectiveness, what medication?

Digoxin

Which herbal supplement decreases digoxin effect?

St. John's wort

What antidote treats digoxin toxicity?

Digoxin immune Fab (Digibind)

What therapeutic range is monitored for digoxin?

0.8-2 ng/mL

A patient on digoxin becomes hypokalemic after laxative use. What risk increases?

Digoxin toxicity

A patient on digoxin starts verapamil and develops arrhythmia symptoms. What is suspected?

Digoxin toxicity

A patient with AV block should avoid which inotrope?

Digoxin

What medication class does sacubitril/valsartan belong to?

ARNI

Why is valsartan included with sacubitril?

Blocks increased angiotensin II from neprilysin inhibition

What beneficial mediators increase with neprilysin inhibition?

Natriuretic peptides

What are the major effects of natriuretic peptides?

Decrease BP and cardiac hypertrophy

What adverse effect risk increases if ARNIs are combined with ACE inhibitors?

Angioedema