16 Questions
What is the mechanism of action of spironolactone and eperenone?
Aldosterone antagonists
What is a common side-effect of spironolactone?
Hyperkalemia
What is an indication for the usage of propranolol?
Migraine headaches
What is the mechanism of action of propranolol?
Beta-1 and Beta-2 blocker
Which medications are known to lower mortality in congestive heart failure?
All of the above
What is an indication for the usage of spironolactone?
Congestive heart failure
What is a difference between spironolactone and eperenone?
Eperenone only causes hyperkalemia
What is an indication for the usage of hydralazine and nitrates?
Congestive heart failure
How does adenosine relieve supra ventricular tachycardia?
Reduces calcium currents and is anti-arrhythmic by increasing AV nodal refractoriness
What is the mechanism of action of aspirin in preventing clot formation?
Aspirin IRREVERSIBLY inhibits COX, which will decrease the production of TXA2
When is aspirin indicated?
Acute coronary syndromes, stroke or TIA, peripheral artery disease, and Kawasaki's Disease
What are the adverse effects of aspirin?
Bleeding, peptic ulcers, asthma, and rash
What is the mechanism of action of dipyridamole?
Inhibits adenosine deaminase and phosphodiesterase, increases cAMP
When is dipyridamole indicated?
In patients who require thinning of the blood, such as stroke and peripheral artery disease
What are the Thienopyridines?
Clopidogrel, prasugrel, and ticlopidine
When are Thienopyridines indicated?
In combination with aspirin for acute coronary syndromes
Study Notes
Spironolactone and Eperenone
- Indicated for congestive heart failure, ascites, adrenal hyperplasia, or small cell carcinoma of the lung
- Also used for acne, hypertension, and amnorrhea
Mechanism of Action
- Both are aldosterone antagonists
- Spironolactone is also anti-androgenic
Side-Effects
- Spironolactone: hyperkalemia, gynecomastia due to anti-androgenic effects
- Eperenone: only hyperkalemia, no effects on testosterone receptor
Medications Known to Lower Mortality in CHF
- ACE Inhibitors
- Angiotensin Receptor Blockers
- Spironolactone and eperenone
- Beta Blockers
- Hydralazine and Nitrates in combination
Propranolol
Mechanism of Action
- Nonspecific blocker of both Beta-1 and Beta-2 receptors
Indications
- Migraine headaches
- Portal hypertension
- Thyroid storm
- Essential tremor
- Pheochromocytoma (adrenal tumor)
Side-Effects
- Bronchospasm, depression, bradycardia, hypotension, erectile dysfunction
- Hyperkalemia by inhibiting Sodium/Potassium ATPase
- Adverse effects on glucose and peripheral arterial disease
Adenosine
Indication
- Supra ventricular tachycardia that does not respond to sinus massage
Mechanism of Action
- Reduces calcium currents and is anti-arrhythmic by increasing AV nodal refractoriness
- Transiently slows sinus rate and AV nodal conduction velocity
- Opens potassium channels, hyperpolarizing nodal tissue and making them less likely to fire
Aspirin
Mechanism of Action
- Irreversibly inhibits COX, decreasing TXA2 production and preventing clot formation
Indications
- Acute coronary syndromes (MI, unstable angina)
- Stroke or TIA
- Peripheral artery disease
- Kawasaki's Disease
- Essential Thrombocythemia
- Fever, RA, Gout
Adverse Effects
- Bleeding
- Peptic ulcers, asthma, renal insufficiency, rash
Toxic Overdose
- Metabolic acidosis
- Tinnitus
- Encephalopathy
- Renal insufficiency
- Increased anion gap
Dipyridamole
Indications
- Thinning blood in patients with stroke, heart valve embolism, or peripheral artery disease
- Diagnostic tool in myocardial perfusion studies
Mechanism of Action
- Inhibits adenosine deaminase and phosphodiesterase
- Increases cAMP, inhibiting platelets
Adverse Effects
- Dizziness, headache
- GI bleeds
Thienopyridines
Examples
- Clopidogrel
- Prasugrel
- Ticlopidine
Mechanism of Action
- Act as blood thinners by inhibiting platelet aggregation
Indications
- Combination with aspirin is standard treatment for acute MI
- Strongest indication is early coronary intervention (angioplasty) with stenting
This quiz covers the indications of spironolactone and eperenone, as well as medications that lower mortality in congestive heart failure. It's a high-yield topic for medical students.
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