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Questions and Answers
Which of the following is NOT a primary mode of treating hypertriglyceridemia?
Which of the following is NOT a primary mode of treating hypertriglyceridemia?
Besides elevated cholesterol, which risk factor contributes to the development of hyperlipidemia?
Besides elevated cholesterol, which risk factor contributes to the development of hyperlipidemia?
What is the primary mechanism of action of HMG-CoA reductase inhibitors (statins)?
What is the primary mechanism of action of HMG-CoA reductase inhibitors (statins)?
Which of the following is a common adverse effect of fibric acid derivatives?
Which of the following is a common adverse effect of fibric acid derivatives?
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Which of the following drugs is classified as an antiplatelet?
Which of the following drugs is classified as an antiplatelet?
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Niacin is most effective at increasing which component of the lipid profile?
Niacin is most effective at increasing which component of the lipid profile?
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What is the primary mechanism of action of heparin?
What is the primary mechanism of action of heparin?
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What is the primary mechanism of action of bile acid sequestrants?
What is the primary mechanism of action of bile acid sequestrants?
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What is a common side effect of Niacin?
What is a common side effect of Niacin?
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Which laboratory test is used to monitor the extent of anticoagulation with heparin?
Which laboratory test is used to monitor the extent of anticoagulation with heparin?
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What is the antidote for a heparin overdose?
What is the antidote for a heparin overdose?
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For what condition are statins primarily indicated?
For what condition are statins primarily indicated?
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Which of the following is a contraindication for the use of Warfarin?
Which of the following is a contraindication for the use of Warfarin?
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What is the primary mechanism of action of thrombolytic drugs?
What is the primary mechanism of action of thrombolytic drugs?
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Which of the following is a common adverse effect of thrombolytic therapy?
Which of the following is a common adverse effect of thrombolytic therapy?
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Which of the following drugs directly interferes with the synthesis of vitamin K-dependent clotting factors?
Which of the following drugs directly interferes with the synthesis of vitamin K-dependent clotting factors?
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Which of the following medications is an example of an Angiotensin II Receptor Blocker (ARB)?
Which of the following medications is an example of an Angiotensin II Receptor Blocker (ARB)?
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What is the primary mechanism by which beta-blockers benefit patients with heart failure?
What is the primary mechanism by which beta-blockers benefit patients with heart failure?
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Which of these diuretics are most commonly used in the treatment of heart failure?
Which of these diuretics are most commonly used in the treatment of heart failure?
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What is a common adverse effect associated with combining hydralazine and isosorbide dinitrate?
What is a common adverse effect associated with combining hydralazine and isosorbide dinitrate?
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How do positive inotropic agents improve cardiac function?
How do positive inotropic agents improve cardiac function?
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In heart failure, what is the cause of pulmonary edema?
In heart failure, what is the cause of pulmonary edema?
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For patients who cannot tolerate ACE inhibitors or ARBs, which combination of drugs is often used in the treatment of heart failure?
For patients who cannot tolerate ACE inhibitors or ARBs, which combination of drugs is often used in the treatment of heart failure?
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Which of the following is classified as an aldosterone antagonist?
Which of the following is classified as an aldosterone antagonist?
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Which of the following is NOT a recognized adverse effect associated with ACE inhibitors, but is not with angiotensin II antagonists?
Which of the following is NOT a recognized adverse effect associated with ACE inhibitors, but is not with angiotensin II antagonists?
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What is the primary mechanism of action for alpha-adrenergic blockers like Prazosin?
What is the primary mechanism of action for alpha-adrenergic blockers like Prazosin?
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Which of the following is a class of drugs that is typically reserved for emergency situations due to their direct action on blood vessels?
Which of the following is a class of drugs that is typically reserved for emergency situations due to their direct action on blood vessels?
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A patient with pregnancy-induced hypertension might benefit from which centrally acting antihypertensive?
A patient with pregnancy-induced hypertension might benefit from which centrally acting antihypertensive?
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In a hypertensive emergency, which of these is NOT a common intravenous drug used?
In a hypertensive emergency, which of these is NOT a common intravenous drug used?
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Which of the following best describes a situation classified as a hypertensive urgency?
Which of the following best describes a situation classified as a hypertensive urgency?
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Which class of diuretics acts primarily on the distal convoluted tubules?
Which class of diuretics acts primarily on the distal convoluted tubules?
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What is the term used to describe the percentage of blood that the heart ejects with each contraction?
What is the term used to describe the percentage of blood that the heart ejects with each contraction?
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A patient is experiencing acute pulmonary edema. Which class of diuretic would be most effective?
A patient is experiencing acute pulmonary edema. Which class of diuretic would be most effective?
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What is the fundamental cause of systolic heart failure?
What is the fundamental cause of systolic heart failure?
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What is the primary mechanism of action of potassium-sparing diuretics?
What is the primary mechanism of action of potassium-sparing diuretics?
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Which of the following is a common adverse effect associated with thiazide diuretics?
Which of the following is a common adverse effect associated with thiazide diuretics?
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Which class of drugs acts by blocking calcium channels in smooth muscle?
Which class of drugs acts by blocking calcium channels in smooth muscle?
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Which of these medications is an example of an Angiotensin-Converting Enzyme (ACE) inhibitor?
Which of these medications is an example of an Angiotensin-Converting Enzyme (ACE) inhibitor?
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What is a common adverse effect associated with Angiotensin-Converting Enzyme (ACE) inhibitors?
What is a common adverse effect associated with Angiotensin-Converting Enzyme (ACE) inhibitors?
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Angiotensin II antagonists primarily act by:
Angiotensin II antagonists primarily act by:
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What is the primary mechanism by which nitrates increase blood supply to the heart muscle?
What is the primary mechanism by which nitrates increase blood supply to the heart muscle?
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Which route of nitroglycerin administration provides the most rapid relief from an angina attack?
Which route of nitroglycerin administration provides the most rapid relief from an angina attack?
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For which condition is Ranolazine primarily indicated?
For which condition is Ranolazine primarily indicated?
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Which of the following best describes the role of Low-Density Lipoproteins (LDL) in the body?
Which of the following best describes the role of Low-Density Lipoproteins (LDL) in the body?
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What is the main function of High-Density Lipoproteins (HDL)?
What is the main function of High-Density Lipoproteins (HDL)?
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What is generally considered an undesirable level of serum cholesterol that is associated with atherosclerosis?
What is generally considered an undesirable level of serum cholesterol that is associated with atherosclerosis?
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A patient with chronic angina is prescribed Ranolazine. What does this drug do?
A patient with chronic angina is prescribed Ranolazine. What does this drug do?
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Which of the following indicates healthy lipid levels associated with a reduced risk of atherosclerosis?
Which of the following indicates healthy lipid levels associated with a reduced risk of atherosclerosis?
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Flashcards
Alpha-adrenergic Blockers
Alpha-adrenergic Blockers
Drugs that block the action of alpha-adrenergic receptors in small blood vessels, causing vasodilation.
Vasodilators
Vasodilators
Drugs that directly relax blood vessels, reducing arterial blood pressure.
Centrally Acting Agents
Centrally Acting Agents
Drugs that act on the vasomotor center of the brain, controlling blood pressure centrally.
Hypertensive Urgency
Hypertensive Urgency
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Hypertensive Emergency
Hypertensive Emergency
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Heart Failure (HF)
Heart Failure (HF)
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Ejection Fraction (EF)
Ejection Fraction (EF)
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Systolic Heart Failure
Systolic Heart Failure
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Triglycerides
Triglycerides
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Hypertriglyceridemia
Hypertriglyceridemia
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Statins
Statins
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Fibric acid derivatives
Fibric acid derivatives
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Niacin
Niacin
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Bile acid sequestrants
Bile acid sequestrants
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Risk Factors for Hyperlipidemia
Risk Factors for Hyperlipidemia
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Treatment for High Triglycerides
Treatment for High Triglycerides
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Antiplatelet drugs
Antiplatelet drugs
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What are antiplatelets?
What are antiplatelets?
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Anticoagulant Drugs
Anticoagulant Drugs
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Heparin
Heparin
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Antihypertensive drugs
Antihypertensive drugs
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Warfarin
Warfarin
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Thrombolytic therapy
Thrombolytic therapy
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Hyperlipidemia
Hyperlipidemia
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Low-density lipoproteins (LDL)
Low-density lipoproteins (LDL)
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What is aPTT?
What is aPTT?
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What is INR?
What is INR?
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High-density lipoproteins (HDL)
High-density lipoproteins (HDL)
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Nitrates
Nitrates
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Ranolazine
Ranolazine
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Nitroglycerin
Nitroglycerin
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Angina
Angina
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Angiotensin II Receptor Blockers (ARBs)
Angiotensin II Receptor Blockers (ARBs)
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Aldosterone Antagonists
Aldosterone Antagonists
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β-Blockers
β-Blockers
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Diuretics
Diuretics
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Nitrate and Hydralazine Combination
Nitrate and Hydralazine Combination
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Inotropic Drugs
Inotropic Drugs
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Headache
Headache
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Hypotension
Hypotension
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What are thiazide diuretics and how do they work?
What are thiazide diuretics and how do they work?
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What are loop diuretics and what is their main use?
What are loop diuretics and what is their main use?
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What are potassium-sparing diuretics and what is their mechanism?
What are potassium-sparing diuretics and what is their mechanism?
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What are beta-adrenergic blocking agents and what is their primary effect?
What are beta-adrenergic blocking agents and what is their primary effect?
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What are calcium channel blockers and how do they work?
What are calcium channel blockers and how do they work?
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What are ACE inhibitors and what is their primary function?
What are ACE inhibitors and what is their primary function?
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What are angiotensin II antagonists and what is their mechanism?
What are angiotensin II antagonists and what is their mechanism?
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What is the renin-angiotensin-aldosterone system (RAAS) and what is its role?
What is the renin-angiotensin-aldosterone system (RAAS) and what is its role?
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Study Notes
Cardiovascular Drugs
- Antihypertensive drugs, anti-heart failure drugs, antianginal drugs, anti-hyperlipidemic drugs, antiarrhythmic drugs, and antiplatelets, anticoagulants and thrombolytic drugs are all cardiovascular drugs.
Hypertension
- Hypertension is high blood pressure.
- Adults are diagnosed with hypertension when blood pressure is greater than or equal to 140 mmHg systolic pressure, or greater than or equal to 90 mmHg diastolic pressure.
- Controllable risk factors include obesity, sodium intake, alcohol, lack of exercise and stress.
- Uncontrollable risks include age, race and heredity.
- Non-pharmacological treatments include weight reduction, salt restriction, moderation of alcohol use and eating healthy foods.
Antihypertensive Drugs
- Diuretics, beta adrenergic blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II antagonists, alpha-adrenergic blockers, vasodilators, and centrally acting agents are antihypertensive drugs.
Diuretics
- Diuretics are drugs that promote a loss of sodium ions and water from the body which results in increased urine flow.
- Different diuretics act at different sites of the nephron in the kidney
- Diuretics are frequently used for managing abnormal fluid distribution disorders such as hypertension, heart failure, pulmonary edema, cerebral edema, peripheral edema and acute renal failure.
- Types of diuretics include thiazide diuretics, loop diuretics, K+ sparing diuretics, osmotic diuretics, and carbonic anhydrase inhibitors.
Thiazide Diuretics
- Examples like Chlorothiazide and Hydrochlorothiazide interfere with Na, K and water reabsorption in the distal convoluted tubules.
- They are used to treat chronic edema and essential hypertension.
- Adverse effects include hypokalemia, hyperglycemia, and postural hypotension.
Loop Diuretics
- Furosemide, Bumetanide and Ethacrynic acid interfere with the reabsorption of salt and water in the ascending loop of Henle.
- These diuretics increase potassium excretion, making them the most potent oral diuretic agents available.
- They are useful for treating acute episodes of pulmonary edema.
- Adverse effects like fluid and electrolyte imbalances including hypokalemia.
Potassium-Sparing Diuretics
- Triamterene, Spironolactone, Amiloride, and Triamterene block the action of aldosterone in the kidneys which leads to Na and water diuresis and the retention of K.
- Thiazide or loop diuretics can be combined with K sparing diuretics to prevent K loss.
- They are used in edema.
- Adverse effects include hyperkalemia.
Beta-Adrenergic Blocking Agents
- Propranolol, Atenolol, Metoprolol, Timolol, Nadolol are examples that block the action of beta-adrenergic receptors (selective and nonselective).
- They are recommended as a first-line therapy.
Calcium Channel Blockers
- Nifedipine, Diltiazem, Verapamil, Amlodipine, Isradipine, Lercanidipine are examples of calcium channel blockers that act by blocking calcium channels in smooth muscle.
- Reducing or preventing contraction in smooth muscle, they have a vasodilation property.
- Adverse effects include dizziness, peripheral edema, hypotension, and asystole.
Angiotensin-Converting Enzyme (ACE) Inhibitors
- Captopril, Enalapril, Lisinopril, Perindopril block the conversion of angiotensin I to angiotensin II.
- This prevents the vasoconstrictive effects of angiotensin II and sodium retention caused by aldosterone.
- Adverse effects include dry cough, taste disturbances, and hypokalemia.
Renin-Angiotensin-Aldosterone System (RAAS)
- The RAAS is a system of hormones that regulates blood pressure.
- It involves the following steps:
- Kidney releases renin
- Renin converts angiotensinogen from the liver to angiotensin I.
- Angiotensin I is converted to angiotensin II in the lungs.
- Angiotensin II causes vasoconstriction.
- Angiotensin II stimulates the adrenal gland to secrete aldosterone.
- Aldosterone increases sodium reabsorption.
Angiotensin II Antagonists
- Losartan, Candesartan, Valsartan, Irbesartan, Telmisartan prevent the effects of angiotensin II.
- This leads to relaxation of smooth muscle, vasodilation, increased renal salt and water excretion, and reduced plasma volume.
- Two adverse effects of ACE inhibitors, angioedema and cough have not been linked to the use of angiotensin II antagonists.
Alpha-Adrenergic Blockers
- Prazosin, Phenoxybenzamine, Phentolamine block the action of alpha-adrenergic receptors in small blood vessels, leading to vasodilation.
- The main adverse effect is tachycardia.
Vasodilators
- Nitroprusside, Hydralazine, Minoxidil directly relax blood vessels, reducing arterial blood pressure.
- Reserved for emergency situations.
Centrally Acting Agents
- Methyldopa, Clonidine act centrally on the vasomotor center of the brain.
- Clonidine is reserved for patients not controlled by other less toxic antihypertensive agents.
- Methyldopa is used in pregnancy-induced hypertension.
- Adverse effects include sedation, drug fever, anemia, and hypotension.
Hypertensive Emergency
- A rare and life-threatening situation characterized by severe elevation in blood pressure.
- Presents with evidence of impending or progressive target organ damage (stroke, myocardial infarction).
- Immediate lowering of blood pressure with intravenous drugs (nicardipine, nitroprusside, nitroglycerine, phentolamine, esmolol, labetalol, hydralazine, or fenoldopam).
Anti-heart Failure Drugs
- Drugs used to treat heart failure aim to increase heart efficiency and/or reduce extra load.
- Heart failure is a complex, progressive disorder where insufficient blood is pumped by the heart.
- Main symptoms include dyspnea, fatigue, fluid retention.
- Ejection fraction (EF) measures the percentage of blood leaving the heart per contraction. Normal ejection fraction is 50% or higher.
- Two types of heart failure include systolic heart failure (reduced ejection fraction) and diastolic heart failure (preserved or near normal ejection fraction).
- Causes of heart failure include arteriosclerotic heart disease, myocardial infarction, hypertensive heart disease, valvular heart disease, dilated cardiomyopathy, and congenital heart disease.
Positive Inotropic Agents
- Digoxin, β-receptor agonists (dobutamine and dopamine), phosphodiesterase inhibitors (milrinone) enhance cardiac contractility and increase cardiac output.
- Primarily used intravenously for a short period in acute heart failure (HF) settings.
Digitalis Glycosides
- Most digitalis glycosides come from the digitalis (foxglove) plant.
- Digoxin is most commonly used.
- Digitoxin seldom used due to long duration of action.
- Digoxin has a narrow therapeutic index and is available in oral and injectable formulations.
Pharmacokinetics of Digoxin
- Digoxin has a large volume of distribution and a long half-life (30-40 hours).
- Eliminated mainly through the kidneys, requiring dose adjustments in renal dysfunction.
Therapeutic Uses of Digoxin
- Digoxin is indicated in patients with severe HF after initiation of ACE inhibitor, β-blocker, and diuretic therapy.
- In mild to moderate HF, other treatments such as ACE inhibitors, β-blockers, aldosterone antagonists, direct vaso- and venodilators and diuretics may adequately treat the condition without digoxin.
Adverse Effects of Digoxin
- Digoxin toxicity is a major concern due to a narrow therapeutic index.
- Symptoms like anorexia, nausea, and vomiting may indicate toxicity.
- Hypokalemia, because digoxin usually competes with potassium for the binding site on the Na+/K+-ATPase pump, can also contribute to digoxin toxicity.
- Treatment for digoxin toxicity includes discontinuation of digoxin, serum potassium level determination and replenishment if indicated.
- Severe cases require antibodies to digoxin (digoxin immune Fab) to inactivate the drug.
- Adverse effects may include yellowish vision (xanthopsia), and various cardiac arrhythmias.
Beta-Adrenergic Agonists
- Dobutamine and dopamine are beta-adrenergic agonists that improve cardiac performance through positive inotropic effects and vasodilation.
- They increase calcium ion entry into myocardial cells which results in enhanced contraction.
- Dobutamine is commonly used over Dopamine as an agent for treating heart failure.
- Both are administered intravenously for short-term acute HF management.
Phosphodiesterase Inhibitors
- Milrinone is a phosphodiesterase inhibitor that increases intracellular calcium and consequently cardiac contractility.
- Administered intravenously for short-term acute heart failure treatment.
Antianginal Drugs
- Antianginal drugs manage angina (chest pain due to insufficient oxygen-rich blood supply to the heart).
- Angina is a symptom of an underlying condition such as coronary artery disease (CAD), ischemic heart disease (IHD) or coronary artery disease.
- Common causes of angina include atherosclerotic disease and vascular smooth muscle spasms.
- Angina can be categorized as stable, unstable, and variant angina.
- Medications managing chronic stable angina include beta-blockers, calcium channel blockers, nitrates, and a sodium channel blocker (ranolazine).
Stable Angina
- Characterized as intermittent, short-lasting burning, heavy or squeezing sensations in the chest, usually relieved promptly by rest or nitroglycerin.
Unstable Angina
- Angina episodes characterized by increased intensity, duration, frequency and can be precipitated by progressively less effort.
- Not relieved by rest or nitroglycerin.
Prinzmetal or variant angina
- Uncommon pattern of episodic angina at rest.
- Caused by spasm of coronary arteries.
- Responds promptly to coronary vasodilators like nitroglycerin and calcium channel blockers.
Acute Coronary Syndrome
- An emergency resulting from acute coronary artery thrombosis caused by plaque rupture and partial or complete occlusion.
- Untreated acute coronary artery occlusion may result in necrosis of the cardiac muscle (myocardial infarction).
Antiplatelets, Anticoagulants, and Thrombolytics
- These drugs prevent and/or treat thrombotic disorders like acute myocardial infarction, pulmonary embolism, acute ischemic stroke and deep vein thrombosis)
- Platelet aggregation inhibitors decrease formation of platelet rich clots (e.g., aspirin, clopidogrel, ticlopidine, dipyridamole).
- Anticoagulants either inhibit or interfere with coagulation factors (e.g., heparin, warfarin, others).
- Thrombolytics dissolve clots (e.g., streptokinase, urokinase, alteplase, reteplase, tenecteplase) available intravenously and used for treatment of coronary artery thrombosis.
Antihyperlipidemic Drugs
- Drugs that treat hyperlipidemia (increased lipids like cholesterol and triglycerides in blood).
- Elevated lipid levels are associated with coronary heart disease (CHD).
- Lifestyle modifications (like diet and exercise and weight management) and/or medications (HMG-CoA reductase inhibitors (statins), fibrate acid derivatives, and niacin, bile acid sequestrants) can be used to treat elevated lipid levels.
HMG-CoA Reductase Inhibitors
- Statins (Atorvastatin, Lovastatin, Pravastatin, Rosuvastatin, Simvastatin) are inhibitors of HMG-CoA reductase.
- This enzyme is responsible for cholesterol synthesis in the liver.
- Statins are indicated for patients at high risk of myocardial infarction (MI) and those with high or combined elevated cholesterol and triglycerides.
- Side effects include myopathy and contraindications in pregnancy, lactation, and children.
Fibric Acid Derivatives
- Gemfibrozil, fenofibrate, clofibrate lower serum triglycerides and increase HDL levels.
- They decrease triglyceride levels by 20% to 50%.
- Side effects include GI irritation and arrhythmias.
Niacin (Vitamin B3)
- Also known as vitamin B3 or pellagra-preventing vitamin,
- Niacin can reduce LDL-C levels by 10-20% and increases HDL-C levels.
- The use of niacin to lower triglycerides is in the 20-35% range.
- Adverse effects include cutaneous flush and itching diarrhea.
Bile Acid Sequestrants
- Cholestyramine, Colestipol, and Colesevelam reduce elevated LDL levels by forming an insoluble substance with bile acids that are then excreted.
- This process prompts the liver to utilize cholesterol for bile production, decreasing cholesterol levels.
Antiarrhythmic Drugs
(Class I-IV)
- Classifications are based on effects on the action potential of cardiac cells and the refractory period.
- Class I: Sodium channel blockers (e.g., Quinidine, Disopyramide, Procainamide, Lidocaine, Phenytoin, Mexiletine, Flecainide, Propafenone).
- Class II: Beta-adrenoceptor antagonists (e.g., Propranolol, Metoprolol, Atenolol, Esmolol).
- Class III: Potassium channel blockers (e.g., Amiodarone, Dronedarone, Dofetilide, Ibutilide, Sotalol).
- Class IV: Calcium channel blockers (e.g., Verapamil, Diltiazem).
Cardiac Arrhythmias
- An arrhythmia is an irregular heartbeat due to defects in impulse generation or conduction.
- A heart disorder, emotional stress, hypoxia, or electrolyte imbalance are some factors that result in arrhythmias.
Electrocardiogram (ECG)
- ECG provides a record of electrical activity in the heart.
- Proper interpretation of ECG with thorough physical assessment is necessary for determining cause and type of arrhythmia.
- Abnormal R waves indicate enlarged ventricles, abnormal S-T segments can indicate cardiac ischemia, and abnormal Q-R or Q-T intervals may indicate various cardiac conditions.
Management of Arrhythmias
- Pharmacologic management involves drugs acting directly on cardiac cells to inhibit ion channels or alter autonomic inputs.
- Non-pharmacologic interventions include non-surgical procedures to correct the cause of arrhythmia in a less invasive way such as catheter ablation, pacemaker implants, or defibrillation.
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Test your knowledge on the pharmacological treatment of hyperlipidemia and anticoagulants. This quiz covers key mechanisms of action, indications, and adverse effects of various lipid-modifying agents and anticoagulants. Prepare to challenge your understanding of these important pharmacological concepts.