Basic

140909.4 Anti-hypertensives
Which type of diuretic is the drug of choice for heart failure patients?
- Loop Diuretics
- *To treat volume overload
Name the 4 Loop Diuretics
- Furosemide
- Bumetanide
- Torsemide
- Ethacrynic Acid
What are these drugs?
Furosemide
Bumetanide
Torsemide
Ethacrynic Acid
- Loop Diuretics

Name the 4 Thiazides

- Hydrochlorothiazides
- Chlorthalidone
- Metolazone
- Indapamide
What should you know about thiazides?
- Hydrochlorothiazides
- Chlorthalidone
- Metolazone
- Indapamide
-

Great choice for as initial choice for hypertensive or as an add-on drug

Need good kidney function
o Because site of action is so far down nephron (distal convoluted tubule)
o If creatinine clearance is 30 or less, this drug is no good

What are these drugs?

- Hydrochlorothiazides
- Chlorthalidone

- Metolazone
- Indapamide
- Thiazides

Which drug is the better antihypertensive?

Loop diuretics of Thiazides?
- Thiazides
What are the 4 K+ Sparing Diuretics?
- Spironolactone
- Eplerenone
-

Triamterene
Amiloride

What are the 2 Aldosterone receptor antagonists (K+ Sparing Diuretics)?

- Spironolactone
- Eplerenone

What are these drugs?

Spironolactone
Eplerenone
Triamterene
Amiloride
- 4 K+ Sparing Diuretics

Which drugs end in -pril?

- ACE Inhibitors
Which drugs end in -sartan?
- ARBs
Patient cant swallow but needs ACE inhibitor.
Which one do you give them?
- Enalaprilat
Which ACE Inhibitor is shortest acting and was the first on the market?
- Captopril
When choosing between ACE Inhibitors and ARBs, which is preferred?
- ACE Inhibitors

*More safety data

What type of drug is Aliskiren?

- Direct Renin Inhibitor
Contraindications for ACEs, ARBs, RIs
- Critical bilateral renal artery stenosis
- Pregnancy
- High Potassium (> 5 meq/L)
Which antihypertensive drugs cause birth defects across all trimesters?
- ACEs, ARBs, RI
Which hypertensive drugs can cause angioedema?
- ACEs, ARBs, RI
Side effects for ACEs, ARBs, and RIs:
- Hypotension
- Hyperkalemia
- Angioedema
- Kidney injury
Which hypertensive drug that causes an unproductive cough that cant be relieved with cough
medication?
- ACE Inhibitors
- *Due to build-up of bradykinin in lung tissue
- Use ARBs instead
Which antihypertensive drug gets metabolized to cyanide (contraindicated for renal insufficiency)
- Nitroprusside
Only IV ACE Inhibitor on the market
- Analaprilat

140910.3 Anti-anginal and Statins

3 Drugs Types that act as anti-anginals
- Nitrates
- Beta Blockers
- CCBs

2 types of drugs that vasodilate and increase myocardial perfusion

- Nitroglycerin
- Dihydropyridine (CCBs)

Calcium channel blockers can decrease O2 demand by decreasing HR.

Which one also increases myocardial perfusion by vasodilating the coronary arteries?
- Dihydropyridine
How do nitrates treat angina?
- Vasodilators Increase coronary flow
o Increase O2 supply
- Decrease preload
o Decrease O2 demand
Aspirin helps maintain O2 supply during angina. How?
- Preventing thrombus formation
When a patient has angina, these 2 drugs help prevent thrombus formation:
- Aspirin
- Thienopyridines
Patients with stable angina will be on: (can be post MI)
- 1st line
o Beta blockers
o Aspirin
nd
- 2 line (Physician preference)
o ACE Inhibitors, nitrate or CCBs
- *Aspirin, Beta Blockers and ACE Inhibitors improve survival
- **Other two only improve symptoms
2 work horse beta-blockers for Stable angina and post MI:
- Carvedilol
- Metoprolol
Who uses Ranolazine
- Basically a 4th line drug for angina
-

Patient already takes Aspirin, Beta-blockers, ACE inhibitors, CCBs, but still gets angina upon
exertion
Or if they intolerant to other anti-anginals

Side effect for Ranolazine:

- QT elongation
o Torsades
Treatment for Prinzmetal Angina (vasospasm) (2)
- Drugs that cause smooth muscle relaxation
o Nitrates
o CCBs
- *Avoid Beta-blockers
o Because then you have unopposed alpha activity which would make it worse
Which drug type would you avoid for Prinz Metal angina?
- Avoid Beta-blockers
o Because then you have unopposed alpha activity which would make it worse
Ticlopidine
Clopidogrel
Prasugrel
Ticagrelor
MOA?
- P2Y12 Inhibitors
Ticlopidine
Clopidogrel
Prasugrel
Ticagrelor
Which one is the reversible P2Y12 inhibitor
- Ticagrelor

Patient has a past medical history of TIA/stroke. Which anti-platelet drug would be contraindicated?
- Prasugrel