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Cardiovascular Drugs


  1. Nitrates are the DOC of initial choice for all sorts of angina pain
  2. Nitrates act by delivering NO (nitric oxide) and are mainly venodilators
  3. Beta-blockers are contraindicated in variant angina (would cause unopposed vasospasm)
  4. DOC for variant angina (also called Prinzmetal’s angina) are CCBs
  5. MC side effect of nitrates is headache or postural hypotension (tolerance develop with nitrates on regular use)
  6. DOC for hypertension with BPH is Terazocin\Prazocin
  7. DOC for hypertension with angina is beta-blocker (Beta-blockers are DOC for HT in stressed patients & those with high rennin levels)
  8. DOC for hypertension with diabetes\nephropathy or normal rennin hypertension is ACE inhibits (MC side effect-cough, also cause hyperkalemia, CI in bilateral renal artery stenosis)
  9. ACE inhibitors are now initial DOC for CHF, young patients with hypertension, normal renin hypertension
  10. Alpha-blockers of selective type (Prazocin, Terazocin) don’t cause reflex tachycardia (nonselective type e.g. phentolamine cause it)
  11. Quinidine can increase plasma levels of digoxin by reducing its renal elimination.
  12. Procainamide is MC drug causing drug induced SLE (kidney is NOT involved); it has little or no anticholinergic activity. Note that other members of this class e.g. quinidine/disopyramide have high of such activity.   
  13. Amiadarone is the most efficacious, broadest spectrum & longest –acting (t\1\2=70 days) anti-arrhythmic drug. Its most common side effect is pulmonary fibrosis-it also causes hypothyroidism & hyperthyroidism
  14. Amiodarone causes fatty liver initially and later causes shrinkage leading to micronodular cirrhosis. 
  15. Bretylium is DOC for LA induced arrythmias-acts by inhibiting release of norepinephrine
  16. Sotalol is beta-blocker with K+ channel blocking activity
  17. Adenosine is the shortest acting anti-arrhythmic drug (<10 seconds) and is DOC for paroxysmal supraventricular tachycardia
  18. Digoxin (t\1\2=24-36 h) is MC used cardiac glycoside, excreted unchanged from kidney. Therefore, CI in renal failure. Digitoxin (t\1\2=165 h) undergoes enetro-hepatic circulation and is safe in renal failure (CI in hepatic failure)
  19. Digoxin acts by inhibiting Na+K+ATPase and therefore increases cardiac contractility; heart rate is NOT increased (rather, decreased due to AV block)
  20. Digoxin is CI in obstructive cardiomycopathy, aortic stenosis, ventricular tachycardia, & partial heart block (it is safe in full heart block)
  21. MC precipitating factor of digoxin toxicity is hypokalemia (hyperkalemia is protective)
  22. DOC for digoxin toxicity is potassium (CI in overdose)
  23. DOC for overdose of digoxin toxicity is DIGIBIND (Fc fragment of digoxin binding antibody)
  24. Esmolol is shortest acting beta-blocker (t\1\2=<10 minutes); metabolized in plasma therefore is safe in renal\hepatic failure (Nadolol is longest acting beta-blocker)
  25. Sincere ANS (Nadolol, Atenolol, Sotalol) are water soluble beta-blockers and are excreted unchanged (CI in renal failure)
  26. PALM (Propranolol, Pindolol, Acebutolol, Labetalol, Metoprolol) are beta-blockers with local anesthetic activity
  27. MC side effect of beta-blockers is bradycardia, they cal also cause AV nodal block, depression, suicidal tendencies, nightmares, hyperlipidemia, impotence and worsening of asthma, diabetes & peripheral vascular disease. All nonselective blockers (propranolol, sotalol, nandolol, & timolol) are CI in pregnancy while cardioselective (atenolol, metoprolol, Bisoprolol, betaxalol & esmolol) are safe in pregnancy.
  28. Beta-blockers with ISA (Alprenolol, oxprenolol, pindolol, carteolol, celiprolol, penbutolol) have NO adverse effect on lipid profile & they don’t cause bradycardia
  29. Carvedilol (antioxidant property), labetalol (DOC for aortic dissection) & Dilevalol are combined acting beta-blockers. Carvedolol is the DOC for cardioprotection in CHF
  30. Statins are MC used hypolipidemic drugs (others are fibric acid derivatives-clofibrate, fenofibrate, niacin, bile acid derivatives-colestyramine, colistipol)
  31. Statins (atorvastatin, Lovastatin (prodrug), Simvastatin (prodrug), prastatin) are inhibitors of HMG CoA reductase (LDL receptor overexpression occurs-seen also with bile acid binding resins)
  32. MC side effect of statins is increase in CPK (10% cases), many have muscle pain or myoglobinurea
  33. MC side effect of nicotinic acid is flushing-also causes hyperuricemia (only drug to increase HLD levels)

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