Cardiovascular, Renal, and Hematologic Pharmacology

ezetimibe: - ezetimibe is a unique drug that inhibits the absorption of dietary cholesterol - after oral administration, ezetimibe is absorbed from the intestines and then is metabolized to the pharmacologically 1

1: active metabolite ezetimibe-glucuronide

calcium channel blockers (CCBs): - 1 belong to the dihydropyridine class - 2 are unique members of other classes - all of the CCBs, except nimodipine, are indicated for the treatment of hypertension - diltiazem and verapamil are also used to treat certain types of 3 - nimodipine is indicated for the treatment of 4 - CCBs produce smooth muscle relaxation and suppress cardiac activity - all of the currently available CCBs selectively bind to L-type calcium channels - the most common side effects of CCBs are 5 - CCBs can also cause constipation by relaxing gastrointestinal smooth muscle and reducing peristalsis - the CCBs occasionally cause 6 in persons with poor dental hygiene or care - diltiazem and verapamil are effective treatments for 7

1: amlodipine, felodipine, isradipine, nicardipine, nifedipine, and nimodipine 2: diltiazem and verapamil 3: cardiac arrhythmias 4: subarachnoid hemorrhage 5: fatigue, headache, dizziness, flushing, peripheral edema, and other manifestations of vasodilation and hypotension 6: gingival hyperplasia (gingival overgrowth) 7: typical and variant angina

diuretics: - loop diuretics (e.g., 1) have greater natriuretic activity than other diuretics and are preferred for reducing plasma volume in heart failure - 2 increases the risk of digoxin toxicity, and patients with heart failure should be closely monitored for this condition

1: bumetanide, furosemide, and torsemide 2: hypokalemia

beta-adrenoceptor antagonists: - chronic stimulation of cardiac β-receptors leads to both myocyte hypertrophy and apoptosis in a manner that contributes to cardiac dilatation and ventricular wall thinning - several clinical trials have shown that some β-blockers, particularly 1, benefit patients with mild to severe heart failure caused by left ventricular systolic dysfunction

1: carvedilol, metoprolol, and bisoprolol

angiotensin-converting enzyme (ACE) inhibitors: - the ACE inhibitors reduce the formation of angiotensin 2 and are used in the treatment of 1 - 2, and other ACE inhibitors reduce plasma volume, venous pressure, and edema while increasing cardiac output by reducing arterial resistance and cardiac afterload

1: diabetic nephropathy, hypertension, and heart failure 2: ramipril, enalapril, lisinopril

site of drug action - glomerular filtration: 1 and other cardiac stimulants can indirectly cause diuresis by increasing cardiac output, renal blood flow, and the glomerular filtration rate

1: digitalis glycosides

α-adrenoceptor antagonists: - selective α1-blockers, such as 1, are NOT recommended for the initial treatment of high blood pressure but can be added to other drugs when blood pressure is not adequately controlled - the α1- blockers may evoke reflex activation of the sympathetic nervous system

1: doxazosin, prazosin, and terazosin

Class 2 drugs: - the Class II antidysrhythmics are β-adrenoceptor antagonists (β-blockers) such as 1 - esmosol pharmacologic properties make it ideally suited for the treatment of 2 during or immediately after surgery - metoprolol and propranolol are used to treat and suppress 3 - in patients with myocardial infarction, metoprolol is often administered intravenously during the early phase of treatment, followed by oral maintenance therapy that can continue for several months

1: esmolol, metoprolol, and propranolol 2: acute supraventricular tachycardia or hypertension 3: supraventricular and ventricular dysrhythmias

carbonic anhydrase (CA) inhibitors: - used in the treatment of disorders such as 1 - in patients with glaucoma, inhibition of CA reduces aqueous humor secretion and intraocular pressure - CA is also required for the reabsorption of sodium bicarbonate from the proximal tubule and for the secretion of hydrogen ions in the collecting duct - it alkalinize the urine and produces a mild form of 2 - CA inhibitors have been used occasionally for the treatment of 3

1: high-altitude sickness (mountain sickness) and glaucoma 2: hyperchloremic metabolic acidosis 3: epilepsy

drugs for familial hypercholesterolemia: - 1 act to reduce the production of VLDL in the liver and are used to treat homozygous familial hypercholesterolemia (HoFH) - lomitapide inhibits the 2, which is essential for VLDL assembly and secretion in the liver - mipomersen is an antisense (complementary strand) oligonucleotide that binds to the messenger RNA for apo B, preventing synthesis of apo B required for VLDL production in the liver - 3 are monoclonal antibodies to a protease enzyme that destroys LDL receptors in the liver. This enzyme is known as proprotein convertase subtilisin/kexin type 9 (PCSK9)

1: lomitapide and mipomersen 2: microsomal triglyceride transfer protein (MTTP) 3: evolocumab and alirocumab

site of drug action - loop of Henle: the reabsorption of sodium from the thick ascending limb is inhibited by 1, which can produce a greater diuresis than any other class of diuretics

1: loop diuretics

the most important drugs for treating hypercholesterolemia are the 1. Other drugs that can be added to or substituted for statins include the 2

1: statins 2: bile acid-binding resins, ezetimibe, and niacin

1 is caused by acute coronary vasospasm and may occur at rest or during sleep

1: variant angina (prinzmetal angina)

classification of diuretics. Name the antidiuretic hormone antagonists:

conivaptan (Vaprisol)

classification of antianginal drugs. Name the other agents:

ranolazine (Ranexa) ivabradine (Corlanor) trimetazidine

efficacy of drugs used in the treatment of coronary heart disease:

0: not efficacious +++: highly efficacious

thiazides and related diuretics: - thiazide diuretics act on the early portion of the distal tubule to inhibit the 1 that participates in the reabsorption of sodium and chloride from this segment of the nephron - thiazides have a kaliuretic effect that leads to 2 in some patients - they are often prescribed for hypertension and can be used to treat 3 associated with 4 - because thiazides reduce calcium excretion and decrease urinary calcium levels, they are helpful in treating patients with 5 - thiazides are also used to treat 6 - thiazide-like diuretics include 7

1: Na+,Cl− symporter 2: hypokalemia 3: edema 4: heart failure, cirrhosis, corticosteroid therapy, estrogen therapy, and renal disorders such as nephrotic syndrome 5: nephrolithiasis (kidney stones) associated with hypercalciuria 6: nephrogenic diabetes insipidus 7: chlorthalidone, indapamide, and metolazone

loop diuretics: - loop diuretics inhibit the 1 in the ascending limb of the loop of Henle and thereby exert a powerful natriuretic effect - loop diuretics are sometimes called high-ceiling diuretics because they produce a dose-dependent diuresis throughout their clinical dosage range - loop diuretics can produce a variety of electrolyte abnormalities, including hypokalemia, hypocalcemia, hypomagnesemia, and metabolic alkalosis - loop diuretics are highly effective in the treatment of 2 - loop diuretics can be used to treat 3 - 4 are sulfonamide derivatives with similar pharmacologic actions and effects - 5 is the only loop diuretic that is NOT a sulfonamide derivative

1: Na+,K+,2Cl− symporter 2: pulmonary edema 3: hypercalcemia 4: bumetanide, furosemide, and torsemide 5: ethacrynic acid

the 1 is the usual site of spontaneous impulse initiation (automaticity), but other cardiac tissues, including the AV node and the His-Purkinje system tissues, are also capable of spontaneous depolarization afterdepolarizations are believed to be triggered by 2 and can be provoked by digoxin as well as by other drugs or potassium channel defects that prolong cardiac repolarization and the QT interval

1: SA node 2: abnormal calcium influx

drug combinations: - the most useful combinations are those consisting of 1

1: a statin with ezetimibe or a bile acid-binding resin

adenosine diphosphate (ADP) inhibitors (antiplatelet drugs): - clopidogrel and related drugs block platelet 1, which inhibits activation of GP-2b/3a receptors and prevents ADP-induced platelet aggregation - clopidogrel and prasugrel are irreversible P2Y12 antagonists that inhibit platelet function for the life of the platelet - cangrelor and ticagrelor are reversible receptor blockers, which can be advantageous in patients about to undergo surgery or in those receiving PCIs - clopidogrel, prasugrel, and ticagrelor are used for 2 in persons with ACSs, including those with unstable angina - the activation of clopidogrel by CYP2C19 is inhibited by 3, particularly omeprazole, that are used in treating peptic ulcer

1: adenosine diphosphate P2Y12 receptors 2: prevention of thrombosis and MI 3: proton pump inhibitors (PPIs)

site of drug action - collecting duct: the collecting duct is the site of action of 1 the 2 are primarily used to reduce potassium excretion and prevent hypokalemia

1: aldosterone and antidiuretic hormone 2: potassium-sparing diuretics

other vasodilators: - hydralazine and minoxidil often evoke reflex tachycardia and cause fluid retention - minoxidil is marketed as a topical formulation for the treatment of several forms of 1 in men and women - fenoldopam activates vascular 2 and produces vasodilation in systemic vascular beds, including coronary, renal, and mesenteric vessels

1: alopecia (baldness) 2: dopamine D1-receptors

thrombolytic drugs: - the thrombolytic drugs include recombinant forms of human t-PA named 1, as well as 2, a protein obtained from streptococci, and 3, a complex of streptokinase and plasminogen - thrombolytic drugs are usually administered by intravenous infusion to degrade thrombi in patients with 4, and they are used to open thrombosed renal dialysis and central venous catheters - they have also been used in treating 5 - 6 is used to stop the bleeding caused by thrombolytic drugs, and it is also used to prevent bleeding in patients who have hemophilia or are recovering from gastrointestinal or prostate surgery - 7 is taken orally for the treatment of cyclic heavy menstrual bleeding. The major adverse effect of tranexamic acid is thrombosis, which is increased when hormonal contraceptives are used, especially in women who are obese and smoke cigarettes

1: alteplase, reteplase, and tenecteplase 2: streptokinase 3: anistreplase 4: MI, thrombotic stroke, or PE 5: venous thromboembolism 6: aminocaproic acid 7: tranexamic acid (Lysteda)

potassium-sparing diuretics: - examples of potassium-sparing diuretics are 1 - these agents have a mild natriuretic effect, and they reduce renal potassium excretion and thereby prevent 2 caused by thiazide and loop-acting diuretics - eplerenone has been found to cause 3 in hypertensive patients and 4 in patients with type 2 diabetes

1: amiloride, spironolactone, and triamterene 2: prevent hypokalemia 3: regression of left ventricular hypertrophy 4: regression of microalbuminuria

management of dysrhytmias - ventricular tachycardia and fibrillation: - in less severe cases of unsustained VT, 1 may be administered as a series of bolus doses or an intravenous infusion to prevent further episodes and reduce the need for cardioversion - 2 is a 2nd-line drug that is occasionally used to treat acute VT - ventricular fibrillation is the most common cause of 3 - if ventricular fibrillation persists after 3 rapid shocks, intravenous 4 are administered, followed by continued attempts at defibrillation - an 5 is the most effective long-term treatment for patients with life-threatening sustained VT or ventricular fibrillation. These patients should also be treated with β-blockers and with an ACE inhibitor or angiotensin receptor blocker - patients who have taken an overdose of a tricyclic antidepressant drug (e.g., imipramine) can develop a wide QRS complex tachycardia believed to result from the blockade of cardiac sodium channels by the antidepressant. The treatment for this particular form of VT includes the intravenous administration of 6, which increases dissociation of the antidepressant from sodium channels. Magnesium sulfate and β-blockers have also been used successfully

1: amiodarone 2: procainamide 3: sudden cardiac death 4: epinephrine (or vasopressin) and amiodarone 5: implantable cardioverter-defibrillator 6: sodium bicarbonate

organic nitrites and nitrates: - 1, the only nitrite compound used to treat angina, is administered by inhalation - 1 has the most rapid onset and the shortest duration of action, whereas 2 have the slowest onset and the longest duration. 3 has an intermediate onset and duration - amyl nitrite and other similar agents are sometimes abused and used recreationally, called 4 - like other inhalant drugs of abuse, amyl nitrite can produce 5 - the most common adverse effects of organic nitrates are caused by excessive vasodilation, including 6

1: amyl nitrite 2: isosorbide compounds 3: Nitroglycerin 4: "poppers" 5: euphoria and increase sexual libido 6: headache, hypotension, dizziness, and reflex tachycardia

angiotensin receptor blockers (ARB): - these drugs selectively block 1 in various tissues and thereby reduce vasoconstriction, aldosterone secretion, sodium reabsorption by the proximal tubule, and norepinephrine release from sympathetic nerve terminals - many orally effective ARBs are now available, including 2 - the ARBs may cause 3

1: angiotensin AT1 receptors 2: candesartan, irbesartan, losartan, telmisartan, valsartan, and others 3: hyperkalemia, neutropenia, and elevated serum levels of hepatic aminotransferase enzymes

active factor X inhibitor: - 1 are orally administered inhibitors of active factor X (Xa) - the active factor X inhibitors are employed to reduce the risk of 2 in persons with nonvalvular atrial fibrillation, as well as for prevention of 3 in persons undergoing knee- or hip-replacement surgery

1: apixaban, edoxaban, and rivaroxaban 2: stroke and systemic embolization 3: DVT and PE

statins (HMG-CoA reductase inhibitors): - among the HMG-CoA reductase inhibitors are 1 - 2 are inactive prodrugs that must be converted to active metabolites in the liver, whereas the other statins are active compounds - the statins are used to reduce blood cholesterol levels in persons with 3 - 4 is the most potent statin currently available, followed by 5 - patients treated with simvastatin had a lower rate of death, myocardial infarction, stroke, and revascularization procedures - clinical trials also indicate that statins may also protect against osteoporosis and certain forms of cancer - the most serious adverse effect of statins is 6, which is a potentially fatal form of skeletal muscle toxicity (myopathy) - there is anecdotal evidence that 7 supplements may prevent or improve myopathy in persons taking statins - atorvastatin, lovastatin, and simvastatin are metabolized by CYP3A4, and their plasma concentrations are greatly increased by strong inhibitors of this isozyme, such as 8 - fluvastatin is metabolized by CYP2C9, and its plasma levels may be increased by inhibitors of this CYP, including some nonsteroidal antiinflammatory drugs (NSAIDs)

1: atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin 2: lovastatin and simvastatin 3: hypercholesterolemia 4: rosuvastatin 5: atorvastatin 6: rhabdomyolysis 7: vitamin D and coenzyme Q-10 8: erythromycin, itraconazole, and ritonavir

natriuretic peptide: - natriuretic peptides include 1 produced and released by cardiac ventricles in response to excessive stretching - 2 is a form of human B-type natriuretic peptide obtained from Escherichia coli using recombinant DNA technology. It is approved for the treatment of patients with acutely decompensated heart failure who have shortness of breath (dyspnea) at rest or with minimal activity - nesiritide binds to a 3 in vascular smooth muscle and endothelial cells, leading to increased intracellular concentrations of cyclic guanosine monophosphate (cGMP) - clinical trials show that nesiritide reduced 4, a clinical measure of venous pressure and cardiac preload, and thereby decreased vascular congestion and dyspnea in decompensated patients with heart failure

1: atrial natriuretic peptide (ANP) and B-type natriuretic peptide 2: nesiritide (Natrecor) 3: guanylate cyclase receptor 4: pulmonary capillary wedge pressure

angiotensin-converting enzyme (ACE) inhibitors: - in patients treated with ACE inhibitors, renal sodium retention is decreased, renal potassium retention is increased, and serum potassium levels typically increase by about 0.5 mEq/L - ACE inhibitors can cause fetal and neonatal injury and death when administered to pregnant women, especially during the 2nd and 3rd trimesters - ACE inhibitors can also cause renal failure in patients who have a rare condition known as 1 - nonsteroidal antiinflammatory drugs, such as ibuprofen, can impede the effects of ACE inhibitors as well as other anti- hypertensive agents - in diabetic patients who exhibit early signs of renal impairment (e.g., albuminuria and increased serum creatinine levels), ACE inhibitors exert a 2 - 3 classes of ACE inhibitors have been developed: 3

1: bilateral renal artery stenosis 2: renoprotective effect 3: - sulfhydryl compound: captopril - phosphoryl agents: fosinopril - carboxyl derivatives: benazepril, enalapril, lisinopril, quinapril, and ramipril

direct thrombin inhibitors: - 1 binds directly to thrombin and does not require AT-3 as a cofactor, which probably explains why it has a more predictable anticoagulant effect than heparin - bivalirudin has been used to prevent thrombosis in patients with 2 - 3 is a synthetic direct thrombin inhibitor given intravenously for the prophylaxis and treatment of thrombosis in patients with heparin‐induced thrombocytopenia (HIT), including persons undergoing percutane- ous coronary interventions (PCIs) for MI - 4 is a potent, competitive, reversible inhibitor of thrombin - dabigatran is used to reduce the risk of stroke and PE in patients with 5 - it is also indicated for treatment and prevention of DVT and PE in patients who have been treated with a parenteral anticoagulant for 5 to 10 days, and for prevention of DVT in those undergoing hip-replacement surgery - 6 is now available and approved to reverse dabigatran's anticoagulant effect in cases of life-threatening or uncontrolled bleeding or emergency surgery - dabigatran etexilate is a substrate for the 7 in the gut and kidneys

1: bivalirudin 2: unstable angina and acute MI 3: argatroban 4: dabigatran 5: nonvalvular atrial fibrillation 6: idarucizumab (Praxbind) 7: P-glycoprotein (Pgp) transporter

Class 3 drugs: - amiodarone, dofetilide, ibutilide, and sotalol are Class III antidysrhythmics that 1 that repolarize the heart during phase 3 of the action potential - amiodarone is an organic iodine compound that is structurally related to thyroid hormones - amiodarone not only blocks potassium channels, but it also blocks sodium channels, calcium channels, and β-adrenoceptors - amiodarone decreases SA node automaticity and AV node conduction velocity, and it prolongs AV node and ventricular refractory periods - its adverse affects include 2 - amiodarone causes 3 in over 90% of patients - amiodarone causes photosensitivity to ultraviolet light - the drug also causes a blue-gray skin discoloration that may necessitate dosage reduction or discontinuation - the more serious adverse effects of amiodarone include 4 - 5 is an uncommon but potentially fatal reaction to amiodarone - amiodarone is given orally on a long-term basis to suppress both 6 - dofetilide selectively blocks the 7 responsible for repolarizing (rectifying) myocardial tissue during phase 3 of the action potential - ibutilide appears to activate the 8, which increases sodium influx and counteracts the outward potassium current so as to slow atrial and ventricular repolarization - ibutilide is indicated for the rapid conversion of atrial fibrillation or flutter to normal sinus rhythm - dofetilide is administered orally to convert atrial fibrillation and for long-term suppression of the dysrhythmia - sotalol is a nonselective β-adrenoceptor antagonist that prolongs the cardiac action potential duration and QT interval by blocking the 9 during phase 3 of the ventricular action potential - sotalol is effective in treating a number of supraventricular dysrhythmias and is used for rhythm control in persons with atrial fibrillation and flutter - has become a 1st-line drug as adjunctive therapy in patients with an 10 - sotalol can cause 11 due to β-blockade, and pulmonary edema and heart failure occur in about 3% of patients

1: block potassium currents 2: bradycardia, impaired AV conduction, and QT prolongation leading to torsades de pointes 3: corneal microdeposits 4: hypothyroidism (6% of patients) or hyperthyroidism (0.9%-2% of patients) 5: pulmonary fibrosis 6: supress supraventricular and ventricular dysrhythmias, including atrial fibrillation, atrial flutter, supraventricular tachycardia, and VT 7: blocks the rapidly activating delayed rectifier channel (I(Kr)) 8: activate the slow (late), inward sodium current 9: delayed potassium rectifier current 10: implantable cardioverter-defibrillator 11: bradycardia, bronchospasm, and dyspnea

Class 4 drugs: - diltiazem and verapamil are nondihydropyridine 1 that have significant effects on cardiac tissue - diltiazem and verapamil are used for controlling or converting certain 2 - they are often used to control the ventricular rate in patients with atrial fibrillation or flutter and a rapid ventricular response

1: calcium channel blockers 2: supraventricular dysrhythmias

site of drug action - proximal tubule: about 85% of filtered sodium bicarbonate is reabsorbed in the proximal tubule, and this reabsorption is inhibited by a class of diuretics known as 1 the 2 are also secreted by proximal tubular cells into the tubular lumen

1: carbonic anhydrase (CA) inhibitors 2: loop diuretics and thiazide diuretics

osmotic diuretics: - glycerol and mannitol are examples of osmotic diuretic - mannitol is used to treat 1 and reduce intracranial pressure. Glycerol and mannitol are both used in the treatment of 2 - mannitol has also been administered along with intravenous fluids to maintain renal function and reduce the 3 - the primary adverse effect of mannitol is 4

1: cerebral edema 2: acute glaucoma 3: renal toxicity of antineoplastic platinum compounds (e.g., cisplatin) 4: excessive plasma volume expansion

centrally acting drugs: - 1 is occasionally used for the treatment of hypertensive urgencies in the outpatient setting, because it slowly reduces blood pressure to a safe level after a single oral dose - 2 has been used to treat hypertension in pregnant women, because extensive experience has shown that it does not harm the fetus

1: clonidine 2: methyldopa

antidiuretic hormone antagonists: - 1 are nonpeptide antagonists of antidiuretic hormone (arginine vasopressin). Conivaptan blocks both 2, whereas tolvaptan is 3 - antagonism of V2 receptors by conivaptan and tolvaptan causes free water excretion or aquaresis, and the drugs have been called aquaretics - conivaptan and tolvaptan are approved for treating 4 in hospitalized patients - conivaptan and tolvaptan may increase serum levels of 5, and other drugs metabolized by 3A4

1: conivaptan and tolvaptan 2: V1A and V2 receptors 3: V2 selective 4: euvolemic and hypervolemic hyponatremia (low serum sodium concentration) 5: midazolam, simvastatin

glycoprotein-2b/3a antagonists (antiplatelet drugs): - the final common pathway in platelet aggregation is the 1, which binds to an activated GP-2b/3a complex on the platelet surface - 2 consists of the Fab fragment of a chimeric human-murine monoclonal antibody that binds tightly to platelet GP-2b/3a receptors, preventing fibrinogen binding and cross-linking of platelets - abciximab is used to prevent platelet aggregation and thrombosis in patients undergoing PCIs, including coronary angioplasty and stent placement - abciximab has been shown to significantly prevent vessel restenosis, reinfarction, and death - 3 are competitive, reversible antagonists of GP-2/3a receptors and bind receptors less strongly than abciximab - 4 is a protease-activated receptor-1 (PAR-1) antagonist approved for patients with a history of MI or with peripheral arterial disease (PAD) - by occupying the PAR-1 receptor, vorapaxar competitively inhibits thrombin access to its target receptor and prevents thrombin-mediated platelet aggregation - in clinical trials, vorapaxar reduced thrombotic cardiovascular events and mortality

1: cross-linking of platelets by fibrinogen 2: abciximab 3: tirofiban and eptifibatide 4: vorapaxar

β-adrenoceptor antagonists: - blockade of cardiac β1-receptors reduces cardiac output by 1 - blockade of β1-receptors in renal juxtaglomerular cells inhibits 2 - nonselective β-blockers are contraindicated in persons with 3 - 4, which blocks α- and β-receptors, is used to treat chronic hypertension and hypertensive emergencies - 5 is an intravenously administered, ultrashort-acting β1-blocker used to treat hypertension in surgical patients and in persons with hypertensive emergencies - 6 is a 3rd-generation α- and β-blocker with antioxidant properties that can protect the vascular wall from free radicals that damage blood vessels - 7 is a selective β1-blocker with antioxidant properties, and it also increases the release of endothelial nitric oxide and exerts vasodilation

1: decreasing the heart rate and contractility 2: renin secretion 3: asthma or chronic obstructive pulmonary disease 4: labetalol 5: esmolol 6: carvedilol 7: nebivolol

Class 1A drugs: - Class IA drugs have greater affinity for the open state and have a slow recovery - 1 are Class IA drugs - the Class IA drugs block the 2 and delayed potassium channels - all of the Class IA drugs have some degree of 3 - the most common adverse effect of quinidine is 4 - 5 can also occur with quinidine use - higher doses of quinidine produce a constellation of neurologic symptoms called 6 - quinidine is also formulated in combination with dextromethorphan (Neudexta) for the treatment of 7 in patients with neurodegenerative diseases - long-term use of procainamide often causes a reversible 8, with arthralgia and a butterfly rash on the face, necessitating drug discontinuation - procainamide is occasionally used to terminate the wide QRS complex form of 9 and to convert atrial fibrillation to sinus rhythm - disopyramide is administered orally to prevent life-threatening 10

1: disopyramide, procainamide, and quinidine 2: fast sodium channel 3: antimuscarinic (atropine-like) activity 4: diarrhea 5: thrombocytopenia 6: cinchonism that include tinnitus, dizziness, and blurred vision 7: emotional lability (pseudobulbar affect) 8: lupus erythematous-like syndrome 9: acute ventricular tachycardia 10: ventricular dysrhythmias

hematopoietic growth factors: - several forms of erythropoietin have been developed for treating anemia and are collectively known as erythropoiesis-stimulating agents (ESAs) - 1 was the first ESA to be developed and is identical to endogenous human erythropoietin - 2 are modified forms of erythropoietin that have longer half-lives than epoetin alfa and are given less frequently - ESAs stimulate erythropoiesis in patients with 3 - the larger doses of ESAs formerly used to achieve hemoglobin levels above 12 g/dL were found to increase the risk of 4 - ESAs have also been found to enhance 5 - the production of neutrophils and other granulocytes is regulated by colony-stimulating factors (CSF) produced by leukocytes, fibroblasts, and endothelial cells - recombinant forms of the CSF cytokine have revolutionized the 6 and are essentially devoid of side effects - 7 is recombinant human granulocyte colony-stimulating factor (G-CSF), and 8 is recombinant human granulocyte-macrophage CSF (GM-CSF) - recombinant G-CSF accelerates granulocyte recovery after myelosuppressive chemotherapy and reduces the incidence of infections and shortens hospitalization. It also reduces neutropenia and infection in patients undergoing bone marrow transplantation - filgrastim is also used to mobilize hematopoietic progenitor cells into the peripheral blood when blood is being collected for leukapheresis, and patients exposed to lethal radiation should receive G-CSF to prevent neutropenia - sargramostim (GM-CSF) is used to accelerate myeloid cell (granulocyte) recovery in patients undergoing allogenic 9 - sargramostim can also reduce the incidence of fever and infections in patients with severe chronic neutropenia - oprelvekin (Neumega) is a recombinant form of interleukin-11 (IL-11), one of a large number of cytokine growth factors involved in regulating the differentiation and proliferation of blood and immune cells - oprelvekin is used to prevent severe 10

1: epoetin alfa 2: darbepoetin alfa and epoetin β 3: anemia caused by chronic renal failure 4: hypertension, stroke, myocardial infarction, heart failure, and death 5: tumor progression 6: treatment of leukopenia (neutropenia) 7: filgrastim 8: sargramostim 9: bone marrow transplantation or chemotherapy for lymphoma, acute myeloid leukemia, or Hodgkin disease 10: thrombocytopenia

warfarin: - warfarin and other coumarin derivatives are structurally related to vitamin K - these drugs inhibit the synthesis of coagulation factors whose formation is dependent on vitamin K, factors 1 - warfarin also inhibits the synthesis of 2, which are endogenous anticoagulants that inactivate factors V and VIII and promote fibrinolysis - the most common adverse effect of warfarin is 3 - high doses of 4 reduce prothrombin levels and thereby increase the anticoagulant effect of warfarin - in contrast, treatment with 5 induces CYP enzymes that metabolize warfarin and decreases its anticoagulant effect - 6 inhibits the absorption of warfarin from the gut - 7 directly antagonizes the effect of warfarin on clotting factor synthesis and is used to treat hemorrhage caused by anticoagulant activity - warfarin is primarily used in the long-term treatment of thromboembolic disorders such as 8 and for prevention of thrombosis in patients with 9 - it has also been used with a heparin-type anticoagulant for the treatment of 10

1: factors 2 (prothrombin), 7, 9, and 10 2: proteins C and S 3: bleeding 4: salicylates 5: rifampin or barbiturates 6: cholestyramine 7: phytonadione (vitamin K1) 8: deep vein thrombosis (DVT) 9: atrial fibrillation or an artificial heart valve 10: myocardial infarction (MI)

hypertensive emergencies and urgencies: - hypertensive emergencies are characterized by severe elevations in blood pressure (>180/120 mm Hg) complicated by target organ dysfunction (e.g., encephalopathy or intracranial hemorrhage) - the drugs most often used in treating most types of hypertensive emergencies include 1 - 2 is useful for hypertensive emergencies in persons with acute coronary ischemia - 3 may be of value in patients with acute left ventricular failure (but not acute myocardial infarction) - 4 is useful in persons with aortic dissection and perioperative hypertension

1: fenoldopam, nicardipine, labetalol, and sodium nitroprusside 2: nitroglycerin 3: enalaprilat 4: esmolol

minerals: - pregnant women have the greatest need for routine iron supplementation because their dietary iron often cannot meet the requirements for maternal and fetal erythropoiesis - iron is administered orally in the form of 1 - iron can reduce the absorption of 2 - iron preparations for parenteral therapy include 3 - intravenous administration of iron dextran can cause peripheral flushing and hypotensive reactions. Intramuscular administration of iron dextran can cause injection site reactions, including pain, inflammation, sterile abscesses, and brown discoloration of skin

1: ferrous salts, including ferrous sulfate, ferrous gluconate, and ferrous fumarate 2: tetracyclines, fluoroquinolones, levothyroxine, and vitamin E 3: iron dextran, iron sucrose, and sodium ferric gluconate

Class 1C drugs: - Class IC drugs have greater affinity for the open state and a very slow recovery - 1, which are Class IC drugs, are administered orally - flecainide is indicated for the treatment of 2 - other adverse effects of flecainide include bronchospasm, leukopenia, thrombocytopenia, and seizures - propafenone prolongs the 3, and can cause some degree of QT prolongation - propafenone has the potential to cause ventricular dysrhythmias and 4

1: flecainide and propafenone 2: supraventricular dysrhythmias and documented life-threatening ventricular dysrhythmias 3: PR interval and QRS duration 4: hematologic abnormalities, including agranulocytosis, anemia, and thrombocytopenia

bile acid-binding resins: - cholestyramine, colestipol, and colesevelam are bile acid-binding resins that are moderately effective drugs for hypercholesterolemia and have an excellent safety record - the bile acid-binding resins are 1 containing a chloride ion that can be exchanged for bile acids in the gut - the resins are indicated for the treatment of 2 and are particularly useful in patients who cannot tolerate other drugs - the resins have also been used to treat 3 due to bile acid malabsorption

1: high-molecular-weight polymers 2: hypercholesterolemia 2: chronic diarrhea

thiazide diuretics and related diuretics: - 1 is the thiazide diuretic often used to treat hypertension - thiazides elevate plasma levels of 2 in some patients - less commonly, they cause hematologic toxicity and aggravate hepatic disease - they can also evoke a compensatory increase in renin secretion - one other advantage of taking thiazide diuretics is that they appear to offer protection against 3

1: hydrochlorothiazide 2: glucose, uric acid, and lipids 3: osteoporosis

calcium channel blockers (CCBs): - used to treat 1 - most CCBs, including 2, belong to the dihydropyridine class - the dihydropyridine drugs have little direct effect on cardiac tissue at usual therapeutic levels; however, they can evoke 3

1: hypertension, angina pectoris, peripheral vascular disorders, and cardiac arrhythmias 2: amlodipine, felodipine, isradipine, nicardipine, and nifedipine 3: reflex tachycardia

drugs that 1 are said to have a positive inotropic effect and are commonly referred to as inotropic drugs or agents

1: increase cardiac contractility

the 2 mechanisms primarily responsible for abnormal impulse formation are 1

1: increased automaticity and afterdepolarizations

digoxin: - it has a positive inotropic effect (an increase in the force of contraction), a negative chronotropic effect (a decrease in the heart rate), and a negative dromotropic effect (a decrease in conduction velocity) - digoxin produces a modest positive inotropic effect by 1 as a result of inhibiting the sodium pump (Na+,K+-ATPase) in the plasma membrane (sarcolemma) - digoxin also has potential adverse effects on the heart, including an ability to increase abnormal impulse formation by evoking spontaneous 2 - these abnormal depolarizations occur during or after cardiac repolarization and lead to 3 - it shortens the ventricular action potential duration by accelerating repolarization, and this 4. Finally, it causes ST segment depression, which gives rise to the so-called "hockey stick configuration" of the ST segment - the most common adverse effects of digoxin are 5 - digoxin has also been used to slow the ventricular rate in patients with 6

1: increasing intracellular calcium 2: afterdepolarizations 3: extrasystoles (premature or coupled beats) and tachycardia (rapid beating of the heart) 4: decreases the QT interval 5: gastrointestinal, cardiac, and neurologic reactions 6: atrial fibrillation (AF)

1 is the most common cause of heart failure other important causes of heart failure include 2 less commonly, heart failure results from severe anemia, thiamine deficiency, or the use of certain anticancer drugs, such as 3

1: ischemic heart disease 2: hypertension, valvular disorders, arrhythmias, viral and congenital cardiomyopathy, and constrictive pericarditis 3: doxorubicin

hydralazine and nitrates: - 1 primarily relaxes venous smooth muscle, whereas 2 preferentially relaxes arterial smooth muscle

1: isosorbide dinitrate 2: hydralazine

other antianginal agents: - 1 is a novel heart rate-lowering drug that has been approved for the treatment of chronic angina and heart failure - ivabradine reduces the heart rate by blocking the 2 - a new group of drugs has emerged that reduce angina episodes by improving myocardial metabolism without altering heart rate or blood pressure. These agents include 3 - ranolazine has been approved as a 1st-line agent for 4 and is particularly useful for patients with a heart rate less than 70/min or low blood pressure - ranolazine primary mechanism is to block excessive prolongation of the 5 - the most common side effects of ranolazine are mild 6 - trimetazidine inhibits ketoacyl coenzyme-A thiolase, a key enzyme in the 7

1: ivabradine 2: I(f) current (the so-called "funny current") in the SA node 3: ranolazine and trimetazidine 4: chronic stable angina 5: late inward sodium current (I(Na-L)) in myocardial cells 6: dizziness, headache, nausea, and constipation 7: β-oxidation pathway of fatty acid metabolism

Class 1B drugs: - Class IB drugs have greater affinity for the inactivated state and have a rapid recovery - 1 are Class IB drugs - elevated serum levels of lidocaine can cause central nervous system effects such as 2 - lidocaine is occasionally employed in 3 or in cases of ventricular dysrhythmias arising during or after cardiac surgery - mexiletine can be administered orally for the suppression of 4

1: lidocaine and mexiletine 2: nervousness, tremor, and paresthesia 3: refractory ventricular tachycardia 4: symptomatic ventricular tachycardia

vitamins: - although many vitamins participate in the formation and function of erythrocytes, folic acid and vitamin B12 have a critical role in erythropoiesis, and a deficiency of either of them may cause 1 - folic acid plays a critical role in cell proliferation and erythropoiesis - the requirement for folic acid increases markedly during pregnancy, and inadequate dietary intake of this vitamin can cause 2 - several drugs can contribute to folate deficiency. These include chemotherapeutic 3 - other drugs inhibit folate absorption, including 4 - 2 synthetic forms of vitamin B12, 5, are available for the treatment of B12 deficiency - vitamin B12 is essential for 6 - it is obtained from dietary meats, dairy products, and eggs, and it is absorbed from the gut in the presence of intrinsic factor (a glycoprotein secreted by gastric parietal cells) and calcium - an inadequate secretion of intrinsic factor leads to vitamin B12 deficiency and eventually results in so-called 7 - 8 are available for maintenance therapy after normalization of serum B12 concentrations with intramuscular B12 injections - 9 is also used for out-of-hospital empiric treatment of cyanide poisoning resulting from smoke inhalation

1: megaloblastic anemia 2: neural tube birth defects, such as spina bifida, and megaloblastic anemia 3: folate reductase inhibitors, such as trimethoprim, pyrimethamine, and methotrexate 4: cholestyramine and certain anticonvulsant drugs (e.g., phenytoin) 5: cyanocobalamin and hydroxocobalamin 6: cell replication and growth, hematopoiesis, and myelin synthesis 7: pernicious anemia 8: nasal spray formulations of cyanocobalamin (Nascobal) 9: hydroxocobalamin

leptin deficiency: - 1 is an analog of human leptin hormone, differing by only 1 amino acid substitution with methionine, and produced by recombinant biotechnology in E. coli - 1 binds to and activates the leptin receptor, leading to an increase in insulin sensitivity and reduced food intake

1: metreleptin

primary hyperlipoproteinemias are relatively rare disorders, each of which is caused by a 1 secondary hyperlipoproteinemias are commonly caused by the 2

1: monogenic defect (a specific defect at a single gene) 2: - presence of alcoholism, diabetes mellitus, or uremia, or - by the use of drugs such as β-adrenoceptor antagonists, isotretinoin, oral contraceptives, or thiazide diuretics

antiplatelet drugs: - aspirin and clopidogrel inhibit the synthesis or release of specific mediators of platelet aggregation, whereas abciximab, tirofiban, and eptifibatide directly bind and inactivate GP-2b/3a receptors - a new agent called vorapaxar blocks PAR-1 receptors to prevent thrombin action on the platelet - aspirin is a 1 - the most important prostaglandins affecting platelet aggregation are 2 - unlike other NSAIDs, aspirin 3, the enzyme that catalyzes an early step in TXA2 synthesis - aspirin is given to patients with acute 4 to prevent enlargement of a coronary thrombus and reduce the severity of cardiac damage - high doses of aspirin and other salicylates may cause 5 and thereby increase the likelihood of bleeding - dipyridamole is a coronary vasodilator and a relatively weak antiplatelet drug - it inhibits platelet aggregation by blocking platelet uptake of 6 - this action increases platelet 7, which reduces calcium release and decreases platelet aggregation - as a vasodilator, dipyridamole is used during 8 to dilate and evaluate the arteries of patients with coronary artery disease - cilostazol is a vasodilator and antiplatelet drug that inhibits 9 and the breakdown of cAMP, thereby increasing cAMP levels in platelets and blood vessels - the drug is indicated for the treatment of 10, a form of peripheral vascular disease characterized by pain and weakness in a limb leading to limping or lameness - cilostazol can improve blood flow and reduce muscle pain while increasing walking distance in persons with this disorder

1: nonsteroidal antiinflammatory drug (NSAID) 2: prostacyclin (also called prostaglandin I2 [PGI2]) and TXA2 3: irreversibly inhibits cyclooxygenase 4: MI 5: hypoprothrombinemia 6: adenosine 7: cyclic adenosine monophosphate (cAMP) levels 8: myocardial perfusion imaging (thallium imaging) 9: inhibits type 3 phosphodiesterase (PDE3) 10: intermittent claudication

fibric acid derivatives: - the fibrates reduce serum levels of triglycerides and LDL-C while raising levels of HDL-C - the fibrates produce these effects by activating a receptor in cell nuclei that regulates gene transcription and is called the 1 - PPAR-α activation also reduces expression of an inhibitor of lipoprotein lipase, 2 - gemfibrozil and fenofibrate are indicated for the treatment of 3 to prevent pancreatitis when dietary therapy has failed to lower these levels

1: peroxisome proliferator-activated receptor-α (PPAR-α) 2: apolipoprotein C-III 3: very high triglyceride levels (higher than 1,500 mg/dL)

direct renin inhibitor: - aliskiren lowers 1 and levels of angiotensin I and angiotensin II

1: plasma renin activity

the hallmark of heart failure is a 1 at any given diastolic muscle fiber length, as determined by measuring the ventricular end-diastolic pressure (preload)

1: reduction in stroke volume and cardiac output

management of dysrhytmias - supraventricular tachycardia: - PSVT is caused most frequently by a 1 - acute PSVT is often treated with intravenous 2, which causes AV block and interrupts the reentrant pathway - alternatively, AV block can be produced by a 3

1: reentrant circuit in the AV node 2: adenosine 3: - calcium channel blocker (e.g., verapamil), or - β- blocker (e.g., esmolol)

specific agents (anticoagulant drugs): - 1 is largely metabolized by P450 isozymes, particularly 3A4, before renal excretion, and dosage adjustments should be considered in patients taking strong 3A4 inhibitors - potent inhibitors of CYP3A4 and P-glycoprotein are contraindicated with 2 because they increase plasma drug concentrations - 3 is eliminated primarily by renal excretion of the unchanged drug, and it does not inhibit or induce P450 enzymes or P-gp

1: rivaroxaban 2: apixaban 3: edoxaban

neprilysin inhibitor: - neprilysin is an endogenous endopeptidase enzyme that degrades vasoactive peptides such as bradykinin and natriuretic peptides - 1 is a neprilysin inhibitor that is available in a 1 : 1 molecular ratio combination with 2 - the sacubitril-valsartan combination is touted as the first new drug in more than a decade to decrease death rates in patients with systolic heart failure

1: sacubitril 2: valsartan (Entresto)

potassium-sparing diuretics: - 2 types of potassium-sparing diuretics exist: the epithelial 1 and the 2 - 3 are epithelial sodium channel blocker - amiloride and triamterene are primarily used to prevent and treat 4 induced by thiazide and loop diuretics - treatment of hyperkalemia is the sole indication for 5 - spironolactone is a structural analog of aldosterone that competitively 6 in epithelial cells of the late distal tubule and collecting duct - spironolactone has a special role in the treatment of 7 - because of its antiandrogenic effect, spironolactone is also used in the treatment of 8 in women - the adverse effects of spironolactone include 9 in men (caused by the drug's antiandrogenic effects) and hyperkalemia

1: sodium channel blockers 2: aldosterone receptor antagonists 3: amiloride and triamterene 4: hypokalemia 5: patiromer (Veltassa) 6: blocks aldosterone binding to the mineralocorticoid receptor 7: primary hyperaldosteronism 8: polycystic ovary disease and hirsutism 9: gynecomastia and impotence

miscellaneous drugs: - in the body, adenosine is derived from adenosine triphosphate and activates 1 - AV node conduction can be completely blocked for a few seconds, resulting in a brief period of asystole. These actions serve to terminate 2 by preventing the retrograde conduction of reentrant impulses through the AV node - adenosine is primarily used to terminate 3, including the type associated with 4 - 5, a vasodilator used to facilitate angiographic studies, inhibits the cellular uptake of adenosine and markedly increases its cardiac effects - digoxin has been used to slow the ventricular rate in patients with 6 - magnesium sulfate is administered intravenously to suppress drug-induced torsades de pointes, to treat digitalis-induced ventricular dysrhythmias, and to treat supraventricular dysrhythmias associated with magnesium deficiency - ivabradine and ranolazine are ion channel-blocking agents used in the treatment of 7 - ivabradine blocks the so-called "funny current" responsible for 8, whereas ranolazine blocks the 9 in ventricular tissue

1: specific G protein-coupled adenosine receptors 2: supraventricular tachycardia 3: terminate acute PSVT 4: Wolff-Parkinson-White syndrome 5: dipyridamole 6: atrial fibrillation 7: angina pectoris 8: diastolic depolarization in the sinoatrial node 9: blocks the late sodium current

aldosterone antagonists: - 1 are mineralocorticoid receptor antagonists that compete with aldosterone for the mineralocorticoid receptor in renal tubules and other tissues - aldosterone can produce endocrine side effects resulting from its binding to androgen and progesterone receptors, leading to gynecomastia and impotence in some male patients

1: spironolactone and eplerenone

1 can cause tachydysrhythmias other drugs cause dysrhythmias by slowing ventricular repolarization and evoking a form of polymorphic ventricular tachycardia called 2 the types of drugs causing torsades de pointes include 3

1: sympathomimetic drugs and digoxin 2: torsades de pointes (French for "fringe of pointed tips") 3: - antidysrhythmic drugs that block potassium channels (e.g., dofetilide and sotalol), and - antipsychotic drugs such as thioridazine

site of drug action - distal tubule: the early distal tubule is responsible for the reabsorption of 5% to 10% of the filtered sodium chloride, and this reabsorption is inhibited by 1

1: thiazide and related diuretics

management of dysrhytmias - torsades de pointes: - torsades de pointes is a polymorphic VT that can be induced by drugs (including 1) or electrolyte abnormalities that prolong the QT interval and predispose cardiac cells to afterdepolarizations - patients with a drug-induced dysrhythmia can be treated by withdrawal of the causative agent, correction of any electrolyte abnormalities such as hypokalemia, intravenous administration of 2, and cardiac overdrive pacing

1: tricyclic antidepressants and antipsychotic agents 2: magnesium sulfate

milrinone: - milrinone is occasionally used in treating acute heart failure and other conditions requiring myocardial stimulation - the drug inhibits 1, an enzyme that converts cAMP to inactive 5′-AMP - it also increases cAMP in vascular smooth muscle and produces vasodilation, so it is sometimes called an 2 - it has also been used for inotropic support of infants and children awaiting 3 and for other conditions requiring myocardial stimulation

1: type 3 phosphodiesterase 2: inodilator 3: cardiac transplantation

β-adrenoceptor antagonists: - these β-blockers are often used in 1 - the β-blockers have a 2 that can be hazardous to patients with heart failure if large doses are given

1: typical angina pectoris and acute MI 2: negative inotropic effect

heparin and related drugs: - the heparin family of anticoagulants includes 1 - heparin inactivates clotting factors by potentiating the activity of a circulating endogenous anticoagulant called 2, which is a powerful inhibitor of active factor 2 (thrombin) and active factor 10 (Stuart factor) - in contrast to unfractionated heparin, enoxaparin and dalteparin primarily inactivate 3 - fondaparinux is an even more selective inhibitor of 3 - heparin is indicated for the treatment of 4, including peripheral and PE, venous thrombosis, and coagulopathies such as disseminated intravascular coagulation. It is used prophylactically to prevent clotting in 5 - heparin is also used to prevent embolization of thrombi that might cause a cerebrovascular event in patients with 6 - low doses of heparin can be administered subcutaneously to prevent 7 in high-risk patient - enoxaparin and dalteparin are used to prevent 8 associated with abdominal surgery or knee- or hip-replacement surgery, and in other conditions that place patients at risk for thrombosis - enoxaparin and dalteparin are also approved to prevent ischemic complications of unstable angina or non-ST-segment elevation MI, and they are used in 9 - the treatment of bleeding caused by unfractionated or LMWH consists of administering 10

1: unfractionated heparin, LMWHs, and fondaparinux 2: antithrombin 3 (AT-3) 3: active factor 10 4: acute thromboembolic disorders 5: arterial and heart surgery, during blood transfusions, and in renal dialysis and blood sample collection 6: acute atrial fibrillation 7: deep vein thrombosis (DVT) and pulmonary embolism (PE) 8: venous thromboembolism 9: acute coronary syndrome (ACS) and angioplasty 10: protamine sulfate

angiotensin receptor blockers (ARBs): - angiotensin 2 receptor blockers (ARBs), such as 1, prevent binding of angiotensin 2 to AT1- receptors

1: valsartan and candesartan

niacin (nicotinic acid): - niacin and the fibric acid derivatives have been used to treat hypertriglyceridemia and to increase HDL-C levels in persons with abnormally low levels of this lipoprotein - niacin is also known as 1 - niacin acts primarily by inhibiting the formation and secretion of hepatic VLDL, the major carrier of plasma triglycerides and the precursor to LDL. The effect on VLDL secretion is caused partly by inhibition of lipolysis in adipose tissue - the inhibition of lipolysis has been attributed to the binding of niacin to a 2 in adipose tissue - niacin may cause 3

1: vitamin B3 2: G protein-coupled receptor 3: hyperuricemia and gout

management of dysrhytmias - atrial fibrillation and flutter: - there are 2 general approaches to pharmacologic therapy of atrial fibrillation: rate control and rhythm control - drugs used for ventricular rate control are primarily 1 - after the ventricular rate has been controlled, acute atrial fibrillation can be converted to normal sinus rhythm by the use of 2 - surgical catheter ablation of dysrhythmogenic tissue is a treatment option for some patients

1: β-blockers and calcium channel blockers 2: - direct current cardioversion (provided the dysrhythmia is of less than 48 hours duration), or - by administration of ibutilide or dofetilide

classification of diuretics. Name the carbonic anhydrase inhibitors:

acetazolamide (Diamox) dorzolamide (Trusopt)

classification of antidysrhythmic drugs. Name the miscellaneous drugs:

adenosine (Adenocard) digoxin (Lanoxin) magnesium sulfate ivabradine (Corlanor) ranolazine (Ranexa)

classification of antihypertensive drugs. Name the sympatholytics:

adrenoceptor antagonists: - carvedilol (Coreg) - metoprolol (Lopressor) - propranolol (Inderal) - atenolol (Tenormin) - doxazosin (Cardura) - metyrosine (Demser) centrally acting drugs: - clonidine (Catapres)

classification of diuretics. Name the potassium-sparing diuretics:

amiloride (Midamor) spironolactone (Aldactone) triamterene (Dyrenium)

classification of antithrombotic and thrombolytic drugs. Name the antithrombotic and thrombolytic reversal agents:

aminocaproic acid (Amicar) idarucizumab (Praxbind) tranexamic acid (Lysteda, Cyklokapron) phytonadione (vitamin K1, Mephyton) protamine sulfate

classification of antidysrhythmic drugs. Name the potassium channel blockers:

amiodarone (Cordarone) dronedarone (Multaq) ibutilide (Corvert) dofetilide (Tikosyn) sotalol (Betapace)

classification of drugs for heart failure. Name the vasodilators:

angiotensin inhibitors: - enalapril (Vasotec) - valsartan (Diovan) neprilysin inhibitor: - sacubitril (with valsartan in Entresto) other vasodilators: - hydralazine - isosorbide dinitrate (Isordil) - nesiritide (Natrecor)

classification of antihypertensive drugs. Name the angiotensin inhibitors:

angiotensin-converting enzyme (ACE) inhibitors: - lisinopril (Prinivil) angiotensin receptor antagonists: - losartan (Cozaar) direct renin inhibitor: - aliskiren (Tekturna)

classification of drugs for hyperlipidemia. Name the HMG-CoA reductase inhibitors:

atorvastatin (Lipitor) pravastatin (Pravachol) rosuvastatin (Crestor) simvastatin (Zocor)

classification of antihypertensive drugs. Name the vasodilators:

calcium channel blockers (CCBs): - amlodipine (Norvasc) - diltiazem (Cardizem) - nifedipine (Procardia) - verapamil (Calan) other vasodilators: - hydralazine dopamine agonist: - fenoldopam (Corlopam)

classification of drugs for heart failure. Name the beta-adrenoceptor blocker:

carvedilol (Coreg)

classification of drugs for hyperlipidemia. Name the bile acid-binding resins:

cholestyramine colestipol (Colestid) colesevelam (Welchol)

antidysrhythmic drugs are divided into 4 main classes. Name them:

class 1: sodium channel blockers class 2: β-adrenoceptor antagonists (β-blockers) class 3: potassium channel blockers class 4: calcium channel blockers

cardiovascular effects of drugs used in the treatment of heart failure:

decrease (−) no change or variable (0) increase ranging from small (+) to large (++) reflex (R)

effects of diuretics on plasma pH and urinary excretion of electrolytes:

decrease (−) no change or variable (0) increase ranging from small (+) to large (+++)

electrophysiologic properties of selected antidysrhythmic drugs:

decreased (↓) greatly decreased (↓↓) no change (→) increased (↑) greatly increased (↑↑)

classification of drugs for heart failure. Name the positively inotropic drugs:

digitalis glycoside: - digoxin (Lanoxin) - digoxin immune fab (Digibind) adrenoceptor agonist: - dobutamine phosphodiesterase inhibitor: - milrinone

classification of antidysrhythmic drugs. Name the calcium channel blockers:

diltiazem (Cardizem) verapamil (Calan)

classification of antidysrhythmic drugs. Name the sodium channel blockers:

disopyramide (Norpace) lidocaine propafenone (Rythmol)

classification of hematopoietic drugs. Name the hematopoietic growth factors:

erythropoiesis-stimulating agents: - epoetin alfa (Epogen, Procrit) - epoetin β (Mircera) - darbepoetin alfa (Aranesp) - methoxy polyethylene glycol-epoetin β (Mircera) colony-stimulating factors: - filgrastim (Neupogen) - filgrastim-sndz (Zarxio) - tbo-filgrastim (Granix) - pegfilgrastim (Neulasta) - sargramostim (Lekine) interleukins: - oprelvekin (Neumega)

classification of diuretics. Name the loop diuretics:

ethacrynic acid (Edecrin) furosemide (Lasix)

classification of drugs for hyperlipidemia. Name the cholesterol absorption inhibitor:

ezetimibe (Zetia)

classification of drugs for hyperlipidemia. Name the fibric acid derivatives:

fenofibrate (Tricor, Trilipix) gemfibrozil (Lopid)

classification of hematopoietic drugs. Name the minerals:

ferrous sulfate iron dextran (Proferdex)

classification of hematopoietic drugs. Name the vitamins:

folic acid cyanocobalamin (vitamin B12, Nascobal) hydroxocobalamin (vitamin B12, Cyanokit)

classification of drugs for heart failure. Name the diuretic:

furosemide (Lasix)

classification of diuretics. Name the osmotic diuretics:

glycerol mannitol

classification of diuretics. Name the thiazide and related diuretics:

hydrochlorothiazide indapamide

classification of antidysrhythmic drugs. Name the beta-adrenoceptor blockers:

metoprolol (Lopressor)

classification of drugs for hyperlipidemia. Name the other drugs:

niacin (vitamin B3, nicotinic acid) lomitapide (Juxtapid) metreleptin (Myalept)

classification of antianginal drugs. Name the vasodilators:

organic nitrites and nitrates: - amyl nitrite - isosorbide dinitrate - isosorbide mononitrate - nitroglycerin calcium channel blockers: - amlodipine (Norvasc) - nifedipine (Procardia) - diltiazem (Cardizem) - verapamil (Calan) β-adrenoceptor antagonists: - atenolol (Tenormin) - metoprolol (Lopressor) - nadolol (Corgard) - propranolol (Inderal)

usefulness of diuretics in the management of various clinical disorders:

ratings range from 0 (not useful) to ++ (highly useful)

classification of drugs for heart failure. Name the aldosterone antagonists:

spironolactone (Aldactone) eplerenone (Inspra)

classification of antithrombotic and thrombolytic drugs. Name the thrombolytic drugs:

streptokinase alteplase (Activase)

physiologic control of blood pressure and sites of drug action:

the vasodilators, sympatholytic drugs, and angiotensin inhibitors reduce peripheral vascular resistance (PVR) β-adrenoceptor blockers primarily reduce cardiac output diuretics promote sodium excretion and reduce blood volume

classification of antihypertensive drugs. Name the diuretics:

thiazide and related diuretics: - hydrochlorothiazidea potassium-sparing diuretics: - amilorideb

classification of antithrombotic and thrombolytic drugs. Name the anticoagulant drugs:

vitamin K antagonist: - warfarin (Coumadin) heparin and related drugs: - heparin - enoxaparin (Lovenox) - fondaparinux (Arixtra) direct thrombin inhibitors: - bivalirudin (Angiomax) - dabigatran (Pradaxa) - argatroban active factor X inhibitor: - rivaroxaban (Xarelto) antiplatelet drugs: - abciximab (REOPRO) - aspirin - clopidogrel (Plavix) - dipyridamolee - eptifibatide (Integrilin) - tirofiban (Aggrastat) - vorapaxar (Zontivity)